HomeMy WebLinkAboutZ-30257 FORM IQG. 4
TOWN OF SOUTHOLD
BUILD ISSG DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
PkE EXISTING
CERTIFICATE OF OCCUPANCY
No= Z- 30257 ~ Date= 06/25/04
THIS CERTIFIES that the building DWELLING
Location of Property 45 BAY WF_TER AVE SOUTH/PEC
(HOUSE ISO. ) (STREET) (H.AMLET)
County Tax Map No. 473889 Section 075 Block 0004 Lot 026
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements Eor a GNE FAMILY DSPELLIISG
built prior to APRIL 9, 1957 pursuant to which CHRTIFICATE OF
OCCUPANCY NUMBHR Z- 30257 dated JUNE 25, 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*
The certificate is issued to CHARLES R FOSTER
(OWNER)
' of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ IQ/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE P_TTACHED INSPECTIOP7 REPOP.T.
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F~thor zed ignature
~ Rev. 1/61
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EUILDING DEFe•RTMIIST
TOVIN OF FOOTHOLD
HOUS INv CODE INSPECTION REPOP.T
LOCATION: 'IS HAY N?.TER Vb' SOUTH/FEC
soenrvxsxox- MAe No.: LoT (s)
' AAMH OF Uii~iHR IS) c CHPR.LES R FOSTEF.
UCC"UYAHCY: SINGLE F2x9ILY CHFRLES R FOSTER
ADMITIHU ifY: RICA EIRD ACCOMPA4II80 BY: 5.144E
KHY AVASLABLH: SDFF. W. TA% MAP NO.: i5.-4-2E
SOURCE OF RHQi1S+P: CHARLES P.OHERT FOSTER-i/29 /Oi DATE= OEj tS/0#
D~iELLING:
TYPH OF CONSTRDCPION: S]GOD PA~IdE # STDBISS: 1.5 # iDIITS= 2
FODHDATION: HRICK CBT+LAR= PPRT CRAWL SPACE=
' TOTAL ROOM.i: 1ST FLR.: 5 2ND PLR.: 2 3RD FLR.= J
~ UATHROOM IS)= i.0 TOILSI' ROOM IS)= 0-0 OTILITY ROOM IS).
PORCH SYYH: FRONT DHl1C TYPE: PATIO TYPE-
HRHEZHNAY- FIRHPLACE: OAS'
DOMESTIC AOT'NAT~: TYPH IIEATER: L-F.Gr.S AIRCON?ITIORING=
TYPE HEAT: OIL WARM AIR= XX AOTHA'1'BR=
OTHER:
Al'CESS'ORYSTRUCTURES:
' GARAGH, Y'YPE OF CONST-: 1900D-~LFRGE-NITH ELEC.) STORAGE, TYPE CONST..
' SMIMMIIiG POOL- GIIHST, TYPH CONST.-
OIBBR:
VIOLATIGI]S: CIIAFTER 45 Ii.Y. STPSE UIdIFGRIQ FIRE PRECEPITIOt] E BOILDI4IG CODE
LOCATION DESCRIPTIOII PAT. SEC
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aaMAaxA= BF~E 9092-COZ-6251 (AGCY GnA'.CE 4]ITH :DDITIOIi)
INSDHCTHD HY. DATE ON INSPHCTION: G~i OV/G1
i GABY ~
PISH T1"ME START. END:
I
Form No. 6
Toww of souTHOLD-. _
BUILDING DEP:IRTD'IENT
TOR'N IIAI.L
765-fl802 ~ g
~ APPLICATION FOR CERTIFICATE OF OCCUPANCY' ~
This application must be filled in by typewriter ur irilc and submitted to the Buitding Depamnent with [he following:
A. For new building or new use:
1. Final survey of property with accurate location of all bttildings, property lines, streets, and unusual natural or
topograptric feaht2s.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 fonu).
3. Approval of electrical installation from Boazd of Fire Underwriters
4. Srvom statement from plumber certifying that the solder used in s}~stcm contains less than 2,'10 of 1 ° o lead.
Coirunercial building, industrial buildutg, multiple residences azid similar buildings and installations. a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Platning Board Approval of completed site plant requirements.
B. For existing buildings (prior t:o April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
1. Accurate sm ~ ey of property showutg all property lines, streets, buildine and unusual natural or topographic
features.
2. A properly completed application and consent to ittspect si~ued 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
' L Certificate of Occupancy -New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $2;.00,
Switnming pool $25.00, Accessory building $25.00, Additions ro accessory building $25.00, Bwinesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
'i 3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate ofOccupancy - $50.00
5. fetnporary Certificate of Occupancy -Residential $15.00, Couanercial $15.00
Date.
New Cousttuctian: _ Old or Pre-existhtg Buildhtg: _ ~ (check one)
Location of Property: ~3 /SA5 e.ui
0 5~ L) rig Sn e.7.~,0 /cl
House Nop/~~,, pp L~~ Strret Hatnlet
Owner or Owners of Property: ~/1/af(1~ S ~'1 dF+•IIC
1 ~O S/
Suffolk County Tax Ivfap No 1000, Section _ ~ Block ~ Lot
Subdivision Filed Map. _ Lot:
Fermit No. Date of Permit- Applicant:
' Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
08/
F'ee Submitted: $ d®~ rr//
' Applicattt Siconature
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CONSENT TO INSPECTION
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~a~ , thz undersigned, do(es) hereby state:
Owner(s) Name(s)
'That the undersign (is (are) the owner(s) of the premises in the Town of
Southold, located at yj /~q-~e~,ei4if~Q fJ-uE _
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section Bluck Lot ~ 6
'T'hai the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following:
_ nRf Ef s
ice, ~ O
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 any and all
buildings located thereon, to conduct such inspections as they ma}~ deem necessary with
respect to the aforesaid application, including ntspections to determine that said premises
compl}~ with all of the laws, ordinances, rulcs and regulations of the Towu of Southuld. '
The undersigned, in consenting to such inspections, du(es) su with the knowledge
and understandutQ that any information obtained in the conduct of such inspections ma}~
be used in subsequent prosecutions for violations of flee laws, ordinances, rules or
regulations of the'1'own of Southold.
' Dated: 3 2 d ~`,.~'?'S~i
' (Si~tature)
r2 F bs i
e r-
(Print Name)
(Signariire)
ii (Print Name)
i
' 765-1802
BUILDING DEPT.
I'~ 1
[ ]FOUNDATION 1ST [ ] ROUGhI PLBG.
[ ] FouNDATI®N 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL
[ ] FIREPLACE
A CHIMNEY [ ]FIRE SAFETY INSPECTION
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DATE a~ INSPECTORS
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