HomeMy WebLinkAboutZ-31074FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 31074
Date: 08/01/05
THIS CERTIFIES that the building
DWELLING ~ ACCESSORY
Location of Property 20 HARBOR RIVER RD ORIENT
(HOUSE NO.) (STREET) (HAMLET)
Co~uaty TaD( Map No. 473889 Section 024 Block 0001 Lot 011
Filed Map No. Lot No. __
Subdivision
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CEI~TIFICATE OF
OCCUPANCY R-U]4BER Z- 31074 dated AUGUST 1, 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 FRONT AND REAR SCREENED PORCHES AND
ACCESSORY TWO CAR GAR_AGE.*
· ~ne certificate is issued to MARY JANE HICKS
(OWNER)
of the aforesaid building.
SUFFOLK COU~FfYDEPART~4ENTOF~EALTHAPPROVAL
HLEC~rRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'£~U
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Rev. 1/81
BUILDING DEPARTMEHT
TOWN OF SOUTKOLD
HOUSING CODE INSPECTION REPORT
LO~TION: 20 HARBOR RIVER RD
N~ OF OWN~ (S): MARY JANE HICKS
ORIENT
~ NO.: LOT (S)
MARY J~IE HICKS
~ A~-AII~LE: SUFF. CO. TAX W~ NO.: 24.-1-11
SOI]RCE OF P~E~]EST: NATHAN HICKS DATE: 09/01/05
TOILET RO(O (S): 1.0
2,0 # ]{]fITS: 2
C~ SPACE: 1/4
ACCESSORY STRUCTURES:
C~E, ~fPE OF CONST.: 2 CAR WOOD FP~34E SI~)[~E, g'YPE CONST.:
VIOL4tTIONS: CWAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
Form No, 6
TO~VN OF SOUTHOLD
BUILDING DEPARTMENT
TO~qN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPAJNCY
This application must be filled in by typewriter or ink arid submitted to the Building Department with the following:
A. For new building or new use: I. Filml 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 resideuces and similar buildings and installations, a certificate
of Code Compliance from architect or eugineer responsible for the building.
6. Submit Plamfing Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforndng uses, or buildings and "pre-existing" land uses:
1. Accurate sur~'ey of property showing all property lines, streets, building and uuusual natural or topographic
features.
2. A properly completed application and eminent to iuspect signed by the applicant. If a Certificate of Occupancy is
deified, the Buildiug hlspector shall state the reasons theretbr 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.
,~ S',viuuning pool $25.00, Accessory buildiug $25.00, Additions to accessol5 building $25.00. Bnsinesses $50.00.
Certificate of Occnpaucy on Pre-existing Buildiug- $100.00
Copy of Certificate of Occnpancy - $.25
4. Updated Certificate ofOccnpancy - $50.00
5. Temporary Certificate of Occupaucy- Residential $15.00, Coimnercial $15.00
Date.
New Construction:
Location of Property:
House No.
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Sectiou __
Subdivision
Old or Pre-existing Building:
Street
(cbeck one)
Hamlet
Block t Lot
F'iled Map. Lot:
Pernfit No.
Date of Permit.
Applicant:
Health Dept. Approval:
Undenvriters Appmx al:
Planning Board Approx al:
Request for: Temporary Certificate
Fee Subnfitted: $ 1 0 0 '~
Co --5lO'3q
Final Certificate:
eck one)
Applic-ant Si~a~re
c'/,5--3
CONSENT TO INSPECTION
Owner(s) Name(s)
, the undersigned, do(es) hereby state:
That the undersigned Os) (are) the owner(s) of the_premises in the Town of
Southold, locatedat r,~O ~t'LgOt~ I~-IU~I~ I?~1_) :
which is shown and designated on the Suffolk County Tax Map"as District 1000,
Sectiono~ t.J , 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 regulatious 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:
(~tgnature)
(Print Name)
(Signature)
(Print Name)
LOCATION:
(number & street)
SUBDIVISION:
NAME OF OWNER(S):
OCCUPANCY:
MAP NO.:
(municipality)
LOT(S):
(type)
ADMITTED BY: /~} ~t,~
KEY AVAILABLE:
SOURCE OF REQUEST:
(owner-tenant)
SUFF. CO. TAX MAP NO. 1000-
DATE:
DWELLING:
TYPE OF CONSTRUCTION:
FOUNDATION: ~ ~ % CELLAR:.~/~ C~WL SPAC~
TOTAL ROOMS: 1ST FLR:
BATHROOM(S):
PORCH TYPE: ~/~, TYPE: ~ · PATIO, TYPE:
BREEZEWAY:
DO~STIC H~TER: ~YPE HEATER: AIRCONDITION~G:
U AT: /
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTHER:
L~Id~_~RAGE, 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: /t~f/f I END: