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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22806 Date DECEMBER 21, 1993
THIS CERTIFIES that the building ACCESSORY
Location of Property 55 HARVEST LANE CUTCHOGUE N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 97 Block 2 Lot 13.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 6, 1993 pursuant to which
Building Permit No. 21839-Z dated DECEMBER 16, 1993
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 IN REAR YARD AS APPLIED FOR.
The certificate is issued to DAVID & MARYELLEN GAMBERG
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL. N/A
r
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
ilding Inspector
Rev. 1/81
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 AUTHORIZZ/ED)
Date ~~tt 19.. 4.
N° 21839 Z R~j
Permission Is hereby grant d to;
GAr~V3~?LG
Nvlh A,
to....^,5!?rtG....'J....,..~cr`ss.t?/F.?~...........5>%'d.......~:~... Tfi~~
!!`z/?!Z...... /%?d............f~ t9 ?~l':•~cf.~l:.... ?
f ,...,...T!sf ..............,,-/...~........~r f r®.~CiE~..... tea,
E
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at premises located at rSr ."ice
{ S-
County Tax Map No. 1000 Sectlon•.....f... Block.......` Lot No. ....~v~.:.
pursuant to application dated t ........6 19..... n7..3....., and approved by the
Building Inspector.
Fee , .Q`....
E
(
/ B ding Inspector
Rev. 6/30/80
i
r
Form No. 6 L'~ /I/) ""7~ji T"l~~<
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. 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 site plan requirements.
Bs 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
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 - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15..00/, Commmercial $15.00
jy~ Ik J6 Date ..~~'t i l F Jgg5........ .
New Construction~~,v 1. v(~~i0~ cj Q ,P ~elcistiytg BuiLdin ~ . i1~ 1 z
il 1V+111N (~(i UIJ V r c /S
Location of Property........
House No. /n~ I Street Hamlet
Onwer or Owners of Property...b ~ I rl „$..IV ao).
County Tax Ma/p~~N~~~o~~~~((1000, Section..........Block...... ..../.~..~.Lot......:~........
Subdivision.:)l Y/:y'. .~~Y': , , ,yy, , ll „Filed Map.. ~ ?.L~~onnt....yy.^^. 77 ~~f~f~~.//.... .
Permit No.2-.`.$~~._..Date Of Permit.kl l'UV ~ .....Applicant. ~'l..:I~,U'~ ( YV! ~E~j
Health Dept. Approval ..........................Underwriters Approval..............//////...........~ /
:Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted:
y ~3a~ .
~,~a ~Cn~n ...APPLICANT ~.,.m....~,,,..
.~'~S~':°. ~:a l(J:~~w*rnxs agsq.^` :.T ~.;'I~:,,..., ~OMMLNT~ k~F'. es•
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FOUNDATION (13t)
FOUNDATION (2nd) m~
2.
o~
ROUGH FRAME &
PLUMBING
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3. ~
cmn P`
INSULATION PER N. Y. ^a
STATE ENERGY
CODE
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4.
FINAL
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ADDITIONAL COMMENTS: m
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BOARD OF HEALTH
FORM NO. 1. . . . .
3 SETS OF PLANS
1'f TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT C11EC>;-#..q.71...
TOWN HALL SEPTIC FORM
LBT.SOUTHOLD, N.Y. 11971
WNOFSOUTFIOLD TEL.: 765-1802 ttOCALL `.)3`1- W.31
.70 Examined Y,.& 199.3 NAIL TO:
Approved / 199//.. Permit No .°2I..3....... . .
Disapproved a/c
(B g Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19 .
INSTRUCTIONS
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.
I b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stieets
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 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 ;jections.
re of applicant, or name, a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder.
.
.00"0 ....................../...A. /n.,n.,.....
Name of owner of premises . Na? ~U~ ~!D• U Z ,
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .
Plumber's License No . .
Electrician's License No .
Other Trade's License No .
I. Location of land on which proposed work will be done .
f7~............ uu ......I
House Number ~pStreet Hamlet
County Tax Map No. 1000 Section Block Lot
Subdivision .Gr'.V Filed Map No. ^a~.Z... Lot
(Name) ,
1 State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..U............. .
y~~ Q
b. Intended use and occupancyP1~+!....`r..... C.......... ~.~:...,.r.
s: ii-h .
3. Nature of work (check which applicable): New Building 1!.. Addition Alterati
.
Repair . . . . . . . . . Removal Demolition . . . . . . . . . . . O[rk4....
escription)
4. Estimated Cost
Fee........................ ..1.!......
(to be paid on filing this app)*tion)
S. If dwelling, number of dwelling units N.1........ Number of dwelling units on each floor .
If garage, number of cars ! JA
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...N. 4
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories .
h Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
e' ' ea f p........ .
8. Dimensions of entire new cons ruction: Front Rear ,/o?........ Depth
Height ......y:......Number ofStories
9. Size of lot: Front Rear Depth
10. Date of Purchase . JA Name of Former Owner ! erf??K~~ . ~ZL(>h~N~i,
11. Zone of use district in which premises are situated XeA10C1`j17RC. .
12. Does proposed construction violate any zoning law, ordinance or regulation: 0 .
13. Will lot be regraded 14!t?..... Will excess fill be removed from premises: Yes N 1
14. Name of Owner of premises A. kA . A.47.'AgPP 6.. Ad-dress .SS lf~<.°P4/` . !!kr!% Phone No.
Name of Architect ...........&.4 Address Phone No............... .
Name of Contractor !f Address Phone o............... .
15. Is this property within 300 feet of a tidal wetland? *Yes........ No..k/9
*Ii yes, Southold Town Trustees Permit may be required. ,
PLOT DIAGRAM
Local ~ clearly and distinctly all buildings, whether existing or proposed, and, indicate all 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.
e A-rr-A C H ~D
STATE OF NEW Y~I1 S.S
COUNTY F .
being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named. / 11
He is the ...................c)w
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
day of . / 19
Notary PubliL/L~. County
CLAIRE L GLEW .....7...
Notary Public. State of New York l
No 4879606 (Sign a of applicant)
Qualified in Suffolk County y)
~~ammission Expires December 9, 19
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SURVEY FOR
DAVID GAMBERG a MARY ELLEN GAMBERG
AT CUTCHOGUE DATE: JAN. 16, 1992
TOWN OF SOUTHOLD SCALE I 60'
SUFFOLK COUNTY, NEW YORK NO. 92-0025
r UNAUTHORIZED ALTERATION OR ADDITION TO MIS CERTIFIED TO:
SURVEY B A VIOLArIoN DI SECTION Tzo/ OF THE DAVID G
NEIL YORK STATE EDUCATION LAW MARY
*COPIES OF THIS SURVEY NOT SEARING THE LAND AFF R CORP.
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL
NOT BE CONSIDERED TO BE A VALID TRUE COPY C A irl E COMPANY
M GUARANTEES IMOICATED HEREON SMALL RUN ONLY TO
HEALTH DEPARTMENT-DATA FOR APPROVAL. TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED (T NO. 91 G 3)
AND d MIS BEHALF TO THE TITLE COMPANY, GOVERN-
M MEARpT WATER IMP MI if SOURCE OF WATER PNn?TE_NMLIC - MENTAL AGENCY AND LENDING INSTITUTION LISTED
R SURF CO. TAE AIAP =VMQQ-SE C TION S_ BLOCK _2- LOT 1U HEREON, AMID TO ME ASSIGNEES OF THE LEADING
RTHEM ARE M OWELLIMS WITHIN ROD FEET OF TOGS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUGSEGUENT
M THE MATER SUPPLY AM SEMABE (MINIMAL SYSTEM FOR THIS ROIOENCE OWNERS
WILL or "MTN SIC[ ME fTAMDARDI OF THE SUFFOLK COUNTY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY LINES
TO EXISTING STRUCTURES ME FOR A SPECIFIC D• 5> 3 VIA
APKICAOT, PURPOSE AND ARE NOT TO BE USED TO ESTABLISH
PROPERTY LINES OR FOR THE ERECTION Or FENCES `To LAND 5007
ADDRESS
YOUNG a YOUNG 400 OSTRANDRHEADER AVENUE
NOTE : p = STAKE • = MONUMENT
RE: LOT 1 , MINOR SUBDIVISION "CREATIVE VENTURES". ALDEN W.YOUNG,PROFESSIONAL ENGINEER
AND LAND SURVEYOR N.Y.S. LICENSE NO. 12945
a HOWARD W. YOUNG, LAND SURVEYOR
m MTELOCATMOFWILL1WI,KPnCTAM1mBCEWOOLStvIM10WNMAEOM N.YS.LICENSE NO.45893
+ AAE PROM HELD DOEMRTIORS AM OR DATA OBTMMB FROM OWNERS
GRANDIS A SONS INC. HAS -
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Materials List Optional Extra
Quantity Size Description
Lumber 4x4x_12' 'Skids
7 8' Bom Frames `t ) 18 x 15 Torque Window
2 x 4 - 8' Window Framing
4 2x4 -12' Ribbon Boards 1 roll 15A5 FO
3 5/8' x 4 x 8 CD Floor Sheathing '1 10' Ridge Vent
4 7/16' x 4 x 8 OSB Roof Sheathing 2 End Caps
1 2 x 4- 8' Collar Tie T
1 2 x 6. 8' Door Header 4 gal. Stain (siding)
6 2 x 4 - 10' Gable End Framing 1 gal. Stain (trim)
2 2 x 4 - 8' Gable End Framing Tools You WIN Need
11 5/8' x 4 x B T1-11 Siding Level (at least 2 feet long)
4 2 x 4. 8' Door Frame Chalk Line
1 2x4- 10' Door Frame Safety Goggles
4 50" 'Z' Flashing Hammer
12/3 squares Comp, Asphalt Shingles Saw
136 If. 1 x 4 Trim Screwdriver
48 If. 1 x 6 (Fascia & Rake) Measuring Tape (at least 20 feet long)
Hardware Carpenter's Square
3 lbs. 16d Nails
3 lbs. Bd Nails \ Materials for finishing Shed with paint or stain
Pencil
7 lbs. 8d Siding (galv.)
3 lbs. 1 114' Roofing Nails Apron to hold hammer, nails, measuring tape, E
1 lb. 1 114' Drywall Screws _
1 Hardware Kit
(Includes 6 Hinges, 2 Barrel \
~
h Bolts, 1 Hasp, & Screws)
~ooM1r5~' ~o,~~J BE~9~!) ~x`r' I°Ltr7E
JS(r~C~, G~i2V. G/-1-~2rfir~;~- B~~TS• F'c,q%'~ !~~v/<~
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