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Home My WebLink About6216-z FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6216 Z Permission is hereby granted to: .......... 26~....&e~A~1~...~ .............................. ............... M;ba~;I~....JI.~Z~, .................................. DuiX~ new one fll~ dwOll~.~g at premises located pursuant to application dated ........................... ~....~. .............. , 19.~...~,,.., and approved by the ! Building Inspector, Fee ~!.,.~.e. ............. Building ffi'spector ( FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerli[icate O[ Occupancy No..Z~.O~ ..... Date ............ &p~'~]. ....18 ...., 19. ~3 THIS CERTIFIES that the building located at at;anle.~ .Rd ................ Street Map Nol~llOt. Y~ollllllock No ....II ....Lot No. ?.... l~ttittmk.. I~..¥ · .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~¢~? ....~ ..... , 19. ?2. pursuant to which Building Permit No.. Ii216Z dated ........... ~.O~......~ .... , 1972.., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is Pll'~.*.atO..o.~.0. Jf.&m. J.~y..4~tOJ..l,i, llg ........................................ The certificate is issued to ... 1{,.o.8 ,~.,...~;o. Yi, .Do~t;l'~,oli. ....... .Olgllol'. ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~9I't.~ · · ti..$9~. - .blt. 1t, .¥~,J.~& .... UNDERWRITERS CERTIFICATE No.. ][ .~. 80t~.. lla~... ~ .h.... ~ 9~.~ .................... HOUSE NUMBER. ~0 ........ Street .....~t~L].I~T .1:1081~ ............................. ]FORM NO. S TOWN OF SOUTHOLD Building Deportmeul' Town Clerks Office Southold, N. Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 dispcsal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey o'f 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancv on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building .................... Old or Pre-existin~l Building ............................ Vacant Land ............................ Location Of Property ....~~ ~~....~..~_~~ . . Owner Or Owners Of Property ...~'..¢.:. ....... .~.~.~~.-. ............................................................. ate of Per ,,t ........................ ,,alth pt. Approva .................. abor pt. Approva ..... ............................... Underwriters ApproYa~ ..~.....~..~..0.0.....~... ..................... Planning Bo~rd ,aq~proval . Request For Temporary Certificate ........................................ Final Certificate ...~ ........................ Fee Submitted $ ~.....~ .......... Construction on above described building~0~mlt meets all opplioable codes and regulations. Applicant ................................. Sworn to before me this ~ ........... ,~.B~'day of ....... ~ ........ ..?......~.... (stamp or seal, ,/~ ~' ~'O~' ~ ~ota~/Public .................................... Coun~ ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH H.D. Reference APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM 1. Applicant Address 9,%,~ ~'~a~.%~ .~,~,~%f,~"';~t~a~%,~..~.~.6. Section $~-?'~"~ ~ 2. Property locatio ' ' 7~ Lot No. ~' -- ~ 0~ %~ ~.~~$ $~1.~?~ 8 Private ~ ' ~ Village ~%?~ ' Township ~m~%~' 9 Public water ~ 3. Public Water Company name(~.~ ~ ~ Distance to main ~ ~ (~ 4. Lot size: Width ~ feet Len~th~ feet (Enter on center plot below) Sewage Disposa~ystem: A. 6b~gallon septic tank: Precast~"Equivalent Block B. %.~,~aching pools: Number ~ Precast~Block Special -- The undersigned in accordance with thereto." Date ~ ~ be ards 10. If private well fill in blanks below: Tank capacity Gals. Amount of water in well Test Hole Data Feet 0 2 4 6 8 10 12 14 16 18 :ERTIFIES: "Construction of authorized installations will the Suffolk County Department of Health's current stand- Signed~ FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department, that an adequate and satisfactory Sewage Disposal System can be installed on this plot. Date~ Signed , S-15 Revised 4/]/72 APPLICATION FOR APPROVAL TO CONSTRUCT PRIVATE SEWAGE DISPOSAL SYSTEMS INSTRUCTIONS: Applications must be submitted in triplicate 1-Means 09~!e~ or. Sui!der. Address t~hi~h~mail shonld, be directed. 2-Means detailed description of property !qcation, together with street name and distance to nearest intersection of main thoroughfare, also Hamlet/Village & Town~hip. 3-Enter name of Public Water Supply District~ together with the distance to their main. 4-Enter Length and Width of Lot under'appropriate heading, also enter these dimensions on center plot plan shown on the face of this application. 5-Name of subdivision. 6-Section number. 7-Lot number. 8-Private well: Enter "No" if Public water supply is available. Enter "Yes" otherwise. 9-Public water: Enter "Yes" if PubJ-ic water supply is available. Enter '~1o', otherwise. PROPOSED SYSTEMS: Answer to Item number 10, consult the Suffolk County Health Department's Standards for Sewage And Waste Disposal~ Systems Design of Residential Subsurface Sewage Disposal FaciLities. Part I-Residential Subsurface Disposal Systems covering cesspools. PLOT PLAN: The following information is required concerning the AppLicant's lot: ~ size-Length and Width in feet to be indicated at the lot lines of the heavy lined square in the center of Plot Plan shown on face of this application. 2. Surface waters-Streams, Lakes, & Bays, etc., located within a distance of 1OO feet of Applicant's lot lines, must be shown on the plot plan also. 3. Wells and cesspools now on adjacent lots must be shown on the plot plan, together with the distance to the Applicant's proposed Sewage Disposal Systems and well. 4. Where no buildings exist on adjacent lots, state "Vacant" on the ~plot plan.~ 5. Streets adjoining applicant's lot to the right, left or rear, enter street name. WELL LOCATION: To locate the well & sewage disposal systems on Applicant,s lot, ~he following Standards must be observed: ~ Well-100 feet minimum distance from the nearest cesspools. 'Jell- 25 feet distance from rear and rear sides of property lines when possible. Well- 10 feet distance from front, and front sides of property lines when possible. Well- 50 feet minimum below grade for well point. Well- 40 feet minimum into ground water for well point. Well- 4 feet 6 inches mini,mm below grade to w~ll head and lateral water pipe. CESSPOOL LOCATION: Upon determination of the Sewage & Waste Disposal "type of systems" re- quired, the following Standards must be observed for the location of same: 1-Cesspool- 5 feet minimum distance from lot lines to exterior of cesspool. 2-Cesspools exterior mast be 100 feet minimum distance from nearest well. 3-Septic tank exterior must be 75 feet from nearest well. 4-Cesspool exterior must be 7 feet minimum distance from nearest water line. 5-Cesspool exterior must be l0 feet from house foundati~ 6-Cesspool exterior must be 100 feet minimum distance from surface waters, streams, lakes, & Bays, etc. 7-Cesspools must be 20 feet minimum distance from large trees. 8-Csaspool exterior to cesspool exterior, must be at least 8 feet. P-Cesspool cover top to grade must be held to minimum of i foot to maximum of 2 feet. 10-Bottom of cesspool to ground water must be held to minimum of 2 feet. MORRIS ROBERTSON I10.0' LOT ~ LOT ? LOT 6 .._-,, ...I N. 8?°l t W. "4 I10.0 ' STANLEY ROAD Unauthorized alteration or addition, to this survey is a violation of ~eclion 7209 of lhe New York Stale Education Law. Copies of this survey map hal bearing the land surveyor's inked seal or embossed seal shatl not be conda~ed to be a valid person for whom the survc,/: ~rc~,,:a, and on his behalf lo the title company, governmenl~l agency and lending institution listed hereon, and lo the assignees of the lending instilution. Guaranlees or certihcations are nol lransferable to additional instilutions or SURVEY FOR PETER Et HELEN DEMETRIOU,8 NISSIM ALDHADEFF AT MA TTITUCK ~EFERE~CE, TOWN OF "$UNSET JCNOU. S SEC. ~ FLED I-5-8e--FILENO. 5023 SOU THOL D suF o£ ~UARANTEED TO, ~ ~8~~ /~/ ~Y~ L~ MORRIS SUFFOLK COUNTY HEALTH DEFARTMEN~ DATE H.D. REF. ~ · The sewage disposal and water supply fac~]it:[es for this location have been insp~cSe5 by this department and found to be saA~f~cto~lF.~... /~ -7; Services I10.0' LOT 8 LOT ? LOT 6 II - TM X-~ .... " t_. : ,.,I --,.,,,w. ,,o.;r STANLEY ROAD Unauthorized alteration or addition fo this sd~vey is a violation of section 7209 of the New York State Education Law. Copies of lhis survey mop not bearing the land surveyor's inked seal or embo:sec~ ,,I I ~ not be considered to be a vapid copy. SURVEY FOR PETER S~ HELEN DEMETRIOU,8 NISStM ALDH, ADEFF AT MATTITUCK · "SUNSET.KNOLLS SEC. I TOWN OF SOUTHOLD FILED SUFFOLK COUNTY, N. SCALE: I"= 40' SOUTHOLD SAVIN~SBANK.~ NOV. 27, 1972 RIVERNEAD TOWN OF SOUTHOLD ~'/,~..~,/ ~, . ~ ~ -- , ~'~' ~ BUILDING DEPARTMENT /_.-xu ~/~ yo ~ / TOWN CLERK'S OFFIGE ./'?~.~ ,~ ~ )~.~ ,~/~£&z ~/~ sOUTHOLD, N. Y, ""/~//'~ - Examined .............. ~....I ..........., 19.~.....'~-. Application No. ~ Approved ...................... .~.t. ............... , 19~ ......Pemit No...~,..~/..~...~,,,,~ ........ Disapproved a/c ............................................................................................ ~ ~ ~- ......................................... ......... ....... ................. ........................... .............. ..... (Building Inspector) AFPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be ~ompletely filled in by typewriter or in ink and submitted in triplieate to the Building Inspector, wi~ 3 sets 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 or areas, giving a detailed description of layout of property must be drawn on 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 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 Zon/~ Ordinance of the Town of Southold, Suffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or demolition, as herein described, The applicant agrees to comply with all applicable laws~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. M.S.T. Constr. Corp (Signature of applicant, or name, if a corporation) 260 Jericho Tpk Mineola (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~ Owner - builder · M~.T. Ccm_ ~tr~m. _ ..... Name of owner of premises .......................................................... .~ .......( ....................................... If applicant is a corporate, signature of duly authorized officer. ~) L~ ~ )~ T ')~ I O L~ sun. ZZ. , , 1. Location of land on which proposed work will be done. Map No.: .................... -ozmo .............................................. Street and Number ...............~..t.~..e~.....R..o.~..d. ............ .M..a...t..t..i...t..~...c..k.......N......~..*. ........ i ...................................................... ~,~m Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · · vacant lot a. Exmt~ng use and occupancy ................................................................................................................... .... ~ ........ one family dwellin~ .. 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 31~500 + ~1.10 4. Estimated Cost ........................... ..--. ................. Fee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....o.b.e. ....... Numbe~ of dwelling units on each floor ......................................... o~.e If garage, number of cars ............................................................................................................................................ 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 ......... ..~.~...-...8. ......... Depth ..... ..2..6.....~.....2.~ ........... · ode Hmght ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ..!LL.~. ............................. Rear ........................... .....~.....'...~..~....~.. Height .................................................... Number of Stories ......................................... 10. Date of Purchase ..................................... Name of Former uwner .~ ....................... ; ............................ :.....~ ......... z.. ..... "" d '+~"'---~- ~ "1t,/7~..-.- 11. Zone or use d,str,ct ,n wh,ch prem,sa~a, re situated ........... ~ ....... .~...a..~. ................................. ~/....~....~ .... 12. Does proposed construct'ion violate any zoning law, ordinance or regulation: ........ ~o. ............................................... 13. Will lot be regraded __~__e.$_ ............................ Will excess fill be removed from premises: [ ] Yes [ ~No 14. Name of Owner of promises ..... .~...,..$.~..~..~.....C..o...~..s...~.~..u...c.~..o.~....C..o.~?. .............. ..~.~.~...e..o.~a.. .......................................... (Address) (Phone No·) Name of Architect ................................................................................................................ (Address) (Phone No.) s~me Name of Contractor ................................................................................................................................................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, 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. See filed plans STATE OF NEW YOP~llffolk ) SS COUNTY OF...................................................... ) M. Tsontos .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. {Name of individual signing contract} ~ is the ................................................ .9.9.~?...a..9..~.o..~.._..-.....b.....~...~.d..9.~ .................................................................................. i ....................... ~ Contractor, agent, corporate officer, etc. of said owner or owners, and is duly authorized to perform or have performe~Ltbflr~a~ls~f~'L~Nand to make and file this application; that all ~tatements contained in this application are true to the best of his knowl~l~a~atbl~eli~g~a6d i~t~t,~ work will be performed in the manner No 52 44 ,-- set forth m the application filed therewith· . ~2-J~3,4, 963 Suffol~ ~ounty~,n · Commi~,~'o~ 1 . Nov 72 ...................................... say of ................................................ 19 ............. Notary Publi .....~.,.../'.. nty ............. ~ .... b/ ~' (Signature of applicimt) -- ,