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Home My WebLink AboutZ-33682FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 33682 Rte: 05/01/09 THIS CERTIFIES that the building DWELLING AND ACCESSORY Location of Property 11595 SOUND AVE (HOUSE NO.) County Tax Map No. 473889 Section 141 Subdivision MATTITUCK (STREET) (HAMLET) Block 0003 Lot 011 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 (~2C~gPANC~f ~UMBER Z- 33682 dated NL~Y 1, 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 COVERED PORCH AND ACCESSORY TWO CAR GARAGE.* The certificate is issued to GENEVIEVE KOLOSKI (OWNER) of the aforesaid building. N/A N/A N/A /uthorize Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT MAP NO.: LOT (S) GENEVIEVE KOLOSKI #STOP. IES: 2 . 0 # EXITS: __3 ~Y.T~%R: YES C~.AWL SP~: 3RD FLR.: 0 0.0 ~TILITY ROOM(S): PATIO TY~E: GARAGE: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. APR 2009 Form No. 6 TOWN OF SOUTHOLD BUILD/NG DEPARTMENT TOWN HALL 765-1802 BLDG. DEPT, TOWN OF SOLJTHOL~) 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 prnperty with accurate location of ail 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, induslrial 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. 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 consant 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 l. 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 New Construction: Old or Pre-existing Building: LocationofProperty: Ii 5(~ ~ .~OI.L~C~ House No. Street Owner or Owners ofProperty: ~e.V~'i~ J<~('") Suffolk County Tax Map No 1000, Section t/L/-- [ Block (check one) Hamlet Lot / / Subdivision Permit No. Date of Permit. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~ff_.J~), ff.)_/') Filed Map. Applicant: Underwriters Approval: Final Certificate: Lot: 6~ (check one) / Applicant Signature OWNER FORM.ER OWNER J IMP. TOWN OF SOUTHOLD VL. FARM PROPERTY RECORD AGE Nb-W FAI~A Tillable Ho~S~ P~,t Total TOTAl. ,~o"~ VILLAGE CO/v~A. C8. ~CS. ^CR ~ TYPE OF BUILDING BUILDING,CONDITiON */ NORMAL BELOW ABOVE Acre Value Per VGlue Ac~e BULKHEAD FRONTAGE ON WATER J .~'~ ' / FRONTAGE ON ROAD DEPTH CARD SUB. I~I ~ 31 LOT Mkt. Value COLOR TRIM Extens{on Extension ~xtells~o~t Porch Porch Breezewoy ~aroge Pofio Oo B. Totol ~Ba.th Basement Ext. Vv'alls F~re Place Type Roar Recre~ion Room Dormer 4eot :Rooms 1st Floor Rooms 2nd Floor Drivewoy y~r$. LR. DR. BR. FIN. B CONSENT TO INSPECTION 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, locatedat I[~'~.~:, '.~O~l,'l~/ 4~/e~) /Mo~.~qlo{¢_/(. which is shown and designated on the Suffolk County Tax 19laP as Di~tri6t 1000, Section ]L[J 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: ]gt-C ~ C) That the undersigned do(es) hereby give consent to ihe Building hlspectors 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, roles and regulations of the Town of Southold. The undersigued, iii consenting to such inspections, do(es) so with the kmowledge and understanding that aoy 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: KO (Signattlre) (Print Name) (Signature) (Print Name) 51 tUA~ff.. HATTITUGK TOhN.. 5UI=F:OLK COUNT'i', N'r' .5URVEYEI): APRIL 22, 2OOq SUFFOLK COUNT'( TAX # IOOO- 141 - ~- II N NOTES: O PIPE FOUND · 5TAKE E:,ET AI;~,EA = Iq,OOB 5.F. OR O.4;~ ACt:~E ®P,.APHIC, SC, ALE I"= 40' JOHN C. EH~A~D SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.\\Compaq servefipros\09\09-127 .pro