HomeMy WebLinkAboutZ-28132 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- 28132 Date: 12/24/01
THIS CERTIFIES that the building DWELLING & ACCESSORY
Location of Property 5705 MAIN RD EAST MARION
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 035 Block 0002 Lot 016.001
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- 28132 dated DECEMBER 24, 2001
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 AND ENCLOSED PORCH AND ACCESSORY SHED.*
The certificate is issued to STANLEY RUTKOWSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 12/11/01 Pending
PLUMBERS CERTIFICATION DATED N/A
*PLEASE SEE ATTACHED INSPECTION REPORT.
l
Authoriz-M Signature
Rev. 1/81
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
HOUSING CODE INSPECTION REPORT
LOCATION: 5705 MAIN RD EAST MARION
SUBDIVISION: MAP NO_: LOT (S)
NAME OF OWNER (S) : STANLEY RUTKOWSKI
OCCUPANCY: SINGLE FAMILY STANLEY RUTKOWSKI
ADMITTED BY: JENNIFER PRICHARD ACCOMPANIED BY: SAME
KEY AVAILABLE: SUFF. CO_ TAX MAP NO.: 35'.-2-16.1
SOURCE OF REQUEST: DATE: 12 24 01
DWELLING:
TYPE OF CONSTRUCTION: WOOD FRAME # STORIES: 2.0 # EXITS: 3
FOUNDATION: STONE & BLOCK CELLAR: CRAWL SPACE:
TOTAL ROOMS: 1ST FLR.: 3 2ND FLR.: 3 3RD FLR.: 0
BATHROOM(S) : 1.0 TOILET ROOM(S) : 0.0 UTILITY ROOM(S) : PANTRY
PORCH TYPE: SIDE ENCLOSED DECK TYPE: SIDE PATIO TYPE:
BREEZEWAY: FIREPLACE: GARAGE:
DOMESTIC HOTWATER: X TYPE HEATER: NATURAL GAS AIRCONDITIONING:
TYPE HEAT: NAT. GAS WARM AIR: BOTWATER: X
OTHER: BILCO DOOR
ACCESSORY STRUCTURES:
GARAGE, TYPE OF CONST.: STORAGE, TYPE CONST.: WOOD SHED
SWIMMING POOL: GUEST, TYPE CONST.:
OTHER:
VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE
LOCATION DESCRIPTION ART. SEC.
REMARKS- RE-INSPECT 12/20/01
BP#171 6 eck CO Z1704 BP#25926 shed CO Z26798
INSPECTED BY. ' DATE ON INSPECTION: 09 20 01
Av
JO BOUFIS TIME START: 9:45AM END: 10:25AM
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TOWN OF SOUTttoLD
i BUILDING OceARTt• Ek
TOWN ItALL 11 i S SEP — 4 2001 ......
765-1802
I
APPLICATION FOR-CERTIFICATE OF OCCUPANCY
1
A, This application must be filled in by typewriter OR ink•and submitted to Elie building
inspector with the followingl for neo building or new usei
It Final survey of property With accurate location of all buildings, property. linesl
streets+ and unusual hattiral or topographic features.
21 Final Approval from health Uept.' of .water supply and sewerage-disposdl(S-9 form) ;
31 Approval of electrical installation from hoard of Fire Underwriters.
4i Sworn statet4ent from plumber certifying that the solder used in system cohtains
:� . less than 2/10 of 1% lead. '
54 Commercial b►tildingi indus.tria.l building j multiple residences and siiuil.ar buildings
and installations, a 'certificate of Code Compliance froW architect or engineer
responsible for the buildings
61 Submit Planning Board Approval of Completed site plat. requirements.
. Bi For existing buildings (prior to April. 9s 1957) non-conforming uses; or buildings and
11pre-existing" land uses:
It Accurate survey of property showing ail property lines] streets, building and
unusual natural be topographic featUresi
2.' A properly completed application and a consent to inspect signed by ttte applientit;
If a Certificate of, Occupancy is deniedi the Building Inspector shall state the
reasons therefor in writing to the applicant:
Ci Fees w
' l+ Certificate of Occupancy - New dwelling $25.001 Additions to dwelling $25.00i
Alterations to dwelling $25:0.0, St4itmning pool $25.001 Accessory building $25:00,
Additions to accessory building $25i004 Businesses $50:00.
2. Certificate of Occupancy on Pre-existing Building - $100:00
31 Copy of Certificate of Occupancy - $5.00 aver 5 years - $lOi0O
4; Updated Certificate of Occupancy $50,00
.51 Temporary Certificate of Occupancy - Residential $15:001 Commercial. $0.00
August 31 , pool
Date I i t i i i i . , i 1 • : i i 1 1 : i 1 : ♦ : : 1 • i • i i.:.. . :i 1
New Constructionisi : aisi : i : Old Or Pre-existing Building. li : :XXi
j 5705 Main Road East Marion
• LOcotion of Property, , , ii + isiliiiliii : ili + liii + ii ► 1113 : ii1131 . ; i : ii1 . . 1 Ii . . 1 •ii . ii:i!i: i : 1.1
House No. Street Ilumlet
Onwer or Owners of Propertyiii ► 1isPat6+ciaiThom�i�QniV� c�e�ntIsis ; : 131iii . i . lil : : llii: iiii
County Tax Map No 10001 Section+ + iis.;4i5+ 1ii1Blockl : : : iioi? ii ; : ; i : .Lot: 1 ;016+OOl: i:::i ► ii .
Subdivision: . Iiiiil + l : i • 1 • ii . l ; ; iiiiiilii . I ; IilFiled Ctap; i . ; i . li : i ; :Lot• • : i: i : i + 11 ; .':ii:; ii :
Permit tloli ; i,i1 : + 1 : s :Y1 .';Date Of Permit+ + lsiiili / iliii ;llpplicalitll : . ; ; ; 1 . ; ; 4 ; { i : ilii•iiii + : l
11daith Aept1 Approval. . : 44l + iii ; 111Y1i4iii + ii4iUnderwriterd AppCOVali • � iitiiili : . t . .:::: . 31 .
Planning Board Approval4ii :iii4344si4ii4i4s4i44. i
Request for! . Temporary Certifica1:e; ii6i / i111s Final Ce.rticateii ,X, 1111 1
Fee Submitted! 1ii0i0iiO3oiiilliiiiiiii • ti + i + ii
nn -- 1 1i1i1 ' i i , iii�ippi[1.ii .,:i�ipii • • : : ii : : i : . • ..ili ; ii
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CONSENT
TO
INSPECTION
WILLIAM H. PRICE,JR.,the undersigned, does hereby state:
That the undersigned is the attorney for the PATRICIA THOMPSON VINCENT, the
owner of the premises in the Town of Southold located at 5705 Main Road, East Marion, New
York, which is shown and designated on the Suffolk County Tax Map as District 1000,
Section 035,Block 02,Lot 016.001.
That the undersigned has filed, or caused to be filed, an application in the Southold Town
Building Inspector's Office for the following: Pre-existing certificate of occupancy covering
the one-family dwelling.
That the undersigned does 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, does 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 violations of the laws, ordinances, rules or regulations of
the Town of Southold.
Dated: August 31, 2001 ;
WILLIAM H. PRICE,JR.
J-ya'4'
T65-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE &�112WIOI INSPECTO
765-1802
BUILDING DEFT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:�l�//elc
Vtzefi�a�-L-
DATE INSPECTO CZ