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Home My WebLink About29787-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29779 Date: 10/21/03 T~IS CERTIFIES that the building ADDITION Location of Property: 2255 WICKHAM AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 114 Block 3 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 6, 2003 pursuant to which Building Pex~tlt No. 29787-Z dated OCTOBER 7, 2003 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 "AS BUILT" RAMP ADDITION TO AN EXISTING COMMERCIAL BUILDING AS APPLIED FOR. ~e certificate is issued to MONICA & MIKE LTD LIABILITY CO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPART~4ENT OF H]~kLTH APPROVIkL EI~t-I'KICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DA'r~U3 N/A N/A N/A Rev. 1/81 Signature FORM NO. 3 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) PERMIT NO. 29787 Z Date OCTOBER 7, 2003 Permission is hereby granted to: MARINA INC MATT-A-MAR MAIN STREET MATTITUCK,NY 11952 for : "AS BUILT" PJ~4P ADDITION AS APPLIED FOR at premises located at 2255 WICKHAM AVE County Tax Map No. 473889 Section 114 Block pursuant to application dated OCTOBER 6, 2003 Building Inspector to expire on APRIL 7, Fee $ 400.00 MATTITUCK 0003 Lot No. 001 and approved by the 2005. / "~ut hyi z e~ Signature ORIGINAL Rev. 5/8/02 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 Department with the followiug: Ao For new building 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 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 buildii3g, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect ~ engineer responsible for the building. 6. Subrndt Planning Board Approval of ¥ompleted site plan requirements. B. F~r existing bui~dings (pri~r.to April 9~ ~957) n~n-c~nf~rming uses~ ~r bui~dings and ``pre-existing~ land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural m topographic features. °~ ' ' 2. A properly completed application and cc~ns'ent to inspect signed by the applicant. Ifa Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 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 Occupan:y on Pre-existing Building - $100.00 3. Copy of Certificate Cf Occupancy - $.25 4. Updated Certificat6 of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: ~Location of Property: House No. Date. Old or Pre-existing Building: Street ~-OwnerorOwnersofProperty:~.,,9/'t?~ ~ /~z~ ~ ~_~ ~Suffolk County Tax Map No 1000, Section Block Subdivision Permit No. ~q'~ ~/~ Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~--C.D ~ Date of Permit. 2_,::,0 3 (check one) ~ ~1!,O~ t-T- Hamlet Lot Filed Map.. Applicant: Lot: Underwriters Approval: Final Certificate: ~// (check one) Applicant Signature TOWN OF SOUTHOLD BUILDING DEPARTMENT TO;VN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined Approved , Disapproved a/c BUILD1NG PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 3 sets of Building Plans Planning Board approval Survey. Check Septic Form N.Y.S.D.E.C. Trustees Contact: ~ Mail . 3 ..,/./.APPB0¥ED AS NOTffi~PLiCATiON FOR BUILDING PERMIT FEE:_ gf~'~ ~V ~ ~Date , 20 NOTIFY BU/LD,N~ ?q_ ~NT~ INSTRUCTIONS 7654802 SAM TO m~ FONT E ..... a,~~a~e co~etely filled m by t~ewnter or ~n ~ ~d sub~tted to the Building bspector with 3 sets of plJa~Q~at'~lot ~t~e according to schedule. b. Pf~l~bff~ing[o~a~{~ and of buildings on presses, relationship to adjoining premises or public streets or areas, an~'~.g~AM,hd & PLUMBINg... ~'~vered by this apphcahon may not oe comence~ before issuance of Building Pe~t. ~'~ap~bN~~on, the Building ~spector will issue a Building Pemt to the applicmm Such a pen~t shall be kq~~ble ~r inspection t~oughout the work. ~g~Nb{~gE~ in whole or in pa~ for any pumose what so ever until the Building ~spector ~%&7~i~i~e~gls[~i~the work authorized has not co~enced within 12 months aaer the date of issuanc~ b~~~onths from such date. If no zoning amendments or other re~lations affecting the prope~y have been enacted in the interim, the Building ~spector may authorize, in writing, the extension of the pe~it for an addition six months. Thereafter, a new pen~t shall be required. ~PLICATION IS HE,BY M~E to the Building Depa~ment for the issuance of a Building Pe~it pursuant to the Building Zone Ordin~ce of the Town of Southold, Suffolk County, New York, ~d other applicable Laws, Ordinances or Re~lations, for the const~ction of buildings, additions, or alterations or for removal or demolition as herein deschbed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorize~sp~cto[s ~ preceded in building for necessa, inspections. use , ' ' ~' ~ (Signature of applicant or name, if a c o~oration) WlTPOUT 3ERT FICA ;E, OF OCCUPANCY addressoeapplicant) ~ate whether appIic~t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder J}(ame of owner of premises ~t3~ i(LO-~ '~- ~v[( ~e., & L ~_~ (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Lgcation of land on which proposed work will be done: ,~House Number Street sCuOunty Tax Map No. 1000 Section Block bdivision (Name) Hamlet Filed Map No. LOt Lot , ~ .ttateexisting use and occupancy ofpre_mises and intended use and occupancy of proposed construction: a. Existing use and occupancy /r~'~,~-m/Soo-- ~ /'~,~. ,,. o,. __ b. Intended use and occupancy }/~RNature of work (check which applicable): New Building. epair Removal Demolition 4. Estimated Cost Fee 5. Addition Alteration Other Work (Description) If dwelling, number of dwelling units If garage, number of cars (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height_ Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth_ Height Number of Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear _Depth 9. Sizeoflot: Front Rear Depth 10. Date of Purchase Name of Former Owner l 1. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO ~". Names of Owner of premise~ ' d ddress.~ ~ ¢~'(~'~"~ Y~5-~- Phone No.&Y/' 7yz/ Name of Architect Address Phone No Name of Contractor Address Phone No. '~/ffa. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO '~IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUI~/ED. b. Is this property within 300 feet of a tidal wetland? * YES NO · IF YES, D.E.C. PERMITS MAY BE REQUIRED. c~. Provide survey, to scale, with accurate foundation plan and distances to property lines. 7~f elevation at any point on property is at 10 feet or below, must provide topographical data on sUrVey. / STATE OF NEW YORK) SS: COUNTY OF ) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make 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 performed in the mmmer set forth in the application filed therewith. Sworn to before me this. ~ d~ay of ~ C,~ 20~_ ~ ' Notary Public L~fNDA M. BOHN . ~y puBLiC, State of New ~0 ~ niB06020932 Term Expires March o, ~ ~