HomeMy WebLinkAbout33370-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-33092
Date: 06/13/08
THIS CERTIFIES that the building OUTDOOR PATIO
Location of Property: 13550 MAIN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 114
(STREET)
Block .!l- Lot 4
MATTI TUCK
(HAMLET)
SUbdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
AUGUST 22, 2007 pursuant to which
Building Permit No. 33370-Z
dated SEPTEMBER 6, 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 OUTDOOR PATIO ADDITION TO AN EXISTING RESTAURANT AS APPLIED FOR.
The certificate is issued to MAZZELLA HOLDING LTD
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE 11IO.
4001600
06/02/08
PLIlMBERS CERTIFICATION DATED
N/A
~i~
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 than 2/1 0 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:
I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed 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
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.
"-/.20,/()!
Owner or Owners of Property:
Steve
)t(a;iII e r/
Street
Me.. zelIa..
.
I[ '-(
V (check one)
Jkl/;I",ck.
j..J. Y,
1/9[2
Hamlet
New Construction:
Old or Pre-existing Building:
I~S{6
House No.
Location of Property:
Suffolk County Tax Map No 1000, Section
Block
(!Jot (
Lot 00 t:...(
.
Subdivision
Filed Map.
Date of Permit. 9! ' /0 7 Applicant:
Lot:
Permit No. 53370
sieve
Me., -zell "I
Health Dept. Approval:
Planning Board Approval:
-
Underwriters Approval:
-
..---
Request for: Temporary Certificate
,'/,1\ 0"
Fee Submitted: $ _~
~?9D1d-.
Qp & 'l"\ ~ \."\.,,
Final Certificate:
v'
(check one)
~u
Applicant Sigr{ature
,,--,,-.-'.
'-n-i'-.':-i-;--il""
',,' ':--. ...- ;---- -'----1 ----;;----- r---;, --Ii --- ii-----:,
I "I --, -.- 1 -,.,~-,.. _ -"
!, :,1. _, ,~'__, ," ........" I .
,i ---I i.... ~ \_'-
r', -~ I'
[!)~
~
~
~
~
~
~
~
~
~
~
~
~
i Located at
~ Application Number: 4001600
i Section:
~
~
~
~
~
~
~
~
~
~
~
I
~
~
~
~
~
~
~
~
~
~
~
~
~[!)
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
~
BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET - NEW YORK, NY 10038
CERTIFIES THAT
Upon the application of
upon premises owned by
1WIN FORK ELECTRIC
PO BOX 48
JAMESPORT, NY 11947,
ADAM LOVETT
13550 MAIN ROAD
MA TTITUCK, NY 11952
13550 MAIN ROAD MA TTITUCK, NY 11952
Certificate Number:
4001600
Building Permit: 33370
BDC:
ns11
Block:
Lot:
Commercial
Described as a occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
First Floor, Outside, PorchlDeck,
A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed
herein, was conducted in accordance with the requirements of the applicable code and/or standard
promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
authority having jurisdiction, and found to be in compliance therewith on the 2nd Day of June, 2008.
Name OTY Rate Rating Circuits ~
AdditionalCharges
patio lighting
Wiring And Devices
Fixture
Receptacle
Switch
o
o
o
6
2
1
Incandescent
Gen, Purpose
Gen, Purpose
seal
1 of
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
ii!ffi!If:!~~ii!rr.!
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.
33370 Z
Date SEPTEMBER 6, 2007
Permission is hereby granted to:
MAZZELLA HOLDING LTD
13550 MAIN RD
MATTITUCK,NY 11952
for :
CONSTRUCTION OF AN OUTDOOR PATIO AS APPLIED FOR
at premises located at
13550 MAIN RD
MATTI TUCK
County Tax Map No. 473889 Section 114
Block 0011
Lot No. 004
pursuant to application dated AUGUST
22, 2007 and approved by the
Building Inspector to expire on MARCH
6, 2009.
Fee $
250.00
!
A
d Signatu
ORIGINAL
Rev. 5/8/02
JAMESJ. DEERKOSKI, P.E.
260 Deer Drive
Mattituck, N.Y. 11952
(631) 298-7116
2 i.
Date: May 20,2008
I '
L
----.....;.......:.
...... "?'''--'Il~_
i
~. ~ i
:._1
To: Town of Southold Building Dept
Re: Framing, Strapping, Foundation Inspections
Red Door Rest.
13550 Main Rd.
Mattituck, NY 11952
Permit# 33370
To Whom It May Concern:
A Foundation inspection was done on the above mentioned patio area, and the foundation
was installed as per plan and meets all state and local Codes. An Strapping/Framing
Inspection was also preformed on the building, and the framing/Strapping was installed as
per amended plan and also meets all State and local Building Codes. Any questions please
feel free to call.
r:"---~~-'-- . ._-~, .~ '..j
Ir~ ~ lL r~ n W [~I i,: '
I[ ,I,
n .' ~ 6 : tU I i,
U I ."- i
I . ___._.--.-J ,
t.~ll c CiP . I
T~"'''' r,~ C''^'-' 'T'-Jf"'\,'
I ,.'el ",. .- '.
ANGEL B. CHORNO , ARCHITECT
51020 Main Road
Southo1d, NY 11971
Phone (631) 765-6530
Fax (631) 765-4643
September 4, 2007
Mr. Michael Verity
Southold Town Building Dept.
Southold Town Hall
P.O. Box 1179
Southold, NY 11971
Re: Stephan Mazzella (Red Door Restaurant)
Premises: 13550 Main Road, Mattituck, NY
SCTM # 1000-114-11-4
Dear Mr. Verity:
This is to advise you that Mr, Mazzella will be moving a portion of his indoor seating
to the outdoor patio on a seasonal basis. There will be no increase in the number of
customers seated.
If you have any questions, please give me a calL Thank you.
Very truly yours,
ANGELB. CHORNO
ARCHITECT
51020 MAIN ROAD SOUTHOLD. NY 11971
(631) 765- 6530 FAX (631) 765- 4643
May 20th, 2008
Southold Building Department
Southold - NY - 11971
20
I.
l
~
:._,~_..
') I
---J
Re: Stephan Mazzella ( Restaurant)
13550 Main Road, Mattituck, NY
SCTM # 1000-114-11-4
This is to affirm that the substitution of 3 LVLs (9 % ") for 2 LVLs ( 11 7/8 )
at the new door opening to the patio is structurally sound, and acceptable
to me.
Sicerely,
Angel B. Chorno, AlA
iwr( (3 ~
33.3 70 Z-
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING [><1 FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: F ~ d:h_~_-e~
#- ~F~ r!- ~~
~~j- ~ ~ Df\'
E hdA~c ce~6f-~evt~ ~\ ~ '
r~~ ~, ::t:t Jt~f\1 /
~'L-~~ct .
DATE S - ~d- ~() f' INSPECTOR ~ ~
.
. FIELD INSPECTION REPORT DATE I , COMMENTS
\../.,
, ."
'j) toJ
" ~
~,
,. ,! --.c
FOUNDATION (1ST) ~ ~ '--' --3
../II" . U l.AV \,\, ..
------------------------------------- \"',
<If / A '~
-:1",
FOUNDATION (2ND) " toJ
'Of r(
2:
p
',.
\.1.'
/' \ ' . '"
\,';
r ...,
I A/>/J hf. \ ' ' l;J
.
ROUGH FRAMING & toJ
'- v~ ...,
PLUMBING
, j
.
, ~
~' ~
""c,
"
-.
---,..-.- f-' - == ~
------ ~
C
INSULATION PER N. Y. ; t'J
iJ/ It ...,
STATE ENERGY CODE ~
rr\
'1l
(1'\
---: ("'
-'
A ~,- r-
0
S --)--; ,r 0 'X Ft.~~ d6-~, ~Dfc. t/.A =L -
';J'
_r rtr '- ~
..-.a:Z::;;:,,, " ,V .l.'l , '[} \
,/"J :;-;r J- --..JL-w-, , ( ~
-
c,R~~ l.// _A E~~.-' r
t ./
FINAL :: ~ Af2.C-:hct1Y-' c.vVf . h/14\.~ r;1 .--e 'e.
. ../":? .-..' e ;"
,CIA. . ~ .J ,7.., A-f-- )---..0.':. ;"A .er ',r',
____'r" 7' f:
. I "
,
~
- '
ADDmONAL COMMENTS !.::--
','
c; r)c-{) J, /29-<:-1...& PF 024. , /r-c-<-~ -ei!.--<.---:Cc t'J'v__..., .
}I.Q . .:.c
./.J:b\. - ...l- t? J\ ~.,.""";"a v /./ hI '0
'Y: , ::::
'/ {/ - (/ cr- .,.. z
^ n ":i m
5- 22--0il fJtz.t ~{J~tcrYI ( '.f) ~' A K'L..Y.. A ~ ;0
n,f2- .,
,
.
:! ,
" .
(., t.!I!j
, ?d
.-- ~
, ...,
-
0
2:
- [;j
. ~
-
----...,
-i ==
I:;j
toJ
."
~
,
.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
PERMIT NO. 333 ':my"
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y,S.D.E.C.
Trustees
Contact:
Examined
Approved
Disapproved alc
,2~
,20P.
Mail to:
Expiration
,20
r
Building In
Phone: c/// f'/hu /#",fl,)oJ
rr.. -::-;--r; -;,,-;: . r";; ~~
..,.: '-, i> I'
APPLICATION FOR BUILDING PERMIT
I AUG22 I
I . .
L.,_'.. .--1
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 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 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.
- ....------
Date
?--p
,20~
INSTRUCTIONS
(/~
(Signature of applicant or name, if a corporation)
mtJ2-0 mOl,.} /?d" J{)u-/-hc lei
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, erigineer, general contractor, electrician, plumber or builder
/J/ltI '~
Name of owner of premises S~h(:l/1 /J1tJ Z ~I/c:r Red ~JI')r
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(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 wor!l: will be done:
/35tPO Mar;' (.{ood
House Number Street
/l1. a..-th fr/de-
Hamlet
(Name)
II tf'13;WJ>9,~:~/ /
tt:ii..all '0 .liiIe~ilIl\.
mUli.
__nf=r.::a,= A
Lot L/
Lot
County Tax Map No. 1000 Section
Subdivision
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~ ~~ -
b. Intended use and occupancy
uclcl ])00..- -h:;?;on i
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
.. ~ fZ.s /z::uv1C4<..7- IW ;-utdtxJO /7M1
/,a-h'o .
Alteration NUl) /AJp,...
Addition
Other Work
4. Estimated Cost
12..-~, t??70
(Description)
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(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. errslnu/ M!;k:uMa4Pf-
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
Height Number of Stories
Rear
Depth
9. Size oflot: Front
Rear
Depth
10. Date of Purchase
Name of Former Owner
II. 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
- - --
14. Names of Owner of premises
Name of Architect
Name of Contractor
Address
Address
Address
Phone No.
Phone No
Phone No.
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.
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.
18. Are there any covenants and restrictions with respect to this property? * YES NO
--
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF Svtfb//C. )
;;:: Ircu a (' l11o()--r""- being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
(Co actor, 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
dcl day of
200'1
fn.lL
,>
C)
'"
C>
:ti'::l
f"tJ~
"'C>
. ~
~a-
- ~
~':J
~'"
(b~
I ~"
I
I
I / ~/. .-
1/ ~ 7
.
~O.':~--
, "'(I },O;:.-'.
ele 25) !.$t~.:..~o..Jr:/
( N.Y:;' ~~-..:::-,/........
ROAD ~/
""."".,~~~'"''
\~ \:~. \2.:"p"I:'(
~ ('. '.
. ,
, ,
\ '. ~
, . ,
," 0
~ ~ 0
.... '" \
.... .0 ~ ~ 10 !"l
,..1 CIO
i O. ,'; ;; 1" .I.'.~~
'~l~ . ~ ~
UUt~.
"
?::
C>
-
c-
Co
\ ,
,.
'J
.,
'..
~
L
~
~
a
\ '"'
Co
~
--.
.........-\
..'
(
!
MAIN
,,,,.60~
101/<40 ;:.--
N' --
~.--
~
~
,
"
t"
~'
'"
'"
'"
,
'"
'I
c-
~
"
"
'"
~
,
.
\
::,
-.. -.
C> '"'
~ "
" C>
~t5
,,~
,,<ll
~.~
~.'<
.. ",.
'" '-'.
o a
,;J
",,,<
~ a
~ 0
"
a
~
o
o
,.
o
.
,
o
o
<
.
,
,
o
i
o
<ll
'<
a
<>
"-
~
a
~
~
~.
""
r-,
<>
h
~
"
<>
"
I\l
!-"
,~
<0
'"
~
C>
....
~
. ~~ :':
:;
~
IADtI, .
o 4QI""r
'"
"
!-
Q
'"
"
p
'"
~.
..0". .........'..(...1 _
01'00.....1 ~.. ~J~
n,10t..,.r Co",,..,. ~Co..lnc,
74.60 ~~d""'O(~ij1C)
o,iOO'''. ~ e. '1100
.. 5,73 .' (fiber
..~ ~:..--tr;;eve LV (or",er1Y
.....~ . nOw Of MooneY
'$ a.
I nonc'
, . . (r~erI1 .
( 0 fI' \
nOW ~d F. Nine \
r.oY"'o
NorE:
a :MON/JM[NT FOUNO.
nf.VI510N:'.
YOUNG 1\ YOUNG
400 OSTRMIDf,1l AVENUE, IlIVEnH(AO, UEW Y(l(;K
oce. 5, 19 T T
ALOI:N W. YOUNG
rftl)r("'''....l,. INOINt'-" ""D
lotti" .vny( TO". ".Y._, lIe. NO. 111 ~ a
H0w..."n ~v. ",JI"
lHII) ~u,,'"' r['IO
N.T.I. lll:. "D. 'HlO
v-.o.u'_'IIO """"n_ t>" 'N''''~'' 1"0
'RIII"""""'''''.O.''ItI''r.
,,,.,....RI"'.........""O"'''.O.
.,.
'SUHVEY fon,
EDIVARD COSGROVE
(r,"" II' r~'1 'II"" ~.. "'" Of ..,".
,.., "'0 W"I'(I'" ""0.... ""
.......11 (I II I, """ ~O' 01 ,~'" ~I"O
'00' '",'o,""IU'''
^' MATT/TUCK
10WN 0.... SOUTI-IOLO
"'" '~If I' '_n.'" r~ HI" (I. 1"'.\ .".
....... 10 1"( ,,"\). '(1' ..,~.. ''''
r......I' II '11 ""11, ..n n. ~., "...,,
lr 'H( ",.1 10....~.. ~'''''I .....,..,
'~I ,~, ...n ., ..n'H~ ,..." ~,.o. ,.. II n
~"(Q~. '''0 '0 'HI ","O_11l 0' '"'
U"nl"l '''''''''''0. r.""""Il "1
.~.' """IU.\! '(I _r..''''II''''
,"''''U1l,.",O''',.....,O''''''I-',''I.
SlIffOLK CO., N. Y.
r
OCT 25./977
"CALC: ,": 40'
rW:rF:'
" -,.
,\,
j' .,i !lll\jn~fi~11:~I'I;;~!;jl~ l~!I]~~~JiD,~;'! '
:' .~1:~-f..t'.1Ib. _~!'fffr~:t:\-.'i~W)l"/~;'i';;,,
','",It
~ ; : ~'!E~;;: .
.1, '1'~/,('",
L_,Ii:... '.
:1 (
.~~:' [LVI',':; t!
I"
Ii 'I
Town
ff3337D
of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.C.T.M. #:
I ~g -IJk .IL -':b-
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN
CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
Item Number: (NOTE: A Check Mark ( ~) for each Question is Required for a Complete Application)
1
2
3
4
5
6
7
8
9
Willlhis Project Retain All Storm-Waler 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 and/or Survey Show All Proposed Drainage Structures Indicating Size & Location?
This Item shall Include ail Proposed Grade Changes and Slopes Controlling Surface WalerFlowl
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?
Will this Application Require land Disturbing Activities Encompassing an Area in Excess of
Five Thousand (5,000) Square Feet of Ground Surface?
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 WeUand or Beach?
Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to
One Hundred (100') of Horizontal Distance?
Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off
into and/or in the direction of a Town right-of-way?
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 wlll NOT Include the Installation of Driveway Aprons.)
Will this Project Require Site Preparation within the One Hundred (100) Year Hoodplain of any Watercourse?
Yes
No
x [J
X [J
[J 'I..
[J X
[J X-
[J x.
[J 'i.
[J )(
[J 'f-,
NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark In the Box, a Stann-Water, Grading,
Drainage & Erosion Control Plan Is Required and Must be Submitted for Review Prior to Issuance of Any Building Pennftl
EXEMPTION:
Yes
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 Required!
5TATEOFNEWYORK,
COUNTY OF ""?~1.fk,~\~""",,,,..,,,,,,,., 55
That I, .."...S6,h.!.u.I:\.".c.".W\Q.~.."""".". being duly sworn, de'poses and says that he/she is the applicant for Penni4
(Name of individual signing Document)
And that he/she is the ''''''''''''''''~~;;'~:~;;';~:;:'~~~~t:'~~~;;;;;;'~'':;~;''''''''''''''''''""".""""....".".""""""".""...
Owner and/or representative of the Owner of Owner's, 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 herewith.
Sworn to before me this;
..........A?.~.~..""................. day of ".S.t.-f!J.l:.c;,..~.h........... , 20.Q.:7
. ~~ f'- ~- . .0 John M. Judge
Notary PublIc: .CJ':':.:..................0~..~~Tttt~~:J~6$late 01 New.
Qualified In Suffolk Count
FORM - 06/07
(Signature of Applicant)
~.~~~ .' 'c;. ~26)
i 'jfl, ~~- -. " '.~-
~~77gA1j}Jsdl'f?~r _. -
s:
I~
s ~
/
I
\,
, /I-
li-fP, ~"
-~~~ ~
-. .~ """.-.-....,
" '" r'J \
~._-----",> . ~
t-\
~
/
,'~
}
l ~'~ ~r
\ . \;
",~s"", ','
\
~
,~,~.
o
,
_ 8::3:),--
P/li.~.() 70
"1:
~Tg ~t.fl)fdt:: P~7/D
(NOZ-Zl:.8EJsIc;: ,SIre 79
SC<!f.e=~/8":1 0"
.
-\ .',
I
I :'
j.-',
FIRE IN PECTION
REQUI ED BEFOR
OPENI
.....
ALL CONST ION SHALL
ME T THE REQU EMENTS OF TH
ODES OF NEW YOP.K STATE,
I
--/9.2.
.~
~
-,-.... '
"" ..,;,
'. '
" .'1
'kl
',y!.!.
..~.
.IL.
.~.
.A./(:
"
OAT :~DB~: N~~ED
FE~~~ BY I
NO~ OEPA TMENT A
76S-1802 8 A 0 4 PM FOR THE
FOLLOWlt~G I ECTIONS:
I, FOUNDATIO - TWO REQUIRED'
FOR POUR CONCRETE
2, ROUGH - F MING & PLUMBING
3. INSULATION
4. Flt:ffi.L - CONSTRUCTION MUST
, BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET T E
REQUIREMENTS OF THE CODES OF N
YORK STATE., NOT RESPONSIBLE F
ESIGN OR CONSTRUCTION ~RROR .
, i
~:..o,
. .s 7"5/5
->l)oo,e s
~
,1000-1,14-11-4'
,
l ' '
I ;CSUP/\NCY OR
ut,E IS UNLAWFUL
WITHOUTCERTiFIC
I
OF 0 CUPANBY .'
\
~
I
NEW(L~~~lltr/(~,
fL2 'S'p.<jN)
~
.
,I
"
, ~ "
-a:T;f;It P,P7;P~'~P.-rvG'~ l
,fj\)
~
,
~"~i-~G
-a.';"X ~, ."" .'.'-.-
t
scale=1/4": 1'-0';
.$
~EST ALJRANT PROPERTY
OF STEPHAN MAZZ~LLA
l2b50 MAIN RD. MATTITUCK NY
A:~
CHORNO ASSOCIATES
- . archlteet.. .
SOUTHOLD, NEw YORK.