HomeMy WebLinkAboutZ-28465FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPD~NCY
No: Z- 28465
Date: 05/28/02
T~IS C~LRTIFIES that the building DWELLING
Location of Property 15895 NEW SUFFOLK AVE NEW SUFFOLK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 117 Block 0006 Lot 023
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a ONE F~ILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPA/~CY N~q~BER Z- 28465 dated MAY 28, 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 COVERED FRONT PORCH AND REAR SCREENED PORCH*
The certificate is issued to NANCY & RAYMOND DELL'~2qGELO
( OWNER )
of the aforesaid building.
SUFFOLK COUNtrY DEPARTMENT OF ~%L'l~ A~PROVAL
ELE¢-£~ICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'r~43
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Auth/orized Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 15895 NEW SUFFOLK AVE NEW SUFFOLK
SUBDI~ISION: }~%P NO.: LO~ (S)
}~NE OF OWNE~ (S): N~-NCY & RAYMOND DELL'ANGEL0
OCC~IPANCy: SINGLE FAMILY NANCY & RAYMOND DELL'ANGEL0
AD~I'$-r~3 BY: ALBERTSON REALTY ACCOMPANIED BY: SAME
K]{Y AVAILAB~: SI]FF. CO. TAX MA~ NO.: 117.-6-23
SOURCE OF P~UEST: CRISTINA HESSEL DATE: 05/28/02
DWELLING:
· YPE OF CON~"~RUC'TION: SINGLE FAMILY # ~TORIES: 1.0. # EXITS: 2
FOUNDATION: CONCRETE BLOCK f~LLm%R: FULL CRA}~L SPACE:
TOTAL ROOMS: 1ST FLR.: --6 2ND FLR.: 0 3ED FLR.: 0
BA'r~(OO~(S): 1.0 TOILET ROOM(S): 0.0 UTILI~"f ROO~(S):
PORC]{ ~"fPE: REAR SCREENED~ FRONT COV. DECK ~p}z: PATIO
B1AEEZEWAy: FIREPLACK: 1 GARAGE:
DOMESTIC HOTWA'r~: YES ~YPE HEA~ER: KEYSPAN GAS AIRCONDITIONI~IG: YES
O~HE~: Outside shower
ACCESSORY STRUCTURES:
GARAGE, ~SCpE OF CONST.:
SWIPING POOL:
STOP, AGE, ~"~PE CONST.:
GIIEST, ~"fPE CON~.:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
P,~K~: BP#5924 ADD/ALT CO #Z5345
GARY J FISH
DATE ON I~SPEC~ION: 05/24/02
TI~ START: 10:00AM E~D: 10:30AM
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 Department with the following:
A. 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. Ifa 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,
/,~3Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00.
- 2(~2-~- Certificate of Occupancy on Pre-existing Building _ $100.00
3. Copy of Certificate of Occupancy - $25.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
Location of Property:
Old or Pre-existing Building:
House No. "~ ~ Street
Owner or Owners ofProperty: ~[~,~o,.d 4 ~Q~c~ ~)~{{
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No.
Health Dept. Approval:
Planning Board Approval:
Date of Permit.
Date. ~-~/[~/o 2.
~/ (check one)
Block
Filed Map.
.Applicant:
Underwriters Approval:
Hamlet
Lot
Lot:
Request for: Temporary Certificate
Fee Submitted: $ I{D0
Final Certificate: ~ (check one)
~ure
Dated:
CONSENT
TO "
INSPECTION
Owno~(s) Name(s)
do(es) hereby
., the undersigned,
Thai the undersigned (is) (are) the owner(s) of the premises in the Town
or Southold located a,
~ ~0 ~-0_ ( ( , which is shown and deslgm~,ed on the Suf£olk
County tax map[as District 1000, Section ~ I-~ Block ~P , Lot 2.~
That the undersigned (has) (have) filed, 'or caused robe filed, an applica
;
That the undersigned do(es) hereby give consent to the ]3uildlng Inspectors
of the Town of $outhold 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 laws0 ordinances, rules
·
and regulations! of the Town of SouthOld.
The undersigned, in consenting to such inspections, do(es) so with the
knowledge and dnderstanding ti)at any information obtained In the conduct of
such inspection~ may'be used as evidence in subsequent prosecutions for vio-
lations of the l~ws, ordinances rules or regulations of [he Town orSouthold.
_ (print name)
(siHnature)