HomeMy WebLinkAboutZ-24509FORM NO. 4
TOWN OF 5OUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
5outhold, N.Y.
EXISTING
U]~TIFICATE OF OCC:U~ANCY
No Z--24509
Date JULY 19, 1996
THIS CERTIFIES that the building
Location of Propert~ 2425 COX LANE
House No.
County Tax Map No. 1000 Section 96
Subdivision
OWE FAMILY DWELLING
CU'&~-~HCOUE, N.Y.
Street Hamlet
Block 3 Lot 3.1
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-24509 dated J~LY 19~ 1996
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 6 ACCESSORY BUILDINGS INCLUDIN~
A BARN *
The certificate is issued to
of the aforesaid building.
WILLIAM C. BOLENIUS
(owner)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PT.~SE S~ATT~,~-K,, INSPECTION REPORT.
Rev. 1/81
l~ing Inspector
IUI I I.I) I ti(; I)lf~l'^lt'l IIl~,|l 11
lll()'~[I OF !]Olllll{)l,I)
11~)115111¢~ (~01)1~, l~l,";l'lr.~;I lot! lll~,l,Oltr
I.o(:^rror~: 2425 COX ~ CUTCRO(;UR, N.Y.
' ' ) (,,,,,,,~c{I,nl,ty) '
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TOI~N OF SOUTIIOLD
BU LI,DINC i)~PAItTHENT ,
TOWN IIALL
765-1802 L
BLDG. D£PT,
L_.,~TOWN OF SOUTHOLD ,,,_.~
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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:
1. Filial survc~ of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features,
2.Final Approval from H~hlth Dept, of water supply and sewerage-disposal(S-9 form).
3.Approval of electrical installation from Board of Fire Underwriters,
Sworn statement from/plumber certifying that the solder used in system contairs
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
amd installations,kc certifzcate of Cede Compliance from architect or engineer
responsible for the building,
6.Submit Planning Board Approval of completed site plan requirements.
, B. F~r 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 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.
C. Fees
i. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.O0~
Additions to accessory building $25.00. Businesses $50.00.
2. Cer~ificate of Occupancy on Pr~=existin~ Ouildine - $[00.00
3. Copy of Certificate of Occupancy ~ $20.00
4. Updated Certificate of Occupancy - $50.00
5, Temporary Certificate of Occupancy - Residential $15.00-, Commercial $15.00
~4ew' Construction ........... Old Or Pre-e×istin~ Building'C'--,~....~- ,,~- ,
Rouse No. Street Hamlet'
. .
Subdivision .................................... Fi[cd Map ............ Lot ......................
Permit No Date Of Permit Appliuant ·
ilealth Dept. Approval .......................... Underwriters Approv~l .........................
?lannlng Board Approval ........................
~equest for: Temporary Certificate ........... Final Certica~e ...........
..................... , , .. .
P.C.
(516} 7'65 - 5020
P. O. BOX 909
1250 TRAVELER STREET
SOUTHOLD~ N.Y. 11971
O OA. ',~
SURVEY FOR
THE ESTATE OF
W/LLIAM C. BOLENIUS
A T CUTCHOGUE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N Y.
1000 - 96 - 03 - 3. I
SCALE: I"= 50'
SEPT. 5, 1995
NO. 49618
· AREA = 1.641ACRES
:/
95-,251
CONSENT
TO
INSP~.CTION
do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Southold located a, ~c~_~ ~ ~_, ~~ ~
, which is sho~ and designated on the Suffo~
cou.~y ~x m~p ~ n~t~i~ ~000. S~t~o. 9~ . ~o~ ~ ~ . Uot S~ [
That the unders~ned (has) (have) filed. 'or caused to be filed, an applica-
tion ~ the Southold To~ Building Inspector*s Office for the follow,g:
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 w£th all of the laws. ordinances, rules
and regulations of the Town of Southold.
The unde__rsigned, 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.
-/ (signature) '
Abigail A. Wickham, Exec.
(print name)
(signature)
(print name)