HomeMy WebLinkAboutZ-28125 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 28125 Date: 12/18 O1
THIS CERTIFIES that the building DWELLING & ACCESSORIES
Location of Property 2725 HARBOR LA CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 136 Block 0001 Lot 020
Subdivision 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 NOMBER Z- 28125 dated DECEMBER 18, 2001
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 SCREENED PORCH AND ACCESSORY TWO CAR GARAGE
WITH ATTACHED STORAGE.*
The certificate is issued to MARGARET FRIIS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATBD N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
t
Au orize Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 2725 HARBOR LA CUTCHOGUE
SUBDIVISION: NAP HO.: LOT (S)
NANH OP OWHHR (S): MARGARET FRIIS
OCCUPABCY: SINGLE FAMILY MARGARET FRIIS
ADNITTHD HY: ROBERT DEAOS KI ACCOMPAHIBD HY: SAME
RHY AVAILABLH: SUFF. CO. TAK MAP HO.: 136.-1-20
SOURCH OP RHQUBST: DATB: 12 18 O1
DWELLING:
TYPB OF CONSTRUCTION: WOOD FRAME # STORMS: 1.0 # HYITS: 2
PODHD7ITIOH: CEMENT CELLAR: 3 4 CRAWL SPACH:
TOTAL ROOMS: 1ST PLR.: 1 2ND FLR.: 0 3RD PLR.: 0
BATHROOM (S): 2.0 TOILHT ROOM(S): 0.0 UTILITY ROOK(S):
PORCH TYPH: SCREEN PORCH DHCR TYPH: PATIO TYPH:
HRHHZHWAY: PIRHPLACH: GARAGH:
DOMHSTIC HOTWATHR: YES TYPH HHATHR: ELECTRIC AIRCOHDITIONING:
TYPH HHAT: OIL WARM AIR: X HOTfU\THR:
OTHHR:
ACCESSORY STRUCTURES:
GAAAGH, TYPH OP COHST.: TWO CAR WOOD FRAME STORAGH, TYPH CONST.: ATTACHED TO GARAGE
SWIMMING POOL: GUHST, TYPH COHST.:
OT®t:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION ~ DESCRIPTION ART. ~ SEC.
ura~norS-
IHSPBCTHD BY: - DATH ON MSPHCTION: 12 17 O1
GARY J PI TIIDi START: 9:SOAM HMD: 10:30AM
Form No. b
TOWN OF SOU'C![OLD n ~ ~ ~ ~ ~ D
BUILDING DEPARTMENT tq'
TOWN HALL ~
765-1802 ~
s '
APPLICATION FOR CERTIFICATE OF OCCUPAN, Y BLDG. i.ePf.
TONIM
A. This appli~~ation must be filled in by typewriter OR ink and submitted to the building
inspecCOr 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 17. 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.
B. 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 tp accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildine - $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 :..~OVE/9/gE~L, /S, aoo/
New Construction........... Old Or Pre-existing Building.,
Location of Property...°?7~5,,,,,,,,,~/~~,i3,o/Z•„~C,~/~!6.... ......~G(,TCi~OGG(E...,
House No. Street Hamlet
Onwer or Owners of Property....~.1.~'e6-fL2~,T,,, /1~;,,~'e~~;f,,,,,,,,,,,,,,,,,,,,,,,,
County Tax Map No 1000, Section.....~.-3~~....B1ock.....~..........Lot...
Subdivision....:~u GEivE ..NE iGif TS . , ; ,piled Map..~.`rfs6 , ,Lot. #.9~~. ~~D .
Permit No ................Date Of Permit................Applicant.............................
Health Dept. Approval. .........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...
Fee Submitted: $.~~D; ~ ~
C APPLICA liTZ J !-iL ~N
CONSENT
TO
INSPECTION
m A ~ ~ ~ 2 E ~ ,~iP/ /S . the undersigned,
Owner(s) Name(s)
do(es) hereby state:
That the undersigned (is) (a~e~-the owner(p~) of the premises in the Town
of Southold located at ~7 ~S ~/A.Qf o2 ~A-/yE~ GL~iGl..lyGCfE
i
~Ew 102 K which is shown and designated on the Suffolk
County tax map as District 1000, Section /.3 /O Block ~ Lot ~ O
That the undersigned (has) ()~rrve) filed, or caused to be filed, an applica-
tion in the Southold Town Building Inspector's Office for the following:
P~E-EX~sTiiv~ ~~.e%/FicATC Oi ~C'Ccr/~~~yCy~
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 Ln 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: ~/o(/. /S ; =200/ ~.tn4tn~-`y /~l ~iwc~
~ (signatu e)
(pri name)
ma,eyAZe-t/h- F,e,~,s
(signature)
(print name)
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