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Home My WebLink AboutZ-30749FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 30749 Date: 02/08/05 THIS CERTIFIES that the building DWELLING Location of Property 3770 WICKHAM AVE (HOUSE NO.) County Tax Map No. 473889 Section 107 Subdivision MATTITUCK (STREET) {HAMLET) Block 0009 Lot 018 Filed Map No. __ Lot No. __ conforms substantially to the Requirements for a ONE FAMILY DWELLING built prior to APRIL 9, 1957 pursuant to which CERTIFICATH OF OCCLrPANCYNUMBER Z- 30749 dated FEBRUARY 8, 2005 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 ONE FAMILY DWELLING WITH ACCESSORY GARAGE * The certificate is issued to DOROTHY E BUGDIN (OWNER) of the aforesaid building. SUFFOLK COUNTYDBPART~T OF HEALTHAPPROVAL ELI~L-£KICAL CERTIFICATE NO. PL~q~BERS CERTIFICATION DA'r~u *PLEASE SEE ATTACHED INSPECTION REPORT. N/A N/A N/A Authorized Signature Rev. 1/81 BUILDING DEPARTMENT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT I~TION: 3770 WICKHAM AVE SDBDIVISION: ~ OF OW~EI~ (S}: DOROTHY E BUGDIN OCCI/P~CY: SINGLE FAMILY DWELLING A~l'*-r~ NY: DOROTHY BUGDIN MATTITUCK DOROTHY E BUGDIN SOURCE OF R~UEST: PETER S. DA~OWSKI, JR. 2/4/05 DATE: 02/08/05 TYPE ~F~T: HOT WATER* WAP~AIR: HO'~'ER: NATURAL GAS O'1~: *0IL SEPARATE HOT WATER HEATER. **SMALL ENTRANCE PORCH VIOLATIONS: CHAPTER 45 N.Y. STATE UNIFORM FIRE PREVENTION & BUILDING CODE LOCATIOM DESCRIPTION ART. SEC. 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 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 o f 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 Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. Forexisting buildings (prior to April 9, 1957) non-conforming uses, or buildings "pre-existing" uses: and land 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic 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 New Construction: Old or Pre-existing Building: Location of Property: House No. Street Owner or Owners of Property: Suftblk County Tax Map No 1000, Section Subdivision ~ '?'T'I Date. (check one) Block Filed Map. Hamlet Permit No. Date of Permit. Applicant: Lot Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ 1'~ ° ~ Final Certificate: (checkone) Applicav~Signaturec, / CONSENT TO INSPECTION Owner(s)Name(s) , the undersigned, do(es) hereby state: That the undersigned (is) (are) the own?(s) of the premises in the Town of. Southold, located at ~-I'~O I~ l CK. l.t.~_ tat~e"~td~"~ ~,,~f~t Fl, lEE. iq. Y' which is shown and designated on the Suffolk County Tax Map as District 1000, Section 107 , Block ~ , Lot Iav That the undersigned (has) ~a~e) filed, or cause to be filed, an am~lication in ~e So)~thold Town Building ~spector's Office for th.e follqwing: C~ ~.~c a.~ ~ u ,J J . That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: (Print Name) (Signature) (Print Name) ' ,0,'~ S 77' 0'~ ~' 4~ ~ 36 LOTS SURVEY OF s, s & P/O AMENDED MAP OF MATTITUCKHEIGHTS FILE No. 1184 FILED JULY 24, 1935 SITUA TED A T MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-107-09-18 SCALE 1"=,30' JANUARY 25, 2005 AREA : 34,112.14 sq. ff. (1'o 11E LINE) 0.78,30C. 4 CERTIFIED TO: COMMONWEALTH LAND TITLE INSURANCE COMPANY LEHMAN BROTHERS BANK JOHN ELLIOT AMY ELLIOT NOTE: ADDITIONAL STRUCTURES IF ANY ARE NOT SHOWN DUE TO SNOW COVER ON DATE OF' SURVEY. THE EXISTENCE OF RIGHTS OF WAY AND/OR EASFM[NT$ OF' RECO~D, IF ANY, NOT SHOWN ARE NOT GUARANT[£D. No. 49668 JosePh/A. Ingeg~g Land Surveyor Title Surveys Suni;visions - Site Plans - Construction Layoul PHONE (651)727-,2090 Fax (651)727-1727 OFFICES LOCATFD AT MAILING ADDRESS 522 ROANOKE AVENUE P.O. Box 1951 RIVERHEAD, New York 11901 Riverheod, New York 11901-0965 25-015