HomeMy WebLinkAboutZ-30627PORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPanCY
No: Z 30627
Date: 12/13/04
THIS CERTIFIES that the building DWELLING
Location of Property 530 MIDDLETON RD GREENPORT
[HOUSE NO.I [STREET} (E~MLET)
County Tax Map No. 473889 Section 040 Block 0005 Lot 004
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
OCCI/PD/qC~f AN3MBER Z 30627 dated DECEMBER 13, 2004
was issued, and conforms to all of the requirements of the applicable
provisions of 5he law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH ATTACHED GARAGE *
The certificate is issued to MARy ZIPF~S
of the aforesaid building.
(OWNER
S~/FFOLK COUNTY DEPARTMENT OF}~ALTHAPPROVAL
ELECTRICAL CERTIFICATE NO.
PLL~BERS CERTIFICATION DAT~}
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Authorized Signature
Rev. 1/81
I~DCATION: 530 MIDDLETON RD GREE~TPORT
MARY ZIPKAS
O~ER: *SEPARATE GAS HOT WATER HEATER
ACCESSORY STRUCTURES:
TOWN OF SOUT~LD
TO~N I~LL
APPL.T.r'AT%0N FOR CrP, TIFtCATE OF OCC~PANC~
A. Th~u application ~ h~ ~d ~n by cyp~rica~ O~
t. F~a~ ~ocvay o~ prop~cy ~ich accurac~ location
2. Approval of uluccr~cal in~c~ll~cion from Bo~cd
C.
[. Cc~c~fic~ca of Occupancy - Now d~ullia~ $25,00, Addicious CO dwullin~ $25.00,
Al~racion~ Co dwellin~ $25.00, ~w%~izlg i)oo~ $25.00. Accessory buiidinn $25,00,
2. C~r~ifica~ of Occupancy on Pru-exis~
3. Copy o~ C~rtif&cace of Occupancy - $5.00 ov~c 5 yea~ - $lO.O0
4. Updated C~rcii~cace Of Occupancy -
..... ...............
...................... · ............................. ~X~ ~.: ....
· :~acy Tax ~ap No I O, . c n .............. ~ ...................................
· 'crm~c No ................ D~co O~ ~arm~c...% ............
Approval ..................... ; .... Ul,,~erwriEer,'- Appceval.... .....................
'lanning Beard Approval ...................... ..
t,~Cl~U=[' fur: Temporary Certificate ........... Final Cur
CO~NSENT
TO
INSPECTION
O%vner(s) Name(s)~ ' '
do(cs) hereby state:
That the undersigned (is) (are) theV'ow'ner(s) of the pr~mises in the Town
· x;'hich is sho%cn and designated on the Suffolk
County tax map as District 1000, Section B0 , Block 0~'~ , IJo.t (~.
That the undersigned (has) (have) filed, or caused to be filed, an applica-
tion in the Southold Town Building Inspector's Office for the following:
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 nece. ssary with respect to the aforesaid appl{cation, including inspections
to determine that said premises comply with all of the laws, ordinances, rules
and regulations of the Town cf Southold.
The undersigned, in consenting to such inspections, do(es) so with the
knowledge and understanding that any information obtained in the eond,,ct of
such inspecti6ns may be used as evidence in subsequent prosecutions for vio-
lations of the laws, ordinances, rules or regulations/O~ the To;~ko, f~-thold.
-- (print name) C'-f~r%-%°w-
(signature)
(print name)