HomeMy WebLinkAboutZ-30498FORM NO. 4
T0~{ OF SOUTHOLD
BUILDING DEPA=RTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPanCY
No: Z 30498 Date: 10/08/04
THIS CERTIFIES that the building DWELLING
Location of Property 560 VILLAGE LA ORIENT
[HOUSE NO.) (STREET) /~4LET)
County Ta~ Map No. 473889 Section 025 Block 0001 Lot 011
Subdivision
Filed Map No_ __ Lot No. __
conforms substantially to the Requirements for a ONE F~4ILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCC~3PANCY N I~4BER Z- 30498 dated OCTOBER 8, 2004
was issued, and conforms to all of the requirements of the applicable
provis±ons of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING*
The certificate is issued to JOHN A DORMAN & ORS.
( OWI~E R )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF ~F~LTH AI~PROVAL
ELECTHICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION D~rmu
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
N/A
N/A
NO.: LOT (S)
RATI~IOO~(S) ; 2. o TOILET ROOM(S):
0.0
WOOD
1. # EXITS: __4
R~qARKS: BP~4241Z CCZ3556~ADD;BP#6203Z COZS036(ACCY) BP~1929,Z COZ-1934~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 Depamnent with the following:
For new building or new use:
I. 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. o£water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of FLre Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/l 0 of l% lead.
5. Cormnercial building, indusmal building, multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6 Submit Planning 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 sup~,ey of properly_ showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and a consent to inspect signed by the applicant. Ifa Certificate of Occupancy
is denied, the Building Inspector shall state thc reasons therefor in writing to the applicant.
Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25
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 Certificate of Occupancy - $25.00
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy - Residential $15.00. Commercial $15.00
Date. 9/24/04
New Construction: Old or Pre-existing Building: x (check one)
Location of Property: 560 Villaqe Dane, Orient.. NY
House No. Street Hamlet
OwnerorOwnersofPropea3,: John A. Dorman, [~ary D. Dorman & M~lissa Dorman Sabatino _
Suffolk County Tax Map No 1000, Section 25
Subdivision N/A
Permit No. N/A Date of Permit.
Health Dept. Approval: N/A
Plaimmg Board Approval: N/A
Request for: Temporary Certificate
Fee Submitted: $ 100.00
Block 1 Lot 1 1
Filed Map.. Lot:
Applicant:
Underwriters Approval: ~51~A
Final Certificate: x [check one)
Deborah Doty, Esq., as attorney
for owners
CONSENT TO INSPECTION
John A. Dorman, Mary D.
Dorman, Melissa Dorman Sabatino
Ownerls) Name(s)
the undersigned, do(esl hereby state:
That the undersigned (is) (are) the owner(s) of the premises in the Town of
Southold, located at 560 Village I~ne, Orient
which is shown and designated on the Suffolk Count), Tax Map as District 1000,
Section 25 , Block 1 , Lot 11
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following:
pre-existing certificate of occupancy
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, ordinances, roles and regulations of the Toxtm 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 laws, ordinances, rules or
regulations of the To,~m of Southold.
Dated: 9/24/04
~e~oran ~oEy, Esq., as attorney for owners
(Pnnt Name)
(Signature)
(Print Name
'
Z Z
0 0
< .~
0 0 ~ ~ U
>
I
/
// ///
3
~/o~ ~ /,;
/
/
3
lO/