HomeMy WebLinkAboutZ-29827FOR~tI NO. 4
TOWiq OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Soutbold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 29827
Date: 11/07/03
T~IIS CERTIFIES that the building DWELLING
Location of Property MONTAUK AVE
(HOUSE NO.) (STREET) (HAMLET)
County T~x Map No. 473889 Section 010 Block 0008 Lot 002
Subdivision Filed F~p No. -- Lot No. --
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z- 29827 dated NOVEMBER 7, 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 F~J4ILY DWELLING WITH ENCLOSED PORCH.*
FISHERS ISLAND
The certificate is issued to RICHARD S HEDGE & ANO
( OWNER )
of the aforesaid building.
S~PFFOLK COUNTY DEPARTI~ENT OF HEAL~ APPRO%rAL
EI~CTRICAL C~RTIFICATENO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
~/A
N/A
N/A
t gnature
Rev. 1/81
BUILDING DEPARTT4ENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
~7NBDI~TSION: ~ NO.: LOT (S)
~ OF O~ (S): RICHAEDS HEDGE & ANO
OCCtrPANCY: SINGLE FA~4ILY
DATE: 11/07/03
DWELLING:
TYPE OF CONSTRUCTION: WOOD FR3~4E $ STORIES: 1.0 $ EXITS: 2
FOUNDATION: POURED CONCRETE CEIl: FULL CP~ SPACE:
ACCESSORY STRUCTURES:
VIOLATIONS: CBAPTE~ 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
DAI~E ON INSPECTION: 11/07/03
TI~{E START: ]~D:
Form No. 6
TOWN OF SOUTHOLD
BLrILD]J~G DEPARTMENT
TOV~TN HALL
765-1802
APPLICATION FOR CERTI]~ICATE 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 survey of property with accurate location of ail 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.Approvai of electrical installation from Board of Fire Underwriters.
Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead.
5. Cornn~ercial 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 (prier 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 Certificale of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swi~mning pool $25.00, AccessoW 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, CommemiaI $15.00
Date.
New Constmctinn: Old or Pre-ex/sting Building:
Locatinn oferoperty: ~/?C,~/jq: t..~ ¢
House Nc~// Street
Owner or Owners of Property: ~f?~p~ m~>
Suffolk County Tax Map No 1000, Section ?C)OO ~
Date of Perrrdt.
(check nne)_
Subdivision
Permit No.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $
Block ~'
Filed Map.
Applicant:
Underwriters Approval:
Hamlet
Lot
Lot:
CONSENT TO iNSPECTION
-4~er(s) Name(s)
That the undersi~gr~,ed (is) (are) the owner(s) of the premises in the Town of
Southold, locatedat -~;~*,~' ~.~'/~-' ~,-w~oi?"/~' ,q~'e
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section /0 ,Block ~ .,Lot ~/
, the undersigned, do(es) hereby state:
That the undersigned (has) !have) filed, or cause to be filed, an application iN the .
Southold Town Building Inspectors 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, roles 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, roles or
regulations of the Town of Southold.
Dated:
(Print Name)
(Signature)
(Print Name)
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