HomeMy WebLinkAboutZ-19897FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-19897 Date MAY 7~ 1991
THIS CERTIFIES that the building
Location of Property 210 ~MAPLE LANE SOUTHOLD~ N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 64 Block 1 Lot 18
Subdivision Filed Map No. Lot No.
ONE FAMILY DW~.LLING
conforms substantially to the requirements for a Private One Family
Dwelling built prior to: APRIL 9~ 1957 pursuant to which
CERTIFICATE OF OCC. #Z-19897 dated ~AY 7~ 1991
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 DW~TJ.ING WITH ATTACHED TWO CAR GARAGE *
The certificate is issued to EDITH M. BOOTH
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/a
// B~ilding Inspector
Rev. 1/81
Location
Subdivision
N~me of Owner(s) EDIT~M.
BUILDI!.:G DEP?~qTi.~NT
T0';E,I OF SOUTHOLD, N. Y.
HOUSIi;G CODE IHSPECTION REPORT
210 MAPLE ~ $Ou'r~OLB, N.Y.
~numoer ~ s~ree~) ~un~clpa£i~y)
~ap No. Lot(s)_
Occupancy
A~mitted by:
A-I
(~cype)
EDIT~ M. BOOT~
OWNER
( own er- ~ enan~)
Accompanied b · EDIT~ M. BOOTIt
Y.
Key available
Suffolk Co. Tax No.64-1-18
Source of request
EDITR M. BOOTN
Date 4/23/91
_D%'~EW_LI~IG:
Type of construction WOOD FRA~ #stories
Foundation CEmEnt BLOC~ Cellar F~LL Crawl space
Total rooms, 1st. F1 5 2nd. F1 3rd. F1
Bathroom(s)
Toilet room(s) I/2
Porch, ~-fperear screened in~Deck, type~
Breezeway Garage 2 CAR
Type Heat OIL - 1st FLOOR,
..... ~arm Air
Fireplace (s~ I No.
Domestic hotwater OFF BOILER
Other
Patio, type
Utility room
.Hotwater xx
~its 2 Aircondition~ng
Type heater
_ACCESSORY STRUCTURES: NONE
Garage, type const. Storage, type const.
Swimming pool Guest, type const.
Other -
I STORY
V__IOLATIOMS:
__Lncation
.C~APTER 45--N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
Descriotion ] Art. I Sec.
' Remarks: BP #2667 CO Z-2299 for addition
Inspected by: Gary//~Fis~ Date of Insp.
Time start 9:30
MAY 6, 1991
end I0:00
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:
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 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.
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 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
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .... ./'2/l ~. ~.~ ...........................
New Construction ........... Old Or Pre-existing Building ........
Location of Pro~ert,~ ~ ~i~i ~
House No. Street Hamlet
Onwer or Owners of Property .......................... ' .........
County Tax Map No 1000, Section...~.. ...... Block ....... l ........ Lot ...... ~..~. ............
Subdivision .................................... Fi]ed Map ............ Lot ......................
Permit No ................ Date Of Permit ................ Applicant ..........................
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ...................... ..
Request for: Temporary Certificate ........... Final Certicate ...........
Fee Submitted: $..J.~.0;..~. ................... ~ ~ ~CA~// ~_ .~,x
· ........ ........
CONSENT
TO
INSPECTION
Owner(s) Name(s)
do(es) hereby state:
· the undersigned,
That the undersigned (is) (are) the owner(s) of the premises in the Town
which is shox~ and designated on the Suffolk
County tax map as District 1000, Section ~ . Block ~ . Lot
That the undersigned (has) (ha~e) filed, or caused to be filed, an applica-
tion in 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 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: ~//~ ~/~/ f~ ~, ~
(signature)
(print name)
(signature)
(print name)
Z