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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23848 Date SEPTEMBER 1, 1995
THIS CERTIFIES that the building ADDITION
Location of Property 4350 CAMP MINEOLA ROAD MATTITUCK NY
House No. Street Hamlet
County Tax Map No. 1000 Section 122 Block 9 Lot 8
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 9, 1995 pursuant to which
Building Permit No. 22641-Z dated MARCH 23, 1995
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 A REAR RAISED DECK ADDITION TO AN EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to RICHARD A. CURCIO
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
1 ng inspector
Rev. 1/81
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 AUTHORIZEE/D))~~
Date 191
N6 22641 Z ~j
Permission Is hereby granted to:
to...doz. ~2. / ....ICJwl.S.ed...., PC°/C..........
old. Z.ix0.rv......~... '~.s.. ~ i p ...I . .w../.~fp.....,s9......,~~,v ..I...... }.Ud
at premises located at............"/.... `.ilv./. ~~yQ. f.. <.f%Il~. 4~f...~...........
'P~ ~9t /.•fu . /.1...... T...~,~.r.............I.............
Q
County Tax Map No. 1000 Section...... ;?A.. Block Lot No. ...r
pursuant to application dated ..................y(Y1K•trfT..q..... 19.1 -x......, and approved by the
Building Inspector.
Fee 5...
Buildin Inspect
Rev. 6/30/80
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Rem v 1 Demolition Other Work ` .
QC ~k a{= (Description)
4. Estimated Cost 4%". .d.. Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units I Number of dwelling units on each floor
I garage, number of cars . . .
6. If business, commercial or mixed occupancy, specif natFre and extent of each tyVe of use , t . j4
7. Dimensions of existing structures, if any: Front Rear ...38'........ Depth
Height Number of Stories ......~1~!f! , • , , , ,
Dimensions of same structure with alterations or additions: Front . 4 Rear 33
Depth ...47 Height Number of Stories
.
8. Dimensions of entire new construction: Front Rear Depth .
Height Num erofStories
9. Size of lot: Front /.T... 9 Rear 0.3. sS~~......... Dep h . . . . . . .
.
I .Ff . .
10. Date of Purchase X.
f! x ex Name of Fy rmer Owner :.e h ~e t3.e •2 , z o , , ,
11. Zone or use district in which premises are situated P.e S, dABh~.c e , , , . , , , • , , , , , , , • • • • • • .
12. Does proposed construction violate any zoning law, ordinance or regulation: , y? .
13. Will lot be regraded ,/-~d.../ Will excess fill be removed from premises: es
14. Name of Owner of premises . ~lCf(G-?d .C7WCt A. Address 0M C?y!/~. ~iha !Phone No.. /v .
Name of Architect ,r Address : ....Q, . Phone No..r~..,y...p.. .
Name of Contractor .cStAh~eyY , ..l-lt SS.. ,V..... Address.ln4es.01D. !04th . 61 ' Phone No. CIC3.C A. *.9Q. .
15. Is this property within 300 feet of a tidal wetland?
• Yes....... No.........
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM v
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all 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.
APP OV D AS NOTED
DATE: = 5 B.P. # a °2(
7f~"
NOTIFY BUILDING pEP TMENT AT
765-1802 & AM TO PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH • FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.Q.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW YOR
COUNTY OF f ? S .S
• • • • sue. ae, G .-e` • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the.....4~ct C~U
(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 kbis
..........-:....dayof.. 19.Q
Notary Public, 'count
HELENE D. HORNE
Notary Public, State of New York
No:4951364 v (Sign t~ ure of applicant)
Qualified in Suffolk Counttyy
Commission Expires May
22.1 9 5
BOARD OF HEALTH
l FORM NO.1 3 SETS OF PLANS
(I TOWN OFSOUTHOLD SURVEY
MAR ...91995 CHECK . .
BUILDING DEPARTMENT
TOWN HALL SEPTIC FORM . .
[P7T. ®I SOUTHOLD, N.Y. 11971
6LDG. D : f:OT i FY '
TOVJN OF S HOLD TEL.: 765.1802 ` p 17 F 4
CALL . o?.? Examined.., z319y.f MAIL T0:
Approved . ~1 1994
Permit No. P(A. t~ds. Ql-p- .)?M!
.h. .eq:. .
Disapproved a/c ~G 6 1 ! fi/.LC
~ .
. "
(Building Inspector)
AP LI ATION FOR BUILDING PERMIT
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 for 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 Towni, 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 i pections
(SignatureY apcant, or name, if a corporation) . .
(Mailing address of applicant)
State whether applicant is o~y ner, lesIee, agent, architect, engineer, general contractor, electrician, plumber or builder.
/
4.4.x'1[ Y0..4'..IIQK
Name of owner of premises J. l ! P ....tr. fc./.•Q
(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. ~7e . , Q Aj. .
Plumber's License No. ........L,,,,,,,,,,,,,,,
Electrician's License No.
i
Other Trade's License No. .
q
cJ '
1. Location of land on which proposed work will be done. 'g. ~G~,P j!p!.a...
................................../?1:a
House Number Street Hamlet p~
County Tax Map No. 1000 Section', ....a! Block p Lot R........... .
Subdivision I'................... Filed Map No. Lot
(Na;me)
2 State
Existinexisting use ouoccupancy of premises and intended use and occupancy of proposed construction:
I
Existing use and occupancy e5AhC76nC.E
b. Intended use and occupancy
GENERAL CONDITIONS
Inspections
1. The permitted site or facility, including relevant records, is subject to inspection at reasonable hours
and intervals by an authorized representative of the Department of Environmental Conservation (the
Department) to determine whether the permittee is complying with this permit and the ECL. Such
representative may order the work suspended pursuant to ECL 71.0301 and SAPA 401(3). A copy of
this permit, including all referenced maps, drawings and special conditions, must be available for
inspection by the Department at all times at the project site. Failure to produce a copy of the permit
upon request by a Department representative is a violation of this permit.
Permit Changes and Renewals
2. The Department reserves the right to modify, suspend or revoke this permit when:
a) the scope of the permitted activity is exceeded or a violation of any condition of the permit
or provisions of the ECL and pertinent regulations is found;
b) the permit was obtained by misrepresentation or failure to disclose relevant facts;
c) new material information is discovered; or
d) environmental conditions, relevant technology, or applicable law or regulation have materially
changed since the permit was issued.
3. The permittee must submit a separate written application to the Department for renewal, modifica-
tion or transfer of this permit. Such application must include any forms, fees or supplemental infor-
mation the Department requires. Any renewal, modification or transfer granted by the Department
must be in writing.
4. The permittee must submit a renewal application at least:
a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES),
Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid
Waste Management Facilities (SWMF); and
b) 30 days before expiration of all other permit types.
5. Unless expressly provided for by the Department, issuance of this permit does not modify, supersede
or rescind any order or determination previously issued by the Department or any of the terms, con-
ditions or requirements contained in such order or determination.
Other Legal Obligations of Permittee
6. The permittee has accepted expressly, by the execution of the application, the full legal responsibili-
ty for all damages, direct or indirect, of whatever nature and by whomever suffered, arising out of
the project described in this permit and has agreed to indemnify and save harmless the State from
suits, actions, damages and costs of every name and description resulting from this project.
7. This permit does not convey to the permittee any right to trespass upon the lands or interfere with
the riparian rights of others in order to perform the permitted work nor does it authorize the impair-
ment of any rights, title, or interest in real or personal property held or vested in a person not a party
to the permit.
8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-
of-way that may be required for this project.
Page 2 of
95 20 6 (10190)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER EFFECTIVE DATE
1-4738-00530/00001-0 August 7, 1992
EXPIRATION DATE
FACILITYIPROGRAM NUMBER(S) PERMIT
Under the Environmental Conservation Law (ECL)
August 31, 1995
TYPE OF PERMIT (Check All I ppllcahle Boxes)
12 New ?Renpwal ?Moddtcation ?Permit to Contract ?Permit to Operate
Article
Article PDES 17, Titles 7, 8: HArticle 27, Title 9; 6NYCRR azardous Waste Management
tection of Title
Po
Water S
3
Article 15, Title 15: Article 19: Article 34:
Water Supply Air Pollution Control Coastal Erosion Management
Article 15, Title 15: Article 23, Title 27: Article 36:
Water Transport Mined Land Reclamation Floodplain Management Articles Long Island Title
Freshwater Wetlands 6NYCRR1380: Radiation Control
Article 15, Title Article 25: Other:
Wild, Scenic and R ecreationalll x Tidal Wetlands
Rivers Article 27, Title 7; 6NYCRR 360:
6NYCRR 608: Solid Waste Management
Water Quality Certification
PERMIT ISSUED TO TELEPHONE NUMBER
Richard A. Curcio
ADDRESS OF PERMITTEE
Box 522 Mattituck, NY 11952
CONTACT PERSON FOR PERMITTED WORK I TELEPHONE NUMBER
Marietta Fogerty 1375 Fourth St., New Suffolk, NY 11956
NAME AND ADDRESS OF PRO)ECTIFACILITY',
Curcio Property,
4350 Camp Mineola
LOCATION OF PROJECT/FACILITY
Mattituck
COUNTY TOWN1~ WATERCOURSEIWETLAND NO NYTM COORDINATES
Suffolk Southold e _ NA
DESCRIPTION OF AUTHORIZED ACTIVITY
Replace an existing (7'x'241 deck and add a new (14'x 14 portion. construct a
second story deck (15' x114 1/21). Place a (10' x 10') utility shed. All work
shall be in accordance with the attached NYSDEC approved plan.
I
PIS I,
I
_ n
.....~F3Li34,ITS-fU! C1
By acceptance of this perm t, the permittee agrees that the permit is conthift upon strict compliance
with the ECL, all applicable redulations, the General Conditions specified (See Reverse Side) and any Special
Conditions ipcludled as part of this permit.
De utv Reaiona _ or ntlrcrtrs
PERMIT ADMINISTRATOR ADDRESS Ile.
Ion Y • 131da. 40 S V N I
David DeRidder gr.kI N.y. Ylyto•230
AUTHORIZED SIGNATURE DATE
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Town Hall, 53095 Main Road p Fax (516) 765-1823
P. 0. Box 91971 Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
August 7, 1995
Mr. Stanley Fli!lss Jr.
565 Old Main Road
Mattituck, NY 11952
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx Anllapplication for Certificate of Occupancy is
l
!not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22641-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
o~~gUFFO~,~cO
' may. Gyp
0
i W 2
Town Hall, 53095 Main Road p • Fax (516) 765-1823
P. 0. Box 91971 Telephone (516) 765-1802
Southold, New York 1
Al jr 3 11995 OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
August 7, 1995
II f ~
k.
Mr. Stanley FlISS Jr.
565 Old Main Road
Mattituck, NY 111952
Re: Richard Curcio - SCTM#1000-122-9-8
I~
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of thelfollowing reasons:
xx Anjapplication for Certificate of Occupancy is
,not on file. (Enclosed)
No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
!(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22641-Z
Please contact our office on this matter. Thank you for
cooperation. I
SOUTHOLD TOWN BUILDING DEPT.
III
II
I
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be'lfilled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusualinatural or topographic features.
2. Final,Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1%'.lead.
15. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the certificate
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 completed application and a 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. AUG ; f 1995
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildine - $100.00
3. Copy of Certificate of Occupancy - $20.00
k. Updated Certificate of Occupancy - $50.00
5. Temporary Certificat(e~l,.of Occupancy - Residential $15.00•, Commercial $15.00
NdW 1000 Date ...~71aP/W
New Construction...... r014 Or Pre-existing Building.........
Location of Property. 43sro.!. .........4•a ...Q:.....mm-tt/..i.[ c.k.-
House No' • Street Hamlet
Onwer or Owners of Property... /~~~f...../ ...1..(t,(Q`
County Tax Map No 1000, Section. ../jad,••,,,,Block....../.........Lot.....IQ
Subdivision.
...............Filled Map............ Lot.. C.I......... I.......
Permit No..Qg .4l,Z„D~atto Of Permit.. 31"1/.1-,Applicant ...S, ...!/b"Iss
Health Dept. Approval....!'
~r Underwriters Approval.
Planning Board Approval ...d0l
Request for: Temporar nCertificate........... Final Certicate..xa
Fee
Submitted: $..,0
g0
S+ PLIG~KNT~
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All I ~oAe~
UNAERWRIT~RS CERTIFICATE
REQUIRED
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