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Home My WebLink AboutZ-31759FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 31759 Date: 08/15/06 THIS u~£IFIES that the building DWELLING Location of Property MADELINE AVE (HOUSE NO.) County TaxMap No. 473889 Section 006 Subdivision FISHERS ISLAND (STREET) (HAMLET) Block 0008 Lot 005 Filed Map No. __ Lot No. __ conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9f 1957 pturstuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 31759 dated AUGUST 15f 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 LUCY J AHMAN of the aforesaid building. (OWNER) SUFFOLK COUNTYDEPARTMENT OF m~ALTHAPPROVAL EL~C~rKICAL u~KTIFICATENO. PLUMBERS U~rIFICATION DA'r~u3 *PLEASE SEE ATTACHED INSPECTION REPORT. N/A N/A N/A /t' r~//~ized~/-XSlg atu e Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT FISHERS ISLAND NAP NO.: LOT (S) LUCY J. ~M/LN 6/28/06 DA~: 08/15/06 DWELLING: POI~/DATION: CONCRETE BLOCK 2.0 # EXITS: __5 UTILITY RO(~(S): XX ACCESSORY STRUCTURES: WOOD FRAME VIOI~TIONS: C~APTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. R~: BP #667Z-COZ-421(ADD)BP#7720Z-COZ6411(ACCY TOOL SHED) DATE O1/ Il/SPEC?ION: 08/08/06 Form No. 6 ,"~'f~ i' · ,- e. ~ , TOg/N OF SOUTHOLD i', :? -,~ ' ' ~i/ BUILDING DEPARTMENT ., t ' , TOWN HALL I C~--~-;~'~ : ~P~ICATION FOR CERTIFICATE OF Th~aCion musr be filled in by cypewrirer OR ink and submiCCed ~o ch~ilding in~pecCor ~ith the following: for new building or new use: 1. Final survey of property ~ith accurate location of all buildings, properry lines, 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Under~riters. 4. Sworn starement from plumber certifying char the solder used in system contains less than 2/10 of iZ lead. 5. Comercial building, industrial building, multiple residences and s5milar buildin} and installat5ons, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Subait Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings ant '!pre-existing" land uses: ~. Accurat~e.~survey of property showing all property lines, streets, building and unusual natura~ or 2. A properly completed application and a 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. 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 Qccupancy on Pre-existing Buildin~ - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction ........... Old Or Pre-existing Building...~. ............ Location of Property ~.~P~q~..~-'/~-~' . . House No. Street Hamlet Onwer or Owners of Property . . i .......... ' .................... County Tax Map No 1000, Section .... ~. ........ Block....~.....~ .... Lot..7~--~....~. ......... Subdivision ..... t'/ ..... ~Y~ ..................... Filed Map ............ Lot .................. .. Permit No ..... /.v./..~. ...... Date Of permit ................ Applicant ........ . ............. Health Dept. mpproval..~..~.]/.~. ...... Underwriters Approval .... .~/.~. .............. / 7 Planning Board Approval. . ~//~. ............... Request for: Temporary Certificate ........... Final Certicate..~ ....... Fee Submitted: TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER FORMEF~WNER STREET VILLAGE W DISTRICT / ACREAGE SUB. LOT TYPE OF BUILDING RES. ~,/~ LAND SEAS. IMP. VL. TOTAL FARM DATE AGE BUILDING CONDITION COMM. JlND. JCB. j MISC. NEW NORMAL BELOW ABOVE Farm Acre Value Per Acre Value Tillable Tillable 3 Woodland Swampland Brushland House Plat Total ~. ir i M. Bldg. ._~/](' /~-' 6~S~ I ~-r~J ~Z7 Foundation i ~-~, Bath ~tension ~ y S I ~ ~ Z ~ ~ ~ V ~ Base~nt ~/~,~ ~ Fl~rs Extension ~ ~ ~ ~ ~ ~ ~t. Walls ~j~ ~ ~9'/~' Interior Finish ~tension ~.~ /~ ~ /~76~/ ~ ~,~ FirePlace ~: 5 Hea~ /~ ~ f~ : /~ Porch Attic Porch Rooms 1st Flor Breezeway Patio R~ms 2nd Floor Garage Driveway O.B. CONSENT TO INSPECTION Owner(~) Name(s) do(es) hereby state: · the undersigned, of Southold located at ~.~,~- That the undersigned (is) (are) the owner(s) of the premises in the Town · which is shown and designated on the Suffolk County tax map as District 1000, Section ,Block ~ ,Lot Tha',~ the undersigned (has) (have) filed, or caused to be filed, an applica- tion in the Southold Town Building Inspector's Office for the following: That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, iucluding 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 as evidence in subsequent prosecutions for vio- lations of the laws, ordinances, rules or regulations of the Town of Southold. (sign~atur e) (print name) (signature) (print name) MAD~I-/N~ A V~NU~ ¢M~.~ POLE ~156 RODF LILY EMMET WEST STEPS DECK SECOND STORY ill _PARCEL AREA ---- M~NHOLE PARKING NEE JANET A. TUCKER N 4320.42 W 163.41 / / MON. LOCATION MAP SCALE 1"=400' FISHERS ISLAND, N,Y.; SCALE: 1"4OFT; CHANDLER & PALMER, ENDR'S; NOV. 1.) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED HEREON. ANY EXTENSION OF THE USE BEYOND THE PURPOSED AGREED TO BETWEEN THE CUENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE ENGAGEMENT. 20 IT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY PERSON, 4204.87 UNLESS ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY. W 116.08 3,) ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL ARE THE ProDucT OF THE LAND SURVEYOR, 4,) COORDINATE DISTANCES ARE MEASURED PROM U.S. COAST AND GEODETIC SURVEY TRIANGULATION STATION "PROS" · ' 5.) SITE IS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX MAP 1000, SECTION 006, BLOCK 8, LOT 5 AND BLOCK 4, LOT g, 6.) TOTAL AREA -- 0,60~ ACRES. 7,) SITE IS LOCATED IN B ZONE. QUALI~ CONSOL CERTIFICATION sum,~ FILE F N/F NOW OR FORMERLY SF SOUARE FEE~ ~- STONE WALL ~ FENCE 20 , I0 0 DATE: 06/2,3/2006 SCALE: I" = 20' SHEET: 1 OF 1