HomeMy WebLinkAbout18136-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 218099 Date NNE 9, 1989
THIS CERTIFIES that the building ADDITION
Location of Property 6595 WICKHAM AVE & 3810 MILL RD. MATTITUCK
House No. Street ~ Hamlet
County Tax Map No. 1000 Section 107 Block 05 Lot 02
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 8, 1989 pursuant to which
Building Permit No. 181362 DATED MAY 26, 1989
was issued, and canforms 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.
The certificate is issued to ROBERT W. CLARK & ANO.
(owner, )
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N/A
PLUMBERS CERTIFICATION DATED N/A
Bu ld~spector
Rev. 1/81
soaas xo. s
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)
N ° ~ O J.. ~ U Z Date ..:Jr./.~~...~ 19rJ...l..
Permission is hereby granted o:
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t premises located at .~t..........ylr.._....~f!~Q~?~...~(!:~..........Y.~
County Tox Map No. 1000 Section ...~?J...7......... Block Lot No........~~
pursuant to application doted ...........5~~-3 19..C~~, and approved by the
Building Inspector,
a
Fee $.~d
~.~.f~ ..~C...,¢g . ~c~
Buj~in for
Rev. 6/30/80
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TOWN OF SOUTHOLD
~/,p~~~ BUILDING DEPARTMENT o.~ ~C\ Rf-,.~"°'°`
Y~` TOWN HALL D ~~~~C ~`Vf
SOUTHOLD, NEW YORK 1197 1 JUN p ~9~~ ~ 4 ~
765 - 1802 S7 I',
TOV~Il~ OP SC~,JTFI~LD.....1
APPLICATION FOR CERTIFICATE OF OCCIIPANCY ••.,n~,_~~
NEW CONSTRUCTIO~NQ•~kY ...OLD OR PRE-E%ISTING BUILDING......VACANT LAND........
Location of Property..~tF/~.!!/1~~ 1~4.Y!.fO~c/~(,,Q~l~'~/J~in./=uGr._.~~T/r~,C~V
HOUSE NO.yy/rr/'~~ II STREET HAMLET
Owner or Owners o£ Property,.:`~C~e.1:~.1N:.~J~/`(c
County Taa Map No. 1000 Section .!Y.~. Block Lot
subdivision Filed Map ........Lot.......
~ - t
i'ermit No. . ~~136.~„Date of Permit ..~?'fO~~~ Applicant ~D/?!I. ~!~.~~2f./.3~C//~L~
Health Dept. Approval Underwriters Approval..............
Planning Board Approval
Request for Temporary Certificate Final Certificate
Fee Submitted: a~
APPLICANT..~l/LLIC?-.!~!,., /~!,e:t!~(C.J~-L- V
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rev. 10/ 14/88 ~/y/~
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~h`'~ r ~ TEL.7G5-180'
Toy rr or sou~o~.u
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~~.-~l.M!L36;;~~ ,gip Ol~i'iCEOFBUILDI;JCiNSPECTOR
~~~oj';~ z I'.O. BOX, ] 1 79 _
~ c'<+ „r.~ ~ TOWN IIALL
SOU'I'I10LD, N.Y. 1 1971
June 8, 1989
JOHN BERTANI, INC.
1380 OARWOOD DR.
SOUTHOLD, N.Y. 11971 RE: ROBERT W. CLARK ~ ANO
To L4hcm This, May Concern,
4.e are unable r.o complete your Certificate
of occupancy because of the follocring reasons.
An application for Certificate of Occupancy
- is not on file. <ENCLOSED)
/ / Dlo Undon~rriters Certificate on file.
'Che checl: .i:;(!)~~1~414t1?4~t on file.) $25.00
No 11ca].Lh Dept. Approval on file.
No final inst~~ect:ion has been made.
P]easr. contact our office on this matter. -
Thank you for your cooperation.
Ihiilclir,<J Permit It 1 8 1 3 6` Z
Building Dcpt.
'Mk~k/-/ tlo Plumber Solder Certificate on file.
( all permits involving plumbing being
i~sucd after April 1,1984 )
r1ELD I;;SPE~:iu;J I~Dr+iE i;Ua`4MENT3
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^OUIJDATION^ (1st)
°OUNDATIOIJ (pnd) _
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TOUGH FRAME & ~ ~ f~,
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PLUMBING
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:NSULATIOfI PER N. Y. y
STATE ENERGY
CODE
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ADDITIOfIAL COMMENTS:
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THE NEW YORK BOARD OF FIRE UNDERWRITERS t'~~<:i~~
i ll(1i i7f 1.
r BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
Date !)C`{°G/Ti N;fi 2t; ;L ra:t (i ~U'SJ(7:9 ti; td 6';"3 ~ (S?3ti l~'l
Application No. on file `
THIS CERTIFIES THAT
on~lyAt"he electricwl equipment as deacrihed 6ebw and introduced 6y the wpplicant named on the shove application numher in the premises of
LX-ZINC.. l~.sT~-
~tr7~A:AT Ht2t}f,N, 4e'e~S'1" ~3'S"_, fQi,I2~;?, (.tfpx.#,{~t.>tlit`?', Ctr1~.
,Y,~,
in thefollowinq location, ~ Bwsement ~ /st Fl.~ 2nd Fl. J17 ,Section Block Lot
was examined on artdfomrd to 6e in cmnplianre with the requirements of this Ro¢rd.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FIVORESCENi OTHER PMi N W. AMT K.W. AMi KW. AMi K W AMi. H P.
1Z i i Ft e) 'f
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTIET DIMMERS
PMT K. W. Oll H. P. GAS H. P AMi. NO A W. G. AMT AMP qMT. AMPS. TRANS. AMT N P. SYSTEMS AMi. WAiiS
NO.Of FEET
41} 2
SERVICE DISCONNECT NO.OF 5 E R V,. I C E
AMi, AMP TYPE METER I JF' RW 1 ,a 3W 3W 3,6' 4W NO. OF CG COND A W G A W G. A. W. G.
EQUIP, PER OF CC. COND NO Of HbLFG OF HbLEG NO OF NEUTRALS OF NEUTflAI
i !''6ts Cft ) 3. 1. /
OTNER APPARATUS:
Al)3Ll`k~t'Cz,~Y 'ei> ;<;?;"c, )aG`ka,s',t.`.°aG
E,f,fa~~.. lel>c,t~ ~tl>,~rh;lsrf.-i.h r.~+ ~.kr.
c.~==.c,.~i„ i
- L~>>~
,7t)S)Y PC1M7:Li,q ~]'f. ~L SQtli%
TA'a~ f,ANFz
/`III~I"/°O,'CiJt,~Rr f~"dr, ~.95;> ~ENE,ItAI ~NAGER
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be ~denti ed 15y~^ih€ir credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
BOARD OF HEALTH
FORMN0.1 3 SETS OF PLANS
SURVEY
• ~ TOWN OF SOUTHOLD C}}ECK . .
BUILDING DEPARTMENT SEPTIC FORPI
TOWN HALL
TOWN OFSOUTHOLO SOUTHOLD, N.Y. 11971 NOTIFY
19 TEL.:7G5-1802 CALL ..,~~5„/Sy`f
Exantincd . ~,~0 / PIA I L TO : .
Approved . v~'~~........, I~. Permit No..........f
Disapproved a/c
wild' ,Inspector)
y APPLICATION FOR BUILDING PERMIT ~-y~
Date ..:...o. l .i C~-:~..3.., 15 ~1
INSTRUCTIONS
a. Tltis application must be completely filled in by igpewriter or in ink and submitted to the Building Inspector, with
sets of 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 stree
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl
cation.
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 issued a Building Permit to the applicant. Such perm:
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 Occupanc
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 th
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
Re:ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describes
The applicant acrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc
admit authorized inspectors on premises and in building for necessary inspections.
~ Oh n:. ~)2,C~el(i.~ ~4t:t tier Tn~~.. .
(Signature of applicant, or name, if a corporatton)
(Mailing address of applicant) !!y~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
...~.u(.~.d:~:~.....................
/1 yII~ .
Name of owner of premises ....Y.,/.~ , 1. I F•/~ ~i-- h v .
(as on the tax roll or latest deed)
If,,ap~ploicant is a corporation; signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. . ~ai, ~y,~, , , r~Z .
Plumber's License No . .
Electrician's License No. ,
Outer Trades License No . .
1, Location of land on which proposed work will bc, done. ro; ~
•o•
House Number ' ~ " " " " "
Street\~ Hamlet ~ ~ ~ ~ ~ ~ ~
County Tax t.fap No. 1000 $CChOn .....IL~..~...... , , Block , , ,
Lot...........
Subdivision Filed l.tap No.
(Name) t. ....p..~.... Lot
State existing use and occupancy of premises and intended use and occupy/ncy of ro osed construction:
a. Existing use and occupancy .............V! LW. ~~J Cv~o, ~ .
b. Intended use /i l} (y~~ ,Q~~~~~~~~~~~~~~~~~~~~~'
and occupancy
,
3. Nature of work (check which applicable): New Building Addition , , , , . .
Repair Removal Demolition ~ O 1Vork .C-
•
c¢ ion)
4. Estimated Cost ........~.~~I',Gll w Fee .
(to bQ paid,pn A({gsahis applicatio . • .
5. If dwelling, number of dwelling units Number of dwelling units~on each ?oor .
If garage, number of cars .
6. if business, commercial or mixed occupancy, specify nature and extent of each type of use •
7. Dimensions of existing sttuctures, if any: Front . Rear Depfh'..... .
Height Number of Stories . .
• Dimensions of same structure with alterations or additions: Front Rear .
Depth flcight ......................Number of Stories
8. Dimensions of entire new construction: Front . Rear Depth .
Height . NumUcr of Stories .
9. Size of lot: Front , . . T2car..........'....... Depth .......................r
10. Date of Purchase ame of Former Owner ,
11. Zone or use distrtct in which ~rjc
1.. Does ro osed construction viola rses arc situated ...............................................t
` P P P to any zoning law, ordinance or regulation: ....y.1 l7
13. \Vill lot be regraded Y\t~ • , , \Vi4 excess fill be removed from premises: Yes '~xoJ
14. Name of Owner of premises . QOtYZe,/`;Y Clp,rt~, • , , ,Address fV.1.t.1.\ .`~~..:MCL.`V:~ .Phone No. ?~~.:5.~~~ , , ,
Name of Architect , • Address Phony. No.
Name of Contractor ~~h n. ~J~,fa7,4~, , , , , , ,Address .1.~~? , OU.lC-lcJlrpd,l~r-phone No..~~ ~
~1.~4`~.y~
IS:Is this property located within 300 -feet of a tidal wetland? *YES....NO. Y..•~
*If yes, Southold Town', Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly all 'buildings, whether existing or proposed, and, indicate all set-back dimensions from
property Lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
I
I
STATE OF \EtV YORE, S' S
COUNTI' OF
• • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant
(1\am:: of individual signiijg contract)
about named.
tic is the ~I
(Contractor, agent, corporate officer, etc.)
of said owner or owners. and is dulv~i~audtorizcd to perform or;,havc performed the said work and to make and Gle this
application; that all statements contaritcd in this application arc true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application tiled therewith.
Sworn to bclore nee this I
~ ........day of .I'',..... `Y! 19 P.l.
Notary Public, .../~:QO:^.~!..7.~:....^.%2.11~~...... County ,
HELEN K DE VOE
NOTARYPUOLIC,StateofNewYark ~ (Signature of applicant)
No. d707878, Suffolk County
Term Expires March 30,19...