HomeMy WebLinkAboutZ-30781FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 30781
THIS CERTIFIES that the building
Location of Property 9475 MAIN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 122
Subdivision Filed Map No.
DWELLING
Date: 02/18/05
MATTITUCK
(STREET) (HAMLET)
Block 0006 Lot 014
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- 30781 dated FEBRUARY 18, 2005
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 JUNIUS HUBBARD & WF
(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.
Autriorized Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 9475 MAIN RD MATTITUCK
SUBDIVISION: MAP NO.: LOT (S)
NAME OF OWNER (S): JUNIUS HUBBARD & WF
OCCUPANCY: SINGLE FAMILY DWELLING JUNIUS HUBBARD & WF
ADMITTED BY: PEARL HOLMES ACCOMPANIED BY: SAME
KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 122.-6-14
SOURCE OF REQUEST: BARBARA BOURSIQUOT 11/23/04 DATE: 02/18/05
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 1.0 # EXITS: 2
FOUNDATION: CONCRETE CELLAR: YES CRAWL SPACE: NO
TOTAL ROOMS: IST FLR.: 5 2ND FLR.: 0 3RD FLR.: 0
BATHROOM(S): 1.0 TOILET ROOM(S): 0.0 UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: GARAGE:
DOMESTIC HOTWATER: YES TYPE HEATER: HOT AIR AIRCONDITIONING:
TYPE BEAT: OIL WARM AIR: YES HOTWATER: YES
OTHER: SEPARATE HOT WATER HEATER -CELLAR ENTRANCE (BILCO DOOR)
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTHER:
STORAGE, TYPE CONST.:
GUEST, TYPE CONST.:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART.
REMARKS: 16708Z-COZ19509(DECK)BP#21632-COZ22654(REPAIR)BP#30821Z-COZ30780(SHED)
SEC.
INSPECTED BY: DATE ON INSPECTION: 12/15/04
GEORGE GILLEN TIME START: 10:25 AM END: 10:45 AM
Nov 07 04 11:52a Rndrea Stype Realty,Inc. 631-298-5779 p.2
Form toe, 6 C
TOWN OF SOUTHOLD
BLrILDING DEPARTMENT`
TOWN HALL
765-1802
APPLICATION FOR CERTIFICA,rE OF OCCUPA.N'Ca
This al'plir_.atien must be filled in by typewriter or ink-
A-
subnuttesl to the Building ]7eparttzient witty Lite follr�wing� .
.'l. For r,�r�� htritt!ir��Y car c►�tit� �is��: ?
= . 4 tool sur vc < o; lal vl,�erty wit:; accuz ate lecatioic of all buildings, property lines, streets, acid utiusultr
topographic features.
Final ApproE•al frot t Health Dept, of water supply and sewerage- disposal (S -9f tri). _
3. Approval of electrical installatior, from Board ofFire Unrlenvriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2110 of 1 iu [ted.
5. Conuneroial building, industrial building, multiple residences and sinvlar buildings and installations, a certificate.
of Code Compliance from architect or engineer responsible for the building,
6. Submit Plaiming Board Approval of completed site plan requireucercts.
)For existing buildings (prior to April 9, 1957) non-conforruing uses, yr buildings aud'6 ,,
Accurate sure prop" show' alt
L' ,pr land uses;
features. of r showing property lirtes,,stredta, building and unusual natural or topographic
2. A properly completed application and consent to inspect signed by the applicant. lf'a Certificate of Oc, , ,
denied, the Building Inspector shall state the reasons therefor in writing to the applicant. `uf'anc3 is
C. Pees
I. Certificate of Occupancy- New dwelling $25,00, Additions to dwelling $25.o0, Mterations to dwelling $25:0(),
Swirnniing IWI $25.00, Accessary building
Certificate of l7cct►panc y on Pre -c xisti iltiin�� Additions s to accessary building $25.00, Businesses $50.0,
3. Copy of Certificate of g - $lUO t}t?
4. Updated Certificate of Occ�cu - $.a5
P y - $50.00
5. T'eml►oraiy Certificate of Occ,:ipancy - residential $15.00, Commercial $15.00
Hate.
New Construction,Old or Pre-existilig Building:.✓:
Location of P �}-------- (check one)
roP Y r'I l� HQ►n1 R"C'jr
House No.
Ow17er or Owners of pvpwty: 'T c c N t u s
-_
Suffolk County Tac Map No 1000, Section
Subdivision
Permit No.
Date of'Permit.
n'i rr-" l I G! C
Street
/�u6kovd
1 ,1a
Block ____tom Lot
fiiledMap. c1u_,A8 i _Lot;
A,p Iicxnt•
Hamlet
P
.Health Dept .Approval:
Underwriters Approval:
Planning Board Approval: -- — —
Request for: Temporary Certificate ertificate: ✓
Final C _. (check one)
Fee Submitted: $ /60, oa —'
?e u C Ccr h
Applicant Signature ���� 6
G,, � I
&,Aq Co Z7-3098-/
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THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1205030 BUREAU OF ELECTRICITY
83 JOHN STREET, NEW YORK, NEW YORK 10038
Date OCTOBER 01.,1993 Application No. on file 05096693/93 N 291226
THIS CERTIFIES THAT `
only the electrical equipment as described below+ and introduced by the applicant named on he above application number in the premises of
J.,HUBRARD/B.BOU9`tIQUOT, '9 7 MAI,Q ROAbf MATT ITUC
'in thefollowing location; ❑ Basement ® 1st Fl. ❑ 2nd Fl. OUT Section122 BlocA006 Lot 014
yeas examined on 5 5 r T ti P1IJ b K L y , .Ly y 3
and found to be in compliance with the National Electrical Code.
FIXTUREFIXTURES
RANGES ICOOKING DECKS
OVENS I DISH WASHERS
EXHAUST FANS
FLUORESCENT
OTHER AMT. K. W. AMT.
K. W.
AMT. K.W. AMT.
K. W.
AMT.
H. P.
OUTLETS RECEPTACLES
SWITCHES iNCANDESCENT
15
25
18
14
1 ,
DRYERS
FURNACE MOTORS FUTURE
APPLIANCE FEEDERS SPECIAL RECPT
TIME CLOCKS
BELL
TRANS.
UNIT HEATERS
MULTI -OUTLET
NO.OF FEET
DIMMERS
AMT. K. W.
Olt H. P.'
GAS
H. P.
AMT. NO.
A. W. G. AMT.
AMP.
AMT.
AMPS.
AMT. I H. P.SYSTEMS
AMT.
WATTS
1
20
1
SERVICE DISCONNECT - -
NO.OF
_ _.. _. , _ .._ _...... _
_ .. S E R V 1 C E
AMT.
AMP.
TWE
METER
EQUIP.
1 X 2W 1 0 3W
3 ,e 3W 3 X AW NO. CC. COND.
PER ,B
A. W. G. NO. OF HI -LEG
OF CC. COND.
A. W G• NO. Of NEUTRALS
OF HI -LEG
A. W. G.
OF NEUTRAL
OTHER APPARATUS:
MOTORS.3-F H.P.
G.F.C.It-6
SMOKE DETECTOR: -1
TWIN FORK ELECTRIC
LIC.#3488E PA
P.O. BOX 48
J AM E S P O R T ', NY, 11947
GENERAL MANAGEER
t be altered in any manner; return to the office of the Board if incorrect
'i.('/�?'iA`C'iA?'iA�:'iAi tiAYiAi,'i�i:'iAZ'iAC1A�:7AY 7ACTiAf'iAK'i�tYAC YAZ•7AK]AY 7AYYAC'iAY Y�Y.YACYAt'
Per
y be iden`tif,e -by their credentials.
Nov 07 04 11:52a Andrew Stype Realty,Inc. 631-298-5779
CONSENT TO INSPECTION
%u n� iu s Mu6bo, d 13 �A-� 9� ,��6 °the undersigned, do(es) hereby state:
Owners) Naane(s)
That the undersigned (is) (are) the owner(s) of the premise, in the Town of
Southold, located at M a i til A6co-d At CL -6U- C__ ^—_
which is shown and designated on the Suffoly County Tax Map as District 1000,
Section /), L , Block & , Lot 'r
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold 'ow -n Building Inspector's Office for the following: ___ ?lid_ C/__ 4
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 infornation obtained in the conduct of such inspections Inay
be used in subsequent prosecutions for violations of the laws, ordinances, rules or
regulations of the Town of Southold.
Dated: A ( C
(Print Name)
TT -----(Signature)
(Print Natne)
p.3
TOWN OF SOUTHOLD
OROPERTY
RECORD CARD r
OWNER
STREET _ t745-
VILLAGE
DISTRICT
SUB.
LOT
FORMER OWNfR
Nk
')R ov Sir .vo?
E
�ourS� Lo
ACREAGE
4— xw4%1;4
S//
W
TYPE OF BUILDING
RES. f_ d
SEAS.
VL.
FARM
COMM.
I IND. I
CB. I MISC.
LAND
IMP.
TOTAL
DATE
REMARKS
-6)
a v
,� a
3 -,?,o -v, --�
,mac 8 ✓�D I O
ill 3 - Poi 1 2 - �' �` � �,►v -�a � �"� -�C - a Qa
AGE
BUILDING CONDITION
NEW
NORMAL
BELOW
ABOVE
Farm
Acre
Value Per Acre
Value
Tillable I
Tillable 2
Tillable, 3
Woodland
Swampland
Brush.land
House Plot
�:f \ ...L .. I �
LOCATION: / '� 7-5 /,141 A/ e o 4b
(number & street)
SUBDIVISION: MAP NO.:
NAME OF OWNER(S): 1` " ] 1A --<
OCCUPANCY:
(type)
(municipality)
LOT(S): .
i
E,9R L /fdt.1''i s
-(ovAw-tenant)
ADMITTED BY: fiW L #O L. M E 5 ACCOMPANIED BY:
KEY AVAILABLE: SUFF. CO. TAX MAP NO. 10007
SOURCE OF REQUEST: -Oc,(Ils 0 t O 7— DATE: //—,P-3 — o�c
DWELLING:
TYPE OF CONSTRUCTION: ` Voo .b F/elIAC= # STORIES: I # EXITS:
FOUNDATION: C o � c R S- T 4�- CELLAR: A63- CRAWL SPACE: i✓o
TOTAL ROOMS: IST FLR: S 2ND FLR: R-- 3RD FLR:
BATHROOM(S): / TOILET ROOM(S): UTILITY ROOM:
PORCH TYPE: DECK, TYPE: PATIO, TYPE:
BREEZEWAY: _ FIREPLACE: GARAGE:
DOMESTIC HOTWATER. E S TYPE HEATER: //oT AIRCONDITIONING:
TYPE HEAT: WARM AIR: S HOTWATER: SES
OTHER: SE AERATE A/0 7? W�r,:2 P 9 7 �:�
CCLL1 '
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTHER:
,4/dA/44�7
STORAGE, TYPE CONST.:
GUEST, TYPE CONST:
VIOLATIONS: CHAPTER 45 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
INSPECTED BY: DATE OF INSPECTION: /;- 15 - 0/4-/
TIME START: l a END: A � �<f4of
Young & Young, Land Surveyors N111
400 Ostrander Avenue, Riverhead, New York 11901
516-727-2303
Alden IF. Young, Professional Engineer h Land Surveyors
Howard M. Young, Land Surveyor
Thomas C. Wolpert, Professional Engineer
%nneth F. Abrusao, Land Surveyor
NOTE I o
I. ■ =MONUMENT FOUND *=PIPE FOUND
2. TOTAL AREA =76414 S.F
3, RIGHTSOFWAY DESCRIBEDIN LIBER 7805 PAGE 521
ARE NOT SHOWN HEREON
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: OCT 5,1993ji
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SURVEY FOR:
ANGE BOURSIQUOT d
BARBARA HUBBARD BOURSIQUOT
At: M�T,TITUCK
T6vA
of: SOUTHOLD
uuffolk County, New
York
1000
122
6
13
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r--�
"7000
122
6t4
1000
122
6
15
Suff Co Tax Map
1000
122
6
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Dl.mm
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oma
wt
60344
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DATE
: OCT 5,1993ji
®®®aSCALE
50
:93-725
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