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Home My WebLink About30750-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30537 Date: 11/05/04 THIS CERTIFIES that the building HEATING SYSTEM Location of Property: 240 WICKS RD NEW SUFFOLK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 110 Block 8 Lot 19 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 4, 2004 pursuant to which Building Permit No. 30750-Z dated NOVEMBER 4, 2004 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" HEATING SYSTEM AND HOT WATER HEATER AS APPLIED FOR. The certificate is issued to WILLIAM & VIOLA M SUMPTER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A A horized Signature Rev. 1/81 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. 30750 Z Date NOVEMBER 4 , 2004 Permission is hereby granted to : W & V SUMPTER PO BOX 634 NEW SUFFOLK,NY 11956 for INSTALLATION OF A HEATING SYSTEM "AS BUILT" AS APPLIED FOR at premises located at 240 WICKS RD NEW SUFFOLK County Tax Map No. 473889 Section 110 Block 0008 Lot No. 019 pursuant to application dated NOVEMBER 4, 2004 and approved by the Building Inspector to expire on MAY 4 , 2006 . Fee $ 300 . 00 Authorized Signature COPY Rev. 5/8/02 Form No.6 4 2004 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 following: A. 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 I% 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. B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing" land 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographicuses: features. 2. A properly completed application and 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- $100.00 3. Copy of Certificate of Occupancy-:$.25 4. Updated Certificate of Occupancy/ $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. 4 —o4 New Construction: Old or Pre-existing Building: c ( heck one) Location of Property: D g d ve w 5,V ,V /D ) House No. Street J J"- /�L Owner or Owners of Property:_ i ' 'i6 r» -/ O lee- Suffolk County Tax Map No 1000,Section / Block 8 Lot Subdivision Filed Map. Lot: Applicant: Permit NO. Date of Permit. 6 Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate:_ (check one) Fee Submitted: $ � 3a �� Boulevard Planning East, PC. Architects• Engineers•Construction Management Internet: www.blvdplan.com 32645 Main Road Cutchogue,N.Y. 11935 PHONE: 631.734.2011 November 3, 2004 Southold Building Department Town Hall 53095 Main Road Southold,N.Y. 11971 - 0959 Re: Sumpter Residence,240 Wicks Road,New Suffolk To Whom It May Concern, As per your inspection notice of October 27, 2004, I hereby certify to the Department of Buildings of the Town of Southold that I have inspected the above locations; and I have determined to the best of my professional knowledge and belief that Furnace &Hot Water Heater in question in the cellar of the residence was installed in conformity with the manufacturers specifications, the New York Residential Building Code, and generally approved construction practices. If you have any further questions, please feel free to call me at any time. ED hn I ME mom ME NOMMOMMOMME EMOMMONE MMEMMOM NO ME ESIMMOM ME MEMOMMEM MENEM ME pzaN■ MOMMEME EMMOMMENEXIONOMMEMN ■�� Imo■ ' , TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET 2qo VILLAGE DISTRICT SUB. LOT ,1I15m ,ala Mi1�6 ad New XV04/4. FORMER OW ERN r i,f .� E �, /�, �rK �, ACREAGE J7 Z �I�fd TYPE OF BUILDING/ ]� l :r c it. 9� i Ste' (1'c M/iD y ✓:! W REST SEAS. VL. FARM COMM. I IND. I CB. I MISC. Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS J"a 4 7 OC 0 !J�/ �7, Q C„ rA deo r e/I� .,l:T.T, !f' w.„,►, ,r �... AGE BUILDING CONDITION „NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm .Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD Tillable 2 DOCK Tillable. 3 Woodland Swampland Brushland House Plot Total TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL 4 Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. 30 7,o Pz- Check Septic Form N.Y.S.D.E.C. Trustees Examined ,20 Contact: Approved fi11cr,20__yc Mail to: Disapproved a/c Phone: Expiration ,20� Building Inspector APPLICATION FOR BUILDING PERMIT Date 20_ INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 streets or areas, and waterways. 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 a 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 what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months.Thereafter, a new permit shall be required. 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,Ordinances or Regulations, for the construction of buildings, additions,or alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws, ordinances,building code,housing code, regulations to admit authorized inspectors on premises and in building for necessary inspections. r • „�� OCCUPANCY OR 01 (Signature of applicant or name,if a corporation) USE IS UNLAFUL ACL CONSTRUCTION SHALL 32�f S- A1.0 ES (Mailing CERTIFICATE (Mailing address ofapplicant5 CODES OF NEW YORK STATE. Cn((;;((``II II�p] YY State whether applicant is own9,esseLr,'dgLtit,�e'ct Pn tractor, electrician,plumber or builder ,4 REQUIRED APPROVED AS NOTED DTE: B.P.#rte_ Name of owner of premises W a 1 V/ O / Sv i— (As on the tax roll or lates dIFY BUILDING DFPAR TAT If applicant is a corporation, signature of duly authorized officer 765-1802 8 AM TO '4,PM FOR THE FULLOWING INSPECTIONS: (Name and title of corporate officer) 1. ;JL::C.;T' -V,3 REQUIRED FOR POURED COhgRETE Builders License No. 2. ROUGH - FRAW106A *LUMBING Plumbers License No. 3. INSULATION Electricians License No. 4. FINAL - CONSTRUCTION MUST Other Trade's License No. BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW 1. Location of land on which proposed work will be done: Y=KT LLNOT RESPONSIBLE FOR Z ¢0 1411 e k5 , l e pof Pew DZONSTRUCTION ERRORS. House Number Street Hamlet County Tax Map No. 1000 Section f Block 8 Lot 9 Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy A ..GS j,01 i4 e.e b. Intended use and occupancy !C G5/,d t.7 6-G 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work — s,/tr Gey A1246-0 VVP7 4. Estimated Cost Fee (Description) (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor 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 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 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner/� 11. Zone or use district in which premises are situated /'C— 40 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO—X 13. Will lot be re-graded?YES NO Y Will excess fill be removed from premises? YES NO X 14. Names of Owner of premises .5&m o Air Address Phone No. Name of Architect bkol &n n to Address Phone No Name of Contractor Address Phone No. 15 a. 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 REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO . , •�s-• * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey,to scale, with accurate foundation plan and''distances to property dines. 17. If elevation at any point on property is at 10 feet or below, must provide topograptydata n.st. y1�VJ0 iC+ STATE OF NEW YORK) 1 � - SS: COUNTY OF RD �C/' GNI?-Gr T being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named,, (S)He is the A-7--en (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 thisapplication are true to the best of his knowledge and belief, and that the work will be performed ii7 the manner set forth in the application filed therewith. Sworn to before me this of ,/ 20 O W"PSTUMPF Notary.P 9M PUBLIC,.state of Rota York kj. Signdfure of Applicant No.4856196 Qualified in Nassau Coup Term Exoiws,;u,-,.e 23, ,1