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Home My WebLink AboutZ-30004FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~RTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 30004 Date: 02/06/04 T~IS CERTIFIES that the building DWELLING AND ACCESSORY Location of Property 11365 MAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 142 MATTITUCK subdivision (STREET) (H3IMLET) Block 0002 Lot 018 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- 30004 dated FEBRUARY 6, 2004 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 COVERED FRONT PORCH AND ACCESSORY ONE CAR G~J{AGE . * %~he certificate is issued to AURELIA LUKE BURGON ( OWNER of the aforesaid building. SUFFOLK CO~DEPARTMENT OF ~IEALT~IAPUROVAL EL~-r~ICAL CERTIFICATE NO. PLUMBERS CERTIFICATION D~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 LOCATION: 11365 MAIN RD SUBDIVISION: NA~IE OF OI~NER (S): AURELIA LUKE BURGON OCCUPANCY: SINGLE FAMILY MATTITUCK MAP NO.: LOT (S) AURELIA LUKE BURGON DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME FOU~HJATION: POURED CONCRETE OTHER: REAR MUD ROOM AND PARTRY OFF KITCHEN VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC, P.~: BP#30071 DECK/CHIMNEY COZ30003 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 'This application must~b'e fr~ in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I. 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. ~) 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.~tate the reasons therefor in writing to the applicant. C. Fees / 1. Certificate of Occupancy - New.d~/velling $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. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: Old or Pre-existing Building: 11365 I'rmin Road House No. Street Date. 1/5/03 XXX (check one) Mattituck Hamlet Owner or Owners of Property: Suftblk County Tax Map No 1000, Section Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ 100.00 Estate of Aurelia Burgon, James Burgon, Executor Date ofPermit. 142.00 Block 02.00 Lot 018. 000 Filed Map. Lot: _ Applicant: Underwriters Approval: Final Certificate: XXX (check one) pre-existing use Ai oSgnature CONSENT TO INSPECTION J~nes Burgon, Executor of the Estate of Aurelia Burgon Owner(s) Name(s) , the undersigned, do(es) hereby state: That the undersigned (is) (~the owner(~0 of the premises in the Town of Southold, located at 11365 Main Road, Mattituck, NY which is shown and designated on the Suffolk County Tax Map as District 1000, Section ].42 ,Block 2 ,Lot ].8 That the undersigned (has) (kamO filed, or cause to be filed, an application in the Southold Town Buildin~ Inspector's Office for the following: the orernises are under contract to be solcI and a Certificate of Occupany ~or F~e-bixisting Use rmst be obtained in order to close title. 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: January 5, 2004 ~(Signature~~) James Burgon (Print Name) (Signature) (Prim Name) 11.7 N/F VANR¥SWyK N 51'57'01 "E 69.72' g-14,9'-J l c°~cS ~ ?'40'09"W {59.83' MAIN ROAD z 3.7'm ? 9 NYS 25 SURVEYED: 10 DECEM~3ER 2003 SCALE 1"= 30' SURVEY OF DESCRIBED PROPERTY AREA = 77,314. I7 SF. OR g ·!AT~ 0,397 ACRES MATFITUCK, TOWN OF SOUTHOLD SUFFOLK COUN'IY, N.Y. 'M// ~000-142-02-018 GUARANTEED TO: LINWWOD R WOODHULL AOUEI~OGU£ A~STRACT CORP. FIRST AMERICAN TITLE INS. CO, CtTIMORTGAG£ SURVEYED FOR: LINWOOD R. WOODHULL SURVEYED BY STANLEY d. ISAKSEN, dR. P.O. 130X 294 NEW SUFFOLK. N.Y. 11956