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Home My WebLink About8264-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupency No. ~.~.0. ] .1 ...... Date ............... .l~!a.y .... 6. .... , j _ .. N/S Barlow Pond THIS CERTIFIES that the building located at . .S./.S...P.r.~.v.a..~.e..~ .o.a.a. ....... Street Map No. F.., .l...$. s.t. .... Block No...31. ...... Lot No..13 ........ F.i..s.h.e.r.s...I.s.l.a..n.d.....~...Y, conforms substantially to the Application for Building Permit heretofore filed in this office dated ............Oct...1 ..., 19.7~. pursuant to which Building Permit No..8.2.6..~.Z.. dated .........Dnt.. 27 ....., 197~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Private..gero, ge.. Md. ~.c.Q~$$QT~..$y0?.a.g .e..b.u. ~ .l.d%.n.g ............... The certificate is issued to .M.r..s..G. qr..dg.n' .~i.m'. ~.h. lr ..... . .(~..e.r. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... N.,.R.; ............................ UNDERWRITERS CERTIFICATE No. ~ ;.R., ........................................ HOUSE NUMBER ...n. gT~.e ....... Street .......................................... Building Inspector ~O~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING I:ERMIT ~HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? $26 Z Permission is 'hereby granted to: ................ F~. et~e~ ...I.~.l. ar~ .............................. m. &~ A*. -aeee s~'....ga~age.- ~-' 's ~,ora~e" tr~L~d~ $ ................................................... ................................................... 2~..~..3~/~..~ar.~o~.., ~ ......... .~.~ ..................................... pursuant to application dated ....................... L).C..~,.....1 ................... , 19..~..~.., and approved by the Building Inspector. Fee $..$0,,(}~ .......... FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~I ............... , 19. .. Approved ........................................ , Disapproved a/c ................ (IB'uilding Inspector) APPLICATION FOR BUILDING PERMIT Date .............. .9¢.~.9..b.9.~.....1. .............. 19.7..5. ....... 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¢o adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drown on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building }nspector will issue a 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 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, 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. ... ~,..~ohn..Gada..Gener~l..fianE~aC~ng ~..I~., ................. (Signature of applicant, or name, if a corporation) Drawer B Fishers Island, New York 06390 (~ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................ .Gen~ra.1,..gon.t.rac.to~c. ............................................................................................................. Name of owner of premises ................... ~J.vg.e..~g.¥.~l.o..r~...H..~.tc~.hg ............................................................................................. If applicant i.s c]/corporate, signature of duly authorized officer. .............. ii'&'"J("Jd j:J ¥fi'd'Ji ......... Builder's License No ..................................................... Plumber's License No ...... .~.~.~ ..................................... Electrician's License No ...... 22.§n..~ ........................... Other Trade's License No ...... 2.~.1[.~.~.~ ............................. BIock ]. Location of land on which proposed work will be done. ~ No.: ............. 3.1 ....................... Lot No ......... 1.$ ............. Street and Number ..... ~,.v.~.t..e....R..o..~.,...F..,%Tk.~.¥.~.~......~',i,.$~.e.t;~S .[.$J.~.~ ................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~i~i~:J.~l ..................................................................................................... b. Intended use and occupancy Residential 3. Nature of work (check which applicable): New BuiJding'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .........~E.e. ............................... (Description) 4. Estimated Cost ........... 3. , .2. .4. .0. ~ 9, .0. ................................. Fee ............. $.10.~0.Q ................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~/..A. ................... Number of dwelling units on each floor ....... 1~l.& ............... If garage, number of cars ................... :.~ ...................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... ~/,A, ............... 7. Dimensions of existing structures, if any: Front .......37,! ................ Rear .......... 32.: ................. Depth ....... 2,2, ......... Height ........ 22: ........... Number of Stories .............,2 .................................................................................................. Dimensions of same structure with alterations or additions: Front .......... .3..2.: ..................... Rear ....... ,3...2,.' ................ Depth ........... .3..2.: ................ Height ........... .2..2.: ............ Number of Stories ............. 2~ ................. 2' 4' 8. Dimensions of entire new construction: Front ......... .1. ......................... Rear ............ ~.2`.~ ........... Depth ......... 2~ ............. Height ...... .8.~ ........... Number of Stories ................... 1 ................................................................................................. 9. Size of lot: Front ............. .2..6..4..~. ................................... Rear .......... ~.6D.-. ........................ Depth ......%3.3.9..- ................ ]0. Dote of Purchase ............... Lg.?.Z ................................. Nome of Former Owner ............ ~,.9.Y...W..e..~:.]~.~-.~.~ .................... ] ]. Zone or use district in which premises are situoted ............. ~.e..s.~.e..~.t..l..~..1. .................................................................. ]2. Does proposed construction violate any zoning law, ordinance or regulation: ............ ~. ....................................... 13. Wffl lot be regroded .......~..e..s. ................ Will excess fill be removed from premises: ( ) Yes ( )9~,1~.94~ 14. Name of Owner of premises ,.~.*..,S..,...~..~..~b~. ......................... Address ]~.i¢~e~,~i~.,M~l; Phone No ..... ,5.1.,&7. ......... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..A,..,l'obn,.C-ad~, ................................. Address F.$.S~e.~.S...T~s.~ ........... Phone No. 5:!,.6~.7£.8 ........ PLOT DIAGRAM Ne~ York 7231 Locate clearly and distinctly all buildings, 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 Iol. See Attached STATE OF NEW YORK t c ~ COUNTY, OF ..... .~'kk.F..C...O...q .~.. ....... f~'~. ....................... I~....~,~i.~3.t~...,~.Q,(~¢~..,~..~...' ............................. being du,ly sworn, deposes and soys that he is the applicam (Name of individual signing contract) above named. He is the ........................... ..~..0....~..¢~.o..?.. ............................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contained in this applicetioh are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... ..ct ....... da, of ............ ............. , .... , Notc, .ub,,cCaun ..... ....... .......................... MAI~ B. PANKIEWlCZ "~ ~ (Signature of oppl NOTARY PUBLIC, S1A[E OF NEW YORK NO. 52-82679b0 - SUFPt~LK COUNTY COMMISSION EXPIRES MARCH 30, 19-7~o