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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-24231 Date MARCH 25, 1996
THIS CERTIFIES that the building ALTERATION
Location of Property 360 PARK AVENUE EXTENSION MATTITUCK, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 123 Block 8 Lot 28.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 4, 1992 pursuant to which
Building Permit No. 20693-Z dated JUNE 8, 1992
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 MOVE & RAISE EXISTING ONE FAMILY SEASONAL DWELLING ON TO
NEW PILE FOUNDATION & ENCLOSE EXISTING PORCH AS APPLIED FOR.
The certificate is issued to NOREEN GIACONE
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-286252 - AUGUST 13, 1993
PLUMBERS CERTIFICATION DATED FEB. 8, 1996-PECONIC PLUMBING & HEATING
i Z~
uil ng Inspector
Rev. 1/81
FORK NO. f
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
r~
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°2N? 20698Z Date 19.E
Permission is hereby granted to:\p
JA-4 L,/
eJ YA^rR J.....
p:..
+,....~~a........ A/f . 1... rr97~
to ..'Jltii?riye.` ISGL~?1.. .c~rk ....!F1C~n1.. ~
p `
at remises located at
County Tax Ma No. 1000 Section Block y
Y Lot No.
r pursuant to application dated ........................S0 19../.,x; and approved by the
Building Inspector.
Fee $ ....v.~33..
f;e e-4
C ~6c y7iP-oo~Ftq~pooo/-o
us r4-QCs uilding Inspector
i~~ol ~2~~r# J~~f
Rev. 6/30/80
i
P, (r 7 5
ICCm No. 6
-
f L~J ~S µlJ l'/ m~S
/ (`Y~ TOWN OF SOUT1101.D %~~h lE
l BUILDING DEPARTMENT ~ ~ `MAR 2 0 1996
TOWN FULL ' (.,,_-.__,_.a.-....-........_._r,.._ Y..
763-1802 ".,e;
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: Ear 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-4 form).
3. Approval of electrical installation from Board of Fire Underwriters.
A. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 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.
b. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 4, 1457) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survev 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.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling 05.00, Swimming pool 525.00, 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
A. Updated Certificate of Occupancy - .$50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial S M OO
Da t e OCT4 .?S,.IqV
New Construction........... Old Or Pre-existing Building... X.,
Location of Property.... 141 P.r?R-lC, .*,uaNue..E~X76a.wojo... YhW.77lT.Un .
house No. Street Hamlet
)ewer or Owners of Property ...No.R, w... !3 1!ACONE
2ounCy Tnx Nnp No 1000, Sect ion ...l?-3.... ...Bluck...0 9 Lot. &8.1.
Subdivision ...............X& .........Filed Hop....Ahk ....Lot i.........
:'_rmLt No..~Afo4 'Z... Date Of Pe cm it. to/Of?,, ....Applicant.TDIARIC.{.tG-R CM,.1HMF117EC7
dealLh Dept. Approval .....iW............... .Uncle Cwriters Approval.... .
'lanning Board Approval.. ?1*.
"squest for, Temporary Certifxcnce. Final Certicate . X
=e Submitt97: .ZS.09
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o~~gpFF01/r O
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Town Hall, 53095 Main Road p • Fax (516) 765-1823
P. 0. Box 91971 Telephone (516) 765-1802
Southold, NewYork 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
June 18, 1996
Ms. Noreen A. Giacone
Box 86072
Madeira Beach, F1 33738
Re: Premises: 360 Park Ave. Ext. Mattituck, NY
Suff. Co. Tax map #1000-123-8-28.1
Dear Ms. Giacone:
It has been brought to the attention of the Building
Department that a deck has been erected without obtaining a f
Building Permit.
on March 25, 1996 we issued a Certificate of Occupancy on
the renovations that were applied for under Building Permit
#206932. At that time a separate permit was to be taken out for
the deck, and to date has not been done.
According to the Code of the Town of Southold a Building
Permit is required before any construction can be undertaken.
Please contact this office as soon as possible so this
matter can be resolved.
I thank you for your anticipated cooperation.
Very truly yours,
SOUJHOLD TOWN BUILDING DEPT.
Gard. fish,
Building Inspector
GJF:gar
(Cert. Mail)
I
, l
951U-G IIOi90)-25c NEW YORK STATE OtPARtMFNt Or fNVIRONMENTAt CONSERVATION
DEC PERMIT NUMBER FEFFCTIVE DALE
1-4738-00929/00001-0 April 3, 1992
TAT 11ITY/PROGRAM NUMBEk(l) ~C,rl t~ EXPIRATION DATE
Under the tovir011mentAl tonsetVAHon LAW tECL)
April 30, 1994
(YP-E1of P1 RMlt ((lm<k All Applicahlc pox's) -
tSJNew UkGlewal UModincatlon UPermit to Construct UPennil to Operate
Article 15, Title 5: r ~ Article 17, Titles 7, 8: r Article 21, Title 9; 6NYGRR 373:
U Protection of Water ll SPDES Lj Hazardous Waste Management
r~ Article 15, Title 15: Article ig: Article 34:
I~1 Water Supply E] Air Pollution Control EJ Coastal Erosion Management
U Artlcld 15, Title 15: Article 23, Title 27: Article 36:
Water Transport 0 Mined Land Reclamallon E~ Ploodplaln Management
Article 15, 1100 15: Article 24: Articles 1, 3, 17, 19, 27, 37;
Long Island Wells L~1 Preshwater Wetlands 6NYGRR 380: Radiation Control
a Article 15, Title 27: 1~1 Article 25: a Other:
Wild, Scenle and Recrealiohal x tidal Wetlands
Rivers Article 27, Title 7; 6NYCRR 360:
y---1 6NYCRR 6g8: t~ solid Waste Mahagetnent
ILI Water Quality Certification
TtLEPIIONt NUMBER
p~RMIT ISSU 110
Noreen I.acone f )
ADDRESS Or PfRMnlrr
141 MLU ray Aye.j Dehnarj W 12059
CONIACI r4RSON TOTE PTkMITitt) WORK 1ELT PIIONC NUMBER
Diane tferold Architect Sox 884, Westh ton Seachj b1Y 11978 t )
NAMt AND AbDRr SS Or PROBE UrACILITY
Giacone Pro rty
Peconic Bay/ e hole Creek
LOCATION Or PRORCT/tACILITY
SC7t4 1000-12-8-28
COUNTY TOW Nf~J~$NClC.4CilC WAIERCOUkSEIWETLAND NO NYIM COOkDINATF.S
$ ffolk Southold N4
UFSCRIptION or Ant~no~~hI l7~F1 U~ ACTIVITY
Q~-0-te w C?x3S bla house and install a hela ~i1e foundationL Construct a new enclosed
parch to attach to the relocated house, All Work shall be as shown on the attached
site plan prepared by Diane tleroldj P.A, ddted 6/19/781 last revised 9/20/91 stamped
"NYSDnc roved As Per Terms and Conditions of Permit #1-4738-00429/00001-0 4/3/92."
Tay 2cceptdhcd of this permit, the petmilteo bones thdt this permit IS contingent Upon strict compliance-.
~w;~i,t,h, ~tIh{e' I_CL, dll dppllcdble reguidtlohs, the Genofdl Cdhditions dpeciffed (SO hovairm Sido) and any Speclal
&P~YopQp8jV ed to pdri of this permit. ttentilotory ARVnlri _
PERMIT ADMINISTRATOR ADDRESS neglnn 1 • 61 g• O U I
c ristine costpoulos thony10001c,VI.T. it 700 1".4
nunl9Rlz D s( 14Nnr Re _ lspril 3, 1992 Page 1 of 4
GENthA4 CONDITIONS
Inspectloh§
I . 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 EOL. Such
representative may order the work suspended pursuant to ECL 71-0301 and SAM 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.
hermit Change§ Arid Flenewal§
2. The Department reserves the right to modify; suspend or revoke this permit when:
a) the scope of the permitted activity is exceeded of a violation of any condition of the permit
of provisions of the ECL and pertinent regulations Is found;
b) the permit *As obtained by misrepresentation or failure to, disclose relevant facts;
c) new fhaferlal Information is discoveted; or %
d) environmental conditions, relevant technology, or applicable law of regulation have materially
changed since the permit was issued.
3. The pennittee must submit a beparale written application to the Department for renewal, modifica-
tion or transfer of this permit. Such application most Include any forms, fees or Supplemental Infor-
mation the Department tequires. Any renewal, modification or transfer granted by the Department
must be In writing.
4. the permitted must submit a renewal application at least:
a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPI)ES),
Hazardous Waste Management rgclllties (HWMr), major Alt Pollution control (APC) and Solid
Waste Management FAcilitles (SWMF); And
b) Jo days before expiration of all other permit types.
5. Unles§ expressly provided tot by the Department, Issuance of this permit does not modify, supersede
or tescihd any order of delefmihAtlon previously Issued by the Department of any of the terms, con-
difions or requirements contained in such order of determination.
other LApf obligatibog bi aetntlttee
6. The pbfrhlllee has accepted expressly, by the execution of the application, the full legal responslblii-
ly for all damAgds, direct of Indirect, of whdIever nature and by whbmemi, §uffered, arising out of
the project described In fhis permit and hA§ agreed to Indemnify and §ave harmless the state from
90119, Actloh§, dal-ridges And costs of b0ty hanid dhd description tetulllhg from this project.
7. THIS pbrmll dots hot convey to the pttmittet any tight to trbspdb8 upon the lands of Inlbrfete with
the flpatlah rights of others In order to perform the permitted work hot does It authorize the Impair-
ment of any rights, title, of Interest In feal of pttwint property held of vested in 6 person hot A party
to the pelmll. -
8. The permittee Is te8poh§1ble tot obtaining any other permits, Approvals, lands, easements and rights-
of-way that may be required for this project:
Page 2 of
952063 (10190)-25c
AoOITIONAL GENERAL CoNb1T1oNS tOR ARtICLES 15 (title 5), 24, 25, 14,36 And 6 NYCRR earl God ( 1
9 That if future operations by the Stale of New York require An at. other environmentally deleterious materials associated with the
leralion In the position of file structure or work herein authorized, or project
If, in the opinion of the Department of Environmental Conservation 13. Any material dredged In the prosecution of the work herein permitted
it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across
waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a
the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of
resources of the Slate, the owner may be ordered by the Department to a waterway.
remove or alter the structural work, obstructions, or hazards caused id. There shall be no unreasonable Interference with navigation by the work
thereby without expense to the State, and if, upon the expiration or herein authorized
revocation of this permil, the structure, fill, excavation, or Odle, 15. If upon the expiration or revocation of this permit, the project hereby
modification of file watercourse hereby autbort7ed shall not be com- authorized has not been completed, the applicant shall, without expense
pleted, the owners, shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the
extent And In such time and manner as the bepartment of Environmental Department of Environmental Conservation may require, remove all or
Conservation may require, remove All or any portion of the uncompleted any portion of the Uncompleted structure or fill and restore the site
structure or fill And restore to Its former condition the navigable to Its former condition. No claim shall be made against the State of
and flood capacity of the watercourse. No claim shall be made against New York on account of Any such removal or alteration.
the State of New York on account of any such removal or Alteration. 16 If granted under Article 16, this permit does hot signify In any way
10 That the State of New York shall In no case be liable (or any damage that the project will be free from flooding
or Injury to the structure or work herein authorized which may be caused 17. If granted under 6 NYCRR part 608, the NYS Department of Environ-
by or result from future operations undertaken by the State tot the mental COnseivAtIo" hereby certifies that the subject projectwill not
conservation or Improvement of navigation, or for other purposes, and, contravene effluent limitations or other limitations or standards under
no claim or right to compensation shall accrue from Any such damage. Sections 301, 302, 301,106 And 307 of the Clean Water Act of 1977
1 t . Granting of lids permit does not relieve lbe Applicant of the tesponsi- (I'L 95-217) provided that all of the conditions listed herein are met.
Willy of obtaining any other permission, consent or approval front 1A All activities authorized by this permit musk be in strict conformance
the U.S Army Corps of Engineers, U S. Coast Guard, New York State with the approved plans submitted by the applicant or his agent as part
office of General services or local government Which may be required of the permit application. -
12. All necessary precautions shall be taken to preclude contamination Such approved plans were prepared by
of any wetland or waterway by suspended solids, sediments, fuels,
solvents, lubricants, epoxy coatings, painds, concrete, leachate or Any on
5PLCIAI CONblfiloNS
1. There shall be no placement of fillaS part of this project,
2. The storage of construction equipment and materials shall be confined to within the
project work site and/or Upland areas greater than 50l distant from the tidal wet-
land boundary.
3. Any debris or ekcess material from construction of this project shall be complet2ly
temoved from the adjacent area (upland) and retmved to An approved upland area for
disposal: No debris is perta tied in tidal wetlands.
4. EYquipLnent operation below mean high water is strictly prohibited.
5. there shall be no disturbance to vegetated tidal wetlands as a result of the per-
mitted activity.
Supplementary special Conditions (A) t)ltU (J) attached.
bfC PERMIt NUMOER
1-4738-00429/00001-0
PROGRAM/FACILITY NUMBER
Page 3 of 4
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Town Nall, 53095 Main Bond Fax (516) 765-7823
P. O. Box 1179 Telephone (516) 765-1802
Soul hold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
1 k C E R T I F I C A '1' I O N
MAR ? 0 19 9S nA'rE : c5ags P 6
Tntnr~': -Building Permit No. ~-o&
Owner: /V , ue~~r~l C t AC-a
(please print)
Pl.umber: r e~f,PgTY
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of l% lead.
floe ~,ll
( lun -s S nature)
Sworn to before me this
day of 19~"~
BARBARA STEPNOWSK
Notary Public, COt111Cy Notary Public, State of New York
No. 01ST4844752
Qualified in Suffolk County
Commission Expires Sept. 80, 1 07
Ili o~O%,3FF0j/-cQ
y 2
Town Hall, 53095 Main Road p • Fax (516) 765-1823
P. 0. ew York 9 11971 Telephone (516) 765-1802
Southold, 411
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
October 18, 1995
Ms. Diane Herold
P.O. Box 884
Westhampton Beach, NY 11978
Re: Noreen Giacone - SCTM#1000-123-8-28.1
Prem: 360 Park Avenue Ext., Mattituck
To Whom This May Concern:
We are unable to complete your Certificate of occupancy
because of the following reasons%
xx An application for Certificate of occupancy is t-~
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.
xx No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 20693-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
95206(10190)-25c NEW YORK STAIE b[PARtNIFNI OI INVIRONMENTAI CONSFRVAtION
F RFCTIVf. DATE
DEC PFRAUT NUAIIIrR
1-4738-00429/00001-0 April 3, 1992
MCII ITV/PROGRAM NllhleEkgl plrRE7FYFmlt F%PIRATtON DATF
Under the tnvirontnental Conservation law (ECL) April 30, 1994
Tl'tP-F~Or PTRMIT IC6reK All Appllral& Roves()
Rcilewal 1.~I AiO[llnfdllOp - Pm 'l f Co rstmd IJ Pennil to OPerale
KJNcw L1
Lj
r~ Article 15. Title 5: Article 17, Titles 7, 8: Article 27, Title 9; 6NYCRR 373:
Protection of Water Ej SPDES L-J Nazardous Waste Management
Article 15, Title 15: Article 1i I-._a Article 3
u Water Supply EJ Air Pollution tion Control I-_I Coastal Erosion Management
Water
r~ Article 15, Title 15: Article 23, Title 27: Article ain
u Water Transport ~ Mined Land Reclamation-Floodplain Management
j Article 15, Title 15: ( Article 24: I~ Articles 1, 3, 17, 19, 27, 37;
u Long island Wells Ereshwalet Wetlands l_-J 6NYCRR 380: Radiation Control
And Other:
L~ Article Sc15, enic Title
Recreational 1 x ) Tidal Wetlands o
Rivers Article 27, Title 7; 6NYCRR 360:
6NYCRR 608: Solid Waste Management
Water Quality Certification
IFIEPIIONE NUMIIIR
RMII In 7 a [ )
Doreen ~racone
ADDRESS Or VIRMI1lPF
141 Murray Ave.T Delmar) NY 12054 lnrpnoNFNUMncR
C:ONIACI Pt"ON tort promllttb WORK
Diane Ilereld Architect Dox 884, Westh ton Reach, DTY 11978 I
NAMI AND AwmrSs or PROIr CTItACRNY -
Giacone Property
Peconic Bay(Dee 11o1e Creek
toCMIION Or PROIFCIIrAClUlY
SC1M 1000-12-8-228 WAIFRCOUkSF/WrItANb NO NYIM COORDINATFS
COUNtV fOWN141f1S(~Eikirl Nd
E:~_
muff lk southold
nrsckn'tloN or Aumottincl ACTIVITY
}~oltse and install a neW bile foundation: Construct a new enclosed
porch to attach to the relocated house: All work shall be as shown on the attached
site plan prepared by Mane Herold) R.A. dated 6/19/78+ last revised 9/20/91 stamped
"NYSDEC roved As Per 'Perms and Conditions of Permit 41-4738-00429/00001-0 4/3/92."
By ac(ceptAned of this permit, the petmittee agrees that the permit Is contingent upon strict compliance.
With the PCL, all Applicable regulations, the Geneiral Condltlons specified (Seo I160rse Side) and any Special
6WV oV 9Jptq) ed as part of this permit, dlenc/taeory AFFOic!
rERMlt ADMINISTRATOR ADbRESS R,&,tj t • utda. 40 -gam I
Christine costpoulos Niony Eltootc, 11. Y. li79o.i83i1
A07I7 D 5F Il;Nn"F - bnTE
'AIR
t wn April 3, 1992 Page 1 of 4--
o~~SUFFO(,~co
TRUSTEES Gy
John M. Bredemeyer, III, President c SUPERVISOR
Ilenry P. Smith, Vice President as x SCOTT L. HARRIS
w ~*r
Albert J. Knipski, Jr. 5
John L. Bednoski, Jr. y'rlpl Town Hall
John B. Tuthill 53095 Main Road
P.O. Box 1179
Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES Southold, New York 11971
Fax (516) 765-1823 TOWN OF SOUTHOLD
January 28, 1992
Diane Herold, Architect-
P.O. Box 884
Westhampton Beach, NY 11978
RE: Noreen Giacone Property
SCTM #1000-123-8-28.1
Dear Ms. Herold:
The following action was taken by the Southold Town Board of
Trustees on Thursday, January 16, 1992:
RESOLVED that the Southold Town Board of Trustees grants a
waiver to move the existing house 13 feet north and 9-1/2 feet
east of its existing location to permit the construction of an
enclosed porch on the southwest sides. The house is to be
raised and placed on a pile foundation.
If you have any questions, please do not hesitate to contact
this office.,
?Very truly yours,
John M. Bredemeyer, III
President, Board of Trustees
JMB:jmt
cc: Bldg. Dept.
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE ~5 ~S INSPECTOR
o~~gUFF04coG
John M. Bredemeyer,E1H, President SUPERVISOR
Henry P. Smith, Vice President W SCOTT L. HARRIS
Albert J. Knipski, Jr. ~,j, •
John L. Bednoski, Jr. 'flQl #~0 Town Hall
John B. Tuthill 53095 Main Road
P.O. Box 1179
Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES Southold, New York 11971
Fax (516) 765-1823 TOWN OF SOUTHOLD
January 28, 1992
Diane Herold, Architect'
P.O. Box 884
Westhampton Beach, NY 11978
RE: Noreen Giacone Property
SCTM #1000-123-8-28.1
Dear Ms. Herold:
The following action was taken by the Southold Town Board of
Trustees on Thursday, January 16, 1992:
RESOLVED that the Southold Town Board of Trustees grants a
waiver to move the existing house 13 feet north and 9-1/2 feet
east of its existing location to permit the construction of an
enclosed porch on the southwest sides. The house is to be
raised and placed on a pile foundation.
If you have any questions, please do not hesitate to contact
this office.,
Very truly yours,
John M. Bredemeyer, III
President, Board of Trustees
JMB:jmt
cc: Bldg. Dept.
CAC
aµ~e _ yl BOARD OF HEALTH
FORM NO,1 3 SETS O'Y'PL .\-1S
(
''pp
TOWN OFSOUTHOLD SCIUIRCVcEY
"AIM K ~?h-•---.••-•..••.•
? BUILDING DEPARTMENT
TOWN HALL ;PTIC FORA
I UlD .OUTTHOf;[7 SOUTHOLD, N.Y. 11971 l 69E~
t
TEL.: 765-1802 t. UT I F f ,
CALL ..288.-5049
Examined ~F 19 9y HAIL TO:
I/' / p g Diane ,Hgrg441 Ax.chitect. .
Approved ......l(I/.Q , , 191'. Permit No. .(?d
l'R.O. Box 884
Westhampton Beac3i'
Disapproved a/c New York 11978
(Bull ing Inspector)
APPLICATION FOR BUILDING PERMIT
Date MaX . 29........., 19 9?.
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 cliagiam which is part of this appli-
catiol.
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 Ordnance 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 in ctions. 0-i
+ h~/YK . vu PW
(Signature of applicant, or name, if a corporation)
P.O,, Box, 884x, Westhampton, Bq-CpA NY, 11,978
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
axcha.t.gct
.
Name of owner of premises . Nor eSA .Gj acoge
(as on the tcrx roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. .1?~& . Y .r`«?C~
Plumber's License No .
Electrician's License No . z0 34 (02
'y(LtNG cowl(L{ACYO(L g5J~_ KZ
Other Trade's License No. i'l~-4VSNG„CrnyzAcWC'7v1~
1. Location of land on which proposed work will be clone .
360 PARR AVE E%T Mattituck
House Number Street Hamlet
County Tax biap No. 1000 Section 123....... Block ......8 Lot 28:1.. .
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premises and intende use and occupancy of proposed construction:
a. Existing use and occupancy . , , , single. fam.i.l. .y dwelling .
i
b. Intended use and occupancy single family dwelling / proposed enclosed,' porch . • •
existing house •moved •anc1* 'rai's'ed'on' riew pile foundation
3. Nature of work (check which
pplicable): New Building Addition ...X • . Alteration
Repair ' Re
of'oval . . . . . . . Demolition , . , , ,
Other Work ..^.d.. il , .
Replacement 40 of0 post foundation with pile foundation (Description)
4. Estimated Cost ........1 .00 Fee
(to be paid on filing this application)
5. if If dwelling,
h
e,ellinnumber
umber or of ccarsvellin6 units • • one, • , • • • Number of dwelling units on each floor • .
g g I
6. If business, comrnercial or mixdd occupancy, specify nature and extent of cacti type of use . .
7. Dim isions of existing structures, if any: Front . • • •
..2~..... 30 3 Rear ..3Q.'.:3°..... Depth 9.......
p Nut nber of Stories , i:wo . .
De tlt........$.:.... 25,_6„ Rear 73.............
8. Dimensionsof.4t',-A . structure l'tltalterations oradditions: Front 41'-3"
. t ..Height ......................Number of Stories ..two................ .
entire new puction: Front . Rear Depth .
Height Number of Stories
9. Size of lot: Fran 55' 82' 10. Date of Purchase ' ' • • • • • Rear . • . Depth 15, , • 17,5 ! , , , • •
Name ofFormer Owner
If. Zone or use district in which promises are situated R. .40 . . •
2. Does proposed construction violate any zoning law, ordinance or regulation: , no
13. Will lot be regraded • • • • r x•
n • • • • • , ...........Will excess fill be removed from premises: Yes ~1
14. Name of Owner of premises Noreen Giacone Address ,141 Murray.Ave Ph (518
one No. , .
Name of Architect ,see, bAddress . . . . .
Del , Mar , NY ] 205 tone No.
elow ! 439-4239
Name of Contractor ,see
15. Is this property within 100 feet of a tidal wetland? * g ' .Phone .
*If yes, Southold 'down Trustees Permit may be required. attached
PLOT DIAGRAM
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.
plot;, diagram is part of attached documents
Architect: Diane Herold, P.O. Box 884, Westhampton Beach
New York 11978 (516) 288-5049
Moving contractor: Davis Bros. Engineering Corp.
30 Barteau Avenue, Blue Point, New York 11715
(~16) 363-6240
Piling Contractor: James H. Rambo Inc.
Bi!,shops'Lane; Southampton, New York 11968
(5'116) 283-1254
Carpenter: has not been decided at this time
i
TATE OF NEW YORK,
'OUNT'Y OF Suf.f•olk....... S. i
• • • ' . ' ' ' Ai ane . Hera l d. . . . . . . . . . . . being duly sworn, deposes and says that fie is the applicant
(Name of individual signing contract)
)ove named.
C is the agiant. fA.r..owrlez .
I (Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
Vication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
ork will be performed in the manner self forth in the application filed therewith.
vorn to before me this
.....dayof.. 19
>tary Public,
County
JOYCE M. iNILKIN3 tom' • • • `Y.. Fit `
Notary Public, Stets of New York (Signature of applicant)
No. 4952246, Suffolk Cou
Term Expires June 12, 19 S
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SUPPLEMENTARY SPECIAL CONDITIONS
The toliowing cohditioh§ apply to all permit§!
A. It any of Lhe petmiL cohdiLlohs ate UhcleAt,ttle permitLee §11811 con-
tact the bivlulon of ReguiAtory httAlts At the addre§§ And telephone
noted below.
13. A copy of Lhi§ pettolt With §upplemenL-aty cohdiLloh§ Attd Approved
plahs dhAii be Available at the project §iLe whehdvet authoti-~ed
wotk i§ in ptogte§§.
C. ApprovAii§hdilnbeilptotedLedtfromethetweaLheraandpp §LbdeIne6 con-
spicUou§ location at the work site Until completion of authorized work,
b: At least Ab hour§ pilot to commehcemehL of the ptojecLt the petmittee
shall complete and return the Lop pottloh of Lhe.enclo§ed receipt rotm
cdhdiLfottg of athiht IN fully Awat § pdtmlL; UhdotdEalidd 611 and
petibU tbd Wotkt the bottom portion of that form shall Al§o be com-
pleted and teofned, Accom i, Pot otd p than c one i yeati i theapetmiLLee §hall notifyltheeltegional permit of
m
AdmihisttaLot lit WtiLlncl at least 49 hoUtd prior to the commencement
of tddUmptidh of Wotk each year:
F, I project de§igh hiodific8tions Lake place after permit issuahcet the
permitted §hail submit the 8pptoptiaLe p1Ah chahge§ tot apptoval by
the Pt4lonAl permiL Adminl§tratot prior to undertaking any duch modi-
ficatiohd, the pdrmittdd IN advised that substantial modification
may rdquitd subhfl§§loh of 8 hew Application rot p§tmit,
e, Ali hece§§aty precautions §hall bd taken to prdclude contamination of
any WetiAhdd or WALbfWdy by §uspenddd doi.id§i dedimdhtt rueis,
§olveht§i tubtldant§i epoky coALingdt pAint§t condtdtdi leachate of
Any bLhet envirohmdntsily dat.dtetioud matetiAis A§§odidLed with the
ptojecL wdtk,
li: Any tdiiute to compiy preciseiy with ail of the tdtm§ and dohditions
of thi lone of i Lhd U ttivirolAi+metiLAI cohservALion Law, be Lrdated as a
viblAt
it Thd pdtmlLtde i§ Advid@d Ld obtath any permiLd of apptoval§ Lhat may
bd rdyultdd from Lhd U,St bep8rtmdnt bt Atmy Cdtp§ bf the inedt§t NY
f' dih,
UHoLibng ftn uh)isprlbt to coWtMicdtNeh141 t of 2 Wotk ' Adthtitited leg
,i, Thd gtAhtihl bf thig petmlt dddd hot t@ileve Lhd pdtmiLLed of Lhe
tedpohdibiliLy bt bbLdihihq s gtahts dAddmAhLr br dLhet hAed§dAty
ApptcUAi from thg bivi§ioh bt LAhd U MI ALioni Otticd bt ddndtal
8etvice§t ToWdt Udlidingi >;mplre §tALU plAtAt Albany, Nit 12242, which
may be i:ojolt64 toL Any etictoAchtNLhL Upoh 9W6-oWhed ldhd§ Uhd@NaLet t
tteglohdl petmiL Admihi§LtdLot
Nys bepL, of hhvitchmet1Ls1 conservation
tildl. 40) sUNY-ltooth 2iO
SLony btookt NY illOO-2355
(51Gi i51-Idsg
bLC ~7 Do3~29~DD~Y d
page y of
I
OPEN 2f~IL bnl
P~b71a 51oF`_, ~ ~
- - RESUILO ~ESUILn 5-rE 7U i I
FFwEU Ei RPA'~EtiU ELEV P~Y IDDt
I
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I~- ~_8'- II_~ J_v---~ GFlI<acc ~7ctrE<~J rnwt~ Ie-- - I 1 551or Yr ~<-c sE.-raACk I i
SET BP U5 UNDERWRITERS CN DWATE
- ~ (LCI~ -'!w LT~o ~ REQUIRED
I I IZx OLm, I(G"o.C I ~I
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.J ~ F}ti.~~h _N:J IYt I ~,,,Y ''I_.o02 f,NI ~1{ I kIT_I~IEI!
APPROVED AS NOTED i
OA YB.P.N r'I ;a
3 ~ w FE ,13 By. Ili " i
Howr c, NOTIFY BUI ING DEPARTM NT AT-'
j 766-1802 9 AM TO 4 PM FOR THE Y J
L) RHIL FOLLOWING INSPECTIONS: o~E cn1 i. FOUNDATION - TWOREQUIRED
- - I IJ--- - I 1 R ~ ~ EXI o71NG LOCPY/OtJ ~,cnH slnL'1 fl FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING ~I
{ OF I~uus~ ~ I I T C~C~ ~ ~ -
3. INSULATION ~T 41 A. FINAL CONSTRUCTION MUST
BE COMPLETE FOR C.O.
c~ml J ALL CONSTRUCTION SHALL MEET r STATE CONSTRUCTION & ENERGY
70 I THE REQUIREMENTS OF THE N.Y.
CY1JV =I-=
Ci~CES. NOT RESPONSIBLE FOR --I - T---- y DESiCN OR CON9'rRUCTION ERRORS
REgU 1 L~ :-v t_P~ 70 '
I I ~ ~ I RNI~L-l.ELEV P7lo1~1 I~ i ~ I f
I
I
LIUING c~oom OCCUPANCY OR
I ~ I
USE IS UNLAWFUL
WITHOUT CERTIFICATE a
OF OCCUPANCY
9 I
I~ ~i { ~ ctl of H~~' rtr_ Ft2"PLf\cE 0
!J 2 v1
PLUMBER CERTIFICATION
ON LEAD CONTENT BEFORE
I 306$ -Zx6o:wl``11 mr ~GGC JOI,' Y r-
~G` mob' 's CERTIFICATE OF OCCUPANCY .ArC1; ~>;JIuNG it
SEOL~E c~E~C.~ s-~ 5~~/ x~n CC(~\ 'II~tCf~, 'r p:. LEJI, SOLDER USED IN WATER A
j OwNET~., I SUPPLY SYSTEM CANNOT
S Al ~0CL.o•~Eo PoRC1-1.. • EXCEED 2110 of I% LEAD. D
• NQ';IW:-I ON WKLLS 07z UF: ILIP)G
PWMEUNQ o 0
Lr INa ow„ ALL PLUMBING V09711 A MWTER LINER NEED n _
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