HomeMy WebLinkAboutZ-28255FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 28255
Date: 03/07/02
T~IS CERTIFIES that the building DWELLING
Location of Property 540 TOWN HARBOR LA
(HOUSE NO.) (STREET)
County Tax ~ap No. 473889 Section 062 Block 0003
Subdivision
Filed Map No. Lot NO.
SOUTHOLD
(HAMLET)
Lot 041
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCN3P~C~fB¥Oq~BER Z- 28255 dated MJ~RCH 7, 2002
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 GALE & JULIE ALEXANDER
(OWNER)
of the aforesaid building.
Rev. 1/81
N/A
N/A
N/A
Author~z~ure
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 540 TOWN HARBOR LA SOUTHOLD
S~DIVISION: ~ NO.: LOT (S)
NAME OF OWN~ (S) : GALE & JULIE ALEXANDER
OCCUPANCY: SINGLE FAMILY GALE & JULIE ALEXANDER
ADNITTKD BY: GALE ALEXkNDER ACCOMPANIED BY: SAME
KEY A%7{ILABLE: SI]FF. CO. TAX MAP NO.: 62.-3-41
SO~3RCE OF REQUEST: GALE & JULIE M. ALEXANDER 2/25/02 DATE: 03/07/02
DWELLING:
ACCESSORY STRUCTURES:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
~: BP #276~COZ28254 (ACCESSORY GARAGE)
TOWN Or SOUTHOLD ~, ~. ~ (4~
BUILDING TOWN DEP~NT ~L
765-1802
z~PLICATION FOR CERTWICATE OF OCC~CY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
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. Approx~al of electrical installation from Board o f 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.
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 applicatinn and a 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.
New Construction:
Location of Property: , ~./~O ~ ~'~ cE
-House No.
Owner or Owners ofProperty: ~c~/~ ~- ~/iff A/C~i~.~c~{~_F~
Suffolk County Tax Map No 1000, Section ~- Block
Subdivision Filed Map.
1. Certi~cate ~f ~ocupancy . New dwe~ing $2$.~ Additi~ns t~ dwe~mg $2$.~ ^~terati~ns t~ dwelling $2~.~
Swi~nming pool $2~.00, Accessory building $25.00, Additions to acc~sory building $2~.00, Businesses $$0.00.
2. Certificate of Occupancy o~ Pre~existing Building ~ $100.00
Photocopy of Cc~tifieate of Occupancy - $ 0.25
Updated Certificate of Occupancy - $$0.00
$. Temporary Certificate of Occupancy - Residential $15.00, Commercial $1~.00
Old or Pre-existing Building:
Street
(check one)
Hamlet
Lot:
Permit No. Date of Permit. _ Applicant:
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fe~ Submitted: $
Underwriters Approval:
Final Certificate: ~ (check one)
CONSENT
TO
INSPECTION
Owner(s) Name(s)
do(es) hereby state:
· the undersigned,
That the undersigned ~ (are) the owner(s) of the premises in the Town
ofSoutholdlocatedat _~-~z~ /"~14'h //r;~t /~,~)~ f~
· which is shown and designated on the Suffolk
County tax map as District 1000, Section ~'t~ , Block ~ , Lot
That the undersigned (,ha.-1) (have) filed, 'or caused to be filed, an applica-
tion in the Southold Town 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 as evidence in subsequent prosecutions for vio-
lations of the laws, ordinances, rules or regulations of the Town of Southold.
Dated:
(signatuFe)
(print name)
' (p~lnt'nirh~)'
SURVEY OF PROPERTY
AT $OUTHOLD
TO~'N OF SOUTHOLD
SUFFOLK COUNTY, NEF YORK
1000-6~-03-41
SC~,LE: 1"=30'
JAN. 16. 2001 C~',~tC
Clement J. Chamews. ar.
P.O. Box 1229
Southold, NY 11971-0935
.~DUTI.~LD,
LIC. NO. 49618
N.Y. 11971