HomeMy WebLinkAboutZ-35079FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 35079 Date: 07/20/11
THIS ~TIFIES that the building COMMERCIAL BUILDING
Location of Property 53610 MAIN RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
Cowry Tax ~ap NO. 473889 Section 061 Block 0004 Lot 003
Subdivision 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
OCCUPAN~NI~ER Z- 35079 dated JULY 20, 2011
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 COMMERCIAL BUILDING.* CORRECTED 2/19/13 FOR STATING ONE FAMILY
DWELLING INSTEAD OF COMMERCIAL BUILDING.
T~e certificate is issued to MARGERY D BURNS
(OWNER)
of the aforesaid building.
SUFFOLK COUI%~I~/DEP;~t~ENTOF[~gALTH~pROV]~5
ELB~-rKICAL C~TIFICATE NO.
PL~EltS CERTIFICATION DA'r~D
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTBOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 53610 MAIN RD SOUTHOLD
SUBDMSIO~: MAP NO.: LOT (S)
NAME OF ~ (S): MARGERY D BURNS
~ANCY: MERCANTILE, GROUP M
MARGERY D BURNS
DATE: 07/20/11
ACCESSORY STRUCTURES:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORE FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
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 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 ofelec~ical 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. Commemial building, indusffial 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 buildingr (prior to April 9, 1957) non-conforming u~es, or buildings and "pre-existing" land uses:
1. Accurate survey of property showing all property lines, s~'e~s, 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.
C. Fees I. Certi~cate ~f Occupancy ~ N~w dwc~~ing $25.~~~ Additi~ns to dwe~~ing $25~~~~ A~terati~ns t~ dwe~Iing $25~~~~
Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00.
2. Certificate of Occupancy on Pra-exiating Building - $100.00
3. Copy of Certificate ofOccapancy - $.25
4. Updated Certificate ofOccapancy - $50.00
5. Temporary Certificate ofOccapancy - Residential $15.00, Commercial $15.00
New Construction: Old or Pre-existing Building: ~ (check one)
Location of Property: 5.-.~(o
House No. Sweet Hamlet
Owner or Owners of Property:
Suffolk County Tax MapNo 1000, Section .~_..-_., ~-.~ . --_ Block
Subdivision Lot:
Permit No. Date of Permit.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted:$ ~'lOO, O O
Filed Map..
Applicant:
Underwriters Approval:
Final Certificate:
(check one)
LOCATION:
(number & street) (municipality)
SUBDIVISION:
NAME OF OWNER(S): .
OCCUPANCY: ~
t' t (type)
ADMITTED BY: ~,..~
KEY AVAILABLE: I'M
SOURCE OF REQUEST!
MAP NO.: LOT(S):
(owner-tenant)
ACCOMPANIED BY: ~
SUFF. CO. TAX MAP NO. 1000-
DATE:
DWELLING d
TYPE OF CONSTRUCTION:
FOUNDATION:
# OF BEDROOMS: 1ST FLR:
BATHROOM(S):
t
BASEMENT:
2ND FLR:
TOILET ROOM(S): ~i
# STORIES:
# EXITS:
CRAWL SPACE:
3RD FLR:
UTILITY ROOM:
PORCH TYPE:
DECK, TYPE: "'-
PATIO, TYPE:
BREEZEWAY:
FIREPLACE:
GARAGE:
DOMESTIC HOTWATER:
TYPE nEAT:
# OF KITCHENS:
FINISHED BASEMENT: YES
TYPE HEATER:
WARM AIR:
NO
AIRCONDITIONING: /~J~
HOTWATER:
OTHER:
ACCESSORY STRUCTURES
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTHER:
STORAGE, TY-g~ONST.:
GUEST, TYPE CONST:
VIOLATIONS: CHAPTER 144 & N.Y. STATE UNIFORM FiRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS:
INSPECTED BY:
DATE OF INSPECTION:
TIME START: d/0,~ END:
CONSENT TO INSPECTION
Owner(s) Nme(s)
That thc undersigned (is) (are} thc owner(s) of the premises in the Town of
Southold, located at 5 ~ ¢ tO b4 ~
which is shown and designated on tho Suffolk County'Tax Map as District I OtJO,
Section 0 I, O0 , Block Oq, DO , Lot Oo
That the und~,'rsigned (has) (have) filed, or muse to be filed, aa application in the
Southold Town Building Inspector's Office for-thc following:
That the undersigned do(es) hereby give con§ent to ~e 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 de, em necessary with
respect to the aforesaid application, including inspeotious to determine that said premises
comply.with all of the laws, ordinances, rules and'regulations.of the Town of South01d.
The undersigned, in ~onsenting 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, roles or
regulations of the Town of 8outhold.
Dated:
(Print Name)
'(Signature)
(Print Name)
~,?~_ ~ /_~--3 TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET ~.~-~.~) ~:~ / ~ VILLAGE DIST. SUB. LOT
RES. S~S. VL FA~ ~ C ,CB. MISC. Mkt. Value
~ND./ IMP. TOTAL DATE REMARKS
AGE BUILDING CONDITION
N~ NOR~L BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable 1
tillable 3
~oodlond
Swampland FRONTAGE ON WATER
Brushland FRONTAGE ON ROAD
~ouse Plat DEPTH
BULKH~D
rotal ~ ~ DOCK
'~. Bldg.
~tension
~tension
xtension
orch
orch
3reezeway
~arage
Patio
Fotal
l_ COLOR ~
.~ 0 Foundation B~th Dinette
...... ement Floors K.
Ext. Walls Interior Finish LR,
~ Place Heat . DR.
Type Ro(~f Rooms 1st Floor BR.
Recreation Roorr Rooms 2nd Floo~ FIN, B.
Dormer