HomeMy WebLinkAboutZ-12824 TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, NEW YORK
'CERTIFICATE OF OCCUPANCY
NONCONFORMING PREMISES
THIS IS TO CERTIFY that the Pre- C.O. # Z12824
Land Date Oct. 2 ,1984
Building(s)
/ / Use(s)
located at 1495 Village Lane Orient
Street Hamlet
shown on County tax map as District 1000, Section 025 Block 03 ,
Lot 002 doesinot)conform to the present Building Zone Code of the
Town of Southold for the following reasons:
Insufficient Total Area, Insufficient Front & Side Yard Set-Backs,
Insufficient Side Yard Setback on Accessory Building
On the basis of information presented to the Building Inspector's Office,
it has been determined that the above nonconforming /X/Land % X/ Building(s)
/_/Use(s) existed on the effective date the present Building Zone Code 'of the
Town of Southold, and may be continued pursuant to and subject to the appli-
cable provisions of said Code.
IT IS FURTHER CERTIFIED that, based upon information presented to
the Building Inspector's Office, the occupancy and use for which this Certifi-
cate is issued is as follows: Wood framed building wood accessory garage
situated in the A Residential-Agricultural Zone with access to Village
Lane, a Town Maintained Highway.
The Certificate is issued to MABEL RICHARD
..(owner, 1Pssee nr tenant)
of the aforesaid building.
Suffolk County Department of Health Approval N/A
UNDERWRITERS CERTIFICATE NO. N/A
NOTICE IS HEREBY GIVEN that the owner of the above premises HAS
NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec-
tor to determine if the premises comply with all applicable codes and ordin-
ances, other than the Building Zone Code, and therefore, no such inspection
has been conducted. This Certificate, therefore, does not, and is not intended
to certify that the premises comply with all other applicable codes and regula-
tions.
L
Buildinc inspector
r 1 -
FORM NO.6
TOWN OF SOUTHOLD
Building Department
Town Hall
r Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in
for with the following;for new buildingsror neOw use:R ink, and submitte to the Building Inspec-
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal—(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling land use --Pre-Existing C . O. $ 15 . 00
3. Copy of certificate of occupancy $1.00 ///
Vacant land C . O . $ 5 . 00
Date ,Oct: , 2;1984. . . . . . . . . . , .
New Building . . . . . . . . . . . . . Old or Pre-existing Building . . . . , , , ,
Vacant Land . . . ,
Location of Property .1495 Village Lane Orient• • • . .
Ho�sb No. . . . . . . . . . . . . . . . . Street . . . . . . . . . . .
� ��4ejjQhard • . Ham/et
Owner or Owners of Property . , . . . , , , , , ,} -s- r. . . &i ra��,,Ufa eia-"kiatar-,-2aro3..-jrwin
County Tax Map No. 1000 Section . . . . .25 , , , , , . , Block . . . . . .3 2
. Lot . . . . .
Subdivision . . . . . .N/A. . . . . . . . . . . . . . . . . . . . . . . .Filed Ma N/A . . . . . . . . . . .
p No. . . . . . . . .Lot No. N�A
Permit No. . . . . . . . . . Date of Permit . . . . , , , ,Applicant , , ,Roxanna Mellinger . • . . . • .
. . . . . . . . . . . . . . . . . .
Health Dept. Approval . . . . . . . .
• . . . . . . • . . . . .Labor Dept. Approval „ N/A . , • , .
Underwriters Approval . . . . . . .NSA, , , , , , , , , , , , , ,Planning Board Approval . , >1 -A , , , , , , , • . . . .
Request for Temporary Certificate . N/A � � � •
• a'Pre-ExistirigFC,�S Certificate . . . . . . . . . . . . . . . .
Fee Submitted $ , , , , • 16:00 1;00 Copy
. . . . . . . . . .
Construction on above described building and permit meets all applicable codes and regulations.
�. _Aq q�
QM,Cb a 1.).92L4 Applicant
Rev.10.10-78
•r
AFFIDAVIT
STATE OF NEW YORK)
) SS. .
COUNTY OF MONROE )
1. ROXANNA R. MELLINGER being duly sworn, desposes, and says:
2. I am a partial owner and I am familiar with the property located
at 1495 Village Lane, Orient, Long Island, New York.
3. I grew up in the house and lived in the above said property prior
to April 23, 1957.
4. Since April 23, 1957, I have visited the above said property several
times each year.
5. To the best of my knowledge, there has been no alterations, additions,
or changes to the above said property since April 23, 1957.
6. I make this affidavit for the sole purpose of inducing the Town of
Southold Building Inspector to issue a Pre-Existing Certificate of Occupancy,
knowing full well that said Building Inspector will rely upon the representations
made herein.
Depo ent
Sworn to before me this day of
Not ry, blic
Notar VIRGINIA A. JONES
Y public, State of
N•Y• Monroe fvil Com Reg 4694836 Co,
mission Expires A7arch 30, j9
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