HomeMy WebLinkAboutZ-29826FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 29826
Date: 11/07/03
T~IS CERTIFIES t~at the building ACCESSORIES
Location of Property MONTAUK AVE
(HOUSE NO.) (STREET) (EAMLET)
County Tax Map No. 473889 Section 010 Block 0008 Lot 004
Subdivision Filed Map No. -- Lot No. --
conforms su]~stantially to the Requirements for a ONE FA~4ILY DWELLING
built prior to APRIL 9, 1957 pursuant to wtulch CERTIFICATE OF
OCCUPANCY NUMBER Z- 29826 dated NOVEMBER 7, 2003
was issued, and conforms to all of the reqllirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ACCESSORY GA3-AGE AND SHED.*
FISHERS ISLAiqD
The certificate is issued to RICHARD S HEDGE & ANOTHER
( OWNER )
of the aforesaid building.
SUFFOLK COUNTYDEPARTMENT OF~IEALT~i~PPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA~r~U3
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
ACCESSORY STRUCTURES:
C~6~, T~PE OF CONST.: WOOD FRAME STOPL%GE, TYPE CON~T.: WOOD FP~E
VIOLATIONS: CHAPTER 45 N.Y. STATS UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
Form No. 6
TOWN OF SOUTHOLD
B IY[LDI~G 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 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. 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.
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.
Date.
New Construction: O1~t or Pre-existing Building: b'/
LocationofProperty: 'fiY~C)Q~Lqc~ k A'~ P,
House No./~ Street
Owner or Owners of Property: ~e~ ~ ~ '~eW ~:~ ~
Suflblk County Tax Map No 1000, Sectinn /~DO ~ /O Block ~ '
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 accessmT/building $25.00, Businesses $50.00.
t~) Certificate of Occupancy on Pre-existing Building $100.00
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate o£Occupancy- $50.00
5. Temporary Certificate of Occupancy Residential $15.00, Cmvanercial $15.00
Date o f Pennit.
Filed Map.
Applicant:
Underwriters Approval:
(check one)
Subdivision
Perrrdt No.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $
Hanflet
Lot ~-'/- q
Lot:
Final Certificate: (check one) /Q /]
CONSENT TO iNSPECTION
That the undersigned(is) (are) th_~e owner(s) of the premispS in Ce Town of
Southold, located at 4-~!~ ~ .~ o~/~-~-~,~ '~ ?n/7°>?{~{~' .x~t2'e .
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section /O ,Block jr ,Lot_ ~.nc q
, the undersigned, do(es) hereby state:
'That the umdersigned (has) !have) filed, or cause to be filed, an~ap~plication ip the .
Southold Town Building Inspectors Office for the following: ~ ~ :/O
That the undersigned do(es) hereby ~ve 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, 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, rules or
regulations of the Town of Southold.
Dated:
' (Print Name)
(Signature)
(Print Name)
~ · b r~
>