HomeMy WebLinkAboutZ-27330FOP~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
Ne: S- 27330
Date: 09/29/00
~XS ~£IFXE$ that the ~uiXd~ DWELLING
Lo~ation of Property 1095 VILLAGE LA
(HOUSE NO.) (STREET)
~ountF Tmx ~p Ne. 473889 Section 025 Block 0002
~bdivieion
File~ Nap No. __ Lot No. __
ORIENT
(HAMLET)
Lot 009.002
confoz~ substantially to the ~e~u~-te for a ONE FAMILY DWELLING
built prior to APRIL 9~ 1957 pursuant to w~ich u~TIFI~TE OF
O(~"OP~ ~ S- 27330 dat~ SEPTEMBER 29, 2000
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 ACCESSORY GARAGE *
T~e certificate ie iesue~ to E.WILLIAM & CHRISTOPHER DAVIS
(eWeR)
of the aforesaid building.
~COONT~ DEPA]~NTOF~aT.THAPP~O~AL
~.~TR~CA~ (~TIFIC~TE NO.
P~S U~TIFICATIO~DAT~u
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
N/A
N/A
N/A
' ~utho~iz~signature
BUILDING DEPARTMENT
TOWN OF EOUTEOLD
MOUSING CODE INSPECTION REPORT
2 CAR WOOD- 1-1/2 STORY ~, ~ (~.:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIP~E PREVENTION & BUILDING CODE
~: BPE13243Z-CO~61(FOUNDIBP#15493Z-COZ'15317 (ADDITION TO ACCESSORY)
Form No. 6
TOWN OF SOUTItOLD
BUILDING DEPARTHEIq~
TO~,~I HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submittad to
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 Ptann/ng Board Approval of c6mpleted site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
Vpre-~xisting" land uses:
i. 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.
Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Sw~mm4ng pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existin~ Buildin= - $I00.00
3. Copy of Certificate of Occupancy -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy ' Residential $15.00, Commercial $15.00
Date ...~R~e~R .~,. 2000
New Construction ........... Old Or Pre-existing Building... X
Location of Property .... ~.~age La~,..Orient% New York 11957
House No. Street
Onwer or Owners of Property ....... ~'. .... ~ill~.~.~ ..... qhr~s~qRh~R ~..~a~ .......... ..........
county Tax Map No ~000, Section...q~..qq ..... Block...q~..Qq ........ Lot ..... ~R-.~% ..........
Subdivision ................................ Filed Map ............ Lot ..............
Permit No ................ Date Of Permit ................ Applicant ........................... ..
Health Dept Approval 2Underwriters Approval .......
Planning Board Approval .................... ... .
Request for: Temporary Certificate ........... Final Certicate ...........
CONSENT
TO
INSPECTION
E. William Davis
Chritopher W. Davis
, the undersigned,
Owner(s) Name(s)
do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises In the Town
of Southold located at 1095 Village Lane, 0rient~ New York
, which is shown and designated on the Suffolk
County tax map as District 1000, Section 25 , Block 2 , Lot 9.2
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:
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, doles) 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
lations of the laws, ordinances, rules or regulations of the Town of Southold.
(signature)
(signature)
(print name)