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Home My WebLink AboutZ-31897FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 31897 Date: 10/06/06 THIS CERTIFIES that the building DWELLING Location of Property 735 JACKSON ST NEW SUFFOLK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 Block 0009 Lot 006 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- 31897 dated OCTOBER 6, 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 WITH ACCESSORY COTTAGE* The certificate is issued to PAUL O PRILUCIK (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. Aut orized Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 735 JACKSON ST NEW SUFFOLK SUBDIVISION: MAP NO.: LOT (S) NAME OF OWNER (S): PAUL O PRILUCIK OCCUPANCY: SINGLE FAMILY DWELLING PAUL O PRILUCIK ADMITTED BY: ACCOMPANIED BY: KEY AVAILABLE: BUFF. CO. TAX MAP NO.: 117.-9-6 SOURCE OF REQUEST: PAUL PRILUCIK 9/21/05 DATE: 10106106 DWELLING: TYPE OF CONSTRUCTION: WOOD FRAME R STORIES: 1.0 ¢ EXITS: 3 FOUNDATION: CEMENT BLOCK CELLAR: FULL CRAWL SPACE: TOTAL ROOMS: 1ST FLR.: 5 2ND FLR.: 0 3RD FLR.: 0 BATHROOM(S): 2.0 TOILET ROOM(S): 0.0 UTILITY ROOM(S): PORCH TYPE: DECK TYPE: PATIO TYPE: BREEZE AY: FIREPLACE: NO GARAGE: DOMESTIC HOTWATEB: YES TYPE HEATER: AIRCONDITIONIRG: TYPE SAT: GAS MARK AIR: YES HOTMATER: YES OTHER: SEPARATE HOT WATER HEATER, CELLAR ENTRANCE ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: STORAGE, TYPE COMET.: SWIMMING POOL: GUEST, TYPE CONST.: WOOD FRAME* OTHER: •LIVING ROOM 1 BEDROOM, KITCHEN & BATHROOM) VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE INSPECTED BY: leziC zlz'� DATE ON INSPECTION: 09/28/06 v o7 GEORGE GILLEN TIME START: EBD: Form No. 6 TOWN OF SOUTHOLD r BUILDING DEPARTMENT TOWN HALL 765-1802 f�' SEP 2 1 2006 APPLICATION FOR CERTIFICATE OF OCCUPANCY I 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: 1. 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 1% 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. For existing buildings (prior to April 9, 1957) non -conforming uses, or buildings and "pre-existing" land uses: 1. 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 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 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, Commercial $15.00 Date. 9-22-06 New Construction: Old or Pre-existing Building: X (check one) Location of Property: 735 Jackson Street New Suffolk House No. Street Hamlet Owner or Owners of Property: Paul Prilucik Suffolk County Tax Map No 1000, Section 117.00 Block 09.00 Lot 006.000 Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ (XAc.-)III� &tee Co -Z319 Final Certificate: Applican Signature Paul PPiluci r/ 7 _ _ TOWN OF SOUTHOLD POOPERTY' RECORD CARD OWNER STREET j VILLAGE DISTRICT SUB. LOT Q Ll D JA P U/Y7fV FORMER OWNER N L 20Ad //Ortah E Q �� !t cC� l70UJJ`6A ACREAGE y hYqjo ur e a S a c FCSa 17"W �aer TYPE OF BUILDING / �G RES. d SEAS. VL. FARM COMM. IND. I CB. MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKSfs 300 3000 3 3 ao'f2�-�i�is8-KaI U 3 �/, Ir co- A4 W�Gt (� ;i} o Dd- w ( 4'o ?no I LA &k — n a� oy-Yi1 Ar�f k / 7/ AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD Tillable 2 DOCK Tillable 3 Woodland Swampland — ---- Brushland House Plot Total 04,4 A. -- (x 36 � 7-` _ 6Y � Foundation Bath xtension on 3 �� li . Basement �(/ �/ Floors xtension 9 Z Ext. Walls �� ` Interior Finish xtension `— Fire Place Heat `filet -- - 61 j j �'1n i �f Porch k (Roof Type Porch Rooms l st Floor reezeway Patio Rooms 2nd Floor orage rr L/ k 20 Driveway Dormer j k B. f 61 -7 It. T. TyYret A 9 M^P OF LAwo %Llvw%," P+OQ JONN H. ai QUTN S_ P*PUIRCA AT _ NF -W -1K JACKSON STREET Q trtofau ltlQti$ �.��uaarge-i4ee:d cmzic Cox®ratn4"ty f; orr-�pqx..�, <xc",rA cas aurvP L4&cl CONSENT TO INSPECTION Paul Prilucik the undersigned, do(es) hereby state: Owner(s) Name(s) That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold, located at 735 Jackson Street, New Suffolk, New York which is shown and designated on the Suffolk County Tax Map as District 1000, Section 11 7.00 , Block 09.00 > Lot 006.000 That the undersigned (has) (le) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: Certificate of Occupancy for Pre-existing Building 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 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: 9-22-06 (Si ature) Paul Pri anucik (Print Name) (Signature) (Print Name) LOCATION: 7,z5 - (number & street) SUBDIVISION• NAME OF OWNER(S): _ OCCUPANCY: 1 (type) -ok - , /46 W -- (municipality) LOT(S): (owner -tenant) ADMITTED BY: ACCOMPANIED BY: KEY AVAILABLE: SUFF. CO. TAX MAP NO. 1000- SOURCE OF REQUEST: DATE: DWELLING: TYPE OF CONSTRUCTION: a °� C # STORIES: # EXITS: 3 FOUNDATION: 9t44X+– CELLAR:., 0c4'4= CRAWL SPACE: TOTAL ROOMS: 1ST FLR: 2ND FLR: 3RD FLR: ---' BATHROOM(S): '. TOILET ROOM(S): — UTILITY ROOM: r PORCH TYPE: DECK, TYPE: -- PATIO, TYPE: .— BREEZEWAY: -- FIREPLACE: D GARAGE: �-- DOMESTIC HOTWATER: TYPE HEATER: AIRCONDITIONIING: TYPE HEAT�&/ �"�- HOTWATER: OTHER: ��, ACCESSORY STIWCTURES: GARAGE, TYPE OF CONST.: SWIMMING POOL: OTHER: AMAN VIOLATIONS: CHAPTER 45 & N.Y. STATE UNIFOPM FIRE PREVENTION & BUILDING CODE I, LOCATION DESCRIPTION'- _ „I ART. I SEC. _ REMARKS: INSPECTED BY: �� DATE OF INSPECTION: TIME START: . END: