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Home My WebLink About20522-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPART~fENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20650 Date APRIL 16~ 1992 THIS CERTIFIES that the buildin~ Location of Property 2200 WICKHAMAVE. House No. County Tax Map No. 1000 Section 139 Subdivision ADDITION Street Block 3 Filed Map No. MATTITUCK~ N.Y. Hamlet Lot 25 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 1, 1992 pursuant to which Building Permit No. 20522-Z dated APRIL 3, 1992 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 DECK ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to CB_dROLL J. HkRVEY (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A / ~ld i~g In~c~or Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNT!,L FULL COMPL~-FION OF THE WORK AUTHORIZED) N°-N.o 2052aZ County Tax Map No. 1000 Section ..... ./.,' '~-'..~,. ..... Block ...... ~ .......... Lot No....~ ...... pursuant to application dated ..... ..~..///..~. ......................................... , 19..~...~..., and approved by the Building Inspector. Rev. 6/30/80 Form No. 6 TOI~N OF SOUTllOLD BUILDING DEPARTMENT TOWN ~ALL 765-1802 A~PLICATION FOR CERTIFICATE OF OCCUPAN( A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building er 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 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings ~ and installations, a certificate of Code Complianca 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 buildings 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 ...................... · New Construction ........... Old Or Pre-existing Building...~... ........ Oo Location of Property... ....... .................... . ./ ..... ...... House No.' Street Hamlet Onwer or Owners of Property... ~ ................ County Tax Map No 1000, Section.. ; ..... Block .................. Subdivision ..... Filed Map Lot Permit No .......... Date Of Permit ................ Applicant ......................... .. .. Nealth Dept. Approval'. ............ ... . ....... ... Underwriters Approval ......................... Planning Board Approval . Request for: Fee Submitted: Temporary Certificate ........... Final Certicate ........... APPLICANT FOUNDA'TION FOUNDATIOn4 (lst) (2nd) ROUGH FRAME & .PLUMBING INSULATION PER N. STATE ENERGY CODE FI;;AL ADDITIONA'L COMMENTS: NbTIFY'- BUIL'DING DEPAR~ 76.5~1802 9_AM-TO-4 PI~r'FOR THE FOLLOWING INSPE~IONS: FO~ POURED CONCRETE ~TAI'E CONSTRUCT ON & ENERGY ~CODES:--NOT' - RESPONS1BLE - FO~ T~ru !': ,' APR - I 1992 '! l',i { TEL,: 765-1802 Examined , , ...... 197..~ / Disapproved a/c ..................................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BOARD OF SETS OF PLANS .......... /SURVEY ................... ~.~-"C 11 E C K .................... SEPTIC F 0 R,~! .............. / NAIL TO: APPLICATION FOR BUILDING PERMIT Date .................. , 19 INSTRUCTIONS az This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ;ct;-~f plans, 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 public streets r ara, as, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit nail 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 roll have been, granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Buildin~ Permit pursuant to the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applic,~ble Laws, Ordinances or ,egulations, for the construction of buildings, additions or alterations, or for removal Or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ]mit authorized inspectors on premises and in building for necessary nspections~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) tare whether ~l~plicant is owner, lessee, agent, architect, engineer,~con~racto~r electrician,,plumber or builderi ........... . . :.,,,. ?. . . :. i . .£:. .,. . :amc of owner of premises ........... .0,7 .... /~l~/~/Z'. J.~ .LI ..................................... ' , (as on th~/~r!x roll or latest deed) 'applicant is a corporation, signature of duly authorized officer. ' (Name and title of corporate officm) ......... Builder's License No .... . .~t. ~..~..~., 7..~.~. .... lumber s Lmense No ......................... Electrician's License No .............. O ' ther Trade s L cense No ...................... Location of land on which proposed work will be done ..... ~' IM t~- iQ'. .... 2..z.e ?. ............ ........... !louse Number Street ' Hamlet Cmmty Tax Map No. 1000 Section ...l~.~ .......... Block ...~ ' Lot ~.~ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing Use and occupancy of premises and intended use and occupancy of proposed constrnctioa: Intended us~ and occupancy ........ ~C ~ , : . 3. Nature of work (check which applicable): New Building .......... Addition .... ',Iteration .......... Repair .............. Remoyal ....... Demolition .............. Other Work ............... 4. Estimated Cost .. -- . ~'<ID ese on ~ ............. Fee . ~ (to be paid on filing this application) 5. If dwelling, number of dwelling (nits ............... Number of dwelling Units on each floor · If garage, number of cars .. . i ................. 6. If business commercial or~i,,,,-,/ ............................................................... ify h typ ' · . ,. ,,cu occnpancy, spec nature and extent of eac e of use ..................... 7. Dimensions ot exmting structuresl, if any: Front ............... Rear .... De Height ............... Num6er of Rtr~rle~ .......... pth ............... Dtmensmns of same stn Cture with a terations or additions: Front Depth i Rear He ight ................................... 8 .......................................... NumberofStories · Dlx.nensmns of entire new constn~Iction: Front ................ Height Number of Stories ............... Rear ............... Depth ............... 9 Size of lot: Front ........................................................ · ' ......... [ Rear Depth 10 Date of Purchase : ............................... ............ ~ ........ ........ Name of Fonner Owner I I. Zone or use district in w ch nfo., eoe ', , - ' ............................. 12. Does proposed construction viotat ....................... i .................. e any zoning law, ordinance or regulation: ............................... 13. Will lot be rearaded ........... J ............ ~"i '' Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ................ Address ................... Phone No ............... Name of Architect ........ .......... Address ................... Phone No ................ Name of Contractor .......... i...f ............. Address ................... Phone No ............... ~.: 15. Is this property within 3~0 oet of a tidal wetland? *Yes ........ No ......... *If yes, Southold T~wn Trustees Permit may be required. .... PLOT DIAGRAM Locate clearly and distinctly all bluildings, whether existing or proposed, and, indicate all set-back dimensions from mber or descriptioh according to deed, and show street names and indicate whether property lines. Give street and block m interior or coruer lot. TATE OF NEW YOR~K, ~.. (Signature of applicant) ('Name of individual signing {ontract) ~ (Con tractor, .................. ' ................ ....... agent, corporate officer, etc.) said owner or owners, ~d is du y authorized to perrom or have perforated the said work and to make ~d file this plication: that all statements conta ne~ in this application are true to the best of his knowledge and belief; and that the ~rk will be perfomed in the manner setlforth in the application filed therewith. /om to before me this being duly sworn, deposes a'nd says that he ~s the applicant