HomeMy WebLinkAboutZ-29784FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 29784
Date: 10/23/03
T~IS CERTIFIES that the building DWELLING
I~catlon of Property 3660 WESTPHALIA RD MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
Co%ulty Tax Map No. 473889 Section 113 Block 0009 Lot 013
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
~C~3P~C~f B~3MBER Z- 29784 dated OCTOBER 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 WITH ACCESSORY ONE CAR GARAGE *
be certificate is issued to JOHN D RASANEN
of the aforesaid building.
(OWNER)
SUFFOLK COUNTYDEPARTMENT OFH}L~LT~APPROVAL
ELEC"rRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'£~
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
MATTITUCK
NO.: LOT (S)
SO~Cq{ OF ~NT: DONALD NOVICK, ATTY - 9/23/03 DATE: 10/23/03
DWELLING:
FOUNDATION: CONCRETE
TOTAL RO0~S: 1ST FLR.: --4
PORC~ TYPE: ENCLOSED FRONT
2.0 # MITS: 2
CP~%WL SPACE:
BRICK (REAR)
VIOLATIONS: C}{APTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION kRT. SEC.
~mm~s: NOIE: 50' x 16' ACCESSORY STRUCTURE DEMOLISHED & REPROVED.
~ oE ~ESP~c-rIo~: I0/08/03 reinspected 10/21/03
TIE ~TART: 9:45 AM ~D: 10:15 AM
Form No. 6
TOWN OF SOUTHOLD
BU1LDING 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:
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, iudnstrial building, multiple residences and similar buildings and installations, a ce~lificate
of Code Coiupliance from architect or engineer responsible for the building.
6. Submit Plamfing Board Approval of completed site plan reqoirements.
For existing buildings (prior to April 9, 1957) non-couforming uses, or buildings and "pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and anusual natural or topographic
features.
2 A properly completed application and consent ~o inspect signed by the applicant. If' a Certificate of Occupancy is
denied, (be Building Inspector shall state the reasons flaerefor in writing to tbe applicaut.
Fees
1 Certificate of Occupan%' New dwellmg $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swimnfiug 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 Occupaucy $50.00
5 TemporaryCe~tificateofOccupancy Residential $1500, Commercial $15.00
Date.
New Construction: Old or Pre-existing Building:~ /
House No. Street
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section I [ ~ Block
Subdivision Filed Map.
(check one)
Hamlet
Lot
Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval:
Underwriters Approval:
Plamaing Board Approval:
Request for: Tempo-ar5, Certificate
Fee Subxrdtted: $ [/Y'O, (YO
Final Certificate:
Applicant Signature
76S*~.802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] ~ULATION
· [ ]FRAMING [.~FINAL
'"~,,,~ FIREPLACE & CHIMNEY
INSPECTOR ~ /'~/
CONSENT TO INSPECTION
Suffolk County Public Administrator, as
Administrator of the Estate of
John Rasanen
Owner(s) Name(s)
the undersigned, do(es) hereby state:
That the undersigned (is) (are) the owner4~S) of the premises in the,Town
Southold, located at ~(~ (-tO {2,JOS[~ 'J~[ Ok ~i~0 ~{O~-~F~
which is shown and designat,qd on the Sufirblk County Tax Map as District 1000,
Section i i~_, Block o~ , Lot 0 { ~
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:
9/23/03
(Signature)
Donald Novick. Esq.. As Attorney
(Print Name)
(Signature)
Suffolk County Public Administrator,
(Print Name)
As administrator of the estate of John
maganen