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Home My WebLink About10906-z TO~N BUILDIN~ TOWN:HALL-, SOUTHOLD, N~ ~.~ BUILDING : E P~E~I$~S UNTIL ~F~JLL (THIS PERMiIT MUST BE KEPT ON ~H COMPLETION OF THE WORK AUTHORIZED) N9 109 )6 Z Permission is hereby granted to: at premises located at ... County TaX Map No. lQ00 Sectmn ...... ,? Blo~k .? ......... iLar No ................... -~.. pursuant to application dated ...... ~ .... ~ ........ , 1 , and approved by the Bu Iding Inspector. ~ ~ ~ ~B~Jilding [InsP cio Rev. 6/30/80 ~ ' ~ FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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 features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approvat 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 compteted site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion 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 ....... -~ .... Old or Pre-existing Building ............ Vacant Land ............. Location of Property....~..~. ~..~. ........ ~~. · · ,4~. · ............... .~.~ .... House No, Street Nam/et Owner or Owners of Property ...~ ...... ... ......................... County Tax Map No. 1000 Section .. (.~'. ,,~ ..... Block., .~.. ~ ....... Lot...~...~..,~ ....... Subdivision ................................. Filed Map No ........... Lot No ............. : Permit No..[. O. ~J.~.~.. Date of Permit .......... Applicant ,~~ ,~.... ~.,~ Health Dept Approval ---- Labor Dept Approval Underwriters Approval ..... / .......... Planning Board Approval ................. Request for Temporary Certificate ..................... Final Certificate .... Fee Submitted $.. ~.,.~,. ~ ................... Construction on above described building and permit meets all applicable codes and regulations Applicant ~ ....................... Rev. 10-10-78 FIEL~ INSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME& PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY co~ FINAL DATE COMMENTS ~ /7 _? ADDITIONAL COMMENTS: :[0012.90 THE NEW YORK BOARD OF,,FIRE UNDERWRITerS THIS CERTIFIES THAT only the electrical equipn~ent ~ described below and introduced by the a~pllcan~ n~¢~d qn ~ a~ove . a~llc~ion Cu,~bfr ~ the premises of in the following Iocati?n; [] Baset. ent ~ 1st Fl. ~ 2nd FI. Section Block exatnit~ed ott 0~ ~ ; ~8 ~ and found to be in compliance with the requlrem et, ts' ~f this Board. FIXTURE FIXTURES RANGES 2OOKING DECKS OVENS EXHAUST FANS 20 20 ? DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET OTHER APPARATUS 2 ~ Da~ecCor - A W O ~ NO OF HI L~G ,OF CC COND A W (~ NO OF NEUTRALSJ OF HI LEG AWG OF NEUTRAL Ted Cheshire,Jr ~Co. B~x 255A, Sound MattiL%mk, N. Y. 11952 AMOUI~T ~B~EASE EE~,T BY c.~c~ '22. O0 ~O.DE. To TNE YORK BOARD OF AS CASH SENT I RISK OF SENDER Lic: ~95 3 1 FOI~M ~0, $ TO~VN OF $OUTHOLD BUILDING DEP.4RTJ~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL .. Z4~.z~.,..z..":.~.c..~..:.. ~.....~ ........................ PLEASE TAKE NOTICE that your application dated ~.(z~.f.~...~<~ ................... , 19~.. ~ ~ ......... for permit to construct~.~.~.~..~ ................ at the premises located at ...... ~ ............. ,.,~..~.~..~...~.z/ .......... ~ ~ ...... . ....... ~ ....... :~.~ ....... ~.:....~.~ ............ ~.~:~ .............................. :...' B~l~ing~ In~ector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ..... ' ......... APPLICATION FOR BUILDING PERI~/IIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 issue h 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_~housin_g code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspection_ . ~.0~~,.~,,~ ~ {~5~7~ .... . 95.2. ?.sA:' 57. ,. :. k. ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner Name of owner of premises . .~..N~.. ! .3I.A..R~...]).).. ? .1~..S.~I..R.E ............................................... (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...~5. .~ ................ Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. 9280 Sound A~re. Ma~i~uek House Number Street Hamlet County Tax Map No. 1000 Section .I.2.2. .............. Block . .0.2. .............. Lot...0.0.~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: c u Ro sldelloe a. Existing use and o c pancy ...... ! ............. /~ ......... , ....................................... b. Intended use and occupancy . .R.e.s. Jr .d? .~.°.~. ,-/-~/. ~~~ ..... .......................... 3. Nature of work (check which applicable): New Building .......... Addition .X. ........ Alteration ......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost .~.7., 000 o O0 i Fee .. (to be paid on filing this application) 5. If dwelling, number of dwelling units .1 Number of dwelling units on each floor If garage number of cars 6. If business, commercial or mixed o'ccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front...~7 .......... Rear ... 3.7. ........ Depth... 2,5 ......... Height ...1. 7 .......... Number of Stories . ..1 ...................................................... Dlmansl~ of same structure with alteratmns.1or add~tlons: Front .... .7. ........... ReaL...~7 ............. Depth ...................... Height ....7. ................. Number of Stories...~ .............. 8. Dimensions of entire new construction: Front..1.9. ........... Rear .... ,.1,9 .........Depth . .2.0 ....... Height .18 Numb{r of Stories .1.~, Size of lot: Front ~00 , ' Rear ,.100 ............ Depth ...19't ......... Date of Purchase . .J~¢g..'[970..! ................ Name of Former Owner .... ,Tx:~r~. t3....~gem .......... Zone or use district in which premises are situated.. ~ts.:L4erx~L~L, A .................................... .... ordinance or regulation: Does proposed construcnon wolate any zoning law, . ............................... Will lot be regraded .$.o ........ , ........ , ........ Will excess fill be removed from premises: Yes No Name of Owner of premises . .~.u.n.e...~.B..e.~.h. ~.~? ....Address .S.o.~.~.ct..A.~.o. ~..~.~.~. ~ :Phone No.. 2. ~.-.~..~5 .... Name of Architect .n...o.n? ..... . ...... Address ................. Phone No. .. Name of Contractor ~6r~e ...................... Address ................... Phone No ................ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate ¢leariy and distinctly all bfiildings, 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 NEWi%ORI~,/ ~ W o ~ COUNT.~~~...~ ~ a"a ~ .... '. · 4*~-~. ~...~~ ..... being duly sworn, deposes ~d says that he is the applicant (Name of individual sign~g contract) above named. He is the ................. ~~;~;r ~;;r ~ ~;, ~;~;;~t; ;~i~;;, '~t~ ~ ............................ of said owner or owners, ~d is duly ~authofized to perform or have perfo~ed the said work ~d to m~e and file ~is application; that ~1 statements eont~ned ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner ~et forth in the application filed therewith. Sworn to before me this ~ .......... ...... ........ Not~_public', ............. ,, ~.:...}~~Count~ ~ ~ ~ ~ / Cmza~m au. SmLtt · . .~ ........... , .... /~:' ~ ' ";'' '2 .... NOT~RY PUBLIC,SI~Ie 0f New York '(Signature o~ appncant) N0, 52 8125850, Suffolk Cou~L ~ T~rm Expires March 30, 19~