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Home My WebLink About15684-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate O[ Occupancy No. Z-15586 Date A.p r ~.1 3, Deck addition THIS CBRTIFIBS that the building .............................................. .. Location of Proper 6900 Wickham Avenue Mattztuck, New York ty ~s~ )Vo~ ........................................................ · Street Hamlet County Tax Map No. 1000 Section l 0 7 .... Block 0 10 . .Lot ..... 0. t. 0.... Subdtvision Filed Map No Lot No . . conforms substantially to the Apphcation for Building Permit heretofore Pried in this office dated February 13, .8.7p ildi gP itN .................... ,19. ursuant to whichBu n erin o ................ dated February 13, 19 .8 ,7was issued, andconformstoalloftherequ~rements of the apphcable provisions of the taw. The occupancy for wluch ttus certificate is issued is ......... DECK ADDITION TO EXISTING ONE FAMILY DWELLING LONG ISLAND NURSERIES The certificate is tssued to .......................................................... (owner, 'I~ R~blORK of the aforesaid building. Suffolk County Department of Health Approval..,....,...........N/A ...................... . N/A UNDERWRITERS CERTIFICATE NO ..... Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 15684 Z County Tox Map No. 1000 Section ....... J..Q2 ...... 81o~k ...... ..q:,.L..°.. .... Lo~ No... ~/...~... pursuant to application dated ..... /....~ ........ , 19.~...~., and approved by the Building Inspector. Fee $...~..~......:.~. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A Thru apphcatlon must be filled ~n typewmter OR ~nk, and submitted ,= IImmm~a to the Building Inspec- tor with the following; for new buddings or new use' 1. Final survey of property w~th accurate location of ali buddings, property lines, streets, and unusual natural or topographic features. 2. F~nal approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electmcal installation from Board of Ftre Underwmters 4 Commercial buildings, Industrml buddings, Multiple Remdences and simdar buddings and mstalla- t~ons, a cert~hcat~ of Code compliance from the Architect or Engineer responmble for the building. 5. Submit Planmng Board approval of completed rote plan requirements where apphcable. B. For ex~sting buildings (prior to Aprd 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survev of property showing all property hnes, streets, buddings and unusual natural or topographtc features. 2. Sworn statement Of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any houmng code or safety Inspection of buildings or premises, or other pertinent mforma- tlon required to prepare a cerhhcate C. Fees: 1. Certlf~cate of occUpancy New Dwellzng $25.00, Accessory ,$I0.00 Business $50.00 2. Certificate of bccqpancy on pre-existing dwelling $ 50.00 3 Copy of cert~flcate of occupancy $ .5.00, over .5 7ea~s ~]0.00 4.Vacant Land 'C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ....... ~.~I.~.C f.? ..... NewCons t~uc t ~on Old or Pre-exmtmg Budding Vacant Land o, .... ......... Hou~ No Steer Ham/et CounwTax Map No. lO00Sect,on ..~.~ ...... Block ..D~.C~ ....... Lot O/O Subd~wmon ......................... Fded Map No ........ Lot No ........... Perm,t No./~.~.~.~r..~. 'Date of Permit .~/~//~.f.Apphcant..~.-..~..~..~.~q~..~/.~..-~. ........ Health Dept. Approval .................. Labor Dept. Approval ........................ Underwmters Approval .................... Planmng Board Approval ...................... Request for Temporary Cert~fmate ............... Final Certificate ....................... Fee Submitted $ ...................... Construction on above described budd~n~d~~ ~-¢f~ ~ ets all apphcable codes and regulations. AppIican~..~:) ~ ....... Rev 10 10 78 Co~_ J55~ ~hti~tlllllllllllllltlllltll tltllllllllllltlllllllllllllllllllllllll Itillt~fflt'l~ltlltl~tlltlllll~llllt, i~ilflllltllrlllllllllllllllllllllll - --- -~- .o..~ ,~. c* ....... ,~ .,~u~ J e~a~r sha~] have no claim aga*~ut Landlord for the value of any u~exptted ~erm~f smd lease. ] \ \ ,00'08~ '~,,0£,8£*££*$ .1 / i / (Bud&ng Inspector) APPLICATION FOA BUILDING PERMIT BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO I SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY S, OUTHOLD, N.Y 11971 TEL., 765-1802 CALL ................ MAIL TO: INSTRUCTIONS a This apphcat~on must beicompletely filled tn by typewriter or in ink and submitted to the Building Inspector, w~t sets of plans, accurate plot plan 4o scale Fee according to schedule b. Plot plan showing locatmn of lot and of bufldmgs on premises, relatmnsh~p to adjoining premises or public stre or areas, and g~vmg a detailed descnptlon of layout of property must be drawn on the diagram which t%~bar~ bf~thm ap cation , c. The work covered by ttus apphcahon may not be commenced before issuance of Budding Permit d. Upon approval of tins apphcatlon, the Building Inspector will issued a-Braiding Permit to the applicant Such per, shall be kept on the premises avaflable for inspection throughout the work. e. No budding shall be occupied or used ,n whole or in part for any purpos~ whatever untd~ Cerhficate of Occupm shall have been granted by the Bufl&ng Inspector APPLICATION IS HEREBy MADE to the Bmldxng Department for the msuance of a Bmldmg Permzt pursuant to Bmldzng Zone Or&nance of the Town of Southold, Suffolk County, New York, and other apphcabte Laws, Ordinance- Regulations, for the construction of buildings, additions or alterations, or for removal or demolmon, as herein descnb The,applicant agrees to comply w~th all apphcable laws, ordinances, budding qo,~le, JaOusl~g code, and regulations, and adm.t authorized inspectors on premises and m building for necessary ' iS~ature ~ff~ap~a'n.t, ;; name, ff a (Mmhng address of apphcan, t) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electmcmn, plumber or bmh Name ofownerofpremmes Z* ~ . ~.(-"(~.'~.t'~--../'~---~' .. (as on the tax roll or latest deed) If apphcant is a corporation, mgnature of duly authorized officer (Name and htle of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Braider's Lmense No .. . Plumber's License No ..... Electrician's L~cense No Other Trade's License No Location of land on which proposed work wflI be done. House Number Stree( County Tax Map No 1000 Section /~. 7 · . Subdivision Filed Map No .. Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy ~'~ ~-- ... b Intended use and occupancy .. /.(.~-)-/J,~-q~.l~.- .. 3 Nature of work (checkwhlch apphcable) New Bufldmg . Addition ..~.... Alteration Repmr .. Rempval ....... Demolition ..... Other Work ..... 4. EstlmatedCost '~ 100~) ~ (Description) I ,' ' (to be prod on fihng thru application) 5. If dwelhng, number of dwelhngiumts .. [ Number of dwelhng units on each floor ....... If garage, number of cars .......................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ............... 7 Dmaenmons of existing structures, ~f any Front ..... Rear .......... Depth ........ Height ..... Number of Stones ~--... ............. /'" Dzmenmons of same structure with alterations or additions Front ...... Rear {¢ ~. ) fi' ... Depth ..................... Height ....... I..~..~/z..ii .. Number of Stones ..................... $ Dnnenmons of enhre new construction Front . . . Rear .......... Depth ........... Hmght ........ Number of Stones ................. 9. slzeofIot Front · .... Rea .... V17'ii i ii ii. ......... 10 Date of Purchase .............. Name of Former Owner .................. 11 Zone or use district m which premmes are mtuated. .. 12 Does proposed construction vmlate any zonmg law, ordnance or regulation .. ~q.O ................. 13. Wall lot be regraded ... ~ ........... Wall excess fill be removed from premme~._._ .,~, Yes .~ ~o i4. Name of Owner of premises Name of Architect .... i .......... Address tara~x. ~?.r*~.~ ~ Phone No ........ Name of Contractor ..................... Address ............. Phone No .............. [5. Is this property located withzn 300 feet of a tidal wetland? *Yes ..... No ..~.. · If yes, Southold Town Trqstees Permit maybe required. PLOT DIAGRAM Locate clearly and dmtlnctly all[ buddmgs, whether exmhng or proposed, and indicate all set-back dnnensmns from >roperty hnes Gwe street and block.number or description according to deed, and show street names and indicate whether ntenor or corner lot. ;lATE OF NEW YORK, S S 7OUNTY OF ....... (Name of ~nd~v~dual mgnmg contract) hove named OCCUPANCY OR USE iS UNLAWFUL WITHOUT CERTIFICATE CS OCCUPANCY orang duly sworn, deposes and says that he ~ the apphcant (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and iS duly authorized to perform or have performed the said work and to make and file th~s pphcatmn, that all statements contained h~ this application are true to the best of hm knowledge and behef; and that the ~ork will be performed in the mannel set forth m the apphcat~on filed therewith. ,worn to before me thru ........... ~/.~.~.~. dayof..~.~ ..... 19~7 /~ .., ~ '*°taryPubhc. ',~'" 'J~~' · ''~':''~ '' C°unty P~,nus A~O~ 'kTJ/X I ~el~¥.,.~. --~?'---~ v~,~ ..... t--~'''~' '\ -I' .". · --, ................... (S,gnature of apphcant)