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HomeMy WebLinkAbout35629-Z r".s,..4 a Town of Southold Annex 10/6/2011 ' tlFFOtK t 54375 Main Road Southold, New York 11971 • f ,1 CERTIFICATE OF OCCUPANCY No: 35267 Date: 10/6/2011 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1100 WESTPHALIA RD MATTITUCK, N.Y. 11952, SCTM #: 473889 Sec/Block/Lot: 114.-7-14.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 6/9/2010 pursuant to which Building Permit No. 35629 dated 6/9/2010 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: "as built"accessory in ground swimming pool with fence to code as applied for. The certificate is issued to Milienos, Savas&Milienos, Joanne (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 35659 1015111 PLUMBERS CERTIFICATION DATED ho tzed gnature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35629 Z Date JUNE 9, 2010 Permission is hereby granted to: SAVAS & JOANNE MILIENOS 118 KNICKERBOCKER ROAD MANHASSETT,NY 11030 for "AS-BUILT" IN-GROUND SWIMMING POOL IN THE REAR YARD AS APPLIED FOR. REPLACES EXPIRED BP # 33750 at premises located at 1100 WESTPHALIA RD MATTITUCK County Tax Map No. 473889 Section 114 Block 0007 Lot No. 014 . 001 pursuant to application dated JUNE 9, 2010 and approved by the Building Inspector to expire on DECEMBER 9, 2011 . Fee $ 500 . 00 Authorized Signature ORIGINAL Rev. 5/8/02 Form No.6 - TOWN OF SOUTHOLD_ BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building 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 from Health Dept.of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2110 of I% lead. . 5. Commercial building,industrial building, multiple residences and similar buildings and installations,a certificate of Code Compliance-from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses,or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly spmpleted application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00, Additions to dwelling$50.00, Alterations to dwelling 150.00, Swimming pool $50.00, Accessory building$50.00, Additions to accessory building$50.00,Businesses $50.00: 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy -Residential $15.00, Commercial $15.00 Date. New Construction: ii Old or Pie-existing Building: (check one) W Location of Property: 1 00 p S h0.1 iq V�A I 11 Wcy- House No. Street Hamlet Owner or Owners of Property: `7 a Ua S f J 4 r� Suffolk County Tax Map No 1000, Section Block —7 Lot 1 Subdivision 2 Filed Map. Lot: Permit No. ) .� Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: P S W Request for: Temporary i ate 20j1 Fi 1 rtificate: (check one) Fee Submitted: $ BLDG-DLPT TONlM OF SOIIiHOLD i Applicant Signature pF SOUryo�o Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631) 765-9502 P.O. Box 1179 roger.riche rt(a)town.southo Id.Fly.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Milienos Address: 1100 Westphalia Rd City: Mattituck St: NY Zip: 11952 Building Permit#: 35659 Section: 114 Block: 7 Lot: 14.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: as built DBA: License No: SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor H 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment: in ground swimming pool to include, bonding, cover motor, pool light, heat pump Notes: 7 � � / Inspector Signature: qc Date: C Sh 81-Cert Electrical Compliance Form 3S� z7 OF SON TOWN OF S =765-1 ILDING DEPT. � INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSUJATION [ ] FRAMING / STRAPPING [ INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESGTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: �� C riles 4� DATE �� INSPECTOR 3 Z 2, 9 hoe�tOF s0oftj 6 f®} lil TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU TION [ ] FRAMING / STRAPPING [ INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: zz DATE ��' INSPECTOR F COMMENTS FIELD INSPECTION REPORT DATE W 6 FOUNDATION (1ST) ------------------------------------ FOUNDATION (2ND) t z ROUGH FRAMING& PLUMBING — W o INSULATION PER N. Y. STATE ENERGY CODE - - -- v �c Gc 3lilt �. FINAL c ADD ONAL COMMENT O O m c, <� '> I O = z x Y r M w Ci7 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plane TEL: (631) 765-1802 Planning B/ rd approval FAX: (631) 765-9502 Surveys/ www. northfork.net/Southold/ PERMIT NO. 7SZ Check, Septic Form N.Y.S.D.E.C. Trustees Examined 'A_I lei, 20 bg/ Contact: / 1 Approved,20 15 d Mail to: i rn C�Yt 00 15 Disapproved a/c 471 Q 4Z Z.SA 'OCILt I �i Phone:7LN -91co lll1� Expiration 20 01 Building Inspector I' I APPLICATION FOR BUILDING PERMIT i nLU DEPT. L_T(7\NN' QF.9�'_THO'_0 Date , 20 07 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 waterways. 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 a 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 what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. 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, ordinances,building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. "IMMEDIATELY" n ENCLOSE POOLTO CODE ALL CONSTHU 7 UPON COMPLETION MEET THE REQUIF' (Signature of applicant or name,if a corporation) BEFORE ^WATER^ CODES OF NEV,' r;: 4 nn 71 12�fiC' 26F} KOcLMPt 117?,S UNDERWRITERS CERTIFICATE (Mailing address of applicant) ,..REQUIRED t A'S State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder y__ y s:}tii;i�,�"" 1 tln 4- n Name of owner of premises S J()Q n tj a M i ) tQ (1 D F�j ZTD• �� . /�� (As on the tax roll ors fate§$died) If applicant is a corporation, signature c(XI Y{�UMN(oyfeq ` .._ (Name and title of corporate of ,;w F , WITHOUT ( _ Builders License No. 9 14 1 a 14 h ���° 3. IN,. ni;C,U Plumbers License No. �I 4. F!is'rV- Electricians License No. 5 i4 1 Li PE Other Trade's License No. ALL CON j RUC?I t. i q! L :,;,-°-T THE REOUiREdEt'j7" Cr 1. Location of land on which proposed work be done: YORI< STATE. tiOT RES?OiJ5.' LE FOR 1100 a ri j2hali "ct tCal t(Yl4LOwli m . House Number Street g OF THE TOWN CODE. County Tax Map No. 1000 Section 11 ti Block r:k, Lot I y Subdivision S;dn(( � Q S?e d 1 iZ Filed Map No. g q�1 ri Lot j (Name) 2. State existing use and occupancy of premises and inte ed use and occupancy of proposed construction: a. Existing use and occupancy S f\$1 crr44m,114 (254e4le o b. Intended use and occupancy_ <TtlnilL� W1 5a rnr �gb 0 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal-Demolition-Other Work (Description) 4. Estimated Cost �5'w - 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 cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 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 Rear_ Depth 10. Date of Purchase Name of Fortner Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO ✓ 13. Will lot be re-graded? YES "'�NO_Will excess fill be removed from premises? YES_NO Stb -- 14. Names of Owner of premiseZgA 5 M� h i enU`--Address f I D0 (.l t.@S041la Phone No. ID 5 031 71;0 Name of Architect L 0 _Address 115 1 r bei n+AJe Phone No 331--'U05 Name of Contractor d Address -7t R )!54Phone No. '14(4-g 10 0 tct-L4 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 33?AMMMI„ 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) _ SS: COUNTY OFF Gtr4, T being duly swom, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the d 61-1-[Yaciv el (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. Sworn to before me this _�-7 day of G *20� 64 Nota Public Signature of Applicant KATHLEEN QUIGLEY NOTARY PUBLIC,Stale of New York 'J..J Yl "j i "-,a " NO OIQL06124124 -OtakllWJnsufoik cou* CW WO0nli Expkes Apn125,20j2q New York State Department of Environmental Conservation Division of Legal Affairs, Region One - Building 40- SUNY, Stony Brook, New York 11790-2356 Phone: (631)444-0260 • FAX: (631) 444-0348 AlexanderB. Grannis Website: www.dec.state.ny.us commissioner December 10, 2007 Mr. Randy Rodecker, Pres. Swim King Pools s 471 Route 25A Off Rocky Point, NY 11778 �— Re: RI-20071120-327 -- ' Dear Mr. Rodecker: Enclosed please find a copy of the fully executed Order on Consent and a receipt in the amount of One Thousand ($1,000) Dollars with regard to the civil penalty in the above referenced matter. Sincerely, a Carole A. Gajewski Secretary I Legal Affairs /cag enclosure S YY1 i 11" Us �. 1 IOo I ys(*&A 10--- STATE OF NEW YORK DEPARTMENT OF ENVIRONMENTAL CONSERVATION ............................................................................. ...................................................................... In the Matter of the Violation(s)of Articles 15, ORDER ON CONSENT and/or 25 and 71,as indicated below, of the FILE NO. 1- New York State Environmental Conservation Law, by Swim King Pools Respondent(s) (Suffolk County) .. .......... WHEREAS,Article 15,Title 5 of the New York State Environmental Conservation Law(Protection of Waters)prohibits conducting any regulated activities in any of the navigable waters or protected streams of the State without the requisite permit,or in noncompliance with the requisite permit;and F-9 WHEREAS,Article 11,Title 1,of the New York State Environmental Conservation Law,(Tidal Wetlands Act)prohibits conducting any regulated activities on or adjacent to any tidal wetland without the requisite permit,or in noncompliance with the requisite permit;and WHEREAS,the Department of Environmental Conservation(DEC)has documented a violation of said statutes,specifically Section 25.401.1 Section_,and Section_, in that Respondent(s)caused and/or permitted to be caused, Installation of a swimming pool in a regulated area adjacent to a tidal wetland at 1100 Westphalia Rd in Mattituck,on or before 10/22/2007: an WHEREAS,Respondent(s)has/have affirmatively waived his/her/its/their right to a public hearing in this matter in the manner provided by law and having consented to the entering and issuing of this Order, agree(s)to be bound by the terms and conditions contained herein. NOW,having considered this matter and being duly advised,it is Page I ORDERED,that with r Ispect to the aforesaid violation(s),there is hereby imposed upon Respondent(s),a penalty in the sum of_( $1,250.00 1 Dollars,of which ($1,000.00) )Dollars shall be made payable by certified check or money order to the NY,S Department of Environmental Conservation upon the signing of this Order,and the remaining ($250.00)'Dollars to be suspended provided Respondent(s) strictly adhere(s)to the terms and conditions outlined in this Order,including Schedule A,the compliance schedule attached hereto and made part hereof;and it is further ORDERED,that this Order shall not become effective until it is executed by the Regional Director on behalf of the Commissioner,and the date of execution by the Regional Director shall be the date of execution of this Order; and it is further ORDERED,that in those instances in which the Respondent(s)desire(s)that any of the provisions,terms or conditions of this Order be changed,(s)he/it/they shall make written application,setting forth the grounds for the relief sought,to the Commissioner,c/o Regional Attorney,New York State Department of Environmental Conservation, Building 40, State University Campus, Stony Brook,New York 11790-2356;and it is farther ORDERED,that Respondent(s) shall strictly adhere to the terms and conditions outlined in this Order and in Parts I,II, and/or III of Schedule A,the compliance schedule attached hereto and made a part hereof;and it is further ORDERED,that any change in this Order shall not be made or become effective,except as specifically set forth by written order of the Commissioner,such written order being made either upon written application of the Respondent(s)or upon the Commissioner's own findings; and it is further ORDERED,that this Order shall be deemed binding on the Respondent(s),it/his/her/their successors and assigns and all persons,firms and corporations acting under or for Whim/her/them,including,but not limited to those who may carry on any or all of the operations now being conducted by Respondent(s),whether at the present location or at any other in this State;and it is further ORDERED,that the failure to pay any penalty amounts due under the terms and conditions of this Order may result in a 22%surcharge id recovery costs and a potential tax refund offset by the Department of Taxation and Finance, and it is further ORDERED,that a dishonored check fee of Twenty($20.00)Dollars will be charged for all checks which are returned for insufficient funds. Dated: Stony Brook,New York Drri -c'f'rt C= ,2007 Alexander B. Grannis Commissioner of Environmental Conservation By Peter A. Scully Regional Director To: Kathy Ouiglev Swim Kine Pools,Inc. 471 Route 25A Rocky Point,NY 11778 NOV#: 07AF257 Page 2 CONSENT BY RESPONDENT (Business Entity) Respondent acknowledges the authority and jurisdiction of the Commissioner of Environmental Conservation of the State of New York to issue the foregoing Order,waives public hearing or other proceeding in this matter,accepts the terms and conditions set forth in the Order and consents to the issuance thereof. Respondent Busines Entity: >i BY(signature):/ 4�t Name Title :-1-reside/ot I us.If1C y an individual dually authorized by respondent to sign on behalf of the business entity named herein and whom may bind respondent to the terms and conditions contained herein. Date; ckijw, NOTE TO NOTARY:The correct acknowledgment from below MUST be utilized for signing in New York State versus outside New York State. All blanks MUST be completed. ACKNOWLEDGMENT Si nin within New York State STATE OF NEW ypRl{ ) �` rr )ss.: COUNTY OFti-I( V, ) y On the 13 day of NoJUnher- 11C1-Il(J�Lh ,200.T, before me, the undersigned,Personally appeared «er personall known to me who,being duly sworn,did depoe and say that(s)he resides at " 71 -I e L5,q Authorized Signatory LQU,10%nt Wew*cIL c �, zw17 }u n of � that(s)he is the Title of fill m e of on en m— 1—� `�oo S L the instrument; and that(s)he signed her/his namq thereto 'th f -criv a lierem and o to do Which executed the above / i ; THLEE*QtAGLEY NOTARY PUAUC;b"'Of New York (.L to. 724 Notary Public,Stye of Nev York- Co" IIMIOn9*m 23 b * ACKNOWLEDGMENT Si nin outside New York State ss: On the day of ---------------------- 200._._._, before me,the undersigned,personally appeared (s)he resides at Personally(mown to me who, being duly sworn,did depose and say that Authoized Signatory) that(s)he is the itle of of the fill-in a of business enti described herein and which executed the above instrument; and that(s)he signed her/his name thereto with fall authority so to do and that such individual made such appearance before the undersigned in the *** Notary Public (Insert the State I& County),District of Columbia, Territory,Possession or Foreign Country the acknowledgment was taken.) ** (Insert the city or other political subdivision and the state or country or other place the acknowledgment was taken.) ** (Signature and office of individual taking acknowledgment) s Page 3 '07 SCHEDULE A Compliance Schedule for Article(s) 15 and/or 25 L GENERAL REOUIREMENTS: Immediately, Respondent(s)shall cease and desist from any and all future violations of the New York State Environmental Conservation Law and the rules and regulations enacted pursuant thereto. Respondent(s)shall submit photographs of the completed work,if any,required under this schedule,to the Department within five(5) days of its completion. All submittals to the Department required under this Order shall be made by Respondent(s)as follows: 1) One copy to the Legal Affairs Office,Region One,New York State Department of Environmental Conservation,Building 40, S.U.N.Y., Stony Brook,New York 11790-2356; -and- 2) One Copy to Marine Habitat Protection,Region One,New York State Department of Environmental Conservation,Building 40, S.U.N.Y.,Stony Brook,New York 11790-2356. II. REMOVAL REOUiREMENTS: ❑ Within days from"the date of the Respondent(a)shall have removed the structures and/or fill execution of this Order, which are the subject of this Order as follows: Removal Specifications: none No Removal Required Page 4 Schedule A(Comd.) III. RESTORATION REOUIREMENTS: Within thirty(30)days Respondent(s)shall submit to the Department,an approvable* from the date of the restoration plan and time schedule for implementation of said plan. execution of this Order, *Approvable in the context of this Order shall mean approvable by the DEC with minimal revision. Minimal revision shall mean that Respondent(s)incorporate(s)the revisions required by the DEC and resubmits the plan for approval within fifteen(15)business days of receipt of the DEC's comments. This plan shall include: ❑ Regrading Plantings in disturbed area Specifications: All pool discharee must be directed into a dry well at least 100'landward of the tidal wetland boundary ❑ Other: Upon written approval by the Department,Respondent(s)shall implement the approved restoration plan in accordance with the approved time schedule. Said maintenance shall ensure a success ratio of at least 85%for a 5 year time frame from completion of plantings. ❑ No Restoration Required. Page 5 Erosion Sedimentation and Storm-water Run-off Control Plan ASSESSMENT FORM EXEMPTIONS:. Yes No A. Does this project meet the minimum standards for classification as an Agricultural Project. ✓ Note: If you answered Yes to any of the above,a Storm-water,Grading,Drainage&Erosion Control Plan is not required. ------------------------------------------------------ ACTIONS REQUIRING THE SUBMISSION OF A STORM-WATER GRADING DRAINAGE &EROSION CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORIC Item Number: (A Check Mark (✓)for each question is required for complete application) Yes No 1. Will this project retain all Storm-Water Run-off generated on Site? (This will include all run-off created by site clearing and/or construction activities as well as all Site Improvements and the permanent creation of impervious surfaces.) ` ❑ 2. Will this project require any land filling, grading or excavation where there is a change to the ❑ natural existing grade involving more than 200 cubic yards of material within any parcel? 3. Will this application require land disturbing activities encompassing an area of five thousand (5,000)square feet of ground surface or more? ❑ — 4. Is there a Natural Water course running through the site or is this project within One hundred(100)feet of wetlands or a beach? 5. Will there be site preparation on slopes which exceed fifteen (15) feel of vertical rise to ❑ — One hundred(100)feet of horizontal distance? ✓ 6. Will driveways,parking areas or other impervious surfaces direct Storm-Water Run-off into and/or in the direction of a Town Right-of-Way? ❑ ✓ 7. Will this application require the placement of material,removal of vegetation and/or the ❑ — construction of any item within the Town Right-of-Way or road shoulder area? (This item does not include the installation of driveway aprons.) 8. Will there be site preparation within the one hundred (100)year floodplain of any watercourse? F Note: If any answer to questions one through eight is answered with a check mark in the Box,a Storm-water,Grading, Drainage&Erosion Control Plan is required and must be submitted for review prior to issuance of any building permit. -------- STATE OF NEW YORK, COUNTY OF_ - . ._ .... _ .. . s That I, ..((Name of i QYIUII..T.F�'.uno.(�'�..._......._........being duly swom, deposes and says that he/she is the applicant for Permit, (1Jame of individual signing Document) And that He/She is the ... _. ... .._.... .._.e041fYQ[iz)! ... .......................................... ........................................................................... (Owner,Contractor,Agent,Corporate Officer,etc.) Owner and/or representative of the Owner or Owner's,and is duly authorized to perfomi 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 belier; and that the work sill be performed in the manner set forth in the application filed herewith. Sworn to before me this; (� .... (..day of. rTIA USL........ ._ _... 2001— Notary Public ±L KATHLEENQ(IIQLEy 1.. .. ........WOTARY PU9LC ..... ..tlrM.r+ft�i,;vmrfr No.Oia{jgPit24 (Signature of Applicant) - quatfaed in]pill*cowity Commission EOw Aplif 25,20_p `j ����oE SDUIyo� Town Hall Annex 41 41 Telephone(631))76765--11802 5P.O.Main Road di V(RI.SOUrl101tl.ny.us P.O.Box 1179 G� • � r098r.rlCheltfmt0 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: (v01/� (,�¢ br Date: Company Name: Name: License No.: Address: Phone No.: JOBSITE INFORMATION: ('"Indicates required information) *Name: S Q U S *Address: -5 Q *Cross Street: 0 u /v r> er)U L J *Phone No.: 7/ V - & o2 6, - 0J 5 b Permit No.: 3 5 (�5 9 Tax Map District: 1000 Section: / / 14 Block: Lot: / 'BRIEF DESCRIPTION OF WORK (Please Print Clearly �Sw / m olI-nib %o (Please Circle All That Apply) *Is job ready for inspection: YE NO Rough In Final *Do you need a Temp Certificate: YES / NO Temp Information(If needed) *Service Size: 1 Phase 3Phase 100 150 �300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION 824tequest for Inspection Form 3_ _1 OWN OF `SOUTHOLD PROPERTY RECORD CARD OWNER STREET '/,r VILLAGE DIST. SUB. LOT / FORMEkoWNER 0 1 E _..y ACR. , 1, 2 m5JEn � S W TYPE OF BUILDING ES. SEAS jta*2 . VL. FARM M. CB. ISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS Low L_ / cam 0�� S yewej= i c) 1 7X- ✓ dry Kce a S6 6 7 fwure G a �© t1 BUI DI C NO I o0 - / �� NEW N L B W OV ,o n� ��'��v-.F D� T 020 �S' - 'R�. CGt•,S�Vu_ f}1h llQ.YT')Q W ARM Acre Value Per Value y U O cr D � 3 q0 1 d� ills OD (C� 7 SS- 1 vEL. n)S fNG Tillable 2 �! zaa int t .40 m G - Tillable 3 Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD "4,g. �"7/o House Plot DEPTH BULKHEAD r w Total DOCK awe ct.;.a MEN■■�I!_.■P�!0■■■■■■■■■■■■■■� ■■■■NEON i�_�j. ? �1�■S■■■■■■■■■■■■■ i■■■■■ iiiii2■■■■■■■■■■■■■■■ ■■■■■■■ ■■■■I�!!If■■■■■■■■■■■■ ■■■■■■■ ■■■■I�Jii■■■■■■■■■■■■ iii■iiRooms I st Floor i=��iiiiiiiiiiiiiiiii■ 1, , __ •' ••• .•. r •• . •• �_ pf SOpT�olo Tome liall Ann(x # Tcicphouc(631) 7(i5-1802 ,)1375 Nhiu Rood N Fax (631) 7(Gi 950Y P.U. Box 1179 Southold,A'S 1197 1-0959 Coma BUILDING DEPARTNII,'NT TOWN OF SOUTHOLD FIRST NOTICE May 19th, 2008 Savas & Joanna Milienos 118 Knickerbocker Road Manhassett, N.Y. 11030 RE: 1100 Westphalia Rd. (AS-BUILT IN-GROUND SWIMMING POOL) SCTM: # 1000-15114.-7-14.1 To Whom It May Concern: Please be advised that your Building Permit # 33750 issued March 18th, 2008 has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued before the use of the structure. To renew your Building Permit please submit a fee of $500.00; at that time we can schedule an inspection by one of our Building Inspector's. PLEASE SEE ENCLOSED DOCUMENT REGARDING SWIMMING POOL CODES. If you have any questions, please call us at 765-1802. Respectfully, SOUTHOLD TOWN BUILDING DEPT 5❑p2 8yb8 4318 7�1� 0290 SOUTyo�o Town Hall Annex .f. Telephone(631) 765-1802 54375 Main Road Fax (631)765 9502 CA P.O. Box 1179 • O Southold, New York 1 197 1-0959 OOUNV,�c� BUILDING DEPARTMENT TOWN OF SOUTHOLD May 2, 2011 Savas & Joanne Milienos 118 Knickerbocker Road Manhassett, NY 11030 RE: 1100 Westphalia Road, Mattituck TWO WHOM IT MAY CONCERN: T e ollowing Items Are Needed To Complete Your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. AOL / A fee of 50.00. Final Health Department Approval. Plumbers Solder Certificate. (AII permits involving plumbing after 411184) Trustees Certificate of Compliance. (Town Trustees#765-1892) Final Planning Board Approval. Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. BUILDING PERMIT : 35659-Z swimming pool �o��pF SO(/Tyolo Town Hall Annex y Telephone(631) 765-1802 54375 Main Road '/' Fax (631) 765-9502 P.O. Box 1179 G Q Southold, NY 11971-0959 MIM BUILDING DEPARTMENT TOWN OF SOUTHOLD September 19, 2011 Savas & Joanne Milienos 118 Knickerbocker Rd Manhasset, NY 11030 Re: 1100 Westphalia Rd. TO WHOM IT MAY CONCERN: The Following Item(s) Are Needed To Complete Your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. _2A�A fee of$50.00. Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 4M/84) Trustees Certificate of Compliance. (Town Trustees#765-1892) Final Planning Board Approval. Final Fire Inspection from Fire Marshall. — Bob Fisher Final Landmark Preservation approval. BUILDING PERMIT : 35659 — Swimming Pool 45' � m 24' 0 u / 21 8 w Z h Cl. 5, z _ r0 FILiFK F7.OM FLiEK - 'i FROM 5KIMMEK :� r 7 5' CD FILTER MP PUMP 7' N S-8" DEEP DEEP ro ruRNs ro wAs�E ,��R ARCh, PLUMBING SCHEMAnC w 5f, 3ML FVAMF �9p� oI� \ FOp Eta WATER LINE 'F 10 CONC. M7 WATFV LINE GCE =' to 60Tf0r,�, ;OLLE7 FOAM 6EIWEN LINED ANb CONCO,�fF e // SEMON A / a , 5 10' S� FOAM flES � ���� 3500 P51 FOWL[?CONCRETE \/ — I. 5VUCTUKF 15 19E5I6NW FoK U5E fe OW GAPE AND()FLY IN AITA5 VINYL LINER � ��\ z o VvHM THE GKOUNP WATU tA3LE 15 A MINIMUM OF q'_6" PELOW 2" fO 4" WIP THE F°OP05EP FINISUEP 6ME. �/� z Lu a z �- 2, DACKFILL Wm CLEAN FAM, FMB OF POOf5 AND DE6'15 PO NOf A. 9)V g\ - N _ LL T FXCEEP PHE IfI(AHl OF EK IN Tlt POG c� mE�EI�.�roF 6ACKFI o me wA hlrlirJlr 6YMOPE TWN8" / // // // < 3. WALKS TO 6F SM00 , NON SKIP PE, 5 OPED AWAY MOM OOL, /�A/�A/�A/�A �������/�� O� 9 WATFp PIoSA 5 ALI. 3E LIMIfEP f0 OM ERS p�opE,1Y f0 x if LOCH.CONPMON5. 5. 171VIN6 60AP1V ANP IN5TAb,-AlON TO CONFO M,bum pN51/N5rl 5 I995 5TANPAIn FO° 51DFN AL ImcArovP 5WIMM1%pOOL 5 FOP A YP�11 POG V f SURVEY OF LOT 1 MAP OF SUBDIVISION FOR SIDNY W. OLMSTED , JR. Lor & ROBERT OLMSTED S 84'57'10" E FILE No. 8994 FILED AUGUST 30, 1990 o co "° f74.26 SITUATED AT co °0N' 234.75' 9 MATTITUCK M ,ii £� CONCD I `-3 TOWN OF SOUTHOLD MON. Ln SUFFOLK COUNTY, NEW YORK LOT �i �—] S.C. TAX No. 1000- 114-07- 14. 1 FRAME MMP E 01 ci SCALE 1 "=30' Y SHED �I. NAC.O N _/ CDN M°N. ,� ,yY �;. 1 .11_ SraCHFllE FENtlf "1Y.3' � E N AUGUST 8, 2007 4" ' �ryrVrtlYY-- 'ny p� \ NG 112.48' DES I' / IN 84'57' ux° E^ pp �y 1 O" W COW. NCN, 5.0 181 .75' AREA = 49,650.73 sq. ft. �{ p° TE NNE) LOT O N 1.140 ac. N ham• L J I : NJ L7 � o- O Q: vOf} • J :'?oi:!:'..'..;' aa°Y aRJ` N h 0NO 3oe• 'l a M AGO 7}3 Fri ,P :V 2 se•� � (UOU fORY 20.9' AOp 4 4 • v.. ,. Ms• y r0.0 RgyV4 aRGAe , F t ,ham i� N... :::....::>..::... , �R ' e.'" . Q/1»'�'.::...:,yn...., • UNAUTHORRED ALTERATION OR ADDITION TO THIS OF SEC ION 7209 F5WE N WnON YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEW. OR Ln EMBOSSED BE A VALID TRUE COPY. BE CONSIDERED TO CERr ONLY O WE INDICTED HEREON WE S RUN ONLY TO THE PERSON FOR WHOM THE BURVEY / , TILE COMPANY,GO ON VERNMOVAL AGENCY WE TL AAA A f LENOING INSBm ION LISTED HEREON, AND i ' _ ...,y TO THE ASSIGNEES OF THE LENDING INSR- G TUTON. COM19CATIONS ARE NOT TRANSFERMEM THE EXISTENCE OF RIGHTS OF WAY 3p7'f ANY EASEMENTS OF RECORD, IF MOW ANY,. NOT SHOWN ME NOT GUARANTEED. PREPARED IN ACCORDANCE IVRH WE MINIMUM ABOUPIED STANDARDS FO T11TE Nathan Taft Corwin III BY THE LA. FORMIL SUCH L"F TE LAND MILE As Cl �SAFT CO "P•j- Land Surveyor Title Surveys — SubdivIsfOa9 — Site Plans — Construction Layout S090 O SAc��No��C PHONE (631)727-2090 Fax (631)727-1727 ,,•� OFFICES LOCATED AT MAILING ADDRESS 322 Roanoke Avenue P.O. Box 1931 N.Y.S. Lic. No. 50467 Riverhead, New York 11901 Riverhead, New York 11901-0965