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Home My WebLink About23003-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. ~£IFICATE OF O~JuwAN~Y No Z-23875 Date SEPTEMBER 14f 1995 THIS CERTIFIES that the building. Location of Property 240 SMITH ROAD House No. County Tax Map No. 1000 Section 98 Subdivision ACCESSORY PECONIC~ NEW YORK Street Hamlet Block 3 Lot 37 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 31, 1995 pursuant to which Building Permit No. 23003-Z dated SEPTEMBER 8~ 1995 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 STORAGE SMED IN REAR YArD "AS BUILT" AS APPLIED FOR. The certificate is issued to (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A N/A Rev. 1/81 I~ORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISE$ UN'IlL FULL 23003 Z ~e ........... ~m'~'.~ ..................... ~.'"~ Permission Is hereby g~nt~e~: _ //~ (~', / -,/,../..,/.~.~~~ .................... .... CounlyTax Map No. 1000 Section ........... ..~.~ Block ..............~ ..... Lot No. ,.,,..~.....,'?.., ............ pursua,,,o~p,,o~,,o, d~,~d ................. ~..~ ......... ,~...~,d ~,ov~ b~ Building In~tor. F~ 8 ......................... Bulldi Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-I802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: 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 si~e plan requirements. 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 a 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 I. 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 - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ...~D~D$~.~O,.I~ ....................... New Construction ........... Old Or Pre-existing Building ................. York ll9~ Location of Property .... g~p.~Djth. Bpad~.~ecooj~.~Dw ...................... House No. Street llamlet Onwer or Owners of Property...~D¥~DO)D.F.-.~j~D~b ...................................... . . .. .. County Tax Map No I000, Section...~ ......... Block.~ ......... Lot..~ Subdivision .................................... Filed Map ............ Lot ...................... Permit No ................ Date Of Permit ................ Applicant ............................. Health Dept. Approval .......................... Underwriters Approval ......................... Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ....... ~... Fee Submitted: ?,0, L~OX 706 CUICHO~UE LI NY ' '" ' ' ........................................... ' ' FI~I.D I~.SPECT tON REPORT DATE COMMENTS FO[INDATION (IST) FOUNDATION (2ND) ROUGI1 FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAl, ADDITIONAL COMMENTS: GARY FLANN£R OLS~'N COUNSELLOR AT LAW P.O. BOX 706° MAIN ROAD ,, CUTCHOGUE. LONG ISLAND, NEW YORK 11~,35 · PHONE 516-734-7666 August 30, 1995 Re: Limbach to Tholl Our File # 5963 Dear Georgia: Enclosed please find the following: 1. Application for Building Permit for shed as constructed. 2. Check in the sum of $35.00 for Building Permit. 3. Application for CO for shed. 4. Check in the sum of $25.00 for CO for shed. Very truly yours, GFO:lmk Enclosures Southold Town Building Department Town Hall - Main Road Southold, NY 11971 L Examined . Approved . FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT I 1995 TOWN ttALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 BOARD OF HEALI-I{ 3 SETS OF PLANS SURVEY CIIECK SEPTIC F O g..~l CALL MAIL TO: Date . AlJgl~$.t. 2~3 ......... INSTRUCTIONS a. This apPlication must be completely filled in by typewriter or in ink and submitted to the Building Inspector, w sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan sbowlng location of lot and of buildings on premises, relationship to adjoining premises or public st or areas, and giving a detailed description of Iayout of property must be drawn on the diagram which is part of this ~ cation. c. The work covered by tiffs application may not be commenced before issuance of Building Permit. d. Upon approval of tiffs application, the Building Inspector will issued a Building Permit to the appl/eant. Such p~ shah 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 Occup shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant t, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinanc Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, ar, admit authorized inspectors on premises and in building for necessary inspections. .... 4. ........... --' (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buii Owner Nanre of owner of premises . J~ay~.c.eJ.l.a. ]_.i.m.b.a.c.h ..................................................... (as on the tax roll or latest deed) I f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plu nher s License No ........................ .' Electrician's License No ....................... Other Trade's License No ...................... Location of hind on which proposed work will be done. 240 SrM t.h Road, Peconic, New york lIouse Nam bcr Street Hamlet County Tax Map Nol 11300 Section . .9.8. .............. Block 3 ' Lot . 37 SubdMsiongOP.9.f. Indion Neck Park. ' Filed Map No. 551 Lot 5 (Name) . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: L.,,~, u p yrx:st;n"uscan"occu-anc-Shed as built b, Intended use and occupancy Shed as built · · .Shed~as built . 3. Nature of work (check which applicable): New Buildingx .......... Addition ...... Alteration ' Repair .............. RemoYai .............. Dmnolition .... ; ......... Other Work... ) ..... ' ..... (Description) 4. Estimated Cost ...$2QQ,(]Q ............................ Fee ... ~5:.09 ............................. (to be paid on filing tiffs application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ............... · Ifgarage,'number of cars ....................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, it' any: Front ............... Rear .............. Depth .............. Ileight ............... Number of Stories ........................................................ Dimensions et' shine structure with alterations or additions: Front ................. Rear .................. Depth ...................... lleight ........... ........ ,.. Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... }lcight ............... Number et' Stories ................................................ ..~ ... ~. Sizeoflot: }'rent ...................... Rear ...................... Depth 10. Date of Purchase .................... ......... Name et' Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................ , .... 13. Will lot be regraded ....... '. .................... Will excess fill bc removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property within :300 feet of a tidal wetland? *Yes ........ No ......... *If yes, Sm~thold Town Trustees Permit may be required. PLOT DIAGRAM' Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. See annexed survey with location of shed. ¢OLL,OWI~G ~NSPECTtONS: 2, ROUGH FRAMING ~ PLUMBING 3, INSULATION 4, FINAL CO~4STRUCTION MUST BE COMPL~E FOR C,O. ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE N.~ STATE CONS~UCTION & ENERGY CODES. N~ RESPONSIB~ FOR DESIGN OR ~NSTRUCTION ERRORS ;TATE OF NEW YORK, S.S ?OUNTY OF. SUFF. OL[ ......... ............... M. qr. qe.l.l.a..F....Lj.m.b.a.c.h ................ being dnly s~vorn, deposes and says that he is the applicant (Name of individual signing contract) bore namcd. is the ........ o~oer. ..................... · ......................................... . .............. (Contractor, agent, corporate officer, etc.) o~w~cr or owners, and is dul,.?~rized to perform or have performed the said work and to make and file this said pplication: that all stat(~ncnts co~aincd b} this application are true to thc best of his knowledge and belief;and that thc 'ork will bc performed in the m~ner set f~rth in thc application Bled therewith. worn to before me this / ./ . taw Public .... /:~ .. fix'L/4 1...., ..... ~ .~ ...... County ~'. ~ ~ ~ , ~-.'[u*':~.,~ ~- ~-- (Signature of applicant)