HomeMy WebLinkAboutZ-34776FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPANTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 34776 Date: 01/06/11
THIS CERTIFIES that the building DWELLING AND ACCESSORY
Location of property 775 SKUNK LA
(HOUSE NO.)
County Tax Map No. 473889 Section 097
Subdivision
CUTCHOGUE
(STREET} (HAMLET)
Block 0004 Lot 004
Filed Map No. __ Lot No. __
conforms substantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursuant to which c~TIFICATE OF
(~2CuwANC~f ~0~4BER Z- 34776 d~ted JAMUANY 6, 2011
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 SHED.*
The certificate is issued to PHILIP J NORKELUN
(OWNER)
of the aforesaid building.
N/~.
N/A
N/A
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
BOUSING CODE INSPECTION REPORT
MAP NO.: LOT (S)
PBILIP J NORKELUN
DA~: 01/06/11
ACCESSORY STRUCTURES:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREXrENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
N~: RE-INSPECTED 12/27/10
~'~ (~ INS~CTION: 12/22/10
TI~ START: 10:15AM ~: 10:30~24
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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 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 Pl~anning 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 °f 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 $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00,
Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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:
House No.
Date.
Old or Pre-existing Building: ~//
Street
Owner or Owners of Property: ~ ~, x x_,,
Suffolk County Tax Map No 1000, Section
Subdivision ~ t.% e_
Permit No.
(check one)
-4' ~'4o
~J ~-~ Block ~
Filed Map. \'~
Dateofpermit. x~,\~.t\ x~ Applicant:
(check one)
Underwriters Approval:
Final Certificate:
Health Dept. Approval:
' Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ \ ~ - CD CD
Hamlet
pph nt SIgnature
CONSENT TO INSPECTION
Owner(s) Name(s)
That the undersigned (is) (are) the owner(s) of the promises in the Town of
Southold, located at ~ ~,~7 . f' ./5~,~J
which is shown and designated on the Suffolk Csunty Tax Map as District 1000,
Section ~ ,Block ~/ ,Lot
That the und6rsigued (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 8outhold 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 8outh61d.
The undersigned, in ~onsenting 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 8outhold.
( ignature)
(Print Name)
'(Signature)
(Print Name)
OWNER
TOWN OF SOUTHOLD i~OPERTY RECORD CARD
~OR~MEI~f OWNER
t'/~, ~VO ~'~¢. lq
SEAS.
RES.
LAND
AGE
N~
Farm
Tillable 1
Ti liable ]2
Tillable. 3
Woodland
Swampland
Brushland
House Plot
IMP.
VL.
STnVr
TOTAL
FARM
DATE
TotaI
VILLAGE DISTR1.CT SUB.
· D
LOT
BUILDING CONDITION
NOI:~v~AL
Acre
IBELOW
Va[ue Per Acre
ABOVE
Value
FRONTAGE ON WATER
FRONTAGE ON ROAD
E ' ACRE~ ,,.???
Extension
Extension
Extension
Breezeway
Garage I
Foundation
Basement
Fire Place
Driveway
Porch
Parch
Bath
Fleers
Interior Finish
Roof Type
Rooms Ist Ftoor
Raoms 2nd Floor
Dormer
TOWN OF SOUT~LDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[. ] FRAMING / STRAPPING [ ] FINAL~/~..~ ~
/
[ ] FIREPLACE & CHIMNEY [ ] FIRE SA,.-' ~ ~' INSPECTION
[ ] nm~g~"t,~'r~luo'no~ [ ]
REMARKS:~~'- ~
DATE
LOCATION:
(number & street)
(municipality)
SUBDIVISION:
NAME OF OWNER(S):
OCCUPANCY:
MAP NO.:
LOT(S):
(type) (owner-tenant)
, ) ~ /,.,~E CCOMPANmD BY:
SUFF. CO. TAX MAP NO. 1000-
DATE:
ADMITTED BY:, t~/3; ~/'~
KEY AVAILABLE:
SOURCE OF REQUEST:
TYPE OF CONSTRUCTION: '~ STORIES: ~ # EXITS:
FOUNDATION: C~'~--,~-~;--- /~c4/c
CELLAR. ,/--~.~ CRAWL SPACE
TOTAL ROOMS: 1ST FLR: ~ 2ND FLR: ..... ~ ' 3RD FLR .....
BATHROOM(S): 5.~,.~. T ROOM(S): -'-; · ~TILITY ROO~?
PORCH TYPE: ~_,~ DECK, TYPE: ~-~--- PATIO, TYPE:
BREEZEWAY: ........ FIREPLACE: ~ GARAGE:
DOMESTIC HOTWATER: _ cf_cS' TYPE HEATER: f_),zC/~ f~-~4IRCONDITIONING: -----.
TYPE HEAT: ~ / WARM AIR:
OTHER: HOTWATER: ~ .....
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTI~F~R:
STORAGE, TYPE COJST.:
GUEST, TYPE CONST. ~/
VIOLATIONS: CHAPTER 144 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION ~ DESCRIPTION
REMARKS:
INSPECTED BY:
S.C.T.M. NO. DIS'IRICT: 1000 SECTION: 97 BLOCK: 4 LOT(S): 4
NTT#7
N~r#7s
o d
150.00'
MON.
N82oSl'20"E
40.6'
DWELLING
#775
27.3' 69.5'
CONG.
STOOP
150.00'
SB2°51 '20"W
~HE WATER SUPPLY. WELLS, DRYWELLS AND CESSPOOL
LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS
AND OR DATA OBTAINED FROM OTHERS.
AREA: 16,480.84 SQ.FT. or 0.38 ACRES ELEVAnoN DATUM: .........................
UNAUIHORIZED ALTERATION OR ADDITION TO 1HIS SURVEY IS A ~IOLATION OF SECTION 7209 OF IHE NEW YORK STATE EDUCATION LAY4 COPIES OF THIS SURVEY
MAP NOT 8EARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COP~ GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HiS BEHALF TO THE TITLE COMPANY. GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLe
THE OFFSETS OR DIMENSIONS SHOl~fV HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRUC~URES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY
surVEY OF: DESCRIBED PROPERTY CERTIFIED TO: JOSEPH BEST;
MAP 0F: FIDELITEY NATIONAL TITLE INSURANCE COMPANY;
FIElD: NELLS FARGO BANK.
$~TUATED AT: PECONIC
TOW~ OF: SOUTHOLD I(ENNE?[-[ 1~. WO¥CHUK
SUFFOLK COUNTY, NEW YORK ~~ ~/4~¢1~ Land Surveyin~ and Design
IP,O. Box 3, Mattituck, New York 11952
FILE # ~ O-- ~ ~ 5 SEAL[: ~ "=20' DATE: DEC. ~ O, 20 ~ 0 N Y. $. LIe NO. 50227 malntainln~ the records of Robert J. Henn~y