HomeMy WebLinkAboutZ-31380FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 31380 Date: 01/10/06
THIS CERTIFIES that the building DWELLING
Location of Property 515 MAPLE LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 064 Block 0001 Lot 026
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
OCCD~ANCYNUMBER Z- 31380 dated JANUARY 10, 2006
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 ACCESSORY 3-1/2 CAR GARAGE*
/~ne certificate is issued to ROBERT H & ANNE P PETTIT
(OWNER)
of the aforesaid building.
SIIFFOLKCOUNT~DEPARTMENT OF ~RALTHAPPRO%-AL
EL~t-£RICAL CERTIFICATE NO.
PLU~4BERS CERTIFICATION DA'l'mu
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
uh~riz~
Rev. 1/81
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 ne~v building or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
· topographic feartrres.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation fi-om Board of Fire Underwriters.
4. Sworn statement fi-om 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 ~oard Approval of completed site plan requirements.
(.or existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
Accurate survey of property showing all property lines, streets, building and onnsual 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·
C. Fees
.1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Aheratious to dwelling $25.00,
Swimming pool $25.00, Accesss~ry building $25.00, Additions to accessoD' building $25.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupanc3; - $.25
4. UpdatedCertiticate of Occupancy- $50.00
5. TemporatV Certificate of Occupancy - Residential $15.00, Commercial $15.00
Dat~. __~'0/'
New Construction:
Location of Property:
Owner or Owners of Property: /~OtgF-~ T~/J,
Suffolk County Tax Map No 1000, Section
Subdivision ~
Old or Pre-existing Buildiug: tt~ (check one)
House No. Street Hamlet
mock / Lot
Filed Map ~ Lot:
Pemfit No. ~ Dam of Permit. ~ Applicant:
Health Dept. Approval:
Plamdng Board Approval: "'-'""
Request for: IemporaD' Certificate
Fee Sub[rdtted: $ /~O
Underwriters Approval;
Final Certificate:
CT/z . C :3 / 3
(check one)
Applicant Signature
~84 ~
M.ON. 0.0~
BOLT
5.'7 2' 59'
TIdOME~
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CONSENT TO INSPECTION
Owner(s) Name(s)
, the undersigned, do/~l~J hereby state:
That the undersigned ~ (are) the owner(s) of the premises in the Town of
Southold, locatedat .~-t.5" fi4~rP/.~_-- /-.fir-,W~'/
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section ~/~ , Block ( , Lot 2-4'
That the undersigne~l.{lt~Jt~) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following:
That the undersigned do(~ 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, roles and regulations of the Town of Southold.
The undersigned, in consenting to such inspections, doi~t~ 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:
3an 06 06 01:05p
60RRD OF FISSESSORS
6317651356 p. 1
~an 06 06 Ol~D5p
BORR~ OF RSSESSO[~S