HomeMy WebLinkAboutZ-27623FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUP~uNCY
No: Z- 27623
Date: 04/11/01
THIS c~TIFIES that the building DWELLING
Location of Property 1455 INLET WAY SOUTHOLD
(HOUSE NO.) (STREET) (HAJ4LET)
County Tax Map No. 473889 Section 092 Block 0001 Lot 004
Subdivision Filed Map No. __ Lot No. __
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCYNUMBER Z- 27623 dated APRIL 11, 2001
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING-BP#19527-Z-COZ-19595 DECK ADDITION-BP #20953Z
C0Z-23231 RENOVATION & ADDITION TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to SARA5{ M WARD
of the aforesaid building.
( OWNER )
SUFFOLK COU/FlqfDEPARTMEIFrOFHEALTHAPPRO~CAL
ELEt-rRICAL CERTIFICATE NO.
PLUMBingS CERTIFICATION D~i'F~3
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Signature
Rev. 1/81
03/12/2001 ~4:44
§162988133
C B C~_I¢
Form No. 6
PAGE 85
TOWN OF $OUTHOLD
BUILDING DF. PA~TMENT
TOWN HALL
765-1802
· : APPLICATION FOR.. CERTIFICATE OF OC6'UPANb'~
A. This application must be filled in by typewxiter 0R ink and submitted to the building
~nspector with the follow/rig: for new building or new use:
1. F/nmi survey of ,property with accurate location of all buildinss, property lines,
streets, and unusual natural or topographic features.
2. Final Approval ~rom Health Dept. of water supply and sewera~e-dieposal($-9 form).
3. Approval of electrical {nstallation from Board of Fire
4. Swo~n scate~e~%t from plumber certify~g tha~ the 8older ~8ed ~ s~st~ cont~s
~ess th~ 2/10 of lX
5. C~rcial build.g, ~dustrial building, multiple residences and si~iat
a~ inst~lations, ~ certificlte of Code C~p~lian~e from ar~itect or e~i~eer
responsible for .the ~tldi~,
6, Su~it Pla~in~ Board ~proval of c0~le~ed sit~ plan r~quir~ents.
,
For ~tstinE buildinBs (prior to ~ril 9, 1957) nou-confo~ neap, or butld~Be ~d
%'pr~ist~l" lad umee:
l. Accurate su~ey of property sh~n~ all property lines, streets. ~d~
unus~ ~a~ral or topo~raphi~ features.
2. A pr~erly collated application a~ a aonsenC to inspect 8i~o~ by the applt~nt.
If a Ce=:~cate of Occup~cy is den~ed, the Building Inspector shmll state the
reasons therefor in ~itin8 ~o the
' Fees
· 1. Cer~ificate of Occupancy - New dwelling $25.00, Additions to dwellin~
Alterations ~o dwellin~ $25.00, Sw!~{-~ pool $15.00~ Accessory butldin8 $~$.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificat~ 'of Occupancy on Pre-existinR Buildtn~ - $100.00
3. Copy of Certifica~e of OcCupancy - ~ .~
4. Updated Certificate of Occupancy - $50,00
5. T~ora~ Certificate o~ Occupancy - Resid~t~ $~5.0~, Co~o~aial $15.00
............... ...........
~C~stmc~ion ........... Old O~ Pre-~ts~i~ Butldi~...~ ............
1455 Inlet Way, South01d
oc~tion of Proper~y,.. ...... ... ............................ . ................................
House NO. Stree~
nwer Or O'{,me:rs of PropertT...S.a.~ .~...~a,~.d. ....................................................
o~nu Tax ~ap No 1000, Section,..~{'0), ..Block. 01.00 ,., 004.000
a.~ ~.~.. Cedar B~ach Park . Filed Hap ~. Lot ~[
er~uLt No ................ Date Of Permit ................ Applicant ............................ ,
~alth Dapt. Approval .......................... Undervriters Approval .........................
Lann~ Board Approval ........................
for: Temporary Certificate .......... Final Certicaze.. x
. 100.00
Subuuttted{ ~ ........ · ....................
03/12/2001 14:44 5162988133 ~ B C~_IC PAGE 86
CONSENT
TO
INSPECTIOI~
Sarah M. Ward
Owner(s) Name(S)
do(es) hereby state~
· the undersigned,
That the undersigned (is) (are) the owner(s) o( the premises in the Town
of $outhold located at 1455 Ia]et Way
· which ts sho~n and designated on the Suffo~
County tax map as District 1000, Section092.00 , Block 01.00 , Lot 004.000
That the undersloned (has) (have) filed, 'or caused to Be filed· an applica-
tion in the $outhold Town Buildh~ Inspector's Office for the following:
Certificate of Occupancy on Pre-Existing Building
That the unders~ned do(es) hereby give consent to the ])ulldin(~ .Inspectors
of the Town oF Southold to enter upon the above described property, including
any and all buiidir~s located thereon, to conduct such in~pectior~ as they may
deem necessary with respect to the afo~esaid application, including inspections
to determine that said premises comply with al)~ of the laws, o~rdinancas?rules
and regulations of the Town of Southold.
The undersigned, .in consentl~ to such inspections, do(es) so with the
knowledge and under, standing that any information obtained in the conduct of
such inspections may be used as evidence ~n subsequent prosecutions for vio-
lations of the laws, ordinances, rules or re~ulationa of the Town of Southold.
Sarah 14. Ward
(print ~ame)
(signature)
(print name)
SURVEY OF LOT ~ ell
HAP OF Gi~:)AI~ EYE. ACH PAP~
FI! ~ ~EG. :20, I~::~.~ ~
~ITUATE, ~ATVIEh
TOi~I: 5OUTHOLD
SUFFOLK GOUNT~
SURVEYED: OE,-2E,-OI
SUFFOLK COUNTY TAX ~
I000-q2-1-4
FILE # qO
N
~I/~ E
S
,C
×
x
CERTIFIED TO:
C-Ht~-ISTOPHER PlA
MARY PlA
FIRST AMERICAN TITLE
INSURANCE COMPANY OF N.Y.
ALL COUNTY ABSTRACT
NOTES:
· MONUMENT
0 PIPE
AREA = 20,4qq S.F, OR 0.4q ACRES
®RAPHIC, SC, ALE I"= 90'
?
ERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y. 11901
369-8288 Fax 369-8287 REF.\~I-Ip server\d~PROS\01-146.pro