HomeMy WebLinkAboutZ-30328 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, ES.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No= Z- 30328 Date: 08/05/04
THIS CERTIFIES that the building DWELLING AND ACCESSORY
Location of Property 23530 MAIN RD ORIENT
(HOUSE N0.) (STREET) (HAMLET)
County Tax Map No_ 473689 Section 018 Block 0005 Lot 014.001
Subdivision 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
OCCUPANCY NUMBER Z- 30320 dated AUGUST 5, 2004
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupanc;~ for which this certificate is
issued is ONE FAMILY DWELLING S9ITH COVERED ENCLOSED PORCH AND ACCESSORY G_ARAGE.*
The certificate is issued to PEDER A FERREIRA & ANO.
(OWNER)
of the aforesaid building.
SIIFFOLP. CODNTY DEPARTMENTP OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTIOIS REPORT.
,
Aut orized Si nature
Rev. 1/81
BUILD IISG DE P%;RTfdEMT
TOSdti OF SOUTHOLD
HOUS I[IG CODE INSPECTI OPI REPOP.T
LOCATION: 23530 MF III RD ORIEIST
SUBDNISION: MAP NO-: LOT (S)
AAMB OF ONHSR (S). PEDER A PERP.E IRA S AIIO.
OCCUPANCY: SINGLE PPMILY DS4ELLIP]G PEDER n FERFEI R": & AIIO.
ADMITTED BYc PI-.UL HEFFERN.=.IS ACCOMPANIHD HY: S?INE
ILSY AVAILABLE: SURF- CO- TAIL MAP NO-: le.-5-14.1
SOURCE OF RHQDSSTc P+UL HEPFEP.Li?N DATE: OB/05/04
D47ELLI[iG:
TYPE OF CONSTRUCTION: SSOOD FR ~D]E # STORIES- 2.0 # SITS- 2
FODNDATIOA: pOUP.ED CELLAR: FULL CRANL SPACE:
TOTAL ROOMS: 15T FLR-: 2ND FLR-: 3 3R1] FLR-: 0
BATHROOM(S): 2.0 TOILET AOOM (S): 0.0 UTILITY ROOM(S): CES
PORCH TYPE: COVERED EIICLOSED FRONT DHCA TYPE: PATIO TYPE-
BREHZHAAY: FIRHPLACH- GARnf_R-
DOMESTIC HOTF7ATSR: YES TYPE BRAYER: OIL AIRCONDITIONING-
TYPE HEAT: OIL BASE. WARM AIR: HOTNATHR-
OTT88R: STREET GAS FOR COOF.IIdG. ?70GD STOOP OPI P,E?B. OF DS3LG
ACCESSOP.Y STkUCTURES:
GF,RAGH, TYPE OF CONST-: W000 FPt^.ME STORAGE, TYPE COHST-:
SWIPHIIHG POOL: G[IESY, TYPH CONST-:
OIBffi2:
VIOL:
TI OLSS: CFL?PTER 45 N.Y. STFTE UISI FOP.M FIRE PP.EVENTIOPi & EUI LL IIIG CODE
LG G^,TI W7 ~ DEECkIPTIOPi ~ ART ~ SEC
nBwnaes: RE-IL75 PELTED B/5/04
7NSPECT® HY: ~ DATE ON INSPECTION: 07/2e/04
hIICHAEL J VERITY TIME START: 10:05 ?Id END: 10:45 ?ld
Form No. 6
TO~VN OF SOU'1`IIOLD
BUILDING DEPARTMENT
TOwN HALL
765-1802
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 of property with accurate location of all buildings, property lines, streets, 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 Undet-cvriters_
4. Sworn statement from plumber certifying that the solder used in system contains less than 2%I O of 1 % lead.
Couunercial building, indwtrial building, multiple residences and similar buildings and installations, a certificate
of Code Compliance fiom architect or engineer responsible for the building.
6. Submit Planning Boazd Approval of completed site plan requirements-
B. For existing buadings (prior to Apri19,1957) non-conforming uses, or buildings and "pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building aitd 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 ~c7iting to the applicant.
C. Fees
1. Certificate of Occupancy -New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Switnnung pool $25.00; Accessory buildutg $25.00, Additions to accessory building $25.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Cemficate of Occupancy - $25
4. Updated Certificate of Occupancy - $50 00
5. Temporary Certificate of Occupancy -Residential $li.00, Commercial $15.00
Date. ~~-ff
New Construction: ((Old or Pre-existing Building. (c eck o e) 1
Location of ProperryV° ? " ~ ~ 1 ,
House No. Street - ~ Hratnlet
Owner or Owners of Property:
t c - e
Suffollc County Tax Map No I000, Section Block Lot ,
Subdi~2sion Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
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CONSENT TO IlVSPECTION
~C>[~~ ~ ,the undersigned, do(es) hereby state:
Owner(s) Name(s)
That the undersi d is.~ t e owner s) of pr i es th ` To~~ o
Southold, located at
which is sh and dest aid on the Su k Couuty Tax Map as Distract 1
0~
Section , Block~~___, Lot
That the undersigned (has) O filed, or cause to be fi d an applic ion in the
Southol~ToBr~htspec~or's Office for e follocvit}g: ~ ` Ili'
That the undersigned do(es) hereby °iae consent to the Building Inspectors of the
Toctn of Southold to enter upon the above.;lesclibedpmperty, including any and all
buildings located thereon, to conduct such inspections as they may deem necessary with
respect to the aforesaid application, including inspections to determine that said premises
comply with all of the laws, ordinances, rules and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so with the knowledge
and understanding that any information obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laces, ordinances, rules or
regulations of the Town of Southold.
Dated; ~ ~ L" t/
Print at
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(Signature)
(Print Name)
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