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Home My WebLink About7924-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildzng Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21199 Date DECEMBER 4~ 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 3465 NEW SU~'FOLK AVENUE MATTITUCKr N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 3 Lot 25.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 14, 1975 pursuant to which Building Permit No. 7924-Z dated MAY 14r 1975 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 ATTACHED B~7~EWAYr GARAGE AND DECKS ~ APPLIED FOR. The certificate is issued to of the aforesaid building. ROBIN WICKHAM (owRer) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 53S0-56-OCT. 13~ 1976 UNDERWRITERS CERTIFICATE NO. N-254139 - NOV. 4~ 1975 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 IT EMISES UNTIL FULL N9 7924 Z Perm[ss[ch is hereby granted to: ~ ,.i~..2,~,.. &.. ~m~..;I~n ~...A/C,.T~y'...~;.:L~ ......................... R,~s.'bt~v. at~ .............................. to .J~J.34~..zze~...ome...fnm~ ~r..dw~3-izqi .................................................................................... at premises located at ..~r~..~.ft~...J~J~.q~]~..~qJ~l ........................................................................... ....................... ,~'.'. ................................. ~l;~:.!.t-~_ck ....... ~.,.~,. ............................................................. ...................... ,..:~.~ ......... : ........................................................... ~. ............................................................... pursuant to, apRlication dated ........................ ;IJa3r ........ t~ ........... , 19.~.., and approved by the ,~:, Building .In~s~ectO, r. , . l~'lt~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Z 7z,:5 t 0C7 Z9 V& No ........... Date ........................ , 19 .... '~LIf"5 b. ll'l.t/ SL;I'I'CLK. Aqk' THIS CERTIFIES that the b~d~g located at ...................... Street Map No ............ Block No .......... Lot No ................................. conforms substantially to the Application for Building Permit heretofore filed in this office ~',ai' ~ ].97,.6. dated ..................... , .... pursuant to which Building Permit No ......... dated ..................... , 1 .... , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...................................................................... The certificate is issued to .. (owner, l~ss'ee O~ tenant) of the aforesaid building. Suffolk County Depaztment of Health Approval ............................. U~D'~,RWI:WI'E~S CER'I"I~ICA2~ No ............................................. HOUSE ~U'N~,R .............. Street ......................................... Building Inspector FORM NO. 6 TOWN OF SOUT.OCO ~ , Building Depmtment O~ ~.r~ Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector w,th the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple Residences and similar buddings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing build,ngs (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings 3 Date of any housing code or safety inspection of buddings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees' 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ...~.~.......Z/. ~.... ;...7.....~.. .................... New Building ....~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~..~..~..LLLL~..¢..~..c~.....~ .......... ~.q.~C,..~rL., .................................................... Owner Or Owners Of Property .... ...~...~..~.l....\..:..Y.~:.!..~..'.z:t~k .................................................................... Subdivision ................... : ......................................... Lot No ...... ...-C...,. Block No .~-. .... House No.....'~. Permit No.~Date Of Permit ...~../.'...~....~.~...Applicant ..~...~..~.:..~ ...................................... Health Dept. Approval ..... ~,~.Lc...Ls:?.. ....... ..~..:...'?..~.~..Labor D~..~ot. Approval ............................................... Underwriters Approval ........ ~,~. ........................... ~....Planning Board Approval ........................................ Request For Temporary Certificate ........ .~. ........................... FinaJ Certificate ......................................... Fee Submitted $ ........... = ........................ ¥1/I.~ Applicant ............ ~.~,~£ ./. ?..: ........ 7..., .............................................................. / Sworn to before me this ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number.~-~SO - APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY l. Applicant - ¢ [ Phone 2. Property ~O~q'tion. ~.~. N'~"'~-~ 3. Public W~ter 'Comp~n~ ~ame 4. Lot size. Width ~ee~ lO. ll. 5. Subdiv. 6. Section 7. Lot Number 8. Private WeT~ 9. Public Water--~ ~...~ Distance to main Length "'~feet Sewage Disposal System: A. ~O)gallon septic tank: Precast~Equivalent (For Health Services Dept. Use) Block B. Leaching pools: Number of pools Precast~ Block Special__ If private well, fill in the fol- lowing blanks: A, Tank capacity. B. Pump G.P.M. C,, D. E. ~--gallons Total well depth Depth to ground water Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. Date ~ /~7/'~ Signed ~-~OL~ ~. ============================================================================================= FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Base~h the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE S-15 Rev. 4/1/73 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY -- dl 85 JOHN STREET, NEW YORK, NEW YORK 10038 °"'"November 4, 1975 Ap, l,,-,,,,mrVo, onf~Ze809325 N254139 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of Jay Wickham, n/s New Sullfok Ave. 400' w/o Airway Dr., Mattituck, L.I. in the following location; [] Basement [] )~st Fl. ~ 2nd FI. Section Block Lot uas examined on and.found to be in compftance tt~t~ the requ~rement~ of th~ Board. October 30, 1975 DRYERS J FURNACE MOTORS I FUTURE APPUANCE FEEDERS SPECIALREC'PT TIMECLOCKS [ BELL ~UNITHEATERS MULTI-OUTLET DIMMERS ~ ]/4 3o SERVICE DISCONNEC~ j N,) OF S E R V I C E ~T ~p ~ ~. I~2W 1~3W 3~3W 3~4W NO O~COND OE~N~ NO ~ HJ~ O~ ~L~ NO OFNEUT~ OTHER APPARATUS- Electrician GENERAl. t~L~A~I~ - Mattituck, L.I. [~ATTI ?'ddK, N, ~ 8¢0]¢: '~0 '= I" Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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: 1o 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 site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or bullrings 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 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 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 - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ~.~..~--~.. ~ ..~.. ~CD~ }~ New Construction....~ ...... Old Or Pre-existing Building ................. Location of Property .... ...... .... rD House No. Street Hamlet Onwer or Owners of Property.. .~.~..~ .... L~O ~--l~ ~ ~ ~ County Tax Map No 1000, Section ..... ~..~ ..... Block .... ~ .......... Lot...~..~.~.,..~~. .......... Subdivision .................................... Filed Map ............ Lot ...................... Permit No..V.~..~. .~. ...... Date Of Permit. ~..~..~ .~.~.Applicant..~ ~.~.~ .... .[~..~..~..~..~?..B Health Dept. Approval....~. ~..~.?.~'..~..~. ......... Underwriters Approval..~.~..~.~. J..~. ~ ......... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate .... .~ ..... Fee Submitted: $..Z~:.~.~. .................. APPLICANT (Building Inspector) APPLIGATION FOR BUILDING PERMIT o. This application must be complete y filled in by typewriter oe in ink and submitted ir~triplicate to the BuildingC~i Inspector, with 3 sets of pla~s, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or~"p'Qb"fii: streets or~i areas, and giving o detailed description of layout ofproperty m~st be drawn on the diagram which is part of this application.~: c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. ~'~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the~' Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, O. rdinances or Regulations, for the constructioni of buildings, additions or alterations, or for removal or demolition, as hereto described. / The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to/' admit authorized inspectors on premises and in buildings for necessary inspections. ~!~.~ ' (Signature of applicant, or name, ,f a corporation) 1.- - - (Addres~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. ; ........................... ,,I ,, ............................................................. Name of owner of p emises ..................... ~d4rm...~ ........ .~c~t.t.~,,,-~.~l~.~ ....................................................................... If applicant is a co~oratej~ignature of duly authorized officer. .... ~ (Name and title at' corporat~ Officer) Bu-~Tlder's License No ..................................................... Plumber's License Electrician's License No ....... /~..~...~. .............. 1. Location of land on whil:h p[oposed work will be do. ne. Map No.: ..... /.....x/~ ............ Lot No. 4..~./~ ......... Street and Number ............................................................... \......::::::ii: Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ' Exisiting use and OCcupancy ................~.~,~.~;.....L~)~. ........................................................................... b. Intended use and occupancy ......... ~.~.~C~.ImC~,.....~..~I~.I..~,..~.....~.~,~.I.~I'I~J,~I~ ................................. '. 3. Nature of work (check which applicable): New Building· ...~r.-, Addition .................. Alteration ................. Repair .................. Remaval .................. Demolitior, .................... Other Work ................................................ . .... · ,~" ~ (Description) 4. Estimated Cost ....... [I;~.,S~;~.., ............ : .................. Fee (to be paid on filing this application) If dwelling, number of dwelling units ............................ Number of dwelling units On each floor ............................ If garage, number of cars ............................................................................................................................................. ~___~lf business, commercial or mixed occupancy, specify nature and extent of each ~pe of use ............................ Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ....... · ............. Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear Depth ................................ Height ..................... ; ...... Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ~ ...................... Rear ..... .~...~. ................ Depth ...~'~., .............. Height ....~..~.~... Number. of Stories ....... ..'~.~..C~......; ...................... ; .................................................... i ............... 9. Size of lot: Front ....... ~..~.~'. ...................................... Rear ........ [.~1~~. ....................... Depth .....~...~. ........ ~ ..... 10~ Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ......................... ~ ............................. ~j. ......................... ; ................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... L....~.. ............... ;..,.;...;...; ........ 13. Will lot be regraded ....~..~ ...............Will excess fill be removed from premises: ( ) Yes ~ No 14. Name of Owner of premises .~.~¢~..~...~.J.~J.~d~ ............. Address ~J~L'~.t.'['~..~.~.... Phone No. Name of Architect .~).N.t~IL.~....i~I[.~.~_~I).~ .............. AddreesJ~,J~.~)~le~....Phone No,'l.~.'.3~.t.[.. Name of Contractor ~l~)...~,~ '~..~....~ ...... Address ~'21'.~.~.kl.~l~.... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dim,nsions from property lines. Give street and block number or description according to deed, and show street names and indicate ,vhether interior or corner lot. STATE OF NEW YtO._R~, . S $ COUNTY Ol: .~.~"t~.~. _ ~- ~--...~'"'- ~ . ~~....~%.....~ ........ be,rig duly sworn, d~oses and soys ,~t he is the applicant (Name of i~ividual signing c~trac~ above name. He is the ............................................... -- ~'-- --~~'~-~ .................... ~ .......................................................... (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performe~n the manner ~t fo~h in the application filed ther~ith. Swam to ~ me this ( )~ ~ .... , % ..... ................ _ ' ........ ~"'~'~7~"~' ~ ~ (Signature of appli~nt) NOTARY PUBLIC. State of New York No. S2-~2026 - Suffelk Coun~ / Cemmis~on ~pires Mer~ 3~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~.qoveL"aber 13 ~I~N STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT o~y ~e ' ' t~c' ' ~= ' ~ ' ' ~ ' soy ;n thefollowlng location; [] Basement [] Ist FI. [] 2nd FI. ~a~ ~J ~e Section Block Lot waz examined on NoveDiber {~{~l 7~ andfoundtobeincompllaflcewiththerequirementsofthlsBoard. DRYERS [ FURNACE MOTORS FUTURE AF~qJANCE FHOERS AMT, K.W, I OIL H.P, GAS H,P, AMT, NO, A.W.G, SERVICE DISCONNECT J NO. OF J S J OTHER APPARATUS: RANGES R TIME CLOCKS OF CC. COteD. ,~,OVRN~.Sw. UNIT HEATERS MULTI-OUTLET ~artels: 1-2 lOOan4~s EXHAUST FANS AMT. H, P. DIMMERS OF NEUTRAL Ru].and Elee. P.O. Box i~aCtttuck, L.I, 11952 , , ~-~'~ n[ust not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. ~DING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. T L j I II : I ' I1 I I Jf I I x, Ii t