HomeMy WebLinkAboutZ-29511FORM NO. 4
TOW~N OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 29511
Date: 06/12/03
THIS CERTIFIES that the building DWELLING
Location of Property 200 ROGERS RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 066 Block 0002 Lot 016
Su~ivlsiom 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
OC~ANC"fNUMBER Z- 29511 dated J73NE 12, 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 COVERED FRONT PORCH AND ENCLOSED REAR PORCH.*
The certificate is issued to SUE & JOHN GALATI & ORS TRUST.
(OWNER)
of the aforesaid building.
SUFFOLK COUN~fDEP/%RTI~EI~T OF~i/~TH;%PPRO%rAL
ELEC~RICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION D~l'~u
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
N/A
N/A
N/A
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
I~TION: 200 ROGERS RD SOUTEOLD
OCCUP;~CY: SINGLE FAMILY SUE & JOHN GAL~TI & ORS TRUST.
ACCESSORY STRUCTURES:
VIOI~TIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION P~qT. SEC.
P~: BP#5688~CC/~Y ~GE C0Z5554; BE#21053 ROOF ALTER COZ21053
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 Departmentiwith the fo/loWing! i ,: r,
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
New Construction: Old or mre-exi~ing Building: ~ (check one)
Location of Property: ,~tS~~-~"~l~ ,z~"
House No. ' /Street -r
Hamlct~ '
OwnerorOwnersofProperty:
Suffolk County Tax Map No 1000, Section ~ Bl~ck - ------~ ~-~i
Subdivision
Filed Map.
Permit No. Date of Permit.
Health Dept. Approval:
Plannh~g Board Approval: ......
Request for: Temporary Certificate
Fee Submitted: $ /dg'~·
Applicant:
Underwriters Approval:
Final Certificate:
(check~ '
[,,~/Ap~licant ~ignature t~
CONSENT TO INSPECTION
Owner(s) N an~s)
, the undersigned, do(es) hereby state:
That the undersign~ed (is) (ar.q) the owner(~) of th9 pre. rises in.the To~wn of
Southold, located at ~7~d'~ ~-~ ~ ~ ,
which is shown and designated ol{ the4~uffolk ~ounty Fax Map as District I000,
Section ~.ff ,Block_ / ,Lot
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold To3yn 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 all of the laws, ordinances, rules and regulations of the Town of Southold.
The tmdersigned, 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:
(Print Name)
(Signature)
(Print Name)
~_ Willia~m L. BaMker~
~.~ basemen~
per application on file in this office, and consisting of;
. . ., ~ ~ .,~
NEW YORK 38, NEW YORK "- ~ -.- ~"
~,_ ~u17 3, 1956 d~t/~/~No..~030 ~., ~'
equi~en~ . ~ d~crl~d ~ow.~ l~
/n'pr,mlse~ of__ ~m R ..... ~ TM
765-1802
BUILDING DEPT.
INSPECTION
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