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Home My WebLink AboutZ-34899 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- 34899 Date: 04/07/11 THIS CERTIFIES that the building BARN Location of Property 18525 MAIN RD MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No_ 473889 Section 115 Block 0002 Lot 013 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- 34899 dated APRIL 7, 2011 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 -BARN. The certificate is issued to IRENE RUTKOSKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ N/A PLUMBERS CERTIFICATION DATED N/A � S utho ' zed ignature Rev. 1/81 CONSENT TO INSPECTION the undersigned, do(es) hereby state: Owner(s)Name(s) That the undersigned is) (are Zheowner(s) of the premiss in the Town of Southold, located at I S S Z s Gl ciC , which is shoes and designated on the Suffolk County Tax Map as District 1000, Section J , Block�, Lot ) . That the undersigned(has) (have),filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: (L Ce2n r/( O� C7 c�-�t.PA7U 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 in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: ig ture) ® a- (e-- Q f,21�[-"YZ (Print Name) (Signature) (Print Name) For. s 6 ' D E TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 FEB 10 2011 APPLICATION FOR CERTIFICATE OF OCCUPANC TO BLDF.DEPT. This application must be filled in by typewriter or ink and submitted to the Building Depart OLD 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 siie 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. (9 New Construction: Old r Pre-existingkBuil g:,,,. (check one) Location of Property:P House No Street Hamlet Owner or Owners of Property:�:S7l?C—QL � Lrl�oSl t �0--1 �e) 0t �A �• �ltZl[ C�c>L Suffolk County Tax Map No 1000, Section , Block Z- Lot 13 Subdivision Filed Map. Lot: Permit No. Date of Permit. r 'Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ pl' n nature :tY x MENEM ■■■■■N■■■■■■ N■■■■■■■■■■■■■■� ■■■■■■■■■■■■■■ ■ N■■■■■■NN■�■■ ■■■■■■■■■■N N■N■■■■■NN■ ll-mK �000 TOWN � OF SOUTHOLD �-&OPERTY RECORD CARD OWNER STREET PILLAGE DISTRICT -087' LOT _FORMER OWNER E ACREAGE ' F S TYPE OF BUILDING. fed 9�.J� RES. SEAS. VL. FARM �OMM. I IND. I CB. �' I MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS p 0 ,/- 6 3 ��` /as - IUD Ck60 a 019 r f /I/ I R/11 3-1) AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD Tillable 2 DOCK Tillable; 3 Woodland Swampland Brushland House Plot Totals LOCATION: (number& street) (municipality) SUBDIVISION: MAP NO.: LOT(S): NAME OF OWNER(S): OCCUPANCY: (type) (owner-tenant) ADMITTED BY: ACCOMPANIED BY: KEY AVAILABLE: SUFF. CO. TAX MAP NO. 1000- SOURCE OF REQUEST: DATE: DWELLING: TYPE OF CONSTRUCTION: # STORIES: #EXITS: FOUNDATION: CELLAR: CRAWL SPACE: TOTAL ROOMS: 1ST FLR: 2ND FLR: 3RD FLR: BATHROOM(S): TOILET ROOM(S): UTILITY ROOM: PORCH TYPE: DECK, TYPE: PATIO, TYPE: BREEZEWAY: FIREPLACE: GARAGE: DOMESTIC HOTWATER: TYPE HEATER: AIRCONDITIONING: TYPE HEAT:- 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: l 1� TIME START: END: N SURVEY OF PROPERTY UpSK' AT MATTITUCK . HENRY RU�ps9 _. H OF Sp�TH-LD TOWN OF SO UTHOLD Tpw" SUFFOLK COUNTY, N. Y. 1000-115-02-13 4,3�"E HUGE k� �x %p SCALE.• 12=20' q•0 SEPTEMBER 21, 2010, , � sz. , s o o ts�.1 _N 00 � - 40•� 'O 2 o ONE STOARN o\ ---- FRAME B -= - - - - • C� Q •� 25 5 \�� !a 'n ORS 0.�y6� O ?R I + TO 70 qmc�9`�? 14p0 NHS LANE ELIJA ONEB Nh 143.57' A�NR N _ � NJ � 5.37"w �S.R• 25) YG`NE S76 4 ROAD C2��;c � MAIN to n fiv /C Nb. 49618 ,:0, ANY AL 7ERA 77ON OR ADDI77ON TO THIS SURVEY IS A VIOLA 77ON P CONI C S >` R�`�-i1 :; OF SEC77ON 7209OF 774E NEW YORK ST47E EDUCATION LAW. (631) 765-5 2 V- 765-1797 - - - EXCEPT AS PER SE077ON 7209.—SUBDIV15/ON 2. ALL CER-PFIGA-70NS- - - ---- -— _- - - -- - -- HEREON ARE-VALID=FOR-THIS�1h4P-�4ND�OPIES THEREOF ONCY7F---- _ - P.O. BOX 909 -- - AREA-1�H8O SQ. SAID MAP OR COPIES BEAR 7HE--IMPRESSED SEAL OF 774E SURVEYOR -_ --- _ 1230 TRA VELER STREET _ - - _ ----. - — WHOSE SIGNATURE APPEARS HEREON. - - —_--- SOUTHOCD, N:_Y. 1-1971- - 0 205_ --