HomeMy WebLinkAboutZ-32422FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 32422 Date: 06/21 07
THIS CERTIFIES that the building DWELLING
Location of Property 2030 MILL RD PECONIC
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 067 Block 0007 Lot 010
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- 32422 dated JUNE 21, 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 SEASONAL ONE FAMILY DWELLING*
The certificate is issued to KURT R YOUNGBERG
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
(OWNER)
N/A
N/A
N/A
Au ori2ed Signature
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 2030 MILL RD PECONIC
SUBDIVISION: MAP NO.: LOT (S)
NAME OF OWNER (S): KURT R YOUNGBERG
OCCUPANCY: SINGLE FAMILY DWELLING (SEASONAL KURT R YOUNGBERG
ADMITTED BY: KURT R. YOUNGBERG ACCOMPANIED BY: SAME
KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 67.-7-10
SOURCE OF REQUEST: KURT YOUNGBERG 6/18/07 DATE: 06/21/0
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME S STORIES: 1.5 S EXITS: 2
FOUNDATION: CEMENT BLOCK PIERS CELLAR: CRAWL SPACE• --
TOTAL ROOMS: IST FLR.: 4 2ND FLR.: 0 3RD FLR.: 0
BATHROOM(S): 1.0 TOILET ROOM(S): 0.0 UTILITY ROOM(S):
PORCH TYPE: SCREENED DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: YES -ONE GARAGE:
DOMESTIC HOTfATER: XX TYPE HEATER: AIRCONDITIONING:
TYPE HEAT: NONE WARM AIR: HOTWATER: XX
OTHER: HOT WATER HEATER (NOTE: LOFT ON 2ND FLOOR)
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTHER:
STORAGE, TYPE CONST.:
GUEST, TYPE CONST.:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
INSPECTED BY:
GEORGE GILLEN
DATE ON INSPECTION: 06/20/07
TIME START: END:
SEC.
Form No. 6 q
BUILDING WN OF
DEPARTMNT63 Aoa%� `
TOWN HALL 63 u q
765-1802 —I
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 I% 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
Date. 0611 F Ib —7
New Construction: Old or Pre-existing Building: lz< (check one)
Location of Property: Z o3 p kii, n - b ?j7 k,tC boq:i e eo 1 V
House No. —ten Street Hamlet
Owner or Owners of Property: K U IJ 9 \/0 UY
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No.
Health Dept. Approval:
Planning Board Approval:
Filed Map.
Date of Permit. Applicant:
Request for: Temporary Certificate
Fee Submitted: $ /()0
c�.�a�Y`f
6A co t 3aka2
Underwriters Approval:
Lot to
Lot:
Final Certificate: (check one)
Y
Applicant S/dRature
TOWN OF SOUTHOLD PROPERTY RECORD CARD
0,2".k
STREET 2
VILLAGE DISTRICT SUB, LOT
-Y-4
ORMER OWNER N E ACREAGE1
yy TYPE rc OF BUILDING
,41h
RES. VL. FARM I comm. IND. C6, I misc.
LAND Imp. TOTAL I DATE REMARKS
Tillable 3
IL
cu
cf) Wcodland
0 Swampland
r-
0 Brushland
(n
2 House Plot
cj I (..f ("
I
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AGE
m.
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O
Form
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Tillable I
Tillable 2
Tillable 3
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0 Swampland
r-
0 Brushland
(n
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cj I (..f ("
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W
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0
Cz
of
Cc
0
M
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px-
W Bldg. Tj
9 -
Foundation
Bath
Extension z
'4 Basement
--Interior
Floors
-xtension
Ext. Walls
Z4&&II.-uQ
Finish
xtenslon.
J-L—J,
re Place
He
Porch
Attic
Porch
Rooms Ist Floor
3reezeway
Patio
Rooms 2nd Floor
Garage
Driveway
D. B.
CONSENT TO INSPECTION
KvY t' P= YO y rj S the undersigned, dotes) hereby state:
Owner(s) N e(s)
?o GO)( 60 y
That the undersigned (is) (are) the own s) of the remises in the Town of
Southold, located at 7 0 i y�' / ( �j e ^ ,els 1145$
which is sh ,w�,n and designated on the Suffolk County Tax Map as District 1000,
Section �, Block _�, Lot
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following: ?ice 0(' o_
1
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: 0(o /Is /40
(Signa re)
Atrf i Q y0
(Print Name)
(Signature)
(Print Name)
I
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a
I
GOLosnnITN�3
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MAP OF "too .
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JOHN W MAE L.GLASS r.A
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PECAN iC
TOWN ofI. SOUTi4OLD, N.Y
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Lot.
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MAP OF "too .
suRVEyEp Cpq
JOHN W MAE L.GLASS r.A
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PECAN iC
TOWN ofI. SOUTi4OLD, N.Y
lrori Ripe
Lot.
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LOCATION: a- 03
(number & street)
SUBDIVISION: �-
NAME OF OWNER(S):
OCCUPANCY:
NO.. -
(municipality)
LOT(S):
(type) U (owner -tenant)
ADMITTED BY: k w ACCOMPANIED BY: 09
KEY AVAILABLE: SUFF. CO. TAX MAP NO. 1000-
SOURCE OF REQUEST: i DATE:
DWELLING: )
TYPE OF CONSTRUCTIO • 1o�e'Q�Q- �� # STORIES: /� # EXITS:
FOUNDATION: •+. CELLAR: — CRAWL SPACE:
TOTAL ROOMS: IST FLR: 2ND FLR: 3RD FLR:
BATHROOM(S): TOILET ROOM(S): UTILITY ROOM:
PORCH TYPE: DECK, TYPE: PATIO, TYPE:
BREEZEWAY: ---- FIREPLACE: GARAGE:
DOMESTIC HOTWATER: TYPE HEATER: AIRCONDITIONING: �-
TYPE HEAT: A10 tiles ARM AIR: HOTWATER:
OTHER:`
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTHER:
�
0AIE-
STORAGE, TYPE CONST.:
GUEST, TYPE CONST:
VIOLATIONS: CHAPTER 144 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION I DESCRIPTION I ART. I SEC.
REMARKS:
A
INSPECTED BY: 4 ���� DATE OF INSPECTION: 6—?6-021
TIME START: END: