HomeMy WebLinkAboutZ-30261FORM NO. 4
TO~ OF SOUTHOLD
BUILDING DEPD~TMENT
Office of the Building Inspector
To%~ Hall
Souuhold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 30261
Date: 06/28/04
THIS [~rIFIES t~at the building
Location of Prc~ezty 1100 _~-LBERTSON LA
(HOUSE NO.)
County Tax ~4ap No. 473889 Section 052
Subdivision
DWELLING & ACCESSORIES
GP. EENPORT
(STREET) (~MLET)
Block 0004 Lot 004
Filed Map No. Lot No. __
conforms substantially to the Requ±r~ents for a O~ FAMILY DWELLING
built prior to APRIL 9, 1957 pu~s~n~t to w~ch CERTIFICA~ OF
OCCU~ANC~f I~J~4B~ Z- 30261 dated JI/NE 28~ 2004
was issued, and conforms to all of the requlr~ments of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH ENCLOSED PORCH A2~ ACCESSORY GAP_AGE, BAP~N
~kND SILO.*
~e ce~iflc~te is issued to ~TRONY COP~kZZiNI
!(OWNER)
of the aforesaid building.
~u~FOLK COUNT~DEPARTMENT OF ~E. ALT~APPRO~-DJ~
Rev. 1/81
~/A
N/A
ACCESSORY STRUCTURES:
P.I~,F-~: BP876 ADD COZ~55; BP30404 PORCH ENC COZ30262
DATE ON I~SP~CTION: 00/00/00
TII~ STAHT: END:
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Thi's application must be filled in by typewriter 0R ink and submitted to the buildin
inspector with the following: for new building or new use:
.[. Final survey of .proper'ty ~th accurate locat±on of all buildings, property lines
stree~5,'and unusual ~atural or topographic features.
Final Approval from Health Dept. of water supply and sewerage-dispssai(S-9 form)
3_ Approval of electrical installation from Board of Fire Under%zriters.
Sworn statement from pltnmber ccrtifyJ~lg that the solder used in system contains
less ~han 2/10 of ll lead.
5. Commercial building, industrial building, multiple residences and similar buildi
and ~stallattous, a certificate of Code Compliance from architect or emgineer
responsible for ~he buildinE,
6. Submit Fia~ni~g Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings
'Tpre-existing" land uses:
Accurate survey of property showing mll property lines, streets, buJ-Iding and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applican
If a Certificate of Occupancy is denied, the Building In~pector shall state the
reasons therefor in writing to the applicant. ~-~
1. Certificate of Occupancy - New dwelling $25.00, Addztmoq~ :t6 ~1~ ~.00,.'
Alterations to dwelling $25.00, Sw]'mming pool $25.00, Ad~e~sory building $25'.O0~
Additions to accessory building $25.00. Businesses $5~.00~
2. Certificate 'of Occupancy on Pre-exisnin~ Buildinz - $I0~.00
3. Copy of Certificate of Occupancy - ~
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificane of Occupancy - Residential $15.00, Commercial $15.00
......................
New Construction ........... Old Or Pre-existing Build:f_ng..~..~. ~.
~ouse No. S~ree e Hamlet
..... 2"x .................
County T~x F~ap No i000, Section .... BlOck ....... Lo .w~. .............
Subdivision .................................... Filed Mmp ............ Lot .................
Permit No ................ Date Of Permit ................ Applicant ........................
Health Dept. Approval .......................... Underwriters Approval
Planning Board Approval
Request for: Temporary Certificate ........... Final Certicate ...........
CONSENT
TO -'
INSPECTION
do(es) hereby state:
the under[~igned,
That the undersigned (is)'(are) the oxvner(s) of the premises in the To%~n
~--}"'~.~~t~_] o which is shown and designated on the
CountytaxmapasD~strictl000. Section ~.B'lock ~
That the undersigned (has) (have) [ilFd, 'or caused to be filed, an applica-
tion in'th. Southold Toxm ~u~lding lnsp,~u[~..= orrr.~ ro~ ~.. rnllnwLnff:
That the undersigned do(es) hereby give consent to the Building Inspectors
of thc Town or' Soulhold to enter upon thei above described property, inclpd[ng
any and all buildings located thereon, toiconduct such inspections as they may
deem necessary with respect to the aforesaid appllcation, including'-inspections
[o determine ti]at said premises comply Iwith all of the laws, ordinances, rules
and regulations of the Town of Southold.:
The undersigned, in consenting to sflch inspections., do(es) so with the
knowledge and understanding that any information obtained in tile conduct of
such inspections may'be used as evidence in subsequent prosecutions rot
lations o[ the laws, ordinances, rules or
regulations of the Town or Southold.
( print ~'n a--m e )
(signature)
5UR\/EY OF PROPERTY
SITUATE: AR5HAsMOMAsGZUF �
TOWN: SOUTHOLD 4 r N
SUFFOLK COUNTY, NY Q
SURVEYED 04-20-2004 D 0 '
SUFFOLK COUNTY TAX #
1000-52-4-4 N O �
o WO Oscar J. Bloom R Land Now or For
Prepared For. rn 3 90 ichard D. Zeidler Sr.e
of: d
George 7 CD Richar DZe1dler Jr.
3 0
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NOTES: `y'
0 103'
MONUMENT FOUNDV
g G
O eo' 20'
AREA = 558,6-f5 S.F. or 12.53 Acres
4'N.1;
all r,. n 0 0 03'.5.
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7c Q
fJ a tank N
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08 500814
� '°2 story'' � � v 32q.•78'
of NEW Frame _ N o
r House o
p G Ek O s \9
'Vna�tnorizla alteratlan ar aaa�tlan t•,d wr�1y �'� ��,Z,N CF�s� � -
mop blaring a li�ensad la,d surveyor's Seal�, �+
,aYor or sectE of L... �5ax�2,of Lnea
K3w Yak Stales Eaicdlia,Law." /- Q
"Only copls5 from the orl.3lnal of[M1is 5wvey j• j.�j -G� I TAN
d Nov, a
md-k1d wrtn do drlg'nal�f tie Imes 5uvey��r'S ,. �(/'py+� x.60' Lan r For
5tm""51115halIb1co-f—redtobev—true tel" merIU of
�g Leonard Fink
"G11H cdhon5 rnd'edtla herldn 51g9f4 that this �J''�b r( 1
vey was orepsed In accarchn-1 witr�the 1x-
15tng Code of practice for Lmd Surveys adopletl l•
by the caw rare add-4-ration IF P aresslo dl
Lana Su'vegorF Baia<thencaria,e 5pr o,d, Q
to the person For carom the survey 15 prepares.
and on nC behalr to the tltle corrrcny gave
tal aglncy d,d I If t „�tit.tla,listed rare.aro �O CAND
to the,.r,fees of tha lenmrq Instit-tlon. Gertifices- rr
tens are not tans/erable to additl^nal rnstitution5 O
O k
.NOUN C. EULERS LAND SURVEYOR GRAPHIC SCALE i"= 60'
6 EAST MAIN STREET N.Y.S.LIC.NO.50202 __ � °®� L -
RIVERHEAD,N.Y. 11901 - �
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