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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-32771 Date: 12/03/07
THIS CERTIFIES that the building ACCESSORY DECK
Location of Property: 870
(HOUSE NO.)
COUnty Tax Map 11Io. 473889 Section 56
SOUTHOLD
(HAMLET)
Lot 2.9
subdivision
Filed Map No.
Lot 11Io.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 13, 2007 pursuant to which
Building Permit No. 33422-Z
dated SEPTEMBER 25, 2007
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 ACCESSORY DECK ADDITION AROUND AN EXISTING INGROUND SWIMMING
POOL AS APPLIED FOR.
The certificate is issued to JOSEPH A & LORRAINE SFERLAZZA
(OWNER)
of the aforesaid building.
SUFFOLK COU.....,., DEPAR'l'MKIIT OF HEALTH APPROVAL
N/A
N/A
ELECTRICAL CERTIFICATE 1110.
N/A
PLUMBKRS CERTIFICATION DATED
~~--
Aut rized Signature
Rev. 1/81
~'
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:
I, 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 th~n~ 0 % lead,
5, Commercial building, industrial building, multiple residences and similar buildings and i t t~s ~cate
of Code Compliance from architect or engineer responsible for the building. ~ 'J Ii' "'-.
B. :~r ::::~:~:~::::::P:::;:i:~~:::~:t:~~~~::~::i::r:::::r buildings a~"p1- 's::'~ ~~~
I. Accurate survey of property showing all property lines, streets, building and unusu~J".or tl:lp.Q~plifc . ,/
features. "'0~ C't_-~>,-. _ /~..
2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of..Q~ii~ is../ /
denied, the Building Inspector shall state the reasons therefor in writing to the applicant. '~ ;) /
~/
c. Fees
I. 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 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. II )ze, /67
Old or Pre-existing Building:
<i1D PM/<. Ave.
House No. Street
./' (check one)
SJuTHcLD
New Construction:
Location of Property:
Hamlet
Owner or Owners of Property:
Jt7S6P/I t! ~,<fl,(/~ SFE.e.~'Z.-zA
.
Suffolk County Tax Map No 1000, Section
Subdivision
Block
Lot
Permit No, 3?:tf LZ 2: Date of Permit.
Health Dept. Approval:
Planning Board Approval:
Filed Map.
Applicant:
Lot:
Underwriters Approval:
s/" (check one)
Request for: Temporary Certificate
Fee Submitted: $ 6?~ t1 U
Final Certificate:
~"Z. 73Lf ')7
ca-l: 3:1771
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.
33422 Z
Date SEPTEMBER 25, 2007
permission is hereby granted to:
JOSEPH A SFERLAZZA
870 PARK AVENUE
SOUTHOLD,NY 11971
for :
CONSTRUCT AN ACCESSORY DECK ADDITION AROUND AN EXISTING SWIMMING
POOL AS APPLIED FOR.
at premises located at
870 PARK AVE
SOUTHOLD
County Tax Map No. 473889 Section 056
Block 0001
Lot No. 002.009
pursuant to application dated SEPTEMBER 13, 2007 and approved by the
Building Inspector to expire on MARCH
Fee $
356.00
25, 2009.
ORIGINAL
Rev. 5/8/02
~3 Y;~Z..:-&
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
---
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] -Y"NDATION 2ND [ ] INSULATION
[%FRAMING I STRAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT CONSTRucnoN [ ] FIRE RESISTANT PENETRATION
REMARKS: f'~ *-
DATE I/I!.; ( () J
INSPECTOR
~
3J'f~~~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
N FOUNDATION 1 ST [
[ ] FOUNDATION 2ND [
[ ] FRAMING I STRAPPING [
[ ] FIREPLACE & CHIMNEY [
[ ] RAE RESISTANT CONS1RUCTION [
~
REMARKS:
~
] ROUGH PLBG.
] INSULATION
] FINAL
] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENETRATION
DATE
/D -/7- ~ 1 INSPECTOR ~~
FIELD INSPECTION REPORT
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY CODE
FINAL
.
.
DATE I
ID-A... -7 l\n ,O^
If fir I.
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_______1-_
-----
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COMMENTS
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ADDmONAL COMMENTS
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Examined
Approved
Disapproved alc
BUILDING PERMIT APPLICA nON CHECKLIST
Do you have or need the following, before applying?
Board of Health
3 sets of Building Plans V
Planning Board approval
Survey V--
fERMIT No.mlBc9 ~ Check.........
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to: .:tJl:cJ LOlUIAIt.)", S1=ffi IA Up.
P37D PA/Ut P.ui'AJ{, JI'- :<W 11 UOLb
,
Phone: 7G5" - ZZ:~q
TOWN OF SOUTBOLD
BUILDINGoDEPARTMENT
TOWN"BALL
SOUTBOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.netlSoutholdJ
Expiration
,20_
,
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APPLICATION FOR BUILDING PERMIT
Date 4P7e1l1 ~~ ..5
, 20..sf:/-
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 waterw~ys.
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 South old, 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 agree~ to ;comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit
authorized inspectprs on premises and in building for necessary inspections.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
CXJJ~
Name of owner of premises JoE d 4>lUllII.cllG Sf'E:~I^~
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
},/'A
(Name,and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
I. Location of land on which proposed work will be done:
670 _ PAU. ~uG-AJ()b
House Number Street
SOCJlI-loU::>
Hamlet
County Tax Map No. 1000 Section $
Subdivision ~f.X, PotJDCS7A-76S SECftDIJ OtJtf:;
(Name) .
Block 0 I
Filed Map No.
'60"37'"
Lot
Lot
z.q
Ze.
2. State existing use and occupancy of premises and intended use and occupancy of pro osed constructiM:
a. Existing use and occupancy 51 /JG~ L uJ W /-0 . ~
b. Intended use and occupancy ~ ~'>UI( IOf.} /T::J:~ P-.V-OCJtJb POOL
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated cost~ :JD Sa) ,.-
} r
5. If dwelling, number of dwelling units otJ~
If garage, number of cars _ Z-
Addition
Other Work 'UecJ(s
Alteration
(Description)
Fee
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, commercial or mixed occupancy, specifY nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height Number of Stories
Rear
Depth
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflot: Front
J (QO
Rear
JftJO
Depth L~5. 1\
(. a.1I"- 'D. R'o or
(M.I
l), 0...0 6-,
%,$ Wr
10. Date of Purchase JAtJ\l1Wl.I.( It\o.~ Name of Former Owner
@)zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance orregulation? YES_NO ~
13. Will lot be re-graded? YES _NO ~ Will excess fill be removed from premises? YES_NO ~
:d:; ~ ifJU/l..IP€: $70 ~A\U. M6
14. Names of Owner of premises ~ f:1I..lII. U-I\ Address Q)(J7~o~ Phone No.7"-S - Z<.3q
Name of Architect~ (>JJ6 \.M1Z.O~ Address ~ "(~P7D')1hone Not:,;>,(- 2 f?B -SOV9
Name of Contractor Jce $fettlA ~p.. Address Phone No.
15 a. Is this property within 100 feet ofa 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.
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:
COUNfYOF S...H-.lk.)
'J 0 Hr~ Sf <<RT.A Z-<2.. I' being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contrdct) above named,
(S)He is the
0", lJQ.f\,
(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'inanner set forth in the application filed therewith.
John M. Judge
NOTARY PUBLIC. State of New York
No.01JU6059400
Qualified In Suffolk County
Commission Expires May 29. 20 1L
Town
of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.C.T.M.#:
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM-WATE GRADING DRAINAGE AND EROSION CONTROL PLAN
CERTIFIED BY A DESIGN PROFESSIONAL IN THE STAT OF NEW YORK.
DiSiriCt ~ BiOCk ~
----------------------------------------------------
Item Number: (NOTE: A Check Mark (~) foraach Question is Required for a Complete Application)
Ves
No
----------------------------------------------------
/[J
I[J
[d/
[d/
[dL
[dL
[d /
[d/
[d V
1
Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site?
(ThIs item 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.)
Does the Site Plan andlor Survey Show All Proposed Drainage Structures Indicating Size & Location?
This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFlowI
2
3
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?
4
Will this Application Require land Disturbing Activities Encompassing an Area In Excess of
Five Thousand (5,000) Square Feet of Ground Surface?
5
Is there a Natural Water Course Running through the Site?
Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach?
6
Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to
One Hundred (100') of Horizontal Distance?
7
Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Stonn-Water Run-Dff
into and/or in the direction of a Town right-of-way?
8
Will this Project 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 will NOT Include the Installation of Driveway Aprons.)
9
Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse?
NOTE: If Any Answer to Questions One through Nine 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 Pennltl
----------------------------------------------------
EXEMPTION:
Ves
No
Does this project meet the minimum standards for classification as an Agricultural Project?
Note: If You Answered Yes to thIs Question, a Storm~Water. Grading, Drainage & Erosion Control Plan Is NOT Requiredl
----------------------------------------------------
STATE OF ~~~~~ ..3..~.ffi.l.\L................ 55
That!, ,..Jp.5.~,h...5.,k.(La.z..:z..g",................ being duly sworn, de~oses and says that he/she is the applicant!or Permi4
(Nam. of ~dlv;du.,.~n;ng Dacumenl) C.O .~ o..-eJ--o V
And that he/she is the .......... ......., ........ .......... ....,............. ....... .......,.... ..................... ...., ........,.,...........,.......,............, .....................
(Owner, Contractor, Agent. Corporate Officer, etc.)
Notary Public: .,.".... .
FORM - 06/07
.e
.
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..... .....
1000 .Sw _ (. Z. 9 TOWN OF SOUTHOLD PROPERTY RECORD CARD \
OWNER STREET VILLAGE DIST. SUB.
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ACR.
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TYPE OF BUILDING
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FARM COMM. CB. MICS. Mkt. Value
LAND
IMP.
TOTAL
DATE
REMARKS
C)
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Tillable
Hause Plot
I&D0
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
Woodland
Meadowlon
Total
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.
No.
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M.~~LI/<".Ljb~ ,
\\0 l\ '3. $C) ~~Co4 Foundatio:1 P. c . Bath 3 I.-~)
E~~;Sfci~t R., ru. 3(2("h -
\7 l<.io ' IO"!" 5.'fS ~q.~3 Basement \~ \\ Floors ~ IN 00'<.- 1:>il
E':~XsT5'n .'e I<:'U.' 'Z~C) "
I.q'") 3,';-0, ;?t./Zz, J:xt. Walls c~,pov clo-a Interior F in ish ~,",
_\~.. ~-~ S K Iq , ~Sto \ Fire Place 'IfS \
Extension Heat 5 ~C' .
In l(~' , ~
J \<::st~+'Jj..t- :, '1'\'2 , ~ 103 ~,"7 5" 23b
, , s"~-\ '^"'~
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,
Porch (0 x 2:<. :: \3~ .50 00 Pool Attic
I \t~~
Deck ( 1<'2-1 '" 307 77 Patio Rooms 1st Floor
I"" ,L, "'- ,2-)"
L,,,, ~ C d. Driveway Rooms 2nd Floor
:5Po"-
. , I ,
Garage 2'5 K3.(: ~ S= \,2~ \)000
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