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Home My WebLink AboutZ-29378FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 29378 Date: 04/22/03 T~IS CERTIFIES that the building DWELLING Location of Property 2775 WEST CREEK AVE CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Ta~ Map No. 473889 Section 110 Block 0005 Lot 004 subdivision FiledMap No. __ Lot No. __ conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCC~3PANC~fB~J~BER Z- 29378 dated APRIL 22, 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 GAP~AGE UNDERNEATH & ACCESSORY SHED * The certificate is issued to MARGARET ROSS VAA!DERBECK (OWNER) of the aforesaid building. SUFFOLK COU1F~YDEPARTMENT OF~L~LTEAPPRO~i%L ELECv£KICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'l'mu *PLEASE SEE ATTACHED INSPECTION REPORT. Rev. 1/81 N/A N/A N/A BUILDING DEPkRTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 2775 WEST CREEK AVE CUTCHOGUE SUBDIVISION: ~[%P NO.: ~ (S) NAME OF OW-~ER (S): MARGARET ROSS VANDERBECK O~C~PANC"f: SINGLE FA~4ILY DWELLING MARGARET ROSS VANDERBECK ACCESSORY STRUCTURES: VIOLATIONS: CHAPTER 45 N.Y. STATE LrNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. ~: BP#5968wZ-COZ 5711 (ADDITION) DATE ON INSPECTION: 04/10/0~ TIM START: 10:00 AM E~: 10:30 AM 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. _~.'.'~ 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. ~') 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 New Construction: Location of Property: House No. Date. ~//7/~ Old or Pre-existing Building: ~' (check one) Street d Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision Block ~-- Lot Filed Map. Lot: Permit No. Health Dept. Approval: Planning Board Approval: Date of Permit. Applicant: Underwriters Approval: Request for: Temporary Certificate Fee Submitted: $ /t~dy, dYE) Final Certificate: (check one) Applicant Signature CONSENT TO INSPECTION Jt'/'/q~'~v~q,e'~7'- ~Sg l/~'X't~'ff/~c"E/~_ , the undersigned, do(es) hereby state: Owner(s) Name(s) That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold, located at which is shown and designated on the Suffolk County ~Fa~Map as ~istric't 1000, Section IlO ,Block That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: 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 alt 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: (Signature) (Print Name) (Signature) (Print Name)