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Home My WebLink AboutZ-29280FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 29280 Date: 02/21/03 THIS CERTIFIES that the building DWELLING & ACCESSORY I~)cation of Property 10775 NLAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 031 EAST MARION (STREET) (HAMLET) Block 0004 Lot 018 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 OCCq3PANC~f ~dMBER Z- 29280 d~ted FEBRUA~RY 21, 2003 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 WITH FRONT OPEN PORCH ~ ACCESSORY GARAGE.* The certificate is issued to JOEL RAYMOND DALY & ANO. (OWNER) of the aforesaid building, SUFFOLK COUNT"f DEPARTMENT OF HEALTH APPRO~]%L ELEC~RICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA"£~U *PLEASE SEE ATTACHED INSPECTION R~T. Rev. 1/81 N/A N/A N/A Autho~ure BUILDING DEP~TMENT TOWN OF SOUTHOLD NOUSING CODE INSPECTION REPORT LOCATION: 10775 ~LkIN RD SUBDIVISION: NAME OF OWNER (S): JOEL RAYMOND DALY & AN0. OCCUPANCY: SINGLE FAMILY ADMITTED BY: JASON DALY EAST ~LARION MAP NO.: LOT (S) JOEL RAYMOND DALY & ANO. ~ AVAI~I~: S~F. CO. TAX ~ NO.: 31. 4-18 SOURCE OF REQUEST: JASON DALY DAT~: 02/21/03 ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: OLD WOOD VIOLATIONS: CNAPTER 45 N.Y. STATE LTNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. PURCHASING/'~S ~S BY NEW OWNER, REINSPECTED 2/20/03. BY: ON INSPECTION: 01/13/03 J/BO~/UFI: / TI~ START: 9:45AM E~D: 10:25AM Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Block New Construction: Old or Pre-existing Building: Location of Property: / ~3 7 7 ~ ~ c~ '~ ~x ~ ~) House No. Street Owner or Owners o f Property: '-'~ 5i0 r'~ ~,, Suffolk County Tax Map No 1000, Section '~1 '~ff-~e'4 -] ~t Subdivision Date. (checkone) Hamlet le , - ? occxzlJ Lot / (~ Filed Map. Lot: Permit No. Date of Permit. Health Dept. Approval: Planning Board Approval: Request for: T~nporary Certificate Fee Submitted: $~:~/0{3 , 0 0 Applicant: Underwriters Approval: Final Certificate: (check one) T~)-//// % /'/.Y'.d/4/ CONSENT TO INSPECTION Owner(s) Name(s) , the undersigned, do(es) hereby state: That the undersigned (is) (are) the owner(s) of the premises in the Tow~n of Southold, locatedat /0 77q ~,.v ff, D ~ff~r/ ,,~o,",O.r3 which is shown and designated on the Suffolk County Tax Map as District 1000, Section~ } ,Block O~-'/ ,Lot /~ That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: (1 ~¢c~ ~c3. That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: ~'C_. (o. Zcoo-Z_ /// (Signature) (Print Name) ' (Signature) (Print Name)