HomeMy WebLinkAboutZ-27127 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 27127 Date: 06/07/00
THIS CERTIFIES that the building DWELLING & ACCESSORY
Location of Property 60015 MAIN RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 056 Block 0003 Lot 010
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- 27127 dated JUNE 7, 2000
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 REAR ENCLOSED PORCH AND ACCESSORY 1 1/2 CAR
WOOD FRAME GARAGE.*
The certificate is issued to JON C KERBS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
A horized Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HO 7N OD 7qi P TTOLT aPORT
LOCATION: 50015 MAIN RD SO rrHO •D
SUBDIVISION: MAP NO.: LOT (S)
NAMB OF OWNER (S): JON C KERBS
OCCUPANCY: A-1 RBSrDENTSAr• JON C KERBS
ADMITTED BY: OWNER ACCOMPANIED HY: SAME
REY AVAILABLE: SUFF. CO. TAX MAP NO.: 56.-3-10
SOURCE OF REQUEST: JON C. KERBS DATE: 06/07/00
DWELLING:
TYPH OF CONSTRUCTION: WOOD FRAME tk STORIES: 2.0 # EXITS:
FOUNDATION: BRICK CELLAR: PART. CRAWL SPACE: PART.
TOTAL ROOMS: 1ST FLA.: ~ 2ND FLA.: ~ 3RD FLA.: ~
BATHROOM(S): _ Z.Q TOILET ROOM(S): o.o UTILITY ROOM(S):
PORCH TYPE: ana .N •O ~D DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: ~1ONE GARAGE:
pOMESTIC HOTWATHR: YES TYPE HEATER: OFF BOILER AZRCONDITIONING:
TYPB HEAT: OIL WARM AIR: HOTWATEA: X
OTHER: PANTRY OFF KITCHEN
ACCESSORY STRUC7?TFRS:
GARAGE, TYPE OF CONST.: 1 1/2 zu gRnrm _ anrv STORAGE, TYPE CONST.:
SWIMMING POOL: GUEST, TYPE CON5T.:
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
~.OCATION ' DESCRTamrnni 1 AaT ' SFC
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RHMARRS: HEINSPHCTED 6/6/00.
INSPECTED BY: DATE ON INSPECTION: 05/31/00
GARY F TIME START: 9:35 Abr END: 9:55 AM
Form No. 6 _
510 ~ o~ (0.5
TOWN OF SOUTHOLD
+ BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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 lZ 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 si~ned by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
; 2 3 2000 _
C. Fees FC ~j
1. Certificate of Occupancy - New dwelling $25.00, Additions to~dwe-1Ti~}g_;~~25.QO, -R
Alterations to dwelling $25.00, Swimming pool $25.00, Accesshry hullding,$25QQ__J
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildine - $100.00
3. Copy of Certificate of Occupancy - .25~.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
~1~ ~ a~~a~ ~ ~
(~-~-C- fJ~~ $ I Date ~ a:1 .
New Construction....... Old Or Pre-existing Build3,,~g..
Location of Property..~~Q(.~~....... /'.'l,l-}:t ~..?.~d • • • • . • • .
House No. Str et Hamlet•
Onwer or Owners of Property:-~`:`....~T-.~.~~.~~
County Tax Map No 1000, Section..~~.......Block....~.........Lot....~.~
Subdivision ....................................Filed Map............Lot......................
Permit No ................Date Of Permit................Applicant.............................
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $
I ~~11 J V~ ~ s APPLICANT •
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