HomeMy WebLinkAboutZ-30349FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N_Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 30349 Date: 08/11/04
T~IS CERTIFIES that the buildin~3
Location of P~operty 33995 ~IN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 097
Subdivision
DWELLING
CUTCHOGUE
(STREET) (~LET)
Block 0001 Lot 011.005
Filed Map No. __ Lot No. __
confozms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCuu~ANCY NUMBER Z- 30349 dated AUGUST 11, 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 FAMI~f DWELLING WITH ACCESSORY GARAGE *
The certificate is issued to JOH~ H & CAROL A BINNS
(OWNER)
of the aforesaid building.
SUFFOLK COUN~i"f DEPARTMENT OF ~]EALT~ APPRO~L~L
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Rev. 1/81
CUTCHOGUE
WOOD FPJ4~E
ACCESSORY STRUCTURES:
R/~: BP %19322Z-COZ-19Z95 (REPAIR WORKJ
Form No. 6
TO~VN OF SOUTHOLD
BUILDING DEPARTM~ENT
To~rN HALL
765-1802
73¥7
APPLICA'HON FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewr/ter or ink and submitted to the Building Department with the following:
For new building or new use:
1. Fin al stu-vey of property with accurate location o f ail 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 h~stallation fxom Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead.
5_ Commercial building, indnstrial buildhxg, multiple residences and shnilar buildings ~md installations, a certificate
of Code CompLiance from architect or engSneer responsible for the building.
6. Submit Ptann/ag Board Approval of completed site plan requirements.
and "pre-ex~sting" land Us~
~al or topographic
er t ificat w.o f,,Oor,~ ant
n, For existing buildings (prior to April 9, 1957) non-conforming uses, or build~ngs
1. Accurate survey of property showing all property lines, streets, building and
features.
2. A properly completed application and consant to inspect signed by the applicant.
denied, the Building Inspector shall state the reasons therefor in ~ting to the a~
C, Fees
·.
1_ Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, A ~~-"~--,
Swimming pool $25.00, Accessory building $25.00, Additions to accessory bu~Mir ,%"25.00,'Bfisinesses $50.00.
~--_ Certificat e o f Occupancy on Pre--existing Building - $100.00
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy- $50.00
New Construction: Old or Pre-existiag BuildSng:
Loca~onofProperty: 33qq5
House No. Street
(~wner or O~mers of ?roperty: /~l~-r
Suffolk Cotmty Tax Map No 1000, Section (~) ~ ~ · 0 0 Block
Temporary Certificate of Occapancy- Residential $15.00, Commercial $15.00
Date. '7
(check one)
C,..,'r'~ ~oc.-'u.~
Hamlet
0{,00 Lot 0[{ ~ _OtQ~
Subdivision Fried Map.
P~'rnit No- Date of Pcamit. Apphcant:
Health Dept. Approval:
Underwriters Approval:
Planning Board Approxml:
Request for: Temporary Certificate
Fee Submitted: $ lO0~''
Final Certificate:
CoZ 5,7
(check one)
APr 'can ignamr
CONSENT TO INSPECTION
Owner(s) Name(s)
, the tmdersigned, do(es) hereby state:
That the undersigned(is) (are) the, o~gper(s) of the premises in the Town of
Southold, located at ~]~_~ /[AAr~ ~h9 Coq'~
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section Octq,0*, Block~, 0~o, Lot O[~ ,eo¢ .
That the undersigned (has) (have) filed, or cause to be filed, an agplication in the
Southold Town Building Inspectors Office for the following: ~-'/0
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 may deem necessary with
respect to the aforesaid application, including inspections to determine that said premises
comply with all of the laws, ordhmnces, roles and regnlations of the Totem of Southold.
The undersigned, in consenting to such inspections, do(es) so with the knowledge
and understanding that any intbm~ation obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laws, ordinances, rules or
regulations of the Toxvn of Southold.
Dated:
{~_(eri~~
D ~ (Sig~tt~)
(Phnt Na~e)
TITLE
suewY No..04-- ~t~
~c."c,o~: "?7 D L-O~.~..:
LOT:
MAP OF PROPERTY
. C.U'TOHO6UE'
TOAI td o1~
SE~ION ~ OF THE HEW YO*K STATE SURVEYED
EDUCATION
iSLANDIWIDE LAND SURVEYORS
741 B WEST JERICHO 'IURNPIKE
HUNTINGTON, N.Y. 11743
PHONE: 631-692 0900 FAX. 6,51 692-8759
RECOROS OF WALTER I. BROWNE , GUSTAVE A, ROULLIER
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION I ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS:
[ ] ROUGH PLBG.
[ ]~JLATION
[v'~ FINAL
DATE