HomeMy WebLinkAboutZ-30692FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
NO: Z- 30692
Date: 01/18/05
THIS CERTIFIES that the building DWELLING & ACCESSORY GARAGE
Location of Property 50495 MAIN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 070
Subdivision
SOUTHOLD
(STREET) (KAMLET)
Block 0001 Lot 009
Filed Map No. Lot No.
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which U~rIFICATE OF
OCCUPi~NCY NUMBER Z- 30692 dated JANUARY 18, 2005
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 FAMILY DWELLING WITH COVERED PORCHES & ACCESSORY 2 CAR GARAGE.*
The certificate is issued to WILLIAM W WALDEN
(OWNER)
of the aforesaid building.
SUFFOLK COUNT~DEPART~D~T OF HEALTHAPPROVAL
ELEC~fRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION Dk£~u
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Au t ho r 1 z ~d~i~gna t u r e
Rev. 1/81
BUILDING DEPARTMENT
TOW}I OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
IaTION: 50495 MAIN RD SOUTHOLD
2.0 # EXITS: __4
CP. AI~ SPACE: 1/3
ACCESSORY STRUCTURES:
C~E, ~"fPE OP CONST.: 2 CAR WOOD FR3%ME S'I'OI~E, T~E CONST.:
VIOLATIONS: CHAPTER 45 N.Y. STATE U}IIFORM FIRE PREVEIITION & EUILDING CODE
LOCATION DESCRIPTION ART. SEC.
1~: BP30902 ALTERATION Z30693
DATE ON I~SPECTION: 11/30/04
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This ~plication must be filled in by typewhter 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 (8-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
5. Commercial building, industrial 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.
B ~F.~,r existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
(~ Accurate survey of property showing all property lines, streets, buildin~ and 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 thc reasons therefor in writing to thc applicant.
C. Fees
l. 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 building $25.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.0~
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
Location of Property:
House No.
Owner or Owners of Property: ~ 1 6 t. /
Suffolk County Tax Map No 1000, Section
Old or Pre-existing Building:
Street
Date. 1/- &- 0
(check one)
Hamlet
Block [ Lot ~
Subdivision
Filed Map. Lot:
Permit No.
Date of Permit.
Applicant:
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ [OK).
Underwriters Approval:
Final Certificate:?
(check one)
Applicant Signature
CONSENT TO INSPECTION
Owner(s) Name(s)
, the undersigned, do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises in the Town of
Southold, located at ~-Ot/c~ ~- /F]cIt~ ,~aC~ ,'~ ~.~ ~
which is sho~ ~d desi~ated on ~e Suffolk County Tax Map as Dist~ct 1000,
Section 70 ~Block [ ,Lot ~
That the undersigned (has) (have) filed, or cause to be filed, an application 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 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 lmowledge
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 Town of Southold.
Dated:
(Signature)
(Print Name)
(Signature)
(Print Name)
_ ,oz'z6
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