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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-
32426
Date: 06/25/07
THIS CERTIFIES that the building
DWELLING
Location of Property 68105 CR 48
(HOUSE NO.)
County Tax Map No. 473889 Section 033
(STREET)
Block 0003
GREENPORT
(HAMLET)
Lot 037
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-
32426
dated JUNE
25, 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 .
The certificate is issued to JAMES P. & EARL C. BURT
(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.
Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION:
68105 CR 48
GREEN PORT
SUBDIVISION: MAP NO.: LOT (S)
NAME OF 0WJ:mR (S): JAMES P. & EARL C. BURT
OCCUPANCY: SINGLE FAMILY DWELLING JAMES P. & EARL C. BURT
ADMITTBD BY: EARL BURT ACCOMPANIED BY: SAME
KEY AVAILABLE: BUFF. CO. TAX MAP NO.: 33. ~3~37
SOURCE OF REQUEST: EARL C. BURT, 6/18/07
DATE: 06/25/07
DWELLING:
TYPE OF COIlSTRUCTION:
WOOD FRAME
TOTAL ROOMS: 1ST FLR.: -1
BATHROOM(S): ~
PORCH TYPE:
BREEZEWAY:
DOMESTIC HO'l'WATER:
21lD FLR.: -1
TOILET R<X>>I (S) :
DECK TYPE:
# STORIES: ~ # EXITS: 2
CELLAR; FULL CRAWL SPACE:
3RD FLR.: ~
1.0 UTILITY ROOM(S):
6' X 8 I PATIO TYPE;
FOUNDATION:
CEMENT BLOCK
FIREPLACE :
NONE
YES
TYPE HEATER: OFF BOILER
GARAGE ,
AIRCOlmITIONING:
TYPE HEAT: OIL WARM AIR:
OTHER: FRONT ENTRY ROOM (FOYER)
HOTWATER :
xx
ACCESSORY STRUCTURES:
GARAGE. TYPE OF CONST.:
SWIMMING POOL:
OTHER ,
STORAGE. TYPE COBST.:
GUEST. TYPE COBST.;
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
RIlMARKS ,
INSPECTED BY;
DATE ON INSPECTION: 06/22/07
TIME START; 10:05 AM END: 10:20 AM
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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APPLlCA TION FOR CERTIFICATE OF OCC P A
IkDG. DEPT.
T WN OF SC~TIiOJ.D. I
This application must be filled in by typewriter or ink and submitted to the Building epartiDeilfW.itlftlle-tm~
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 2/1 0 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:
I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
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
I. 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 - $25.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. I go ,T.,,,,e. 100 ?
New Construction:
Old or Pre-existing Building:
v
( check one)
Gru'l fo",f-
Location of Property:
(/61()~
House No.
(! R J-f >r
Street
Hamlet
Owner or Owners of Property: Cr."..1 C. 1:)",..1
Suffolk County Tax Map No 1000, Section '3 ?l
Block
03
Lot 3'7-
Subdivision
Permit No.
Date of Permit.
Filed Map.
Applicant:
Underwriters Approval:
Lot:
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $
Final Certificate:
~
(check one)
{2 R ~ &..i~
Applicant Signature
~_l.'ll'l?-
(fMCO "[.3~IjJ t
CONSENT TO INSPECTION
[;..., I l2. () ... I" -r-
Owner(s) Name(s)
, the undersigned, do( es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises in the Town of
Southold, located at
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section 33 , Block 03 , Lot 37-
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following: Ctri:-P, ud<- ",f
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if
That the undersigned do(es) hereby give consent to the Building Inspectors of the
Town of South old 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 South old.
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 South old.
Dated: /8' r"...t :100 ~
c.:..I r!.- &7
(Signature)
~"I ~ [bvl"r
(Print Name)
(Signature)
(Print Name)
.
;, cJ - ..1J- -..J?
OWNER
.
TOWN OF SOUTHOLD PROPERTY RECORD CARD
.
STREET t ..... ,."
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SUB.
LOT
VILLAGE
DIST.
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RES...2. 1 0 SEAS.
LAND IMP.
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S:. <...:...A\OL..A
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E
ACR.
, ~j.e,
TYPE OF BUILDING
. .
W
.1<. bALL/lEU/ <$ AND.
COMM, CB, MISe. Mkt, Value
VL.
FARM
TOTAL
DATE
REMARKS ;iJ e ,
;). 0 0'
I, (,
( J.i
SOt)
/~_.." 0
AGE
NEW
FARM
NORMAL
Acre
Tillable 1
Tillable 2
Tillable 3
Woodland
Swampland
Brushland
House Plot
--
Total
I~ -~ci ~
"'+r
,~
BUILDING CONDITION
BELGW
ABOVE
Value Per
Acre
Value
---
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
5'0
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L:. ' c
s;!.~
/
DOCK
'-
~I
-
, . COLOR
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l: TRJ~ -*
,
. wf;.J:....
, 'l. 1+
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." I l0- t
!
,
VI. Bldg. I 7~ c) z ":-:z..-<> Foundation ZJi. Both / Dinette
.t..'7K~tl - .3,':'-0 Q~. '<
:xtension ~o ~sement ;::- c/ .;.. Floors , K.
oS y :f' 0 ":7,(1) ,,1 If"o ~- P /-1/ ,C~
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:xtension Ext. Walls Interior Finish LR.
:xtension Fire Place tV!') Heat 1-/ r..J DR.
Type Roof Rooms 1 st Floor BR.
'arch Recreation Room Rooms 2nd Floor FIN. B.
-
'arch Dormer
Breezeway Driveway
:;arage
Patio
O. B.
Total ;?60() 11/
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SURVEY OF PROPERTY
AT GREENPORT
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. 1':
1000-33-03-37
SCALE: 1'-30'
JUNE 5, 2007
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ANY AL TERA nON OR ADDmON TO THIS SURVEY IS A \.10LA nON
OF SEcnON 72090F THE NEW YORK STA TE EDUCA nON LA w.
EXCEPT AS PER SEcnON 7209-SUBDMSION 2. ALL CERnFlCA nONS
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONL Y IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
. =PIPE VrHOSE SIGNA TURE APPEARS HEREON.
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------- :~-
----
CERTIFIED TO:
EARL C. BURT
JAMES P. BURT
CHICAGO TITLE INSURANCE COMPANY
AREA=11,286 sa, FT.
at-~