HomeMy WebLinkAboutZ-30757FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 30757
Date: 02/10/05
THIS CERTIFIES that the building DWELLING
Location of Property 530 (AKA #520) STERLING PL. GREENPORT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 034 Block 0003 Lot 007
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 U~TIFICATE OF
OCCUPANCY NUMBER Z- 30757 dated FEBRUARY 10, 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 *
The certificate is issued to WILLIAM L & MARY A. DAVIS
(OWNER)
of the aforesaid building.
SI/FFOLK CO~DEPART~qT OF ~{F~kLTHAPPROVAL
EL~-rRICAL CERTIFICATE NO.
PL~F~S CERTIFICATION DA-r~
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
N/A
N/A
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
I&)CATIf~: 530 (AKA #520) STERLING PL. GREENPORT
SUBDI~SION: ~3%P NO.: LOT (S}
1~ OF OW~ (S}: WILLIAM L & MARY A. DAVIS
OCCUPANCY: SINGLE FAMILY DWELLING WILLIAM L & MARY A. DAVIS
SOURCE OF I~EQUEST: WILLIAM DAVIS 2/4/05 DATE: 02/10/05
WOOD FRAME # STONIES:
CEMENT BLOCK CEIl: FULL
YES
6
1.0 # EXITS: __2
CRA~ SPACE:
ACCESSORY STRUCTURES:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION kRT. SEC.
DATE ON INSP~/L"rIO*~: 02/10/05
TIME START: 10:05 AM ~/D: 10:30 AM
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 thc 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 (S-9 form).
3. Approval of electrical installation from 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, 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,~or existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
k'-.~.J~Jl. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. Ifa Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing 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 building $25.00, Businesses $50.00.
2. Certificate of Oecupancy on Pre-existing Building - $100.00
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: ._4'"a90
House No.
Old or Pre-existing Building:
Street
Owner or Owners of Property: ~///, ~-,o7
Date. /fi)//~
J (check one)
Suflblk County Tax Map No 1000, Section
Subdivision
Hamlet
Permit No.
Date of Permit.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $//0 i), u ~
Block 03, oo
Filed Map. 1337
Applicant:
Lot
Lot:
Underwriters Approval:
Final Certificate:
(checkone)
Applicant S~ture ,
CONSENT TO INSPECTION
[.~/~/J'~,~ ,~. 4 t'~,,qf~ ~' ~, "~/~///~ , the undersigned, do(es) hereby state:
Owner(s) Name(s)
That the undersigned (is) (are) the owner(s) of the premises in the Town of
Southold, located at ,~%2a ,5-/~/~,'x,,_~
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section ~3~,uqBlock03, ¢o Lot 0o?.
That the undersigned bas) (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 aforfsaid 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 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, roles or
regulations of the Town of Southold.
Dated:
(Signature)
L,
~Signature)
(Print Name)
Wt,v4