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Home My WebLink About15784-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy May 26, 1987 Date ................................ THIS CERTIFIES that the building ...... .A. qc..e.s.s.q r. y..s.h.e..d.. ........................ Location of Property ..... :t 205 ........... M£.qrteh.ah~t. B.l.v.d... ........ S.o.u..t.h.q 1..d ........ House No. Strebt Hamlet County Tax Map No. 1000 Section ....... 8 7...Block ......... 3 .....Lot ........ 3. .6 ....... Subdivision Laughing Water .Filed Map No. 917 .Lot No. 36 conforms substantially to the Application for Building Permit heretofore filed in this office dated March 17, 1987 pursuant to which Building Permit No. 15784Z dated............................March 21, 1987 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 shed. · WILLIAM R. & PATRICIA R. HUMBURG The certificate is issued to ..................... [o~'o'e;',~~) ...................... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO N/A N/A PLUMBERS CERTIFICATION DATED: Rev. 1/81 ~0~ NO. ~ 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) No- i5784 Z Dote ...... .~.~.~.~ ............................ , Permission is hereby granted to: .......... co,,,,~ To× Mop No. ~000 Section ....~..] ...... B,o~ .... .~.~ ....... ~-ot ~o....~...~ ............ pursuant ,o application dat~ .....~~..~..~.~~ ................... , 19,~.~,, and approv~ by the Building Inspector. Fee $..~.~..}~ Building I~tor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPAN BLDG. DEPT, -v TOWN OF SOUTHOLD Instructions A. This application must be filled in typewriter OR ink, and submitted ~I I 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 property showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $25.00 -- BUSINESS $50.00 ACCESSORY $10.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.'00, over 5 years $10,00 5.Updatecl C.O. $ 50.00 Date..,..../._. NewC°nsl;ruc~;i°n· .2... Old or Pre-existing Building ............ Vacant/~and House No. ~treet Hamle~ Subdiv}sion .... .. ........................... Filed Map ~o ........... Lot ~o .............. Health ~eOt~ Ap~roual ........................ kabor Dept. Approval ........................ Unde~rkers Approval ........................ Plannin~ ~oard Approval ...................... ~equest for Temporar~ Certificate ..................... Final Certificate ....................... Fee Submitted $ Construction on above described building and permit meets all applicable coCes and regulations. ............ OUNDATION {1st) OUNDATION ( 2n~ ) OUGH FRAME & PLUMBING ~NSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: OCCU ', NO , USE IS ;'UNLAWFUL WiTHOUT'CERTIFiCATE OF OCCUPANCY / / Z Z Examined . ..~..0~.~ .~k. [ Approved · .~..~..~.$. ., 19~..]. ., l~. Permit No..[. BOARD OF HEALTH ...... 3 SETS OF PLANS ....... FORM NO. 1 SURVEY . · TOWN OF SOUTHOLD CHECK : :.-~: ~a~l.': .~4 ff BUILDING DEPARTMENT SEPTIC PORM ............. :' TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 76§-1802 CALL ................ MAIL TO: Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 1981 a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. 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 buildhngs, 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 anthorized inspectors on premises and in building fo~~ ~ ~- ~--'~Signature of applicant, or name, if a corporatidn) ;'q' ~. ~°)" ~7,~ .Z'~,.,~o(~... ~/..../~...Cr~7/ (Mail~ng address of applicant) State whether applicant is. owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .o...a;..N~ .~. ................................................................ Name of owner of premises..~../..~../.~. · .~. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......... Plumber's License No - ' Electrician's License No '-~ Other Trade's License No ....... .-: ............. 1. Location of land on which proposed work will be done ................... ~ .............................. · .... House Number Street -- Hamlet -- County Tax Map No. 1000 Section ...... 1~...Z ..... Block Lot < Subdivision/~/~'tO. '(Name) ........ Filed Map No.. 7 ....... Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: , .ff..e. Tr ~8,w e a. Existing use and occupancy .............................................................. 3. Nature of work (check which applicable): New Building ..... ' ..... Addition... ! ....... Alteration ........... Repair .............. Removal .............. Demolition .............. Other Work .~O..~. ~ 6 ,,~_O O (Description) 4. Estimated Cost .................................. Fee ...................................... ~/~ ' (to be paid on filing this application) 5. If dwelling, number of dwelling unitL. ........ Numberofdwellingunit~2oneachfloor...~; ........ If garage, number of cars ..... g/~ .... ~. ............................... ; ..................... 6. If business, commercial or mixed occupancy, specffy nature and extent of each type' of use ...~4 ........... 7. Dimensions of existing structures, if any: Front ~ Rear ~ Depth Height ..... T. ........ Number of Stories .... ~ ........................ k .......................... D~ensions'of same strncture with alterations or additions: F~ont .... ~ ....... .... Rear ... ~ .............. Dept ...................... Height .......... ~ .......... Number of Stones ...................... 8. -~: ..... / ~ ~ ...... .~ ....... pt ..g~.'~... Dimensions ofentir~ new construction' Front ~ ~ Rear ~o ~ De h ' Hmght . ~ ..... Number of Stones ..... ~ ........................................ , ........ 9. Sizeoflot Pront ~ ~ . Rear ~ ,~O~ Danth ~[, 1 1. Zone or use district in which prtmises are situated.. ~~ ..... X~ .......................... 12. Does proposed construction vip~te any zoning law, ordinance or regulation: . .~¢ .................... ....... 13. Will lot be r~graded ...... ~ .................. Will~xces~fill be removed from. p~emises: _ Yes No N~e of O~e~m~F~/~..~.~.. Addr~.,~¢~. ~,~ ~o~e No. N~e of Architect ............ ~ ............. Address .......~ .......... Phone No ..... w ......... Nme of Contractor ........... ~ ............. Address .... :..~ ....... ;.. Phone No ....... ~ .... 15. Is this property located within 300 feet of a tidal wetland? *Yes; ..... No ..... *If yes, Southold To~ Trustees Permit maybe required. ~ ' PLOT DIAO~M ~ ~Z ,o~Z ~ Locate cle~ly ~d distinctly ~1 bufld~gs, whether existing or proposed, ana,~nmcare all se~-oacK a~enmons ~rom ~roperty ~nes. Give street and block number or description according to deed, ~d show street nines and indicate whether ntefiororcornerlot. ~ Z~ ~/~4~ ~l~O~/~$~ ~/ ?ATE OF NEW YORK, .OUNTY OF. ~.~../~.,,'~.,~.~..'*' S.S (Name of individual signing contract) .bove named. .... being duly sworn, deposes and says that he is the dpplicant ' te is the .............................................................. ~ .......................... (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work an~ to make and file this pplication; that all statements contained in this application~ are true to the best of his knowledge and belief; and that the york will be performed in the manner set forth in the application filed therewith. ;worn to before me this ........... Z~..? ..... day of .... ~. t~/~...~...., 19 .~. ~' ,otaryPublic, .i~~'.~.~.'.. County ~ota~/Pt ~1 c, State o~ I'l~ York ..x~. .... ,~....~fT. ~"fTr'~'-~Z~ ~ualifi~ In rla~aau Cmun~ ~