Loading...
HomeMy WebLinkAbout1934-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No: Z-30045 Date: 02/26/04 THIS CERTIFIES that the building NEW DWELLING Location of Property: 1155 MARYS RD MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map NO. 473889 Section 139 Block 4 Lot 12.1 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 5, 1962 pursuant to which Building Permit No. 1934-Z dated NOVEMBER 9, 1962 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 CONFORMING ONE FAMILY DWELLING WITH SCREENED PORCH. THIS CERTIFICATE OF OCCUPANCY UPDATES CO #Z-2008 DATED 10/28/64. The certificate is issued to EDWARD & ALTHEA SIDOR TRUSTEES (OWNER) of the aforesaid building. ~u~FOLK COUNT"f DEPARTMENT OF }IF~kLTH APPROVAL EL~-I~ICAL CERTIFICATHNO. PLL~WBERS CERTIFICATION DA'r~o N/A ~t ~ z/ed~ignature' Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 1934' Z Dote .............. ~'O.~.~lll]:H~.....9 ................. 1~ .... Permission is hereby granted to: Jot~.. ~ ~.~o,z- ....................................................... .......... i~t.t.t.tuek ................................................ to Mo.v~. · ~n...ez~ ~t .~mg.. ~w® t.1.~ · ....to .. ¢~ni.s...t-o~a~:~ on .................................................... at premises located at ..(~l,~..I,~.~.gth$...~O~C~...3.3..&..3~, ......................................................... ................................. · ~a~.y.~.s.. ~oad.. &..CP~?..ex. te~t~t, on ........................................................... ....................................................... 14~t.t ~.l~uck .................................................................................... pursuant to application dated ............................. ]~O~ml~'""~ ......... 1~r$)...., and approved 5y the Building Inspector Fee FOH~ NO. A TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~..~,.0. g.~. ............. Date .................. .0e.toher.....2B ........... , 19.6~.. ! THIS CERTIFIES that the building located at ~8~!~...~..~0~C1...~:..~A ............................. Street M a~rden Heigth~, , ap I'~O ....................... alack No...,7,3~ .............. Lot No..~,'~..~..3.~., ....... ~'~t.t~l ~IC,~[.f2J,.~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................................ ~P.V.f~...~ 19~2,... pursuant to which Building Permit No...~,.C)..~...~ dated ........................... J~.O.~.~...~ ............... , 19.(~.., was issued~ and conforms to'lief the requirements local . of the applicable provisions aide law. The occupancy for which this certificate is issued is ........ ..... ~ iv. ~..t...o... ~.~...~. ~..mJ,..~y....~.e. J,.! $~ ................................ The certificate is issued to ....',TP~..~.i..d..~.~. ......................................... .O.~..e.~ .................................... (owner, lessee or tenam) of the aforesaid building. Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must befilled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate iocation of all buildings, property lines, streets, and tmusual natural or ropo~:aphic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 formL 3. A~pproval c~f'electfical installation fi:om Board of Fire Underwriters. 4. S~vom sta~emeg~mgplmnber certifying that the solder used ia syste...m,, contains less than 2/10 of 1% lead. 5. commere~ brocading, industriai building, multiple residences and simiiar buildings and inst allafions, a certificate of Code Compliance from archit .eet or engineer responsible for the building 6. Submit Planning. Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '~pre-existing" land uses · Accurate survey ofproperty showing all property lines, streets, building and unusual natural or topographic features. 2. & properly completed application and consent to inspect signed by the applicant If a Certificate of Occupancy is darned, the Bmlding Inspector shall state the reasons therefor m wntmg to the apphcant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25~90, Swirmmng pool $25.06. Accessory building $25.00. Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing ¢,;[lding - $100.00 3. Copy of Certificate of Occupancy - $.25/ 4. Updated Certificate of Occupancy - $59.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date· New Construction: Location of Property: House No. t,] Street Owner or Owners of Property: Suffolk Coumy Tax Map No 1000, Section Subdivision er tNo. } h:5¥ Health Dept. Approval: Plarming Board Approval: Old or Pre-existing Building: Date 6TPermiu Block Flied Map. Applicant: (check one/ Hamlet Lot Lot: Under~vriters Approval: Request for: Temporary Certificate Fee Submitted: $ ~-'~(D ~ Final Certificate: ~ I check one) Applicant Signature BUILDING DEPARTMENT FOR THE TOWN OF SOUTHOLD COUNTY OF SUFFOLK, STATE OF NEW YORK In the Matter of the Application of EDWARD SIDOR and ALTI-IBA SIDOR for a determinatio~ under and pursuant to Section 100~25(E) oflhe Code of the Town of Sou~old :witl~regard to SCTM 1000 - t3~.00~- ~Oq-.O0 - 012~00I. STATE OF NEW YORK ) .COUNTY OF SUFFOLK ) Affidavit EDWARD SIDOR, being duly sworn, 'deposes and says: My wife, ALTHEA SIDOR, and I own certain property in Mattimck known as 1155 Mary's Road, Mattituck, SCTM 1000/139.00/04.00/012.001, I submit this affidavit in support of my application for a written determination from the Building Deparunent in accordance with Section 100-25(E) of the Southold Town Code that my property ~s exempt from the merger provisions of the Code under section 100-25(C)(5) winch provides a lot is exempt if it is developed with an 850 square foot house for which a Cextificate of Occupancy has been issued. The property for which the written determination is sought is known as 1155 Mary's Road. Mattituck, New York. It is also identified as Suffolk County Tax Map Number 1000- 139.00 - 04.00 - 012,001, and is shown as Lots 33 and 34 on the fried subdivision map known as Map of Garden Heights, hereinafter the "premises". The main purpose of this affidavit is to state that the foot print of the small residence which is located upon the premises has not been changed since the small residence was moved in the early t960s ib it's preggfi{ 16~h~f~dfi. i ha~e per§onal knowledge of this fact because I was acquainted with the size of the small residence when my father purchased it fromthe County in connection with the witt~ning of Route 48~ After the purchase, my father had the structure moved to it's present location. An issue has been. raised by The Southold Town Building Deparanent as to whether the exemption applies because a 170 square foot portion of the small residence is listed on a line of the Southold Town Property Record Card entitled "EXTENSION". I do not know why a 170 square foot area of the premises is listed as an "extension" but I do know there has been no extension to the small residence since my father purchased it from the County and moved it to its present locatiom From the time my father had the structure moved, which pre-dates the issuance of the Certificate of Occupancy for the structure, there has been no construction that increased the footprint of the small residence. The 10' by 17' area in the rear of the building is the kitchen and bathroom area and was there at the tune the structure was moved. I suggest the 170 square foot portion was listed on the "extension" line of the Southold Town Property Record Card because the Assessor was calculating the assessment on the premises and categorized the 170 square footage area differently than the remainder of the 728 square footage of the small residence and not because it was an extension. This is borne out by the fact that a different assessment multiple was applied to the 170 square feet, i.e., a multiple of "1", while a multiple of "2.75" was applied to the remaining 728 square feet of the structure. I reiterate that the portion of the strncmre that is 17' by 10' was part of the structure prior to it being moved. 8. [ give my permission to the Southold TOW~ Building Department to inspect the premises upon reasonable notice. WI-IYeI~F, ORE, the Building Departrnent should give me a written determination in accordance with secdo~ 100-25(E) of~ the Code of the Town of Southold stating that the premises are benefitted by an exemption to the merger provisions of the Code and specifically the exemption pmvid~ed for ~ section 100-25(C)(5). Sworn to before me this Not ¥ub c.X' if ~ FLATLY EDWARD SIDOR , Form No. 6 TOWN OF SOUTH]OLD ""--].. ---. BUILDING DEPARTMENT /.[ ' TOWN HALL -. /~ 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY~ This application must be filled in by typewriter or ink and submitted to the Building Department with the A. For new building or new use: 1. Final survey of property with accurate location of all bu/ldings, property lines, streets, and unusual ~aamral or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. ApprovaI. of electrical installation from Board o£ Fire Underwrit ers. 4. Sworn statement from pl ~mx~ber eerti~ing that the solder used in system comains iess th~n 2/10 o.f 1% lead.. 5. CommCrcial~build~,~ g, iadgstr~al building, multiple residence~ and sin~.lar buildings and installatmns, a certificate oF Code ~llange fi'om~ architect or en~eCr responsible for the building. 6. Submit P~ng B~oard Approval of completed site plan requirements. B. For existing b~ngs (prior to April 9, ~957) non-conforming uses, or buildings and "pre-existing" land uses: l Accura~ SuC~ey o~roperty showhng all pr~>perty lines, streets, building and lmusual natm'al or topographic features. 2. A properly c9~leted application and cOnsent to inspect si~ed by the applicant. If a Certificate of Occupancy is de~l, tt~e ~kilddng Inspector shall state the reasons therefor in writing to the applicant C. Fees 1. Certificate o£ Oeeupancy -~New~dwelling $25-00, Additions t° dwelling$25-00, Alterati°ns t° dwelling $25'00' Swimming pool $25.00, ~cccss~ bnilding $25.00, Additions to accessory building $25.00. Businesses $50.00. e Cerfificate of Ocenpancy on Pr~-exis(ing Building - $100.00 rtifkc~te of~Qcca:~acy - $,~ 44~]ff Upd~a,t.e_~.dr~CCertificat e of Oeeupancy - $50.00 5. !i'en]~o}aryCertificate of c-cup ' ,'y- R-esqd~iaI $15.00. Commercial f 15.00 New Constraction: Location of Property: House No. Old or Pre-existing Building: Street (check one) Hamlet Owner or Owners of Property: ~ r~Wti~d Suffolk County Tax Map No 10013, Section t ~ ~ ~ ID 0 Block bdi, sio Xgkt* - Filed ap. PermitNo. ~5~ ~- DateofPermit. ~O~f, ~,l~/~.Applicant: Health Dept. Approval: Undenvriters Approval: Planning Board Approval: Request for: Temporary Cert/ficate Fee Submitted: $ Final Certificate: t/ (check one) Applicant Signature CONSENT TO INSPECTION ~ct~K(~ 4 ~5~ ~4~J~-~ ~0-~ ., the undersigned, do(es) hereby state: Owner(s) Nme(s) ~at ~e ~dersi~ed ~is) (me) the owner(s) of ~e prmises ~ &e Town of Sou~ol~ located at [[~ ~&t~s ~, ~a~ , which is shown ~d d~ated on ~e Suffolk C~ T~ Map as D~ct 1000, Section ~q, Blo& ~ ,Lot [2~ { That ~e ~dersi~ed ~as) Cave) filed~ or cause to be ~e& ~ application ~ ~e Sou~old Tom Bu~l~ng ~pector's Office for ~e follow,g: That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including i?~i3ections to determ'me that said premises comply with all of the taws~ ordinances, mle~and regulations of the Town of Southold. The undersigned, m consenting to such inspections, do(es) so w/th the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, roles or regulations of the Town of Southold. Dated: · (Signature) . (Print,Nme) (Signature) (Print Name) ~ 11901-0203 Phone: 63Z-727-7760 Fax.' 631-727-7818 LandAmerica Title No.: RH80031189 Applicant: KEEGAN & KEEGAN~ LLP Order Type: I~formational CONFIRMATION Sales Rep: House Account Date of Application: MAY 21, 2003 Other 0~ DANIEL ~;:~ ROSS, Esq. KEG ~,~ "t~. KEEGAN, LLP H~T'flTU;CK, Ny 1~952 63~-2c~g;I.200 ]:ax 631-298-4427 Other TOWN:OF SOUTHOLD 0FEICe~FTOWN AI-FORNEY $3095 MAIN BOX 1179 SOUTHOLD NY 11971 631-755~,1889 Fax 631-765-t823 ROAD - P.O. Record Owner (per applicant): EDWARD SIDOR and ALTHEA SIDOR Premises: 1155 MARY'S AVENUE, MA)litOCK, NY 11952 Dis~ict: 1000 Section: 139.00 Block: 04.00 Lot: 012.001 County: SUFFOLK T/O: SOUTHOLD TRANSAt; m ION: SINGLE & SEPARATE SEARCH Survey Instructions: NONE Additional Searches Ordered: NONE WE ARE PLEASED TO CONFIRM YOUR APPLICATION FOR TITLE EXAMINATION AND INSURANCE. THE EXAMINATION IS NOW IN PROGRESS. PLEASE CALL US W~I'H ANY SPECIAL INSTRUc i ~ONS OR IF ANY CORRECTIONS SHOULD BE MADE IN THE INFORMATION DETAILED HEREIN. THANK YOU. IF THIS IS A REFINANCE WITHIN TEN (10) YEARS~ YOU MAY BE ENTITLED TO A REDUCED PREMIUM. CONTACT THIS COMPANY IMMEDIATELY FOR DETAILS. Confirmation Title No~: ApPl!~nt: AppllCafit #: RH80031!89 TOWN OF SOUTHOLD ~0000743 ~,$,$-~RY'S AVENU~ taA~ :,,, UC~ NY EDWARD SZDOR and A~.THEA SZD6R Date Printed: Order Type: sales ReP: CoUNtY:' Closer.. FEE SHEET 3une 5~ 2003 znfOrmational House Account SUFFOLK , AMOUNT Fire NYS Transfer Tax $ $ suYer/Selfer $ pAYABLE: TO :OTHER THAN CommO~alth ~nd Title zhS,rrPnce company (Circle One) ~Yer/Se]~er : $ _ B~yer/Set ret : $ T~AL REC~PTS $ *NOTE Ra~es & charges herein are subject to change ;based on the rates Jn effect at the ~ime of closing. 185 Old Country ROad, PO Box 419 Suite 2 Rlverhead~ NY I1901~0203 ~Commonwealth Land Title Insurance Company J185 Old Country Road, PO BOx 419 ' JRiverhead~ NY 11901-0203 lPhone: 631-727-7760 Fax: 631-727-7818 FiYe No.: RH80031189 S [NGLE AND SEPARATE SEARCH Effective Date: 04/20/2.003 Title No. RH80031189 Commonwealth Land Title Tnsurance Company DOES HEREBY CERT'~FY TO: DANZEL C. ROSS, Esq. KEEGAN & KEEGAN~ LLP PO BOX 146 f4AT'TZTUCKr NY 11952 THAT it has caused a search to be made in the Office of the Clerk of the County of SUFFOLK, in the State of New York, against the premises described here!n and property ~djacent thereto on all sides from 01/01/1962 to date to ascertain the fee chain of title respecting the premiss described'herein and the property adjacent thereto and has found only the returns as set forth herein on the following pages as they bear on record title; and Certifies that the owners of the premises described herein have owned the same in single and separate ownership as defined by law during this period Of time, except as otherwise shown herein. This Company's liability is limited to One Thousand ($1,000.00) Dollars. NO policy of insurance is to be issued hereunder. Premises: 1155 MARY'S AVENUE, t4A;i'Tl'rUCl~ NY 11952 District: 1000 Section: 139.00 Block: 04.00 Lot: 012.001 County: SUFFOLK T/O-' SOUTHOLD Commonwealth Land Title Insurance Company -Title Number: RH80031189 Dated: 06/05/2003 Single and Separate Search TQ20015NY (07/00) File NO.: RH80031189 CHAIN OF I~TLE FOR SUB3ECT PREMISES: District: 1000 Section: 139.00 Block: 04,00 Lot: 'MAP DEVELOPER: NOTE: L, BARRON HILL& GEORGE C. TERRY. GEORGE C. TERRY DIED 10/26/1950 LEAVTNG ALLTO HIS WIFE HEDV[G P. HILL. (SUFFOLK COUNTY SURROGATE'S FILE #674P1950). L. Barton Hill & Adelaide H. Hill, his wife & HedVig P. Terry to John Sidor (NOTE: Conveyed Tax Lot 012.001 and addiUonal property). dated 11/02/1962 recoCded 11/20/1~62 Liber5267page 46 .lohn Sidor a/k/a John Sidor, Sr. ~ial property)' EdWard Sidor dated 05/21/1979 recorded 06/11/t979 Liber 8639 page 218 dated 06/05/1987 recorded 06/22/1987 Liber 10346 page 200 Edward Sidor to Edward Sidor & Althea Sidor, Trustees of the Edward Sidor Revocable Trust (dated 01/08/1998) dated 01/08/1998 recorded 02/09/t998 Liber 11877page 420 STATE OF NEW YORK ) )SS: COUNTY OF SUFFOLK ) ROBERT GAFFGA, being duly sworn, deposes and says: That he is an Officer of Commonwealth Land Title Insurance Company, That the above is a true Chain of Title of the subjec~ premises as shown on the variance search under the above capUoned title number. Commonwealth Land Title Insu.[rance Company V~CE PRESIDENT Single and Separate Search Subscribed and Sworn to this 5th day of June, 2003. Notary Public CATHARINEJ~.KING -- N0t~y Public. State of New Yor[< No. 01 .KI4844860 ~t~r~'md in Suffolk Commissi0~ F. xpires Dec. 31, . . Fi}e No.: RH80031189 CHA[N OF T~TLE FOR PREM[SES AD3ACENT NORTH: District: 1000 Section: 139.O0 Block: 04.00 Lot: 0~2.002 MAP DEVELOPER: L. BARRON H:ILL 8~ GEORGE C. TERRY. NOTE: GEORGE¢. TERRY DIED ; ALL TO HIS WIFE HEDVT_G P. HILL. FtLE #674P1950), L. Barton Hill &Adelaide H. Hill; his wife & Hedvig P. Terry to .1oh n Sid or ~NOTE: Conveyed Tax Lot 0~2.002 and additional property). dated 09/04/1965 recorded 09/15/1965 L bet 5820 page 578 ]ohn Sidor a/t~/a ,John Sidor, Sr. to a/Edward (NOTE: Conveyed Tax~L~o~(~.002 and additional property). ~/' Edward Sidor& Althea Sidor,'h,s wi:' 'f~ _=dward Sidor & Althea Sidor, his wife (NOTE: Conveyed Tax Lot 01Z.002 and additional property). dated05/21/1979 recorded06/11/1979 Liber 8639 page 218 dated 06/05/987 / recorded 06/22/1987 Liber 10346 page 195 Edward Sidor & Althea Sidor, his wife to Althea Sidor B, Edward Sidor, Trustees of the Althea Sidor Revocable Trust (dated 01/08/1998) dated 01/08/1998 recorded 02/09/1998 Liber 11877 page 42! Commonwealth Land Title !ns~Trance Company · VZCE PRES/DENT~ ' ~' ~ Single and Separate Search Subscribed and Sworn to this 5m day 0f 3une, 2003. Notary Public CATHARINEJ KIN~ ~ua~lied in S,atfolk CounN __ ~- Commis.~on Expires Dec. 31, '~'O.CD..--~.~.~.~.~.~.~-~ CHAZN OF T~[TLE FOR PREI~IZSES ADIACENT WEST: District: IOOB Section: 139,00 Block: 04.00 Lot: D10.000 File No.: RH80031189 MAP DEVELOPER4 NOTE: L. BARRON H;[LL &GEORGE C, TERRY. GEORGE C. TERRY DIED 10/26/1950 LEAVING ALL TO HIS WIFE HEDVIG P. HILL. (SUFFOLK COUN'Pf SURROGATE'S FZLE #674P:L950). L. Barton Hill & Adelaide H. Hi[i, his wife & HedvJg P. Terry to 3ohn Sidor (NOTE: Tax Lot 010.000 and additional property). dated 11/02./1962 recorded 1t/20/1962 Liber 5267 page 46 John Sidor to Edward Sidor dated 12/05/1962 recorded 04/29/1963 Uber 5339 page 399 Edward Sidor to Edward Sidor & Althea Sidor, his wife dated 01/13/1956 recorded 01/14/1966 Liber 5894 page 443 Edward Sidor & Althea Sidor, his wife to .lohn Henry Ship & ]oanne Grohoski, 3oint Tenants dated 04/01/1971 recorded 04/05/1971 Liber 6909 page 398 Single and Separate Search Subscribed and Sworn to this 5~h day of.lune, 2003· ~f~HARINE J KING Notary u ~.p. · ~ta~ ubli~ State of New York No. 01-KN~4660 Quailed in Suffolk County Commiss~ Ex~$ De~. 3~, CO File No.: CHA'rN OF TZTLE FOR PREf41'SES AD3ACENT SOUTH: C. R. 2.'7 (NORTH ROAD) this 5t~ day of .lune, 2003. v'rcE PRESZDENT ry I¢~RARiNEj' KING Notay Pdali¢, State of New York Single and Separate Search No. OI-KI484~60 Qualified In Suffolk Count,/ Commbsio~ Expires Dec. 31, ..~.~) File No.: RH80031~/89 CHATN OF TTTLE FOR PREMISES AD3ACENT EAST: ST. MARY'S AVENUE STATE OF NEW YORK ) )SS: COUNTY OF SUFFOLK ) ROBERT GAFFGA, being duly sworn, deposes and says: That he is an Officer of Commonwealth Land. Title Tnsurance Company, That the above are true Chains of Title of the adjoining premises as shown on the records of the Clerk of the County of Suffolk and the Variance search under the above captioned title number, Commonw/~a~d Title Z~rance Company ROBERT GAFFGA / ~///~'/ / V/CE PRES'rDENT ~" ~ Single and Separate Search Subscribed and Sworn to this 5th day of 3une, 2003. Notary PubIicCATHARINEJ. KING ~iolay Pu~ sta~e of New york No. 01~4844~60 Qualified in Suffotk Counly Comm/ssi0n Expires Dec. 81, .~_._~-~ JOHN C. EHLERS LAND SURVEYOR N JOHN C. EHLERS LAND SURVEYOR TOWN CJF SOUTHOLD BFFIBE BF BUILDINE] INEiPECTnR TE3WIX4 BLERK'~ BFFIE;E SDUTHDLD, N. Y. Mr. }[. F.Bishop Commissioner of Public Works Suffolk County Yophonk Ave., Yophank, N. Y. Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Laws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that .J~%...~TO~..~;J~O~.. has applied to the Town of Southold for a permit to construct a building o, .Ba~.3r. !. s...Ro.a &..&..C ~.uut ~z.. A d..~.?. ,...M~,~ .¢~ ~mal~... 1:[. o. Z, .......... as shown on the attached plot plan, submitted in triplicate, dated ................ We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 2391(. Building Inspector Town of Southold, N. Y. Mettituck TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Bxam,ned ............ 1 ..5 ........ , Approved .......... /...~.,. ,~........'~ .......... , ' /~ '~ 19 ........ Permit No .............................. ............. ............ ......... ............ ............. i"~i:'"-'"~'i;;;'~';~;';li ......................... App'icotion Flo ..... .......... APPLICATION FOR BUILDING PERMIT ~ote .............. .~.°...v.?.~he.~.....~ ........... , ,9~.... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relmJonship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this applica- tion. c. The work covered by this application m~y not be commenced before issuance of Building Permit. d. Upon opprovat of this application, the Building Inspector will issue a Building Permit to the applicont. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or Jn pa ri' for any purpose whatever until o 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, Flew York, and other applicable Laws, Ordinances or Regulations for the construction oF buildings, additions, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ~Toh~ ~'±dor (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, ' ' ~ arcn~te~t, engineer, general contractor, electrician, pbmber or builder. Owner Name of owner of premises .......... John,.. .......... Sldor, ........... , ................ ................................................................................................ If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ..... ..~..~.?...d.?.,..~....,~.,%.,,S. .......... Lot No.: ..... ,~.,3..~..~..~. ..... Street and Number ~ar~.!~ ~Od~ ~ ~.O~Z~. ~¢C~ 2~ ~f~..~.~'J.J~g.¢]~ ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ..... .Y..fkq~,~r,V~..~kQJ~.8 ................................................................................................ b. Intended use and occupancy One fami.l..y, dwe]liD~ 3. Nature of work (check which applicable): New Building .................... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........ ..~.~..i..]:C]iiQ~ moYec] 4. Estimated Cost ...~.Q.0...~./..~ .......................................... Fee 10,00 11'1 (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 occupancy, specify nature .and extent of each type of use .................................... 7. Dimensions of existing structures, if any: Front ....~.~. ................... Rear ......... .bc~. .............. Depth ..,~ ....................... Height Number of Stories OZle Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ................................ Height ................................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .............................. Rear .............................. Depth .............................. Height .............................. Number of Stories .............................. 9, Size of lot: Front ..... ~L.0.Q ................. Rear ............ 1.0.0 ............... Depth ......... .~E~.~'. ............. 10. Date of Purchase ................ .~.~..~.~. ................................. Na'me of Former Owner ....... ~.~.~.~'.IE...~..~]~ .................... 11. Zone or use district in which premises are situated....!~..~.!!....d....1.~..t. .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............... .~.Q ...................................... 13. Name of Owner of premises ..... ,~.g~t...~.;:!,.~O~ .......... Address ................................................ Phone No ................... Name of Architect ~ .................................................... Address ................................................ Phone N~ ................... Name of Contractor .....~,~t...~o.~.e.~..B ................... Address ~.~!q.~..~O~ ....... Phone No .................. PLOT DIAGRAM Locate Elearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description .according to deed, and show street names and indicate whetFler interior or corner lot. COUNTY OF ...tl....~.O.l~ ........... ) S.S. .............................. ~1~...~;I,C1.~ .......................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ........ .Q~fl~ ...................................................................................................................................... (Contractor, agent, corporate officer, etc.) of sakJ owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applicaHon; that all statements contained in this application are true to the best of his knowledge a.nd 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 ............. ~.O~e~ ......... ~9..~. ~/~ ~ ~ ~ k,_t_r_ h--kl:~ ~_ ' _ ~J~. _1. ~ Puulic', qti~t~,v..~'r~"'"~'~"'~: ..... ~ ............. :'=~ ..........................