HomeMy WebLinkAboutZ-30162 FORM NO. 4
TOWN OFSOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold,N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
ASo: Z- 30162 Date: 04/30/04
THIS CERTIFIES that the building DWELLING
Location ofProperty 2760 VILLAGE LA ORIENT
(HOUSE NO.) I(STREET) (HAMLET)
Couasty Tax PRap No. 473889 Section 026 Block 0001 Lot 020.001
~,t;division Filed Nfap No. Lot No.
conforms substantially to the Regcairements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant t® cxhich Cffi2TI&~ICATS OF
bCCUPANCY ER Z- 30162 dated APRIL 30, 2004
was issued, and conforms to all of the requirementsof the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH FRONT PORCH, REAR ENCLOSED PORCH, SECOND
FLOOR BALCONY AND ATTACHED TWO CAR GARAGE.*
~'k'he certificate is issued to DANIEL F & KATHLEEN M KELLY
(OWNER)
of the aforesaid building.
SIIFFOLK COIIA7TY DEPAR OF HEALTH APPROVAL N/A
ELECTRICAL CHRTIFICATE NO. N/A
PLUMBERS CERTIFICATIOA7 DATED N/A
*PLEASE SEE ATTACHED INSPECTIO ORT
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Authorize Signature
Rev. 1/SY ~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSfNG CODE INSPECTION REPORT
LOCATION: 2760 VILLAGE LA ORIENT
sDBnrvasioN: MAP N®.: raF QsD .
NAH~ OF O'Idt%HR. (S): DANIEL F & KATHLEEN M BELLY
OCCDPANCY: SINGLE FAMILY DANIEL F & KATHLEEN M KELLY
ADMITTIDD BY: SIM KELLY ACCOMPANISD BY: SAME
KHY AVAILABLE: SUFF. CO. TAX MAP NO.: 26.-1-20.1
SOURCH OF RE¢UEST: DANIEL & KATHLEEN KELLY DATS:04/30/04
DWELLING:
TYPE OF CONSTRIIC.CIOM: WOOD FRAME ~ STORIES: 2.0 EXITS: 2
FOUNDATION: CONCRETE BLOCK CHLLAR: FULL CRANK, SPACE:
TOTALROOMSa IS'.f FL.R_: 4 2ND FLR.: 5 3RD FLR.: 0
BATHROOM(S): 2.0 TOILSP ROOM(S). 0.0 DTILITY ROOM(S): SIDE
PORCH TYPH: REAR ENCLOSED DECK TYPE: 2ND FLOOR BALCONY PATIO T%PEc
BRSEZEEAY: FIREPLACE: WOOD STOVES GARAGE: TWO CAR
DORIlESTFC HOTbYATSR: X TYPE HEATER: NATURAL GAS AIRCOMDITIO$ING: CENTRAL
TYPE HEAT: NAT. GAS WARM'AIR: H07°6dAT°SR: X
.OTHER: FRONT PORCH
ACCESSORY STRUCTURES:
GARAGH, TYPH OF CONST.: STORAGH, TYPH CONST.:
S¢dII4iIPYG POOL: GOEST. TYPS CONST.:
OS°ffi2:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION ~ DESCRIPTION ~ ART. ~ SEC.
Pamnurck: BP46169 CDZ595; BP164328 ADD COZ4137; BPIk24715 COV PORCH CDZ25881
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IMSPHCTED BY: yp ~ DATE ON INSPECTION: 04/28/04
.IO/HgtM M EOUFYS TIEffi START= 9:45AM HB1D: 10 :30AM
~
~UUbd.•3)ING DEPAfl2T1VI~NT
T®sviv 11.~1,I.
765-1502
~
APPLICAT'I®1®T F®d& CEb3'I'IF'dCATE ®F' ®CCU~AIVC~' `
This application must be filled in by typewriter or ink and submitted to the Building Deparhnei~u+-ith the following: -
A. )r'oa- new Itullding or new use:
1. .Final survey of property with accurate location of alI 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.
Be For exnsting Isnllalings (lerlor to April 9, fl957) non-conffornaing uses, oa- laualrli"n s seed "pre-existing" Iazsl uses:
1. Accurate survey of property showing all property lines, streets, building ~d unu 1 natural or~~
phic
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.
C, Fees ~
1. Certificate of Occupancy -New dwelling $25.00, Additions to dwelling $25.00, Alte> lions to dwelling $25.00,
Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00.
2. 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, Commercial $15.00
Date. ~ / Z dm
New Construction: Old or Pre-existing Building:' J~ S (chec[[[k one)
Location of Property: (v ~ ~ F~Q q~ ~ y~ ~ ~'l (P~v~
House No. Hamlet
Owner or Owners of Property: ~~a , io ~ f~:-~~~ (tee
._~o,I
Suffolk County Tax Map No 1000, Section ® /l~ Block ~ Lot `fir, _ p
b
Subdivision Filed Map. L..o~t/:
Permit No. - Date of Permit. ~ 'Applicant: yt `z~~~,1 ?c
Health Dept. Approval: Underwriters Approval-
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: ~ (check one)
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Fee Submitted: $ ~(F
3~ ~j~ C f~'~ v Applicant Sigria
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CONSENT TO INSPECTION
`~.X~v~~~ ~ `d~~\~~~ \2e~l~va the undersigned, do(es) hereby state:
Owner(s) Name(s)
That dae undersigned (is) (are) the owner(s) of the premises in the Town of
Southold, Located at -~.-e ~ ~,A ~ ~ e O~:en~ ~ ~S ~ ,
which is shown and designated on the Su olk County Tax Map as District 1000,
Section ,Block ,Lot
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's 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 awry 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.
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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: ~~aC~~~~-i C~_:--~~ s~~Z.
(Signature)
(Print N~me
(ignat~~re)
(Print Name)
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