HomeMy WebLinkAboutZ-26408 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 26408 Date: 04/26/99
THIS CERTIFIES that the building DWELLING
Location of Property 28775 MAIN RD ORIENT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 018 Block 0006 Lot 025
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- 26408 dated APRIL 26, 1999
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 FRONT PORCH AND SIDE SCREENED PORCH.
The certificate is issued to MARGARET A YOUNG
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
2%&
Building spector
Rev. 1/81
Form No. 6
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.
22.. Certificate of Occupancy on Pre-existing Buildine - $100.00
3. Copy of Certificate of Occupancy - ' .251�_, -
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date Apri1 .5 ,. 1999. . . . . . . . . . . . . . . . . . . . . . . .
New Construction. .. . . . . . . . . Old Or Pre-existing Building. . X . . . . . . . . . . .
28775 Main Road Orient
Location of Property.. .. ... .. . . . . . .. .. ... .. . . . . . .. . . .. . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property.. . MARGARET. A. .YOUNG. . . . . . .. . . . . . . . . . . . .
County Tax Map No 1000, Section. l$ . . . ... . . ..Block. 06. . . . . .. . . . . .Lot. . .9 25 . . . . . . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . ... . . . . .
Permit No. . . . . . . . . . . . . . . .Date Of Permit. . .. .. .. . . . . . . . .Applicant. . ... . . . . . . . . . . . ... . . .
Health Dept. Approval. . . . . . . .. .. . . .. . . .. . . . .. . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . ... . . . .. . . . . . ..
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. X . . . . . . . .
Fe Submitted: $.IQQ:OQ . . . . . . . . . . . . . . . . .. . . . -
. . . . . . . . . . . . .
APPLIC
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 28775 MAIN RD ORIENT
SUBDIVISION: MAP NO.: LOT (S)
NAME OF OWNER (S) : MaRG_nRET n XOUNG
OCCUPANCY: eraTrT.F RAMTT,y MARAARET A YOUNG
ADMITTED BY: MARGARET A. YOUNG ACCOMPANIED BY: SAME
KEY AVAILABLE: SUFF. CO. TAX MAP NO. : 18 -6 25
SOURCE OF REQUEST: MARGARET A YOUNG DATE: 04/26/99
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME. # STORIES: 2.0 # EXITS: 3
FOUNDATION: STONE & CONCRETE CELLAR: FULL CRAWL SPACE:
TOTAL ROOMS: 1ST FLR. : 4 2ND FLR.: 4 3RD FLR. : 0
BATHROOM(S) : 1.0 TOILET ROOM(S) : 1.0 UTILITY ROOM(S) : LAUND.
PORCH TYPE: SIDE SCREEN DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: 1 GARAGE:
DOMESTIC HOTWATER: X TYPE HEATER: NATURAL GAS AIRCONDITIONING:
TYPE HEAT: NAT. GAS WARM AIR: HOTWATER: X
OTHER: FRONT PORCH, PANTRY REAR MUD ROOM BILCO ENTRANCE
A fy`ESSQRY STRUCTURES:
GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.:
SWIMMING POOL: GUEST, TYPE CONST.:
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART SEC.
i
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:
:
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REMARKS:
INSPECTED BY: DATE ON INSPECTION: 04/13/99
JO BOUFIS TIME START: 10:00 AM END: 10:30 AM
CONSENT
TO
INSPECTION
MARGARET A. YOUNG the undersigned,
Owner(s) Name(s)
do(es) hereby state:
That the undersigned (is) (KNIO the owner(N) of the premises in the Town
of Southold located at 28775 Main Road, Orient, New York 11957
which is shown and designated on the Suffolk
County tax map as District 1000, Section 18 Block 06 Lot 025
That the undersigned (has) ( ,A) filed, 'or caused to be filed, an applica-
tion in the Southold Town Building Inspector's Office for the following:
e
Certificate of Occupancy on Pre-existing Building
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 tc the aforesaid application, including inspections
to determine that said premises comply with all, of the laws, ordinances, Irules
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: April 5, 1999
ignature)
MARGARET A. YOUNG
(print name)
(signature)
(print name)