HomeMy WebLinkAboutZ-41170 Town of Southold
6/11/2020
ao� GG 53095 Main Rd
Southold,New York 11971
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 41170 Date: 6/10/2020
THIS CERTIFIES that the structure(s)located at:. 54100 Route 25, Southold
SCTM#: 473889 Sec/Block/Lot: 61.4-20
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 41170
dated 6/10/2020 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
wood frame one family dwelling with walk up non-habitable attic and two commerical occupancies and an accessory
gars e/g storage/workshop with unfinished loft.*
Notes: BP 1050 addition COZ-640: BP 33262 alteration(office)COZ-33456; BP 42565 Electric COZ-39600
The certificate is issued to Rothman R H Cred Shel Trust
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
i)4,YVV —,A/
ut o ' d Signature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 54100 Route 25, Southold
SUFF.CO.TAX MAP NO.: 61.4-20 SUBDIVISION:
NAME OF OWNER(S): Rothman R H Cred Shel Trust
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: Rothman R H Cred Shel Trust DATE: 6/10/2020
DWELLING:
#STORIES: 2 #EXITS: 2
FOUNDATION: stone/block/brick CELLAR: partial CRAWL SPACE:
BATHROOM(S): 2 TOILET ROOM(S): UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: GARAGE:
DOMESTIC HOTWATER: x TYPE HEATER: AIR CONDITIONING:
TYPE HEAT: oil WARM AIR: HOT WATER: steam
#BEDROOMS: 4 #KITCHENS: 1 BASEMENT TYPE: unfinished
OTHER:
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: wood frame garage STORAGE,TYPE OF CONST:
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
INSPECTED BY: JOHNJ DATE OF INSPECTION: 2/27/2020
TIME START: 3:45pm END: 5:30pm
Form No.6 t
TOWN OF SOUTHOLD z - `
BUILDING DEPARTMENT
TOWN HALL E E B 2 6 2020
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. 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 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$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 /A
Date. �:MI2vt�l h�
New Construction: Old or Pre-existing Building: V (check one)
Location of Property: ���'E �� ( vL �p a"�
House No. Street Hamlet
Owner or Owners of Property: r �GV'r�,D�_LVIA k—Cy7d W111
Suffolk County Tax Map No 1000, Section CO ( Block 'n Lot Z�
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ U�
Applicant Signature
le
CONSENT TO INSPECTION
`a#- r I a ff( the undersigned, do(es)hereby state:
Owner(s)Name(s)
That the undersigned(is) (are)the owner(s) of the premises in the Town of
Southold, located at Lbs 4A1 -�-6gd-, SSD&6( k,
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section L ( ,Block Q1- , Lot c-1D
That the undersigned(has) (have)filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following:
h of l Pr e- C O ,
Aff—I-At c-�- !!52t V d;
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 in subsequent prosecutions for violations of the laws, ordinances, rules or
regulations of the Town of Southold.
Dated: �bi
n (Signature) A�,
IC 4N A-LD 1�TV'ld�wfu
(Print Name)
(Signature)
(Print Name)
February 25, 2020
Ronald Rothman
Town of Southold
Building Department
54375 Main Road
Southold,NY 11971
Re: 54100 Main Road, Southold
To Whom It May Concern:
Please allow this letter to be my authorization for GLENN HEIDTMANN to be the
official agent for all aspects of renovation and/or alterations at 54100 Main Road,
Southold,NY.
Thank you
Sincerely,
-" Kxt-"'�
Ronald Rothman
,
Subscribed and swo before me this o2�(4 ay of , 2020
G
ary P blic
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1 1 r
LOI'1ie 1,A L AMB
Nowy Public,State of New York
#`01 LA6179883 _
Culled to Suffolk County
Term Expires December 31.
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ELEVATIONS REFERENCED TO NA VD 88 PECOAWdt�A�_ ) S,•P.C.
ANY ALTERA71ON OR ADDITION TO THIS SURVEY IS A WOLAnON OF SEC77ON 7209 OF THE NEW YORKAREA= 12,491 SQ. FT. (6J1) 765-5020 FAX (631) 765-1797
STATE EDUCATION LAW. EXCEPT AS PER SEC77ON 7209—SUBDIVISION 2. ALL CER7IFICA77ONS HEREON P.O. BOX 909
ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR 7HE IMPRESSED 1230 TRAVELER STREET
SEAL OF 7HE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y. 11971 20-001
apF SObTyo�
# # TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ]--FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) MICTRICAL (FINAL)
[ ] CODE VIOLATION [ PRE C/O
REMARKS:
DATE Y INSPECTORjX44vj0;0
. , (A
LOCATION; Ufl -
(number & street) (municipality)
SUBDIVISION: MAP:N'0 -' LOT(§L.
NAME OF OWN R(S; , {
O-CCUPANCY: wl
(type) (owner-tenant)-
ADMITTED BY: ACCOMPANIED BY:
KEY AVAILABLE: SUET. 'CO. TAX MAP�N . 1000- •" —Yl�
�OURC'E OF REQUEST: �� DATE: d
DWELLING
TYPE OF CONSTRUCTION: IAMi � # STORIES: '# EXITS:
FOUNDATION: %ne.. �/ yfI G L ; 1wvMENT: , 'CRAWL S ACE:
_ Q v .Na�1
# OF BEDROOMS: 1STFLR: � T �G
,BATHRO-OM(S): _ y TOILET Ri00M(S):• UTILITY ROOM:
PORCH.TYPE: D'E•CK, TYPE: .. . PATIO;TYPE:
BREEZEWAY:' F_. FIREPLACE: . ,/4 GARAGE: q✓. �!o✓ L P
DOMESTIC,HOTWATER: TYP9 HEATER: ,AIRCONDITIONING:
r
TYPE,HEAT-: V WARM_ AYR: HOTWATER SI
'# OF KYTCHENSi •
FINISHED BASEMENT:- YES NO
OTHER: 1A,t1l
ACCESSORY STRUCTURES .
GARAGE; TYPE OF CONST.:W STORAGE) TYPE CONST.:._
IMMING FOOL: GUEM'TYPE CONST:
VIOLATIONS; CHAPTER.144 &N.Y. STATE:UNIFORM FIRE PREV$NTION & BUILDING CODE '
LOCA T 0 DFS PT ON ART, SEC,
REMARKS:
INSPECTED BY, J n DATE OF INSPECTION:
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TIME START: s��i�? END;
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