HomeMy WebLinkAboutZ-33625FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPA~RTMENT
Office of the Building Inspector
Town Hall
Southold,~ N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPA/~CY
No: Z- 33625
Date: 03/31/09
THIS c~KTIFIES that the building DWELLING
I~)catiou of Propex~y 3675 WELLS
(HOUSE NO.)
County Tax }{ap No. 473889 Section 070
subdivision
SOUTHOLD
(STREET) (fLAMLET)
Block 0004 Lot 004
Filed }{ap NO. __ Lot No. --
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
(~2cu~ANC~f 1~3}~3~ Z- 33625. dated F~%RCH 31, 2009
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 ENCLOSED BREEZEWAY, ATTACHED TWO CAR GARAGE,
GREENHOUSE AND SLATE PATIO.*
The certificate is issued to ANNA GPJ~DOWSKI
of the aforesaid building.
(OWNER)
S[~F~LKC~)I~YDEPART~4E~FF OF~THAPPRO~-AL
EI.~L-iaICAL C~K'~IFIC3%THNO.
PLIghtERS CERTIFICATION DA'£~U
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTBOLD
HOUSING CODE INSPECTION REPORT
l~ OF ~ (S): ANNA GP~ADOWSKI
SOU~OLD
NO.: LOT (S)
03/31/09
STOP~IES:
FULL
0.0
1.5 # EXITS: 2
C]{AWL SPACE:
3RD FLR.: 0
UTILITY P.O(~(S):
PATIO TYPE: SLATE - REAR
~: 2 CAR
ACCESSORY STRUCTURES:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
P.~: BP2841 ADD COZ2370, BP30698 FIRE REP COZ30701
I~ATE ON INSPECTIOn: 03/30/09
~ ~TART; 9:50 ]~): 10:15
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPAN(
This application must be filled in by typewriter or ink and submitted to the Building Dep~
A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, st
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.
BLDG.
~ts. and
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 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 $25.0~s to accessory building $25.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Build'fig - $100.0(F'~)
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
New Construction:
Location of Property: ,_~-~ ~ House No.
Owner or Owners of Property: e[ldc~ in&
Suffolk County Tax Map No 1000, Section
Subdivision
Date.
~/' (check one)
Old or Pre-existing Building:
Street
Filed Map.
Permit No. Date of Permit.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~E~t'D . (DC")
Hamlet
Lot:
Applicant:
Underwriters Approval:
Final Certificate: (checkone) ~7..- CO ~
~- - 'App[cant ~ignat[~re ~ - f
TOWN OF SOUTHOLD PROPERTY RECORD CARD
/-~/
OWNER STREET .'~ ~.~ ~" VILLAGE DIST SUB.
FOI~MER OWNEk /j. N L~ A,C~4
~/ l} S W TYPE OF BUILDING
~j SEAS. VL FARM cOMM. CB. MICS. Mkt. Value
RES.2~/O
LAND IMP. TOTAL DATE REMARKS
AGE BUILDING CONDITION
N~ NORMAL BELOW ABOVE
FARM Acre Value Per Value
Ac re
Tillable FRONTAGE ON WATER
w~l~.d ~RONTAGE ON ROAD /~ ~ ~/~
Meadowland DEPTH
House Plot BULKH~D
Total DOCK
COLOR
TRIM' /.x~+~/-~ Z~ '
M. Bldg.
Extension
Extension
Extension
Porch
Porch
Breezeway
Garage
Patio
O.B.
Total
Foundation
Basement
Ext. Walls
Fire Place ~,j
Type Roof
Recreation Room
Dormer
Bath ,
Floors
nferior Fihish
Heat
Rooms 1st Floor
Rooms 2nd Floor
Driveway
Dinette
K.
LR.
DR.
BR.
FIN. B
CONSENT TO INSPECTION
~6IFJq (~(v. t2A \ ~y.~ ~r'- , the undersigne, d, do(es) hereby state:
' Ownbr(s) Name(s) OF lq~c~ (~eadou3~Y..,L
That the undersigned (is) (are) the owner(s) of the premises in the Town of
Southold, located at ovid'-/5 tg3~l~ $ [fMr~
which is shown and designated on the Suffolk~County Tax Map as District 1000,
q['5 ,Block t~q ,Lot 15~ .
Section
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following:
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, roles or
regulations of the Town of Southold.
Dated:
(Signature)
(Print Name)
SURVEY OF PROPERTY
AT SOUTHOLD
TO~N OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000- 70-04--04
SCALE' 1'--30'
MARCH 10, 2009
LoT 5
~01' 3
LOT 4
CERTIFIED TO:
TOR TORKELSEN
JOAN TORKELSEN-
AMERISA VE MORTGAGE CORPORA DON
FIDELITY NATIONAL TITLE INSURANCE COMPANY
PECONIC ABSTRACT, /NC.
LOT NUMBERS REFER TO "PLAN OF LOTS OWNED BY
GEORGE H. 14'ELLS" FILED NOVEMBER 28, 1927
IN THE SUFFOLK COUNTY CLERK'S OFFICE AS MAP NO. 859.
AREA=20,801 SO. FT.
TO TIE LINES
· :MONUMENT
N. ES. LIC. NO. 4961~
¥ORS. P. Co
20 FAX (6,9~) 76,5-1797
1230 TRAVELER STREET[
souTHoL~, N.'~ .97, 109-110