HomeMy WebLinkAboutZ-28915FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
NO: Z- 28915
Date: 10/04/02
CERTIFIES that the building
DWELLING AND ACCESSORY
Location of Property 640 WASHINGTON AVE
(HOUSE NO.) (STREET)
County Tax Map No. 473889 Section 041 Block 0001
Subdivision Filed Map No. Lot No.
GREENPORT
(HAMLET)
Lot 035
confoms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY N--t~4BERZ- 28915 dated OCTOBER 4, 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 WITH ACCESSORY 1 1/2 CAR GARAGE.*
The certificate is issued to BARBA=gA C MOORE
(OWNER)
of the aforesaid building.
SUFFOLK COUNTYDEPARTMENTOFm~AL'i~APPROVAL
ELEt-r~ICAL CF~TIFICATE NO.
PLUMBERS CERTIFICATION DA'£~U3
*PLEASE SEE ATTACHED INSPECTION~RT.~j~
Rev. 1/81
N/A
]0/4/02 Pending
N/A
640 WASHINGTON AVE
NAME OF OWNER (S): BARBARA C MOORE
OCCUPANCY: SINGLE FAMILY
AD~I'I'£~o BY: GARRET MOORE
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
GREENPORT
~ (S)
BARBARA C MOORE
ACCO~PANI~) BY: SAME
K]~Y A%SqII~BLE: S~FF. CO. TAX W~%P NO.: 41. 1-35
SOURCE OF REQUEST: BARBARA MOORE DATE: 10/04/02
DWELL ING:
T"fPE OF CONSTRUCTION:
FOI~DATION:
TOT~25 ROOMS: 1ST FidE.:
BA'I'~OO~ {S): 1.0
POR~ ~"fPE:
BREEZE}{Ay:
~STIC H~'r~:
~E ~T: 0IL
WOOD FRAME # STORIES:
CONCRETE BLOCK CELLAR: FULL
5 21{I) FIR.: 0
TOILET ROO~ (S): 0.0
DECK TYPE:
TYPE ~'rl~K: SUPER STORE
1.0 # EXITS: 2
~ SPACE:
3RD FLR.: 0
~TILI~"f RO(~4(S):
PATIO
ACCESSORY STRUCTURES:
~GE, TYPE OF CONST.:
SWIPING POOL:
1 1/2 CAR WOOD FP, AME STOP, AGE, ~PE CONST.:
(~3EST, ~"fPE CONST.:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
TOWN OF SOUTHOLD /, .' ~;
BUILD?oGwDNEitPAALRLTMENT '~/ S~D .. ,~ 7~~
765-1802 / ~.~,'-. --.~ i
APPLICATION FOR CERTIFICATE OF OCCUPANCY '~' '~:"
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
Ao
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.
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 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.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $25.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Old or Pre-existi¥ Building:
House No. Street
New Construction:
Location of Property:
(check one)
Suffolk County Tax Map No 1000, Section ~'[ ~ Block
Subdivision '~-~ ~ ~ ~ ~6t'~k~O~4 /4c~_~, ~c~Filed Map.
Permit No. ~' Date of P~rmit. ' ~ ~ Applicant:
Hamlet
Lot
Lot:
Health Dept. Approval:
Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ / ~ (~>
Final Certificate:
(check one)
Applicant Signature
CONSENT
TO "
INSPP. CTION
Owner(s) Narne(s)~
do(es) hereby slate.:
That the ur.
of Southold loc-~
County tax map
· , the undersigned,
dersigned (is) ~ the owner(s) of the premises in the Term
· which is shown and desighated on the Suffolk
as District 1000, Section ,.,~ F, · Block / , Lot ~
That the ur tersigned (has) (have) filed, 'or caused to be filed, an applica-
tion in'th, Soutl~old Town liuxlciing lnsp~l;~u~ .~ or.£Zoo zo., +h, fnllowinf:
That the u~,dersigncd do(es) hereby give consent to the Building Inspectors
o£ the Town o£ $outhold to enter upon the above desorlbed property· including
deem necessar~wi~h respect to the aforesaid application, including'inspections
to determine that said premises comply with all of the laws, ordinances, rules
and regulations!of the Town of South01d.
The under~i~nedo in consenting to such inspections, do(es) so with the
knowledge and ~nderstanding that any information obtained In the conduct o~
516-477-0130 P:02
Au~27-02 09:59A Wm H Price Jr
N
Lot
~rashing~n
NOT[=5:
MONOMENT FOUNI)
AREA = I~'/:X)O ~p OR O.2~ A~RE5
~APHIC, %ALE · f"= 20'
JOHN C. EHLERS LAND SURVEYOR
6 {~'{' MAIN ST{~Lzl,' N.Y,$, LIC. NO, 50202
RIq~{~RH~AD, N.Y. I 1901
369-8288 Fu. 369-E87 RER~%.Hp ,'-erve~RO$~02-246.pro