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Home My WebLink AboutZ-24664FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING C~RTIFIC~TE OF OCcu~A_NCY No Z-24664 Date OCTOBER 1, 1996 THIS CERTIFIES that the buildin~ Location of Property PENINSULA ROAD House No. County Tax Map No. 1000 Section 10 Subdivision ONE FAMILY DWELLING FISHERS ISLAND, N.Y. Street Block 3 Filed Map No. Lot Lot No. Hamlet 2O conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-24664 dated OCTOBER 1, 1996 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 DW~.ING WITH ACCESSORY GARAGE * The certificate is issued to ROBERT C. & ~u~IA R. SORENSON (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A *PT.RASE SEE ATTA~D INSPECTION REPORT. Rev. 1/81 I()Ufi OF ,~;(}HIIH)i.I) I,OCA'I'I(}IIt PENINS~A RO~ FIS~RS ISL~, I;UIH)IVI~ifO~I HAP H(), I.OT(,) (11111~1{ ~ ItI~IIAllK!;: Form No. 6 TOWN OF SOUTtIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 mo . 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 from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/lO.of l%.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 Ppre-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. 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 Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ...... ................ : ........ New Construction ........... Old Or Pre-ex~ting B, uildi~..z.~ ....... A/~).,. / ~ . Lo~ation of Property j~,.(~.'~ ~'/ . ~.~..~. O..c~ ~.~.. ~f_~/~ House ~ ~h Street /-~ ~ Hamlet Onwer or Owners of ' f ~~~ Proper ty. ~...~.. ~ 7-.~...-. '. ................................. County Tax Map No i000, Section ..... /.0 ....... Block...-~ ............ Lot.. :~-.~. ................ Subdivision .................. ~ ................. Filed Map .......... ,.Lot..,..,..~ ............. Permit No ................ Date Of Permit ............. ...Applicant..~.~.~¥...'.. ........ tlealth Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ............. ; ....... :... Request for: Tempo. rary Certificate ........... Final Certicate ........... ..... ...... ' ............. A PLZCa T' ...... ....... CONSENT TO INSPECTION _Robert C. and Julia R. Soren. srYn , the undersigned, Owner(s) Name(s) do(es) hereby state: That the undersigned (is) (are) tile owner(s) of the prelx]ises in the Towlq of Southold located at Peninsula Roadr Fishers Island, New York · which is shown and designated on the Suffolk County tax map as District 1000, Section 10 , Block 3 , Lot 20 .. That the undersigned (has) (have) filed, or caused to be filed· an appli, ca- tion in the Southold Town Building Inspector's Office for the following:__ Cer_tit~iaat-a nf O~_m~paney on_pra=axist-irlQ Building That the undersigned do(es) hereby give consent to the Building Inspeciors of the Town of Southold to enter upon the above described property, iucluding 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 ali of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such fl~speetions, do(es) so with the knowledffe and understandin~ that any information obtained In the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- o ,ho,d. // // Dated: ~p~mh~r la~ !996 ~~ /~ ~ r /(sig~atu~e)~ Bagley Reid, Agent (print nan~e) (signature) (print name)