HomeMy WebLinkAboutZ-35977Town of Southold Annex
54375 Main Road
Southold, New York 11971
PRE EXISTING
CERTIFICATE OF OCCUPANCY
9/28/2012
No: 35977 Date: 9/28/2012
THIS CERTIFIES that the structure(s) located at: 4670 Great Pcconic Bay Bird, Laurel
SCTM #: 473889 Sec/Block/Lot: 128.-4-20
Subdivision: Filed Map No. Lot No.
conforms substantially to the requirements for a built prior to
APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z- 35977
dated 9/28/2012 was issued and conforms to all the requriements of thc applicable provisions of the law.
The occupancy for which this certificate is issued is:
wood fi'ame one family dwelling with partially finished basement, attached two car garage and brick patio.*
The certificate is issued to
Alexander, Mary Ann
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
*PLEASE SEE ATTACHED INSPECTION REPORT.
LOCATION:
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
4670 Great Peconic Bay Blvd, Laurel
SUFF. CO. TAX MAP NO.: 128.-4-20
NAME OF OWNER(S): Alexander, Mary Ann
OCCUPANCY:
ADMITTED BY: Mary Ann Alexander
SOURCE OF REQUEST: Alexander, Mary Ann
SUBDIVISION:
DATE: 9/28/2012
DWELLING:
# STORIES: 1 # EXITS: 2
FOUNDATION: cement block
BATHROOM(S): 2 TOILET ROOM(S):
PORCH TYPE: DECK TYPE:
BREEZEWAY: FIREPLACE:
DOMESTIC HOTWATER:
TYPE HEAT: Nafl Grid Ga
# BEDROOMS: 3
OTHER:
CELLAR: 1
GARAGE:
yes TYPE HEATER:
WARM AIR:
# KITCHENS: 1
Nat'l Grid Gas
90% CRAWL SPACE: 10%
UTILITY ROOM(S):
PATIO TYPE: brick
2 car attached
HOT WATER:
BASEMENT TYPE:
AIR CONDITIONING:
X
partially finished
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST:
SWIMMING POOL:
OTHER:
STORAGE, TYPE OF CONST:
GUEST, TYPE OF CONST:
VIOLATIONS:
REMARKS:
INSPECTED BY:
GARYF
DATE OF INSPECTION:
TIME START:
9/19/2012
END:
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 ~d submitted to the Building Department with the following:
For new building or new u. se:
1. Final ~rvey of property with accurate'location of all buildings, property lines, streets, and unusual nature} or
topographic featur6s.
2. Final Approval from Health D~pt. of water supply and sewerage-disposal (S-9 form).
3.. Approval of electrical installation from Board 0fFire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains leas 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 Planning Board Approval of completed site plan r~quirements.
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, streets, building and unusual natural or topographic
features.
2. A properly ~mpleted application and consent to inspect signed by thc applicant. Ifa 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 $50.0t~.
2. Certificate ofOccupancy 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 $t 5.00
Date.
New Construction:
Location of Property:
Old or Pre-existing Building:
4670 Peconic Bay Boulevard
X (cheek one)
Laurel
Haml~
04.00 Lot 020.000
N/A Lot: N/A
House No. Street
Owner or Owners of Property: Mary Ann Alexander
Suffolk County Tax Map No 10(D, Section 128.00
Subdivision N/A
Pm-mit No. N/A
Health Dopt. Approval:
Planning Board Approval:
Request for: Temporary Certificate
FeeSubmi,ed:$ 100.00
Date of Permit. N/A
N/A
Block
Filed Map.
Applicant:
Underwriters Approval:
Final Certificate:
N/A
N/A
(check one)
~(~/plicanl Signature
MAI{,Y ANN ALEXANDER
CONSENT TO INSPECTION
MARY ANN ALEXANDER
Own )
, the undersigned, do(es) hereby state:
That the undemigned (is) (~o) thc owns(s) of the premises in the Town of
Southold, locatedat 4670 Peconic Bay Boulevard, Laurel, NY
whieh is shown and' designated on the Suffolk County Tax Map as District 1000,
S~tion 128.00,Block 04.00 ,Lot 020.000
That the undCn'signed (has) (have) filed, or cause to be filed, an application in the
$outhold Town BuildingImpector's Office for-the following: C ertif icate of
· Occupancy for Pre-Existing Building
That the undersigned do(es) hereby give eon~ent 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
red,peet to the aforesaid application, including inspections to determine that said premises
comply with all of thc laws, ordinances, rules and'regulations.of the Town of Southdld.
The undersigned, in censenting to such inspections, do(es) so with the knowledge
and understanding that any information obtained in the eonduet of such inspections may
be used in.subsequent prosecutions for violations of the laws, ordinances, rules or
~gulatious of the Town of Southold.
Dated: September 12, 2012
/ (/ (signat )
MAR~ ANN ALEXANDER
(Print Name)
Sig amr )
(Print Name)
September 12,
2012
Southold Town Building Department
P. O. Box 1179
Southold, New York 11971
Attention: Building Inspector
Re: Mary Ann Alexander - Premises: 4670 Peconic Bay
Boulevard, Laurel, New York
Dear Sir:
I represent Mary Ann Alexander the current owner of
premises located at 4670 Peconic Bay Boulevard, Laurel, New
York. Mary Ann Alexander and her husband, Eric H.
Alexander, acquired the premises in June of 1975.
Please find enclosed herewith the following:
1. A completed Application for Certificate of
Occupancy on Pre-Existing Building for the original
dwelling executed by Mary Ann Alexander.
2. A completed Consent to Inspection Form duly
executed by Mary Ann Alexander.
3. A survey print done by Young and Young Surveyors
on May 29, 1975 and revised on August 12, 1991 at the time
an addition to the premises was made under Certificate of
Occupancy Z-20419, a copy of which is enclosed herewith.
4. My Office Check to your order for $100.00
representing your fee for said Certificate.
Please be kind enough to review same and trusting same
meets with your approval, issue said Pre-Existing
Certificate of Occupancy for the original dwelling.
Very truly yours,
CHARLES E. RAFFE
CER/mg
Enclosures
f OWNER
FORMER OWNER
SEAS.
OF SOUTHOLD PROPERTY RECORD' CARDi
STREET ,:?. VILLAGE SUB. LOT
VL.
S
W
COMM. CB,
VdSC,
LAND iMP. TOTAL DATE REMARKS
NORMAL
Acre
BUILDING CONDITION
BELOW ABOVE
· Vatue Per
F~ONTAGE
FRONTAGE ON ROAD
DEPTH
BULKHCAD
DOCK
M. Bldg.
Extension
Extension
Extension
Porch
Porch
Breezeway
Garage
Patio
COLOR
TRIM
IBc~sement ~F¢ Il
Ext. Walls
Room ~¢¢¢..o Rooms 2nd Flor
LOCATION:
(number & street)
(municipality)
SUBDIVISION: MAP NO.: LOT(S):
NAME OF OWWER(S): RtA,0.,~ .(5,3,3 ~&,~ ~ ,~ .
OCCUPANCY: ' ~ ; ] .... ,
ty e) (omer-ten~t)
ADMITTED BY:
KEY AVAILABLE:
SOURCE OF REQUEST:
ACCOMPANIED BY:
SUFF. CO. TAX MAP NO. 1000-
DATE:
DWELLING
TYPE OF CONSTRUCTION:
FOUNDATION: ~ ~ r~
# OF BEDROOMS: 1ST FLR:
BATHROOM(S): ~
PORCH TYPE:
BREEZEWAY: ~
DOMESTIC HOTWATER:
60vD A # STORIES:
.~ ~,~ ~'!C BASEMENT: ~0~
. ~ 2ND FLR:
TOILET ROOM(S): /
DECK, TYPE:
~ # EXITS:
CRAWL SPACE: r/o
3RD FLR:
TYPE HEAT'~J.~.r~ C.a?,! (~d'. WARM AIR:.
# OF KITCHENS: C)"-~
FINISHED BASEMENT: yEs~ NO '
FIREPLACE: ~ GARAGE:
TYPE HEATER:~_~~AIRCONDITIONING:
· HOTWATER:
OTHER:
ACCESSORYSTRUCTUREg
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.
REMARK S:
INSPECTED BY:
DATE OF INSPECTION:
TIME START:
END: _.
.~v~s~o.. YOUNG & YOUNG
AUG 12, 1991 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
SURVEY FOR:
ERIC A£EXANDEt? ~ MARYA~II~ A££XA~IDER
SUFFOLK CO., N,Y.