HomeMy WebLinkAboutZ-30293FORM NO. 4
TO~ OF SOHTHOLD
EUILDING DEP~TMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPanCY
No: Z- 30293 Date: 07/14/04
THIS CERTIFIES that the building DWELLING
Location of Property 3505 BAY SHORE RD
(HOUSE NO.)
County Tax Map No. 473889 Section 053
Subdivision
GREENPORT
(STREET) (}IAMLET)
Block 0006 Lot 013-001
Filed Map No. __ Lot No. --
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCC~IPANCYNUMBER Z- 30293 dated JI3LY 14, 2004
was issued, and confor~s 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 CYi~THIA BLITZ
of the aforesaid building.
(OWNER)
SUFFOLK COUNTYDEPARTMENT OF HEALTHAPPROV~%L
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION D~r~u3
*PLEASE SEE ATTACHED INSPECTION REPORT.
H/A
N/A
Rev. 1/81
BUILDING DE PARTgIENT
TOWN OP SOUTBOLD
HOUSING CODE INSPECTION REPORT
MAP NO.: LOT [S)
CYNTHIA BLITZ
ACCESSOK¥ STRUCTURES:
Form No. 6
TOWN OF SOUTltOLD
TO~N HALL
765-1802
~PLICATION FOR CERTllrICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the follmxfing:
For new building or new use:
1. Final survey of property with accurate location of all bu/ldings, property lines, streets, and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 lbxm).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement fiTom plumber certifying that the solder used m system contains less than 2/10 of 1% lead.
5. Coromercial building, industrial building, multiple residences and similar buildings and installations, a certificate
of Code Compliance from ~chitect or engineer responsible for the bailding.
6_ Submit Plannirtg Board Approval of completed site plan requirements.
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, build/rig and unusual natural or topo~aphic
features.
2. A properly completed application and consent to Lnspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building h~spector shall state the reasons therefor in writing to the applicant.
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 Cerkficate of Occupancy- $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. %~
New Construction:
Location of Property: '~,~- q ~
House No. --. '~ '~ Street ~
Owner or Owners ofProperty: qy~hi ~ [~ ~!
, loek
Subdivision ~C ~/~1 (_~ ~f~? ~f,~ ,'~-,~ Filed Map~_
Permit No.
Health Dept. Approvah
Planning Board Approval:
Old or Pre-existing Building: X~ (check one)
Applicant:
Underwriters Approval:
Request for: Temporary Certificate
Fee Submitted: * //) ~' ~ 0
Fiml Certificate:
Date of penmt.
(check one)
CONSENT TO INSPECTION
Name(s)
, the undersigned, do(es) hereby state:
That the undersigr?d (is) ~,e~,.)~l~ ,owner(s)_.of the prer~se.s i.~_.n the T_owr~of, ,xt ~ ;~ ~ x~ X
S~u~old, locatedat ~ ~5~ ~o~P ~~ &/Y,lt~
which is ~wn md desi~¢ted on ~e Suffolk Cou~W T~ Map as Dis~ct 1000,
Section ~ , Block ~ , I
That the undersigned (has) ('!~t~,~file& or cause to be filed, an applicatipq, in the
Southold Town Building Inspector's Office for the following:
';-O ,
That the undersigned do(es) hereby ~ve consent to the Building Inspectors of the
Town of Southold to enter upo~a the above described propert55 inclnding any and all
buildfi~gs located thereon, to cqndnct such inspections as they may deem necessary, with
respect to the aforesaid application, h~cluding inspections to determine that said premises
comply with all of the laws, ordinances, roles and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so with the knowledge
and understanding that any intbnnation obtained in the conduct of such h~spections may
be used in subsequent prosecutions for violations of the laws, ordinances, roles or
regulations or'the Town of Southold_
Dated:
(Signature)
(Print Name)
.50'
5HOfirr.. '