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Home My WebLink AboutZ-27963FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 27963 Date: 09/24/01 THIS CERTIFIES that the building DWELLING AND ACCESSORIES Location of Property 28565 MAIN RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 102 Block 0005 Lot 020 Subdivision 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- 27963 dated SEPTEMBER 24. 2001 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 DWELLING WITH FRONT PORCH, ACCESSORY 1 1/2 CAR GARAGE WITH 1/2 STORY, ACCESSORY SHED, AND ACCESSORY OUTHOUSE.* The certificate is issued to H ALBERT ORLOWSKI (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 INSPECTI Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCATION: 28565 MAIN RD CUTCHOGUE SUBDIVISION: NAP NO.: IAT (S) NAME OF OWNER (S): H ALBERT ORLOWSKI OCCUPANCY: SINGLE FAMILY H ALBERT ORLOWSKI ADMITTED BY: ALBERT ORLOWSKI ACCOMPANIED BY: SAME KEY AVAILABLE: SUFF. CO. TAX MAP NO.: 102.-5-20 SOURCE OF REQUEST: ALBERT ORLOWSKI DATE: 09/24/01 DWELLING: TYPE OF CONSTRUCTION: WOOD # STORIES: 2.0 # EXITS: 3 FOUNDATION: STONE CELLAR: PART CRAWL SPACE: PART TOTAL ROOKS: IST FLR.: 5 2ND FLR.: 5 3RD FLR.: 0 BATHROOM(S): 2.0 TOILET ROOM(S): 1.0 UTILITY ROOM(S): REAR PORCH TYPE: FRONT DECK TYPE: PATIO TYPE: BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOTNATER: X TYPE HEATER: OIL AIRCONDITIONING: TYPE HEAT: OIL NARK AIR: HOTWATER: STEAM OTHER: ACCESSORY STRUCTURES: GARAGE, TYPE OF CONST.: 1 1/2 CAR W/ 1/2 STORY STORAGE, TYPE CONST.: SHED, OUTHOUSE, SAT. DISH SWIMMING POOL: GUEST, TYPE CONST.: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE t'\;k0 INSPECTED BY: 9DATE ON INSPECTION: 09/06/01 20AM Form No. 63�� P�Q TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 F {� APPLICATION FOR.CERTIFICATE OF OCCUPAN Y A. This. application must be filled in by typewriter OR ink lding 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 buildin; 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_an( '•'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 Occgpancy 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 Buildinr>_ - $100.00 3. Copy of Certificate of Occupancy - .25ie 4. .Updated Certificate of Occupancy - $50.00 _ 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .......7.i 3QZ0,1 ........................ New Construction........... Old Or Pre-existing Building.. ....X......... Location of Property ....... ?$565,,,,,,,,,,;,, Main Road .�..�..�:.",.Cutcho� .... ......., ... .... House No. Street Hamlet Onwer or. Owners of Property..... H Z,.bert, Orlowski and Theresa E. Orlowski .his wife .. ... .... .. .. .,. County Tax Map No 1000, Section.... 102, Q0„ Block..,95;00.......Lot...,020.000........ Subdivision........yA............................ 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: ............................. r ..:................... CONSENT TO INSPECTION H_ A1herf and. Theresa E. Orlowski , the undersigned, Owner(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 28565 Main Road, Cutchogue, N.Y. 11935 which is shown and designated on the Suffolk County tax map as District 1000, Section 102.,OBlock 05. QOLot 020 -OP That the undersigned (ham (have) fir6U-X'or caused to be filed, an applica- tion in the Southold Town Building Inspector's Office for the following: certificate of -Occupancy 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 uch inspections may be used as evidence in subsequent prosecutions for vio- ions of the laws, ordinances, rules or regulations of the Town of Southold. 9: 7/30/01 H. Albert Orlowski (print name (signature) ThPraca F nrinwcki (print name) Z� �2 765-1802 BUILDING DEPT. INSPECTION ] FOUNDATION IST ] FOUNDATION 2ND ] FRAMING [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL ] FIREPLACE HIMNEY MAR": DATE ��L� INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ [ ] FOUNDATION 2ND [ [ ] FRAMING [ [ ] FIREPLACE A CHIMNEY REMARKS: /5'k ] ROUGH PLBG. ] INSULATION ] FINAL DATE ! al INSPECT( �L- r (2a d 1#-- SURVEY. OF PROPERTY AT CUTCHOCUE TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET - VILLAGE DIST. SUB. LOT FORMER OWNER N ACR. u 9-1 S W TYPE OF BUILDING RE` SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS o o 5 IA a► 'o 4.4( 0 3 o v C) ie o Y 73/go z5P AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Acre Value Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH (/P' e d Housq,.Pot.,., BULKHEAD Total DOCK LOCATION: cqO d `p✓ W z�w 140 number streety— SUBDIVISION NAME OF OWNER (s) OCCUPANCY .(municipality MAP N0. LOT (s) T . t type),� (owner -tenant) o ADMITTED BY: �/��Dk%c�L' `ACCOMPANIED BY: KEY AVAILABLE, SUFF. CO. TAXMAP N0. Bwy— SOURCE OF REQUEST : �" (�jl �- DATE:- DWELLING: ATE: DWELLING: TYPE OF CONSTRUCTION Gc/4, A# STORIES # EXITS /- � STORIES FOUNDATION� jy-G. CELLAR CRAWL SPACE TOTAL ROOMS: 1ST FI.R. 2ND FLR._ 3RD PLR. BATHROOM (s) p� TOILET ROOM (s)`" UTILITY ROOM PORCH TYPE f/j�,,,,, DECK, TYPE - PATIO, TYPE BREEZEWAY FIREPLACE GARAGE DOMESTIC HOTWATER �_ TYPE HEATERAIRCONDITIONING T�ERHEAT �i/ WARM AIR HOTWATER '5714-v ` ACCESSORY STRUCTURES : GARAGE, TYPE OF CONST._,/y�� W Jt" STORAGE, TYPE CONST. SWIMMING POOL , GUEST, TYPE CONST. OTHER: VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE. ':ry INSPECTED BY: DATE ON INSPECTION CO TIME START END �`d