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Home My WebLink About9819-z FO~ NO, 6 TOW~ OF $OUTHOLD , Building Departmenf Town Clerks Office Sou~hold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE 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 disposol--(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, o 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: I. Accurate survey of property showing oil property lines, streets, buildings end 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 occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ................ Old or Pre-existing Building ................ ¥ocont Land .............. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~..../..~..~ Date Of Permit ....................Applicant .................................................................. Health Dept. Approval ....~..~..,.~..c.)....~....c~ ............... Labor Dept. Approval ................................................ Underwriters Approval ......~..,~......'.~....7./_~ ............... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate ....... ~ ............................. Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ..... ....~..C~.~-~;t~.......~..~,~z.~.~,~ ....................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) /o/, Bldg, 40, sUNY S~ony Brook, NY 11794 516 751-7900 Mr, Stephen O. Tsontaki8 P.O, Box 791 Middle l%oad Mattituck, NY 1195~ ' "" ' · ~ RE: ~%pplication No, FW 15273-0074 Dear Mr, Tsontakts: ' Your application for a freshwater we%tannin ~n~mrim permit h~ls been ~aviewed by this offie,e, ,AS? reso~t we have determined that constr~ction of a sl~e family'dwelling ~5' frc~ the edge of the La~e and Marsh in accordance With the w~r~ plan on file with th~s Department. will harm no effect Upon £reshwatsr w~tlands, ~rovided a snow fence is erected tn prevent construction debris amd fill from entering th~ marsh, Therefore, pursuant to'Section 24-0703 of the Environment-al Conservation Law and 6NYCRR Part 662.4(b) you are hereby notified that no permit will be necessar3~ A Copy of this determination at ali times during construction D/L :elm muat be a'vailable at the jab sita' aetivity~ ~Region~l Parmit Administrator By: A1 Wolff, Sr. Enviro~ental Analyst TOWN OF SnUTHQLD OFFICE OF' E]UILDING INSPECTOR TOWN I~-LERK'$ OFFICE SOUTHI]LD, N. Y. 11971 .~-- FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................. ~,..~..~./.....~, 19.Z....~,~...,~ Application No. ~ .................. D,sopproved a/c ....... ............... .................................................................... ...... ............... ........ APPLICATION FOR BUILDING PERMIT Date ................................. t .............. , INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule, b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty 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 available for inspection throughout 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 ether 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ........................ ..................... State whether applicant is owner, lessee, agent, architect, engineer, lgeneral contractor, electrician, plumber or builder. Name of owner of premises ....... .~_..~..~..~...~....~..~.i ........ ..~,....~....~.....1~.. .......... ..(.'..4~.~ .............. . ......................................... If applicant is a corporate, signature of duly authorized offJcez. (Name and title of carparate afficer) Builder's License No .............................................. Plumber's License No ................................................. Electrician's License No ..... C,.~¢.~,,,',,~.,,~.,.~',,,,,~~:'~'~ Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: · Lot'No. Street and Number ....... ~:~:~!...~....O..~.k.~.......t~....~.~. ........ ~.~..~..O..~.¥...~,~ ..................... ~/~unicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use ond occupancy ............... ..~..~.~...~...~..,~ .............................................................................. b. Intended use and occupancy . ~ 3. Nature of. work (check which applicable): New Building i/ Addition .................. Alteration ' Repair .................. Removal .................. Demolition .................... Other Work ................................................ ~ .... ~J~ (Description) 4. Estimated Cost ................... , ....................................... 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 c~rs ..................... .J......~~ ................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..........J~"'~"J~4~." 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 ...' ....... ~...C~.. .................. Rear ......... ..~...O. ............ Depth ...... ..~.....~.. ......... Height ....~...'~. ......... Number of Stories .................................................................................................................... 9. Size of ot: Front ............. ...... ........ i0. Date of Purchase .~.~..,....L.~...~.,~. .......................... Nome of Former Owner ........................... ~ ........................ 11. Zone or use district in which premises are situated .................... ~.~'~..~...~....~.~ ......................... 12. Does proposed construction vioJate any zoning law, ordinance or regulation: ............. ~.,..t,~ .............................. 13. Will lot be regraded ........ .~......Q ........... Will excess fill be removed from premises: ( ) Yes ( 14. N ama of Owner of premises .....j~..~.-~...~....~...~......~... ('A~(~ls~s ....~..~.~...~. J,.r ._~..~..'~t~h~l~on~e~. ~.~ .., ~ ~ Name of Architect ....................................... Address ..... Phone No . Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, I, e ~ COUNTY,OF ................................ ~' '~'-' ....................................... ;... ~.. .............................................. being duly sworn, deposes and says that he is the apphcam (Name of individual signing contract) above named. He is the ~,,~t~-~ ~ (Contractor, agent, corporate officer, etc.) of sakJ 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 perfarm.,e~d in the manner set forth in the application filed therewith. Sworn.~.....~..to~b~fore me this / J ..... .......... ................. , C , (Signatu~ of applicant) ~ ~/~ - !'~ABE'I'TE C. CONRO¥ -quffolk County No. ~ommlal~n EXpires March 30, POND N.O $2 40 W. tie h~e ~ 155,95~ bulkhead J · ! T~$T HOL~ top so/I hea~ loam traces of clay ~ rocks ......... ,SUFFOLK FOR APPROVAL OF CONSTRUCTION DATE , HS REL NO. APPROVED ' COUNTY DEPARTMENT QF HEALTH SERVICES' ONLY HEAL'TH DEPARTMENT- DATA FOR APPROVAL TO CONSTRUCT 'K'NEAREST WATER MAIN "~ MI.-~ ~'SOUR~EOF WATER, PRIVATE V' PUBLIC~ ~(' BUFF. CO.~TAX MAP DIST. SECTION BLOCK LOT · ATHERE ARE NO OWELLINO3 WITHIN IOO FEET OF THIS PROPERTY OTHER THAN THOSE BHOWN HEREON. · ~THE WATER BUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. APPLICANT= ADDRESS ' TEL., · = MONUMENT · -' SPIKE 'X' THE LOCATION OF WE LL (Wi,SEPTIC TANK (S'~') & CE*~SPOOLS (CPi SHOWN HER EON AR,E FROM F~LD OBSERVATIONS AND OR D~TA OBTAINEO PROM OTHERS SURVEY FOR ADELPHI LA~,ND COF~P. AT ~,SOUTHOLD TOWN QF SOUTHOLD SUFFOk:K COUNTY, NEW YORK ~UNAUTH~RIZEO ALTER,~TION OR ADDrTION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION [:AW, -X-CO?lES 0~: THIS SUBVE~F NOT REAR NG THE LAND SURVEYOR S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO RE A VALID TRUE COPY ~GUARANTEES INDJCATE[~ HEREON SHALL RUN ONLYTO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HI~ BEHALF TO THE TITLE COMPANY~GOVERN- MENTAL AGENCYAND LENDING INSTITUTION LISTED HEREON,AND TO THE ASS~IGNEES OF THE LENDING INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE TO ADDiTiONAL JNsTrTuTflONS OR SUBSEQUENT OWNERS· ~DiST~NCI~S SHOWN HEREON FROM PROPERTY LINES P'URPOSE ~NO ARE NOT ~0 DE USED TO ESTABLISH PROPERTY LINES OR FOR THE ERECTION OF FENCES. DATE ' dUNE 8, 197B SCALE: / "-- ~0~ ~o. : 78 - 306 GUARANT~£D TO: 400 OSTRANDER AVENUE RIVERHEAD,NEW YORK Ii//h IIIllt ~lll~ .Iht Illlll rK$T HOL£ top soil haovy loom lroc~s of cloyS rocks ,00 1.0 ~2 Fac]lit]os i'or this location have bee~, HEALTH DEPARTMENT- DATA FOR APPROVAL TO CONSTRUCT · N. SUFF. CO. TAX MAP DIST. SECTION BLOCK LOT -X-THERE ARE NO DWELLIN(~ WITHIN I00 FEET OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON. ~-THE WATER SUPPLY ANO SEWAGE DtSPOSA~ SYSTEM FOR THIS RESIDENCE WiLL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVIEES, · = MONUMENT ·: SPIKE '~THE LOCATION OF WELL(W),$EPTIC TANK(ST)~CE~SPOOL$ (CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND ON DATA OBTAIHE D FROM OTHERS. suRVEY FOR JOAN L. TSONTAKIS A T SOU THOL D TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK '~UNAUTHORtZED ALTERATION OR AODITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OFTHE DATE S~t~. , 1978 SCALE ' / "= NO. 78 - 306 GUABANrEED ro : NFW YORK ~ USLlm r/IAg INSU~AIVCF COMR~NY OF fill , YO NG a YOUNG ALDEN W. YOUNG PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.S. LICENSE N0'12845 HOWARD W. YOUNG, LAND SURVEYOR ORTA N.YS. LICENSE NO. 45893 ~DER AVENUE RIVErHEAD,NEW YOrK , i~, ;,,i~ ~CAVAIISIt IN~P[CIIUli Jff.~!~[~ " '78 JUN ~ ~ 9 ' b~ -~ ~ ~ ...~.D. , Y' '_,6v ........ ~.2 ~UFFOLK COUN~ ~A~T~ENT OF HEALTH AT ~OUTHO&~ ~TE . JUNE ~, ~ APP~WL OF CONSTrUCTiONal. ~ONLY TOWN ~ SOU~HOLO sc~ ~"= 40' DATE~'~S~ ~' APPRO E : ~ ~COPI/S OF THIS SURVEiY NOT ~EARJNG THE LAND H~L~H DEPARTmeNT- DATA FOR APPROVAL TO CONSTRUCT t~E P~S~N FOR WHO~ ~HE SURVEY IS PRePaRED, OTHERT~AN THO~E 8.OWN HEREON. TO ADD~T,ONAL ,NSTITU*iONSORSUBS~U~NT WILL CONFORM TOTHE'TANDARDSOF'HE SUFFOLK COUNTYDEP~TME"T TO EX ~T 'G STRUCTURES ARE FORA SPECIFIC. ~ APPLICANT' ~CO~l ~ ~-- PROPERTY'LINES OR FOR THE ERECTION OFFENCES. ~ YOUNG sYOUNG ~ooo~.~.o[. , ~ RIVERHEAD, NEW YORK J = MON~ENT ALDEN W. YOUNG,PROFEssIONAL ENGINEER · = SPIKE AND~LAND SURVEYOR N.~S.LICENSE N0.12845 HOWARD W. YOUNG, LAND SURVEYOR '~ THE ~T~ ~ WELL (W)tSE~IC T~K{S T) ~ C~$P~LS (CP) SHO~ HER EON N.~ ~, L J C E N~ E NO, 458 9 ~ ARE FR~M ~ ~LD OB~RVAT~S ANO OR ~TA O~TA~NE~ ~ROM OTHERS. ,, ~9AM to 4PM FOR REQUIR- eD INSPECTIONS: ]. BEFORE BACKFILLING FOU[~DA- TION OR START FR~.-. ~, ~ ~flS~UCT~O~ MUST R~UIR~EN'~'~ ~'F ~I.Y. ~T~ CODE [ .-~-,o.o.... l,,?,.,*,-I~,-,I,'--! ", J J J J~V ~ 'i'SONTAKI$ ~tO NS U LTr!N~' INGINEER '[ STEV" ' · ' II _1 UT'