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Home My WebLink AboutZ-26840FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF O~uumANCY No Z-26840 Date DECEMBER 16, 1999 THIS CERTIFIES that the building Location of Property 125 SOmm~ AVE. House No. County Tax Map No. 1000 Section 120 STRUCTURES MATTITUCK, N.Y. Street Hamlet Block 1 Lot 2.1 Subdivision Filed Map No. Lot No. conforms substantially to the Requirements for Farm structures built Prior to: APRIL 9, 1957 pursuant to which CERTIFICATE OF OCCUPANCY NUMBER Z-26840 dated DECEMBER 16, 1999 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 F~_aMR FArM BUILDING & CONCRETE POTATO BARN W1TH ADDITION * The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Jn~N K~JAWSKI, JR. & P~LYMOND K~JAWSKI N/A N/A N/A *BP ~7577Z DATED 10/1/74 ISSUED FOR ADDITION TO FARM BUILDING, CO Z-8096 ISSUED ON DEC. 28, 1977. --- // B/ildin~ Inspector Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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 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 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 requirements. B. F~r 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. 2. Certificate of Occupancy on Pre-existinR Buildinm - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. ,Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ... P~.q~pp~...~ t. A~? .................. New Construction ........... Old Or Pre-existing Building ..... ~ ........... Location of Property.. ~.~ ...................... ~p~. ~.~qg~ ............ ~/~9~ ........ House No. Street Hamlet 0nwer or Owners of Property. f~.~j~.,..q~:..~. ~?n~. ~~% ................... County Tax Map No 1000, Section..~ ........ Block .... ~ ........... Lot...~:~ ................ Subdivision .................................. [.Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval.' ......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~ ...... Fee Submitted: $.Aqq:PA .................... ¥ 3, ........... ~C~ ~&~0 -' aymond Ku]awski '- - RAYMOND KUJAWSKI CONSENT TO INSPECTION · the undersigned, Owner(s) Name(s) do(es) hereby state: one of That the undersigned (is) (~)/the owner(m) of the premises in the Town of Southold located at 125 Sound Avenue, Mattituck · which is shown and designated on the Suffolk County tax map as District 1000, Section 120 , Block 1 , Lot 2.1 That the undersigned (has) (have) filed, or caused to be filed, an applica- tion in the Southold Town Building Inspector's Office for the following: ~ Certificate of Occupancy ~on Pre-existing Building 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 as evidence in subsequent prosecutions for vio- lations of the laws, ordinances· rules or regulations of the Town of Southold. ecem er Raymond Kujawski (print name) SURVEY OF PROPERTY SITUA TED A T MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-120-01-2.1 SCALE 1"=50' NOVEMBER 17, 1999 AREA = 157,294.80 sq. ff. 5.152 Dc. CERTIFIED TO: FIRST PIONEER FARM CREDIT, ACA. FIDELITY NATIONAL TITLE INSURANCE GEORGE E, GABRIELSEN JANICE GABRIELSEN COMPANY THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTRED. Joseph A. Ingegno Land Surveyor PHONE (516)727-2090 Fox (516)722-5095