HomeMy WebLinkAboutZ-34421FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEP~RTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUP~/qCY
No: Z- 34421 ~te: 06/28/10
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 390 NOKOMIS RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
Co%Lnty Tax Map NO. 473889 Section 078 Block 0003 Lot 023
Sutx~ivision Filed Map No. Lot No. __
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuit to which C~RTIFIC~%~ OF
~OF~C~f N~3~ER Z- 34421 dated JUNE 28, 2010
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.*
The certificate is issued to CHARLOTTE DELITERIS & ORS
(OWNER)
of the aforesaid building.
ELEC~fRICAL CERTIFICATE NO.
*PLEASE SEE ATTACHED INSPECTION REPORT.
N/A
N/A
N/A
~t ho/z ed~gnature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 390 NOKOMIS RD SOLWfHOLD
~i~ BY: MARI~_~_~i~_ ACCOMPANIED BY: SAME
BATHROOM(S): 1.0
D~MESTIC HOTMATER: YES
ACCESSORY STRUCTI/RES;
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
1~: BP1219 ADD COZ1251
GARY
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Tow7 a^LL
This application must be
A. For new building or new use: ~m suvmitted to the Building Depa~
1. Final sumcy °f pr°pc~y with acc~atc location of all buildings, propeny lines, strects, and
topog~phic features.
2. Final Approval from Health Dept. of water supply and sewe~ge-disposal (S-9 fo~). unusual natural or
3. Approval of electrical installation ~o~ Board of Fire Undemfiters.
4. Sworn statement from Pl~ber cool,lng ~at the solder used in system contains less than 2/10 of 1% lead
5. Commercial building, industrial building, multiple residences and simii~ buildings ~d
of Code Compliance from architect or engineer responsible for the building.
6. Submit Pla~ing Board Approval of Completed site plan requirements.
/ . installations, a ce~ficate
{ B~~ For existing buildings
'.~ (prior to April 9, 1957) non-conforming uses, or
1 ~ccu~te SUmey ofpropc~y showing ali buildings and "pr~exlsfing- land uses:
features, property lines, streets, building and Unusual natural or topographic
2. A properly completed application ~d consent to inspect Signed
denied, thc Building MspcCtor shall state the reasons therefor in writing to the applicant.
C. Fees by the appJicant. Ifa Certificate of Occupancy
I. Certificate of Occupancy _ New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swiping pool $25.00, Accesso~ building $2~.00, Additions to acccsso~ building $2~ 00, BUSinesses $50 00
2. Ce~ificate of Occupancy on Pre-ex/sting Building _ .
3. Copy of Certificate of Occupancy_ $.25 $100.00
4. Updated Certificate of Occupancy_ $50.00
5. Tcmpora~ Ce~ifiCate of Occupancy. Residential $15.00, CO~ercial $15.00
New Construction: Date.
~ Old or Pre-existing Building: ~
Location of Property: ~~. ( ~ .,~----~ (check one)
House No. Street . _~D; ,..~. ~.~
Owner or Owners of Prope~y: ~ ~Gv {~ ~, ~ ~/. ~
~uffolk County Tax Map No 1000, Section :~ ~ ~ Block '&
;ubdivision
' ' Lot
e~it No. ~ Filed Map.
Date of Pe~it. ~ Lot:
ealth Dept. Approval: ~ Applicant:
arming Board Approval: ~ Unde~hters Approval:
,quest for: Tempor~ Certificate
~ ~ ~Final Ce~ificate:
3 Submitted: $_ ~:~,~,,,, 7~ -- ~ (check one)
Hamlet---~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ] FRAMING/STRAPPING [ ] FINAL f,~-_ ~--~
] FIREPLACE & CHIMNEY
] FIRE RESISTANT CONSTRUCTION
REMARKS: ~'-
[ ] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT PENETRATION
DATE
INSPECTOR ~//~
TOWN
OWNER
~FORMER OWNER
OF SOUTHOLD PROPERTY
VILLAGE
RECORD CARD
DISTRICT SUB.
RES..2/O
LAND
AGE
NDvV
Farm
Tillable 1
Tillable 2
Tillable 3
Woodland
Swampland
Brushlond~
House Plot
ACREAGE
LO~
NORMAL
Ac re
BELOW
Value Per Acre
ABOVE
Value
BUILDING CONDITION
N kJ
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 :5:i~, ;~ ~ /~.~:. ¥~:~ fA.,. ~
which is shown and designa?d on the Suffolk County Tax Map as' District 1000,
Section ~[ <~ , Block :~x) , Lot :.¢ ~7
That the undbrsigned (has) (have) filed, or cause to be filed, an application in the
Southold Town Buildi.ng Inspector's Office for the following: ~'~--- ~ ~ t '2 ,~Vc~
That the undersigned do(es) hereby give consent to ~he 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, roles 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:
(Si,gnatur~e) /
(Print i',Fame)
'(Signature)
(Print Name)
SURVEY OF PROPERTY
A T SOUTHOLD
TONrN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000- 78-03-23
SCALE: 1'=30'
APRIL 28, 2010
~f I)¢; DEPT.
TO',',"!! r)F
Z
Z
N/O/F H^~OL~ r-
AREA=23,301 SO. FT'.
ANY ALTERATION OR ADDI~ION TO THIS SURVEY IS A ~10LATION
OF SECTION 72090F TME NEW YORK STATE EDUCATION LA~
EXCEPT AS PER SECTION ?20~-$UBDIVISION 2. ALL CERTIFICATIONS
HEREON ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COP/ES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
ICI-lOSE SIGNATURE APPEARS HEREON,
/ ~tECONIC SlOthfUl'OffS, P, C.
(651) 765-5020 FAX (651.) 765-1797
P.O. BOX 909
· =MONUMENT 1250 TRAVELER STREET
o=P/PESOUn~O,D, N.× 11971 10--126