HomeMy WebLinkAboutZ-23611 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-23611 Date APRIL 27, 1995
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 3100 SKUNK LANE CUTCHOGUE NY
House No. Street Hamlet
County Tax Map No. 1000 Section 97 Block 8 Lot 13
Subdivision Filed Map No. Lot No.
conforms -substantially to the Requirements for a One Family Dwelling built
Prior to: APRIL 9, 1951 pursuant to which CERTIFICATE OF
OCCUPANCY NUMBER Z-23611 dated APRIL 27, 1995
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 A ONE FAMILY DWELLING WITH AN ACCESSORY TWO CAR GARAGE*
The certificate is issued to BENJAMIN KUJAWSKI
(owner)
of the aforesaid -building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
I-ldin6 Inspector
Rev. 1/81
BUILDING DEPARTMENT
.. �. TOWN OF SOiTrHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 3100 SKUNK LANE CUTCHOGUE NY
number & street municipality
SUBDIVISION MAP NO. LOT(s)
NAME OF OWNER (s) BENJAMIN• RUJAWSKI
OCCUPANCY A-] RES. OWNER
type owner-tenant)
ADMITTED BY: SCOTT RUSSELL ACCOMPANIED BY: SAME
KEY AVAILABLE SUFF.CO. TAX MAP NO. 1000-97-8-13
SOURCE OF REQUEST: SCOTT RUSSELL DATE: 1/23/95
DWELLING:
TYPE OF CONSTRUCTION WOOD FRAME # STORIES lZ # EXITS 2
FOUNDATION LOCUST POSTS CELLARSMALL PIT CRAWL' SPACE
TOTAL ROOMS: 1ST FLR. 4 2ND FLR. 2 3RD FLR.
BATHROOM (s) ONE TOILET ROOM (s) UTILITY ROOM
PORCH TYPE FRONT ENTRY &" REAR ENTRY (ENCL.) DECK, TYPE PATIO
BREEZEWAY FIREPLACE NO GARAGE
DOMESTIC HOTWATER YES TYPE HEATER ELECTRIC AIRCONDITIONING
TYPE HEAT 2 KEROSENE HEATER94ARM AIR HOTWATER '
OTHER: SITTING ROOM 2ND FLOOR & PANTRY OFF KITCHEN.
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST. 2 CAR CEMENT BLOCK STORAGE, TYPE CONST. WOODFRAME (NEED OF REPAIR)
SWIMMING POOL GUEST, TYPE CONST.
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
TOP OF CHIMNEYS, SMOKESTACKS, FLUES, GAS VENTS, SMOKE PIPES AND
CHIMNEY CONNECTORS SHALL BE MAINTAINED STRUCTURALLY SAFE AND SMOKE NYCRR 9(B)
TIGHT, SO AS TO SAFELY CONVEY THE PRODUCTS OF COMBUSTION TO SEC. 1243. 1(b)
THE OUTER AIR.
SOME FLOOR BUILDINGS AND STRUCTURES SHALL BE MAINTAINED FREE OF INSECT, SEC. 1242.9
BEAMS VERMIN AND RODENT HARBORAGE AND INFESTATION:
REMARKS:
INSPECTED BY DATE OF INSPECTION 1/27/95
GARY J. I TIME START 9:40AM END 10:00AM
_ Form No. 6
TOWN OF SOUTIIOLD
BUILDING DEPARTMENT
" 3 TOIM 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 lZ 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
if
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 s
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.
Certificate of Occupancy on Pre-existing Building - $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 �1•/?/l.�r. . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . . Old Or Pre-existing Building. , . ,l, , , , , •
Location of Property. . . . .3. n(� . . . . . . . . . . . . . . . . . .. ,�N•. . . . . . . . . . . . GU`` fchor� .
House No. Street . . .Hamlet
Onwer or Owners.of Property. . . . . . . b:'? . l�ys—aW`?Ik,l , • , . • , • . • . . • . . • • . • . . . . . • . • . . • . . . . . . . . .
County Tax Map No 1000, Section. . . . .2.7. . . . .Block. . . . . . , , , , , , , ,Lot. . . . .
L , . . , , , , , • , , , ,
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:
. . . . . . . . . . . . . . . . . .
APPLICANT_
CONSENT
TO
INSPECTION
S(o 14 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 j O j��y✓ �i(J
,�rhich is Ysho/?
wn and designated on the Suffolk
County tax map as District 1000, Section , Block Lot
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:
ce 0
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.
Dated:
(signature)
print name)
u: u- (signature)
r __�9 [-,
3 (print name)
.I ; •,�}1 If _ ! .iw •.. •" .5. ): �, ! �� ;f s••.s:r:a u .lt.
,1 ," .,1 r• y L.7 (, •'�: :s�r':5.�, d Sskl `+��^ °y '��.i,,`•z'•��'• �p� '��� !. . i
�` till 1• f .i I� !. 4.
If 1�r' ?1�A• .1. • i . elNl.:.. NO-
.....
S r fa 7 L t t s{
TOWN O
} ; SOUTHOLD :,; PROPERTY RECORD CARD
OWNER . �br. _ .• _, r
STREET � -r. - :�.� � - - .� , •
3��� VILLAGE 'F: ti.. IS.�. .: :� - ! .
,.jY: .D •; SUB:. YI
;
oe
U Pr'. eS ,>- aid r: �i'.• `.�":..f �1
FORM OWNER y` -
W 02
TYPE OF BUILDING
'`• � �•�� � T ate ne w:r° 9`�, k<. � I
f:
RES.
R: p SEAS. VL. FARM
COMM. CB. MICS. Mkt. Value v
LAND IMP. TOTAL DATE REMARKS.
71
,: i d !T'�1j 7 usaws a
_ Q / 3c, J 3/3 A 2
Cb
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVEO
FARM,;: Acre Value Per Value — ``, - ��
., Acre Q �l�. Q 7 fL _ .• . ., TO
`r J'
Tillable.:
' FRONTAGE ON WATER d
E Woocilarid. FRONTAGE ON ROAD Q
Meadowland `f• DEPTH`S l�
House Plot - BULKHEADotal I -
- �i tr'�..;,; :Y �j"''u:•': DOCK r
t1 •� • '�' ' '� ,•.
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•;�i �p gIr t id H!
Fir ;12 } COLOR TRIM
Vj
it <ti
is
M., Bldg.
35v i7
i Extension
z x /
x' Extension
} V T L j 1 0. 2,00 r —
Extension
Foundation 'All Bath Dinette
Porch Basement Floors K.
4:
Porch Ext. Walls D Interior Finish LR.
Breezeway Fire Place v Heat DR.
Garage o v G Z Vpe Roof �� Rooms 1st Floor BR.
/ l r9
Patio i F Recreation Room Rooms 2nd Floor FIN. B
7 ,a"o- : Dormer Driveway
" rTotal , x
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MAP: OF PROPE2TY
1 / i SURVEYED FQ2Ls
s I
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�
FENCE G'±S (o+ _ ✓ uJ i WN =�F SOUH. ' p N.Y: ;.f.•
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I STORY N ;
ly2 STORY .. ;
CONCR. n FR.FAO
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CANC.BL. GRhVEI"�SLUESTC=NE - j„ r j��'•�K �1 s4 ,i - v�>�v�"'• Y'
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N . SCALE_30%l'
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y 49h �!JP.i2ANT� _-r _71= TfTlLF GUAfLAWTE r�
N A)JQ T7 THE a./jN i E Q
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7UFi—• Z3. Rx VlAx' DATA:!O 'V9Z-c3 13
mnS j 4'�i§.dd.
lJ l iE 1i c• - oREE�JPC{cT`}y
BUILDING DEPARTMENT
TOWN OF SOUTHOLD-
HOUSING CODE INSPECTION REPORT
LOCATION:
number & street municipality
SUBDIVISION MAP NO. LOT(s)
NAME OF OWNER ('s)
OCCUPANCY /� S�• C
type owner-tenant)
o
ADMITTED BY: cJ 9a� �.2-4171 ACCOMPANIED
KEY AVAILABLE SUFF.CO. TAX MAP NO. -
SOURCE OF REQUEST: DATE:
DWELLING:
TYPE OF CONSTRUCTION Q # STORIES `��' # E%ITS
FOUNDATION �0 � p s 7-J CELLAR �,m 4-_fl �I/- CRAWL SPACE ,
TOTAL ROOMS.- 1ST FLR. 2ND FLR. 3RD FLR.
.BATHROOM (s) 072' �' TOILE7zo "")DECK,
(s) UTILITY ROOM
PORCH TYPE 9 (e 2 �✓�/ TYPE �'' PATIO
ti �--
BREEZEWAY F REPLACE GARAGE �--
DOMESTIC HOTWATER f, TYPE HEATER AIRCONDITIONING �-
1
TYPE HEAT jh',/r / ,67ejWARM AIR HOTWATER
OTHER:�r o
ACCESSORY S UCTURES:
GARAGE, TYPE OF CONST.d CAK_ ` KAr,� 1-L14STORAGE, TYPE CONST.
SWIMMING POOL GUEST, TYPE CONST.
OTHER:
----------
-------------------- ----------
VIOLATIONS: - CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
--Xorp of dcl C410
MSG %��
e
4
AA A-A
ti
REMARKS:—
INSPECTED BY DATE OF INSPECTION 07 7 I�
TIME START END