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Home My WebLink AboutZ-27679FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~-RTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 27679 Date: 04/27/01 THIS CERTIFIES that the building Location of Property 50575 CR 48 (HOUSE NO.) County Tax Map No. 473889 Section 051 DWELLING SOUTHOLD (STREET) (HAMLET) Block 0003 Lot 011 SuJ0division Filed Map No. __ LOt No. __ eonfoms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuazlt to which CERTIFICATE OF OCC~/PANCYI~O~BER Z- 27679 dated APRIL 27, 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 WITH ACCESSORY GARAGE * The certificate is issued to TELESPHORE & HELEN WOLANSKI (OWNER) of the aforesaid building. SUFFOLK COUNT"f DEPARTMENT OF m~ALTH APPROVi~L ELECTRICAL CERTIFICATH NO. PLUMBERS CERTIFICATION D;~*'~O *PLEASE SEE ATTACHED INSPECTION Rev. 1/81 N/A N/A N/A Aut-~o~rize~ ~igiture BUILDING DEPARTMENT TOW~ OF SOUTEOLD HOUSING CODE INSPECTION REPORT LOCATION: 50575 CR 48 SOUTHOLD S~DI~ISION: MAP NO.: LOT (S) ~ OF OW~ (S): TELESPHORE & HELEN WOLANSKI OCC~ANC"Z: SINGLE FAMILY TELESPHORE & HELEN WOL~SKI ADMi-~-r~o BY: SHELLY FASZCZEWSKI ACC~PANIED BY: SAME ]~EY A%LqII~I~: ~/FF. CO. T~ ~ NO.: 51.-3-11 SOURCE OF P,E(~JEST: HELEN WOLAMSKI, 4/20/01 DA~: 04/27/01 DWELLING: ACCESSORY STRUCTURES: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. P~: BP#19~-COZ-19337 (ADDITION) DAW ON INSPECTION: 04/27/01 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 inspector with the following: for new building or new use: 1. Final sarvey 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 o{ 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. 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 a 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 Buildinm - $i00.00 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 Date ...... ~1~.~ ~ .......................... New Construction ........... Old Or Pre-existing Building.../~...~...~ Location of Property .~..O~. ~. N.~"~T.~RO.~.."~., ~(~.~f~).t.'~. ~,?. ..... House No. Street Hamlet Onwer Owners of Property ~.~..~ .~0.~.~..~. · · County Tax Map No 1000, Section...~.l ......... Biock..~. ........ .... Lot.....l I .............. ... Subdivision ................................... . Filed Map ............ Lot ................... ... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept Approval Underwriters Approval ................. Planning Board Approval . Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: $ .... .~. J~ ~ 0.O .............. APPLICANT fob CONSENT TO INSPECTION ~L~/'d ~OL~I~K~ ' the unaersignea, Owner(s) Name(s) do(es) hereby state: That the undersigned (is) (are) the owner(s) of the premises in the Tovm of Southold loeatea at .50~q5' NO~ ~g~ ~0]~0~ . which is shox~ and designated on the Suffolk County tax map as District 1000, Section ~ , Block ~ , Lot ~ ~ That the undersigned (h~s) (have) filed, ~or caused to be filed, an applica- tion in the Southold To~ Buildin~ Inspector's Office for the follow.f: __ That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southoldto 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 as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: (signature) (print name) (si~nafure)