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Home My WebLink About33283-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 08/30/07 No: Z-32568 THIS CERTIFIES that the building ALTERATIONS (STREET) Block 11 MATTITUCK (HAMLET) Location of Property: 13520 MAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 114 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 1, 2007 pursuant to which Building Permit No. 33283-Z dated AUGUST 1, 2007 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 ALTERATIONS TO AN EXISTING ACCESSORY BUILDING TO REVERT BACK TO AN ACCESSORY NON-HABITABLE STORAGE BUILDING AS PER CONDITIONS OF ZONING BOARD OF APPEALS #3958 DATED 9/12/1991. The certificate is issued to JOSEPH & BETTY A HARDY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N230963 04/07/92 PLUMBERS CERTIFICATION DATED N/A ~~ Authorized Signature Rev. 1/81 Form No.6 TOWN OF 80UTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 , r,\ ') q APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be fllled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (8-9 fonn). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/1 0 of I % lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations. a certificate of Code Compliance from architect 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: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a CeI1ificate of Occupancy is denied; the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees I. CeJ1ificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinuning pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. f -J 7 ~~.7 :::t~::l:t~::~:rty / 3~ ;l D Old R;e~kr~ldmg:N :; 11 r-rl~l~~ne) ) V . House No Stre6t ~J.- Hamlet Owner or Owners of Property 0\)S e ~Cl r~ 7 "t- 1St i-I- V ..q~J-+/11c.j) y Suffolk County Tax Map No 1000, SectIOn 3 1 3 g Z q Block J I 1f1, - Lot 11- S- Subdivision Pennit No. 33d, g3 - '7 Date of Permit. Filed Map. Applicant: Lot: Health Dept. Approval: __________ Underwriters Approval: Planning Board Approval: ___ ______ Request for: Temporary Certificate Fce Submitted $ !,;O 10 D - Final Certificate: ...rK'__ (check one) ~1u cant Signature ~ f5-v:- . 7 J.;). 3 'J--- LOi.~J5(Pr- ))?-Z'3.2- TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. [ ] INSULATION [pq FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~~ J4~ ~ A- ~ - ~~ ~~ JrA~ _~..e. ~e___ /LO~~, 't --/1J -- 0 7 DATE INSPECTOR ~,~ FORM NO. 3 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) PERMIT NO. 33283 Z Date AUGUST 1, 2007 permission is hereby granted to: JOSEPH & BETTY A HARDY 1654 CO. ROAD 39 SOUTHAMPTON,NY 11968 for : CONSTRUCT ALTERATIONS TO AN ACCESSORY BLDG. NECESSARY TO REVERT BACK TO ACCESSORY USE .CONDITIONS OF ZBA APPEAL # 3958.REPLACES BP # 20430 at premises located at 13520 MAIN RD MATTI TUCK County Tax Map No. 473889 Section 114 Block 0011 Lot No. 005 pursuant to application dated AUGUST 1, 2007 and approved by the Building Inspector to expire on FEBRUARY 1, 2009. Fee $ 392.00 ORIGINAL Rev. 5/8/02 r~~--- i . ! ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS --i h\ (, t: 1 r'lfJln BUREAU OF ELECTRICITY BS JOHN STREET, NEW YORK, NEW YORK 1003B Dati. !\PP'll.. en" 1:)9:2 Application No.onfUe :f.4",o",rj2/9:\ N ;~{;~19E~, THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application numbe,. in the premises oj K.W. AMT. I .. ! s i JOS~p~ "A~8Y, 13500 in thefoUowinlf location; was exomined on A. P ~{ r: 11 H~rN ROAD, H~Tr[rUCf, N,Y D Basemen' D 1<, Fl. D 2nd n ';AR Sertion Block Lo' ')i I t 9 9:> and found to be in compliom'f> u'i,h the requiremenll'l of this Board. fiXTURE OUTleTS KEPT ACLES SWITCHES FIXTURES INCANDESCENT flUORESCENT RANGES COOKING DECKS AMI. I(,W OVENS DISH WASHERS EXHAUST FANS OTHER AMI. K.W. AMT K,W. AMI. " , , , 2 ,) AMT. K.W. OIL H. P. GAS H.P. A. W. G. AMT. AMP. AMT. AMPS BELL TRANS. UNIT HEATERS MULTI-OUTLET SYSTEMS AMT H. P NO. OF FEET DIMMERS DRYERS FURNACE MOTORS FUTURE "PPllANCE FEEDERS SPECIAL REe'PT TIME CLOCKS AMT. NO. AMT. WATTS AMT. AMP. .:. ~;\rG NO. OF NEUTRAlS A,W.G, Of NEUTRAL I TYPE NO. OF 5 E R V METER EQUIP, l)l1W 1,B3W 3J!3W 3j14W NO.O~E~'.e-CONO. OF~C':"CgND NO. OF HI-lEG C E SERVICE DISCONNECT OTHER APPARATUS: 1 . ;: I\Ur. p. H1jRtJS ;'15 T0WN j,~!{B{)~ LANi I ~l(lU\':iO[ ':, N'!, 11U( I GENERAL MANAGER., , (f I - This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~---~---- ------------- ---- LfC.#?82 ~ ~~~ ;EL;J - '" l..~" -....... -: " ," II'" -- il ..... V~ v - J..Uo.J~':....... _1.;.. VM.....:. .." I '" )..) 1. :::! . ~ --~ H . , -l 'OUlIDA TIO!'! (1 s t) I - "" - -- -'- I ~ I c .. en 'OUlIDATIOll (2nd) , '" I ~ ~ . - = I ~ 0 I . ~OUGH FRAi-lE & .PLUMBING I I ., I en -l :0 3. I '" '" :lISULt.TIOll PER N. Y. I ., -l STATE E/lERGY II ,~ II ,;J 'v~ -~~ CODE 1<l10J7 ve ...~ vy,iJ , !,lJ.,4 . t4L- "1'_...~", I. il ~..4J' "".tr.u ,I f- ~ -r. "11 v .-tli....... '1,....." -l , II,.,A.... 0 ' \I'L ~~.,,,,,,,,;, '.(' ..., .A ~ IX .. tU \ . ...."'c. - FI;IAL I \~ -. < I .. 0 '~ ADDITIONAL COMMENTS: '[>] '" \, ~ .. . , . - - " . . . - . ,.." >< .. .." . H :0 '. . >> ' -l ~< 0 - \t . . - . =:c [>] . ", . r- -l - =: - j "". '" , .." .... . . . - . .. . "" I .. ''-('lLNT~ ~ \.A'J 0\)' l>J ~ "- ~ <:,l o i ~ ~ ~ ~ ~' ~ -..::::::. ~ ~ ~ ~ ".:JPl. No. Ass - V - "JOSEPH AN!l"'BETTY HARDY i.~n-Rendered September 12, 1991/6 1,f)j 'b ~ RESOLVED, to GRANT alternative relief for the additional dwelling unit in the existing two-story dwelling structure, for establishment of a two-family dwelling use, sUbject to the following CONDITIONS: . 1. Compliance with all zoning code requirements, including but not limited to the following: (a) Site Plan approval by the Southold Town Planning Board, which Board may require more stringent parking requirements than the conditions stipulated below concerning the Special Exception; (b) accessory structure must revert back to an accessory use with removal of all cooking and housekeeping plumbing facilities {electrical utilities for lighting purposes will be permitted to remain}; (c) accessory structure shall not be permitted for office use or any business or separate rental/profitable use, and shall be permitted for garage and/or dead storage purposes only. 2. Two parallel parking spaces to be painted in front of the retail business building for vehicles traveling in an easterly direction (to park with vehicles facing east); 3. A printed sign to be placed at the front of the business building directing all vehicles to "PARK IN THE REAR." 4. Before issuance of a Certificate of Occupancy or other documentation, acceptance and final inspection concerning the above conditions shall be made by the Board of Appeals, or member thereof. Vote of the Board: Ayes: Messrs. Goehringer, Dinizio and Villa. (Absent were Members Doyen and Grigonis.) This resolution was dUly adopted. * * 1 k *-7~~~- / GERARD P. GOlO-HR"INGER, ,CHAIRMAN / JOSEP/1 HARDY t'36DD III A /10 Rb . /)1A7fITUCj( I j). y. ~. 1/ ~~& /{P!i. R.Tf/'r tJT tZ()',OLIT IoN /ktcr".pvI\G ~/~ -U/4 t1'~~ ~~' "#$3;J-S8 ':;0'3'" lor I uP I.......J I ~ - I '\/0 -J~,.I^IG. II -<h<1Il- u_ \! ~~ I~. , ' I' ' : 'I .20"1" STOR~(;'E;./[,l E C'7~'<: ~L ARE II 1/ h ') /1 ~~tL L J oS f P# flll~ /3500/J1A.I/J 1<)>. .m,fTTiTIA LK... J 1lJ, y. ~~ -, ./ .::: , /, r ,., , .~. .~. II T - KENOl) 1\T( b ST01<AGE.. BARN ~ __h____ I i J'i Or -\ ..... I I i------ ~ 5TEE~ SuPPoRT G\Rt>~R. I- I I I 1----- L , I S rORAc.E kOFT I ';Q'I./" I I , ! .10' OVI.',e,HJ'b hooR. ~ ,. '^\I n j<~~ ;~v I l.} UNDERWRITERS COOIRCATE REQUIRED U. , , , , t ?'! ~ ~" ~;'k ~.:' Lf t~ r~('t~T~ f?'" '. ~ ~ l" " ) ;;- ~ ~ ~...1: t, ~ ~..,. ~^/:. // -'../ -' 1/ J- j Iy- ~'tLL ,\ ~ 1 I . "". -':_~-;':~!ii~.". . <~r:~~~\:~~~-;' i't~;~_ _'.'~:;-, -.'.f :;';~,*.'{~ . ,-,,'~,- ',,, -"'''''''--'' " ("':",'":)U.-:..:::>" ';'," ,TYPE OF BUILDING, ' , ~, . , v'Peh.Z.'6~ ~RESl~FS ", SEAS. I;LrAND,-", :", IMP. f/ ,l~ ~i' , h'" Mkt. Value '( ~I,' ,.. . I - ",:~_:-r"<':~.:,..,..,""l"'"~ ~:;,:.:-,,;:~.~. ~lI~ y slit....} "1. 1- SI.."i~" "~ c;(':7"f"-J""ki""-;( -" kOUy,,6S h Cla.l??1iJ" .;. r Zakv~ f,~'ii)a'oo bJ- ~.'*~OllD .... ~C!-. $ 5"arrD ..... W' ~ '>'",. ,.....,...",7"'.' t NEW.;,,: FA~!;~f.ffi.~B~;;, "".,,"""", ,,,!,'-' ,r~"\~..~.""':_"_'.'_:'.(~" J.;.~<4~~lt?~f;;~~:,:::t:~:~; ;~~~';~t]'~W{:..\:~r:..-. :_; ",_' y"',;;;h':,,,_ to Tillable '; '~~'; ....,. .....--, FRONTAGE ON WATER FRONTAGE 'ON ROAD fDEPTHf~itj}";'flV BULKHEAD ' " -';-'.'::, -',\' h "~_,,,"'>';':~_ iil oc ..'r *"':;~:, D K,;,'~;;",: :":\~-~-.y,, .:;~tf~-~lC~~:! I ...-,~....~~ ."::t' ;'. ,-":':-:'{."-~ (" "" ",.""~.,;j",j~",,, '" .-~>;'-~~-;Z'~~~:1~,~~~Li~r~-,<';'; ,>-. ;.7.- ~tc~i'-'I:tf~~i!;j~-~ ,:_,:'~iitli~~~lE~~B~1ltr,i'~:-:,~,y~' ,.' ~- . )}:;~!;;~~~: ,"j,- ,.,' ~":' ; . ~:";':' "'--"",- ','" .::;::~~~-';~e-~>.:i:~;:', r " . .> ""~'i;,.'" .'': ", 'u I , 1 ~ __~...:.:;;t__., i y;,-~...,~,.,. ~ .., :/~:;O-\;.." ;,,:C';' , 1<:" t,~::'!' ~ I I '" ! r i i . 'j , . ,.' ~l , ~ ~..,,:, ,', " .......1 ," ~- -.\: .~ / "';_:_;;~~,~t- ,'," :'~ " '.L. " . \rr~.. 'r "'-~~i! ;!;~'~s:{~,~._,>J,~",.\\ti . '.' -.", .",~~,.,.." -",,"..-~ > .. . .",..')~~~~~gf. .. "'. .. "", , "'.. ":'~?~"'li.<j.i!;'~d" ~lI'~""'A"'-" '. ..........:.....'. :".,.Jc.".t'.~,.:."..,;.i.".._ . .;> COLOR ~j;::".\,,;~~~l~Fj;U. r""~'. TRIM' '. )r;;'~2:~~l;: ..~ _"< i '-.::' '-- - ''1;"';..'.;,''-'.- ': ,,- i. ... .', _.,?" ""iI;,:'--~':'- 10':" .f'''] _~_ ;' , -, 'vi .~:" .;i~1~J.1~;'.~-".. -,....-. ',.."'-, -,' ~ '.r. I. . ,01 .' '91 '. '. ", ..... I .,g ,J,.'_t FORM NO.1 TOWN OF SOUTHOLD BUilDING DEPARTMENT TOWN HALL SOUTHOLD. N. Y. 11971 TEL 765.1802 Examined. $.f p. V .. .. . " 19.9.~ '. , .-\PProv~d . . . ~?y.. . '" . ., 19 .~Pcrmit No. .:::?t? y~ y& BOAGD OF HEALTH ......... J SETS OF PL.\11S .......... SURVEY ..... _............. CHeCK ,................... SEPTIC FORM ........,..... r:OTIF1: CALL NAIL . .7.-df.3.--:-.J P. cf. !. . , ~~k? 6.~tf<f!..... Disapproved pic . . . . . . ~ . . . . . . . . . . . . . . ..... .......... ... .... ..... ......... q q q q~"'CAT:~~F~~~e .9-&1:1 Date ..Jl~.f6.:........, 199.~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 Jr areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- :ation. 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 issued a Building Permit to the applicant. Such permit ,hall 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 ,hall 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 Juilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Or Zcgulations, for the construction of buildings, additions or alterations, Or for removal or demolition, as herein described. rhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ,dmit authorized inspectors on premises and in building for necessary inspe~tions. I / ~_ II . .. .. .~4-A .-:tttWk.. . . o.qf.~.. . . - (Sifn~~ure of applicaw, Or na . a corp~ .... ........ ..... ............................. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . Q .WIJ E R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . .-. . . . . . . . . . . . . . . . . . . .. " . \ame of owner of premises . . Jo.S.t::P.H. / .&11.'1, H!.tfi. b.'I... . . . .. .. . .. .. " . . .. .. ....... .. . ........... , (as on the tx( roll or latest deed) If applicant is a corporation, signature of duly authorized officer. , - . ... ...... ................. .......... ......... (Name and title of corporate officer) Builder's License No. ..,....:................. Plumber's License No. ...,...'~................ Electrician's License No. ...................... Other Trade's License No. ..................... Location of land on which proposed work will be done. . KcJt R . . J;:,x.(~'J:/.N..G: . Co.7TflG.E:.. . . . . . . . .. . . . . . . . . ... /35.0.0. . . .. . . . . . . . . .. . . . mAI.N. R b. ( .. . .. . . . . . . . . ... " ~ 1l1./J-1t /r.(J.c.k.. ... ..... . . . ...... 1I0use Number Street Haml"t County Tax Map No. 1000 Section. . . .!.l!-f.. .. . .., " Block.... .J.(. .... . '" . .. Lot..0..5......... '.... Subdivision. , . , . . . . . . . . . . . . . . . . , . . . . . . . . , . . . . . . . Filed Map No. .............. Lot............... (Name) Slale existing Use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....C O. IT Ii G E . . . . . . . . . . . . . . . . . . . . . . " ...: ,;'; .':' . . . . . . :. '"co' ,. , , , , , , . b.lntended use and Occupancy" . S:r.o.l:i'flGE:.. .-gUI.L;/).I.II1G.....,..,. ";'. ,'........ .'.... .....n'..... ~c , , 3. Nature of work (check which applicable): New Building .......... Addition.. . . . . :. .. Alteration . V. . . . . . Repair .............. Removal. . . . . . . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . (Description) 4. Estimated Cost. . . II. 31.0.00 I . . . . . . . . . . . . . . . . . . . . . . . Fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 . .Qm~AG.E. . . . . . . . . 7. Dimensions of existing structures, if any: Front. . . . . . . . . . . . . . . Rear. . . . . . . . . . . . .. Depth............... Height ............... Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear.................. Depth. . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Num ber of Stories. . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front. . . . . . . . . . . . . .. Rear............... Depth ............... Height...... .:.. ."...,llIumberofStOries........................................................ 9. SIze of lot: Frl'fB. ;'. , ~. . . . . . . . . . . . .. Rear...................... Depth....................... 10. Date of Purchase ............................. ,Name of Former Owner .CJ{$ R./YE-S . :z Atd~~ . . . . . . . . 1 I. Zone or use district in which premises arc situated. . .1:f.6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ./.N. 99/11 t'I-JIlJJcE.. . . . . . . . . . . . . . . 13. Will lot be regraded .. Nt::. ........,'.... . ...... . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises J".~f;fll.~ :6err'i./lAt<:t)';Address ~,,;( P/SIJ~,,{Je:,Jft>/y: . Phone No. 2JO.-/O.L!{.. " . Name of Architect. . . . . . . . . . " . . . . . . . .. . . . . . . Address. . .If:I}~~~,:,( ~ . .'. Phone No. . . . . . . . " . . . " . Name of Contractor ... . ....... . ............ " Address...... ........... .. Phone No. ....... .'....... 15. Is this property within 300 feet of a tidal wetland? *Yes........ No..)(..... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM 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 lot. AP,,!~ AS NOTED DATE:~//"9.:2::B.P.# ~tL3o ~ FEEL.3'9f';'~BY' ,..-- oK NOTIFY BU!L[51111(f" OE'PARTM T 765-1802 9 AM m 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2, ROUGH - FRAMING & PLUMBING 3 INSULATION 4. FINAL '. CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHAll MEET " THE REQUIREMENTS OF THE N Y STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ~tI~$F~~:~-d{~(!:. S.S . ..... .~~./1. Wa.t;.~./............... being duly sworn, deposes and says that he is the applicant (oNa'~;;o'f individual signi~ 'J"ntract) Jove n~lfllcd. ,is the. . . ... .. ... .. . . .. . . .DW~.Y.':..... .. . . . ... . . . . . ... ..... ... ........ '" " .... . .. '" .... . (Contractor, agent, corporate officer, etc.) , said owncr or owners, and is duly authorized to perform or have perfonned the said work and to make and file this plication; that all statements contained in this application arc true to the best of his knowledge and belief; and that the >rk will be pcrformcd in the manner set forth in the application filed therewith. om to before me th~ "~I:';I[jf5;;;;:;':7 ~~~;;?~...l~, ;"51.. /) . ClAIRE L GlEW . ',.." / '-i NoteryPu~~~~~~N_Yort . '--;~/. L:. .... ;g~~~~;e'~i ~;;I;~;n't) Qualified in Suffolk County <fz-- C_/ ! ~lasion Expiraa Dacembet 8, 19_ ..0.. NO. . 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) N~ 20430 Z Dote ..:.?::I!..:.:........................................ 19..1.~ Pennission is hereby ~~...~~~:...................... p, D . ~ I'" S4 /01 (,~.~....iQ.-1f..~...~L................... ~~~t99,,,...>.1~..")'.!.(:(6f>// /!/.. ...~d~~..:L.~.~~_.~~,;........ /Jf~~....~~.~1Jj...~..~................~~f.!..........~ mt /III: . J .. .2::.4.~....:3/!pt.:~:{!..~...2..?.~<f:................................................. .d:......:::.-?.4:(!..q,.......~....~c(,................................................................................... .................................~~~~........:................................................................................ County Tax Mop No. 1000 Section ........I!.(;,.... Block .........1(...... Lot No. ............!;?.~ pursuant to application doted ............I./..A.L........................ 19.1/., and approved by the Building Inspector. A4:: 2ft~Z-- Fee $...I-2.i~ 3Q;:).- ~~~~.._.. Rev. 6/30/80