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Home My WebLink AboutZ-26196FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 26196 Date: 12/29/98 THIS CERTIFIES that the building DWELLING Location of Property 360aka307 CHAMPLIN PL GREENPORT (HOUSE NO.) (STREET} County Tax Map No. 473889 Section 034 Block 0003 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 26196 dated DECEMBER 29, 1998 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 ATTACHED PORCH.* (HAMLET) Lot 040 The certificate is issued to JEROME & PATRICIA URBAN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. Rev. 1/81 N/A H4831 N/A Building Ins/ector aka 307 LOCATION: 360 /Cmm~PLIN PL SUBDIVISION: NAME OF OWNER (S): JERONE & PATRIC~ URBAN OCCUPANCY: A-1 RESIDENTIAL ADMITTED BY: JEROME URBAN BUILDING DEPARTMENT TOWN OF SOUTHOLD EOUSING CODE INSPECTION REPORT GREENPORT MAP NO.: -- LOT (S) -- JEROME & PATRICIA URBAN ACCOMPANIED BY: SAME KEY AVAILABLE: __ SUFF. CO. TAX MAP NO.: 34.'3'40 SOURCE OF REQUEST: JEROME & PATRICIA URBAN DATE: 12/29/98 TYPE OF CONSTRUCTION: WOOD FRAME FOUNDATION: CONCI~ETE BLOCK & POURED CONCRETE TOTAL ROOMS: 1ST FLR.: __~ BATHROOM (S): 1,0 PORCH TYPE: FRONT ROOF BREEZEWAY: DOMESTIC HOTWATER: ~ TYPE HEAT: OIL 2ND FLR.: TOILET ROOM(S) DECK TYPE FIREPLACE: TYPE HEATER: ~ WARM AIR: HOTWATER: OTHER: BASE OF PORCH REMOVED ~ STORIES: 2.5 # EXITS: CELLAR: PART CRAWL SPACE: 3RD FLR.: ._~ O-0 UTILITY ROOM(S): -- PATIO TYPE: GARAGE: AIRCONDITIONING: ACCESSORY STRUCTUP~E$: GARAGE, TYPE OF CONST.: SWIMMING POOL: OTHER: STORAGE, TYPE CONST.: GUEST, TYPE CONST.: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION , DESCRIPTION ~ ART. SEC. INSPECTED BY: , DATE ON INSPECTION. 12/03/95 HN M." BOUFIS TIME START: 10:50 ' END: 11:20 DATE: 12/9/98 ELECTRICAL INSPECTION SERVICE INC. 375 DUNTON AVENUE EAST PATCHOGUE, NEW YORK 11772 (516) 286-6642 H4831 ,dPPLIC,4TION No. ON FILE VILLAGE: Greenport ADDRESS: 307 Champlin Place ISSUED TO: Jerome Urban TOg~T¢: Southold INTRODUCED BY: Above was examined on LIC No: 12/9/98 and found to be in complianc~ w~th th~ National Electrical Code LOCATION: Base., xx 1st 2nd 3rd Attic DeL Garage Hot Tub Pool SWITCHES RECEPTACLES FIXTURES HEATERS FANS G.F.L AIR. COND. DISHWASHER DRYER CLOIHES WASH. GAR. DISP. RANGE ' OVEN SMOKE DETECTOR FURNACE OIL GAS CIR~ MOTORS [ BF.t.L IItAN. SERVICE DISCONNECT 1 100 OTHER EQUIPMENT Outside, Res. Panel Only HUGO X. SURDI PRF_,~2DENT BUILDING PERMIT No. TlUs ~fieatemustr~t ba a/~ed ~a ~ny maranar BLUE ORIGINAL YELLOW COPY PINK COPY OFFICE 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 inspector with the following: for new building or new use: 1. BLDG. DEPT. 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. .~For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '3pre-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. Certificate of Occupancy on Pre-existinR Buildinm - $100.00 Copy of Certificate of Occupancy - ~ -25~. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residentialj $15~00, Commercial $15.00 ~O) Date .//./.~.7/f~'~,~ ....... ................... uild n . Const~ction...~~. or Fre-exis~!ng B i g..~... ........... House No. ) Street H~ml et _, . .L. ... ?. . . . .,m ...................... ,,nty ~ ~. ,o lOOO, Section..q~Y; ~q .... Bloc~.. [J~,d~ ..... ~ot..(2.~.~.'.~"057 ......... · .rmit No ................ Date Of Permit ................ Applicant ............................. · alth Dept. Approval .......................... Underwriters Approval ......................... 1arming Board Approval ........................ *.quest for: Temporary Certificate ........... Final Certicate.../.. ..... -_,~ub-~tted: *./~..~.,..Ch.. ................... ,./-- ~, ... q o (..x'. . .................. CONSENT TO INSPECTION Owner(s) Name(s) do(es) hereby state: · the undersigned, That the unders ,~is) (are) the owner(s) of the premises in the Town sout o. -- f / ]~-V (f(/' , which is shoxm and designated on the Suffolk ~o~nt~ ~ax m~ ~ ~,~t ~o0o, ~.o~ &>7. ~o~ ~. ~o~ 0 That the undersigned (has) (haue) flied, ~or caused to be flied, an appl~ca- tion in the Southold Town Building Inspector's Office for the following :~ .__ . 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: ,/~/~ i/, ,/ (signature) ....... ) (print name) (signature) (print