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Home My WebLink About17542-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18619 Date DECEMBER 5, 1989 THIS CERTIFIES that the building Location of Property 1360 TRUMAN'S PATH House No. County Tax Map No. 1000 Section 31 Block 12 Subdivision Filed Map No. Lot No. ADDITIONS EAST MARION, N.Y. Street Hamlet Lot 11 conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 19, 1988 pursuant to which Building Permit No. 17542-Z dated OCTOBER 19~ 1988 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 DECK & SHOWER ADDITION~ & CELLAR FOUNDATION UNDER EXISTING ONE FAMILY SEASONAL DWELLING AS APPLIED FOR. The certificate is issued to of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL DAVID & MARY GIUGLIANOTTI (owners) UNDERWRITERS CERTIFICATE NO. PENDING - DECEMBER 4, 1989 PLUMBERS CERTIFICATION DATED NOVEMBER 15~ 1989 - HENRY J. SMITH & SON. · ' ' Inspector Rev. 1/81 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) N~ 017542 Z Permission is hereby granted to: ~ , · _ _ ~...~.........,~.~,,,~..,..~.,...~,. ...... .,r..../..~,~ ., ....... ~....~~.~~..~.-~..~.>>.. ...... ~...~~....~ ,, ~,~,,, ~,,,~,,....z~ ..... :~.~......~~ ........................................ .......................................... :~....~~ ...................................................................... County Tax Map No. 1000 Section ........ ~.~'., ...... Block ........... ~...~..... Lot No .......... ./,~.. .......... pursaont '0 application doted ...... ~../~ ......................... . 19.~ and opprov~ by the BuiJdlng I~spectar, Fee $...2'.~. Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPART}lENT TOWN RALL SOUTROLD, NEW YORK 765 - 1802 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE ..... /Z/~/(.~ ... CONSTRUCTION -- ~--..OLD OR PRE-EXISTING BUILDING ...... VACANT LAND ........ Loca~o. o~ P~operty. f3~ '-"- ~ HOUSE NO. STREET HAMLET Owner or Owners of Property ~d~ ~ ~ County Tax Hap No. 1000 Section ~ / Block Subdivision ....................... Filed Map ........ Lot .......... · ?~ ./,~ / ,~ . ~,o ~ ~,~.~, Permit No. / ........ Date of Permit .[ .... l---AppAicant -- ~4.~. Health Dept. Approval .................. Underwriters · Approva? .............. Planning Board Approval ................ Request for Temporary Certificate ....... Final Certificate ................ Fee S-~it~ed: ~ ..... .4.,r.,.,'". ......... rev. 10/14/88 FOUNDATION (1st] FOUNDATION (2nd) ![DATE COH~gNT~ ROUGH FRAME & .FLUMBING INSULATION PER N, STATE ENERGY CODE FINAL ADDIT!ON~L COMMENTS: 95-19-3 (gJ89)-7e DEC ,~PPLICATION I~UMBER · NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION JOINT APPLICATION FOR PERMIT U.S.^RMV CORPS OF ENGINEERS APPLICATION NO, Please read ALL ilestructions on back before completing this application. Please type or Prlnt clearly in,ink. Attacb additional information as needed. [:]ARTICLE 15; TITLE 15 [:]6NYCRR 601 (WATER SUPPLY) J-]6NYCRR 602 (LONG ISLAND WELL) [:]ARTICLE 15~ TITLE 27 6NYCRR 666 (WILD, SCENIC AND RECREATIONAL RIVERS) [:]ARTICLE 24 6NYCRR 662, 663 (FRESHWATER WETLANDS) 2. APPLICANT IS A/AN [~]Owner r--JOperator 3. NAME OF APPLICANT (Use Full Name) David Giug [ianotti r-JLessee [:]Munic~pality/Governmental Agency (Check as many as apply) MAILING ADDRESS /~ ~'/,/ 36 Woodland ~ J T ELEPHONE (Where can be reached during day} (516) 269-5348 POST OFFICE , J STATE ZiP CODE Kin( Park NY X1754 4. NAME OF J~'Owner ~-JAgentJContact Person (Check one) David Giuglianotti MAIL{NGADORESS36 Woodland ~7~ J TEkEeNONEtWhe,ecanbe,eacbedduringda,)(516,) 269-5348 STATE ZiP CODE NY 11754 POST OFFICE 5. pRO, JECT/FACILITY LOCATION (Mark location on map, see Number la on reverse side) County Suffolk J Townorcity Southold J Village STREET ADpRESS (If different from applicant) 1360 Trumans Path STATE ' NY POST OFFICE Southold ~AME OF STREAM OR ~ODY OF WATER Marion,Lake HAS WORK BEGUN ON PROJECT? If YES, attach explanation on starting work w~thout permit, include dates. J~Yes J~No Show work on map and/or drawings. J-lyes ~JNo 9. PROPOSED USE, r~ Private ~0. PROPOSED STARTING DATE: I 11, APPROXIMATE COMPLETION DATE: [ 12. FEE OF (NY5 Permit Only) [] Pubbc [] Commercial ASAP $ Enclosed 13. PROJECT DESCRIPTION. (e.g. quantity and type of material to be excavated, dredged or used for fill or rip rap, location of disposal sites; type q! structure to be installed; height of dam; size of ~mpoundent; capacities of proposed water sources; extent, of distribution system; etc.J TO erect a 16x16 rear extension and a 16x16 deck WILL PROJECT UTiLiZE STATE LAND? J 14. WILL THIS PROJECT REQUIRE ADDITIONAL FEDERAL, STATE AND/OR LOCAL PERMITS? [] Yes [] No If yes, please list: 15. CERTIFICATION: I hereby affirm that under penality of perjury that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Further, the applicant accepts full responsibility for all d~mage, direct or indirect, of whatever nature, and by whomever suffered, arising out of the project described herein and agrees to indemnify and save harmless the State from suits, actions, damages and costs of every name and descnption resulting, from said prolect. In addqion, Federal Law, Eg U.S.C. Section 1001 provides for a fine of not more than $10,000 or imprisonment for not more than five years, or both, where an applicant knowingly and willfully falsifies, conceals, or covers up a material fact; or knowingly makes or uses a false, fictitous or fraudulent statement. J'~l hereby authorize the agent named in Number 4. above to submit this application on m behalf. PART II--ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 if yes, coordinate the review proceed and uae the FULL EAF. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617,67 If No, a negative declaration may ~e superseded by s~olbdr involved al~dn0y. [] Yae( No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, If leglbte) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or dinpenel, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural raeourcee; or community or neighborhOOd character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, signifisent habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural ranourcec? Explain briefly G5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In 01-C57 Explain briefly, C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. tS THERE, OR tS T~ERE LtKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVtRONMENTAL tMPACTS') [] Yen [~No If Yes, explain briefly PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) iNSTRUCTIONS: For each adverse effect identified above, determine whether It is substantial, large, Important or otherwioe significant. Each effect should be assessed In connection with its (al setting (i.e. urban or rural); (bi probability of occurring; (c) duration; (d) irreversibility; (el geographic scope; and (fl magnitude, If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. [] Check this box If you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ~ Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons SUpporting this determination: Print or Type Name of Responsible Officer in Lead Asency Name of Lead Asency Title of Responsible Ofhcer Signature of Preparer (if di/ferent from responsible officer} Date 2 14.164 (2JEff--Text 12 ,,PROJEOT I,C, NUMBER i I I 917.~1 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION ,(To be completed by Applicant or Project sponsor) 1. APPLICANT ISPONBOR i 2. PROJECT NAME David Giu~rlianotti i 3. PROJECT LOCATION: ; Municipality Southold i County ~uffOlW 4. PRECISE LOCATION (Street address a~d road intersections, prominent landmarks, etc., or provide map) 1360 Trumans Patch, Southold, NY SEQR ' 5. IS PROPOSED ACTION: [] New [~] Expansion ' i~[] .Modlfieatlonlalteratlon 6, DESCRIBE PROJECT BRIEFLY: i To erect a 16x16 ~ear extension and a~16x16 deck 7, AMOUNT OF LAND AFFECTED: Init/ally &ores Ultimately seres B. WILL PflOPOBED ACTION COMPLY WITH ExIErING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes [] No If No, desnrlpe briefly 9. WHAT i8 PRESENT LAND USE INVI¢ ~ Residential [] industrial Dovoribe: INITY OF PROJECT? [] Commercial [] Agriculture [] park/Forest/Open specs i-]Other 10. COES ACTION INVOLVE A PERMIT ~ ~PPROVAL, OR FUNDING, H'OW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, RTATE OR LOCAL)? [--]'Yes [~No f yes, list agency(s) and permit/approvals 11, DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAUD PERMIT OR APPROVAl.? [] Yes ~[~ No If yes, list agency name and permit/approval 12, AS A RESULT OF PROPOEED ACTI~" WILL EXISTING PERMIT/APPROVAL REQUIRE MOCIFIOATIO"? [] Y,s ~ No I I CERTIFY THA'~ THE INFORMATION PROVIDEC ABOVE IS TR~JE TO THE BEET OF MY KNOWLEDGE Applleent/sponsor name: David Giu~rlianOtti Cato: If the action I$ In the Coastal Ama, and you are a stats agency, complete the Coastal Assessment Form before proceeding with this assessment OVER ~TRUCTURAL-ARCHE.OLOG]CAL AS~rRS#ENT FOR# [SAAFI PART 2 - DEPARIHENTOF ENVIRONgENTAL CONSERVAT~O# (DEC) CO~IPLETES Applicant/Project Informat1on l, Applicant Name 2. pro~ect/Faclllty Name David Giu~lianotti 1360 Trumans Path, Southold 3. DEC Number Buildings and Structures 4. Might the ....n<.d Droiect have any impact (physical/visual) ~pon ~ny buildings ~'~t~re~ listed in the State or National Register o~ Historic Places ~C built prior to 19407 Yes No x ]f yes, OEC must consult ~ith the Office of Parks, Recreation and Historic Preservation (OPRHP). The DEC must request a determination of eligibility for the State Regtster of Historic Places and/or comments regarding pro~ect impact. ]nclude Information supplied by the applicant in'response to questions 5, 6, 7 and 8 of Part 1 of this form. Archeological Sties 5. Ooes the proposed pro~ect area cotncide with a ctrcle, square or stippled area on OPRHP's Statewide Archeological Inventor~ t4ap? Yes No x Is the.proposed pro~ect area out~le.of,.a,~trcle o~,~quare, but one for which ~nformation has been provided (ex. documented ~eports of known sites) that suggests the area ~s archeological~ysens~ttve? Yes No x Zf yes, what is the nature and source of information? 7. Is the proposed project area apparently undisturbed? Yes No x 8. ~11 the proposed action include a physical disturbance of the project' area? '" Yes No ~ 10. 9. Zs the slope tn ~hearea characteristically less than 15%(unless on limestone/flint escarpments)? project area characteristically moderately well or well Yes Is the proposed drained? Yes x No If the answers ito 5, 7-10 are yes, an archeological survey should be performed by the applicant. Provide the applicant with a copy of Reoort Format for Cult'ural Resource Investioations and list of archeological consultants. If the answers to 6-10 are yes, OEC must consult with OPRHP before requiring that the applicant perform an arcbeological survey. ~n No buildings, structures~ or archeologtcal sites identified at the project lo~atton (SHPA-1) n/a . Butldings,i structures or archeological sites identified, but no impacts wt)l occur, 'no survey required~ No further cultural resources review required ($HPA-2) n/a Consultattion'by OEC with OPRHP required structures archeology n/a .-.Archeologlcal survey required Results of Evaluati4 Prepared by/J~ Oate SAAF2.LK/G OWNER 10/90 9~-20-7(10/90) New York State Department of Environmental Conservation Supplement to Application,for Permit ~TRUC~URAL-ARCNEOLOGICAL ASSESSHENT FORH (SAAFI PART I - APPLICANT COHPLETES Applicant Info~matton .. David Giuglianotti 1. Applicant Name _ '2. Applicant Address. 36 Woodland ~..~, Kings Park, NY 11754 Pro~ect Information 4. 5. David Giuglianotti Pro~ect/Fact]ttY Name project/Facility Location 1360 Trumans Path, Sout~old,NY 11791 Is the proposed project adjacent to, or does it contain a bui]ding or structure listed in the State or National Register of Historic Places? Yes No x Are there any buildings or structures built prior to 1940 adjacent to or within the proposed project area? Yes No x If the answer to question 5 and/or 6 is yes, provide the following information for each building and structure (use attachments if necessary): a. name of structure b. location c. type of structure (ex: house, outbuilding, barn, bridge, dam, ruins) d. approximate age or date of construction Hight.the --nnos.d .ro~ect have any tmpact"(phys,ical/v~sual) ~pon ~ny buildings ~-~tr~t~re~ listed in the State or Nattonal Regis:er ot Historic Places or built prior to 19407 Yes 'NO x If yes, describe briefly (use attachments if necessary): Provide photographs of every butldtng and structure that may be impacted by the project ~ described in number 7, above. The following standards are recommended.i o minimum of two photographs o mtnlmum stize 4" x 4" prints from negatives preferred; polaroid photos are acceptable o .photos must be ~ and ~j).rJ~f. eJ o clearly label photos so it is obvious what is being Illustrated; key photos to!map or plan, tf posstble o photo 1: Show both the entire front and side of'the structure in a single shot from as close to the bulldtng as possible. Be sure the structureits not partially or fully blocked by trees or other obstructions o photo 2: show relationship of building or structure to roadway or surroundings Has the land wiithin the proposed project area been previously disturbed or altered (excavated, landscaped, filled~~utilities installed)? Yes No x If yes, describe briefly, including depth of disturbance (use attachments if necessary):i 10. Approximate percentage of proposed project area with slopes: ~ % 15% or greater~ 0-10% × )% 10-15% .... 11. Approximate percentage o proposed project site with the following drainage characteristics: 'well dratned i × % moderately we?l-'d'~it~ed ...% poorly drained ..% OWNER Date SAAF1.LK/G lo/9o HENRY J. SMITH & SON, PLUMBfNG, HEATING & FUEL OIL MAIN ROAD SOUTHOLD, N,Y. 11971 (516) 765--3690 Inc. D a t.e _ ._N_o_v_e m_b_e_r_ 15_ ~ _1~9~ q _ Building Permit No._~7~2~ Owner David Gigglianotti Plumber HenrI J. Smith & Song Inc. I system certify that the solder used in the water supply contains less than 2/10 of 1% lead. Sworn to before me this _~5~_day of November ct~o~ary Notary Public, Suffolk County BERNADETTE L, IAPI.II"I NOTARY pUBLIC ~84489~ State o! New York Residing in SuffOlk County ,~ Cemmission Expires Sept. 30, ~.9.,.~L~. TOWN OF SOUTtIOLD OFPICE OF BUILDING INSPECTOR ILO. BOX 1179 TOWN IIALL SOUTIlOLD, N,Y. 11971 November 14, 1989 TEL. 765-1802 DAVID P. GIUGLIANOTTI 36 WOODLAND PATH KINGS PARK, N.Y. 11754 To Whom This May Concern, We are unable r.o complete your Certificate of Occupancy because .of the following reasons. /_-/ An application for Certificate of Occupancy is Bot on file. /_~// No Underwriters Certificate on file. /.--_/ The c]leck i:;(outdated/not on file.) /~/ No Health Dept. Approval on file. /~/ No final inspection has been made. Please contact: our office on this matter. Thank you for your cooperation. lhiilding Perm.kt tl I 7 5 4 2 Z Bui 1~17 Dept. **~/~ Uo Plumber Solder Certificate on file. ( all ',' -,- ' . pe~uxto ~nvolv~.ng plumbin~ being issued after April 1,1984 ) NOTE: AMENDED FEE OF $20.40 DUE BEFORE CO CAN BE ISSUED.