HomeMy WebLinkAboutZ-30410FORM NO. 4
T0~'~ OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Halt
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 30410
Date: 09/09/04
THIS CERTIFIES that t_hebuilding DWELLING
Loeatio~ of Property 1525 SHIPYARD LA
(HOUSE ~0.) (STREET) (~zuNiLET)
County Tax Map No. 473889 Section 038 Block 0001 Lot 016
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a ONE FA~4ILY DWELLING
built prior to APRIL 9, 1957 pursuant to WhlchCAR~TIFICAT~ OF
OCCUPANCY NUNR~ER Z- 30410 dated SEPTEMBER 9, 2004
was issued, and conforms to all of the requirements of 5he applicable
provisions of the law. The occupancy for which this certificate is
issued is 0~ FAMILY DWELLING *
EAST MARION
The certificate is issued to JO~q VOLINSKI
of the aforesaid building.
(O~RCER)
SUFFOLK COUNT~DEP/kRTMEI~T OF t~ALTHA~PROIrAL
ELEC%~tICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION D~£mu
*PLEASE SEE ATTACHED INSPECTION REPORT.
~/A
N/A
N/A
u~t~riz e~ Signature
Rev. 1/81
LOT (S)
ACCESSORY STRUCTURES:
WOOD $X12
~: BP~763-COZ600 (ADD)-BP~30607Z-COZ30409 (DECK)
Form No. 6
TOWN OF SOUTHOLD
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 Depart~e_nt-x~:it}/:th6 follow/ng~'
A. For new building or new use: 1_ Final survey o f property with accurate location of all bnildings, properW lines, streets, and unusual natural or
topographic features.
2. Final Approval fi:om Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation fi-om Board of Fire Under~ters.
4. Sworn statement Eom plumber certif35ng that the solder used in system contains less than 2/10 of 1% lead.
5. C0mmetyial building, industrial building, multiple residences and similar bmldin~ and installations, a certificate
of Code. Compl/ance fi-om architect or engineer responsible tbr the binldLng.
6- Submit P-.jannmg Board Appmx. al of completed site plan requirements_
/~.-'~r existing buildings (prior to April 9, 1957)~ non-conforming uses, or buildings and "pre-e~sting" land uses:
~---,~,} AccUrate survey, O£property showing all property lines, su:eet~, building and unusual natural or topographic
~ feafares. .'
2. A properly completed application and consent to inspect signed by the appI/cant. If a Certificate of Occupancy is
denied, the Build,ag Inspector shall state the reasons therefor in xwhing to the applicant.
C. Fees 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 btfdding $25.00, Businesses $50.00.
2. Certificate of Occupancy ou Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy- $.25
4. Updated Certificate ofOcenpancy - $50.00
5. Temporary Certifieate of Occupancy - Residential $ l 5.00, Commercial $ l 5_00
Date.
Old or Pre-existing Building: 0/ (check one)
House No. Street H~ml~
New Construction:
Location of Property:
Suffolk County Tax Map No 1000, Section //~90 O Block
Subdivision
Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval:
Planning Board Approval:
Underwriters Approx~l:
Request for: Temporary Certificate
F/nat Certificate:
(check one)
Fee Submitted: $
Applicant ~gnainre
CONSENT TO INSPECTION
Owner(s) Name(s)
That the tmders~gned 0s) (are) the owner(s) of the premises m the Town of
Southold, located at ./~ %5~
which is shown ~d desi~ated on the Suffol~CounW Tax Map as Dis~ct 1000,
Section [~Od , Block ~ ~ ~, Lot
That the undersigned (has) (have) filed, or cause to be flied, all application in the
Southold Town Building Inspector's Office for the following:
That the und~'~signed do(es) hereby ~ve consent to the Building Inspectors of the
Town of SoutholdAo enter upon the above described propet~y, including any and all
buildings located thereon, to conduct such inspections as they may deem necessary with
respect to the aforesaid applicatio~, including inspections to detemrine that said premises
comply with all of the la~vs, ordinances, rules and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, do(es) so with the rknowledge
and understanding that any information obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laws, ordinances, roles or
regulations of the Town of Southold_
Dated:
(Print Name),
(sig ._ -
(?nnt ~ame)
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL -~?L/~C~ ~
[ ]FIREPLACE & CHIMNEY [ ]FIRE. SAFETY INSPECTION
REMARKS: T~_/,~_.~ , ~ ~,~w_w ~ ~
DATE
1/1