HomeMy WebLinkAbout34194-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33524 Date: 02/04/09
THIS CERTIFIES that the building DIESEL TANK
Location of Property: MAIN RD CUTCHOGUE
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 102 Block 6 Lot 20.2
Subdivision Filed Map No_ Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 25, 2008 pursuant to which
Building Permit No_ 34194-Z dated SEPTEMBER 30, 2008
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 ACCESSORY DIESEL TANK AS APPLIED FOR.
The certificate is issued to WICKHAMS FRUIT FARM
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 4020906 01/05/09
PLUMBERS CERTIFICATION DATED N
r
Z
Auth `rized Signature
Rev. 1/81
i DE
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' Form No.6 D
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 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.
B. For existing buildings (prior to April 9,1957) non-conforming uses,or buildings and"pre-existing"land uses:
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
Date. 2 ��
New Construction: Old or Pre-existing Building: (check one)
Location of Property: ML3906;(2 _ �
House No. I 1 Street mlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section C 2 Block Lot
Subdivision Filed Map. I Lot:
Permit No. Date of Permit. Applicant: 1 WI
Health Dept.Approval: Underwriters Approval: S �rw Yu).A
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: eck one)
Fee Submitted: $ Z S
CJv 3 9 5,._q
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U L,-1 e-)� � A p icant 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. 34194 Z Date SEPTEMBER 30, 2008
Permission is hereby granted to:
FRUIT FARM WICKHAMS
PO BOX 928
CUTCHOGUE,NY 11935
for
INSTALLATION OF AN ACCESSORY DIESEL TANK AND RELATED ELECTRIC WORK
at premises located at MAIN RD CUTCHOGUE
County Tax Map No. 473889 Section 102 Block 0006 Lot No. 020 . 002
pursuant to application dated SEPTEMBER 25, 2008 and approved by the
Building Inspector to expire on MARC ,
Fee $ 100 . 00
utho ed ' gnature
ORIGINAL
Rev. 5/8/02
3 1-1
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5 BY THIS CERTIFICATE OF COMPLIANCE THE 5
5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
BUREAU F 5
5 u o ELECTRICITY
c . 5
5 40 FULTON STREET - NEW YORK, NY 10038 C�
SCERTIFIES THAT 5
5 5
5 Upon the application of upon premises owned by
5 TOM WICKHAM TOM WICKHAM L�
5 PO BOX 928 PO BOX 928 5
5 CUTCHOGUE, NY 11935 CUTCHOGUE, NY 11935 5
5 Located at 28700 ROUTE 25 CUTCHOGUE, NY 11935
5 Application Number: 4020906 Certificate Number: 4020906 5
5 Section: Block: Lot: Building Permit. BDC: ns11 5
5 5 Commercial 5 Described as a occupancy, wherein the premises electrical system consisting of
5 electrical devices and wiring, described below, located in/on the premises at: 5
SBasement,Outside, c5
5 5 A visual ins 5
pection of the premises electrical system, limited to electrical devices and wiring to the extent detailed
5 herein, was conducted in accordance with the requirements of the applicable code and/or standard
5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other ,
5 authority having jurisdiction, and found to be in compliance therewith on the5th Day of January, 2009.
5 Name OTY Rate Ratin Circuits Tapes,
5 AdditionalCharges 5
5 install a 20a circut under ground,to a diesel 5
5 fuel dispencing pump c5
5 Appliances and Accessories 5
5 Fuel Dispenser Unit 1 0
5 5
5 5
5 5
S 5
5 5
S 5
5 . 5
5 seal
5 1 of 1 5
5 � 5
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal a'l:the locati,n,indicated. 5
5 5
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [, ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS:
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DATE — �� y INSPECTOR
1_
FIELD INSPECTION REPORT DATE I. COMIVIENTS
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FOUNDATION(1ST)
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FOUNDATION (2ND) \�
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PERMIT TO CONSTRUCT
Toxic and/or Hazardous Material Storage Facility
Suffolk County Department of Health Services
Humayun J. Chaudhry,DO,MS Commissioner
SCDHS REFERENCE#13723 Date of Issuance: SEPTEMBER 18,2008
SCDHS REGISTRATION#10-0108 Permit expires one year from
SCDHS PLAN#HM08-215 the Date of Issuance*
FACILITY NAME &ADDRESS
SITE NAME' WICJG1"'M'S FRUIT FARM'LLC.
SITE ADDRESS,. 28700 MAINROAD/NYS RTE 25
SITE V/HSZ CUTCHOQUE;NY 11.93. 5
The application for pennit to construct a.Toxic or Hazardous'Nlaterials storage facility—for the above;referenced
site has been reviewed for compliance with Article 7& 12 of the Suffolk,County Sanitary Code:--The application
has been approved. The items:listed below and on the back of this form are conditions of this permit.
1. A copy of the approved plan must be kept at the construction site.A copy of this permit must be kept
on display at the facility during construction.
2. Safe.construction practices must be followed during the installation of the storage facility(s).
3. The storage facility(s) must be constructed in accordance with the approved plan. Any changes in
design, materials or use requires prior written consent of both the design professional and the Office
of Pollution Control. The changes have to be submitted in a form:that is acceptable to the Office of
Pollution Control. The contractor and/or design professional is_required to inform the owner that the
changes are being made.
4. The:Office of Pollution Control has7 the right to inspect alas.installation at any time to verify its being
constructedin compliance with tliis'permit.
The Office of Pollution Control must be contacted at 854-2523 at least 2 business days prior to commencement
of any work to arrange.for the required construction inspections:
Contact the local building department and/or fire safety enforcement office for any additional requirements that
may apply to your project.
The storage facility cannot be placed into service until the Office of Pollution Control performs all
required installation inspections and issues an interim permit to operate.
The Office of Pollution.Control reserves the right to revoke this permit as allowable by law.
ISSUED BY:
Otto J.R neberg,P.E.
Bureau of Environmental Engineering
Office of Pollution Control
Division of Environmental Quality
*CONMINUED ON REVERSE*
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Q Surve
1y
SoutholdTown.NorthFork.net PERMIT NO.�j / / Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined ,20 Storm-Water Assessment Form
Contact:
Approved ,20 Mail to:
Disapproved a/c
Phone: `O
Expiration ,20
In ctor
D U APPLICATION FOR BUILDING PERMIT
SF.P 2 5 ZO
Date �r , 20 07
biDG.oEPT. INSTRUCTIONS
T�w��!TNOI_D
--plus 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, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
( ;j.0 . G t i;�L., LL C
(Signature of applicant or name,if a corporation)
WRITERS CER�IFICA' CL 1/� f-
=UNDER REOUIRER �
(Maili g address of applicant)
State whether applicant s owner essee, agent, architect, engine r, gen�contra , electrici plumb r r b ild
Name of ow of;premises (L ` '�S �—vL<(As on the tax roll Q tm e 'd
If applican i a co gnature of du authorized officer
(Name and title of corporate officer) ��
Builders License No.. ;
Plumbers License No.
Electricians License No.
Other Trade's License No.
•;LaGN � V
1. Location of land on which pro po ed work will be done: "11��P P G0�.. - �\ EEi �w
2 �U-t Mp4"I' HP MS pF N
House Number Street
'' RFQV�RE�PEE NQS�R 10N '
County Tax Map No. 1000 Section ��Z Block
Subdivision Filed Map No. S501 Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
u
b. Intended use and occupancy G414k
J`
3. Nature of work(check which applicable): New Building Addition Alterat'on
Repair Removal Demolition Other Work -T tj it-S-�'v Oe k R
IT (Description)
4. Estimated Cost vo Fee
(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. kil
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 u ber of Storiesr
8. Dimensions of entire new construction: Front C Rear s 1 : 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
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
14. Names of Owner of premises Address Phone No.
Name of Architect 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
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property ikl4es;
17. If elevation at any point on property is at 10 feet or below,must provide topographical dath'on.survey. "
18. Are there any covenants and restrictions with respect to this property? * YES NO
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF )
C5. (,- C(' being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
CONNIE D.BUNCH
(S)He is the —� Notary Public Sta185050WYork
(Contractor,Agent, Corporate Office c.) Qualified in Suffolk un
Commission Expires April 14,YGL �-
of said owner or owner , and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements con tined in this application are true to the best of his knowledge and belief; an at the work will be
performed in the manner set forth in the application filed therewith.
Sworn o Ppfiore me thi
day of �. 20
Clk-��
Notary Public Signature of Applicant