HomeMy WebLinkAbout18066-z FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Tawn Ha11
Southold, N.Y,
CERTIFICATE OF OCCUPANCY
No 217972 Date APRIL 26, 1989
THIS CERTIFIES that the building ACCESSORY
Location of Property 395 PVT. RD. #21 SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 078 Block 09 Lot 40
Subdivision Filed Map No. Lot No.
canforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 20, 1989 pursuant to which
Building Permit No. I8066Z dated APRIL 21, 1989
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 ACCESSORY STRUCTURE IN REAR YARD.
The certificate is issued to [~rinur.FS & ANNE ANASAGASTI
(owner, }
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
n
Building Lector
Rev. 1/81
irostii xa s
TOWN OF SOUTHOLD
6U14DING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT OIJ THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N 8 0 6 6 Z Date 19.
Permission is hereby grantedr)to:
...3.~~t...... Qsr~. ~..1~....~ ....................1......... .
~..:y.......~.'.~.~.~.........
t0 .~~n:~T.`.!~4~~N...//l)'.Stf:.s.~......~M... ..1R. r~r:~:~:~t...rf1.Allr.S:~^1...1.R::~....R~:~4~' .
M......ITS.......• • •
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of premises located at ....~,.~.~......~!?~......°1~............~a,~~.':a~!'t!~:Q`.Qr^-
County Tax Map No. 1000 Section .....Q 7..~...... Block .......Q.~.....4. Lot No....:
?..D........ .
pursuant to appi~cation doted ..i-:C:.. ~'.p 19..4.„ and approved by the
Building I~n/'spector. VV
Fee /.r.•
.C C~ . . .
Building Inspector
Rev 6/30/80
r
TOWN OF SOUTIIOLD ~ Cc~.,~~JLG~~y
BUILDING DEPART2IENT 's~ e
r ' y{I
. TOWN HALL it E ~ Z 6 ~ ~`t
SOUTIIOLD, NEW YORK 11971 5 L
~~1.GG
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7b5 - 1802 ~ TO~ti•H: OF SCL~FIOl0 _
APPLICATION FOR CERTIFICATE OF OCCUPANCY ~f/ r^ /
DATE _ _ f . ~Z?~/.~~
NEW CONSTRUCTION _V....,OLD OR PRE-E%ISTING BUILDING......VACAN/T1 LAND.///.._._.,
Location of Property.~~-~.......~/~.r~~~~_.~.~,/.~~j..'~~~a~~....
HOUSE NO. STREET HAMLET
ma~yy// ,,,,tt s
Ovner or Owners of Property..~j_..r.G.(.~._l! .P74~.~i~IV.~d-.~i~4 J......_..
y
County Taa Map No. 1000 Section .C.... Block Lot
Subdivision Fileld/ M/apQ'/J__....._Lot...._..._.
Permit No. ~~`~~~L?..Date of Permit ..7 ,(fY,t.~plicant
Health DepC. Approval Underwriters Approval..._..........
Plannins Board Approval
Request for Temporary Certificate Final Certificate
Fee Submitted; $
APPLICANT. l~~d[~:,,~~.(.. f: JC.`.~.V ~ !
P . 3 7
Yla~~y
cdz,~y~z
rev. 10/14/88
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765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
(]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [~INAL
REMARKS: ~ r [
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BO.1RD OF HE.ILTH .
3 SETS OF PL.1NS
FORM NO 1 SURVEY
TOWN OF SOUTHOLD CHECK :~:.3~s.y .
BUILDING DEPARTMENT SEPTIC tOR:1
' TOWN HALL
. EOUTHOLD, N Y. 11071 NOTIFY
- TEL.. 7651802 CALL
E~amtnrd ..~.~,(~t~ ct~.~.., 19.1. h1AIL T0: 3cJS ~,t,}-Q,,~ (F-aI
Approved . `~~W..~~. 19gq Permtt No. g ~?~4 rR'~Z. ~ O `ems
DtsaPProved a(c
~p._. TOWN
OF
S
.~.f.¢.! V:4. .
(Buildtnglnspector)
APPLICATION FOR BUILDING PERMIT
Date .'~'.`~~L..l~......, 15.
INSTRUCTIONS
a. This aophcatron must be completely filled m by typewriter or to Ink and submttted to the Building Inspector, wit
sets of plans, accurate plot plan to scale Fee according to schedule.
b. Slot plan showing location of lot and of buildings on premtses, relationship to adlommg premtses or public str~
or areas, and gtvtn~ a detailed description of layout of property must be drawn on the diagram which is Bart of this ag
capon.
c.' The work covered by ttus application may not be commenced before tssuance of Building Permit.
d. Upon approval of this application, the Building Inspector will Issued a Butldutg Permtt to the applicant. Such pets
shall be kept on the premtses available for Inspection throu_ltout the work.
e. No building shall be occupied ar used to whole or to part for any purpose whatever unttI a Certtfcate of Occupai
shall have been granted by the Butldmg Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the tssuance of a Butldmg Permtt pursuant to
t,uildtng Zone Ordinance of the Town of Southold, Suffolk County, Nety York, and other appftcable Laws, Ordinance-
Reculattons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnb
'fhe applicant agrees to comply with all appitcab'le laws, ordinances, butldm, code, houstn, code, and regulations, anct
"sdmtt authorized inspectors on premtses and m building for necessary inspect ens. ~
(Stgnature of applicant, or name, t4 a corporation)
• (hlailtng address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buil~
....DU1.n1~o
Name of owner of premises CfFFI eC'4E-`r..'<. ~}!v~3t:-3d.Fi!5`..~j1.......A _
(as on the tam roll or latest deedTPPItOVED AS NDT,ED^' ,
If applicant is a corporation, Stgnature of duly authorized officer DATE: B P, tl~~
FEE: s~'•' ~ BY Y • 1-
NOTIFY BUILDING DEPARTMENT AT
{Name and bile of corporate officer) V 785.1802 9 AM TO 4 PM FOR THE
A C QR FOLLOWING INSPECTIONS
Builder's Ltcense No. `fy~QA . NfEU~„ i. FOUNDATION - TWO REQUIRED
.......u~4 ~s ~HI. tP`F'~.~'(~ FOR POURED CONCRETE
Plumber's Liccnsc No. ~~R ~ 2. ROUGH -FRAMING & PLUMBING
~`j~Qi'1 t~4pHCY 3 INSULATION
Elcctnctan's Ltccnsc No. ~f~'~jV 4 FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C O
Other Trade's Ltcense No . ALL CONSTRUCTION SHALL MEET
• THE REQUIREMENTS OF THE N V.
t, Location of land on which proposed work will be done . . . .STATE CONSTRUCTION. 8 ENERGY
'1 CODES.- ~NO'f~ •FtESPONSIr#t:~ ~ i:OFt-
. iO c! T/y~C1EStl6 NS'f1fUF~1OWE_RRORS
House Number Street Hamlet
q C
County Tai Map No 1000 Section ~ Block , , . , , , • • , • Lot .
Subdtvtston Fded I<fap No Lot
(Name)
State c~tsgng use and occupancy of premtses and intended use .Ind occupancy of proposed construction
a. Exts[tn~uscand occupancy
b Intended use and occupancy . • • • • • • • • • • • ~:~~SO~ ,
3. A`ature of work (check which applicable). New Uudding AddiUOn .Vteranon .
Repair . Removal • . Demolition • Other 1I'ork .
(Descnptton
4. Estimated Cost L30.A . ~o . Fee .
(to be paid an Glmg ilia application)
5. If dwelling, number of dwelling units Number of dvvcllmg units on each floor .
If gara;e, number of cars .
6. If business, commercial or mired occupancy, specify nature and cetent of each type of use .
7. Dimensions of cxistinp structures, if any Front .Rcar Depth . , , , , , , , , • • -
Hcigtr[ . Number of Stones
Dimensions of same st with alterations or additions Front Rear .
Depth ~`4"~ ~ IIcight Nuntbcr of S[oncs
Dimensions of entire new constntchon. Front ...l`.f . Rcar y~"... Depth , , ,
~
Hcig}tt Number of Stones _ .
9. Size of lot: Front ~
Rcar... Depth .....7.5.
10. Date of Purchase . . .Name of Former Ovvner .
1 1. Zone or use district in vvhiclt premises arc situated .
1~. Does proposed construction violate any zoning lavv, ordinance or rcCUl~tion .
L3. R'IlI lot be re,raaed 1Vill excess till be remov d from premises: _Yes
14. Name of Owner of prcmtses~'f~~`~('LGS..~.~fi?.~5~5!~?~C~ldress ~~IS'~~Pi.?~ T~.... re?! Phone No..7~:5 : ! ~ 3~
Name of Architect .......J~fftr.F
. .Address ...................Phone No............ •
Name of Contractor ....~$r'~inE .Address ...................Phone No............ .
IS.Is [his property located within 300 feet of a tidal wetland? *YES....NO....
*If yes, Southold Town Trustees Permit may be required. ~
_ PLOT DIAGRADS
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate al( set-back dunerstonY fr.
property Lines. Give street and block number or descnption according to decd, and show street names and indicate whet;
intenor or comer lot. ~ ~A ~ ~
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STATLOF~EtVYORI:, ~ SS
• • • • • • • •~~+~-L'•+• ~+s.=.-~f~,c~Y~..... being duly sworn, deposes and says that he is the applic
(Name of mdrvidual signing controct)
about named.
ileisthe ~'%r,~-r.ex
(Contractor, agent, corporate officer, etc.)
,
~f said oivner or owners, and is duty authonzcd to perform or h.ivc performed [}te said work and to make and fife
'ppliranon; that all statements contained in this application arc true to the best of his knowledge and belief; and that
work wdt be performed in the manner set forth m the application filed therewith.
iwom [o before me this
+ v
03 U ......day of ...C.`jl?ne-E'.. 19~Y.
tt
~ / ~
.otary• Pubtic, . ,E~~t.-...~5:..~`=. • • Count -
HELEN K OE VOE
NOTARY PIlOi1C,State of New York
No 4707878, Suffolk CaeMy ~ -
Term E><p~res Mcrah 30,19--~ (Signature o f applic: