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Home My WebLink About6377-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi[icnte Of Occupnncy THIS CERTIFIES that the building located at .Map No. ~r~ ........ Block No... ~m: .... Lot No..~xz. · .l~out, hel4...I~o.Y.o ........ ..... ..._~0nforms substantially to the Application for Building Permit heretofore file~, in this office -'"-----._.._dated ............ .l~eb .... 2?, 19. ~3 pursuant to/which Building Permit No..637.2r~. dated ............ ..Pcb .... 21~., 19..?3, was issue, and conforms to ali Of the require- ments of the appli,cab!e provisions of the law. T~e occupancy for which ~ certificate is issued is ...Pri.V. ate. One. fanil¥, d~l.],ln~ ? .............. The certificate is isslle~ to . Charle~ .~ti ..... o~,,~- ...................... of the aforesaid bulling. (owner, lessee or tenant) Suffolk~.~unty Depar~'ment of Health Approval · Ju~y. 2. 4.~. · .by. I~, .¥~.~ ...... UNDERWRITERS Ci~RTI~ICATE No. }1 .O97979.. · .l:.~,me. 2,. 1,97.3 ..................... Building InsPectOr, FOILM NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6377 Z Date ................... J'~ ~.¢.Jl......'J ................... 19~.3 .... Permission is hereby granted to: .c~.~.~ge.. AI~ 1..L ~.~.~....~.r~.0...AZ..~...g~a~.~ s Anasagast:L .......... 2~0...¢ox..~ ............................................. ................. Da.t,c]~3 83,re ......................................... to ,~:t.3.cL ..r~w. · ~ · · .$ a m ~3..y. · ~we~. i..~ ..................................................................................... at premises located at ....... l~.,d:).~.~../:L~'...J~/.J~..~O~.t~-...~&Jl~.:l~.~..lq.O&l~ ..................................... ..................................................... J~t~l~ ...... .q.~.,. ....................................................................... pursuant to application dated ........................... ~.e]~ ....... ~.~. ..........19.~.., and approved by the Building Inspector. Building Inspector FORM NO. 8 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR GERTIFIGATE OF OGGUPANGY Insfructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, /v~ultiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 19§7), No~-oanforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. New Building ..... ~. ..... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .... ..~.7~..~........~..~-~.........~..~.....~......~.._.....~.~.....~.....~...~.....~..~.,~/-~/ Owner Or Owners Of Property ..... C.~...~...~....~....~.~/o A ~'/ .................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No....~'.....~.../...~..... Date Of Permit~.;/.~/~..,~...Applicont .~~.....~.~. .............. Health Dept. Approval ................ ~../~..~'...~. ............. Labor Dept. Approval ................................................ Underwriters Approval ..... ..~.....~/.....~/..~/..~..~... ............. Planning Board A~proval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....~.... ................................ Fee Submitted $ .....~-.x.~....~)... .................. TERRI L~E ELAK I~J'A,RY P,'~L3, State of F, ew ~mrn;ssion Lx~,,[6s J~;arch 30, 19 Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ,~ ~'/~ ~ ..~..~.~ .~ \ ..~...~.. ~o sram or ...~.~ ......... day of .................. ( p seal) /~Z~-~'~ Noto ry Public .'~..-~'~.'~..~ .. County ~.j4.~ 2f~'/ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D.Reference No ~O- Ic~ ~ EASTERN DISTRICT, RIVERHEAD,N.Y. APPLICATION FOR APPROFAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTF24S h: Date~ '~ '~- Approval tn construct sa~,d systems~ is requested,pertinent~ data herewit , ~~ 1-Applican~ ~ · u_ Address ~O C~ $-~.~ %id'~ ~o~d~ _ _ ?-Section 2-Detailed_D~op~ .rty location ~o~ ~4w~_~ ~ 8-Lot No. '~: L Hamlet ~d-~ Wd Town ~ ~ ~ .9-Private well? 3-~ublic water sup~ name Distance to nearest main 4-Lot Size: Width ~' ft. Length'~9-ft. (also enter on center plot plan below:) - ellin : Singl? Family T .Fa il 3_J_JCellar? ! !.Slab? ; Craw Smce?! ! 10-Proposed system. Septic tank .~_~,~PreW~_JCesspools / /Shallow pools / /Other / / il-Septic tank inside dimensions~.~olum ~e~Gals.Length ft. Width ft. Liquid. depth ft. 12-Precast sections: ~', FNumber~Square Ft. Cesspools: Block sizeL ' incs.D ins. H ins. Total blocks below inlet: ~1__~2 ~3 PLOT PLAN Street dL/ Capacity Gals. . P.M.. ~_~__ ,G ~ade ~ ~ G W.L. Data ~eet ~'%~'= 0 ~ 8 12 14 ~6 18 ~o m ~ No 'th The U~ersigned ~IF~S: "Const~ction of authorized installations ~11 be in accordance with ~e Suffolk County Health Departments' current StarsYs, ~lletins, a~ ame~ments thereto, covering Private Sp~e Dis~Aa% Systems". Owner ~ or ~ilder -'. ~R HEALTH ~NT USE ON~. Based on the info~ation prese~ed here~th, it is the opinion of the Health Department, that an ad~uate and satis~cto~ Sewage Disposal S~tem can be installed on this ~ot. Date g'~/f/~ Signed ~--~-'--"~ ~_ -- ~ (10/65 Revis.) !~0~1~ NO, 1 ~ ~ ~LDING DE~MENT ~ OWN CLERICS OFFICE ~ ~u H~D, N. Y. ~ ......... ,,23. ' Appr~ed Di~pprov~ a/c ,,,,,,-,-,..,~,,~,_. ,~..., ,,, ................. ... ................................................................... .............. ................ ............................................. .................... , ,NST~U~IONS ~. This appli~tion mus~ ~ ~mple~ely filled in by ty~writer or in ink and submitted in tripli~te to the Building Inspemor, w 3 ~ts of plans, accurate plot plan.~o scale. Fee according to schedule. b. Plot plan showing locatiOn of Io~ and of buildings on premises, relationship to adjoining premiss or public streets or areas, and giving a detailed description of I~you~ of pro~rty must ~ dr~wn on diagram which is par~ of this appli~tion. c. The work covered by this application may not ~ commen~ before issuan~ of Building Permit. d. U~n approval of ~his application, the Building Ins~ctor will i~ue a Building Permit to the applicant. Such ~rmit shall be kept the premiss available for ins~ction throughout ~he work. e. No building shall ~ occupied or used in whole or in pa~ for any purpo~ whatever until a ~ifi~te of Oc~pan~ shall have ~n gran~ by the Building Ins~ctor. ' ~P[IC~TIO~ IS H~fiB~ M~Dfi to th~ Buildin~ De~m~nt for th~ i~uance of a Buildinfl ~*rmit ~u~u~nt to Ordinane* of the Town o~ ~uthold, Suffolk Count~, ~ ~o~, and other a~li~bl~ [aw~, Ordin~n~ or ~ulati~, ~or th~ ~n~tru~ion buildings, ~ddifion~ Or alterations, or for r~mo~al or demolition, a* h~r~in d~cri~d. Th~ ordinan~*, buildinfl cod~, ~ou~in~ cod~, ~nd r~Oul~tion~, and to admit authorized in,~etor~ on ~r~mi~ ~nd in buildin~ ~or n~ar~ in~iom. ...... State whether applicant is owner, lessee, agent, a c,~ect, engin,eer, general contractor, electrician, plumber or builder. Name of owner of premises ........... ...... ....~,~,{~(~2~ ........................................................... If applicant is a corporate, signature of duly authorized officer. ' (3(Name and title of corporate officer) 1. Location of land on wh~L~h proposed work will be done. Map No.: ................................ .................... Lot No ............. Streetand Number ..... ~/)~.c~.....~...~......~l~......~..~...~,~.: ........ ~ Municipality 2. State existing use and oCCupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ..~.~ ............................................................................................ ~. b. I ntended use and occupancy ..~,,sk,~l~L,,~,,_~,, ....................................................................................... ..~ 3. N~ture of work (check which applicable): New Building .............. Addition ..................... Alteration ........... ,~. Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... 4. Estimated Cost ..........~.-..~.4 ~ ................... (Description) Fee ~~~~~~~~~~~~~~~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.~~~~~~~~~'~~~~~~~~~~~~~~~~~~~~~~~~ (to be paid o~ filing this application) 5. If dWelling, number of dWelling units .............. :.. Number of dWelling units on each floor ......................................... .,..~.^~o.. I ~ qc~..~,~ ..................................... If garage,. ..... ,~, v. ,f ................................... ~ ........... o' ...................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of usa ..................................... 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 ....... .~....~.. ................... Height ................................................. Number of Stories ............................................................................. 9. Size of lot: Front .2~ Rear -~3~', /~ f~ ° ................................................................................ Depth .................. , ............................... l~ate of Purchase .~.~:a~.....~ .......... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ~ ....................... Will excess fill be removed from premisas:'J~l~Yes ,[~No .... ,~ ..... ,,.,.-,--, c}~ ~..~....~ ~.~ ...~:.~¥.*.~ 14. N ................ . ......................... ~ .......... ~'~'~l~;ess) ......... ~ ................. (Phone No.) Name of Architect .............................................................................................................................. :....~ ............... i --~ ,~ ddre s) . (Phone r~o. ~o~ ~,,,~,~, ~ ~,~ · ~ ; ~ ~ ~.~,,., ~~......z~.,..:~:.~ ....... PLOT DIAG RAM Locate*clearly and distinctly all building, whether existing or proposad, and indicate all sat-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. Lc) F- STATE OF NEW YORK~ /.~, ~ ) COUNTY~ //~('~ ~ ~,OF ........... ~/~, ~ ............ ) "~ (3tdme of individpal si&ning contrgct) {Contractor, agent, corporate officer, etc. ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application 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. .......................... ............ ....................... /, · , ,Notary Public ...................................................................... Co W ........... :.~.'.".:~.....,.:,,...:..: .... ~: ..................... : ........................ fa~mre o! applicant} r/ R°4 0 ' - SUFtVEY FOR ~EF~R£f~¢£ , CHARLES ANAS~GASTI AT BAYVIEW TOWti OF SOUTHOLD ~A~T~D TO, SUFFOLK COUNTY~ SCALE FEB. SURVEY FOR CHARLES ANASAGASTI aT BAYVIEW TOWN OF $OUTHOLD SUFFOLK COUNTY, N. Y. / s/~ct°n720i 9 of the New York State Education Law. eopies of this survey map not bearing the land surveyors in al or embossed seal shall not be considered to be a ~alid ~ ,ore nl~es or ¢edi[icadons indicated hereon shall run any 1o ~m~n for whom lhe survey is prepared, and on his ~ Io .~!le company, governmental agency and lending inst~ Ii I~Ell~l~'m~quent owners. 4UARAII'rI~ED TO, ISCALE' I"' 40' FEB. 7, 1973 ~,:*;, 20, *',97'3 V # A .Y. APPROVED AS NOTED NOTIFY BUILDING DEPARTMENT AT 7S5-2660 9AM TO 4PM FOR REC}UIR- kL~ iNSPECTiONS: 1 BEFORE BACKFILLING FOUNDA- i['~N OR START FRAMING 'Z, B~_FOR~- COVER NG p?ELINE ~. Fh,IAL WHEN JOB COMPLETED