HomeMy WebLinkAboutZ-34011FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 34011
Date: 10/19/09
THIS CERTIFIES that the building 2 DWELLINGS & ACCESSORIES
Location of Property 175 LAUREL AVE SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 056 Block 0002 Lot 008.001
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- 34011 dated OCTOBER 19, 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 TWO ONE FAMILY DWELLINGS WITH ENCLOSED PORCH, ACCESSORY TWO CAR GARAGE
AND CHICKEN COOP.* CORRECTED 1/4/11
The certificate is issued to RUBY GAFFGA
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ N/A
PLDMBEzs CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 175 LAUREL AVE SOUT14OLD House #1 On survey
SUBDIVISION: MAP NO.: IOP (S)
NAME OF OWNER (S): RUBY GAFFGA
OCCUPANCY: ONE FAMILY DWELLING RUBY GAFFGA
ADMITTED BY: ACCOMPANIED BY:
KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 56.-2-8.1
SOURCE OF REQUEST: GEORGE GAFFGA DATE: 10/19/09
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME $ STORIES: 1.0 Y EXITS: 2
FOUNDATION. CONCRETE BLOCK CKLT.TR: 1/2 CRAWL SPACRc
TOTAL ROOKS: IST FLR_: 4 2ND FCR.: 0 3RD FLR.: 0
BATEROON(S): 1.0 TOILET ROOK(S): 0.0 UTILITY ROON(S):
PORCH TYPE: REAR ENCLOSED DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE-
DOIESPIC HOTWATER: YES TYPE BEATER: PROPANE AIRCOEDITIONIING:
TYPE HEAT: PROPANE MARK AIR: X HOTiATER:
OTHER:
ACCESSORY STRUCTURES:
TYPE OF CONST_: 2 CAR WOOD FRAME STORAGE, TYPE CONST.:
SWINKINC POOL: GUEST, TYPE CONST..
OTHER: 8 X 12 CHICKEN COOP
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
INSPECTED BY: -� DATE ON INSPECTION: 10/08/09
GARY S P TINE START: HND:
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 175 LAUREL AVE SOUTHOLD House #2 OR survey
SUBDIVISION: MAP NO.: LOT (S)
NAME OF OWNER (S): RUBY GAFFGA
OCCUPANCY: ONE FAMILY DWELLING RUBY GAFFGA
ADMITTED BY: ACCOMPANIED BY:
KEY AVAILABLE: BUFF. CO. TAX MAP NO.: 56.-2-8.1
SOURCE OF REQUEST: GEORGE GAFFGA DATE: 10/19/09
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 1.0 # EXITS: 2
FOUNDATION: CONCRETE BLOCK CELLAR: 1/3 CRAWL SPACE: 2/3
TOTAL ROOKS: IST FLR.: 4 2ND FIR.: 0 3RD FLR.: 0
BATNROOK(S): 1.0 TOILET ROOK(S): 0.0 UTILITY ROON(S):
PORCH TYPE: ENCLOSED DECK TYPE: PATIO TYPE:
BREEZEWAY: FIREPLACE: GARAGE:
DODUCSTIC HOTWATER: YES TYPE HEATER: PROPANE AIRCONDITIORING:
TYPE HEAT: OIL WARN AIR: X HOTWATER:
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.: 2 CAR WOOD FRAME STORAGE, TYPE CONST.:
SWINNING POOL: GUEST, TYPE CONST.:
OTHER: 8 X 12 CHICKEN COOP
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
INSPECTED BY: - ` DATE ON INSPECTION: 10/08/09
GARY J FI TIME START: END:
Form No. 6 . -
TOWN OF SOUTHOLD �7 J
BUILDING.DEPARTMENI
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 fiom Health Dept. of watersupply and sewerage -disposal (S-9 form),
3. Approval of electrical installation fi±om Board of Fire Underwriters.
4. Sworn statement from plumber teal mg that the solder used in system contains less than 2/I0 of 1016, 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:
1. Accurate survey of property showing all property.lines, streett 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 masons 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
Date.- f CciK E 25 Z
New Construction: Old or Pre-existing Building:. (check one)
Location of Property LGCI%/> Ue__ 5oclzr�
House No.. /.� Street Hamlet
.Owner or Owners of Property � !9e_ C _ zr .
Suffolk County Tax Map No 1000, Section 5 Cp Block Lot
Subdivision Filed Map. Lot:
Permit No. Date of Permit. , Applicant:_
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ /d O
C//-�k� 1
kic -7 log Appli t igna r
GUAPoNI/EESWDICATEDHEREONS RW
D/$YTOOW: P6LSONEORWNOMTNE SURVEY
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TRCECOMPANY. GOVERMB3V AGENCY.
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GUARANTEED TO:
RUBY GAFFGA
216'
NSF BOOTH 1
AGTNE CE'SPO A
a O O.
N 68.43'00"E W 34.4'
� m
25.00' 9,2' ONE—STORY N 28.9. o
� RESIDENCE
FENCE pT m Il
FRAME
a
o J AcrlvE GEssPGDEs O GARAGE P 15.4' 16.3'
0 0
o
O
N
CGNG WALE ^' 26.3' m LL
c
8.2'
a Z
o
o
'2.7' ONE-STORY
8-2.'7 RESIDENCE
BLUESTONE RIBBONS - DRIVEWAY I N 7Fi'4.5'
N/F R & K GAFFGA
0
N/F HUSEL _
SURVEY OF
DESCRIBED PROPERTY
SITUATE
SOUTHOLD, TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
SURVEYED FOR: RUBY GAFFGA
TM# 1000-056-02-07.3 �
TM# 1000-056-02-008 b C1
0
O
GRUTr R
POLE WWIRE
T 25
MAIN ROAD NYS R
SURVEYED: 7 NOVEMBER 2005
SCALE 1'= 30'
AREA = 43,734 S.F.
OR
1.004 ACRES
SURVEYED BY
STANLEY J. ISAKSEN, JR.
P.O. BOX 294
NEW S�FFOLK. N.Y. 11956
631-7 4-5835 /A
NYS Lic. 'No. 49273 05R1450
1
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GVY UIILf1YW IRAME
WIRE PoLE 'p SHED
2.2'
O
BRICK
WELL
(BACKFILLED)
CESSPOOLS
O
0
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O
UNE
00 W
,, E DRIP
S 68'43
N/F HEHR
I'
raaMF GARAGE
0
N/F HUSEL _
SURVEY OF
DESCRIBED PROPERTY
SITUATE
SOUTHOLD, TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
SURVEYED FOR: RUBY GAFFGA
TM# 1000-056-02-07.3 �
TM# 1000-056-02-008 b C1
0
O
GRUTr R
POLE WWIRE
T 25
MAIN ROAD NYS R
SURVEYED: 7 NOVEMBER 2005
SCALE 1'= 30'
AREA = 43,734 S.F.
OR
1.004 ACRES
SURVEYED BY
STANLEY J. ISAKSEN, JR.
P.O. BOX 294
NEW S�FFOLK. N.Y. 11956
631-7 4-5835 /A
NYS Lic. 'No. 49273 05R1450
CONSENT TO INSPECTION
(;a f4G- , the undersigned, do(es) hereby state:
/ Own ) Name(s)
That the undersigned (is) (are) the owner(s) of the premises in the Town of
Southold, located at /7S La a ✓ e -e 4Ve— �o v 7-fW /if
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section �, Block oZ Lot X.
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Building Inspector's Office for the following:
CCU1,7a PC
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, rules or
regulations of the Town of Southold.
Dated:
l�iigna
C , 9 "
(Prfnt Name)
(Signature)
(Print Name)
LOCATION:
(number & street)
SUBDIVISION:
NAME OF OWNER(S):
OCCUPANCY:
� -Tt I wAJ
(municipality)
MAP NO.:
LOT(S):
(type) (owner -ten
ADMITTED BY: ACCOMPANIED BY: ��
KEY AVAILABLE: SUFF. CO. TAX MAP NO. 1000 -
SOURCE OF REQUEST: DATE:
DWELLING:
TYPE OF CONSTRUCTION: #STORIES:- #EXITS: y'
FOUNDATION:_( & - CELLAR: / v CRAWL SPACE:
TOTAL ROOMS: 1ST FLR: 2ND FLR: 3RD FLR:
BATHROOM(S): TOILET ROOM(S): UTILITY ROOM: �---
PORCH TYPE: < „ti DECK, TYPE: i--- PATIO, TYPE:
BREEZEWAY: ' FIREPLACE: GARAGE: ------
DOMESTIC HOTWATER: TYPE HEATER: AIRCONDITIONING:
TYPE HEAT: WARM AIR: HOTWATER:
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTHER:
STORAGE, TYPE CONST.:
GUEST, TYPE CONST:
VIOLATIONS: CHAPTER 144 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS: jQ J5 j� AA d C,-) a
INSPECTED BY:
DATE OF INSPECTION: Q
TIME START: 4o /1— END: It ` �
LOCATION:
(number & street)
SUBDIVISION:
NAME OF OWNER(S):
OCCUPANCY:
(type)
ADMITTED BY:
KEY AVAILABLE:
SOURCE OF REQUEST:
DWELLING:
MAP NO.:
cipality)
LOT(S):
(owner -tenant)
ACCOMPANIED BY:
SUFF. CO. TAX MAP NO. 1000-
DATE:
TYPE OF CONSTRUCTION:4�4L C�. �# STORIES: _ # EXITS: v
FOUNDATION: C CELLAR: CRAWL SPAC
TOTAL ROOMS: 1ST FLR: 2ND FLR: 3RD FLR:
BATHROOM(S): dXa-- OILET ROOM(S): UTILITY ROOM: �-
PORCH TYPE: _�� DECK, TYPE: PATIO, TYPE:
BREEZEWAY: - FIREPLACE: GARAGE: ----
DOMESTIC HOTWATER: V<5 TYPE HEATER:.gc4-e— AIRCONDITIONING:
TYPE HEAT j WARM AIR: HOTWATER:
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.: 4coo C STORAGE, TYPE CONST.:
SWIMMING POOL: GUEST, TYPE CONST:
OTHER: e >c 4y <�-
VIOLATIONS: CHAPTER 144 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCIOPTION ART. SEC.
l
REMARKS:
INSPECTED BY:
DATE OF INSPECTION: ��' I j
TIME START: /0 5/'5' END: