HomeMy WebLinkAboutZ-31075FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 31075 Date: 08/01/05
T~IS CERTIFIES that the building DWELLING
Location of Property 905 NINTH ST
{HOUSE NO.)
County Tax Map No. 473889 Section 048
Subdivision
GREENPORT
(STREET) (HAMLET)
Block 0002 Lot 029
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- 31075 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 OPEN WOOD PORCH.*
~e certificate is issued to ALICE VANBOLT
of the aforesaid building.
( OWNER )
SUFFOLK COUNT"f DEPARTMENT OF }IEALT~ APPRO~-AL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Authorized Signature
Rev. 1/81
GREENPORT
MAP NO.: LOT (S)
ALICE VA/~BOLT
TOTAL ROOMS: 1ST FLR.: __7 2ND FLR.: __0 3RD FLR.: __0
}{ATHI(0(O (S): 1.0 TOILET ROOM(S): 0.0 UTILITY R0~(S):
ACCESSORY STRUCTURES:
VIOLATIONS: CPJ~PTER 45 N.Y. STATE UNIFORM FIRS PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART, SEC.
P.E- INSPECTED 7/29/05
GEORGE GILLEN TIME START: 10:30AM El]D: 10:55AM
Form No. 6
TOW'N OF SOUTHOLD
BUILDING DEPARTMENT
TO~VN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUP.adNCY
This application must be filled in by typewriter or ink and submitted to the Building Departmeot with the tbllowing:
ho
For new building or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusnal natural or
topographic features.
2. Final Appro`.'al from Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Under~,riters.
4. Swol'n statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead.
5. Connne~ial 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 Plamfing 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 surx 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 applicam. If a Certificate of Occupancy is
denied, the Building h~spector shall state the reasons therefor in writing to the applicant.
1. Certificate of Occupancy - Ne,,',' dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swilmning pool $25.00. Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Cop3' of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporal, Certificate of Occupancy - Residential $15.00, Contmercial $15.00
Ne`.'., Construction:
Location of Property: q{,) jr
House No.
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
Subdivision
Old or Pre-existing Building:
Stj'eet
yOc> Block ~) 'Z.-,'"
Filed Map.
(check oue)
Handel
Lot:
Pemfit No.
[)ate of Permit.
Applicant:
Heahh Dept. Approval:
Underwriters Approval:
Planning Board Approval:
Request for: TemporaD Certificate
Final Certificate:
(check one/
Fee Submitted: $
Applicant Signature
CONSENT TO INSPECTION
Owner(s) Name(s)
, the undersigned, do(es) herebystate:
That the undersigned,~is) (are.) the owner(s) of the premises in the Town of
Southold, located at t~ ~ ~}'/t4_ ~' ~. ~____-~',~_..fffP~tO_ 'T-
which is shown and designated o~ the suffolf{ C6unty Tax Map as District 1000,
Section q~53~' ., Block cl 7,~_, Lot 7,~ ?
That the undersigned Cas) ~filed, or cause to be filed, an application in the
South~o~ Town Building Inspector's Office for the, following:
. czu .d w_-
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 o t' the laws, ordinances, roles 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:
/ t
(Signatu~;e) ,
(Print Name)
(Signature)
(PrintName)
LOCATION:
(number & street)
SUBDIVISION:
NAME OF OWNER(S):
OCCUPANCY:
MAP NQ.:
(municipality)
LOT(S):
(type)
ADMITTED BY:
KEY AVAILABLE:
SOURCE OF REQUEST:
(owner-tenant)
ACCOMPANIED BY: ,C/ct'hO '3
SUFF. CO. TAX MAP NO. 1000-
/~OLT-- DATE:
FOUNDATION: <:20,n/'~_~&-/" ~ CELLAR:
TOTAL ROOMS: 1ST FLR: r)r 2ND FLR: ·
BATHROOM(S): 1 TOILET ROOM(S): -~
PORCH TYPE: OpCn/ x/dOo~ DECK, TYPE: .~--
BREEZEWAY: ~ FIREPLACE: /t/tgA/~
DWELLING:
TYPE OF CONSTRUCTION: LDool) ~J~- #STORIES: [ #EXITS:
P/~RT CRAWL SPACE:
3RD FLR:
UTILITY ROOM:
PATIO, TYPE:
GARAGE:
DOMESTIC HOTWATER:
TYPE HEAT:
OTHER:
TYPE HEATER: /~oT k~flT"~P-AIRCONDITIONING:
~'A~$ AIR: ff~ HOTWATER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTHER:
STORAGE, TYPE CONST.:
GUEST, TYPE CONST:
VIOLATIONS: CHAPTER 45 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION ~C~~_~l, ART. SEC.
,,.
REMARKS:
INSPECTED BY: ~ ~ DATE OF INSPECTION: 7'- ~-
TIMESTART: lit),'.3'o ~ END:
107
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