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Home My WebLink About5521-zFORM' NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southol~ N. Y. Certificate Of Occupancy No..Z.~.2..8.6. ..... Date . .J..~....2.~. .................. , 19.~.~.. THIS CERTIFIES that the building located at 930 ~tl~ ~tr®et Street Map No....F.~.~.~. ..... Block No ........... Lot No. ~8 conforms substantially to the Application for Building Permit heretofore filed in this office dated . .~.ep.t.q.m.b.e.r...~ ....... , 19..~. pursuant to which Building Permit No..~..~.2.~.Z.. dated . $.ep.t..e/~..b.e.~...23 ........ , 19..7~.., 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 . .PT..i.v.a..t.®. . .0~..~..F..a~...~...~..~.~ ....................................... The certificate is issued to ..... . .B~..r..t~....J:..F.o..r!l..~' ................................ (owner, lessee or tenant) of the aforesaid building. N,R, Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No. Pomll~ HOUSE NUMBER . .9.~..0 ......... Street .. ? .t~...~.t.~.??.~..~.?.?~...ILO..~.t.s...L:.I.,...N.,.~..,.. ~80 Flint StFeet~ Ol~eestpo~t~ L,I,t 1~,~, Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5521 Z Permission is hereby granted to: .............. ~:.~..~...~......~.e...~.. ................................ to ................... I~,~&~e~.&~ .................................... at premises located at ........... Ii~,,/~,..~l~lll~.d~..~/&..~'.tJ~lMi..~ ......... ~l~r.~jL....~...~ll~..~..tl~. .................................................... e~e ........... z;z ..................................................................... pursuant to application dated ..................... ~e~t, ....... ~ ................. , 19~.~...., and approved by the Building Inspector. F. S.['..~ .............. Building Inspector FOR~! NO. 1 TOWN OF $OUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exom,ned 19 ........ mm ~ ..................................... ~proved ........................................ , . Disapproved a/c ......... ~ ~ .... Application No. '~'-~'"~/' 7 APPLICATION FOR BUILDING PERMIT ~ Date .............. ~....~....~... ...... , · INSTRUCTIONS , a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building~i Inspector. I~ b. Plot plan showing location, of lot and of buildings on premises, relationship to adjoining premises or public streets o~"~ areas, and giving a detailed description of layout of property must be drawn 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 Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises avoilab!e for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a 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, ordi nances, building'cede, housing code, and regulations. ....... ........ ............ (Address, of applicant) State whether applicont is owner, lessee, agent, architect, engineer, general contrpctor, electrician, plumber or builder· Name of owner of premises .......................................... :.....~ ....................................................................................... If applicant is a corporate, signature of duly authorized officer. "7''7 ........................................................................................(Name and title of corporate officer) 1. Location of land on wl~ich Dropo,~l~[ work w Ibedone Map No ~p~-'-'.~,~f./~ ....... Lot No~~,~'~ ............ Street and Number ~L~...~...../"~ ^,,~ i ....... i.Municipality, i ................ ..~~ 2. : State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisitlng use and occupancy ,, b. Intended use and occupancy 3. Nature of work (check which applicable): New 'Building .................. Addition ............... Iteration................../' Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..~....~...-~..~'~..~.. ..................iii'...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 ............................ 7. Dimensions of existing structures, if any: Front ...... ..~....~.'.-..~...~.~.~.' Rear ..... ~-~.~....~..~.'. ....... Depth .....~.~....~' Height ....~..../. ............. Number of Storie~ ...~ii ............... ~-,-jt, ~ ......................................................................... Dimensions of same structure with alterations or additiOns: Front .................................... Rear ............................ ................................................................. 0 Depth Height ............................ Number of Stories .~;) ~ · 8. ~Dimensions of entire new construction: Front ......................~'. .......... Rear. ; .~ ~ ..... D~-~pth ................ Height ..... ~ ......... Number of Stories ....~ ............................................................................................... 9. Size of lot: Front ...... .~.~.--~ ......... Rear ....... .~.~...~...~. ................. Depth ........ .~..~.~..~.../. ............ 10. ~ Date of Purchase ........................................................ Nome of F,,ormer,Owner ........................................................ 11. Zone or use district in which premises are situated .......... ~ ...... ~ .............................................. 12. Does proposed construction viol$tte an~, zoning, law, ordinance or r_egu at on.;) .~...~ ...... 13. Name of Owner of remses ~J, ~c~, Address ,~'/0 ~o~/~,,~ ~--- ~'i ........................ P .................................................................... mane r~o ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nam8 bf contractor ~",~..~l~.~e/.~ ............ Address .~...~/n..~....~.-..~...?....~._.~.:.~.. Phone No..~..~.~,.~..~..~..~. PLOT DIAGRAM Locate clearly and distinctly all-buildings, whether existing or proposed, and indicate all set-back dimensions from property line?. Give street and block number or description according to deed, and show street names and Indicate whether intermr or comer lot. · STATE OF NEW ¥~N~i~/;'~;~ t~;. .... .......... y; ...... ~~.~......~-; ............. ~i~ duly ~om, d~es and says t~t he is the applicant tmame of ~divi~al signing~l~tion) above nosed. He is the ................. ~~ .................................. ;;; ................ ; ................... (~ntmctor, ~t, co,rate officer, etc.) of said owner or ~ners, and is duly auth~riz~ to ~o~m o~. ~ ~ffo~ the ~id work and to ~ke o~ file this application; that all statements con~m~ m..~ ~li~.am t~ to the ~st of his knowledge and belief; and t~a~ the work will be performed in the manor ~ f~ in ~e wlic~I~ fil~ themwi~. Swam to ~fom me this ~ _ .................... ........ ...... ..... ........................... ~ ELIZAB~Tff ANN NEVI~E ' No 52.8]258~, Suffolk C~n~