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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-
32602
Date: 09/14/07
THIS CERTIFIES that the building
DWELLING
Location of Property 1000 MILL RD
(HOUSE NO.)
County Tax Map No. 473889 Section 074
(STREET)
Block 0002
PECONIC
(HAMLET)
Lot 014.001
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-
32602
dated SEPTEMBER 14, 2007
was issuedl 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 1 CAR WOOD FRAME GARAGE*
The certificate is issued to SONYA & WALTER BRIGHAM III
(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.
d Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATIOH :
1000 MILL RD
PECONIC
SUBDIVISIOH: MAP :NO. : LOT (S)
KAME OF OWNER (S): SONYA & WALTER BRIGHAM III
OCCUPAHCY: SINGLE FAMILY DWELLING SONYA & WALTER BRIGHAM III
ADMITTED BY: WALTER BRIGHAM
ACCOIIPAllIED BY: SAME
KEY AVAILABLE: SUPF. CO. TAX MAP HO.: 74.-2-14.1
SOURCE OF REQUEST: DEBORAH DOTY, ATTY 7/18/07 DATE: 09/14/07
DWELLING:
TYPE OF COBSTRUCTIOH:
FOmmATIOH: CEMENT BLOCK
TOTAL ROOMS: 1ST FLR.: -2
BATHROOM(S): ~
PORCH TYPE: SCREEN PORCH REAR
2ND FLR.: -2
TOILET ROOM (S) :
nECK TYPE:
# STORIES: ~ # EXITS: 2
CELLAR: 1/2 CRAWL SPACE: 1/2
3RD FLR.: --9.
0.0 UTILITY ROOM(S):
PATIO TYPE:
WOOD FRAME
BREEZEWAY:
DOMESTIC HOTWATER: YES
FIREPLACE:
TYPE HEATER: OFF BOILER
GARAGE:
AIRCONDITIONDIG: CENTRAL AIR
TYPE HEAT: OIL
OTHER: WOOD STOVE
WARM AIR: XX
HOTWATER ;
ACCESSORY STRUCTURES:
GARAGE, TYPE OF COHST.: 1 CAR WOOD FRAME STORAGE, TYPE COHST.: 6 X 8 WOOD FRAME
SWIMMDlG POOL: GUEST. TYPE CONST.:
OTHER ,
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION
DESCRIPTION
ART.
SEC.
REMARKS: BP #13811Z-COZ22335 (ADD) BP#33321Z-COZ32601 (WOOD STOVE)
DlSPBCTED BY:
DATE OR DlSPBCTION: 08/02/07
TIME START: 10:10 AM END: 10:30 AM
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
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 certilYing 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
7/18/2007
Date.
New Construction:
Old or Pre-existing Building:
x
(check one) sfd & detached garage
Location of Property: 1000 Mill Lane, Peconic
House No. Street
Hamlet
Owner or Owners of Property :
Walter Cole Brigham, III & Sonya King Brigham
Suffolk County Tax Map No 1000, Section
74
Block
2
Lot 14.1
Subdivision
Penuit No.
Date of Permit.
Filed Map.
Applicant:
Lot:
Health Dept. Approval:
Planning Board Approval:
Underwriters Approval:
Request for:
Temporary Certificate
Final Certificate:
x
(check one)
Fee Submitted: $
~
c- ~~"" ~
pplicant Signature ~
Deborah Doty as attorney for
owners
BM./,?05t'
6'1I.t (ot 3;2(; o~
.
G:?\-"16S -3 \"
CONSENT TO INSPECTION
Walter Cole Brigham, III & Sonya
Owner(s) Name(s)
Brigham
King ~ the undersigned, doe es) hereby state:
That the undersigned (is) (are) the owner(s) of the premises in the Town of
Southold, located at 1000 Mill Lane. Peconic
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section 74 , Block 2 , Lot 14.1
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following:
Pre-Existing C/O for single family dwelling & detached garage
That the undersigned doe 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 South old.
The undersigned, in consenting to such inspections, doe 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:
07/18/2007
A~
;~l;~
~nnt~
(Sig re)
Sonya King. Brigh~ffi
(PrmtName)
. ... ..
"... _ ;<. l ~/. j TOWN OF SOUTHOLD PROPERTY RECORD CARD
STREET I Do 0 VILLAGE DIST. SUB.
~~~>)-:"~
.
l/.,.. 6'
LOT
I'
{l.AA:r, , ( <:..-
E
ACR.
0:1 I
TYPE OF BUILDING
N
(<;
W
..
, '
h ,#A",44~ I'
S
,"')"u:ci
COMM. CB. MISe.
Mkt. Value
ES, t-IO SEAS.
LAND
VL.
FARM
IMP.
TOTAL
DATE
REMARKS
AGE
NEW
FARM
'illable 1
'illable 2
illable 3
loodland
wampland
rush land
louse Plot
-
atal
;
f4/ /7/
",,<,c. r'S (""2.5<;3 +.2.5 '*"'2",-\5 j
,1"'1" C J,
BUILDING CONDITION
NORMAL
BELOW
ABOVE
Acre
Value Per
Acre
Value
,'3 f ~ 7
-
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
o
bb (C)..
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DOCK
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'J-A.-mag. ._-----,. -- Foundation ,-', Bath / Dinette
"- " r /Jj...r '.",
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Extension cry ;;2 / fY / Basement , f Floors K,
l<;
.fC/t1 ,
Extension /r )( ~ / t/ Ext. Walls Interior Finish lR.
;;;(p . ' .
Extension ) ,t 7L/C; 1/ TO 35 70 IJJ;e Place /J i; Heat [' . . L/ J- DR.
>_i" /
'.... . ~
r a.t:- /) I ;z. Yt, 3o() 7 :J-()
.,< .y ;2' ;) :!:we Roof ( Rooms 1 st Floor BR.
Porch IXI":c,' Y<,/ ) ?2- ,Recreation Roorr Rooms 2nd Floo FIN. B.
J~'/l ,c, jV'! Jr'O
~/' W!/T'lCZ. o.t::>. /~~ .;)"'" Dormer
/ .:? }( If: .' nJIC ~./~~ .--
Breezeway q "'1'( d) I./l,t '2.! Driveway
<4.,,;, / 5"'1' "
Garage 1-g-79 ,
,
. 0(,.)
~19Po>, '- 1.3 X a 7= '3 S-I /- 3';" I
, -"
O. B.
Total 3'2..~'" ,
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N/O/F RONALD & SH8LA ~CCA
SURVEY OF PROPERTY
AT PECONIC
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y:
1000-74-02-14.1
SCALE: 1"=30'
AUGUST 23, 2004
339.86'
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N/O/F
ANNE. A. HUBBARD
TOWN OF SOUTHOLD
CERTIFIED TO:
WAL TER BRIGHAM
SONYA BRIGHAM
ABSTRACT INC. 12-77289
l+f"LLS FARGO NA
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.~I 8'JJ618
P CONIC SUR OR,
(631) 765-5020 FAX
P.o. BOX 909
1230 TRAVELER STREET 04-2r'70
<::nllTl-lnln AI Y 11071 rl
ANY AL TERA T10N OR ADDITION TO THIS SURVEY IS A VIOLA T10N
OF SECTION 72090F THE NEW YORK STA TE EDUCA TlON LA W.
EXCEPT AS PER SECTION 7209-SU8DIVlSION 2. ALL CERTlFICA TIONS
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONL Y IF
SAID MAP OR COPIES 8EAR THE IMPRESSED SEAL OF THE SURVEYOR
'M-/OSE SIGNA TURE APPEARS HERtoN.