HomeMy WebLinkAboutZ-30196FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPA~RTMENT
Office of the Building Inspecmor
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 30196
Date: 05/14 04
T~IIS CERTIFIES that the building DWELLING
Location of Property ORIENTAL AV~
~OUSE NO.
County Tax Map No. 473889 Section 012
Subdivision Filed Map No.
FISHERS ISLAND
STREET) HAMLET
Block 0002 Lot 008
Lot 7o.
conforms substantially to the Requireme3ats for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCC~/P~/qCY ~R Z- 30196 dated M3~Y 14, 2004
was issued, and conforms to all of the requlremenns of the applicable
provismons of the law. The occupancy for which this certificate ms
issued is ONE FAMILY DWELLING*
The certificate is issued to DONA LYNN GIBBS
(OWNER)
of the aforesaid building.
SUFFOLK COUlqTY DEPARTMENT OF ~F~J~T~APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'£~U3
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Rev. 1/81
BUILDING DEP~TMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
FISHERS ISLAND
MAP NO.: LOT
ACCESSORY STRUCTURES:
WOOD FPJ~gE
VIOI~TIONS: CRASTER 45 N.Y STATE UNIFOPJ~ FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART.
SEC
~: BP$13763Z-COZ14071 ADD)-BP$20049Z-COZ2059[ ACCY)BP$24780Z-COZ26241 ADD~
BP~;27924-COZ3019 l(,~DD)-BI~;30282-Z-COZ-30195(ADD)
Farm Ne. 6
TOWN OF SOUTHOLD
BLrtJ~D~G DEPARTMENT
TOWN tlALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY ·
This application must be filled in by typewriter or ink and submitted tc the Building Dep~rTS~t with the following:.
Ao
For new b~Iding er new use:
1. Final survey of property with accurate location of all bfiildings, property lines, streets, and unusual natural or
topographic features.
2. Final Approval ~com Health Dept. of water supply and sewerage-rtbposat (S-9 form~.
3. Approval of eIec~cal instal/ation from Board of Fire Underwriters.
4_ Sworn statement from plumbe/: certifying that the solder used in system contains tess than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate
of Code Compliance from arch/tect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plma requirements.
For e~sfing hula. Jugs (prior to Ap~ 9~ 195~ non-cenfo~Jng uses, or buildings and '~pr~-e~s~g'' !and uses:
1. Accurate survey of property showing all property I'mes, streets, building and unusual natural or topographic
features.
2. A properly completed application and consem to inspect signed by the applicant If a Certificate of Oecupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
I. Cer~cate ~f ~ccupancy- New dwe~ling $25.~ Add/li~ns t~ dwe~ing $25~ ~tem~ns t~ dwe~ing $25.~
Swimming pool $25.00. Accessory' building $25.00, Additions to accessory building $25.00. Businesses $50_00.
2. Certificateo£OccupancyonPre-erdstingBu/lding- $100.00
3. Copy of Certificate of Occupancy - $.25
4_ UpdatedCertificateofOecupancy- $50.00
5. Temporary Certificate of Oecupancy - Residential $15.00. Commercial $15.00
Date. April 21, 2004
New Construction:
LocadonofProperry: (no #)
Old or Pre-exiSting Building: X
(che6~ onel
Fishers Island
House No. Street
OxrrnerorOwnersofProperry: Dona Lynn Gibbs
Suffolk County Tax MapNo 1000. Section 012.00
Subdivision
Permit No. n/a
Health Dept. Approval:
Planning Board Approval:
Request for:
Fee Submitted: S
n/a
Date'of Permit. n/a
~/a
u/a
Temporary Certificate
100~00
Block 02,00 Lot
F/led Map. u/a Lot:
Applicant: n/a
Underwriters Approval: ~ n/a
Final Certificate:
X _ (Check one)
; A15~l{c~nt Sighatu~e
Stephen Lo }[am, III
Hm~et
008.000
n/a
CONSENT TO IN~PBCTION
Owned,~)
Town Buitdlng lrisp~clo~"~ Oft~¢~ for the following: _
To~ of Sou~hold to ont~ upon the ~bow
buildings lo,;.i~d thereon, ~o ~nduot ~uc~ mipecnon~ ~ they may demn nece~s~ with
b~ us~ in mabg~quct3~ prosecution~ for ~olation~ of th~ l~w8 ordia~c~e ~cs or
ro~laNons of the Tmvn of $outhold.
x~ "=400'
~~ LOCATION MAP SCALE
O0
// ~- ' / .~;'~X (~') /.. O~ SIGNATURE AND AN ORIGINAL EMBOSSED OR INK S~L ARE THE PRO,UGT OF
./// ~-, ,,~.~. ~(//z P~:E~ SECTIONS') SITE 012,1S IN BLocKTHE TOWN2, LoTOF 8*SOUTHOLD' COUN~ OF SUFFOLK TAX MAP 1000,
~ ~. ~/,,, ~ ~o~.~., OVERALL BOUNDARY
~,~ ~ zu ~M~., ~ / ~ ~ MARTHA ANNE G~PHIO SCALE IN ~ ~0 TO:
~~~ '~, ~ / LAURENCE P. RUBINOW
JACK RIVERS / /
SCALE: AS NOTED
QUALI~RoupCONTROLR~iEwEDCERTIFICATIONDATE / / ,/// ~~00~ ' '~' '
FILE 3 I