HomeMy WebLinkAboutZ-34899FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 34899 Rte: 04/07/11
CERTIFIES that the building BARN
Location of Property 18525 MAIN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 115
subdivision
MATTITUCK
(STREET) (HAMLET)
Block 0002 Lot 013
Filed Map No. __ Lot NO. __
conforms s~stantially to the Requirements for a ONE FAMILY DWELLING
built prior to APRIL 9, 1957 pursu~-t to which U~TIFICATE OF
~uuF~/~C~f ~ Z- 34899 dated APRIL 7, 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 BARN.
The certificate is issued to IRENE RUTKOSKI
of the aforesaid building.
(OWNER)
SUFFOLK COUNTYDEPARTMENTOFHEALTHAPPROVAL
ELEt-rKICAL CERTIFICATE NO.
PLU~ERS CERTIFICATION DA'r~U3
N/A
N/A
N/A
t/zed ~ignature
Rev. 1/81
CONSENT TO INSPECTION
.~t~,v~4 ~ Z 6e~&F?_~. ?~,~C ,. the undersigned, do(es)hereby state:
Owner(s) Name(s) ~ '
That the undersigned(is) (are)~ t~e owner(s) of the pr~emis~s in the Town of
Southold, locatedat i~c¢,~ fda_.._ L ~ , t~ F4 ~4~ ~ C~[C · ,
which is showj~ and designated on the Suffolk County Tax Map as District 1000,
Section I1.~q ,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: ~Q ~ CGCnn ~1 c+-rc~
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.
(Print Name)
(Signature)
(Print Name)
Fox. No. 6" ~ ~ ~ r~ .
TOWNOFSOUTUOL, III )1
This application must be filled in by ~pewriter or ink and submi~ed to the Building Depa~~
A. For new building or new use: I. Final su~ey of pmpe~ with accurate location of all buildings, prope~ 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 o~Fire Underwriters.
4. Sworn statement from plumber ce~i~ing that the solder used in system contains less than 2/I0 of 1% lead.
5. Commemial building, industrial building, multiple residences and similar buildings and installations, a ce~ificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed si~e plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
I. Accurate survey of properW 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 $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:
Location of Property:
House
Owner or Owners of Property:'_~(zg3G
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $
Old ~; P~e-e:~is "':' il (check one)
Street
[ ~ ~ Block Z Lot
Filed Map. Lot:
Hamlet
Date of Permit. Applicant:
Underwriters Approval:
Final Certificate: (check one)
J;~pl~n('~4g'nature
k4. Bldg. Foundation
Extension Basement
Extension Ext. Walls
~xtensJon
~reezeway
~arage
). B:
/-7'0 ~50~
/.~oO
Fire Place
Porch
Porch
Patio
Bath
j Floors
Jlnterior Finish
~H,eat
Roof Type
Rooms 1st Floor
Rooms 2nd Floor
Driveway Dormer
TOWN OF $OUTHOLD PERTY RECORD CARD
OWNER
RES.
LAND
//o 0
~"oo
AGE
NEW
SEAS.
IMP.
/~ oo
NOR,/v~AL
Farm Acre
Tillable l
Tillable 2
VL
TOTAL
S*RE / '5z5
FARM
DATE
BUILDING CONDITION
V~lue Per Acre
VILLAGE LOT
E
DISTRICT ~
ACREAGE ~,
TYPE OF BUILDING
ABOVE
Value
FRONTAGE ON WATER
FRONTAGE ON ROAD
BULKHEAD
DOCK
Tillable 3
Woodland
Swampland
Brushland
House Plot
I MISC.
Est. Mkt. Value
N
N/OY.~,OS~
y RU ~ SKI
sToRY
SURVEY OF PROPERTY
A T MA TTITUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000-115-02-18
SCALE: 1'=20'
SEPTEMBER 21, 2010
AREA=14,880 80. ~-r.
(S.I~.
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION
OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW.
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS
HEREON ARE VAUD FOR THIS-MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
WHosE SIGNATURE APPEARS HEREON.
× PECONIC SlJ~
(651) 765-5
P.O. BOX 909
1230 TRAVELER STREET
SOUTHOLD, N.Y. 11971
LOCATION:
(number & street)
SUBDMSION:
NAME OF OWNER(S):
OCCUPANCY:
MAP NO.:
(municipality)
LOT(S):
(type)
ADMITTED BY:
KEY AVAILABLE:
SOURCE OF REQUEST:
(owner-tenant)
ACCOMPANIED BY:
SUFF. CO. TAX MAP NO. 1000-
DATE:
DWELLING:
TYPE OF CONSTRUCTION:
FOUNDATION:
TOTAL ROOMS:
BATHROOM(S):
PORCH TYPE:
BREEZEWAY:
DOMESTIC HOTWATER:
TYPE HEAT:
OTHER:
CELLAR:
1ST FLR:
2ND FLR:
TOILET ROOM(S):
DECK, TYPE:
FIREPLACE:
TYPE HEATER:
WARM AIR:
# STORIES: # EXITS:
CRAWL SPACE:
3RD FLR:
UTILITY ROOM:
PATIO, TYPE:
GARAGE:
AIRCONDITIONING:
HOTWATER:
ACCESSORYSTRUCTURES:
GARAGE, TYPE OFCONST.:
SWIMMING POOL:
OTHER:
STORAGE, TYPE CONST.:
GUEST, TYPE CONST:
VIOLATIONS: CHAPTER 144 & N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION . ~ ART. ] SEC.
I
17
REMARKS:
INSPECTED BY:
DATE OF INSPECTION:
TIME START:
END: