HomeMy WebLinkAboutZ-30971FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEP~TMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: z- 30971 Date: 06/09/05
T~IS CERTIFIES that the building DWELLING
Location of Property 2750 PINE NECK RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 070 Block 0010 Lot 003
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
OCCUPi~qCY NUMBER Z- 30971 dated JUNE 9, 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 CEMENT PATIO.*
The certificate is issued to HELEN MACNISH
of the aforesaid building.
( OWNER )
SUFFOLK COUNT"f DEPARTMENT OF ~ALT~APPROV-AL
BLECTI~ICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Authorized Signature
Rev. 1/81
BUILDING DEPARTMENT
TB?~! OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
SOUTHOLD
MAP NO.: LOT (S)
HELEN MACNISH
ACCO~PANI~ BY: BRUCE LOUCF~A
TOTAL ROOMS: 1ST FLR.: --6
BATHROOM (S): 2.0
PORCH TY~E:
BREEZEWAY:
I)O}{ESTIC H~TE£: YES
1.0 ~ EXITS: 3
ACCESSORY STRUCTURES:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFOPJd FIRE PREVENTION & BUILDING CODE
LOCATIOD DESCRI PTI01! ART. SEC.
RI~4AP~S: RE II;SPECTED 6/8/05 BP4355 Add COZ5546; BP5552 AccyBldg COZ5547;
BP21970 Alter COZ22923; BP3~ ]68 Add to Accy C~=Z30970
· _u : DEP-
Form No. 6
TOVCN OF SOUTHOLD
BUILDING DEPARTMENT
TOXVN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled iii by typewriter or ink and submitted to the Building Department with the followiug:
Ao
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 Undem,riters.
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 sinfilar buildings and installations, a certificate
of Code Compliance from architect or engiueer responsible for the building.
6. Submit Plmming Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land nses:
1. Accurate suo:ey of property showing all property lines, streets, building aud uuusual natural or topograptfic
features.
2. A properly completed application and conseut to inspect sigued by the applicant. If a Certificate of Occupancy is
denied, the Building luspector shall state the reasous therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.(}0, Additions to dwelliug $25.00, ,Mterations to dwelliug $25.00.
Swinmfing pool $25.00. Accessory building $25.00, Additions to accessory, building $25.00, Businesses $50.00.
2. Certificate of Occopancy 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, Comniercial $15.00
Old or Pre-existiug Building:
House No. Street
New Constmctioo:
Location of Property:
/ / --
(check one)
Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section__
Subdivision
Block /D Lot
Filed Map. Lot:
Pen'nit No.
Date of Pemfit.
Applicant:
Health Dept. Approval:
Underwriters Approval:
Platming Board Approx al:
Request for: TemporaD' Certificate
Fee Submitted: S / ~0 o o
Final Certificate: (check one)
- ~'[p-plic~n~- fi ignatufe -
CONSENT TO INSPECTION
Owner(s) Na~e(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
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section 7~ , Block /O , Lot ,~
That the undersigned (~as) (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 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 Town of Southold.
Dat~:
(Print Name)
(Signature)
(Print Name)
LOCATION: ~Z 7_~'--~ /O ~ /~f.p.~ ~ , )
(number & street)
(municipality)
SUBDIVISION: MAP NO.:
NAME OF OWNER(S):
OCCUPANCY: 0 ,q~'~
(t~e)
ADMITTED BY: ~
KEY AVAILABLE:
SOURCE OF REQUEST:
LOT(S):
(owner-tenant)
ACCOMPANIED BY:
TAX MAP NO~ 1000- DATE:
DWELLING:
TYPE OF CONSTRUCTION:
FOUNDATION:
TOTAL ROOMS: 1ST FLR:
BATHROOM(S): ~.
PORCH TYPE:
BREEZEWAY: ~
DOMESTIC HOTWATER: ~ TYPE HEATER:
TYPEHEAT: OIL HoTkaJ/St/0t_WARMAIR: -- --
OTHER:
Ldoo]) /~/~]~1.~ # STORIES: I # EXITS:
~.~/-e_~ CELLAR: /9/~T-. CRAWL SPACE:
~ 2ND FLR: ~-- 3RD FLR:
TOILET ROOM(S): '"'-'- UTILITY ROOM:
DECK, TYPE: ~- PATIO, TYPE: c~ ~::/n~=/d 7-
FIREPLACE: ~ GARAGE:
AIRCONDITIONING:
HOTWATER:
ACCESSORYSTRUCTURES:
GARAGE, TYPE OFCONST.:
SWIMMING POOL:
OTHER:
STORAGE, TYPE CONST.:
GUEST, TYPE CONST:
VIOLATIONS: CHAPTER 45 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION
DESCRIPTION
ART. / SEC.
REMARKS:
INSPECTED BY: ~ ~
DATE OF INSPECTION:
TIME START: //0 / ~0