HomeMy WebLinkAboutZ-27251FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 27251
Date: 08/16/00
THIS CERTIFIES that the building DWELLING
Location of Property MUNNATAWKET AVE
(HOUSE NO.)
County Tax Map No. 473889 Section 006
Subdivision
FISHERS ISLAND
(STREET) (HAMLET)
Block 0003 Lot 003
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- 27251 dated AUGUST 16, 2000
was issued, and conforms to all of the requirements of the applicable
proviaions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWELLING WITH DECK.*
The certificate is issued to JOHN C & SUSAN E M CLAVIN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
N/A
N/A
N/A
BUILDING DEPARTMENT
TOWN OF SOUTEOLD
BOUSING CODE INSPECTION REPORT
LOCATION: MUNNATAWKET AVE FISHERS ISLAND
SUBDIVISION: MAP NO.: __ LOT (S) __
NA~ OE OWNER {S): JQ~N C & SUSAN E M CLAVIN
OCCUPANCY: SINGLE FAMILY JOHN C & SUSAN E M CLAVIN
ADMIT'FED BY~ ACCOMPANIED BY:
KEY AVAILABLE: EUFF. CO. TAX MAP NO.:
SOURCE OF REQUEST: JOHN C CLAVIN DATE: 08/16/00
TYPE OF CONSTRUCTION: WOOD FRAME
FOUNDATION: POURED CONCRETE ;LND STONE
TOTAL ROOMS: 1ST FLR.:
BATHROOM(S): 1.0
PORCH TYPE:
BREEZEWAY:
DOMESTIC EOTWATER: yES
TYPE HEAT: ~WARM AIR:
OTHER:
# STORIES: 1,O # EXITS: 1
CELLAR: __ CRAWL SPACE: __
TOILET ROOM(S): Q,Q UTILITY ROOM(S): --
DECK TYPE: WQQD PATIO TYPE:
FIREPLACE: ] GARAGE:
TYPE HEATER: ELECTRIC AIRCONDITIONING:
BOTWATER:
GARAGE, TYPE OF CONST.:
SWI~4ING POOL:
OTHER ~
STORAGE, TYPE CONST.: STORAGE SHED
GUEST, TYPE CONST.:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRM PREVENTION & BUILDING CODE
LOCATION ~ DESCRIPTION ~ ART.
DATE ON INSPECTION: 06/02/00
TIME START: 11:00 AM END: 11:30 AN
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the build}~g---.-j
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.
Submit Planning Board Approval of completed site plan requirements.
r existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
re-existing" land uses:
Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
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 $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00
3. Copy of Certificate of Occupancy - ,
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
X
New Construction ........... Old Or Pre-existing Building .................
Location of Property ..... } ~g~g~kq~ ~v&ggq,. ~J~J_qO~ ................................
House No. Street Hamlet
Onwer or Owners of Property..4qhg .Q...Q~v.i~%~ ~u,~r~.~..~J~vj~n. ............................
County Tax Map No I000, Section..~O.~..~ ...... Block.. ~..~ ......... Lot..OOB~O00 .............
Subdivision .................................... Filed Map ............ Lot ......................
Permit No ................ Date Of Permit ................ Applicant .............................
Health Dept. Approval .......................... Underwriters Approval .........................
Request for: Temporary Certificate ........... Final Certic t ...........
.e. Submitted: $.,1.0.0...0~ .................
c_ .... ..........
CONSENT
TO
INSPECTION
John C. Clavin
· the undersigned,
Owner(s) Name(s)
do(es) hereby state:
one of
That the undersigned (is) (~W(~Ythe owner(s) of the premises in the Town
of Southold located at 5 Munnatawket Avenue, Fishers Island
· which is shown and designated on the Suffolk
County tax map as District 1000, Section 006.00, Block 03.00., Lot 003.000 .
That the undersigned (has) :(~o~ filed, 'or caused to be filed, an applica-
tion in the Southold Town Building Inspector's Office for the following:
Certificate of Occupancy on Pre-existing Building
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
evidence in subsequent pros~r rio-
ae ~c. Clav~n
(p*[nt name)
~ (~l~na~ure)
(print name)
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