HomeMy WebLinkAboutZ-43192 r„1y
Town of Southold
��o�oguEfOi,t 6/28/2022
53095 Main Rd
N z Southold,New York 11971
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: 43192 Date: 6/28/2022
THIS CERTIFIES that the structure(s) located at: 425 Lake Dr, Southold
SCTM#: 473889 Sec/Block/Lot: 59.-5-21
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- 43192
dated 6/28/2022 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 single family dwelling and accessory shed.*
The certificate is issued to Faught Lynn Living Trust
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
1hor' e Signature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 425 Lake Dr, Southold
SUFF.CO.TAX MAP NO.: 59.-5-21 SUBDIVISION:
NAME OF OWNER(S): Faught Lynn Living Trust
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: Faught Lynn Living Trust DATE: 6/28/2022
DWELLING:
#STORIES: 1 #EXITS: 2
FOUNDATION: Cement Block CELLAR: CRAWL SPACE: X
BATHROOM(S): 1 TOILET ROOM(S): UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: 1 GARAGE:
DOMESTIC HOTWATER: yes .TYPE HEATER: Electric AIR CONDITIONING:
TYPE HEAT: Electric BB WARM AIR: HOT WATER:
#BEDROOMS: 3 #KITCHENS: 1 BASEMENT TYPE:
OTHER:
ACCESSORY STRUCTURES:
GARAGE,TYPE OF CONST: STORAGE,TYPE OF CONST: wood frame shed
SWIMMING POOL: GUEST,TYPE OF CONST:
OTHER:
VIOLATIONS:
REMARKS:
INSPECTED BY: JOHNJ DATE OF INSPECTION: 5/19/2022
TIME START: END:
Form No.6
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 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$50.00,2 Iterations to dwelling$50.00,
Swimming pool$50.00,Accessory building$50.00,Additions to accessory build g�$50.00 B side ses$50.00
2. Certificate of Occupancy on Pre-existing Building- $100.00 � L 2019
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00
Date. 5 1 r
New Construction: Old or Pre-existing Building: a/ (check one)
Location of Property: `�oZ Jr aLv&, DP iye,>
House No. Street Hamlet
Owner or Owners of Property: 1_�► �= c,�Q `F L-L V LCV2 r
Suffolk County Tax Map No 1000, Section Block S Lot R
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: $
Ap icant Signature
CONSENT TO INSPECTION
, the undersigned, do(es)hereby state:
4ner(s) Name(s)
That the undersigned (is) (are) the owner(s)of the premises in the Town of
Southold, located at 42 5 L nj6-Z, bCo e- ,
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section 5, Block Lot SQ
That the undersigned(has) (have) filed,or cause to be filed,an application 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 in subsequent prosecutions for violations of the laws, ordinances, rules or
regulations of the Town of Southold.
Dated: 01� 1 >t
(Signature)
L
(Print Na e)
(Signature)
(Print Name)
rg souryO�
TOWN OF SOUTHOLD BUILDING DEPT.
courm 765-1802 Pr, l.,qo
INSPECTION-
FOUNDATION
1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
S
IAJI4j OUA
ctos
DATE 10114 INSPECTOR
1 f 31 7'0 �0Av'y
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TOWN OF SOUTHOLD PROPERTY R g ►RD y 1
OWN ERLSTREET L42,5 VILLAGE DIST. SUB. LOT
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FQR$AER OWNER N E -,V ACR�
C S TYPE OF BUILDING
V I :40A r. • 1, V�<. ✓T I I
RES. SEAS VL. FARM COMM. CB. MISC. Mkt. Vclue
LAND IMP. TOTAL DATE REMARKS
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2 3 6
7
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40�
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E iE ltDING"&14 41
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NEW RMAL BELOW
FARM Acre Value Per VaTde
Acre )0z c1/7y X
Tillable I
Tillable 2
Tillable 3
Woodland
Swampland FRONTAGE ON WATER
Bru'sh'lancl FRONTAGE ON ROAD
House Plot DEPTH
BULKHEAD
Total DOCK
101
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SECTION 72C9 QF THE NEW YORK STATE
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. LOCATION: �v� I, S •
(number & street) (municipality)
SUBDIVISION: MAP-NO.: -. -- LOT(S): ., .
NAME OF OWN R(S)-:
OCCUPANCY: r 1-
(t%yp
_e) (owner-tenant)-
ADMITTED BY: —ACCOMPANIED ACCOMPANIED BY:
KEY AVAILABLE: SUFF. 'CO. TAX MAP'NO. 1000-
SOURCE OF REQUEST:
_..---- ., . . DATE: . . . . . .
DWELLING
TYPE OF CONSTRUCTION: STORIES: # EXITS:
FOUNDATION: �I $ASEIIENT; _CRAWL SPACE:
2
# OF BEDROOMS: IST FLR: J 2ND 'FLA.: 3RD FLA: :
BATHRO`OM(S): ` TOILET R'OOM(S): ------UTILITY ROOM: .
PORCH.TYPE: DECK, TYPE: .. PATIO;TYPE.-
BREEZEWAY:'
YPE:BREEZEWAY:' FIREPLACE: ( QARAGE:
'DOMESTIC HOTWATER: TYPE HEATER: lL AIRCONDITIONING:
U%-- - -
TYPE HEAT A %L1 ARM AI. ,R: HOTWATER:
# OF KITCHENS:`
FINISHED BASEMENT:- YES NO
OTHER:
ACCESSORY STRUCTURES
GARAGE; TYPE OF CONST.: b STORAGE, TYPE CONST.:Ogg S&L
SWIMMING POOL: GUEST,'TYPE CONST: .
OTHER: -
VIOLATIONS:. CHAPTER.144 &N.Y. STATE:UNIFORM FIRE PREVENTION &BUILDING CODE
LOCATION– D�ESCRIPTIQjN A ART. SEC.
tuddizc
REMARKS:
INSPECTED BY: DATE OF INSPECTION:
TIME START: END:.
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