HomeMy WebLinkAboutZ-10094FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
Date ........ ~..g~.~, ~t ............. 19.~Q
THIS CERTIFIES that the building ................................................
Location of Property ....3.2./*.0...W.i.c.k.h..~.m..A.v..e.n.u.e. ,. ............. .M.~.t.t..i.t.u.c.k. ............
House No. Street Hamlet
County Tax Map No. 1000 Section ...!9.7 ...... Block ..... 9.9 ........Lot ..... .0.1.3. ........
Subdivision Mattituck Heights .Filed Map No. 192 .Lot No. 12
requirements for a Rne-F,mily Dwelling built prior to
conforms substantially to the Application for Building Permit heretofore filed in this office dated
Certificate of Occupancy
April 23, 19 57 pursuant to
dated ........ A.u. g~..s.t...2.'1., ......... 19...8,qvas issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
....... P..r.Lv.~.t' .e. 9.n.e.-..~.~. y.~..y...~. ?.~.~y.n.g... ........................................
The certificate is issued to ..... T. ¢rrZf...R....Tuthill ...................................
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev 4/79
BUILDING DEPARTMENT
TOWN OF SOUTHOLD, N. Y.
HOUSING CODE INSPECTION REPORT
Location ,~ ~3
-(number & street)
Subdivision./~y~/~Q~ ..~_~//Y~ Map No.
Ns~e of Owner(s)
Occupancy /~--/
~ (tYPe)
A~mitted by:
Key available
s our c e o f r e ~ues
(Municipality)
///~ Lot(s)
DW~J~LING:
TYPe of con~ruction ~_~/~'0~ ~~
Foundation C~/~/u7- ~5~ c ~c_ Cellar~//
Total rooms, 1st. Fl,J- z ~. 2nd. Fl.. ~' ~,
Bathroom(s)
Porch, tYPe.
Breezeway
Type Heat~/~
Fireplace(s) xyd
Domestic hotwater
Other
#stories
Crawl space
3rd. F1 "
Toilet room(s), o~-
Deck, type Patio, type_~/
Garage ~ Utility room --,
Warm Air oz~ ~/~ Hotwater
No. Exits g Airconditionin~
:>~_~, Type heater
' /
ACCESSORY STRUCTURES:
Garage, type const,~~/~,A~gtorage, type const.
Swimming pool ,~/ Guest, type const.
Other
VIOLATIONS: Housing Code, Chapter 52
Location Description Art.~ Sec.
Time st ar rd.'/~-ZAf.~.nd
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic featu res.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
· land uses:'
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safeW inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
Co
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
New Building ............. Old or Pre-existing Building .. ~ ........ Vacant Land .............
Location of Property ...3.2.4.0..~.~.c..k.h.a.m..A..v.e.n.u.e. ,...Ma...t.t.:[.t.u.c..k .............................
House No. Street Ham/et
Owner or Owners of Property .... ~'err, y..~,...Tlal;hi[1 .....................................
County Tax Map No. 1000 Section ...1,0.7.,0,.0 ...... Block ,0.9,;.0.0 ......... Lot..0..1.3...q0..0 ......
Subdivision....M~..t.t..i.t.u.c.k...[-[.e.~.§.h.t.s .......... Filed Map No...1.9.2. ..... Lot No ..... 1.2. .......
Permit No ........... Date of Permit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .... 5., .0.0. ....................
Construction on above described building and p~mit meets all applicable codes and regulations.
' Applicant...~..~.~,~.~J ~,.,~'''/ ~'. .......................
~Y~.' ~ILL
R~. 10-10-78
AFFIDAVIT
STATE OF NEW YORK )
) SS:
COUNTY OF SUFFOLK )
TERRY R. TUTHILL, being duly sworn, deposes and says:
THAT, I am the owner of property located at 3240 Wickham
Avenue, Mattituck, Town of Southold, County of Suffolk and State
of New York, as shown on the attached survey as prepared by Young
& Young dated June 24, 1976;
THAT, the structures as shown on the attached survey
were in existence prior to 1957, the date of inception of zoning
and that no other structures have been erected since that time so
as not to necessitate a building permit or Certificate of Occupan-
cy;
THAT, I make this Affidavit to induce the Town of
Southold to issue a letter of pre-existing use relative to the
structures as shown on the attached survey.
Sworn to before me this
~y of June, 1980.
Notary Pub~ '
RUTH ENGE~[
NOTARY PUBLIC, State of New York
No. 52-1116645, S~f~olk Cou,.~t~
Term Expires MaTch ':LO,
TERRY R/ TUTHILL ·
~02.
NOTE:
· -- ~401VU~4ENT
SUBDII/ISION I~AP FILED IN THE OFFICE
OF TNE C£ERI( OF SUFFOLK COUNTY ON
.IUL Y 2'~, 1955 AS MAP NO. 1184.
REVISIONS
YOUNG & YOUNG
400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
ALDEN W. YOUNG HOWARD W. YOUNG
PROFESSIONAL ENGINEER AND LAND SURVEYOR
SURVEY FOR:
TEt~t~Y ,~. TUTHILL L~ DOROTHY P. TUTt~I£L
LOT IVY2 12 "AMENDED MAP OF MATTITUCt( HEIGHTS"
AT GUARANTEED TO:
MATTITUCK SOUTHOLD SAVINGS BANK
THE TITLE GUAt~ANTEE CO.
TOWN OF
SOU THOI D
suFFoLK co., N.Y.
SCALE: !,,.._ 40' J DATE: JUNE' 24, 1976` NO. 76'-5'/5