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Home My WebLink AboutZ-29844FORM NO. 4 TO~q OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 29844 Date: 11/17/03 TI{IS CERTIFIES that the building DWELLING & ACCESSORY MATTITUCK Location of Property 17905 MAIN RD (HOUSE NO.) County Ta~ ~ap NO. 473889 Section 115 (STREET) (~LA~4LET) Block 0002 Lot 009.002 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 OCC~DPANCYAN3q~BER Z- 29844 dated NOVEMBER 17, 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 ENCLOSED PORCH AND ACCESSORY BARN.* The certificate is issued to BARNEY SIDOR of the aforesaid building. (OWI~ER) SUFFOLK COU1F~YDEPARTMENT OF~L~LTEAt~PROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'r~u3 *PLEASE SEE ATTACHED INSPECTION REPORT. N/A N/A N/A Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT 17905 MAIN RD N~ OF O~ (S): BARNEY SIDOR (~C~/PANCY: SINGLE FAMILY MATTITUCK MAP NO.: LOT (S) BARNEY SIDOR DWELLING: TYPE OF CONStrUCTION: FOUNDATION: CEMENT BLOCK WOOD FP~E 2.0 TOILET RO(~(S): 0.0 PORCH TYPE: ENCLOSED PORCH DECK~PE: BREEZEWAY: FIP~PI~CE: DOMESTIC H(Y~T~: YES ~"fPg HFSdiR: OFF BOILER ACCESSORY STRUCT~3BES: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. DATE ON INSPECTION: 11/13/03 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 a 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 - $25.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Da~. October 22, 2003 New Construction: Location of Property: 17 9 05 Old or Pre-existing Building: _ Main Road X (check one) Mattituck House No. Street Owner or Owners of Property: Barney Sidor Suffolk County Tax Map No 1000, Section 115.00 Subdivision Permit No. Date of Permit. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ 100.0 0 Hamlet Block 0 2.0 0 Filed Map. Applicant: Underwriters Approval: Lot Lot: 009.002 Final Certificate: X (check one) oF O OR Applicant Signature Ann T. Krom, as Executor CONSENT TO INSPECTION Ann T. Krom Owner(s-) Nme(s-) the Executor of the Estate of Barney Sidor That the undersigned (is) [ar~-) the owner(s-) of the premises in the Town of Sotuhold, located at 17905 Main Road, Mattituck, New York which is shown and designated on the Suffolk County Tax Map as District 1000, Section 115.00,Block 02.00 ,Lot 009.002 _, the undersigned, do(es) hereby state: That the undersigned (has) (ahaw) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: Certificate of Occupancy on Pre-existing Building 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: October 22, 2003 E~ATE OF ANN T. KROM (Signature) Ann T. Krom, as Executor (Pritu Name) (Signature) (Print Name) SURVEY. OF PROPERTY SITUATE: CUTCHOGUE ~'"' TOWN: SOUTHOLD SUFFOLK COUNTY, NEW YfORK BUPFOLK COUNT'r' TAX MAP NUMBER I000-115-2-q.I ~ : CERTIFIED TO, BARNEY 51OOR TO!,'~N OF f~DUTHOLO COI"iMONHEALTH LANE> TITLE INr::~JRANCE COMPANY L'qND NOI. v 0,~ pO,~H~e~L ¥ Op LAND NOw 0,~ ' F:O~i"IE'~£ "r' 0~- : '- ~LADyS N.Y.S. LIC. NO. 50202 6 EAST MAIN STREET N.Y. 11901 REF.7_\Xltp, ~ERVER'~D~PROS\01-291 .Pr ° ®RAPHI(. 5CALI~ I 0 I0 1 3OO ~UTKo~sKi MONUMENT FOUND ,?