HomeMy WebLinkAboutZ-29261 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
PRE EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 29261 Date: 02/11/03
THIS CERTIFIES that the building DWELLING
Location of Property 360 OLD SALT RD MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 144 Block 0005 Lot 009.001
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- 29261 dated FEBRUARY 11, 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 ONE FAMILY DWELLING
The certificate is issued to CARYL R KIENDL
(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.
A hor' ed Si nature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 360 OLD SALT RD MATTITUCK
SUBDIVISION: NAP NO.: LOT (S)
NAME OF OWNHR (S): CARYL R KZENDL
OCCUPANCY: SINGLE FAMILY DWELLING CARYL R KZENDL
ADMITTHD BY: CARYL KZENDL ACCOMPANI® BY: SAME
RSY AVAILABLH: SUFF. CO. TAR NAP NO.: 144.-5-9.1
SOURCH OF RHQUHST: OLSEN & OLSEN, ATTYS 2/3/03 DATE: 02/11/03
DWELLING:
TYPH OF CONSTRUCTION: WOOD FRAME # STORMS: 2.0 # H%ITS: 2
FOUNDATION: CEMENT HLOCK CHLLAR: FULL CRANL SPACH:
TOTAL ROOMS: 1ST FLR.: 4 2ND FLR.: 3 3RD FLR.: 0
BATHROOM(S): 2.0 TOILSf ROOM(S): 0.0 DTILITY ROOM(S):
PORCH TYPH: DHCR TYPH: PATIO TYPH:
BRHHZHNAY: FIRHPLACS: ONE GARAGH:
DONSSTIC HOTfU~THR: YES TYPH HHATHR: KEYSPAN AIRCONDITIONING:
TYPH HHAT: KEYSPAN HARM AIR: HOTNATSR: STEAM
OTfD3R:
ACCESSORY STRUCTURES:
- =^H, TYPB OF CONST.: 2 CAR WOOD FRAME STORAGH, TYPH CONST.:
SNIMMZNG POOL: GUEST, TYPH CONST_:
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION ~ DESCRIPTION ~ ART. ( SEC.
FRMaRRt: BP#50782-COI-4355 - ACCESSORY GARAGE
INSPSCTHD BY: ` DATH ON INSPECTION: 02/10/03
GARY ISH TIMH START: 9:40 AM END: 10:10 AM
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, 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. 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,•Certi-ficate of Occupancy -Residential $15.00, Commercial $15.00
Date. February 3, 2003
New Construction: Old or Pre-existing Building: % (check one)
Location of Property: Old Salt Road Marr; r„rk
House No. Street Hamlet
Owner or Owners of Property: Caryl Richards Riendl
Suffolk County Tax Map No 1000, Section 144 Block 5 Lot q _ ~
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: / ,.(check one)
Fee Submitted: $ 100.00 ~
OLSEN b OLSEN LIP ~ ~
52495 MAIN ROIIp ' /
PO BOX TOb
(q~~~ r. 3 2 ~ ~ i~ A plicant Signature
cap-i" 2>.~ ~ G~f
CONSENT
TO
INSPECTION
' ^9 T,F7 ~-_..or nl con ~c ~rrnrnnF- for ~:~~1 Ri rhartl c. Ki Pnrll 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 old salt Road
Mattituck which is shown and designated on the Suffolk
County tax map as District X000, Section 144 ~ Block 5 Lot 9.1
That the undersigned (has) (have) filed, 'or caused to be filed, an applica-
tion in"tho Southold Town ]iuitding lnspc:c~.,. or.r;~~ tam. rho fnlln~ving:
1~ro story residence
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 ali 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 pr secutions for vio-
lations of the laws, ordinances, rules or regulations o the/'d'own of Southold.
Dated: February 3, 2003
' (s nature)
Gary Flanner Olsen
(print name)
(signature)
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