HomeMy WebLinkAboutZ-29778FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 29778 Date: 10/21/03
THIS CERTIFIES that the building DWELLING
Location of Property 15 THIRD AVE PECONIC
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 067 Block 0006 Lot 001
Sul~ivlslon Filed Map No. __ Lot No. __
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICA~E OF
OCC~JPANCYlqL~4BER Z- 29778 dated OCTOBER 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 SINGLE FAMILY DWELLING WITH ATTACHED GARAGE *
The certificate is issued to BERNARD M MACKAY
(OWNER)
of the aforesaid building.
SUFFOLK CODlqTYDEPi%RTI~EN~rOFHEALTHAPPROVAL
ELEL-rKICAL CERTIFICATE NO.
PLUI~BERS CERTIFICATION DA'r~u
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
nature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 15 THIRD AVE PECONIC
1~ OF O~ (S): BERNARD M MACKAY
(~ANCY: SINGLE FA~4ILY DWELLING
W~ NO.: LOT (S)
BERNARD M MACKAY
DATE: 10/21/03
DWELLING:
TYPE OF C(~S~UCTION: WOOD FRAME ~ STORIES: 1.5 # EXITS: 2
FON~ATION: CEMENT BLOCK CE~I~%R: PIT C~A~q~ SPACE:
ACCESSORY STRUCTURES:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
DATE ON rNSPHCTION: 09/23/03 Reinspected ]0/20/03
TIME STJ~T: 10:00 AM ]~D: 10:20 AM
Form No. 6
TOWN OF SOUTHOLD
BLrlLDING 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:
For new building or new use:
1. Final smwey 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 stateInent from plumber certifying that tile solder used in system contains less than 2/10 of 1% lead.
5. Conunercial buildiog, industrial building, multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Plmming Board Approval of completed site plan requirements.
Fei- existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
1. Accurate smwey of property showing all property lines, streets, building and dnusual natural or topographic
features.
2 A properly completed application and consent to inspect sigmed by the applicant. Ifa Certificate of Occupancy is
denied, die Buildiug Inspector shall slate the reasons therefor ill wilting lo tile applicant.
Fees
Certificate of Occupal]cy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Sxvimmmg pool $2500, Accesso:y buildiag $25.00, Additions to accesso~3: building $25.00, Businesses $50.00.
2 Certificate of ()ccupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy- $.25
4. Updated Certificate of Occupancy- $50.00
5 Temporar3 Certificate of Occupancy- Residential $1500, Commercial $1500
Date.
New Consttnaction:
Location of Property:
Old or Pre-existing Building: t'/ (check one)
House No. Street
Owner or Ow, ,s of
Suffolk County Tax Map No 1000, Section O{.a' 7 Block
Subdivision ~'I'C ~A~re r Filed Map.
Permit No. Date of Permit. Applicant:
Hah-del
Lot
Lot:
Health Dept. Approval:
Underwriters Approval:
Plmming Board Approval:
Request for: Tempo a 3 C.e tificate
Fee Submitted: $ /t~- DO
Final Certificate:
co o ot
(cbeck one)
'/~~tt Applicant S~
CONSENT TO INSPECTION
Owner(s)Name(s)
, the undersigned, do(es) hereby state:
That the undersigned (is) (are) the owner(s) ~2f the pren),ises in t. he Town of
Southold, located at /~4- ~ ,d- ~ , P'¢/fr~ ~
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section O~'7 , Block O~ , Lot ~tg/
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following: ~0£¢ C '~ tS~
1
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: ~/2
~ ~-(Signa~ture) .~ - --
(Print Name)
(Signature)
(Print Name)