HomeMy WebLinkAboutZ-31639
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-
31639
Date: 06/27/06
THIS CERTIFIES that the building
DWELLING
Location of Property
735
(HOUSE NO.)
County Tax Map No. 473889 Section 141
WESTPHALIA RD
(STREET)
Block 0003
MATTITUCK
(HAMLET)
Lot 021
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-
31639
dated JUNE
27, 2006
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 EDITH D CHARKOW
(OWNER)
of the aforesaid building.
N/A
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
PLUMBHRS CERTIFICATION DATED
N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
~~
Authorized Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION:
SUBDIVISION :
NAME OF OWNER (S): EDITH D CHARKOW
OCCUPANCY: SINGLE FAMILY DWELLING
735 WESTPHALIA RD
MATTI TUCK
MAP NO. :
LOT (S)
ADMITTED BY:
EDITH D CHARKOW
ACCOMPAHIED BY:
KEY AVAILABLE: SUFF. CO. TAX NAP NO.: 141.-3-21
SOURCE OF REQUEST: GARY FLANNER OLSEN, ATTY 6/15/06 DATE: 06/27/06
DWELLING:
TYPE OF COllSTRUCTION: WOOD FRAME
FOOHDATION: CEMENT BLOCK
# STORIES: ~ # EXITS: ~
CBLLAR.: PART. CRAWL SPACE:
3RD FLR.: -9.
UTILITY ROOM(S) :
TOTAL ROOMS: 1ST FLR.: 5
BATHROOM(S): ---.!..:....Q
PORCH TYPE:
BREBZENAY:
DOMESTIC HOTWATER: YES
2ND FLR.: -9.
TOILET ROOM (S) :
DECK TYPE;
0.0
PATIO TYPE:
CONCRETE
FIREPLACE;
ONE
TYPE HEATER: HOT WATER
GARAGE:
AIRCOHDITIOHIHG :
YES
TYPE HEAT; OIL
NARM AIR;
NO
BOTWATER :
OTHER: SEPARATE HOT WATER HEATER
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.: 22'X22' WITH STORAGE STORAGE, TYPE CONST.: 8'X6'SHED WOOD FRAME
SWIMMIRG POOL: GUEST. TYPB CORST. :
OTHER ,
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS: BP#897-COZ570(ADD)BP#4129Z-COZ3334 (ACCY GAR.)BP#18494Z-COZ18791 (ADD)
IHSPBCTED BY:
GEORGE GILLEN
DATE ON INSPECTION: 06/26/06
TIME START: 10:00 AM END: 10:30 A,
\
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT \
TOWN HALL
765-1802 ..-..
APrLICATlON FOR CERTIFICATE OF OCC~~
Ie ,-
J\m\60~
- 1
i__~..._---
This application must be filled in by typewriter or ink and submitted to th,,: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 2/1 0 of I % lead.
5. Conunercial building, industrial building, multiple residences and similar buildings and installations, a celiificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and co.nsent 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
I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swinmling 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. Temporaf)VCeitificate of Occupancy - Residential $15.00, Commercial $15.00
Date. June 15, 2006
Old or Pre-existing Building:
x
( check one)
New Construction:
Location of Property: 735 WestPhalia Rd., Mattituck, NY
House No. Street
Hamlet
Owner or Owners of Property:
Edith D. Charkow
Suffolk County Tax Map No 1000, Section 141
Block 3
Lot 21
Subdivision
Filed Map.
Lot:
Permit No.
Date of Pernlit
Applicant:
Health Dept Approval:
Underwriters Approval:
Plalming Board Approval:
Request for: Temporary Certificate
Final Certificate:
Fee Submitted: $
100.00
OLSEN & OLSEN LLP
32495 MAIN ROAD
PO BOX 706
CUTCHOGUE. NY 11935
Applicant Signature
~~ l6'117
{J.M. roc 31fo3 Cf
CONSENT
TO
INSPECTION
Gary Flanner Olsen as attorney for Edith D. Charkow
Owner(s) Name(s)
doles) hereby state:
, the undersigned,
That the undersigned (is) (are) the owner(s) of the premises in the Town
of Southold located at 735 Westphalia Rd., Mattituck, NY 11952
County tax map as District 1000, Section
141
and designated on the Suffolk
Block 3 , Lot 21
, which is shown
That the undersigned (has) (have) filed, 'or caused to be filed, an applica-
tion in-the Southold Town ilullCling lnspe",v. '", O~Haa Co~ +h" fnllnwing:
, .
one story frame house and one story frame garage and shed
That the undersigned dotes) 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 inspl1ctions, dotes) so with the
knowledge and understanding that any inCormation obtained in the conduct oC
such inspections may be used as evidence in subsequent prosecutions for vio-
lations of the laws, ordinances, rules or regulations 0 t e own oC Southold.
Dated: June 15. 2006
.~.
Gary Flanner Olsen
(print name)
(signature)
(print name)