HomeMy WebLinkAboutZ-29730FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 29730
THIS CERTIFIES that the building
DWELLING
Date: 09/22/03
Location of Property MADELINE AVE FISHERS ISLAND
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 006 Block 0007 Lot 009
Subdivision
Filed Map No. Lot No.
conforms substantially to the Requirements for a Three Family Dwelling
built prior to APRIL 9, 1957 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z- 29730 dated SEPTEMBER 22, 2003
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
THREE FAMILY DWELLING *
The certificate is issued to EUGENE R PUSKARZ AS TRUSTEES
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
4 �- /-4�
'f
// A orized Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: MADELINE AVE FISHERS ISLAND
SUBDIVISION: MAP NO.: LOT (S)
NAME OF OWNER (S): EUGENE R PUSKARZ AS TRUSTEES
OCCUPANCY: THREE FAMILY DWELLING EUGENE R PUSKARZ AS TRUSTEES
ADMITTED BY: OWNER ACCOMPANIED BY: SAME
RKY AVAILABLE: SUFF. CO. TAX MAP NO.: 6.-7-9
SOURCE OF REQUEST: MATTHEWS & HAM, ATTYS 9/2/03 DATE: 09/22/03
DWELLING:
TYPE OF CONSTRUCTION. WOOD
FRAME
# STORIES: 1.5 # ERITS: 6
FOUNDATION:
POURED CEMENT
CELLAR: FULL CRAWL SPACE.
TOTAL ROOMS:
IST FLR.: 8
2ND FLR.: 9
3RD FLR.: 0
BATHROOM(S):
3.0
TOILET ROOM(S):
0.0 UTILITY ROOM(S):
PORCH TYPE:
WOOD COVERED
DECK TYPE:
PATIO TYPE:
BREEZEWAY:
FIREPLACE: NONE
GARAGE:
DOMESTIC HOTWATER: YES TYPE HEATER: PROPANE AIRCONDITIONING: NO
TYPE HEAT: 3 TYPES * WARM AIR: HOTWATER:
OTHER: *1. -PROPANE, 2. -WARM AIR, 3. -STEAM
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
STORAGE, TYPE CONST.:
SWIMMING POOL: GUEST, TYPE CONST.:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART•
REMARKS: BP #4867-Z-COZ-4415 (ACCESSORY GARAGE)
INSPECTED BY: ( DATE ON INSPECTION: 09 08 03
ROBERT E. TIME START: SND:
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, anA 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.— 2
20
4. Sworn statement from plumber certifying that the solder used in system contains less than/10 of 1 % lead.
5. Commercial building, industrial building, multiple residences and similar buildings and insWlatiions, cerfificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning 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 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 $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
Date. August 29, 2003
New Construction: Old or Pre-existing Building: X (check one)
Location of Property: (no #) Madeline Avenue Fishers Island
House No. Street Hamlet
Owner or Owners of Property: Puskarz Family Living Trust
Suffolk County Tax Map No 1000, Section 006.00 Block 07.00 Lot 009.000
Subdivision n/a Filed Map. n/a Lot: n/a
Permit No. n/a Date of Permit. n/a Applicant: Stephen L. Ham, III
Health Dept. Approval: n/a Underwriters Approval: n/a
Planning Board Approval: n/a
Request for: Temporary Certificate Final Certificate: X (check one)
Fee Submitted: $ 100.00
Gam•, L • •�
App icant Signature
Stephen L. Ham, III
TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER
VILLAGE
DIST. SUB. LOT
FARM
COMM. CB, MICS. Mkt. Value
e,5 c
IMP.
TOTAL
--
FORMER OWNER N
E
ACR.
n 0
V I
-7
S.
W
TYPE OF BUILDING
I
RES.\
SEAS.
VL.
FARM
COMM. CB, MICS. Mkt. Value
LAND
IMP.
TOTAL
DATE
REMARKS
U
n 0
V I
-7
PV L kCA Y -z 10 IAV aY4 OY
BUILDING CONDITION
BELOW ABOVE
AGE
NEW
NORMAL
FARM
Acre
Value Per
Acre
Value
Tillable
FRONTAGE ON WATER
Woodland
FRONTAGE ON ROAD
Meadowland
DEPTH
House Plot
BULKHEAD
Total
DOCK
TM1 k k �. /
M. BId4?,]_
Extensior,i
Extens on
Extension
09/26/2003 14:40 FAI 631 788 7798 FITELEPHONE
Fishers Island Utility Co.
Drawer E
Fishers Island, NY 06390
631788 7251
Date ` O�
To:
FAX #L214,
From: (�
Fax # 631788 7798
Subject
Number of pages including this one,
IM001
09/26/2003 14:40 FAX 631 788 7798 FITELEPAONE
MTN
AFFIRMATION
I, MILDRED DIXON, do hereby affirm under the penalties of perjury that.,
1. I have been a resident of Fishers Island, New York since 1938.
2. lam very famillar with the dwelling now owned by The Puskarz
Family Living Trist which is located on Madeline Avenue. Fishers island (SCTM No.
1000-006.00.07.00-009.000).
3. The subject dwelling has been used continuously at least Since
the early 1950's as a three-family residence with separate apartments.
4. 1 make this affirmation knowing that the Building Department
of the Town of Southold will rely on the truthfulness hereof in issuing a pro-eAsting
Certificate of Occupancy for a three-farnily dwelling covering the premises designated on
the Suffolk County Tax Map as District 1000; Section 6; Block 7; Lot 9.
A.i�)
� �'jMildred Dixon
1@002
TOTAL P.02
09/19/2003 14:34 FAX 631 788 7798 FITELEPHONE Q 002
LOCATION:
(nuunber & stc
SUBDIVISION:
NAME OF ONVNER(S):
OCCUPANCY.
(type)
ADMITTED BY:
KEY AVAILABLE:
SOURCE OF REQUEST:
DWELLING:
TYPE OF CONSTRUCTION:
FOUNDATION: _ e a ,
TOTAL ROOMS 1ST FLR: —�
BATHROOM(S): T(
PORCH TYPE:
BREEZEWAY: FI
DOMESTIC H ATER: lAgr,4
TYPE HEATVV
OTHER: A
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.:
SWIMMING POOL:
OTHER:
VIOLATIONS. CHAPTER 45 &N—Y.
I:4:gLvg
INSPECTED BY:
MAP NO..
�igs9Y,fl y
(o
(municipality)
LOT(S):
ACCOMPANIED BY:
SUF)h. CO_ TAX MAP NO. 1000- a•— ?---
DATE: 9 T
+C� # STORIES: �'L� # EXITS:
CELLAR; LL CRAWL SPACE: --
2ND FLR: _� 3RD FLR: —>
T ROOM(S): UTILITY ROOM•
TYPE: --- PATIO, TYPE:
DACE: GARAGE:%a
>EiEATER: 840- —o9mle , AIRCONDITIONING:
I AXR' HOTWATER:
STORAGE, TYPE CONST.:
GUEST, TYPE CONST:
ATE UNII�ORM FIRE PREVENTION & BUILDING CODE
TE ON INSPECTION:r�'��`�
TIME START: END:
ART.
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QUALITY CONTROL CERTIFICATION
GROUP
REVIEWED
DATE
PROJECT MANAGER
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ALFRED R. GREBE, JR.
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LOCATION MAP
SCALE 1 "=400'
1.) PLAN OF PROPERTY TO BE CONVEYED BY WEST END LAND CO, INC. TO
EUGENE R. PUSKARZ AT FISHERS ISLAND NEW YORK; SCALE: 1"=40 FT.;
CHANDLER do PALMER, ENGRS.; JAN. 1957
1.) THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE INDICATED
HEREON. ANY EXTENSION OF THE USE BEYOND THE PURPOSED AGREED TO
BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE
ENGAGEMENT.
2.) IT IS A VIOLA7110N OF THE STATE EDUCATION LAW FOR ANY PERSON, UNLESS
ACTING UNDER THE DIRECTION OF A LICENSED LAND SURVEYOR, TO ALTER AN
ITEM IN ANY WAY.
3.) ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND SURVEYOR'S
SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL ARE THE PRODUCT OF
THE LAND SURVEYOR.
4.) COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND GEODETIC
SURVEY TRIANGULATION STATION "PROS"
5.) SITE IS IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK TAX MAP 1000,
SECTION 006, BLOCK 7, LOT 9.
6.) TOTAL AREA = 1.02f ACRES.
7.) SITE IS LOCATED IN R-80 ZONE.
COMMONWEALTH LAND TITLE INSURANCE COMPANY AND WALSH PARK BENEVOLENT
COPORATION IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS
OF THE NEW YORK STATE LAND ASSOCIATION.
TITLE NO. RH80031405
LEGEND
N/F NOW OR FORMERLY
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