HomeMy WebLinkAboutZ-31013FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 31013
Date: 06/29/05
THIS CERTIFIES tb~at the building DWELLING AND ACCESSORY
Location of Property 630 SOUND AVE PECONIC
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 068 Block 0003 Lot 012
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
OCCUPANCY NUMBER Z- 31013 dated JTJNE 29, 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 ENCLOSED PORCH AND ACCESSORY SHED.*
The certificate is issued to ROBERT J & JANE TARA CURRIE
(OWNER)
of the aforesaid building.
SUFFOLK COUN~PYDEPART~ENTOFH]~LTHAPPROV~J~
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'r~u3
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Authorized Signature
Rev. 1/81
LOCATION: 630 BOUND AVE PECONIC
SUBDIVISION: MAP NO.: __ LOT {S} .-
NAME OF O~[ER (S): ROBERT J & JA}IE TARA CURRIE
OCCUPANCY: SINGLE FAMILY ROBERT J & JA~IE TAR3~ CURRIE
AI~I'l-r~u3 BY: BOB BARRETT ACCOMPANIED BY: SAME
1~ A~rAII~I~: S~F. CO. TAX ~ NO.: 68.-3-12
SOURCE OF P~QUF~: JANE T/kRA CURRIE DA~: ~29/05
WOOD FRAME
CEMENT BLOCK
ACCESSORY STRUCTURES:
VIOLATIONS; CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDIWG CODE
LOCATION DESCRIPTION ART. SEC.
P~: BP31235 DECKS COZ31012 (RB-INSP 6/27/05)
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 Department with the following:
A. For new building or new use: 1. Final survey of property with accurate location of all buildings, propert)' lines, streets, and unusual natural or
topographic features.
2. Final Approval fi.om Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement fi.om plumber certi~'ing that the solder used in system contains less than 2/10 of I% 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
I. Accurate survey of property showing all properS' lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and a consent to inspect signed by the applicant. If a 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, Accessor)' building $25.00, Additions to accessory building $25.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Cop)' of Certificate of Occupancy - $25.00
4. Updated Certificate of Occupancy - $50.00
5. Temporal' Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
Location of Property:
Old or Pre-existing Building: f (check one)
House No. Street Hamlet
Oxvner or Owners of Propert)':
Suffolk Count), Tax Map No 1000, Section
Subdivision
oto}-.0o
Permit No. Date of Permit.
Block 0 _~ ' O0 Lot
Fired Map. Lot:
Applicant:
Olo . ,ooo
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ tO0 · 0 0
Under~riters Approval:
Final Certificate: ~
(check one)
~----/- Applicant Signature
CONSENT TO INSPECTION
Owner(s) ~ame(s)
That the undersigned(is) (a_re) the owner~) of the premises in the Town of
Southold, located at
which is shown and designated on the Suffolk County Tax Map as District 1000,
SectionOtO~ , BloekO$.00, Lot Oh,~'000.
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold To~,vn Building. Inspector's Office for the following: 0,.'1~ - -~(-. t.~ ~jj
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.
Dated:~o~--/!
(Si~.nature) ~,4 .
o= r-a
(Print Name)
d. 6o,,-r,'e._
LoNG ISLAND
DESCRIBED PROPERTY
P£CONIC, TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y,
SURVEYED FOR: LORI M FEILEN
SOUND
AVENUE