HomeMy WebLinkAboutZ-21097FORM NO. 4
TOWN OF SOUTHOLD
BUILDIN~ DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-21097
Date OCTOBER 16{ 1992
THIS CERTIFIES that the building,
Location of Property 625 FRANKLINVILLE ROAD
House No. Street
County Tax Map No. 1000 Section 125 Block 2
Subdivision Filed Map No.
ACCESSORY STRUCTURE
LAUREL{ N.Y.
Lot 1.25
Lot No.
Hamlet
conforms substantially to the Requirements for a Accessory Structure built
Prior to: APRIL 9~ 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-21097 dated OCTOBER 16~ 1992
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 ACCESSORY 10.4 x 31.6 ONE STORY BUILDING
The certificate is issued to LISA PETERS-KOT
(owner)
of the aforesaid building.
SO~'~'OLK COUNTY DEPARTMENTOF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
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 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 f~om Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder ~sed in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences an~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
Vpre-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 anH'~ 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.
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-existing Building.- $100.00
3. Copy of Certificateof Occupancy - $5.00 over 5 years - $10.00
4. .Updated Certificate of Occupancy - $50.00
5. T~mporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date October '~, 1992
Construction ........... Old Or Pre-existing Building..X .............. :
ocation of Property...~P~ ........... F~u%gl~v~ll~.~ .................... .. . .. .
.... House No. Street Hamlet
Owners of Property
Or
ewer .. . .,...... ..... ....,... .... .--.........o.o...,.
~unty Tax Map No 1000, Section..%~ ......... Block ...... P~ ....... Lot 1.~5.
,bdiviaion ~[~.'. " ; Filed Map ~V.% Lot ~
:rmit No ................ Dat~ Of Permit ................ Applicant .............................
· alth Dept Appro al
arming Board Approval .....................
quest fo[: Temporary Certificate .........
e Submitted: $. ~OO~ O/l ..................
'"
...Underwriters Approval .........................
James A. Schondebare, Attornev/acenr
TO
Lisa Peters-Kot
do(es) hereby state:
That the undersigned (is) (arc) the owner(s) of thc promiser; [n [he Tow
of Sou:hold located ak Franklinville Road, Laurel
, xvh[ch [s sho%vn and dcsicn.ntcd on the Suffolk
County tax map as District 1000, Section 125 . Elock 02 . Lot 1.25
'That the undersigned (has) (have) filcd, or caused ~o be filed, an nppl~ca-
tion in the Southcld To%%~ Euildin~ Inspector's Office for the follov;~: __
3~-4 x 31.6 one story building
That the undersigned do(es) hereby give consent to the Building Inspectors
of the Town of Southoldto enter upon the above described property, including
any and all buildings located thereon, to conduct such inspections as they
deem necessary with respect to the aforesaid applies:ion, inc!udLn% inspections
to dc:ermine that said premises comply with all of the laws; ordinances, rules
and regulations of the Town of Southold.
The undersigned, in consentin~ to such inspections, do(es) so ~cith 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 thc laws, ordinances, rules or regulations of ~he Town of Southold.
Dated: October 8, 1992
J~mes A. Schondebare, Attorney/Agent
{print na~nc)for Lisa Peters-Kot