HomeMy WebLinkAboutZ-22689FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-22689
Date OCTOBER 29r 1993
THIS CERTIFIES that the buildin~
Location of Property 41190 MAIN ROAD (RTE 25)
House No. Street
County Tax Map No. 1000 Section 15 Block 9
Subdivision Filed Map No.
ONE FAMILY DWELLING
ORIENTr N.Y.
Lot 10.1
Lot No.
Hamlet
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9r 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-22689 dated OCTOBER 29~ 1993
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 DWR. LLING WITH ACCESSORY 4 CAR GARAGE WITH
SNRD ADDITION *
The certificate is issued to
of the aforesaid building.
H.B.B. ASSOCIATES
(owner)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE A~TACHED INSPECTION REPORT.
N/~
Rev. 1/81
Building- Inspector
LOCATION:
SUBDIVISION
NAME OF OWNER (s)
BUILDING DEPART}~NT
TOWN OF SOU~IOLD
IIOUSING CODE INSPECTION REPORT
41190 MAIN ROAD (ROUTE 25) ORIENT, N.Y.
(number & street) (municipality
MAP NO. LOT (s)
.H.B.B. ASSOCIATES
OWNER
OCCUPANCY
(type)
(owner-tenant)
ADMl'l-r~D BY:. SELF
KEY AVAILABLE
SOUKCZ OF REQUEST:
ACCOMPANIED BY: SELF
SURF. CO. T~-X ~ NO. m5-9-10, l
PAUL A. CAMINITY, ESQ. DATE: OCT. 15, 1993
DWELLING:
TIrPE OF CONSTRUCTION WOOD FRAI4E
FOUNDATION CEI~NT BLOCK
TOTAL ROOMS: IST FLR.
BATHROOM (s) ONE
PORCH TYPE SCREEN PORCR
BREEZEWAY
D0~STIC U0~ATER TES.
TYPE UEAT NONE
O~IER:
· 3
2ND FLR. 4
TOILET ROOM (s)
DECK, TYPE
FIREPLACE
TYPE HEATER
WARM AIR
{ STORIES 2 # EXITS 2
CELLAR NONE CRAWL SPACE NONE
3RD FLR. --
ORE UTILITY ROOM
· PATIO· TYPE
ONE
ELECTRIC
GARAGE
AIRCONDITIONING
HOlX4ATER
ACCESSORY STRUCTURES:
CARAGE, TYPE OF cONsT.
S~ING POOL
O~R:
4 CAR WITIt SHED ADDITIONsToRAGE, TYPE CONST.
· GUEST,.TYPE CONST.
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ~RT. SEC.
REMARKS:
INSPECteD BY:
DATE ON INSPECTION
TIME START
OCTOBER I9, 1993
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
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.
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.
Certificate of Occupancy on Pre-existing
Building
$ioo.oo
Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
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, .... ~.//..~.P .......... . .~..·.~. !..~.. ..... .C?.~..~ ....... .~B.I..~.~.'~. .......
House No. Street Hamlet
3nwer or Owners of Property ....° ................................................. ..... ..
~ounty Tax Map No 1000, Section .............. Block ............. ot ~ O ,
;ubdivision .................................... Filed Map ............ Lot ......................
~ermit No ................ Date Of Permit ................ Applicant .............................
lealth Dept. Approval .......................... Underwriters Approval .........................
~lanning Board Approval ......... ~ ..............
~,equest for: Temporary Certificate ........... Final Certicate ...........
Submitted- $
' ...... .............
CONSENT
TO
INSPECTION
Oxwmr(s) Name(s)
· the undersigned,
do(es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises'in the Town
of Southold located at Z/1/ rn4 z
County tax map as District 1000, Section /~ , Block 9 , Lot /0,/ .
That the undersigned (has) (have) filed, 'o~ caused to be filed· an applica-
tion in the Southold Tox~ Building Inspector's Office for the ~ollow~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 ihereon; 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)
dt name)
AC/Ill,,/ ~' O ,I~ D - .a,/ y Z'.ff