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Home My WebLink AboutZ-29587 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- 29587 Date: 07/23/03 THIS CERTIFIES that the building DWELLING Location of Property 165 BUNGALOW LA MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 123 Block 0003 Lot 004.001 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- 29587 dated JULY 23, 2003 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 The certificate is issued to MARIE HILLER (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. A oriz d Si ature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 165 BUNGALOW LA MATTITUCK SUBDIVISION: MAP NO.: LOT (S) NAME OF OWNER (S) : MARIE HILLER OCCUPANCY: SINGLE FAMILY DWELLING MARIE HILLER ADMITTED BY: SUZANNE SMITH ACCOMPANIED HY: SAME KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 123.-3-4.1 SOURCE OF REQUEST: OLSEN & OLSEN, L.L.P. 6/23/03 DATE: 07/23/03 DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 1.0 # EYITS: 4 FOUNDATION: CEMENT BLOCK CELLAR: 2/3 CRAWL SPACE: 1/3 TOTAL ROOMS: 1ST FLR.: 7 2ND FLR.: 0 3RD FLR.: 0 HATHROOM(S) : 2.0 TOILET ROOM(S) : 0.0 UTILITY ROOM(S) : 1 PORCH TYPE: REAR COVERED DECK TYPE: PATIO TYPE: CEMENT BREEZEWAY: FIREPLACE: ONE GARAGE: DOMESTIC HOTWATER: YES TYPE HEATER: ELECTRIC AIRCONDITIONING: TYPE HEAT: OIL WARM AIR: XX HOTWATER: OTHER: ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: 1 CAR WOOD FRAME STORAGE, TYPE CONST.: SWIMMING POOL: GUEST, TYPE CONST.: OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. RRNTRRC: BP#5133-Z CO Z-4281 (ADDITION) INSPECTED BY: DATE ON INSPECTION: 07/08/03 GARY S. PI TIME START: 10:20 AM BND: 10:40 AM Form No.6 TOWN OF SOUTHOLD 3 2003BUILDING 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$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. 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. Temporar}WCerti-ficate of Occupancy-Residential $15.00, Commercial $15.00 Date. June 10, 2003 New Construction: Old or Pre-existing Building: X (check one) Location of Property: 165 Bungalow Lane Mattituok House No. Street Hamlet Owner or Owners of Property: Estate of Marie Hiller Suffolk County Tax Map No 1000, Section Block 3 Lot 4.1 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: $ 100.00 OLSEN & OLSEN LLP u rrII 32495 MAIN ROAD PO BOX 708 Applicant gj(gF1000E,NY 119311 PP Signature CONSENT TO INSPECTION Estate of Marie Hiller by Gary FlanAer Olsen as Attorney the undersigned, Owners) Names) do(es) hereby state: That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold located at 165 Bungalow Lane, Mattituck which is shown and designated on the Suffolk- County uffolkCounty tax map as District 1000, Section 123 Block 3 Lot 4.1 That the undersigned (has) (have) filed, or caused to be filed, an applica- tion in-the Southold Town Builaing inspecw. ro,. +ka fnllnwing: House and detached garage 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: June 10, 2003 (signature) Gary Flanner Olsen (print name) (signature) GUARANTEES INDICATED HERE ON SHALL RUN pSURVEY OF ONLY TO THE PERSON FOR WT IOM THE SURVEY DESCRIBED PROPERTY IS PREPARED, AND ON HIS BEHALF TO THE DILE COMPANY, GOVERNMENTAL AGENCY, SITUATE LENDING INSTINTTON, IF LISTED HEREON, AND TO THE ASSIGNEES OF THE TRANSFERABLE TO INSTITUTION MATTITUCK TOWN OF SOUTHOLD GUARANTEES ARE NOT TRANSFERABLE TO , ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS WATER SUFFOLK UNAUTHORIZED ALTERATION OR ADOOION TO TH15 PPRox' SUFFOLK COUNTY, N. SURVEY) THE NEW SYORK VIOLATION EDUCATION LAW 1209 OF A E N 21,70 s 89'14'28"E 4x;40' S pyo is y SURVEYED FOR: RAYMOND WEATHERS COPIES THIS vrURVORS E AP NOT SBEARING EARIEAL aL( N 7.1 317 s 1 \F �'9T ��F BARBARA HILLER WEATHERS NOT BE CONSIDERED TO BE A VALID TRUE C F COPY \ FlT- � \Ss �9�g6�5 \\2\owe GUARANTEED TO: RAY WEATHERS N \ 'r3 BARBARA HILLER WEATHERS \ P � \ 6 0 1 o �9Nb PGP P�P �h °o� s � JUN2 62003 y R9 �h 9r 2 O 510 ATjF� tilp0 x �v, n)\ NUTILITY / QN 8 g$, N POLE 6119PGF, ti TH nV , OVERHEAD DRIVE �' i, WIRES Air y� SURVEYED: 27 AUGUST 2002 2$°O ' SCALE 1"= 40' v UTILITY AREA = AS SHOWN POLE SURVEYED BY STANLEY J. ISAKSEN, JR. P.O. BOX 294 NEW SUFFOLK. N.Y. 11956 631 -7 4-5835 (CENSE LAND SU OR NYS Li I. No. 4927 02C1166 LOCATION: (number& street) (municipality) SUBDIVISION: MAP NO.: LOT(S): NAME OF OWNER(S): OCCUPANCY: (type) (owner-tenant) f ADMITTED BY: ACCOMPANIED BY: KEY AVAILABLE: SUFF. CO. TAX MAP NO. 1000- SOURCE OF REQUES DATE: DWELLING: TYPE OF CONSTRUCTION: GJ .0 # STORIES- 0-Jjf-- # EXITS: FOUNDATION: ce6nuo CELLAR: CRAWL SPACE: TOTAL ROOMS: 1,$,T FLR: 2ND FLR: 3RD FLR: BATHROOM(S): ,� _ TOI ET ROOM(S): UTILITY ROOM: _ PORCH TYPE: DECK, TYPE: r---- PATIO, TYPE: BREEZEWAY: � FIREPLACE: GARAGE: --� DOMESTIC HOTWATER: � TYPE HEATER: —e . AIRCONDITIONING: TYPE HEAT: —WARM AIR: HOTWATER: OTHER: ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: 0 STORAGE, TYPE CONST.: SWIMMING POOL: UEST, TYPE CONST: OTHER: VIOLATIONS: CHAPTER 45 &N.Y. STATE UNIFORM FIRE PREVENTION &BUILDING CODE LO TION D SCRIPTION ART. SEC. . 07► tea. �3 REMARKS: INSPECTED BY: DATE ON INSPECTION: TIME START: 10 },(j END: ftp