HomeMy WebLinkAboutZ-24009FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
C~RTIFICATE OF OCCUPANCY
No Z-24009
Date NOVEMBER 2, 1995
THIS CERTIFIES that the building
ONE F&NIT~Y DW~T.T.ING
Location of Property 2510 pRIVATE ~o~D $8
House No. Street
county Tax Map No. 1000 Section 18 Block 3
n,T~N~, NEW YORE
HamleL
Lot 6.10
Subdivision Filed Map No. Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-24009 dated NOV~?~RR 2, 1995
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ONE FAMILY DWFT~.TNG*
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
N/A
N/A
N/A
pLUMBERS CERTIFICATION DATED
*pT.R~SE SEE ATTAc~D INSPECTION REPO~ ~~
Building Inspector/
Rev. 1/81
I.OCATI OH: 25 I0 PRIVATE ROAD #8
· ';UIH) 1V / S ION HAl'
[IAHI< OF ()~4NI.;I((n) RODE H. & P~LLIS g. ~g
O(~(~IH'ANCY S~ngle F~ily
ADH 1TTEI) IIY: RODg ~R
KEY AVAII.ABI.E
SOIJRCF. ¢)1r
RODE HALE
ACCOHPA}{ I El) BY: SAI~
.';UF'F.(2¢). '{'AX HAl' lq(). {000-{8-3-6~r0
I)A'rE: OCT. 25, 1995
I)%4EI.1, l lq(2:
'I'YI'I'] OF C. ONSTIHIC'I'ION WOOD CONSTRUCTION
FOIJNI)ATION POURED CONCRETE & CEI.I,AR FULL
----CI~{~OCK .........................
TOTAl. ROOHS: l ST FI,l{. 8 2NI) F1.R. 2 3RI) FI,R.
BATIII{OOH (s) ;2 TO I I.ET I{O()H (s)
I'OIICII 'I'YI'E REAR SCREENED IIICCK, TYI'F.
IIRI':E ZI.:I4AY F l I{I':I'I.ACE
EXITS 4
I STORIES 2
CRAWl. SI;ACE PART
UTI I.'ITY ltOOH
· PATIO CONCRETE
GARA(;E 2 CAR UNDER
I)(}HICSTIC IIO'I'UATISI{ XX 'I'YI'E III{A'I'F:I{ ELECTRIC
A IRCOHI) ITi()H 1 Iq(;
TYI'E IIEAT ELECTRIC MAI{ti A l It IIO'IV^'fI'~R
o'rlll,:lt: FRONT ~ ROOM
ACCI';SSOIIY STRIICTURE$: .
GARA(;E, 'I'YI'I'~ Ol.' C(114.~;'1'.
.................... · qTOI{A(;I,~, 'rYi'{C COHST.
5%41tlHIN(; I'OOl. , (;IJEST, 'I'YI>E CONST.
OTIIICI(:
.................................................. zZ_ZZZZZZZ ...............................................
_V~Ii~)I_._A_'_I'I_~O~:_ CIIAI"FI,~R 65 N.Y. S'I'ATI,~ IINIFOI{H I,'IIIF. FllEVENTIOH & BtIII.I)ING CODE
I.(}CAT 10}t
i)ESCRIPTIOH
IHCHARKS: BP #I0539-Z-COZ-IOI25 (ADD) .............. :
~o~rn NO. ~
TOWN OF SOUTIIObD
BUILDING DEPARTHENT
TOWN HALL
765-[802
A?PLiCATION FOR CERTIFICATE OF OCCUPANCY
Ao
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:
Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or ~opographic features.
2. Final Approval from Health Dept. of ~nter supply and sewerage-disposa!(S-9 form).
3. Approval of electrical instal!trion from Board of Fire Underwriters.
&. Sworn statement from plumber certifying that the solder used in system contains
less than 2/i0 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildlngs
and installa~tions, 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-exis~ing" 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.
Certificate of Occupancy - Ne~ d~e±iing $25.00, Additions to dwelling $25.00,
Alterations to d~elling $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-exis~inz Buildin~ - $[00.00
3. Copy of Certificate of Occupancy - $20.00
Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00-, Commercial $15.00
Date .........................................
New Construction ........... Old Or ?~e-existing Building .... ..t~.... .......
~ouse No. Street tla,,le=
0.~ o= 0=,~=, o~ ~=o,~=:y~.~..~5~...+.~v..~ 75s%. ~i .~.~ ................
~ounty Tax Map No [000, Section .... {~ ....... iLluck ..... ~ .......... Lot .... ~]~ .............
~uod!vls~.on .................................... Fi}cd N:]p ............ Loc ......................
Permi5 No ................ Date Of Permit ................ App[ic:mt .............................
~[ealth Dept. A~provai .......................... Umler~vriters Approval .........................
'ion,ling Board Approv~ll ........................
Request for: Temporary Certificate ........... Fi.si Certicate ...........
T__oo Submitted: $ .............................
3 ¢ ....... ?< :. .................