HomeMy WebLinkAboutZ-24651FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF QC~u~ANCY
No Z-24651
Date SEPTEMBER 23, 1996
THIS CERTIFIES that the building
Location of Property. 420 MILL CREEK DIRVE
House No. Street
County Tax Map No. 1000 Section 135 Block 3
Subdivision Filed Map No.
ONE FAMILY DWl~T.LING
SOu'£~OLD, N. ¥.
Lot
Lot No.
Hamlet
45
conforms substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-24651 dated SE~£~BER 23, 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 DWELLING WITH ATTA~D GARAGE *
The certificate is issued to DEBOEAH EWERSIE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. H-051850 - SEP'£~/~BER 13, 1996
PLUMBERS CERTIFICATION DATED N/A
*PT~%SE SEE ATTA~u~D INSPECTION REPORT.
Rev. 1/81
Building I nspe~or
'T()HH OF !;OUIIH)I,B
I.OCAT1011: 420 NILL C~gK DR. SO--OLD, N.Y.
DEBO~H
()(;(;(Ji'~I~;Y SINGLE F~ILY
[i(IUItUI[ Ol; ITI~(IIH[EVI': DE~ S~RSIE I)A'I'E: . SEPT. 6,1996.
I
Form No. 5
TO~ OF SOUTHOLD
BUILDING D£PARTMENT
TOWN F~LL
765-1802
.kPPLiCATION 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,
s:reets, and unusual natural or topographic features.
2. Final Approval from Healmh Dept. of water supply and sewerage-disposa!(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 connains
less :hat 2/10 of i% 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 al! property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect si~ned by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
re~soms therefor in writing to the applicant.
C. Fees
[. 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-existin~ Buildinm - $100.00
3. Copy of Certificate of Occupancy - . .25~
£. Updated Certificate of Occupancy - $50.00
~ 5. Temporary Certificate of Occupanly- R~ile~[i~i.iii[C.~,.~.C.o~.~.ci~i.,_~, 5.11]~ ..........
Location of Property ....
House No. Street ~a~e~
Onwer or O~ers of Property ..........................................
County Tax Ma~ No i000, Section...~. ..... Block ...... ~ ........ Lot...~ ..............
~ermSr 5o ................ Dare Of Pe~5[ ................ App~Scan~ .............................
Health Dept. Approval .......................... Underwriters Approval .........................
_a_nn~n= Board Approval.
Request for: Temporary Certificate ........... Final Certicane ...........
Co Z q65 1
CONSENT
TO
INSPECTION
Owner{s) Name(s)
do(es) hereby state:
· the undersigned,
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Southold located at
· which is shown and designated on the Suffolk
County tax map as District 1000, Section /33~, Block ~ , Lot
That the undersigned (has) (have) filed, or caused to be filed· an applica-
tion in the Sou/~old Town Building Inspector's Office for the following: ~
That the undersigned do(es) hereby give consent to the Buildh~g 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 ail of the laws, ordinances· rules
and regulations of the Town cfi 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
lations of the laws, ordinances, rules or regulations of the Town of Southold.
..... / ~ (signature)
(print name)
(signature)
(print name)
C,
\
~c2'~
\