HomeMy WebLinkAboutZ-30222FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 30222 Date: 06/02/04
T~IS CERTIFIES that the building
DWELLING AND ACCESSORY
Location of Property 505 SKIPPERS LA ORIENT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 024 Block 0002 Lot 002
Filed Map No. __ Lot No. __
Subdivision
conforms su]~stuntially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z- 30222 dated 0-JNE 2, 2004
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 DWELLING WITH FRONT PORCH AND SECOND FLOOR DECK
ACCESSORY ONE CAR GARAGE.*
The certificate is issued to WILLIAM H & SHEILA S BACHMAN
(OWNER)
of the aforesaid building.
SUFFOLK COLSK~Y DEPAR~4ENT OF ~]~ALTE APPROVkL
ELEC~fRICAL CERTIFICATE NO.
PLI~BERS CERTIFICATION D~
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
N/A
N/A
N/A
Autho~iz ed Signatl~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 505 SKIPPERS L~ ORIENT
SUBDI~TSION: MAP NO.: LOT (S)
~ OF OWNER (S): WILLIAM H & SHEILA S BACHMAN
DWELLING:
T~PE OF CONSTRUCTION: WOOD FRAME # STORIES: 2.0 # EXITS: 3
FOUNDATION: STONE & CEMENT BLOCK CEIl: PART CR~ SPACE:
ACCESSORY STRUCTURES:
GARAGE, T'fPE OF CONST.: ONE CAR WOOD STORAGE, ~'YPE CONST.:
VIOLATIONS: CKAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
P~: BP2~DS COZ24372; BP23524 ADD COZ25483
JO:M'B:UFIS // TINE START: 9:45AM END: 10:25AM
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Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
MAy J
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use: .
1. Final survey ofpropertywith accurate location of all buildings, property lines, street's, 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:
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.
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 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/Cer~i.ficate of Occupancy - Residential $15.00, Commercial $15.00
Date. May 14, 2004
New Construction:
Old or Pre-existing Building: X
(check one)
Location of Property: 505 SkigDer's Lane. Orient. NY
House No. Street
Hamlet
Owner or Owners of Property: William and Sheila Bachman
Suffolk County Tax Map No 1000, Section 24. Block 2
Subdivision / Filed Map.
Lot 2
Lot:
Pennit No. Date of Permit. Applicant:
Health Dept. Approval:
Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: //~clS&ck one)
Fee Submitted: $ 100.00 ~k~e.~,u, ~ ~.SE[~
C~~ 11~ ~ - ' ~pplicant Si~ature
CONSENT
TO
INSPECTION
Gary Flanner 01sen as Attorney for WiRliam H. Bachman and tbe undersigned,
Owner(s) Name(s) Sheila S. Baahman
do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Sou[hold located at 505 Skipper's Lane, Orient
· which is sbox~n and designated on the Suffolk
County tax map as District 1000, Section 24 Block 2 , Lot 2
That the undersigned (has) (have) filed, 'or caused to be filed, an applica-
tion in'th. Southold Tow~] lJUlld~ng inspeu~,~ 'o C, Ffl~-. £o.* %¼,~ fn]]f)xvin~:
Two story frame house and detached garage
That the undersigned do(es) hereby give consent to the Building Inspectors
o[ the Town of Southold to enter upon the above described property, iucludlng
any and all buildings located thereon, to conduct such inspections as they may
deem necessary with respect to the aforesaid application, ineluding~-inspections
to determine that said premises comply with all of the laws, ordinances, rules
and reRulations of the Town of Southold.
The undersigned, in consenting to such ~spec~ions, do(es) so x~th the
knowledge and understanding that any ~formation obtained In the conduct of
such inspections maybe used as evidence in subsequent I ~secutions for
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lations o[ the laws, ordinances, rules o~ re~lations ~[ e Toxvn of Southold.
Dated: Mav 14. 2004 , ./ / ' ~igna[ure)
Gary Flanner 01sen
(print name)
(sitznatu re)
(print name)
1,8
M'q F:~ 0"~' F::',~e O F:'~ F~ 7-,r.-