HomeMy WebLinkAboutZ-23055FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
~PDATED
EXISTING
CERTIFICATE OF OCcuPANCY
No Z-23055
Date JUNE 20, 1994
THIS CERTIFIES that the building.
Location of Property 395 GT?.T.~'£-£~ DRIVE
House No.
County Tax Map No. 1000 Section 31
Subdivision
ONE F~MILY DWELLING
EAST M~RION, N.Y.
Street
Block 6 Lot 4
Filed Map No. Lot No.
Hamlet
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-23055 dated ~ONE 20, 1994
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 DW~?~.ING WITH ATTA~D GARAGE & REAR WOOD DECK
SLIG~'£LY ~AISED A~O~E G~ADE*
The certificate is issued to WILLIAM & CAROLINE HESS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*THIS UPDATES PP~ ~O Z--8948 DATED 3/1/78.
Rev. 1/81
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 lihes,
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
"p~e-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
i. 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.
2. Certificate of Occupancy on Pre-existin~ Buildin~ - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial ~15.00
New Construct Date.~7__..
ion ........ ~.~Old Or Pre-existing Bu~,ilding''
Location of Pro er~ ~5
p -y ............................ .~. f..~,..~.~..Z~...~...~.,. ..... ~.~ T....~..~..~J.~.~....
House No. Street Hamlet
Onwer or Owners of Property.. ~ I.~.L-~ ~.Y~ ~ C ~_~JO~_
County Tax Map No 1000, Section..6.~. j.,.~.?. .... Block... ~.~:.~..~. ..... Lot..~.~.~.9.~..~ ..........
Subdivision...~.~..~.~...~.~.~.~.~.N~...~.~.~..~.~,..'...Filed Map...~. ,~.$.~....Lot....~..~. ..............
Permit No ................ Date Of Permit ................ Applicant .......... · ...................
Health Dept. Approval.. ~"~.".~.~ ......... Underwriters Approval .... .~..~.4~.'~(..~.~.~.~.k~. .......
Planning Board Approval .... ~.. ~
Request for: Temporary Certificate ........... Final Certicate..~. ........
Fee Submitted: $.....~,.,..~. .................. ~·~·
~,~. ~]3 ' '~ ' APPLICANT
Q'IOHJ.I'IOS JO N~O.I." ~
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$.2~,o...fi9,10,,~. -
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