HomeMy WebLinkAboutZ-29166FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 29166
Date: 01/07/03
TI{IS CERTIFIES that the building DWELLING
Location of Property 2555 OLD ORCHARD RD
(HOUSE NO.) (STREET)
County Tax Map No. 473889 Section 037 Block 0006
subdivision Filed Map No. __ Lot No.
conforms su]~stantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 p%mrsuant to which CERTIFICATE OF
OCC~JPANCY NUMBER Z- 29166 dated JANUARY 7, 2003
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 *
EAST FLARION
(HAMLET)
Lot 006.001
The certificate is issued to RALPH MARTIN, JR.
( OWNER )
of the aforesaid building.
SUFFOI.KCOUNTSfDEPAR~?4ENTOF~AL~APPRO~J~
ELEC~r~ICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DAT~
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
N/A
N/A
N/A
A~thori z e;'S ignature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 2555 OLD ORCHARD RD
SUBDMSION:
NAME OF OWNER (S): RALPH MARTIN, JR.
OCCUPANCY: SINGLE FAMILY
AD~i-,-r~U BY: RALPH MARTIN
SOURCE OF REQURST:
EAST MARION
MAP NO.: LOT (S)
RALPH MARTIN, JR.
ACCOMPANIED BY: SAME
SUFF. CO. TAX MAP NO.: 37.-6-6.1
RALPH MARTIN, JR. 02/12/01 DATE: 01/07/03
DWELLING:
TYPE OF CONSTRUCTION: WOOD FR3%ME # S~)RIES:
FOUNDATION: CEMENT BLOCK
~(S): 1.0 DI~ R~(S): 1.0
PORCH T~PE: REAR ENCLOSED
BREEZEWAY:
T"fPE HEAT: OIL
DECK TYPE:
FIP~EPLACE: ONE
XX TYPE HEA'r~K: OIL FIRED
NOTE; 2ND FLOOR UNHEATED AREA.
1.5 # EXITS: 3
CRAWL SPACE:
3RD FLR.: 0
t]TILITY ROOM(S}: MUD
PATIO TYPE:
GARAGE:
AIRCONDITIONING: CENTRAL
ACCESSORY STRUCTURES:
TYPE OF CONST.:
SWI~4ING POOL:
STORAGE, TYPE CONST.:
(~3EST, TYPE CONST.:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
P,~KS: BP#2902~-29165 (AIR COND.& NEW FUP~NACE)
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FORCERTIFICATE 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:
i. 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 o{ 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 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
is. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, ~wimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
Z. Certificate of Occupancy on Pre-existing Buildin~ - $100.00
3. Copy of Certificate of Occupancy - ,
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .... ~'{.L (~'. l ~ ( ..........................
New Construction ........... Old Or Pre-existing Building...~ ............. !
, ..... o t)
=oca~lon oz rroper~y ....... ...... ........... -, ....... ~..-.~... ........ ......,~. .............
House No. Street Hamlet
Onwer or Owners of Property ................ ~ .......................................
County Tax Map No 1000, Section .............. Bf~ck ................
Subdivision .................................... Filed Map ............ Lot ......................
........................... A ii a i~ ~tO~( ~.77~;,~ ..
Permit No. ..Date Of Permit. . pp c nt[~ .........................
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final C~
Fee Submitted: $ ..... [..~. ~ '. ................... · ~:'
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
?
CONSENT
TO
INSPECTION
Owner(s) Name(s)
do(es) hereby state:
, the undersigned.
of Southold located at
County tax map as District 1000, Section
That the undersigned (is) (are) the owner(s) of the premises in the Town
· which is shown and designated on the Suffolk
· Block , Lot
That the undersigned (has) (have) filed, 'or caused to be filed, an applica-
tion in the Southold Town Building Inspector's Office for the following: ~
_y;. ~ ....
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 tn the conduct of
such inspections may be used as evidence in subsequent prosecutions for vio-
Iations o~ the laws. ordinances, rules or re~ulations/;/~;r~,,wn of Southold.
Dated:
(print name)
(siEnaiure)
LoT' 7
b~A~7'IN
/.o:r 6
/D