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HomeMy WebLinkAboutZ-30879FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 30879 THIS CERTIFIES that the building DWELLING Date: 04/26/05 Location of Property 14895 MAIN RD EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No_ 473889 Section 022 Block 0003 Lot 038 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- 30879 dated APRIL 26, 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 CHARLES S. GILLISPIE, JR.&ORS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL NO. PLUMBERS CERTIFICATION DATED *PLEASE SEE ATTACHED INSPECTION REPORT. Rev. 1/81 N/A N/A BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 14895 MAIN RD EAST MARION SUBDMSION: NAP NO.: LOT (S) NAME OF OWNER (S): CHARLES S. GILLISPIE, JR.&ORS OCCUPANCY: RESIDENTIAL CHARLES S. GILLISPIE, JR.&ORS ADMITTED BY: FRANK VAUGHAN ACCOMPANIED BY: SAME KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 22.-3-38 SOURCE OF REQUEST: GAYLE P. VAUGHN 4/9/05 DATE: 04/26/05 DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME 3 STORIES: 20.0 8 EXITS: 0 FOUNDATION: STONE CELLAR: 1/2 CRAWL SPACE: 1/2 TOTAL ROOKS: 1ST FLR.: 6 2ND FLR.: 5 3RD FLR.: 0 BATHROOM(S): 3.0 TOILET ROOK(S): 0.0 UTILITY ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: THREE -ONE RAISED BRICK - BREEZEWAY: FIREPLACE: 1 OPERATING GARAGE: DOMESTIC HOTHATER: YES TYPE HEATER: OIL AIRCONDITIOUING-. TYPE HEAT: OIL WARM AIR: HOTWATER: X OTHER: +WITH ARBOR -ROOFED OVER SLATE & CEMENT IN REAR - ACCESSORY STRUCTURES: GARAGE, TYPE OF CORST.: SWIMMING POOL: OTHER: STORAGE, TYPE CONST.: GUEST, TYPE CONST.: --ONE U14HEATED ROOM ON THE WEST SIDE OF DWELLING, PANTRY OFF UNHEATED ROOM - ALSO A SHED ATTACHED TO WEST SIDE. REMARKS: BP #129u1 -Z -NZ -15551 (INGROUND SWIMMING POOL WITH DECK) INSPECTED BY: DATE ON INSPECTION: 04 25'05 GARY J. SW TIME START: 10:00 AM END: 10:40 AM Form No. 6 TOWN OFSOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY AI'R I 12005 L.i 1 iWN 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: L 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 10% 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. OB For existing buildings (prior to April 9, 1957) non -conforming uses, or buildings and "pre-existing" land uses: L 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 L 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, Conunercial $15.00 r p Lr Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: /Ykq57 Matti feud EE -q Sr -41 % Dq House No. Street Hamlet Owner or Owners of Property: E6o Pet_�IZOU(leV6QlI`, VO) #�Mk-67-I& )e C,(kG:-4tl0rl6AIfrl�fTt� Suffolk County Tax Map No 1000, Section 2 Z Block 3 Lot 3 Subdivision Permit No. Health Dept. Approval: Planting Board Approval: Date of Request for: Temporary Certificate Filed Map. Applicant: Underwriters Approval: Lot: Final Certificate: (check one) Fee Submitted: $ o i 0-6 Applicant Signature or -me a!- work Cp 3;z to d=2t0P an�ppa,'n��tdr�f T%+7ky�zc. eLI pt TOWN OF SOUTHOLD PROPERTY RECORD CARD f h r®A OWNER STREET VILLAGE DIST. SUB LOT Z hale s s. Galli �e5r ors _ \.- ��, t� Fas+ HcAr ACR. REMA KS I�r � I %- I. C,r _ (1 �` I VNJ TYPE OF BLD.: -ll i s (� uI, ,e ru.s} PROP. CLASS ZIO LAND IMP. TOTAL DATE S n G �, o�} L�Z339 60 � I�,s'�e (�usfi h G;Ills �rf�rs 'p 133 on FRONTAGE ON WATER FRONTAGE ON ROAD g Z/CC TILLABLE n WOODLAND DEPTH MEADOWLAND - - -- -� ...-._.._ I BULKHEAD HOUSE/LOT �II ...... - 1- — TOTAL — � P651S ,, TOPOGRAPH I G SURVEY SITUATE. EA5T MARION TOWN: SOUTHOLD 5UFFOLK COUNTY, NY SURVEYED 0I-20-04 SUFFOLK GOUNTY TAX u 1000-22-3-38 QUALIFIED TERMINABLE HfrEREST PROPERTY TRUST f vZ 0 3p 9p� " �A rT `S� N O 14 _ - -- siz AT ?' \ X21' 1� �• � _ _---"� - -- - NOTES1 ! O PIPE FOUND ELEVATIONS REFERENCE N6VD' 29 GRAPHIC, SGALE I"= 40 LAND NO SALIFIED WERMIFORM PRoPER N T&SR TEREST JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\03-273b.pro LOCATION: (number & street) SUBDIVISION: NAME OF OWNER(S): OCCUPANCY: (type) MAP NO.: (municipality) LOT(S): (owner -tenant) ADMITTED BY: Fes« j�GIM,:) ACCOMPANIED BY: KEY AVAILABLE: SUFF. CO. TAX MAP NO. 1000 - SOURCE OF REQUEST: DATE: DWELLING: TYPE OF CONSTRUCTION: "W/u��_ # STORIES: 7"-V # EXITS: FOUNDATION:t CEL CRAWL SPACE: y. TOTAL ROOMS: FLR: 2ND FLR: 3RD FLR: BATHROOM(S): T T ROOM(S): PORCH TYPE: DECK, TYPE: —� =?�7p BREEZEWAY: — FIREPLACE: . GARAGE: - DOMESTIC HOTWATER: TYPE HEATER: AIRCONDITIOIN TYPE HEAT: OTHER: ©.4 ACCESSORY GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.: SWIMMING POOL: Zj GUEST, TYPE CONST: OTHER: VIOLATIONS: CHAPTER 45 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION I DESCRIPTION I ART. I SEC. REMARKS: INSPECTED BY: C 0 -?, 155 DATE OF INSPECTION: TIME START: /O '6v END: �® CONSENT TO INSPECTION Goy V6�hC01 , the undersigned, do(es) hereby state: Owner(s) Name(s) That the Southold, located at is) (are) the owner(s) of th premises in the Town of which is shown and designated on the Suffolk County Tax Map as District 1000, Section 22 , Block 3 , Lot 3 a' . That the undersigned (has) (have) filed, or cause to be filed, an application in the Sout�old Town Building Inspector's Office for the following: 02-e- �J_� @ 1j CGU 0a'✓lC4 . /G.fS0 /7,19 10�� /moiAAlin i �P IJ �?' )✓' Cjou✓l x fad r t�Cu► Opt oAl �4is r�rs%e e %"e�8y 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: nature) le V�(Print Name) (Signature) (Print Name)