HomeMy WebLinkAboutZ-30253 TO~I OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Soushold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
NO: Z- 30253
Date: 06/24/04
THIS CERTIFIES that the building
Location of Property 28375 CR 48
(HOUSE NO-)
County Tax ~ap No. 473889 Section 074
DWELLING A~ ACCESSORY
PECONIC
(STREET) (PLAYLET)
Block 0001 Lot 042.005
Subdivision Filed Map No. __ Lot No. __
conforms substantially to th= ReClUlr~m~nts for a ONE F~ILY DWEL~±NG
built prior to APRIL 9, 1957 pursuit to wh/ch CEMTIFIC--~rE OF
OCCOPANCYNUMBER Z- 30253 dated JUNE 24, 2004
wms issued, and conforms to all of the requirements of the applicable
provisions of the lmw. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH COVERED FRONT AND SIDE PORCHES _AND
ACCESSORY GAt~AGE_*
The certlf~cate is i~sued to RICHARD E & ELIZ.Si:~ETH S ME.AD
(OW~IER)
of the aforesaid Duilding.
SOFFOLKCOUNTYDEPARTMENTOFM~,AL-£nAPPROVAL
ELECTRICJkL CEETIFICATE NO.
PLUMBERS Ck~TIFICATION
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Rev- 1/81
R~: BP1076i DECK COZ101~4 BP22997 SEED COZ24053
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 all buiJdin gs, property lines, streets, and umusnal natural or
topographic features.
2. Final AppmvaI from Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Appt oval of electrical installation from Board of Fire Undcp~'dtct~.
4. Sworn statement t~om plumber ce~if3'ing that the solder u~ed m system contains less than 2/10 of 1% lead.
5_ Commercial building, industrial building, multiple residences and siimlar buildings an:l installations, a certificate
of Code Compliance from architect or engineer responsible for the buildLug.
6. Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming us~s, or buildings and "pre-existing" land uses:
1. Accurate smwey of property showing ali 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
dcnied, thc Building Inspector shall state the reasons therefor in xwriting to the applicant.
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, AI. temtions to dv,-elling $25.00,
Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50 00.
2. CertLficate of Occupancy on Pre-existing Building $100.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15_00
New Construction:
Location of Property: 2 g3 7E dC:>.
House No.
owner ofProp :
Suffolk County Tax Map No 1000, Section
Old or Pre-existing Building:. ~/ (cheek one)
6/o
Street Hamlet
Subdixrision Filed Map. Lot:
Permit No.
Health Dept. ApprovaI:
Date of Permit.
Applicant:
Underxwiters Approval:
Planning Board Approval:
Request tbr: Temporary Cemficate
Fee SubmitteA: $ ./tO ~., ~9 ~
Final Certificate: b,/ (check one)
,~pplicant Signature '-
CONSENF 1'0 INSPECTION
~wner(s) Name(s)
That the undersigned (is) (are) the owner(s) of the pr~4nises in the Town of
Southo'ld, locatedat ,q37:5 tq,,4 't-Yet ,olVi6'_
wkich is showg and d¢~guatcd on the Suffb~k C0u~nty~rax 'Ivlap a~ Dis~ct 1000,
Section 7~ 'Bl°ck [ ,Lot /]Y_., ~'
That the undersigned (has) (have) filed, or cause to be filed,.an appli3ation in the
Southold Tow~n Building h~sp_ector's Office for the following: Jt~ b'l ~2_~[I
That the undersigned do(es) hereby give co2sent to the Building Inspectors of~J~e
To,~m of Southold to enter upon the above described property, including any and alJ--~
buildings located thereon, to conduct such mspectipns as they may deem necessary with
respect to the aforesaid application, including inspections to detemtdie that bald premises
comply w~th all of the laws, ordinances, rules and regulanons of the Town of Southold.
The undersigned, in consentin_g to such inspections, do(es) so with the knowledge
and understanding that any information obtah~ed h~ tim conduct of such inspections may
be used in subsequent prosecutions for violations qfthe laws, ordinances, rules or
regulations of the Town of Southold_
Dated: