HomeMy WebLinkAboutZ-29717FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 29717 Date: 09/17/03
THIS CERTIFIES that the building DWELLING
(aka 18|5 Albertson Lane)
I~cation of property 1955 ALBERTSON LA GREENPORT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 052 Block 0005 I~Dt 056
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
OCCN3P~CYAU3MBER Z- 29717 dated SEPTEMBER 17, 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 OPEN FRONT PORCH, SIDE SCREENED PORCH AND
SIDE DECK.*
The certificate is issued to CAROLE M CASSIDY
(OWNER}
of the aforesaid building.
SUFFOLK COUlqTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PL~EP~g CERTIFICATION
N/A
Rev. 1/81
Au~o'ri~ed Sign~ure
(aka 1815 Albertson Lane)
I~TION: 1955 ALBERTSON LA
SOBDIVISION:
NAI4E OF OWNER (S): CAROLE M CASSIDY
OCCUPANCY: SINGLE FAMILY
AI~I~TED BY: MARGARET HOME HEALTH AID
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
GHEENPORT
MAP NO.: LOT (S)
CAROLE M CASSIDY
KEY A%5~ILABLE: SIIFF. CO. TAX MAP NO.: 52.-5-56
SODRCE OF REQUEST: CAROLE M CASSIDY ~ATE: 09/17/03
DWELLING:
· 'YPE OF CONSTRUC~FION: WOOD PR3~ME
TOILET ROOM(S): 0.0
PORCH TYPE: FRONT OPEN/SIDE SCREENED DECK TYPE: SIDE
2.0 ~ EXITS: __4
CEA~ SPACE:
ACCESSORY STRUCTURES:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Departrffg.~W~ (l~e l~oll6w.ing:: '
A. For new building or new use: '
1. Final survey of property with accurate location of all buildings, property lines, streets and unt~lol~ ~tural 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 that~n'}'/i~) of 1% lead.
5. Cmmnercial building, industrial building, multiple residences and sinfilar 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 smvey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect sigmed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
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
Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
Location of Property:
Owner or Owners of Property:
(check one)
Old or Pre-existing Building:
House No. Street
Date of Permit.
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~/I~D O, O ~)
Hamlet
-~' ~x, Block ~ Lot
Filed Map. Lot:
Applicant:
Underwriters Approval:
Final Certificate:
(check one)
Applicant Si~gnalur~
(~~~-~ -- 76S*~.802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG,
[ ] FOUNDATION2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE~f~ CHIMN~
REMA~
INSPECTOR~
CONSENT TO INSPECTION
~t~ ~"~ /~ ~'~.ff..F/j)/6~ the undersigned, do(es) hereby state:
Owner(s) Name(s)
That the undersigned (is)_.(arel the owner(s) of the premises in the Town of
Southold, located at ~ 8/,.t'- '/42~ ~',,~e.2'~..to~./ /_. ,~t'~_ 6"~..~: ~:a./~ /a///t~
which is shown and designated ola the Suffolk County Tax Map as District 1000,
Section 5"D-,., Block ,.1e'''-, Lot ._~"/g> .
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 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:~7 6 2tl~J.,~
(Signature)
(Print Name)
(Signature)
(Print Name)