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Home My WebLink AboutZ-31060FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPAI~CY No: Z- 31060 Date: 07/25/05 T~IS CERTIFIES that the building DWELLING Location of Property 625 PRIVATE RD #2 SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 061 Block 0004 Lot 010 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- 31060 dated JULY 25, 2005 was issued, and conforms to all of the requirements of the applicable previsions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ACCESSORY GARAGE & ACCESSORY BARN* The certificate is issued to GEORGE M & EDNA C. BRIDGE (OWNER) of the aforesaid building. SUFFOLK COUlFfY DEpDRtTMENT OF I~ALTE APPRO~]%L ELBt-£~ICAL CERTIFICATE NO. PLI~BERS CERTIFICATION DA'£~3 *PLEASE SEE ATTACHED INSPECTION REPORT. N/A N/A N/A Authorized Signature Rev. 1/81 BUILD II~G DEPARTMENT TO%~; OF SOUTEOLD HOUSING CODE INSPECTION REPORT LOCATION: 625 PRIVATE RD ~2 SOUTHOLD SUBDIVISION: ~ NO.: I~ (S) NA~ OF OWNER (S): GEORGE M & EDNA C. BRIDGE OCCUPANCY: SINGLE FAMILY DWELLING GEORGE M & EDNA C. BRIDGE SOUBCE OF P, EQUF~qT: RUDOLPH BRUER~ ATTY 7/12/05 DATE: 07/25/05 OTHER: SEPARATE HOT WATER HEATER ACCESSORY STRUCTURES: C4%RAGN, %'YPH OF CONST.: WOOD FP~AME S~P~E, ~"fPE CONST.: BARN WOOD FP~E VIOI~ATIO~IS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. 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, 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 planmng Board Approval of completed site plan requirements. )For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate sup,'ey 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. If a Certificate of Occupancy is denied, the Building h~spector 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. Aherations to dwelling $25.00, Swimming pool $25.00, Accesso~' building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupmmy - Residential $15.00, Cotmnercial $15.00 Date. 7/1/05 New Construction: Old or Pre-existing Building: XX (check one) Location of Property: 62.5 Private Road #2, Southold House No. Street Owner or Owners of Property: Bridge, George 14. and Edna C. Suffolk County Tax Map No 1000, Section 61 Block Hamlet 4 Lot i0 Subdivision Permit No. Date of Permit. Filed Map. Lot: Applicant: Rudolph It. Bruer, Esq. Health Dept. Approval: Underwriters Approval: Planmng Board Approval: Request for: Temporary Certificate Final Certificate: XX (check one) Fee Submitted: $ 100.00 - Avnticat{t-Si~nature Ru~61ph H. ~Bruer, Esq. CONSENT TO INSPECTION Estate of George M. Bridge and Edna C. Bridge Caroline Ciochetto. Co-Executor of the/, the uodersigned, 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 625 PR±rate Road #2, $outhold which is shown and designated on the Suffolk County Tax Map as District 1000, Section 61 , Block 4 , Lot 10 That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: PreEx~ ~ting C.O. 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 atbresaid 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: July , 2005 (Signature) Caroline Ciochetto (Print Name) (Signature) (Print Name) GAg'