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Home My WebLink About13143-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... .Z J .3.9.8. 8. ....... Date Nov° 6 1985 THIS CERTIFIES that the buildh~g A d d i t i on Location of Pro err .. 9.28.0. SOUND AVE. MATTITUCK P Y ~lous'e ~/o: ............ Street Hem/et County Tax Map No. 1000 Sect[on 1 2 2 . .Block .... 02 .Lot 0 03 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ...... ~.a.y.. ] .8 ........ ,19~~. . pursuant to which Building Permit No. 1 3 1 4 3 Z dated ..... H ~ Y..1.8. ................ 19.8. 6., 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 ......... ...... gd,c~5, t ~,~& .Go..e.x~.t.~..a.~q~.qt?y. ~.t.r. ~.c.t.~tr..e .......................... The certificate is issued to DAVID G. CHESHIRE of the aforesaid building. Suffolk County Department of Health Approval ..... ?./. ~. ................................. UNDERWRITERS CERTIFICATE NO. N 7 0 1 2 5 8 Rev. 1/81 Building Inspector ~'O~m' NO. B TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 131t3 Z Permission is hereby granted to: ..~,'~..~..C~.~..~.~ .......... ...... ~a.~........z..~. ...................................... ........ ~. .,~~..=.~..,.._/..,..../..~.V..~-z , to ............ ~.. ,~. /. z~.~. . .~. . . . . ~. ~. ~ /. .~. ~ . ~.:~ ........ /. ,~ . . . . ~ ~ . . . ~Z .~. . . .~. . . . . ~. .¢. .¢/ ;~ ~ ~..~?~ .......... ~Y~.~.~;z"~.~/;~....~ ................. .~ .......................... ~, ....................................................../ ., ,rem,,, ,~,t., ., ...... ~.~.~ ........ ~.~.....~.~ ......................................... ............................................................................................................. ~~~..~..~/~ County Tax Map No. I000 Section .... /,.~,~ ...... Block ....,,C~,,., ,,~,,, ...... Lot No..,(~.(~,.~ ........... ~u~uo~t to ~p~,,~o,,o~ ~t.~ ..... ~.,.,~ ........ /.Z ................. , ,,~.., ond op~.o..~ ~, ,h. Building Inspector. /~) do Fee $..,4. L,.....,~u~ ...... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ~ 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. 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 re~quirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 requ ired to prepare a certificate, Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling 3, Copv of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date /~/¢/,~. · , ............. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Propertv .......................... House No. Street Ham/et Owner or Owners of Property ' County Tax Map No. 1000 Section ./-~L...~. ..... Block ...(~..-~ Lot..C~.~. ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.~/.~.'~-'.'~ '~ Date of Permit . .Applicant .~.~O..(~,~'~ ~.~ ... Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval . ~..~.~ ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ~. ..................... Construction on above described buil~rmit meets al,I applicable code~ and regulations. Apphca~-.~'..~ .. C'%. ~-~- ................. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1 1290 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 1OO38 oat~ A,;,llc.tlon No. on flle 343821/85 T.,S 19 s N701258 only the electrical equipment os described below and introduced by the applicant ha,ned on Ehe above application number in the pre~nises of ~avid G. Cheshire, Sound Ave., 1/8 mi. W. of Factory Ave., Mattituck~ in tbefollowinglocation; [] Basement [] 1st FI. [~ 2nd FI. garage Section Block Lot wosexatni~ed°nJul~ 15F~985 andf°undt°beinc°"~pliancewlthther;quire~ne~tsWthisBoard. FIXTURE FIXTURES RANGES OVENS OUTLETS SW~TCHES EXHAUST FLUORESCENT VApO~ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATER MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: Panelboards 1- GoF.C.I. 1-6 (Ciro) 100amps. S E R V NO O~ERC%,COND. A W G. _ OF CC COND I C E NO OF HI-LEG A.W G OF NEUTRAL A. W, G NO, OF NEUTRAl OF HI.LEG Ted Cheshire Jr. Sound Ave. Mattituck, NAY., CO~ 11952 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Igspectors may be identified by their credentials. COPy FOR tNT. THIS COP' MANNER. FIELD IIW3PECTION DATE I COMMENTS ~ ., FOUNDATION ( 2nd ) ROUGH FRAME & PLUMBING - -- INSULATION PER N. Y. '' k STATE ENERGY CODE ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 APPLICATION FOR BUILDING PERMIT Application No .................. INSTRUCTIONS a. This application must b~ 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 dia~am 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 a Building Permit to the applicant. Such pemait 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 buildings for necessary inspections. (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 builder. Name of owner of premises ....~IDJ~.6'. · A.-..~t{ ~.fl j g,,~. ............................................. (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 .... .c~..~.t~..g~.... ........... Plumber's License No ......................... Electrician's License No... ~).c~-.~..~. ............ Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · ............. ..................... z t,q ....................... House Number Street Hamlet "Coimty Tax Map No. 1000 Section .../.&..~. ........... Block ,. · .cD.~ .......... Lot... Subdivision ................ (iq'a~)' Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~,.ff~.t.~g,a. Jr_~. .................. .~,. .......... ~ .................... b. Intended use and occupancy ...q~.~ O~.... ~-~. ,,,52~. ~. ~(_~...~.q. Voff/5~./~ ./,~5'~"/~0,/~.. 3. Nature o f work (check which applicable): New Building ~ Alteratio .......... Addition ........ n .......... Repair ............ RemoVal .............. Demolition .............. Other Work ............... i (Description) 4. Estimated Cost ..... C).o.p.: ...... , (to be paid on filing this application) 5. If dwelilng, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ... ~ ! .................................................................. 6. if business, commercial or mixe~ occupancy, specify nat. ure and extent of each type of use .................... 7. Dimensions of existing structure?, if any: Front ..... /.{~k ....... Rear . .].~.. ......... Depth...[..C:>I ........ Height .~.: ........... Number of Stories '.... ~ ............................................... Dimensions of same structure wffh alterations or additions: Front . ,~,.G ............ Rear/,. ,.;[~, ........... Depth ;. ~ .~. .............. i.. Height ...l ~ ................ Number of Stories.. ].~.~,~ .............. 8. Dimensions of entire new construction: Front .. ,4-.G ......... Rear .. ,~.t~ ......... Depth . ~ .~ ........ Height .. ,t. 7. ......... Number of Stories . ../~'z~ ............................................... 9. Size of lot: Front .. [.Q.~. .... i ........... Rear .... /. aq~ .............. Depth ./,5-$ ............... 10. Date of Purchase ...... /:F.Z'-)i .................. Name of Former Owner ~TolI~..~..(~'-r~j,~ .......... 11. Zone or use district in which prdmises are situated .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ......... i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ..2 ................. Address ................... PhoneNo ................ Name of Architect .......... i ................. Address ................... Phone No ................ Name of Contractor ......... I ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate wheth.er interior or corner lot. STATE OF NEW YORK, ' S.S COU,hlTY OF ................. c,.,. ................ (Name of individual sil ;ning contract) above named. being duly sworn, deposes and says that he is the applicant He is the .G~. ~.~tcrv,~ ..... $ .................................................................... I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d¢ly authorized to perform or have performed the said work and to make and file this application; that all statements coatained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manher set forth in the application filed therewith. Sworn to before me this ........... I.g. ......... Un ~RY PUBLIC, Stat(~ of New York · . . ~tm t~xp~res March 30, 19~ ' ' '1