HomeMy WebLinkAboutZ-31071 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 31071 Date: 08/01/05
THIS CERTIFIES that the building DWELLING AND ACCESSORY
Location of Property 35 NORTH RILEY AVE MATTITUCK
(HOUSE N0.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 143 Block 0004 Lot 014
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- 31071 dated AUGUST 1, 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 WITH SCREENED PORCH AND CEMENT PATIO AND
ACCESSORY SHED.*
The certificate is issued to ANN KONCHAN
(OWNER)
of the aforesaid building.
SUFFOLK COIINTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT. ~~~ppp~~~~ppp o/~
Authorized Signature
Rev. 1/61
EUILDIWG DEPARTMENT
TOL•R] OF SOUTHO LD
HOUS IC7G CODE ICJSPECTI OC7 REPORT
FACATION: 35 [70RTH RILEY AVE MATTITUCK
SUBDIVISION: MAP NO.: LOT (S)
NAME OP OWNER (S) : ANN KONCECAIJ
OCCUPANCY: SINGLE FAMILY AC7N KONCHAC7
ADMITTHD BY: SUSAtJ FALCON ACCOMPANIHD BY: SAME
IO3Y AVAILABLB: SUFF. CO. TAZ MAP NO.: 19s.-i-14
SOURCE OP RHOUHST: MARY SANE WALSH, TRUSTEE DATH: 08/01 OS
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME # STORMS: 1.0 # H%ITS: 2
PODHDATION: CEMENT BLOCK CHLLAR: PART CRAWL SPACH: PART
TOTAL BOONS: 1ST PLR.: 5 2ND PLR.: 0 3RD PLR.: 0
HAT®tOOM (S): 1.0 TOILHT ROOM(S): 0.0 UTILITY ROOM(S):
PORCH TYPE: SCREEtJEO PORCH DHCR TYPE: PATIO TYPE: CEMENT
BRHHZH{AY: FIRHPLAC6: GARAGE:
DOlatSTIC HOTWATSR: YES TYPE BHATBR: GAS AIRCONDITIONING:
TYPH HHAT: I7AT'L GAS NARM AIR: HOT AIR HOTiN\THR: YES
OTHHR:
F.CCESSORY STRUCTURES:
GARAGH, TYPE OP CONST.: STORAGH, TYPH CONST.: WOOD FRAME SHED
SWLMING POOL: GDHST, TYPE CONST.:
OTHHR:
VIOLATIOWS: CHAPTER -k5 N.Y. STATE UIII FORM FIRE PREVENTION & BUILD ICJG CODE
LOCATIOCI DESCRIPTION ART. SEC.
I ~ I
I I I
I I I
I I I
I I
II II II
ura~nazc: ePd31} ADD COZ3525
INSPHCTHD BY: DATH ON INSPHCTION: 07/28/05
GSORG6 GILLHM TIlU{ START: 10:18AM HND: 10:40AM
JUL 14 '05 02:37PM SOUTHOLD BUILDING 631 765 9502 P.1
. ~ - a9B~-g6ov
Form No. u
r - - - r ~ TOV6'N OI' SOUTHOLD ~~'dl
't' ~ $UII,DING DEPARTMENT
TOWN HALL
~ ~ 765-1803
~ n
- - - APPL3C'ATIQN TOR CERTIIrIC'ATE 01~ OCCUPANCY
'''.'his aptilication must've filled in by tynecE'riter or rnk and subtmtted to the Iiuildtng Department with the T-ollowing:
Ftn' new' buikliug or new use:
? . Final survzy of property wifi, accuiate locatirn) oi' all buildings. property lines, streets, and unusual natural or
~apographic features
~ .'rival Approval froth iicalth Dept. of water supply and sewerage-disposal (S-9 fonn).
Approval of electrical installattan from $otu•d of Fire Underwriters.
Sworn ;tateruent Eton, plumber cu+'tifying that the solder used itr sysiern contaitu less than 2,x10 of 1 % lead.
(;:mun~.tcial building, irtdustriei l,uilding, tnultipl.e residences and similar buildings and installations, a certificate
of CJgde Corn}aiarzec hoot archiie=ct or engineer responsible for the budding.
t. $arhznil 1'latrrri xg Beard .~ppn,vaf of completed site plan requitromznts
fs, h'or existing buildings (priar to April 9, 1957) non-conforming uses, or haildiugs and "pre-existin$° laud uses:
1 . .4.xuraG: survc}' of property ,howeng aEl property lines, streets, budding and unusual natural or topogxapluc
feature,.
7_. A propc;ly cornplated application and consent. to inspect sigrred (,y the applicant If a Cemticate of Occupactey is
denied, the Building lasl;eetnr ;hall state the rc:aso.ns therefor i+t wriiirg ro the applicant.
s~, I~ ec+
* C:ertif irate of t)ccupancv - Nzt~ dEVZlling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00.
S•,vin•,tning pool $25.00; Accacsory building 4125 00, Additions to accessory building $25.00, Businesses $50.00.
7... Cv~tnlicare ai ()ccupactcy on Pre-misting 1"iuilriing - $L00.00
Copy ofCc;r[ificate of (.?ccuptutcy - $.25
y. Updated Cenilicate of ('ccupaacy - 9+50.00
T'r_r.•+porary Ccrtiticcuc el Oc•~upanrr - li.estdential $15.00, Commercial $15.00
Date /ate'
Ne'a• t.,O115lIUCt10n: ~)l.d or Pre-exiatcrg Building: --C
„ _ ~ (check one) _ 1.
:vocation ofpn~perty: N6a'1~, ~t /c ~Jc hue, ~ ~ ~"~-~t
~
5.--~ - -
1•iousc .No. S~ t_- _ Hamlet
')wm,er or Owners ef•1'ropzrtY: _ ..----_~1~/!~ L~ ` ~e.G[-~~
SuTbllc County'iax Nap No } 000, Sent imt ~ y 3 Black ~ ~ Lot n~
Subdivision __^.__-FiledMaP L,ot: -
Pet'tttic. Ldo• Daze of ]permit--- - Applica~n. ~e~ _._~,n~ (.l~~~d-h
~r... r r~
Iieahla?)ept Alrproval:.._...-.._.-....._...-~-----.------....--...Unden~riter.;Approvnl:__•~_~----
I'ltmning Dusrd ,31.~pro~ a1' . _
Reques~ fer: "1 emporari Certclicate _ Final Certifica~e: (check one)
Fee Subxntrted: j ._.~.d~ V
` O A 1 ant Sigrxature
LocATION: 3.~ Nv, R, ~ ~Y ,4V E , /YI/}T7'lT~ Cf~
(number & street) (municipality)
SUBDIVISION: MAP NO.: LOT(S):
NAME OF OWNER(S): N O/?C dl~/b
occUPANCY: o ~_~/~I ~.~5 /
(type) (owner-tenant)
ADMITTED BY: s/7-N~ ACCOMPANIED BY:
KEY AVAILABLE: ' ~ SUFF. CO. TAX MAP NO. 1000- /'1`3 - ~ - /'f
SOURCE OF REQUEST: /+~q/2y TjgN~ WfjL,Sf/ DATE: 'I~~8'-~S
DR'ELLING: WD D ~ ~iP,gm # STORIES: ~ # EXITS: 02
TYPE OF CONSTRUCTION:
FOUNDATION: C~I'lF/r'(~' jj~U~~f CELLAR: CRAWLSPACE:~7"
TOTAL ROOMS: 1ST FLR: S' 2ND FLR: 3RD FLR:
BATHROOM(S): / TOILET ROOM(S): - UTILITY ROOM:
PORCH TYPE: 5~12~NFD DECK, TYPE: PATIO, TYPE: ~EY+) FN j
BREEZEWAY: - FIREPLACE: GARAGE:
DONIESTIC HOTWATER: Y~~ TYPE HEATER: ~ S AIRCONDITIONING:
TYPE HEAT: n/AT~L , G/1'S WARM AIR: f~D~- HOTWATER: y~S
OTHER:
W~aD F~Pf1Mt
ACCESSORY STRUCTURES: T
GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.: ~ Sy~D
SWIMMING POOL: GUEST, TYPE CONST:
OTHER:
VIOLATIONS: CHAPTER 45 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS:
INSPECTED BY: ~ DATE OF INSPECTION: '7~d~~ -ate
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JUL 08 '05 10~38AM SOUTHOLD BUILDING 631 765 9502 p,2
CONSENT TO INSPECTION
__~}ttl/U ,oN~HR~ the undersigned, do(es) hereby state;
Ownr~~(s) Name(s)
That the unders~ed (i~arcl)
t_
~
Jhe or}t~q~(s) of tha rert~ises in the Town of
Southold, located at_ J S o /C ~ c ,
which is shown and designated on tr{e Suffolk C c my Tax Map as District 1000,
Section ~ y Block O y ,Lot
That the undersigned (has) (have) filed, ar cause to be fil application ip the
5authold Town wilding Inspector's OfFice for the following: ~Tfit a
f--- -
That the undersigned do(es) hereby give consent to the Building Inspectors of the
'Town of Southold to enter upon the above described properKy, including any and all
buildings locate:9 thereon, to conduct such inspections as tuey may deem necessary with
aspect to the aforesaid application, including inspections to determine that said premises
comply with al] of thr, laws, ordinances, rules and regulations of the Town of Southold.
'The undarsigna;d, in wnsenting to such inspections, do(es) so with the knowledge
and understanding that any information obtained in the conduct of such inspections may
ise used in subsequent p.~~osecutions 1'or violations of the laws, ordinances, rules ar
regulations of the Town of Southold.
paced: ~f I Q~ 'f/ ~iw?~'-""
(PriratName)
(Signature)
(Print Name)