HomeMy WebLinkAboutZ-33377FORM NO. 4
TOWlq OF SOUTHOLD
BUILDING DEPA/{TMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
NO: Z- 33377
Date: 11/06/08
THIS CERTIFIES that the building DWELLING
Location of Property 24485 MAIN RD CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 109 Block 0001 Lot 014
subdivision Filed Map No. Lot No.
conforms substantially to the Requiren~-nts for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which C~KTIFICATE OF
OCCUPANCY NI~BER Z- 33377 dated NOVEMBER 6, 2008
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.*
The certificate is issued to MARY BARAN
of the aforesaid building.
(OWNER)
N/A
N/A
N/A
Rev. 1/81
BUILDING DEPAR~ENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
ACCESSORY STRUCTURES:
TYP~ OF CO.ST.:
POOL:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
APPLICATION FOR CERTIFICATE OF OCC~CY
T~s applicatiou must be filled in by t~ewriter or i~ and sub~tted to the Building Depmm~ith the following:
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. Co~mnercial 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. Ifa 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, 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. UpdatedCertificateofOccupancy- $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction: ~ Old or Pre-existing Building:
Date.
Location of Property: ~ t~q<~ ~ ~ House No. Street
Owner or Owners ofProperty: ~31"~"~ ~ ~-~/~p~
Suffolk County Tax Map No 1000, Section ] t~) r.~ Block
Subdivision '-
Pemait No.
Health Dept. Approval:
Planning Board Approval:
Request for:
Date of Permit.
Temporary Certificate
Filed Map.
Applicant:
Underwriters Approval:
Final Certificate:
(check one) for a one-story frame
dwelling.
Lot:
(check one)
Fee Submitted:
Xpplicant Signature
Deborah Sutherland, Executrix
I~ICKEY
MAI~
MAP
ZYGMUNT ~ MARY' BARAN
CUTCHOBUE '
KJ.Y.
PlDE: g
^~ ~UF~VEYED ~uLY ~0/
SON
OTTO ~, VA~ TU~L~ · ,
CONSENT
TO
INSPECTION
O~n~er(s) ~ame(sl
do(es) hereby state:
· the undersigned,
That the undersigned (is) (are) the owner(s) of the premises in the Town
, ~vhich is sho~ and designated on the Suffolk
County tax map as District 1000, Section ~ 0~, Block ~ , Lot [~ .
That the undersigned (has) (have) filed, 'or caused to be filed, an applica-
tion in the Southold Town Building Inspector's Office for the following:
--~, ¢~-. CO ~/ ~.~_f.~ (one-story frame dwelling)
~hat 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 w£th 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 as evidence in subsequent prosecutions for vio-
lations of the laws, ordinances, rules or regulations of the Town of ~outhold.
Deborah Sutherland
(print name)
(signature)
(print name)