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Home My WebLink AboutZ-33744FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA=RTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY NO: Z- 33744 Rte: 05/28/09 THIS CERTIFIES that the building DWELLING Location of Property 645 MILL CREEK DR SOUTHOLD (HOUSE NO.) (STREET) (HANLET) County T~ Map No. 473889 Section 135 Block 0003 Lot 034 S%~odivision Filed ~4ap NO. Lot NO. __ conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF ~uuFaN~ ~3~ Z- 33744 dated M3%Y 28, 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 GARAGE UNDER.* The certificate is issued to ELAINE DOMALESKI & OTHERS ( OWNER ) of the aforesaid building. S~3FFOI~KCO~DEPAR~TOFf~A~TH;EPI~O%~AL EI.Rt-£KICAL C~RTIFIC~%TH NO. PL~S CHRTIFIC3%TION DATHD *PLEASE SEE ATTACHED INSPECTION REPORT. N~A Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT 645 MILL CREEK DR SOUTHOLD ~OT (S) ACCESSORY STRUCTURES: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. GEORGE GILLEN I A¥ 2 1 2%9 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be fdled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I. 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 3vater supply and sewemgeMisposal (S-9 form). 3. Approval of eleCtrical installation fi'Om 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, mulQple reskienoes and similar buildings and installations, a certificate of Code Compliance from amhitect 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, struts, building and .unusual natural or topographic "-~-~features. ~ 2. A properly completed appfication and eousent 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, Additious to dwelllng $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: Location of Property: Date. Old or Pre-existing Building: House No. (/ Street (check one) Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision Permit No. Date of Permit. Bleck CD 3 Lot Filod Map. Lot: Applicant: Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ '~ ~)(~ L~ ~ Underwriters Approval: Finai Certificate: ~ (check one) Applicant Signature _3_~zTOWN OF SOUTHOLD PROPERTY RECORD OWNER FORMER OWNER RES. ~.10 SEAS. LAND IMP. VL ACREAGE TYPE OF BUILDING COMM. t IND. CB. TOTAL DATE REMARKS / oeo fao S4~eo AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE Form Acre Value Per Acre Value Tillc~.le 1 Tillable 2 Tillable 3 Woodland Swampland Brushland House Plot Total ~ ~ ~ .~ ~,. ~ ~-[ ~ ' ~ · ~- Foundation ~;~,~' Bath ~ .~ . ~ ,~, , ' ' /z - ~ ~' Basement ~' Fl~rs / ~Nt ~' ~' ~ ~ 4. ~ ZZ~ ~t. Walls ',. -' Interior Finish ~ t ~It~ Porch , -' ~ ~'~" ~ ~ ~.~ ~1~ Porch R~ms 1st Flor Ireeze~ Patio R~ms 2nd Flor ~/~ ~arage Driveway ).B. CONSENT TO INSPECTION ~")~./Kifi} ~)~_~-~lx,.) (~(2t7-2: , the undersigned, do(es) hereby state: Owner(si Name(s) That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold, located at which is shown and desigmated on the Suffolki County Tax Map as District 1000, Section I _~5 , Block~._~ , Lot 3 ~'J . That the undersigned (has) (have) filed, or cause to be filed, an application in the ~,u,th~old Town Building~In~)ector's Office fo,r. th%fogJlowing: That the undersigued do(es) hereby give consent to ihe Building h~spectors 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 necessmy 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 Southol& The undersigned, iu cousenting to such inspections, do(es) so with the kno~vledge and understanding that any infonnation 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: (Sigmature) (Print Name) (Signature) (Print Name) N SURVEY OF PROPERTY A T SOUTHOLD TO'tN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-135-03-34 SCALE: i'--EO' MARCH 11, 2009 AREA=7,924 SO. FT. TO TIE LINE · =MONUMENT ANY ALTERATION OR ADDITION TO THIS SURVEY IS A [40LATION OF SECTION 72090F THE NEW YORK STATE EDUCATION LAW. EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES ~EAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. lC. NO. 49618 ~OUT~O~O, N. ~. ~97~I 09--109