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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 AUTHORIZED)
pr q
NO ~ 8 J 4 4 Z Date .....q.~:~7 19.V.l.
Permission is her~e~by ~gra ed to•
..................................................................c~.,./...~~..} .........................IUU/................................................
at premises located at ...~.el..~d ~........rQ.l~...~i!r'L
County Tax Map No. 1000 Section .4..~. Block yyL~~ot No .....-3.
' pursuant to application doted /i 19.~l.,, and approved by the
Bwiding Inspector.
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Fee ~.,,fclt..
Gs.~~~~`~ ...~...~rt,,,............ .
Buil nspectdr
Rev 6/30/80
THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 3
s 1~nOi143a BUREAU OF ELECTRICITY
i 8S JOHN STREET, MEW YORK, NEW YORK 10038
Date DECEMBER 11, ] 991 Applicotion No. on file 6+175490/90 T 007 865
THIS CERTIFIES THAT ~ ;
i
only the el~ctricol equipment v deeerihed bebso and introduced by Ch/ oppl featst rwmed an the ohooe apptit~tion number in thepremisea of
RANK MC.GIIIRE, 280tl BRIDGE LA., PL,12, PECONIC, N,Y.
in the fdbtcinR bcation; ? Boaement ? lxt Fl. ? Ynd Fl. OU I Sertian Block Lot
woxr:aminedan DECEMBER A4,3.991
and found to he in compliance rcith the reyuiremenG uJ thie Buard.
NXTUR! RXTURES RANOEf COOKING DECKS OVENS pSN WASNBS EXHAUST TANS
s ~T~S ACtJEt SYVITCINS INUNDESCEM /1Ua11ESCENT OTHER AMT. t. W. AMi. N. W. AMi. R.W. AMT. R.W. AMT. N. P.
1
DRYBK RJRNACE MOTORS R/TURE AtMl1ANCE IgDERS KlKIM REL"?i 71ME ClOCKE EELL UNIT HEATERS MY[i40UilET pIMMEES E~
AMi. R. W. pl N, P. GAS N. P. xllt. NO. A. W, G. AMT. AMP. AMT. AMPS. TRANS. AMT. M. P. ~
~ AMT. WAT15 E'
SERVICE DISCONNlCT NO.OF S E R V I C E
AMT. AMP. 11PE ~ I / tW I 1 SW 71 SW 71 AW NO.OF C. CWID. A. w. G. NO. GP N4lEG A. W. G. NO, f/ NEUTEAI!i A. W. G.
y$~ NI/ CC.C Of NFVG a NEIIIxAI
t
£ OIIIER AMARATUS:
DLC P.P-1
A(BI(,L ONLY) This is not a
Certificate. This is a Bill
for Services Rendered Only.
J~
RiLARY N. NOLLRARN & SONS LIC.µ75b2
1A2-5 CARLETON AVE.
ISLIP TERR., NY, 11751 Owgu MANAp~
33
Per
This certificate must out be altered in any manner; return to 1M office of 1FIa (bard if incorrect. Inspectors. may ba ideotifiid by flair credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE'MUST NOT 8&ALTERED IN ANY MANNER.
_ r
i
BOARD OF HEALTH
3 SETS OF PL.\NS
FORM NO.1 SURVEY .
TOWN OF SOUTHOLD CkECh t~.-'b': 1971 - .
BUILDING DEPARTMENT SEPTIC FORS!
' TOWN HALL
~OUTHOLD, N Y 11971 NOTIFY
TEL..7G51802 CALL ..........~r.n..•.~.y.,....
,,pp MAIL T 0 : ~/tiM+ PL p rv.- XJU.u~.z.
E~antincd . g. 19 l/,% ___ff~~~y7t)~ c~¢~ sd- '
Approved ..~,lzr! 19~ Permit No. f~;~~5,~ O IS ~ L5 ~ U
Duapprovedalc D
~ 2 fi 1988
~~:i.P ~ ~~,~/L~ ~~bly7~. ~ TOWN OF
SOUTHOLD
FEE'~SY'PAAT ~f ~/uddm^ nspector
NOTIFY BUILDING DE A7APPLICATION F R BUILDING PERMIT
766-1802 8 AM lO 4 PM FOR THE G
FOLLOWING INSPECTIONS. Date ~ V.°~. 15C
T. FOUNDATION TWO REQUIRED
FOR POURED CONCRETE INSTRUCTIONS
2 ROUGH -FRAMING & PLUMBING
IN2°14~5~9ation must be coin letely filled m by typewriter or jn ink and submitted to the Building Inspector, witE
setsArilF aecu~@I~7~1~1~ Fee according to schedule.
b. ~'l~~ Pa~"s~oFi ~;Cl~auon of~lot and of buildings on premises, relationship to adlommg premises or public stre
or s,pEQ ~N Yon of layout of property must be drawn on the diagram which is part of this aPl
cab ~ T , I
D n may not be commenced before issuance of Building Permit.
o n, the Building Inspector will issued a Building Permit to the applicant. Such pen
shaft' mspechon throughout the work.
e.76>So1~98c~rigtS{i~U,y p~tl-p};Etised m whole or m part for any purpose whatever until a Certificate of Occupan
shall IFp~LlQbwu>~'i~il,SilEDi'1(}!6$uildmg Inspector.
AYP ~~~~~o the Building Department for the issuance of a Building Permit pursuant to t
Build g r ~ ~plv,Fl~,o~ Southold, Suffolk County, New York, and other applicable Laivs, Ordinances
ReguL~Ii~,;ts„ rry ti BB'~f°06644`~! dings, additions or alterations, or for removal or demohtron, as herein descnb•_
The a~ip~"~ctl^an`L age Otp~~R~,y
with a 1 applicable laws, ordinances, building code, housing code, and regulations, and
admit a 'ry7 1Cj,'~}i'~i~~~nd m building for necessary mspectrons.
ALL CONSTRUCTION SHALL MEET ~a,~.~ ~:r: ~cr. ci,~,.5. S.r.~vrti5 .
THE REQUIREMENTS OF THE N Y (Signatu~ of apphcant, o~ame, if a corporation)
STATE CONSTRUCTION & ENERGY !
CODES NOT RESPONSIBLE FOR p~ ~rrl~':i~o~.d..Wx? 1 ~ 7 1..
uFSIGN OR CONSTRUCTION ERRORS (Dtailmg address of appbcant)
State((w~hether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build.:
Name of owner of Premises ..........~r:4S~.lri..1 ,.1.G S~I~.T.'CP?
(as on the tax roll or latest deed)
IC appbcant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. JY. ~p ....~.aCzQ. ~ .
Plumber's License No .
Electrician's License No .
Other Trade's License No . .
1. Location of land on which proposed work will be done , , , , • , , , , , , , , , . , •
'~j }
House Number Street JJJ • ~ ~ • ~ •
Hamlet
County T.i~ \1ap No 1000 SeCtlOn • • • • • Block . ~ , , , , , • , _ , Lot .
Subdivision Filed \fap No Lot .
...(Name)
State existing use and occupancy of premises and intended use .Ind occupancy ofrproposed cons[nichon
a. Existing use and occupancy Q .lj' `z •''1 • • ,r, i ~~.-z
: t ~-e~ • • of n cE ..:FT.a>:+:T.. ~s t'.4G„~.......... .
b Intended use and occupancy G ~ a•~' • t n. r 1~~'~• S t •e\,•~. a. JJJ~ r Q n~~, ~ n.~ ~~G i n~.
3. Nature of work (check whtch appltcablej. New E3utldtng AddRtcn Alterat~i-o-?~ .
Repazr Removal Demohuon . Other }Nock .'T~ n.~ ~
(Dcscnpito
4. Esumatcd Cast ~ ~ . d O .Q . Fee ..aZ < Q.A...... .
(to 6e patd on filing thts apphcauon)
5. If dwelhn„ number of dwclhng units Number of dwelling units on each floor .
If garage.numbcrofcars
6 If business, commercial or mteed occupancy, specify nature and cYtent of each type of use .
7. Dimensions of c~ctsting structures, tt any Front . Rear Depth , .
Ilet~ltt . Number of Stones .
Dimensions of same structure with alterations or additions Front Rear .
Depth .....p~s ;..,i.,....... Iictght Number of Stones .
g, Dimensions oFdYltt're new construction. Front . Rear d'•-'r!~:yy.~rDLtaitH .
Hetglit ...............Number of Stones .
~ ...f _ .
. . . . .
, _
9. Size of lot. Front Rear "
Dcpt
10. Date of Purchase ..........Name of Former Own_~;_ , ;
.
l 1. Zone or use district m which premtses are situated . ' ` ' ' "
12. Does proposed construction violate any zoning law, ordinance or regulauon~ ~ .
13. 1Vil1 lot be regraded will excess fill be removed from premtses. Yes
14. Name of Owner of premtses ..............Address , ~'I7one Na.... .
Name of Architect ..Address ..Phone No.......:.. .
Name ofContractoS¢ev.r,rr. ~~v,<.e...~ySTeo,~Address~4~4$S.S.~csi.-?w.~caPhoneNo.'~~.~.o2oRC~
lS.Is this property lo~ed withi-e1~00 feet of a tidal wetland? *Y>;5....NO?'C'.
*If yes, Southold Town Trustees Permit may he required.
PLOT DIAGRAh1
Locate clearly and distinctly all buildings, whether exuttng or proposed, and indicate all set-back dimensions fr
property fines. Give street and block number or descnptton according to deed, and show str~et names and indicate whet
intenor or cornea 1~~
,E~ ~0 1 0~ SI?f ~oo-r
_ f ~ ro~v~ wiry
L3~~h ( li~u5~-
l ~-rC,,,c ~c~ -to
Y+OT G tar q ~rof~tr~7'.
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sib _ _ _ ` 0 3 , -r .~:-t h-¢-a.C.-.
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rS~ cp d qv' S'.I.OC~i4a~~. ~G'7'c+ 1 G~,p P (`o~~l+v1~"e h
O h Q. ~ u ((h~t,,fL11 (r` L11~1 ~ O t^-t' 1~
17 Y1~ J J J
STATL OF NE1V YORK, S S
COUNTY OF . .
. , being duty sworn, deposes and says that lie is the applic:
(Name of individual signing contract)
above named
flctstlte
(Contractor, agent, corporate officer, eic.)
of said owner or owners, and is duly .mthonzed to perform or have performed the said wort. and to make and file t
apphcauon, that all statements contautcd to this apphc~tton arc taste to the best of his l.nowledge and bchef, and that
work will be perforated in the manner sei forth to the apphcauon filed thertavtth.
Sworn to before me this
a~... .day of 19~1.J~.
~ D-~
Notary Public, ~ County
ppplKOEYOE (Si;nature of applica
~NO~.
4T4~7S7& Sult~elkOeMlist
Tetra Exptes Merch 30, l r