HomeMy WebLinkAboutZ-27020 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- 27020 Date: 04/03/00
THIS CERTIFIES that the building DWELLING & ACCESSORIES
Location of Property 955 CONKLIN RD MATTITUCK
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 139 Block 0003 Lot 030.001
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- 27020 dated APRIL 3, 2000
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 DECK, ACCESSORY FRAME SHED, AND ACCESSORY
METAL SHED.*
The certificate is issued to BEULAH RICKETTS
(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.
c
th ized Aignature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 955 CONKLIN RD MATTITUCK
SUBDIVISION: MAP NO. : LOT (S)
NAME OF OWNER (S) : BEULAH RICKETTS
OCCUPANCY: a-1 RESIDENTIAL AEULAH RICKETTS
ADMITTED BY: CART AUSTIN ACCOMPANIED BY: SAME.
KEY AVAILABLE: SUFF. CO. TAX MAP NO. : 139 -3-30 1
SOURCE OF REQUEST: r_ARY FTANNF.R OLSEN, ATTY. DATE: 04/03/00
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 1.0 # EXITS: 2
FOUNDATION: CEMENT BLOCK CELLAR: PART CRAWL SPACE: PART
TOTAL ROOMS: 1ST FLR.: 0 2ND FLR.: 0 3RD FLR. : 0
BATHROOM(S) : 2.0 TOILET ROOM(S) : 0.0 UTILITY ROOM(S) :
PORCH TYPE: DECK TYPE: WOOD PATIO TYPE:
BREEZEWAY: FIREPLACE: NONE GARAGE:
DOMESTIC HOTWATER: YES TYPE HEATER: AIRCONDITIONING:
TYPE HEAT: LIPA WARM AIR: HOTWATER: X
OTHER:
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.: WOOD FRAME STORAGE, TYPE CONST. : METAL & WOOD
SWIMMING POOL: GUEST, TYPE CONST.:
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION 4 DESCRIPTION ART 1 SEC
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REMARKS: BP9511 ADD C08998: P9307 GARAGES DECK CO27013
INSPECTED BY: DATE ON INSPECTION: 04/03/00
GARY J. FISH TIME START: 9:40 AM END: 10:00 AM
r TOWN HALL
LS�yi; 765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
i AJ4; Th_fs^application must be filled 'in by typewriter OR ink and submitted to the buildir.
t ,.�
C pefbr,..with the following: for new building or new use.
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 buildi
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 a
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural o'r topographic features.
2. A properly completed application and a consent to inspect signed by the applicar.
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 Buildine - $100.00
3. Copy of Certificate of Occupancy - -25G:
4::, _Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy '- Residential $15.00, Commercial $15.00
Date . 3M99 . . . . . . . . . . . . . . . .. . . . .
X 1• �
storyframe.house and shed
New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . .
.7.25 -farmer. did �' tt tuck,.NY. .
Location of Property. . " ' • ' • Hamlet
House No. ' Street
Onwer or Owners of Property.. . euJALJVJckeJtXP .. . . . . .. . . .. . . . . . . . . . • • - . . . . . .
County Tax Map No 1000, Section. .M . . . . . . . . .Block. .3. . . . . . . . . . . . .Lot. .IQ%l . . . . . . . . • • .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . .
Permit No. . . . . . . . . . . . . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . .
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . • • • •
PlanningBoard Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Cert ate. . . . . . . . . . .
Fee Submitted_ $. • • • . . . . . . . . . . . . . . . ... . . . . . .
. . . . . . . . . . . . . . .
PLICANT
fY.g 9- - GARY FLANNER OLSE11
Main Rd,PO Bu 706
catchogue,NY 1193S
CONSENT
TO
INSPECTION
Beulah Ricketts by Gary Flanner Olsen as Attorney the undersigned,
Owncr(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 725 Farmers Rd. Mattituck, NY
which is shown and designated on the Suffolk.
County tax map as District 1000, Section 139 Block 3 Lot 301
That the undersigned (has) (have) filed, 'or caused to be filed, an applica-
tion in'the Southold- Town Building lnspeUWA. o.rrso.* rar +hn fnllowina:
One story frame house and shed
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 p o ecutions for vio
lations of the laws, .ordinances, rules or regulations f th Town of Southold.
I
Dated: March 2, 2000
ignature)
Gary Flanner Olsen as attorney
for Beulah iRicket name)
(signature)
(print name)
L
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