HomeMy WebLinkAboutZ-35380Town of Southold Annex
54375 Main Road
Southold, New York 11971
1/5/2012
No: 35380
PRE EXISTING
CERTIFICATE OF OCCUPANCY
Date: 1/5/2012
THIS CERTIFIES that the structure(s) located at:
SCTM #: 473889 Sec/Block/Lot:
Subdivision:
conforms substantially to the requirements for a
A~RIL 9, 1957
475 Ackerly Pd Ln, Southold
69.-5-11.1
Filed Map No. Lot No.
built prior to
pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-
35380
dated 1/5/2012 was issued and conforms to all the requriements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
wood frame one family dwelling.*
BP 3270 addition COZ-2618
The certificate is issued to
Klos, Frank & Klos, Robert
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIHCATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 475 Ackerly Pd LA, Southold
SUFF. CO. TAXMAP NO.: 69.-5-11.1 SUBDIVISION:
NAME OF O~NER(S): Klos, Frank & Klos, Robert & Ano.
OCCUPANCY:
ADMITTED BY:
SOURCE OF REQUEST: Klos, Frank & Klos, Robert DATE: 1/5/2012
DWELLING:
TYPE OF CONSTRUCTION:
FOUNDATION: cement block CELLAR:
TOTAL ROOMS: ~ST FLR.: 2ND FLR.:
BATHROOM(S): 1 TOILET ROOM(S):
PORCH TYPE: DECK TYPE:
BREEZEWAY: FIREPLACE:
DOMESTIC HoTw~ERi ~es TYPE HEATER:
TYPE HEAT: oil WARM AIR:
# BEDROOMS: 2 # KITCHENS: 1
OTHER:
# STORIES:
1 # EXITS: 2
CRAWL SPACE:
3RD FLR.:
UTILITY ROOM(S): dryer
PATIO TYPE:
GARAGE:
off boiler AIR CONDITIONING:
HOT WATER: x
BASEMENT TYPE: unfinished
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST:
SWIMMING POOL:
OTHER:
STORAGE, TYPE OF CONST:
GUEST, TYPE OF CONST:
VIOLATIONS:
REMARKS:
INSPECTED BY:
DATE
OF INSPECTION: ///.,d~y ,/{/'
TIME START: ~y~~ ~'~END:
This application ~ust be filled in by typewriter or ink and submitted to the Building Department with thc 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 I% lead.
5. Commercial building, industrial bnilding, multiple residences and similar buildings and installatious, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. ,,~r existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
Accurate survey of 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.
Owner or Owners of Property:
Old or Pre-existing Building:
Street /
(check one)
Hamlet
Lot: ~ ~ ~
Suffolk County Tax Map No 1000, Section
Subdivision
Permit No.
Health Dept. Approval:
Planning Board Approval:
Date of Permit.
Block ~ 5''~
Filed Map.
Applicant:
Underwriters Approval:
Request for:
Foe Submitted: $
Temporary Certificate
Final Certificate:
(check one)
Applicant Signature
CONSENT TO INSPECTION
Owner(s) Narn (s)
, the undersigned, do(es) hereby state:
That the undemi.g~_ e~l~ (is.) (are) the&owner(s) of the premises in tha Town of
Southold, locatedat ?~ /~ck,e~t I~'r~.,~4 1. t t~,JY-~,,l~
'-/1_._,. ,_,.,, ,_...._.
which is shown and designated on the/Suffolk County Tflx Map as Distri" ct 10~0, t ,
Section ~ 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:
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 ail
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 ail of the laws, ordinances, roles and'regulations.of the Town of South~ld.
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 8outhold.
Dated:
(Signature)
(Print Name)
'(Signature)
(Print Name)
/TOWN OF SOUTHOLD PlJOPERTY R.E.C
STRE~ H
OWNER
FORMER OWNER
SEAS.
IMP.
VL
FARM
TOTAL
~z'-C.o 0 ,/
RES.
LAND
AGE BUILDING CONDITION
NEW NORA4AL BELOW
Farm Acre Value Per Acre
Tillable 1
VILLAGE
E
COMM.
~RD CARD
DISTRICT SUB. LOT
ACREAGE }
TYPE OF BUILDING
MISC.
REMARKS
D
Est. Mkt. Value
/ / FRONTAGE ~N WATER
ABOVE
Value
//~lz~
&ZO
FRONTAGE ON ROAD ~l~. '
Tillable 2 ~. ,
Tillable 3
Woodland
Swampland
Brushland
House Plot
Tara I
J
r
Bldg.
:ension
:ension
~ x:~ - Bath
Floors
nterior Finish
Foundation
Basement
Ext. Walls
:ension Fire Place
Heat
.~ezeway Patio Rooms 2nd Floor
Driveway Dormer
6-O
rage
B.
Roof Type
Rooms 1st Floor
Porch
Porch
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST
[ ]FOUNDATION 2ND
[ ]FRAMING / STRAPPING
[ ]FIREPLACE & CHIMNEY
ROUGH PLBG.
INSULATION
[ ]FINAL /~-~ ~
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRIC~OUGH) [ ], E/~,.~ECTRICAL (FIRAL~
REMARKS.~
LOCATION:
(number & street) (municipality)
SUBDIVISION:
NAME OF OWNER(S):
OCCUPANCY:
MAP NO.:
LOT(S):
(type)
ADMITTED BY:
KEY AVAILABLE:
SOURCE OF REQUEST:
(owner-tenant)
ACCOMPANIED BY:
SUFF. CO. TAX MAP NO. 1000-
DATE:
BATHROOM(S):
PORCH TYPE:
BREEZEWAY:
DWELLING
TYPE OF CONSTRUCTION:
FOUNDATION: ~'"'x~:""~7~
# OF BEDROOMS: 1ST FLR:
DOMESTIC HOTWATER:
~A-- BASEMENT:
2ND FLR:
TOILET ROOM(S): '--
DECK, TYPE:
FIREPLACE:
# STORIES:
~ # EXITS: )"--
CRAWL SPACE: ~/~'---
3RD FLR: ~
UTILITY ROOM: ~-~&_.~
PATIO, TYPE:
GARAGE:
TYPE HEATER: ~ ~4xAIRCONDITIONING: --
WARM AIR:
HOTWATER: ~
TYPE HEAT: ~
# OF KITCHENS: ~
FINISHED BASEMENT: YES
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.
INSPECTED BY:
TIME START: ~:/(Z~Utd'~ END:
ACKERLY POND ROAD
(BOWERY LANE)
88'02'00" E
90.00
S.C, TAX No. 1000-69 05-11.2 O.¢~coNc COVER
S 88'00'00" E 90.00'
S.C. TAX No. 1000-69-05-11.5
W
86'52'20" W
SURVEY OF PROPERTY
SITUATE A T
SOUTHOLD
TOWN OF SOUTHOLO
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-69-05-11.2
1000-69-05-11.3
SCALE 1"=$0'
SEPTEMBER 15, 2011
AREA = 17,728 sq. ff.
0.407 ac.
N.YS. L[c No 50467
Nathan Taft Corwin III
Land Surveyor
PHONE (651)727-2090 Fax (651)727 1727