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Home My WebLink AboutZ-34017FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPA/qCY No: Z- 34017 Date: 10/16/09 THIS CERTIFIES that the building DWELLING Location of Property 525 OLD SALT RD (HOUSE NO.) County Tax Map No. 473889 Section 144 subdivision MATTITUCK (STREET) (HAMLET) Block 0005 Lot 017 Filed Map No. Lot No. conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which C~KTIFICATE OF OC~oPaNt"f NUMBER Z- 34017 dated OCTOBER 16, 2009 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 ENCLOSED PORCH AMD ATTACHED TWO CAR GA=qAGE.* The certificate is issued to HELEN W BICKING ( OWNER ) of the aforesaid building. N/A N/A N/A Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT MATTITUCK }{AP NO.: LOT (S) HELEN W BICKING YES - 2 CAR ACCESSORY STRUCq~URES: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. ]~: BP1259 ADD COZ1259, BP14402 ADD COZ14732 ~-*-'---~ATE (~ ~NSRECTION: i0/i5/09 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUP/ This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. 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. I. Accurate survey of property showing all properly 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 I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Acgessory h'lilding '~75.~00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy c~ P_re-existing Building~ ~0t/,e~ ~ C, C) 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 New Construction: Location of Property: Date. Old or Pre-existing Building: (check one) House No. Street Hamlet Owner or Owners of Property: )~.7/.~ ~_~ ~:~ ~t't,~' Suffolk County Tax Map No 1000, Section /t'/~7/ Block S Lot //7 Suhd,v,s,on Lo,: Permit No. Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ [, Q~' ~ ' Final Certificate: (check one) CONSENT TO INSPECTION · /g'/-~ecq /~t'~ , the undersigned, do(es) hereby state: Owner(s) Name(s)/ That the undersigned (is) (are) the ow,ner(s3..ofthe pre~ses in the Town of Southold, located at c~',~-" t~9/'C~/ ~/~ /~ which is shown and designated on the Suffolk CounW Tax Map as District I000, Section /Vq, Block .~ , Lot /7 · That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold T~wn Building 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) foo,~-/¢,./-oX-o/7 TOWN OF S~HOt_n PERTY I~'CORD CARD E W A, CREAGE -TYPE OF BUILDING LAND IMP. TOTAL DATE REMARKS 0 0 0 L ~ ~~ NEW Farm Tillable I Ti liable 2 Tillable 3 Woodland Swampland Brushla~d House P~ot Total 0 EL.OW Value Per Acre NOPJVtAL Ac re ABOVE Value FRONTAGE ON wATER FRONTAGE ON ROAD :, ..~ BULKHEAD 0 iD eezewQ¥ ~_ _ ~ Basement Ext. Wat[s j Fire PIace Patio Driveway Porch Porch ~th Floors Interior Finish Heat Roof Type Rooms Ist FIo~r · Rooms 2nd Floor Dormer MAY-21-2009 08:17A FROM:MCD 631 728 4018 TO:16316617119 P.2 .I