HomeMy WebLinkAboutZ-32258 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- 32258 Date: 03/23/07
THIS CERTIFIES that the building DWELLING
Location of Property 1940 MASON DR CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 104 Block 0007 Lot 016.001
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- 32258 dated MARCH 23, 2007
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 CEMENT PORCH, OUTDOOR SHOWER AND ROOFED OVER
CONCRETE PATIO.*
The certificate is issued to SUSAN M MICHELSON
(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.
thrized Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 1940 MASON DR CUTCHOGUE
SUBDIVISION: MAP NO.: LOT (S)
NAME OF OWNER (S) : SUSAN M MICHELSON
OCCUPANCY: ONE FAMILY DWELLING SUSAN M MICHELSON
ADMITTED BY: SUSAN MICHELSON ACCOMPANIED BY:
KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 104.-7-16.1
SOURCE OF REQUEST: RONALD HOLIK, ATTY DATE: 03/23/07
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME i STORIES: 1.0 I EXITS: 2
FOUNDATION: CEMENT CELLAR: CRAWL SPACE: YES
TOTAL ROOMS: 1ST FLR.: 4 2ND FLR.: 0 3RD FLR.: 0
HATHROOM(S) : 1.0 TOILET ROOM(S) : 1.0 UTILITY ROOM(S):
PORCH TYPE: CEMENT DECK TYPE: PATIO TYPE: ROOFED OVER CONCRETE
BREEZEWAY: FIREPLACE: 1 GARAGE:
DOMESTIC HOTiATER: YES TYPE HEATER: OIL BURNER AIRCONDITIONING:
TYPE HEAT: OIL WARM AIR: YES HOTWATER: YES
OTHER: OUTSIDE SHOWER
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.: PLASTIC SHED
SWIMMING POOL: GUEST, TYPE CONST.:
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS:
INSPECTED BY: _ �i� �/!! %J. DATE ON INSPECTION: 03/23/07
GEORGE GILLEN V/l TIME START: END:
Form No.6 (--_..— _ -
1AR g - TOWN OF SOUTHOLD
b BUILDING DEPARTMENT
TOWN HALL MAR - q .
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY _ - ----
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.
B. 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
Dale.
•
New Construction: Old or Pre-existi•• Building: 1. (check one)
Location of Property: • I 9(d 1cksor 1 I A k '' Q
House No. Street I Hamlet
Owner or Owners of Property: �J
Suffolk County Tax Map No 1000, Section_ /6y Block 1 Lot_ l� , Od
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval: _
Request for: Tem ora YCertificate Final Certificate:
(check one)
Fee Submitted: $y0-0
5- Si ___AaM �rG�
L
162 G ?-c):1 O Applicant Signatur-
CONSENT TO INSPECTION
Sus ami. (IQ chtiSCIPI , 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 l9go (blct.san Dr. Cvtt-Livc
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section /G , Block 7 , Lot l6 .Uo I .
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's1( Office for the following:
(Pre C. U. C !C Y' f; V cl G+e
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:
3/9/07
7c n(Sigr (uref t jn Ir
671
(Print Name)
(Signature)
(Print Name)
03/05/2007 02:43 6317540291 WOLFGANGHOLIK PAGE 02
AFFIDAVIT
STATE OF NEW YORK)
COUNTY OF S FOLK) ss.:
I Curtis Horton, b; ing duly sworn, state under the penalties of
perjury that:
1. I am a residfrii t of Cutchogue, Suffolk County , NY and have
resided at # 835 Mason Drive since 1952.
2. I am famili• with the house that stands on the property
known as 194 a Mason Drive, Cutchogue, NY and personally
know that it as there when I moved into my home at # 1835
Mason Oriv. in 1952.
I am making this ; 1 davit in support of Susan M. Michelson's
application for a P e-C.O. Certificate for her home located at 1940
Mason Drive, Cut i hogue, NY
Curtis Horton
Sworn to before m
This% day of Marsh, 2007
Notary Public
it e
sin
TOWN OF SOUTHOLD PROPERTY RECORD CARD A9
/000 --/0V-7- C<o_I
OWNER STREET K_ to VILLAGE DIST. SUB. LOT
SuckJ - COUr�6'
Ad—rem D,—/itC o 7 .Jo y ve iiUerc e Q'ORMER OWNER , M.. vv??rht(soh N E ACR.
_FORMER
trnor .1) anon � ajto'. .cit.- fee 401-4Lsc i tec000
F.,t,0.0. a n d S W TYPE OF BUILDING
A t4-A" o„ f Cloth .h 4,ea� GF- vhwc/
K, Rlc fl1 hU Deed G' t--ee. /( f T ,
RES. o!/C.) SEAS. VL. 9 FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS 7 j 7/ 4dal ft; 4A4 e� fFa4I' 0e a - .a , Ie` a/,
F L.69T`S r j , / nA
�f 44 .2 / od 72e 67 _ _ . 44. [ths, nFdL3/ ! d A 2Xcf4
3 d6 04 1 /J 72. _ is - - ... . ? - .
a ) 1210_4. . X f 8 o, - L 4 f Cill- h ` - -. a , t . , Cty - Int 541 4/c.
sc.-1
73n c7 wi:`! .t IL3
Tillable FRONTAGE ON WATER
/e if,C7(cz ,;,e) , _Ar - 4rzir)
Woodland FRONTAGE ON ROAD / v
Meadowland DEPTH Ae fro_, .e. 2 .�Jf,
House Plot I BULKHEAD
Total
, F SOUTHOLD PROPERTY RECORD CARD M -7
STREET /� VILLAGE� DIST. SUB. LOT
47401n, �. MaJdn ,A1 ro l 4 - Cr�>e , t /c E jve I be-set-Ai P 17/
FORMER OWNERN,*d.Jan Df-ii e E C, Ta h f z e A ACR./ I /;
S W TYPE OF BUILDING
RES a/O SEAS. VL. FARM COMM. CB. MISC. Mkt. Value
LAND IMP. TOTAL DATE REMARKS Ar
((�� / fa/d f/0, +-- asea Wk./ %9.23-
` oo 42.26 6 370 /0 ✓ // S-` /214fil /fen,oueY/ 4'ttnd5 a...e 6 .Qee , _ •
in,C) 2--660 y/ t 0 J 9//,r ,%7
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
finable 1
finable 2
"'liable 3
Voodland
wampland FRONTAGE ON WATER Fs' r ,
.rushland FRONTAGE ON ROAD '7o cPf
louse Plot DEPTH A V e Y&; e_ 367 J
..... .00-, BULKHEAD f7
IS. .-.
'otal DOCK
COLOR
` ri Ii
-:il`l .P ,, 11°` /:ui„ `r.; 4,t,.0, ..£jyid /8-171- e
.'• ' t' TRIM I '�' _ r
41
is . - — �_ �f far. 154.
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_ / 1
_ - Lid; ...7._
I
M. Bldg. VLF. v5 L1- (‘ 3 qv :�?Inundation , Bath Dinette
Extension Basement 0424„,Nf L. Floors K.K.
Extension _ Ext. Walls 4,4„,,,,'
y" dli Interior Finish (bit,//9 ALR.
Extension 5- C( - V-i7 f (,i,c tise Place / Heat —Z,/ y? DR.
Type Roof R f ^\ Rooms 1st Floor BR.
Porch Recreation Room ` Rooms 2nd Floor FIN. B.
Porch Dormer
Breezeway Driveway
Garage
Patio NdG , )C L c , o' -). _,A -- 1 r° 1/
O. B. `�
Total _ v G 6 g f
A /t
N SURVEY OF PROPERTY
AT EAST CUTCHOGUE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000-104-07-16.1
SCALE: 1'=40'
DECMEBER 14, 2006
Dec. 28, 2006 (revision)
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CERTIFIED TO: Y Y IL
SUSAN M. MICHELSON Y t
EMIGRANT MORTGAGE CO., INC. Y Y Y 6,
SUFFOLK ABSTRACT 6"
BRAD ap. ewsteOF NES
AT SSP\to%�wEt_, sspm
AFIEl4=62,612 SO. FT. Cop? '°' . c
�k �;n :yw A%= *
TO TIE LINES l V 1`! 1I. Y. .. IC. NO. 49618
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION •EC• „,�,� `moi- rf, '.
OF SECTION 72090E THE NEW YORK STATE EDUCATION LAW. (631) (4,—V Z'. 3 •31) 765-1797
EXCEPT AS PER SECT7ON 7209-SUBDIVISION 2. ALL CERTTFlCATIONS
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P.O. BO +(.AND so-
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ■=MONUMENT 1230 TRA - •EET 06-257
WHOSE SIGNATURE APPEARS HEREON. •=PIPE SOU THOLD, N. Y. 11971
° /44,04141 )3)1;4_
LOCATION: / -1 G
(number& street) (municipality)
SUBDIVISION: MAP O.: LOT(S):
NAME OF OWNER(S): Attia ,^--- ilf .
OCCUPANCY: �•.C. ieQ-h, _ --ce 4)-"6 �.
(,,_)
134
(type) Ck\'.-9)
(owner-tenant)
41
ADMITTED BY: r- ACCOMPANIED BY:
KEY AVAILABLE: &— - SUFF. CO. TAX MAP NO. 1000- /0 y • 7- /(o • l
SOURCE OF REQUEST: 14 #�? j DATE: -9-i-a 7
DWELLING:
TYPE OF CONSTRUCTION: " / t' # STORIES: ) # EXITS: a
FOUNDATION: C,-- CELLAR: CRAWL SPACE:
TOTAL ROOMS: 1ST FLR: T 2ND FLR: - — 3RD FLR:
BATHROOM(S): / TOILET ROOM P .•Y..421 UTILITY ROOM: —
PORCH TYPE: c - gj '-12 : •: "dam-PATIO, TYPE: ,y,
BREEZEWAY: FIREPLAC : D ARAGE: 'f
DOMESTIC HOTWATER: (E-5 TYPE HEATER: OIL gio6ho AIRCONDITIONING: ----
TYPE HEAT: 0/ WARM AIR: y S. HOTWATER: ) �
OTHER: ® _�,a
ACCESSORY STRUCTURES: ��� pp
GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.: r�°� reel_
SWIMMING POOL: GUEST, TYPE CONST:
OTHER:
VIOLATIONS: CHAPTER 144 &N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
131)--3- &Mr,-
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REMARKS:
-' +
INSPECTED BY: Alft)
DATE OF INSPECTION: 3 - & 7
c.
TIME START: END:
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TOWN OF SOUTHOLD BUILDING DEPT. 0
765-1802 / , ,
1 INSPECTION t- miti
1
{ , FOUNDATION 1ST [ ] ROUGH PLBG.
3', 3
[ ] FOUNDATION 2ND [ ] INSULATION
1
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRAT •
REMARKS:
70,A)2__ - c, • ot 6 i - o-K,
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1 DATE 3 -.7-31-0 7 INSPECTOR 4itri 41A----
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