HomeMy WebLinkAboutZ-28564FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 28564
Date: 07/01/02
THIS u~TIFIES that the building
Location of Property 52800 CR 48
(HOUSE NO.)
County Tax Map No. 473889 Section 135
DWELLING
SOUTHOLD
(STREET) (HAMLET)
Block 0003 Lot 001
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
OCCUPANC"f NUI~BER Z- 28564 dated JULY 1, 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 & ACCESSORY 20X30 GDR~_AGE*
The certificate is issued to WALTER S & AGNES E BUSCH
(OWNER)
of the aforesaid building.
SUFFOLK COUNTYDEPARTMENTOF~RALTHAPPROV/EL
ELECTHIC3kL CERTIFICATE NO.
PLUMBERS CERTIFICATION D~r~u3
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81 ~
N/A
N/A
N/A
Authorized~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
ROUSING CODE INSPECTION REPORT
LOCATION: 52800 CR 48
SUBDIirlSION:
NAME OF OWNER (S): WALTER S & AGNES E BUSCR
OCCUP/I/~CY: SINGLE FAMILY
ADMI'l-rl~u BY: AGNES BUSCH
SOUTHOLD
MAP NO.: LOT (S)
WALTER S & AGNES E BUSCH
ACCOMPANIED BY: SA,E
KEY AV~-TLABLE: SUFF. CO. TAX ~AP NO.: 135.-3-1
SOURCE OF REQUEST: PATRICIA C. MOORE, ATTY 6/20/02 DAT~: 07/01/02
DWELLING:
T"fPE OF CONSTRUCTION: WOOD FRAME
FOUNDATION: BRICK
TOTAL ROO~: 1ST FI~R.:
BA'rltRO0~ (S): 2.0
PORCH TYPE:
BREEZEWAY:
TYPE H~AT: NAT.GAS WARM AIR:
~ritiiit: BILC0 DOOR
4 2ND FIR.: 3
TOIl, ET ROOM(S):
DECK TYPE:
FIREPLACE: YES
STORIES: 1.5 # EXITS: 3
~J~iR: FULL CR~ SPACE:
3P, D FLR.: 0
0 I]TILITY ROOM (S):
PATIO TYPE: CEMENT
GARAGE:
AIRCONDITIONING: YES
TYPE HEATER: NAT.GAS
HOTWATER:
ACCESSORY STRUCTURES:
C~E, TYPE OF CONST.: 2 CAR WOOD FRAME* STOI~E, T~fPE CONST.:
SWIPING POOL: GUEST, TYPE CONST.:
WOOD
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
P,I~: BP#7011Z-~BP#8849Z-COZ7304-BP#10869Z-C0Zl1223-BP#12535-COZ16659
INSPEt-I'~ BY: '~'/~/~.~~~'D DATE ON INSPECTION: 07/01/02
Form No, 6
rlO'~5:rN O17 SO UTHOLD i
TOSVN HXLI, :i,! ~'( V ............
APPI,I(~ATION F(}I{ CISRTIIqCA'FI( OF O(¢(~UI'~N(~:, J
This application must be filled in by typewriter or h~ and submitted to the Building Department 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
topograplfic features.
2. Final Approval fi'om Health Dcpt. of water supply and sewerage-disposal (S-9 form).
3. Approx;al of electrical installation from Board of Fire Underwriters.
4. Swolu statement fi'om t)lmnber certifying that the solclcr used iii system contains tess tlian 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and sinfilar buildings and installations, a certific
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 us,
1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
fealnres.
2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupam
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 $25.0(
Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.0
2. Certificate of Occupancy'on Pre-existing Building - $100.00
3. Photocopy of Certificate of Occupancy - $ 0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
Location of Property:
Owner or Owners of Property: /~, ~,
8uffolk County Tax MapNo 1000, Section / ~ 5"- Block
Date.
Old or Pre-existing Builaing: X ~rt/~t'r~a~(o~ecO~°ne)
House No. Street Hamlet
Subdivision Filed Map.
Permit No. Date of Pemfit. Applicant:
Lot:
Health Dept. Approval:
Plamfing Board Approval:
Underwriters Approval:
Request fbr: Temporary Ce~ntificate
Fee Submitted:
Final Certificate:
(check one)
?
,4r
CONSENT
TO "
INSPECTION
· , the undersigned,
do(es) hereby siate:
That the un!dersigned (is) (are) tile owner(s) of the premises in the Town
co ,t fa× maplas Sistriet 000, Seotion/ --. mocl, . Lot..Z O/
That the ugdersigne~s)] (hay 'or caused to be filed, an applica-
tion in'th,~ Sout~old Town lgU~l~ing lnspeu~,,, .~ or.t:°° to~ +~,, tnllowln~:
That the undersigned do(es) hereby give consent to the Building Inspectors
o[ the Town otSouthold to enter upon the above described property, including
any and all builOings located thereon, to conduct such inspections as they may
deem necessar~ with respect to the aforesaid application, including'-inspections
to determine thht said premises comply with all of the laws. ordinances, rules
and reRulationslof the Town of SouthOld.
The
under~xgned0 in consenting to such inspe.ctions,, 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 o~ the laws, ordinances rules or regulations of the Town of Southold.
(signature) --
(print name) ~ ~.~/~
(signature)
(print name)