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Home My WebLink AboutZ-22396FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No Z-22396 Date JUNE 15~ 1993 THIS CERTIFIES that the buildin~ Location of Property 270 MEDAY AVENUE House No. County Tax Map No. 1000 Section 113 Subdivision ONE FAMILY DWELLING MATTITUCK{ N.Y. Street Hamlet Block 10 Lot 5.1 Filed Map No. Lot No. conforms substantially to the Requirements for a One Family Dwelling built Prior to: APRIL 9~ 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-22396 dated JUNE 15~ 1993 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 SEASONAL DWKLLING * The certificate is issued to STANLEY ADAMKIEWTCZ (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A *PLEASE SEE ATTACHED INSPECTION REPORT. g' Inspector Rev. 1/81 Form No. 6 TOwN OF souTHoLD < !! BUILDING DEPARTMENT '[ '~--7'~ TOwN HALL 765-1802 ~ : APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: 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 f0rm). 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 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 requirements. 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 completed application and a 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. Certificate of Occupancy on Pre-existing Building - $100.00 Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.,00 Commercial $15.O0 Date .. ... . New Construction ........... Old Or Pre-existing Buildin~~.~. '... ................. Location of Property. 'ZTO ,~O~7...h...~' ......... ~. ...... (.~ ..... ,. House No. Street Hamlet 3nwer or Owners of Pro ert, :ounty Tax Map No 1000, Section. j ~..~. ..... Block.../O Lot..'~.~.7 {ubdivision .... . . .............................. Filed Map ........ Lot .......... 'ermit No Date Of Permit ....... Applicant {ealth Dept. Approval ..................... Underwriters Approval ...................... 'lanning Board Approval ........ ~ ......... request for: Temporary Certificate .......... Final Certicate ......... APPLICANT BUILDING DEPARTHENT TO~N OF SOU~[OLD HOUSING CODE INSPECTION REPORT LOCATION: 270 NEDAY AVE. (number & street) SUBDIVISION ~ NO. NAME OF OWNER (s) STANLEY ADAI~IEWICZ OCCUPANCY A-{ RES. (type) MATTITHCK, N.Y. (municipatity LOT (s) · ONNER (owner-tenant) ADMI'i-rEO BY: NR. SHIN KEY AVAILABLE ' S~URCE OF REQUZ~ST:_ S. AUAN~TEWTCZ ACCOMPANIED BY: SUFF. CO. T.,'~ MAP NO. 1000-113-10-5.1 DATE: MAY 28, 1993 DWELLING: TYPE OF CONSTRUCTION FOUNDATION TOTAL ROOMS: BATHROOM (s) PORCH TYPE BREEZEWAY DOMESTIC HOTWATER TYPE HEAT NONE OTHER: WOOD FRA~ CENENT BLOCK IST FLR. ~ ONI/ F~LL BATH 2ND FLR. TOILET ROOM (s) DECK, TIME FIREPLACE TYPE HEATER PROPANE WAI~MAIR ~ STORIES ONE # EXITS 2 CELLAR FULL CRAWL SPACE 3RD FLR. UTILITY ROOM PATIO, TYPE GARAGE AIRCONDITIONING HOTHATER ACCESSORY STRUCTURES: NONE GARAGE, TYPE OF CONST. SgIMMING POOL OTttl~R: STORAGE, TYPE CONST. · GUEST, TYPE CONST. VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATION DESCRIPTION ART. SEC. INSPECTED BY: DATE ON INSPECTION JUNE II, 1993 TIME START END TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER ,', STREET ~-~.'(~ VILLAGE DIST. ...~S.UB. LOTS "~/~""-~_ '-~'~, &~ >~'~ ~.~ 5 W ~PE OF BUILDING RES. ~ / ~ S~S. VL. ~ FARM COMM. CB. MISC. Mkt. Value ~ND IMP. TOTAL DATE REMARK~ ~,~ ~- ~o ' G '~lO~ ~,,,,,,~.,",~- · AGE BUILDING CONDITION N~ NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable Tillable 2 Tillable 3 Woodland Swampland FRONTAGE ON WATER BruShlond FRONTAGE ON ROAD House Plot DEPTH BULKH~D Total DOCK M. Bldg. Extension Extension Extension COLOR Foundation ~ ,Z~ . Bath / Basement Floors Ext. Wails Fire Place Type Roof Interior Finish Heat Rooms 1st Floor P.orch Recreation Room Rooms 2nd Floor Porch Dormer Breezeway Driveway Garage Patio 7 TOWN OF SOUTHOLD PROPERTY RE(:ORD CARD OWNER STREET VILLAGE DIST. SUB. LOT '7 ~:~ ~O~M~ owu~ ~ *c~. I ~ /,~ ~/,,'P, S W ~PE OF BUILDING RES. / S~S. VL. FARM COMM. CB. MISC. Mkt. VQlue AGE BUILDING CONDITION NORMAL BELOW ABOVE Acre Volue Per Volue Acre Tillable 1 Tilloble 2 Tilloble 3 Woodland Swampland FRONTAGE ON WATER Brushlond FRONTAGE ON ROAD Hou*o ~lot D~PTH ~ ~ BULKH~D Total DOCK CONSENT TO INSPECTION Ox~rner (s) Name(s) do(es) hereby state: That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold located at} / 2 Va ~[ e-~ ~7 h ~ ~ ./ mToHx /4.7! . which is shown and designated on the Suffolk That the undersigned (has) (~) filed, or caused to be filed, an applica- tion in the Southold To~ Building Inspector's Office for the follow,g: That the undersi~vned 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 aferesaid 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 w/th the knowledge and understanding that any information obtained in the conduct of such inspections may be used as evidence in subsequent prosecutions for vio- lations of the laws. ordinances, rules or regulations of the Town of Southold. Dated: ~'-/~247~ ~ ( s~ig4u r e )~4~,.Z (print name) /N 7-o 70 (signature) (print name) AREA = 23,139 sq. ft. Prepared in accordance with fha minimum slondords for lille surveys as established by fha L.I.A.L.$. and approved and adopted for such use by The New York Stale Land Titie Association. SURVEY OF CERTIFIED TO~ ROBERT D. IFHITE ICENDY A. WHITE CHICAGO TITLE INSURANCE LOTS 75 & 76 'TOLLEWOOD' FILED JANUARY25, 1927 FILE NO. 175 A T MA TTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. ,o , SCALE, 1" = 30' / ,.~"~;'% MA Y 24, 1993 iSOUTHOLD, N.Y. 11971 BLDG. DEPT. 93-202 C(