HomeMy WebLinkAboutZ-23622FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
UPDATED
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No Z-23622 Date MAY 10, 1995
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 1460 TOWN HARBOR LANE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 64 Block 5 Lot 12.1
Subdivis
Filed Map No. Lot No.
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957
OCCUPANCY NUMBER Z-23622
pursuant to which CERTIFICATE OF
dated MAY 10, 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 DWELLING WITH ACCESSORY GARAGE
The certificate is issued to ANDREW P. KRUPSKI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*NOTE: THIS UPDATES PRECO Z-7232 DATED SEPT. 13, 1976.
B lding sp ctor
Rev. 1/81
Form No. 6 7 y -4--0
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 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.
B. 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 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 - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .,Februpr,X_10,,,,1995,,,,,,,,,,,,,,,,,,,
New Construction........... Old Or Pre-existing Building...* .............
Location of Property... 146Q ............ TPX11,Harbr
o,Lane............ $ PW; $ 91.4............
House No. Street Hamlet
Andrew P. Kru ski
Onwer or Owners of Property.... p .............................................
County Tax Map No 1000, Section..f 4..........Block.....5..........Lot.....I2.J ............
Subdivision.P.AiW];.ArXkq'1 P%....Filed Map..3 U.....Lot....I.................
Krupski
Permit No................Date Of Permit ................ Applicant .............................
Health Dept. Approval..........................Underwriters Approval.........................
Planning Board Approval ........................
Request for: Temporary Certificate........... Final Certicate... X.......
Fee Submitted: $ 50: 00.......
Y3y..................................
APPLICANT Andrew P. Krupski
,fied,a�7C..c2. CO - ---
CONSENT
TO
INSPECTION
ANDREW P. KRUPSKI the undersigned,
Owner(n) Name(:9)
do(es) hereby state:
That the undersigned (is) (zzW the owner(a) of the premises in the Town
of Southold located at 1460 Town Harbor Lane, Southold, New York
which is shown and designated on the Suffolk
County tax map as District 1000, Section 64 , Block 5 , Lot 12
That the undersigned (has) (Ammar) filed, or caused to be filed, an applica-
tion in the Southold Town Building Inspector's Office for the following:
UPdated Certi.ficate of Occupancy on Pre-existina buildincr.
That the undersigned do(es) hereby give consent to the Building Inspectors
of the Town of Southold to enter upon the above described property, including
any and all buildings located thereon, to conduct such inspections as they may
deem necessary with 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 Southold.
The undersigned, in consenting to such inspections, do(es) so with 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 the laws, ordinances, rules or regulations of the Town of Southold.
Dated: February 10. 199
(signature)
Andrew P. Krupski
(print name)
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