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Home My WebLink AboutZ-31287FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 31287 Date: 11/18/05 THIS CERTIFIES that the building DWELLING Location of Property PVT RD OFF E END RD FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 009 Block 0001 Lot 004 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- 31287 dated NOVEMBER 18, 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* l~ae certificate is issued to GOOD TERN CORPORATION (OWNER) of the aforesaid building. SUFFOLK CUU1F~Y DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. N/A N/A N/A Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: PVT RD OFF E END RD SUBDIVISION: NAME OF O~ (S}: GOOD TERN CORPORATION OCCUPAMC"~: RESIDENTIAL ADMITTED BY: WALSH CONTRACTORS FISHERS ISLJ~ND MAP NO.: LOT (S) GOOD TERN CORPORATION ACCOMPANIED BY: DATE: 11/18/05 DWELLING: ACCESSORY STRUCTURES: C~GE, TYPE OF CONST.: SWIPING POOL: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. DATE ON INSPECTION: 05/06/05 TOWN OF SOUTHOLD BU1LDING 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: Ao For new building or new use: I. 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. Bo 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 the applicant. 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. 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 Occupancy - Residential $15.00, Commercial $15.00 Date. April 27, 2005 New Construction: Location of Property: Old or Pre-existing Building: X (check one) 358 Ark Hill Fishers Island House No. Street Hamlet Owner or Owners of Property: Good Tern Corporation Suffolk County Tax Map No 1000, Section 009.00 Block 01.00 Lot 004.000 Subdivision n/a Filed Map. n/a Lot: n/a PerrrfitNo. n/a Heal~ Dept. Approvah Date of Permit. n/a Applicant: n/a n/a Underwriters Approval:. n/a Planning Board Approval: n/a Request for: Temporary Certificate Final Certificate: X (check one) Fee Submitted: $ 100.00 Applicant Signature Stephen L. Ham, III CONSENT TO INSPECTION Good Tern Corporation, by Stephen L. Ham, III, the undersigned, 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 358 Ark Hill, Fishers Island which is shown and designated on the SuffoLk County Tax Map as District 1000, Section 009.00, Block 01.00 .,Lot 004.000 That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: pre-existing Certificate of Occupancy for single-family dwelling That the undersigned do(es) hereby give congent 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: April 27, 2005 (Signature) _Stephen L. Ham, III, attorney (Pritu Name) (Signature) (Print Name)