The URL can be used to link to this page

Home My WebLink About15761-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date September 16, 1987 THIS CERTIFIES that the building ...O.N..E. ?.A.M..I .L.Y.. D..W.E.L.L.I..N.G...W .I ?.H.. ? .A.R.A.G..E ........ 50 Captain Kidd Drive Mattituck, New York Location of Property ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section 106 .Block 03 .Lot 028 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 12, 1987 15761 Z ..................... pursuant to which Building Permit No ...................... dated ..... M..a.r.c.h. ~ ! .6.,.. ! .9 .8.7 ....... 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 ......... ONE FAMILY 'DWELLING WITH GARAGE AS APPLIED FOR The certificate is issued to MICHAEL & CATALIA TOFFALIS (owner, levee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 87 - S 0- 19 UNDERWRITER S CERTIFICATE NO ........... P E N D I N G September 2, 1987 PLUMBERS CERTIFICATION DATED: B~ting Inspector Rev. 1/81 Z~RM* ~i'O. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ ~5761' Z Permission is hereby granted to: _ , __ n .....m~..o...~.......q...o..~. ............................................. ..~.. ~..~. ~.....~.:~.,....u..~.~..~ ..... , _~ ,o ~ .~..~.~ , ....~..;.~ .~.~.~' ~~. at premises located at ..'~ ....... ¥~m~. .. ...~....j .............. County Tax Map No. 1000 Section ..... L.~'.....~. ......... Block ........ .,~,..,,~. ..... Lot No ...... ..C~..,.~....~. ...... pursuant to application dated ...~....~..~..,..l...2~... ................. , 19..~...'7., and approved by the Building Inspector. Fee $.. ~..~.L:....~...~... Building Inspector Rev. 6/30/80 ~/,~7 /O,~ TOWN OF SOUTNOLD [[7 ~ ~ Building Department · Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPA~ Instructions A. This application must be filled in typewriter OR ink, and submitted mm ~mmmmmm to the Building Inspec- tor 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 disposal-{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 installa- tions, 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 "pm-existing" land uses: 1. Accurate survey of p~operty 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 informa- tion requ ired to prepare a certificate. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling $25.00, Accessory,S10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $I0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date .......................... NewCons cz"uc tion ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ....... ~t DD { d ~ Hou~ No, Street Ham/et Owner or Owners of Property ~ ( ~ ~, ~ ~ ~ ~ ~ ~ County Tax Map No. 1000 Section ............... Block O Lot Subdivision ................................. Filed Map No ........... Lot No .............. Permit No../..~. 7~../.. Date of Permit ~.?.b/7~?...Applicant/~..~..Y~?. (~: ?..~'../~..~.~?..J./~c~ Health Dept Approval Labor Dept Approval ................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. d/4~~ s and regulations, Construction on above described building an all appli, i,i,i,~le coati Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit NO. Owner ~td~(,~L ~ (please print) Plumber ,~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before ~ ?~ ~/~ day of //~f-L - , Notary Public,,~0v County ~OTARY PUBLIO, State of New ¥~ 76S.1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: ~L DATE INSPECTOR -~' ~~::/* 765-1802 ~~ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION · [ ] FRAMING [ ] FINAL REMARKS: ~ ,~/~/~'~, /~~~' 76S-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL DATE /~//~-~/,~ INSPECTO~ 765-1802 BUILDING DEPT. INSPECTION [ ] F~OU'NDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ,q / [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [~ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE INSPECTO~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [~']'~OUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL ( REMARKS= ,~,//"/' ~;~ ,~/~~"/~-- OUNDATION ( ls t) OUNDATION (2nd) OUGH FRAME & FLUMBING iNSULATION PER N. Y. STATE ENERGY CODE Fi;IAL T. R. ARNOLD & ASSOCIATES, INC. ~ndustrialized housing advisors 700 E. BEARDSLEY AVENUE · P. O. BOX 1081 · ELKHAR'~, IN 46515 (219) 26~-0745 · TELEX 2S-534~ To Whom It May Concern: This is to certify that our organization, T. R. Arnold & Associates, inspected Deluxe Homes unit Serial New York Label Number ~ <)'~)~ , on and sold to (Builder/Dealer) Inc., and hereby certify that it has been ~anufactured in accordance with the New York Basic Building Code to the best of our knowledge. The unit is to be sold by (Builder/Dealer)_ Very truly yours, T. R. ARNOLD & ASSOCIATES, INC. TRA Inspector PLANNING · MANAGEMENT · MARKETING · DESIGN · PRODUCTION · TECHNOLOGY SERVING THE PREBUILT HOUSING AND MODULAR CONSTRUCTION SYSTEMS INDUSTRY NER(SY 3YSTEM$, INC. Auburn Industrial Park, 1705 Pumphre~ Ave. · Auburn, Alabam~ 36830 Phone: (205) 821-9400 SUBJECT: Verification of Compliance. to. STATE.ENERGY CONSERVATION CONSTRUCTION CODE, STATE OF NEW YORK PRODUCT(S) TESTED: Damper Assemblies, Designated Sizes 24, 30, 33, 36; 42 and 48. Products tested included rotary and poker controls with steel and cast iron dampers. DATE TESTED: June 20, 1979 MANUFACTURER: Vestal Manufacturing Company Sweetwater, Tennessee 37874 TEST RESULTS: The products tested by Energy Systems, Inc. have been found to meet or exceed the requirements for residential fireplace units as specified in Section E402o4 (7B13.5), STATE ENERGY CONSERVATION CONSTRUCTION CODE, STATE OF NEW YORK. The con~pliance of these products is not affected by glass doors or other accessories. Energy Systems, Inc. is an independent, ICBO and SBCC approved testing laboratory located in Auburn, Alabama. Alabama Registered ?~ofessional £nginee~ No. 809q CHIEF ENGINEER ENERGY SYSTEMS, INC. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL PLEASE TAKE NOTICE that your application dated ............... ~~~ ~ 19 ~ .~. forpennittoconstruct...~.~. ~~~, ~' ....... ~ ................. ~ at Location of Property .A;~...~.%~. ~.~ County Tax Map No. 1000 Section . .'.]. O. ~ ....... Block ....~. ~ ...... Lot .. ~ .&.~ ...... Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and disapproved on the following grounds .~.~.'..~....~.. ~./..~. 7.~. ~ ..... Braiding Inspector RV 1/80 TOWN OF $OUTHOLD BUILDING DEPARTMENT ' .- APPLIGATi0~' ,FpR BUILDING PER/~IT I. Application must be filled in by typewriter OR in ink end subr~itted to Building Inspector, with: !;,. ? a. Health Department approval to construct private well and s~?age disposal system, OR aPProval to hook up to public water and sewer system if available. .~r b. Accurate plot plan TO SCALE showing all lot lines, streets, buildings, unusual natural features, exact size of lot and proposed buildings, and existing buildings, elevations and other topographical information, Subdivision name, lot and block number etc. Plot plan or survey must be signed by person or engineer or surveyor preparing same. c. The plot plan must show the actual shape, dimensions, radii~ angles and area of the lot on which it is proposed to build, or add to an existing building. d. The dimensions of all yards, setbacks, distance between proposed building and existing buildings or structures on same lot must be shown. Plans for proposed building OR addition to existing building must be clear and legible, submitted ih triplicate. One copy of each filed ¢~pplication, plan or document will be returned to applicant for their records. f. Where required, copy of approved special exception from Board of Appeals and/or site plan approval from the Planning Board must be submitted with application for such building permits. g. Application for sign permits will use same forms and procedure as for buildings, however separate "plan sheets" giving outlines, dimensions, exact locations and other detailed pertinent information may be submitted. h. Permits expire in twelve (18) months from date of issue with exceptions os noted in i~ilding zone ordinance. As soon as a foundation for a building OR for on addition to a building is completed and before any first story framing is started, an accurate "foundation survey" showing accurate distance from foundation to all property and street lines shall be submitted to the Building'!nspector and approved before further construction is permitted. If you do not begin work within a 12 month period the '· Building Permit becomes VOID. (Starting from date of Issuance.) k. Permits may be revoked for cause as outlined in the building zone ordinance. I. Stop orders will be issued under conditions outlined in the ~zonin~ ordinance. 3. Regrading of building lot or premises, removal of excess fill from such grading, cellar or basement excavation, cesspool excavation, driveway construction, etc., must be applied for at time of building 'permit and permit issued by Building Inspector (sand, gravel & excavation ordinance). - nnotti o.o ot.. 380 Station Road New York 11713 Area Coda 516 - 266 · g49;~ Rockhall Builders Inc. P.O. Box ~02 Rocky Point, N.Y. 11778 'S · ept. 3, 1987 Re: House at 50 Capt. Kidd Driv~ Mattltuck, N.Y. Gentlemen: An inspection was made on Sept, 2, 198~ of the above referenced house to determine the structural integrity of the foundation walls. The vertical hairline crack on the north cellar wall, above grade, does not affect the structural integrity of the wall. This has been sealed with mortar and is apparently tight tQ air and water. Also it is to be noted that there are intermediate partition walls on either side. The south wail was modified and is now constructed of a concrete 10" foundation wall, 2" below grade and 6" above grade~ with a 2 by 6 ~ 16" o.c. stud wall on top, completing the cellar wall.' A brick facing, supported by the concrete walla finishes the outside. This wall is a structurally acceptable design. Auburn Industrial Park, 1705 Pumphrey Ave. - Auburn, Alabama 36830 Phone: (205) 821-9400 ~' SUBJECT: Verification of Compliance to. STATE.ENERGY CONSERVATXON CONSTRUCTION CODE, STATE OF NEW YORK PRODUCT(S) TESTED: Damper Assemblies, Designated Sizes 24, 30, 33, 36~ 42 and 48. Products tested included rotary and poker controls with steel and cast iron dampers. DATE TESTED: June 20, 1979 MANUFACTURER: Vestal Manufacturing Company Sweetwater, Tennessee 32874 TEST RESULTS: The products tested by Energy Systems, Inc. have been found to meet or exceed the requirements for residential f~replace units as specified in Section E402.4 (7813.5), STATE ENERGY CONSERVATION CONSTRUCTION CODE, STATE OF NEW YORK. The con~oliance of these products is not affected by glass doors or other accessories. Energy Systems, Inc. is an independent, ICBO and SSCC approved testing laboratory located in Auburn, Alabama. A).abm~a Registez'ed Proleaslon&l £ngineer liDo 809~ CHIEF ENGINEER ENERGY SYSTEMS, IHC. ~ TOWN HALL .~ 4~~ SOUTHOLD, N.Y. 11971 ~ ~ TEL.: 765~1802 Disappmwd a/c ..................................... (Building Inspector) ~[~C~TIO~ FOB BD~[D~G ~EBMIT Application No..., ............... Date .................. , 19... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued 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 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, ordinan/c, es].jgja',~i,~code, hg;usin~ code, and re~lationk, and to admit authorized inspectors on premises and in building for nece ' s. c //,~, (Si~guatu~r~'o.~pp~)cant, or__name, if a corpora 'o) (Mailing addreVs of applicant) ] State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... i .......... ......... ,¢' .................................. Name of owner of premises ~.,:~...,~.. ~.~.~..~.~.~( .... ~ .~.' ." .................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. 6 g,~f ~. ~, Plumber's License No. fi?O? Electrician's License No....~..' .~...~. ............ Other Trade's License No ....................... ~J ' /, ,~ -- , don ht h o sed or will be done ~rt[~-/~"'~'~"' ~t~' /~_~.7.~..~.~ 1. Location of lan w 'c pr)po w k ' .z,-t2v~T~rt~.+.o.~...t'~"~... · .-.-// ................. ................... ..... ":. .................. House Number Street Hamlet County Tax Ma No 1000Se t, ion 10~ Block D~:~ Lot Subdivision..~,~..~.,~. ~'?~.t~.fi/.~.(~A~iled M'a;'~' i ii~,",~.i i i... ~i i i i'~,~, (Name~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy... YAf-~/~JF ' . ......... : :..,~ [. .................. b. Intended use and occupancy .................................. ii .' ' '"" .' .........( ':" ...... Other Work ............... 4. Estimated Cost ............................. Fee ...................................... ~ (to be paid on f'fling this application) $ If dwelling ' ' ' ' Number of dwelling units on each floor · , number of dwelbng .UPlts. .......................... If garage, number of cars .... /~/0~. ............................................ ~ ........ 6. If business, commercial or mixed occupancy, specify, nature and extent of each type of use ./,]~ ................. 7. Dimensions of existing structures, if any: Front./~0~:. · · .... Rear .............. Depth ~ . ....... Height ............... Number of Stories ........................................................ l)imensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i. · Height ......... , ............ Number of Stories ...................... 8. Dimensions of entire new consffuction: Front ... ~'.~. ........ Rear . ..~..~. .......... Depth .~' ........... Height ..... ~ .0. ..... ~N~unlber of Stories .' ....... l .~ .......................... 9. Size oflot: Front . .~0,~.0.. ........... Rear ...... 10. [)ate of Purchase ........... i .................. ~ame of Former O~vfi~r ............................. 11. Zone or use district in which pr4mises are situated .... 12. Does proposed constructiqn rio!ate any zoning law, ordinance or regulation: .~.~.~.../~.~.~../f~...~./f .t~>.. 13. Will lot be regraded .../¢[I~0P~. .................. Will excess_fill be ren~ov=.d, from premises,/i?~= x~Z_~"~ .... No NameofOwnerofpremises~' ~. [~.h~ . .Addre~ 14. ~ .... ..... Name of Architect ~I_0]D~.-~.-J'~...~4~. ~, r.e.-r~)~/t~,~, .mress ./~'~ .'-~.~/~/.~.~1~7o°7~e No.'-~-:~ :' . . .~. Name of Contractor K~4~at'(./:~td.~./.% ....... Address I~0~ 7o~/.~/~.~ ......1 Phone No. ~.~.¢:x.~.~./.~. .... Locate clearly and distinctly all property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate ail set-back dimensions from aumber or description according to deed, and show street names and indicate whether STATE OF NEW, XOP~_/D S S COUNTY~,~:__ ~OF'. ~>~.r. ~_.q .g~...z~f ~' ' ' --, i ' .... ~.~,-) ~.~C(['4~...o7-.'~..C ~¢d&.~;L) .~ .L~.: .............. being duly sworn, deposes and says that he is the applicant (I'~ame of individual/_~nlng contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~~ authorized to perf.orm or have performed the said work and make and file this application; that all statements contained in this applicatmn 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 theiewi~h. Sworn to before me th. is ........... ~.¢ ......... day of! ........... 19 ~.~ ................... County Notary Public,. ...... ' '~'~'~' 'f)~ !~' 'x''~ ~ff--~. ~~.,.~, ROSAUE 8ALEMME ; ; ' .". ..... ' .' ......... ~ , BOARD OF HEALTH · 3 SETS OF PLANS ~'FORMNO. 1 ?t*,,' SURVEY Town OF SOUTHOLD CH~CK BUILDING DEPARTMENT SE'~TIC FORM TOWN HALL NOT I'FY $OUTH'0LD,.N.Y. 11971 TEL.: 765-1803 CALL MAIL TO: xamined ................. 19 .. ,pproved ................ ,19 .. Permit No ............ )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspeet0r, with · ts 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 streeL. : areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli ~tion. 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 issued a Building Permit to the applicant. Such permi~ ~ail 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 Occupan% ,.all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th,. uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building c. ode, housing code, and regulations, and trait authorized inspectors on premises and in building for necessary ~'!'!~~/~ ~ ~' f~Signature of appli~in~, or name, '! P, (Mailing address of applicant) rate whether applicant is owner, lesseea agent, architect, engineer, general contractor, electrician, plumber or~ builder. (as on the tax roll or latest deed) .' applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No...I ..................... Electrician's License No. ~-~ ~- Other Trade's License No ...................... · Location of land on which proposed work will be done: Z House Number Street Hamlet County Tax Map No. 1000 Section .. ]~ ~ Block (<tOO ff$(~ ~{ ~f~ fv~ Filed Map No Subdivision~Ff. .. . ..... . · ...... ........................... · (Name) State existing use and occupancy of premises and intended use and occupancy of proposed E ti d a. xis ngusean occupancy ..................................................... b. ~se ................................... · .. ... . I 3. Nature, of work (check which a cable: New Building ......... Additio .......... Alteration ......... Repai~ .... Removal Demolition ' Other Work .~.~ ~,~",~ ; (Description) ,, ~<.,e~ .~*',-g~" . (tol' b~ paid on filing this application) 5. ifdWe~ing~ number of dwelling units~.,. ~ ..... Number of dwelling hnits on each floor ............... If gauge, number of c~ .... ~ ~ ~ ~ fly htyp use' ' ~' ' ' ' ' .~ .............. 6. If b~lae~ eom e mi or m~xed occupancy, spec natur~ and extent of eac e of D~)~ e t ~P~ [ pth 7. s of ex~st~ng stmctur s if any: Fron ...... Rear .............. De ............ He , ~ ............ Number of Stones ......................... i .................... D~ons'of same structure with alterations or additions: Front ~ ' Rear De~ He'~t Numbe3 of .... , ................. ........ . ~,, ~,,~ . -- '~t Re ~1:' Depth~ ' ...... 8. D~il~s bf entire n~w constmctwn: Front ...... ' ..... ar ......................... .............. o < ......... ........................ .,. ........... .... 9. SiZ~Ofl~t: Pront . ~:~ ............... Rear.. ]).~; ................ Depth .. ~,. ............. I0 Dat6 of Purchase Name of Foyer Owner l 1. Zone oruse district in which premises are situated., i~.~.~ ....... , .............................. 12. Doei~Proposed construction violate any zoning Iai, ordinance or regulatiom ,~;i.. ~.~.~t}~ 13. W~I lot be regraded .... ~. t ~.°.~ ................. Will excess fill be removed from pre~ises: 14. N~o~o~Ow~er of premises ~t~. ~/}.. Address ~.~T~e6,~ .?~,. Phone No ~: ~.~,~ N~e of Architect . ~O.h~ ~, 19~;~t~ ~!~Addr~ss ~ ~i~, .~. Phon~ No .... ' ........... tS. Is this property located ~i~hin 300 fee~ of a tidal wetland? ~Yes ..... ~o .~. *If yes~ ~outhold To~ Trustees Pe~iC maybe r~uired. ~ .: ~ PLOT DIAG~ Locate cl~ly ~d dist~ctly MI bu~d~gs, whether existing or proposed, and. indicate ~1 set-back d~ensions fror prope~ fl~b~i 'GiVe street ~d block number or deso~ption aocord~g to deed, ~d ihow street n~es and indioat~ whethc inte~or O~o~m~r lot. :TAT[ S.S !~.~.. ~-.~.. ~'~.~,~. 7, ............ being duly sworn, eposes a~'[ tS the ~pplica~ ' ~ contract) ~ " lc is the,. '., ;,., · ,;-~ (C(>ntractor, agent corporate office,, ~ f said ow~ or ownem, ~d is duly autho~e,d to perform or have perfona,,za ,.~ said w6ik afld {o m~ ~d file thi~ )>plicafld~;:that all statements cont~ned ~ this applicat~n are true to th~ of his ~oWiedge and belief; and that thc 'ork w~l~e perfo~ed m the m~ner set forth m the apphcation filed L ,ctg~th. worn tb~f0~ me t~ ' ' ~ '" , ...... , .......... ~ ..... day of...~ ........... ~... oFEICE OF THE TOWN CLERK Town of Southold Judith To Terry, Town Clerk Town Hall, 53095 Main Road P. Oo Box 1179 $outhold, New York 11971 Telephone (516) 765-1801 TOWN OF SOUTHOLD Appli, Con: Alteration Residentia! N0n-Resi< SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. ., , , APPLICANT NAME: APPLICANT ADDRESS: SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Mus~t be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: ~Ct+~EL- ~ C,4f-~l/~ ?~'~.,~/'-I~ '~ OWNER MAILING ADDRESS: ~ ~'~ ~ Po rr, /(7Z , ' TELEPHONE NUMBER OF CONTACT PERSON: Z¢¢c~F/o Cgo~z,~) RECEIVED BY: DATE: TAX MAP NO.: Section CROSS STREET: CuT(~-S BUILDING PERMIT NUMBER CROSS REFERENCE: Town Clerk'~ Office Lot 162 CAPTAIN":':° IqDE~ MAR 6 10~ . DwEt;.LING' ' ' Lot 160 DWELLING Lot SINGLE FAMILY DWELLING ONLY EXPIRES TWO YEARS FROM DATE OF APPROVAL ,~UFFOLK COUNTY DEPARTMENT OF HEALTH SERVICI~,. FOI~ AP.J)ROVAL OF CONSTRUCTION ONLY &PPROVED~ , O~PARTMEHT~OATA F~ APPRO~L TO E: MONUMENT ~= STAKE ~= UBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON ~AN.19,1987 OAS FILE N0.167~ SURVEY FOR MICHAEL TOFFALIS 8~ CALATIA TOFFALI$ LOT NO. 161)"CAPTAIN KIDD ESTATES" AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY~ NEW YORK ,J _ YOUNG a YOUNG ALDEN W. YOUNG~ PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.C. UCENSE NO. 12845 HOWARO W. YOUNG~ LAND SURVEYOR N.Y..S. LICENSE N0.45895 BRAttDI$ & SONS II~O. 1046 FEB. 26, 1987 dAN. 2:8, i987 DATE: dAN. 6, 1987 SCALE: I": $0' NO. 86'144E 400 ~OER AVENUE RIVERHEAD~ NEW YORK Chief of ~stewater Management Soctlon ~[ ~)~ ~ ~.~ ~,,.o, SU~Y FOR JUNE ~0~1987 MICHAEL TOFFALIS & CALATIA TOFFALIS F~B. 26, 1987 LOT NO. 161,"CAPTAIN KIDD ESTATES" JAN,28,198;7 AT MATTITUCK D~E= JAN. 6, 1987 ~WN ~ $OUTHOLD SUFFOLK COUNTY, NEW ~RK No. 86-144Z HE~ DEPARTMENT-DATA F~ APPRO~ TO C~STRUCT AND ~ Nil ~LF ~ T,[ ~TL[ CM~Y, NEARESTJW mAIN--ML ~ N SOUHCE ~ WATER, ~I~TE__P~IC ~ MENTAL AGENCY AND LENDING INSTITUTION LIS~D NOTE: I=MONUMENT ~: STAKE SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W. YOUN~)PROFESSIONAL EN61N/ER AND ~ND SURVEYOR N.Y.S. UC/NS/NO. SUFFOLK COUNTY ON JAN. 19~1987 OAS FILE N0.1672 HOWARD W. YOUNG~ LANO SURVEYOR ~ L~ ~ ~L(W),~IC TA~(S~IC[~S(~)WN ~ . N.Y.S. LICENSE N0.45893 ME mM FIELD ~Tl~S ~ ON DATA OITNMO Fq OTHERS .- BRANDI$ & SON8 lNG, 1046 CAPTAIN KIDD DRIVE // / __ SUFFOLK couNTY 8~GLE FAMILY DWELLING ONLY THE S~AGE DISPOSAL AND WATER SUPPLY FACILITIES FOR LOCATION HAVE BEEN INSPECTED BY THIS DEPARTMENT AND FOUND TO BE SATISFACTORY. . i Chief of Wa~tewater Management S~tion SU~ FOR ' aULY JUNE 10~1981 MICHAEL TOFFALI8 FEB.~6~ 1987 LOT NO. 161,"OAPTAIN KIDD ESTATES" ~AN.~8,198~ ., AT MATTITUCK D~TE, dAN. 6, 1987 ~WN ~ SOUTHOLD SCALE, I"=SO' SUFFOLK COUNTY, NEW ~RK NO. 86-144z M~[~ A~ ~ ~[L~i~l WITHIN lO0 FElT OF TW~ P~OPKNTY iNSTITUTI~. GUArANTEeS ARE ~T TWSFERAIg[ : ~. ~ } ~ ~NDER AVEWE NOTE' ~= MONUMENT ~: STAKE SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF AL~EN W. YOUNG~PROFESSIONAL ANO ~ND SURVEYOR N.Y.S. UCENS[ NO, 12845 SUFFOLK COUNTY ON JAN. 19~I987 OAS FILE N0,1672 HOWARD W. YOUN6~ LAND SURVEYOR a N L~ ~ ~L(WI, EHIC TA~II~i C[~lle) WN W[~ N.~ S. LICENSE NO. 45893 BRANDI8 & 80N$ INC, 1046 /¢ ,' ~ ~ ~ ~*~. 'sz .~¢' z/ ~ ~ ~ ~~.. ~ ..~ I_~ ~ _~ ~ / ~.o, SU~'Y FOR ' JULY 21,19~7 JUNE 10,1987 MICHEL TOFFALIS ~ CALATIA TOFFALIS ~A~a~,~go7 - FEB. 26 ~ 1987 LOT NO. 161, CAPTAIN KIDD ESTATES" JAN.28,1987 ., AT MATTITUCK DATE: dAN. 6, 1987 '' ~WN ~ SOUTHOLD SCALE~ 1"=30' SUFFO~ COUNTY, NEW ~RK NO. 86-144Z HE~ DEpARTMENT-DATA F~ APPRO~ TO C~STRUCT -- ~ ~R~ FOR WHOM THE SU~EY i$ PREPAREO NOTE= I:MONUMENT ~: STAKE SUBDIVIStON MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W. YOUNG~ PROFESSIONAL ENGINEER AND ~ND SURVEYOR N.Y.S. UCENSE NO. 1~845 SUFFOLK C~NTY ON JAN. 19 ~1987 OAS FILE N0.167~ HOWARO W. YOUNG~ LANO SURVEYOR a~ L~T~ ~ ~L(W),~IC T~(~)aCE~OLt(~) ~ ~ N,Y.$. LICENSE N0.45893 t Lof 160 ----------. __ .' Lot 162 ~ ~ - ~~ ~¢~ / r~ ~,~. .... ~ ,~/ ~ / , CAPTAIN~;**'° KIDD DRIVE ~[.~., / ~ ' SU~ F~ ........ MICHAEL TOFF~LIS ~ CALATIA TOFF~LIS ~F~K ~UN~ D~A~M~ OF ~L~H ~RVl~t LOT NO. 161,"CAPTAIN KIDD ESTATES" JAN.Z8,1987 AT MATTITUCK DATE: daN, 6, 1987 ~R ~ROY~ OF CONSTRUCTION ONLY ~H ~ SOUTHOLD SCALE: SUFFOLK COUNTY~ NEW ~RK NO. 86-1442 REP. [ ~'~ ~UTH~tZED ALTERATION ORADDITION ~ ~IS, ' SURVE~R'S INKED ~AL OR EMIOSSED SE~ SHALL NGUARANTEES INDICTED HE~EON ~ALL eUN ~CY ~ HE~ DEPARTMENT-DATA F~ APPRO~L ~ C~STRUCT mE ~R~ ~e WHOM THE SU~EY IS PREPAeEO YOUNG YOUNG .,v~.~o, ~NOTE, B=~ONU~ENT ~= STAKE .... I AL..N~,~.~,~,PROF.~i~NA.'..;~4.P.e~ ' SUeOIVlSlON MAP FILED IN THE OFFICE OF THE CLERK OF ANO LAND SURVEYOR N.Y.S. UCENSE N0.12845 SUFFOLK C~NTY ON daN. 19,1987 OAS FILE N0.1672 HOWARD W. YOUNG, LAND SURVEYOR ~ L~ ~LM),~IC TA~(~IC[~(~) WN ~E~ N.~S. LICENSE N0.45893