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Home My WebLink AboutZ-28345FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, PRE EXISTING CERTIFICATE OF OCCUPARCY No: Z- 28345 Date: 04/19/02 THIS CERTIFIES that the building DWELLING Location of Property 795 MARLENE LA (HOUSE NO.) County TaxMap No. 473889 Section 143 Subdivision MATT/LAUREL (STREET) (HAMLET) Block 0003 Lot 024 Filed Map No. __ Lot No. -- conforms substantially to the Requlre~ts for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 28345 dated APRIL 19, 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 WITH ATTACHED ONE CAR GARAGE * The certificate is issued to ROBERT & VIRGINIA DIESENBERG (OWNER) of the aforesaid building. SUFFOLK COUNTYDEPARTMENTOFHEALTHAPPRO%rAL ELECTRICAL CERTIFICATHNO. PLUMBERS C~K'rIFICATION D~rmu *PLEASE SEE ATTACHED INSPECTION REPORT. N/A N/A Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTEOLD NOUSING CODE INSPECTION REPORT · ~(~ OF P.~: VIRGINIA DIESENBEHG - 2/8/02 DA~'~: 04/19/02 DWELLING: TYPE OF CONSTRDi~TIO~: WOOD FP~AME FO~TION: CEMENT BLOCK CEI~: PART. CRAWL SPA/2E: ACCESSORY STRUCTURES: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. DATE (~ INSPECTIOn: 03/04/02 TI~E ST~T: 9:45 AM ~/I): 10:15 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-t802 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: i. 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 Buildinz - $100.00 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 Date .................................... .... . New Construction ........... Old Or Pre-existing Building .............. Location of Property. ~?~ ;~7~L~;V~- .LC.?..~.¥' House No. Street Ha~et ' · ............. Block ......... Lot ...................... Subdivision ............ Filed Map Lot Permit No .............. .. Date Of Pe~it ............... . Applicant .......................... .. . Health Dept. Approval .......................... Unde~riters Approval ......................... Approval .................... Planning Board .... Re~est for: Temporary Certificate........... Final Certicate ........... Fee Submitted /~ O~ ~ ~ CONSENT TO INSPECTION · 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 r~ ~ ~-~ /~?~z(:/. LVA/~ /-. ~z ~ ~/~:i~ ~ ~ , which is shown and designated on the Suffnlk County tax map as District 1000. Section /~3. Block ~., Lot ~ ~. That the undersigned (has) (have) 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. (print name) (signature) (print name) THIS SURVEY NOT TO ~BE USED FOR TITLE PURPOSES NOTE= a =~ONUMEHT O = PIPE FOUNC SURVEY FOR ROBERT D!ESENBERG 8~ VIRGINIA M. DIESENBERG MATTITUC?( TOW',',; OF SOUTHOLD SUFF. CO., N.Y. GLIARANTEEDTO: SOUTHOI. D SAVINGS BANK SCALE : I'~= 40' INTE'='-COUNTYTITLEGUARA~TYe MORTGAGE CO. ~N~ LAND SURVEYOR ~ N.7.~ LtC. NO.I ZS45 RIVERHEAD ,~ N.Y.