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Home My WebLink About7244-z~ NO. 4 TOW~ OF $OUTHOLD BU~.nI~ DEPART~T Town ~erk's Office $outhold, N. Y. Certificate Of Occupency No. ~ ~/7~-... Date /~" .~...7', 'lg.~..t./. THIS I~S that ~e b~di~g loca~ Map No .............~ Block No ..... co~o~ subst~fi~ly to the App~cafion for B~l~g Pemit here~fore ffl~ ~ th~ o~ce dat~ .......... ?. ~.~:~, dated merits of ~e appUcable pro~io~ of ~e law. ~e occup~ for w~ The certifica~ ~ ~ued to (o~, of the Mores~d b~ld~g. S~olk Co~ty Dep~ent of He~ Approv~ UNDER. IT.S CERTIFICATE No. HOUSE ~ER ~ S~eet B~g ~p~r TOWN Of SOUTHOLD BU~LMbI~ I~PAIFrMENT 'I'~WN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7244 Z Permissio~ is hereby granted to: ]~...~lm~....~.g,....gm o,.. 84~ez~ ............ 7 ............ /iii"i pursuant to application dated ........................ HE~' ......... 9, ............. 19'~..., and approved by the Building Inspector. Building I n~'~ ........... APPLICATION FOR BUILDING PERMIT ...... ........ .¥.. ............ INSTRUCTIONS a. This application mu~t be completely filled in by typewriter oe in ink and submitted n trp icate to the Buildina~l Inspector, with 3 le~. ~.k~.., accurate ploe plan to scale~ Fee according to ~chedule. -- b: Plat'pitin ~irig'1~cat~0n of lot and of building~ on premises, relationship to adjoining pre. mises or public streets or areas, andgi~ing a detailed description of layout ofpmperty must be drawn on the diagram which c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Build ng Perm,t. d. Upon aPPi, oval of this aPPliCation,'the BUilding Inspector will issue 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. B .A,P..PLI ~CATIO~I~ .I.S HEREBY.MA_DE to the B.uilding Department for the issuance of a Building Permit pursuant to the unamg :one uramance at the lawn of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of building, 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 buildings for necessary inspections. _ .............(Si~.nd~"'J~'~z'/~"of applic/~nt, .................. or nd~l ~i~J ........ licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ~ .......... '~ ..................... ;~7'"'"'~' .......................... '~ .................. : ....... ~ ........ : .................... '~'; ............... , (Name and title of corporate officer) Builder'S License No ..................................................... Plumber's License No ....... ~~: ................. ~'~7~"~t9 ..... Electrician's License No..~...~...3....~..E ....................... Other Trade's License No ............................................... 1. on which pr,~osed, work wil] be done. Mep I~o.:..~'~?~-- ~" ~., ,at So...~.O..~...Z.L. Location of land Street and Number ../~/~..~.....~......~ ............................................. /~~. ~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use ond occupancy ..... ~'~...~,..~.~,~... t ,..~......~ ..,...~...i~ 3. Nature of work (check which applicable): New Building .................. Addition ......... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ...................................................... (Description) 4. Estimated Cost ..'~'..~./...0~...O..:...'.~.. ..................................... Fee ...L~..~ ....................................................................... (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 o~upon~y, specify nature and ~xtent:of each type of use ............................ 7. Dimensions of existing structures, if any: Front .........i..~..~. .......... Rear ......... ,~?..I. ............... Depth ......~....o..~. ...... Height .....~:....'~...~. ........ Numbe~ of' Stories ..... ...~C... ................ .;.....~. ........................ I .......................................... ; .......... Dimensions of same structure with alterations or additions: Front ............. .~.~. ................ Rear ........ ~..7. ............. Depth ......... :I~.~.. ............... Height ....... .~.,..'~.. ........... ;Number of Stbries ....'~.... ....................... 8. Dimensions of entire new construction: Front .............. ~.~...~. .............. Rear ........... I..~....'. ........ Depth ..... ./...~....i .......... Height .................... Number of Stories ........ !. ............................................................................................................ 9. Size of lot: Front ................... .(..~..~..f. .......................... Rear ............ /.~..(~....!. ................ Depth ........ ~/...~....~....~. .......... 10. Date of Purchase ................................. ; ...................... Nome-~--~. -~. · a°~°f Fo. rm£r Owrjer ........................................................ 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 be removed fror~ pre~es~L(,) Yes ( ) No 14. Name of Owner of prem~ses .................... Address. ~9 , Name of Architect .............................................................. Address ................................ Phone No. ...................... Name of Contractor ."~..~.....~.~. .......................... Address P J . Phone No. PLOT DIAGRAM Locate 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. STATE OF NE'W~'Olt. K~,. ,~/} ~S S COUNTY OF~ ...... )' ' / ' ... bein duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above He is the ....... (~.~l.~u ...... ......... ;; ....................................................................................................................................... (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 t,h~ewi~. Sworn to before~me this ~,~ ~ ~ ./ //~,/ JUD1TH T Notary Public, Slate of New York/ NO. 52~0344963 Suffolk Commission Expires March 30~ THE NEW YORK BOARD OF FIRE UNDERWRITERS C"~W BUREAU OF ELECTRICI'FY 85 JOHN STREET, NEW YORK, NEIN YORK 10038 THIS CE~IFIES THAT o~y t~ el~t~al ~uip~nt ~ ~scdb~ be~ ~ int~ ~y t~ ~ilcant Mm~ on ~ ~pl~at~ number in t~ p~mi~s of George 8che~b, 5qO Sigsbee ~., ~b~ituc~, ~.~.. wosexamlnedon September- 27, 197~ andfoundtobeincompliancewlththerequirementsofthisBoard. FIXTURE OUTLETS ~ECEPTACLE$ SWITCHES FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS DRYERS UNIT HEATERS MULTI-OUTLE SYSTEMS NO. OF FEET OTHER APPARATUS: R V I C PER ~' OF CC. COND, NO. OF HI-LEG A.W.G. OF HI-LEG NO. OF NEUTRALS OF NEUTRAL 2/0 Water Heaters: 1-4.5KW Ted Cheshire Jr. Co. Box K Jamesport, L.I.119~7 Per COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANN2~. Lot 9 i. of lO .~ LOtI Lof m = MONUMENT SUBDIVISION Mx~P P!LED IN THE OF TH~ CL~RK OF ~UFFOL~ COU~ ry .EWS~ONS YOUNG & YOUNG 400 OSTRANDER AV£NUE, RIVERHEAb, N,rW YOR~, SURVEY FOR: GEORGE $CHERB LOT NO. I0 ~ II, "MATTITUCI~ P~~/~,~C" ~j PORCN FLOOR PLRN DFtTE: FOP, PROSED H^¥ 3, 1f,7~/ FIDD I'F/ON AT rLU~iN~; k/, ~/ /1 F~OT FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office 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 Inspector 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 features. 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 installations, 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: l. Accurate survey of property 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 safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date New Building ................ Addition ...... ~ ...... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~,.~..~.......~..~...~__ ~:'~.,~ , ......... ~.~..~..:..~.~..~...~....~) Owner Or Owners Of Property ....~.~.......~ Subdivis,on ..... ,or No. B,ock No ............. .ouse No ............. Dote Of Permit .,~.2.~...Z.~..~...Applican, ~....~_~.~..C....~.~.J~/~L/~..~... ................. Permit No. Health Dept. Approval .......... ...~..:...~..: ................... Labor Dept. Approval~ ........ ..~.../.m....~...: ............ Underwriters Approval .~.....~......J~'~..~.O.~ ............Planning Board Approval ......... ..~......../~.... ................. Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ..,~.~..~...~.. ................... Construction on above described building and permit meed aJ),.g~plicable codes and regulations. Applicant /.~-/.5'- ~o~1 Z~ ~ITZ- Notary Public .................................... County · (stamp.or seal)