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~"'"~'~"'~: ..... ~ ............. :'=~ ..........................