HomeMy WebLinkAboutZ-30427FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N_Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 30427 Date: 09/14/04
THIS CERTIFIES that the building DWELLING
Location of Property 1020 TOWN HARBOR LA SOUTHOLD
(HOUSE NO_) (STREET) (HAMLET)
County Tax Map No. 473889 Section 064 Block 0005 Lot 007
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- 30427 dated SEPTEMBER 14, 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-FAINILY DWELLING & ACCESSORY STRUCTURES ALL DILAPITA_TED &
NON -HABITABLE AT THIS TIME_
The certificate is issued to JOHN JERNICK & 49F.
of the aforesaid building_
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL
U92
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/61
(OWNER)
N/A
N/A
N/A
Authorized Signature
BUILDING DEPARTME14T
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 1020 TOWN HARBOR. LA SOUTHOLD
SUBDIVISION: NAP NO.: LOT (S)
NAME OF ONNER (S): JOHN JERNICK & WF.
OCCUPANCY: RESIDENTIAL JOHN JERNICK & SPF.
ADMITTED BY: SELF ACCOMPANIED BY:
KEY AVAILABLE_ SUFF_ CO. TAX MAP NO.: 64.-5-7
SOURCE OF REQUEST: EDWARD & MARYAN N DOBBIN 8/20/04 DATE: 09/11,04
DWELLING:
TYPE OF CONSTRUCTION: WOOD
FOUNDATION: ROCK
TOTAL ROOMS: IST FLR.: 0
BATBROOM(S): 0.0
PORCH TYPE:
# STORIES:
2.0
# EKITS:
4
CELLAR: PART
CRAWL SPACE:
YES
2ND FLR.- 0
TOILET ROOM (S) 0.0
DECK TYPE:
BREEZEPTAY: FIREPLACE:
DOMESTIC HOTNATEP- NOITE TYPE BEATER:
TYPE HEAT: NONE WARM AIR: HOTWATER:
ACCESSORY STRUCTURES:
GARAGE. TYPE OF CONST.:
3RD FIR.: 0
UTILITY ROOM(S):
PATIO TYPE:
GARAGE:
STORAGE, TYPE CONST..
SWIMMING POOL: GUEST, TYPE CONST.:
OTHER: REAR EUILDIHG HPD HEATING&PLUMB ING -LOOKS TO BE A COTTAGE AT ONE TIME
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
REMARKS_ NOTE: ALL EUILDINGS ARE DILAPITATED & AT THIS TIME ARE NON -HABITABLE.
INSPECTED BY: / )/1,.�'Wf � V� - (O••(t&cCDATE ON INSPECTION: 09/04/04
CHRISTOPHER M. TALBOT TIME START: SND:
Form No. 6
= TONYN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL, -
i !;
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. Swopt statement from plumber certifying that the solder used in system contains less than 2/10 of 1°/0 lead-
s. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engine er resp onsible for the building.
6. Submit Planning Board Appro%al of completed siteplanrequirements-
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 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. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
�C;p C. 2 �2-t 400�
6
c ,53 — q3-3-0 J-0 .31.1, ( Date.
New Construction: Old or Pre-existing
II Building: _ (check one)
Location of Property: 10 2-01 GLQ M fl 60r c>.M e– K y
House No. Street Hamlet
Owner or Owners of Property: J ePpv I -e-2 �� ! u C)b j M
Suffolk County Tax Map No 1000, Section t_( Block 5 Lot 37
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
I Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
cne,
Fee Submitted: $ j u G
LNC � �g�� v Applicant Signature
CONSENT TO INSPECTION
J(frM.ce-)L 7D DA6 r�-' , the undersigned, do(es) hereby state:
wner(s) Name(s)
That the undersigned (isj (are) the owner(s) of the premises in the Town of
Southold, located at 1077 l Otos HL, Iocr sou+kdel N'Y'
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section �, Block 5 Lot 7 _
That the undersigned (has) (have) filed, or cause to be
an pplicationI in the
p.`_ (rte ue.�T t 'o ii
U
That the undersigned do(es) hereby give consent to the Building Inspectors of the
Town of Southold,z01 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: AUrt c f 1 2,ro
U
(Signature) f�
c+lu-��>f-re� W dJdbbl M
(Print Name
o C�
Signa^ � tl
Tint Name)
7
e<o'-°E NEWr„
Eq
L 13. 49618
bt 3 765-1797
9
ly SEE rwN p AL CC,?-rTfEATM%kS
�kC�,' IS P.F. Z;Err-N 7:205�-f- YFF
Ezr vx� 71
LOCATION: LA,�r Sou-E`oldl
(number & street) (municipality)
SUBDIVISION: MAP NO.: LOT(S):
NAME OF OWNER(S): 'G.
OCCUPANCY: s► t..►fiM Moa - KA,�.4-n-6(4
(type) (owner -tenant)
ADMITTED BY: ACCOMPANIED BY: N IN
KEY AVAILABLE: SUFF. CO. TAX MAP NO. 1000-
SOURCE OF REQUEST: 'F-ct 6 DATE:
DWELLING:
TYPE OF CONSTRUCTION: W # STORIES: # EXITS:
FOUNDATION: FZecfe- CELLAR: ^^ r CRAWL SPACE: `� S
TOTAL ROOMS: IST FLR: 2ND FLR: 3RD FLR:
BATHROOM(S): TOILET ROOM(S): UTILITY ROOM:
PORCH TYPE: DECK, TYPE: PATIO, TYPE:
BREEZEWAY: FIREPLACE: GARAGE:
DOMESTIC HOTWATER: ` TYPE HEATER: AIRCONDITIONING:
TYPE HEAT: "-4 WARM AIR: HOTWATER:
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.: VJ��
SWIMMING POOL: GUEST, TYPE CONST:
OTHER: V-A- an t,. , ( s &-+ 4 11 ., %o%, �;—&( k oo lc s
VIOLATIONS: CHAPTER 45 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION-- ART. SEC.
V
REMARKS:
• 1 DATE OF INSPECTION: 0
TIME START: END:
NYSRPS ASSESSMENT INQUIRY
DATE 08/20/2004
473889 SOUTHOLD
SCHOOL SOUTHOLD SCHOOL
ROLL SEC TAXABLE
PRCLS 210 1 FAMILY RES
TOTAL RES SITE
64•-5-7
TOTAL COM SITE
1020 TOWN HARBOR
LA
ACCT NO 08
= OWNER & MAILING INFO
===1=MISC 1======== ====== ASSESSMENT DATA
JERNICK JOHN & WF
IRS-SS I **CURRENT**
RES PERCENT
C/O E DOBBIN
1 1 ILAND 800
**TAXABLE**
103 DAVID PLACE
I BANK ITOTAL 3,600
COUNTY 3,600
HILLSDALE NJ 07642-2308
**PRIOR**
TOWN 3,600
1 ILAND 800
SCHOOL 3,600
1 ITOTAL 3,600
==DIMENSIONS===1=====_=
SALES INFORMATION
ACRES •31 IBOOK
2 SALE DATE 00/00/00
IPAGE
00087 PR OWNER
=======TOTAL EXEMPTIONS
0_____________1== TOTAL SPECIAL DISTRICTS 4
CODE AMOUNT PCT
INIT TERM VLG HC OWN CODE UNITS
PCT TYPE VALUE
IFDO28
IPK070
IWWO20
ISW011
F1=NEXT PARCEL
F3=NEXT EXEMPT/SPEC
F4=PREV EXEMPT/SPEC
75.10- 03-050 F6=G0
TO INVENTORY F9=G0 TO XREF
F10=G0 TO MENU
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ALICE i 6NAMLN
NOTARY PUBLIC, State of New York
Residing in Suffolk County
No. 52-4822133
My Commission Expires / — j/ — 0-
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N 0�o-y 1.
ALICE i r rro i;ay
NOTARY PUBLIC, StatE ui (4to
Residing in Suffolk Counr�
No. 52-4822133
My Commission Expire,/ -3/, QJ
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and acknowledged to me that he executed the same.
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Wore me came
described in, and who executed, the foregoing instrument,
PAUL R. DeP ALE SR.
NOTARY PUBLIC STATE OF MARYLAND
My Commission Expires May 15, 2007