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Home My WebLink AboutZ-27819FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUP/LNCY No: Z- 27819 Date: 07/17/01 THIS u~KTIFIBS that the building DWELLING Location of Property 620 FOUNDERS PATH SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 064 Block 0002 Lot 020 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- 27819 dated JIJLY 17, 2001 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 COVERED AND SCREEN PORCHES.* The certificate is issued to JAMES A BAKER III (OWNER) of the aforesaid building. SUFFOLK COUNT~DEPART~4EIgTOFHI~ALTHA~PROVAL ELBt-~ICAL c~KTIFICATENO. PLUMBERS CERTIFICATION DAT~U *PLEASE SEE ATTACHED INSPECTION REPORT. N/A N/A /~~i~nat u r e Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT SOUTHOLD MAP NO.: LOT (S) JAMES A BAKER III AC~PANI]~ NY: SARE CO. TAX ~ NO.: 64.-2-20 DA~: 07/17/01 BATHRO(X~ (S): WOOD FRAME CONCRRTE BLOCK STORIES: C~?.LAR: FULL 1.0 # EXITS: __3 CRAWL SPACE: ACCESSORY STRUCTURES: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. DATE ON INSPECTION: 07/17/01 TIME START: 9:55AM ~SD: 10:15AM A. 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 inspector with the following: for new building or new use: l. 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 Plann/ng Board Approval of c6mpleted site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and qpre-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 a consent to inspect signed by the applicant. ~f 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, Alterations to dwelling $25.00, Sw~-~4ng pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existinR Buildin~ - $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 $15.00 Date ...... .q :.. ~: .0..I ........................ ~e. ~onstructio= ........... Old Or .re-~istin~ Building..~U/4.~ ......... --. t Location o~ Froperty .... .~.$.9. .............. ..~....~...c~.. ~ .......... ~,~4~o~ .............. c~ House No. Street Hamlet Onwer or O~mers of Property .................................... ~//o/~7 ~ c Subdivision. ...... Filed ....... Permit No Date Of Permit Applicant ............. Health Dept Approval 2Underwriters Approval ... · · · Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate....~/../.. ..... Fee Submitted: ~ ...................... .. - · .......... ~f~'c s ~ ~ I ~ 'o' .... j~i~i~ ..... CONSENT TO INSPECTION /// . the.ndersigued. Owner (s9 Name(s) do(es) hereby state: That the undersigned (is) (are) the owner(s} of the premises in the Tovm of Southold located at ~(~/~ /~/y , which is sho,~rn and designated on the Suffolk County tax map as District 1000, Section ~ t~ · 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: pre do 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 condsct 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 Southold. Dated · (print name) (signature) (print name)