HomeMy WebLinkAboutZ-31125FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
NO: Z- 31125 Date: 08/19/05
THIS u~KTIFIES that the building
Location of Property 43375 CR 48
(HOUSE NO.)
County Tax Map No. 473889 Section 059
BUSINESS BUILDING
subdivision
SOUTHOLD
(STREET) (HAMLET)
Block 0003 Lot 029
Filed Map No. -- Lot No. __
conforms substantially to the Requirements for a BUSINESS STRUCTURE
built prior to APRIL 9, 1957 pursuant to which c~KTIFICATE OF
OCCUPANCY NUMBER Z- 31125 dated AUGUST 19, 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 BUSINESS BUILDING.*
The certificate is issued to JOHN J & JOAN D CALLAHAN
(OWNER)
of the aforesaid building.
SUFFOLK COUI~TYDEPARTMEI~T OF HEALTHAPPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION D~l'~u
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
Rev. 1/81
BUILDING DEPARTNENT
TO%<N OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
PATIO TYPE:
ACCESSORY STRUCTURES:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. EEC.
P~: BP837 ADD COZ448~ BP31270 ALT COZ31124
Form No. 6
TOWN OF SOUTHOLD
765-1802
~1~,1 ,~.Ofil 0 U
APPLICATION FOR CERTIFICATE OF~ ~p._~?~ UPANCY
This application must be filled in by typewriter or ink and submitted to the l~ull~di~gl~ment 9f~l~he ft
.. lowing:
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 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:
1. Accurate survey 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 Inspector shall state the reasons therefor in writing to thc 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, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00.
.Certificate of Occupancy on Pre-existing Building - $100.00
Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date.
New Construction: Old or Pre-existing Building:
Location of Property: q ~"~ ~
House No. Street
Owner or Owners of Property: (q_, ~[
Suffolk County Tax Map No lO00, Section
Subdivision Y' J (~
Permit No. ~ ~ ~ Date of Permit.
Health Dept. Approval: ~
Planning Board Approval: ~ /_~
Request for: Temporary Certificate
Fee Submitted: $ [ ~)(~) .
(check one)
Hamlet
Block
Filed Map.
Underwriters Approval:
Lot
Lot:
Final Certificate: 9//
check one)
CONSENT TO INSPECTION
¢;/ qJ~5~d/~J ~'~O//~,~/~), the undersigned, do(es)hereby state:
Owner(s) Name(s)
That the undersigned (is) (are) the owner(s) of thc premises in the Town,of
Southold, locatedat Zt/.~3~6' /,...JD~ ('-~/ ,..~OC. PP~OZt::7' .,
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section ,.~ , Block O....~ , Lot .,~.~
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Bj41ding 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.
Dated:
(Print Name)
(Signature)
(Print Name)
/y)~ Ir_ ~
(number & street) (municipality)
SUBDIVISION:
NAME OF OWNER(S):
OCCUPANCY:
MAP NO.: LOT(S):
(type)
KEY AVAILABLE:
SOURCE OF REQUEST:
(owner-tenant)
ACCOMPANIED BY: ~
SUFF. CO. TAX MAP NO. 1000-
DATE:
DWELLING:
TYPE OF CONSTRUCTION:
FOUNDATION:
TOTAL ROOMS: 1ST FLR:
BATHROOM(S):
PORCH TYPE:
BREEZEWAY: ~
DOMESTIC HOTWATER:.-,
#STORIES: ~# EXITS:
CELLAR:
2ND FLR:
TOILET ROOM(S):
DECK, TYPE: ...---'-
FIREPLACE:
,-.-.--TYPE HEATER:
CRAWL SPACE:
3RD FLR:
UTILITY ROOM: ~
PATIO, TYPE: ~
GARAGE:
AIRCONDITIONING: ~
TYPE HEAT: WARM AIR: .. HOTWATER: t~ ~~1~
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
LOCP~xlON ~ DESCRIPTION /ag~ ~,RT. SEC.
ff ~ i /z~ ~ ~ ~/-~ ~ ~ / ~ ~ ~,
REMARKS:
INSPECTED BY.~~' ~'~
DATE ON INSPECTION:
TIME START:
END:
(number & street)//
(municipality)
SUBDIVISION:
NAME OF OWNER(S):
OCCUPANCY:
~_~IAP NOd .. LOT(S):
(type) (owner-tenant)
ADMITTED BY: ~._.z~ ~/~./~ ACCOMPANIED BY: Z,~t~~e~
SOURCE OF REQUEST: DATE: ~
DVCELLING:
TYPE OF CONSTRUCTION:
FOUNDATION:
TOTAL ROOMS: 1ST FLR:
BATHROOM(S):
PORCH TYPE:
BREEZEWAY:
DOMESTIC HOTWATER:
TYPE HEAT:
OTHER:
CELLAR:
2ND FLR:
TOILET ROOM(S):
DECK, TYPE:
FIREPLACE:
TYPE HEATER:
WAR3i AIR:
# STORIES: ~ff~...~ # EXITS:
CRAWL SPACE:
3RD FLR:
UTILITY ROOM:
PATIO, TYPE:
GARAGE:
AIRCONDITIONING: ~
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTHER:
STORAGE, TYPE CONST.:
GUEST, TYPE CONST:
VIOLATIONS: CHAPTER 45 & N.Y. STATE UNIFORIVl FIRE PREVENTION & BUILDING CODE
INSPECTED BY,>'~ ~ DATE ON INSPECTION: /d~/..3~jO~
· TIME START: ///, /$c..~ END:
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