HomeMy WebLinkAboutZ-34033 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- 34033 Date: 10/27/09
THIS CERTIFIES that the building DWELLING AND ACCESSORY
Location of Property 11645 SOUND AVE MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No_ 473889 Section 141 Block 0003 Lot 012
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- 34033 dated OCTOBER 27, 2009
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 AND ACCESSORY TWO CAR GARAGE.*
The certificate is issued to WILLIAM LYNCH SR
(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.
i
A horized Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 11645 SOUND AVE MATTITUCK
SUBDIVISION: MAP NO_: LOT (S)
NAME OF OWNER (S) : WILLIAM LYNCH SR
OCCUPANCY: ONE FAMILY DWELLING WILLIAM LYNCH SR
ADMITTED BY: ERIN KAELEN ACCOMPANIED BY:
KEY AVAILABLE: SUFF_ CO_ TAX MAP NO.: 141.-3-12
SOURCE OF REQUEST: WILLIAM LYNCH DATE: 10/27/09
DWELLING:
TYPE OF CONSTRUCPION: WOOD FRAME # STORIES: 2.0 # EXITS: 2
FOUNDATION: BRICK CELLAR: PART CRAWL SPACE:
TOTAL ROOMS: 1ST FLR_: 5 2ND FLR.: 2 3RD FLR_: 0
BATHROOM(S): 1.0 TOILET ROOM(S) : 0.0 UTILITY ROOM(S):
PORCH TYPE: DECK TYPE: PATIO TYPE-
BR ZEWAY: FIREPLACE: GARAGE:
DOMESTIC HOTWATER: YES TYPE HEATER: ELECTRIC AIRCONDITIONING:
TYPE BEAT: OIL WARM AIR: YES HOTHATER:
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.. 2 CAR WOOD FRAME STORAGE, TYPE CONST_:
SWIMMING POOL: GUEST, TYPE CONST_:
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION I DESCRIPTION ART. I SEC.
I
REMARKS: BP34971 ALTERS COZ34032
INSPECTED BY: DATE ON INSPECTION: 09/11/09
GEORGE GILLEN TIME START: END:
��V
Form No.6 `� /U l
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALT.
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,'
topographic features. property lines,streets, and unusual natural or
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.
For.existing buildings(prior to April 9, 1957) non-conforming uses,or buildingsand" re-exis
i. Accurate surveyof roe .. P tang land uses:
property rty 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 $50.60.
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.
New Construction: Old or Pre-existing Building. (check one)
.-Location of Property:
House No. Street
Hamlet
Owner.or Owners of Property:
Suffolk County Tax Map No 1000, Section I Ll `
Block 3 Lot
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: $16l0 L
CIO �l C23
64Applicant Sign
TOWN OF SOUTHOLD PROPERTY RECORD CARD _
OWNER STREET VILLAGE DIST. SUB. LOT
FORMER OWNER N- ACR.
v TYPE Of BUILDING
ES ,O SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. -TOTAL DATE REMARKS -
Q 3 0 0- Z7 p i
/V�-
� vD o, c a v � /o -✓ Y/ �� � .
AGE BUILDING CONDITION
SEW NORMAL BELOW ABOVE
:ARM Acre Value Per Value
Acre
liable FRONTAGE ON WATER
'oodland FRONTAGE ON ROAD
S ' = 77d
eadowland DEPTH
ruse Plot BULKHEAD
)tal DOCK
F +
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Ir •
kir
ENO MEMEM
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Basement
•• M=011-ails Interior Finis
Fire Place
•
Type Roof Rooms Ist Floor
Recreation Room Rooms 2nd Floor
lormer Driveway
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CONSENT TO INSPECTION
.4
( J i :Ilia r C d' , the undersigned, do(es) hereby state:
Owne ame(s)
That the undersigned (is) (are) the owner(s) of the premises in the Town of
Southold, located at j((p Lj uy-)Id AA
which is shown and designated on the Suffolk County Tax Map as,District 1000,
Section , Block , Lot
That the undersigned (has) (have) filed, or cause to be filed, an application in the
Southold T wn Building Inspector's Office for-the following:
That the undersigned do es
gn 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 in subsequent prosecutions for violations of the laws, ordinances, rules or
regulations of the Town of Southold.
Dated: -
f (Signa e
(Prin e)
(Signature)
(Print Name)
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LOCATION: J V 4 4-5
(number& street) (municipality)
SUBDIVISION: M NO.: LOT(S):
NAME OF OWNER(S): ,
OCCUPANCY: I `
(type) (owner-tenant)
ADMITTED BY: ZER/N /�e¢E�-Ei'✓ ACCOMPANIED BY: �~
KEY AVAILABLE: - SUFF. CO. TAX MAP NO. 1000- ,� 2
SOURCE OF REQUEST: w1, DATE:
DWELLING:
TYPE OF CONSTRUCTION; , # STORIES: #EXITS:
FOUNDATION: CELLAR: �° CRAWL SPACE:
TOTAL ROOMS: 1ST FLR: �' 2ND FLR: 3RD FLR:
BATHROOM(S): 1 TOILET ROOM(S): UTILITY ROOM:
PORCH TYPE: DECK, TYPE: PATIO, TYPE:
BREEZEWAY: FIREPLACE: GARAGE: -—
DOMESTIC HOTWATER: TYPE HEATER: 4� 76ef e, AIRCONDITIONING:
TYPE HEAT. O/L - WARM AIR: HOTWATER: �.
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE'OF CONST.: _STORAGE, TYPE CONST.:
SWIMMING POOL: GUEST, TYPE CONST:
OTHER:
VIOLATIONS: CHAPTER 144 &N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS:
INSPECTED BY: �.�: DATE OF INSPECTION:
0
TIME START: END: