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Home My WebLink About2351-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z..3571 ...... Date ....... AU~UZt ..... .22., ......, 19..6.9. / THIS CERTIFIES that the building located at l~l~.~.al~eth. ~.aae .......... Street Map No. Zebxaaki.. Block No ........... Lot No.. southoid,. I,..I, O,D.A. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... APX $~...3.4,, 19.6.~4 pursuant to which Building Permit ATo..23.5.],. ~.. dated .......... A~)Nil...14,., 19.64., 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 ...p~:~,v. al:~..Qne..t~am;[~.y..~w.e.~]~q ..................................... The certificate is issued to .... Leslie. ~azzola ................................... · (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . August .14.,..196.9, .Ro]~e~:t. ....... .... Building Inspector House % 495 Elizabeth Lane FOItM 1~O. 2 TOWN OF $OUTHOLD BUILDING DEPAR'rMEN'r TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ~N..o 2351 7 Permission is hereby granted to;~ BUILDING PERMI,r .(THIS PERM T MUST BE KEPT ON,THE pREMisEs UNTIL FULL · 'coMpLETiON OF 'I~HE,WORK AUTHORIZED) ~, ': ' ~ ............ ........ , Date to.~U,~lS..~e~..o~e..$m~,l~..~aw~.;~1,~[to, g .......... , ........................... , ............................................. ,. at premises located at .~.~. I~,.O~,:~,..~O~:~...~/~,..~...V&eI~.._Po~&~[ ............. ~ ................... , ............. ...... .(~,~l~...O. ~, A,,;I ............. 8~u,~,~l~.:~, I, ~.....: .................................................... '. ...... 1~...., Ond approved by.the pursuant to application dated .~, ................... ~,...~J~...,.~l,t~, ............. Building Inspector Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located ~ (Oi~ dk~ed locat/ion) - ~ have been inspected by this department and found to be satisfactory. District Engineer TOWN OF SOUTHOLO BUILD'lNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....~....~....L ..~... ..... 19 ........ Parma No ....... ; ......................... Approved ........................................ , Application No. ~..~.....~..~ .......... Disapproved~~ ................ ................................. (Building f nspe~or) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. 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, relationship to adioining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn an 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 available for inspection throughout the progress of the work. e. No building .shall be occupied or used in whole or in pa rt 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, ordinances, building code and regulations. (Si~r~Jurc or applicant, or name, if a corporation) ............ .................. (Address' of applicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a 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~.Z~.:. Lot No: .................... Street and Number .~t.~..,.~,.~.....~.~....~~..~.~.....,..~..~~ ..................................... ~/_ ~ ~,~ ~ ~,,,~¢ ~ Municipality / " 2. State existing ~e and occupancy of premises and intended use and occupancy of proposed construction: a. Existing useandoccupancy .......... ~~....~ ....................................................................... b. Intended uso ond occuponcy ......... ~ ......................................................... 3. Nature of work (check which applicable): New Building ..... ~ ........Addition .................. Alteration ........ ; ..... Rel~air .................... Removal .................... Demolition .................... Other Work (Describe) ..................... ..~: ........ ~ .... (to be paid on filing this applicotlon) 5. If dwelling, number of dwelling units ....(t~t..~Z~ ............. Number of dwelling units on each floor ....................... 'If §oroge, 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 Stories ........................................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ............................ Depth .............................. Height ............................... Number of Stories .......................................... 8. Dimensions of~,entire new construction: Front .......~..~ .............. Rear ....~...~ ................ Depth ....c~....~.. ............. Height ....~..~..~2. ........ Number of Stories ..~ ................. 10. Dote of Purchase ~..,..J.~.~. .............................. Nome of For~er Owner ......~¢~2..~..... ,. ........... 1]. Zoqe or use d,str,ct in which premises c~re situated .......... ~...,.c~...¢¢4~.' .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~.40. 13. Name of Owner of p Phone No. Name of Architect ~ ......................... Address ..2~.~...~ ............ Phone No. Name of Contractor ....... L~. .......................................... Address ........ b. ................ i.'.',: ........... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fn property fines. Give street and block numbers or description according to deed, and show street names and indi, whether interior or corner lot. STATE OF'. NEW )K'OI~K~ ~ ~ / S ~ COUNTY OF ~.....I '°' .............. ~~._ ... ~ .~...z.:....~n~.. .............................. being ~'(Name of individual signing application) duly sworn, deposes and says that he is the above named. He is the ................................................... ;~....:.....:. ....... (,&.~ ........... ;.;: ........................................ ..... ~onwacror, agent, corporate orrlcer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and ~ this application; that all statements contained in this application ore true to the best of his knowledge and beli. and that the work will be performed in the manner set forth in the application filed therewith. Sworn to ,be~frne this ............ dowof ..... ~ ....... ~ ....... , ~o ~ ~ ~ ~Numr~, ~bl~, State of Now York / ~ No [)2=(}~l,196~ Suffolk C~nty --~