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Home My WebLink AboutZ-31965FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPA/~CY No: Z- 31965 Date: 10/30/06 THIS c~KTIFIES that the building DWELLING Location of Property PVT RD INNER BAY (HOUSE NO.) County TaxMap No. 473889 Section 010 subdivision FISHERS ISLAND (STREET) (HAMLET) Block 0009 Lot 014 Filed Map No. -- Lot No. -- confozms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 purs,,a-t to which c~TIFICATE OF OCCupANCY ~]~ER Z- 31965 dated OCTOBER 30~ 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 RICHARD & ELIZABETH DALKOWSKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL u~KTIFICATE NO. PLUMBERS cmKTIFICATION DA'~mu *PLEASE SEE ATTACHED INSPECTION REPORT. N/A N/A Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTROLD HOUSING CODE INSPECTION REPORT OCCUPANCY: ONE FAMILY EO~q~CE OF R]~: RICHARD & ELIZABETH DALKOWSKI DATE: 10/30/06 BATHRO(~ (S): 2.0 PORCH TYP~: ACCESSORY STRUCTURES: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 76~-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink end submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of proporty with accurate location of all buildings, propon~y lines, streets, end unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply end 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 end similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planuing Board Approval of completed site plen requirements. B. )~or existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and ~pre-existing' land uses: it/l; Accurate survey of property showhig all property lines, stn~ets, building end enusual natural or topographic ~ features. i/2. A properly completed applic~ion 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 ofOccupency - 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. v/2. Certificate of Occapancy on Pre-existing Building - $100.00 3. Copy of Certifleate of Occupancy - $25.00 4. Updated Certificate ofOecupency - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Old or Pre-existing Building: ~ (check one) House No. ~ ' Stree~ - Hamlet Suffolk County Tax Map No 1000, Section Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate suni.ed: $ ! 0 0 Date of Permit. Filed Map. Lot: Underwriters Approval: Final Certificate: (check one) CONSENT TO INSPECTION Own s) N/me(s) - Southold, locatedat '~.:~l ~-4"t~/~ttr~,. ~f. ~ '~-t~'~4'~' which is shown and designated on the Suff6tl~ County Tax Map as Di/trict 1000, Section I_~..Block ¢ ,Lot /q That the undersigned (has) (have) filed, or cause to be filed, an application in ~.~_e Bmlamg Inspector s Office Come follow,ng: Soutbold Town 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, roles 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 oftbe laws, ordinances, rules or regulations of the Town of Southold. Dated: (Print Name LOCATION; SUBDIVISION': · ~ NO.: , LOT(~): (~) SOUR= OF =QtmT: ~, ~ DA~: ~~ VIOLATIONS: r.;:'.iS, pll~ 4~ &N.Y. STATIiUNIFORMY~RI~PR.~VEITi'ioNa,'BUiLDiNOCODE LOCATION '[- ~ DESCRIPTION 9-/~ TOWN OF SOUTHOLD PROPERTY RECORD CARD ?~_~- DISTRICT SUB. ACREAGE OWNER I S~TREET .~:QR,MER O'~NER ~ VILLAGE w ,~4..(~ c. TYPE OF BUILDING LOT RES. ~/0 sEAs. VL. FARM CO~. I,ND. CB. I M,SC. LAND IMP. TOTAL ~7oo DATE AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE Farm Acre Value Per Acre Value Tillable 1 Tillable 2 Tillable, 3 Woodland Swampland Brushland House P~'~ "~ Tctol REMARKS Extension (~ ~ ,2 5'~ -' f,~o "~ Basement /.~ ~. ~-- Fl~rs Extension 3 ~ ~ - ~ ~j) f7~ ~ ~ ~ ~' Walls ~, ,, Interior Finish ~tension Fire Place He~ Porch Attic Porch R~ms Ist Floor ~Y /~_ r~ ~~ ~Z ~0 ~ ~6 / Patio R~ms2naFl~r Garage Driveway O.B. MAP REFERENCES 1.) P~N MADE FOR FISHERS IS~ND FARMS, lNG.; SHOWING /~ 1"=40 ~,; CHANDLER ~ PALMER, ENGRS.; MARCH 1954 PURPOSED AGREED TO BE~EEN THE CLIENT AND THE SURV~OR EXCEEDS THE SCOPE OF THE ENGAGEMENT. 2,) IT IS A VIO~TION OF THE STATE EDUCATION ~W FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED ~ ~ ~ ~~~ / ~ND SURV~OR, TO ALTER AN ITEM IN ANY WAY. ~ E 1~2.71 / / / 3.) ONLY COPIES OF THIS SURV~ MARKEB WITH THE / SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL k / N/F ARE THE PRODUCT OF THE .ND SURV.OR. ~ / 4.) COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND m o / SHARON R. PATTERSON / GEODETIC SURV~ TRIANGU~TION STATION "PROS" z ~x''~G~' ~¢~ / 5.) SITE IS IN THE TOWN OF SOUTHOLD, COUN~ OF SUFFOLK TAX -- / MAP 1000, SECTION 010, BLOCK 9, LOT 1~. ~ / 6.) TOTAL AR~ = 0.10~ ACRES. N/F ECSA H. SUZANNE ~ RIVERS FREDERICK ~ ~ / o~ ~ g I I o ~ QU~ CO~ROL CERTIFI~ON , ~ANA~ER/~ /~/~ N/F NOW OR FORMERLY ~ ~ ~ DATE: 08/23/02 ENViROnmENTAL SF SQUARE FEET ~APUlC SCA~ m FE~T SCALE'. SmUCTU~AL SHEET: ARC~ITECTURAL