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Home My WebLink About22574-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCuumANCY No Z-23515 Date FEBRUARy 28, 1995 THIS CERTIFIES that the building Location of Property PETERS WAY House No. Street County Tax Map No. 1000 Section 6 2 Lot Subdivision WALSH PARK Lot No. NEW DWELLING FIS~R.~ ISLANd, N.Y. Hamlet Block 3.4 Filed Map No. 2 conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPteMBER 29, 1994 pursuant to which Building Permit No. 22574-Z dated FEBRUARY 24, 1995 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 DW~TJ, ING WITH ATTain GARAGE AS APPLIED FOR. The certificate is issued to WALSH PARK BENEVOLENT CORP. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-94-Ol16-FEB. 17, 1995 UNDERWRITERS CERTIFICATE NO. PENDING -- JANUAry 27, 1995 PLUMBERS CERTIFICATION DATED JANUARY 30, 1995 Z&S CONTRACTING Bui~ng' In~pectbr Rev. 1/81 FORM NO.$ TOWN OF $OUTHOLD BUILDING DEPAETMENT TOWN HAIL SOUTHOLD, N.Y. N£ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date .~. ',~ ............................................ 19 .~..'~.... 22574 Z CountyTax Map No. 1000 Section ............. ~ ........ Block .........~ ............ Lot No...~(....~.... .......... pursuant to application dated ...~r..../...~.....~../.., .............................. 19..?...~... ..... and approv~ by~e Bulldlnglnsp~tor. ~ ~' /~//~ / ~ Building I~sp~tor Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 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: i. 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. 3. 4. 5. Request for: Fee Submitted: 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 Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 Updated Certificate of Occupancy - $50.00 Temporary Certificate of Occupancy - Residential $~5.00; Commercial $15.00 New Construction ........... Old Or Pr~z~isting Buil%ing .......... Location of Property.. 2 ..~.~.~_~ ~A ~ ........ i.~.''~i.~ .~..f~.~. .................. Onwer or Owners of Property ~g~ ~ ~~OOL~ ~.~, County Tax M~o~ 10~ection..~.~ ....... Block .... ~ ......... Lot .... ~'.~ ............ Subdivision ~ ~ ~ F .................................... iled Map ............ Lot. No Permit .......... ~..Date Of Pe~it..~~ Applic~~~ ..... ......... .................. Health Dept. Approval.~ ~-- O ~ ..... .~ ~ -//~ ......................... on~erwriners Approval..~.~.~ ............ Planning Board Approval ....... ~ ......... Temporary Certificate ........... Final Certi~e..~.. . .... TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTtIOLD, N.Y. 11971 C E~RT I F I C AT I O N TEL. 765-1802 BLDG. DEPT ^YN OF ~OUTE( Date Building Perm-l'~No. ~ ~ ~--~ Owner ~ ~ ],~bl ~ ,'"~_,l(.. '~--~' ~'C .~.~ (pleas~int) Plu~er ~ ~ ~~.~ (please print) I certify that tile solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to befor~k me this ~V4~-'~day of ...)~14~&,[.~1 ' , Notary Public ~ (P!u~e~ - signature} Notar. y Public County ~h)t~l'y Public $~ate of New York No. 4806559 Qulillfiee in Sutfo~k County Term Expires 12/31/~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ! 88 JOHN STREET, NEW YORK. NEW YORK 10038 Date THIS CE~IFIES THAT , u~s examlnea on and fo~ be in ~with the Naaonal Elect~cal Code. FIXTUKE OUTLETS ~ECEPTACLES FIXTURES RANGES OVENS EXHAUST FANS SWITCHES INCANDESCENT FLUORESCENT OTHER D~y~-k~ FURNACE MOTORS FUTURE AI~MANCE FEEDERS SPECIAL REC'PT TIME CLOCKS UNIT HEATERS MULTI.OUTLET SYSTEMS NO. OF FEET DIMMERS SERVIC~ DISCONNECT OTHER APPARATUS: HOTORS:i-*P B.P, G.F.C, [: ~'1 S}{OKE DETECTOR S E E V I C NO. OF CC. COND. A.W. G. NO. OFHbLEG A.W. G, NO.1OF NEUTRALS A.W.O. PER ~ OF CC. COND. OF HI-LEG OF NEUTRAL %~ & S CONTRS. INC. P~ O. BOX FISHERS ISLAND, NY, ~639~ LIC. #924-E MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR ? UILD.~ S DEPA~T;¥~E.~JY. lH~5 CCFY OF CE~;I'~FICA'F~ F~UST NOT EE ~,LTE~q~D IN A~JY N~AN;4ER.