HomeMy WebLinkAbout35018-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-35019 Date: 10/16/09
THIS CERTIFIES that the building ADDITION
Location of Property: 485 RACCOON RD
(HOUSE NO.) (STREET)
County Tax Map No. 473889 Section 106 Block 10
Subdivision
Filed Map NO. __ Lot No. --
MATTITUCK
Lot 9
( HAMLET )
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 9, 2009 pursuant to which
Building Permit No. 35020-Z dated SEPTEMBER 23, 2009
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 "AS BUILT" REAR PORCH ADDITION TO AN EXISTING ONE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to ROBERT E PAL~DINO
(OWNER)
of the aforesaid building.
SUFFOLK COI~I~fDBPART~T OF HEALTH APPROVAL N/A
EL~t-rKIC~J~ C~u~TIFICA~ NO. 4031958 08/18/09
PLIERS CERTIFICATION DA'r~u N/A
Signature
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-35018 Date: 10/16/09
THIS cKKTIFIES that the building ALTERATIONS/ACCESSORIES
Location of Property: 485 RACCOON RD MATTITUCK
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 106 Block 10 Lot 9
Subdivision Filed Map NO. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 18, 2009 pursuant to which
Building Permit No. 35018-Z dated SEPTEMBER 23, 2009
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 "AS BUILT" GARAGE CONVERSION TO LIVING SPACE AND INTERIOR ALTERATIONS,
ACCESSORY HOT TUB AND BAR (NO SINK) AS APPLIED FOR.
The certificate is issued to ROBERT E PALADINO
( OWNER )
of the aforesaid building.
SuFfOLK COUNTY DEPART~NT OF HEALTH APPRO~-AL N/A
BL~t-rKICAL CERTIFICATE NO. 4031958 08/18/09
PLIghtErS CERTIFICATION DA'r~o N/A
Signature
Rev. 1/81
BUILDING DEPARTMENT TOWN
This application m~t be fill~ in by t~wfiter or ~ ~d submi~d to ~ Buil~~~llow~g:
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 2/10 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:
t. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
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.
New ConstrUction:
Location of Property:
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 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, Commemial $15.00
Date. t/i~/~O7
Old or Pre-existing Building: ~-~ (check one)
House No. Street Hamlet
Owner or Owners of Property: /~l/'~ ~'~)~¢~
Suffolk County Tax Map No 1000, Section /~ ~:~
Subdivision
Permit No. '~ ~"O°°~ '~' Date of Permit.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ OQ~
Block t/cD Lot q
Filed Map. Lot:
Applicant: ~F.. ~6eq.~' ~", pAq/trtatt',a/O
Underwriters Approval:
Final Certificate:
(check
pp icant Signature
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUP
This application must be filled in by typewriter or ink and submitted to the Building i
OCT
BLDG. DEPT.
I'OW.N,OF ~OUT~O[D .
A. For 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 frem 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 2/10 of 1% 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. F~r existing buildings (pri~r t~ April 9~ ~957) n~n-c~nf~rming uses~ ~r bui~dings and ``pre-ey.isting~~ 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 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 $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
New Construction: '~ Old or Pre-existing Building: ~ (check one)
Locationoferoperty: 7t9~" ~)< ]l~/[o~, ~'~0 4 ~7z~'~' ~I~U_~OM I~--~.
House No. Street
OwnerorOwnersofProperty: [t/~__, ~0~)'~.~'"' ~ ~t~]Prd~O0
Suffolk County Tax Map No 1000, Section / t.9 ~ Block f' t9
Subdivision
PermitNo. ~"~)l ~'~ DateofPermit.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ t5 'C)C)
Hamlet
Filed Map. Lot:
Applicant: ~'~. /~of~ ~7'" ~',
Underwriters Approval:
Final Certificate:
~'N... ~check one)/q
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
REP ELECTRIC ROBERT PALANDINO
485 RACOON RD
PO BOX 635
MA~I'ITUCK, NY 11952, MA'I-I'ITUCK, NY 11952
Located at 485 RACOON RD MA'I-rlTUCK, NY 11952
Application Number: 4031958
Certificate Number: 4031958
Section: Block: Lot: Building Permit:. BDC: ns11
Described as a Residential occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
First Floor, Outside, Spa, Deck,
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 thelsth Day of August, 2009.
Name QTY Rate Rating Circuits Tvoe
Appliances and Accessories
Pool / Spa Bonding 1 0
Pool Heater 1 0 hot tub Gas
Time Clock Switch 1 0 hot tub
Miscellaneous
includes additions to house, deck, and hot
tub
Wiring And Devices
Fixture 3 0 Incandescent
Outlet 3 0 Fixture
Outlet 12 0 Gen, Purpose
Paddle Fan 2 0
Receptacle I 0 GFCl
Receptacle 2 0 20a-hot tub Special I twist lock
Receptacle 8 0 Gen, Purpose
Switch 8 0 Gen, Purpose
seal
Continued on Next Page ] of 2
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
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
REP ELECTRIC ROBERT PALANDINO
PO BOX 635 485 RACOON RD
MATT~TUCK, NY 11952, MA'VrlTUCK, NY 11952
Located at 485 PJ~COON RD MATTITUCK, NY 11952
Application Number: 4031958 Certificate Number: 4031958
Section: Block: Lot: Building Permit:* BDC: ns11
Described as a Residential occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
First Floor, Outside, Spa, Deck,
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 the18th Day of A.gust, 2009.
Name QTY Rate Ratin~ Circqits Tv~e
seal
2 of 2
This certificate may not be altered in any way and is validated only by the presence a
of
raised
seal
at
the
location
indicated.
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. 35018 Z
Date SEPTEMBER 23, 2009
Permission is hereby granted to:
ROBERT E PALADINO
PO BOX 635
M3~TTITUCK,NY 11952
for :
"AS BLTS" GAR3kGE CONVERSION TO HABITABLE SPACE (2BDRMS), INTERIOR
ALTERATIONS, HOT TUB AND BAR PER APPROVED PLANS. METAL SHED TO BE REMOVED
at premises located at 485 RACCOON RD
County Tax Map No. 473889 Section 106
pursuant to application dated JUNE
Building Inspector to expire on MARCH
MATTITUCK
Block 0010 Lot No. 009
18, 2009 a~d approved by the
23, 2011.
Fee $ 900.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [~)~ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT CO/~I$1~UCTION[ ] FIRE R ,F.S, ISTANT PENETRATION '~,~
REMARKS: ~ "~ -/~~, )
DATE /~-/~-'D~ INSPECTOR
Robert E. Paladino
PO Box 635
Mattituck, NY 11952
July 16, 2009
To whom it may concern,
I Robert Paladino purchased a house at 485 Raccoon Road in 1992. There was a cabana,
hot tub and all the hot tub equipment here on the premises when I bought the house.
Thank~'~Y ~~'~ you.,
Robert E. Paladino
Christine M. Christie
Notary Public, State of New York
01 CH6125800
Qualified in Suffolk County
Commission Expires 4/25t20._~/~.~
INspECTION REPORT DATE I COMlVIENTS ~J
C
FO~A~ON (1ST) ~ ~
~o~mO~ (2~) (~
PL~G
~S~A~ON P~ N.Y. ~ ~
STA~ ~RGY CODE ~
/~1~-o ~ . .~ ~,, ~
~D~ION~ COUNTS
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.
35020 Z Date SEPTEMBER 23, 2009
Permission is
hereby granted to:
ROBERT E PALADINO
PO BOX 635
MATTITUCK,NY 11952
for :
AS BUILT REAR PORCH ADDITION TO EXISTING SFD AS PER APPROVED
PLANS AS APPLIED FOR. METAL SHED TO BE REMOVED
at premises located at 485 RACCOON RD
County Tax Map No. 473889 Section 106 Block
pursuant to application dated SEPTEMBER 9, 2009
Building Inspector to expire on MARCH 23,
MATTITUCK
0010 Lot No. 009
and approved by the
2011.
Fee $ 400.00
Authorized Signature
Rev. 5/8/02
ORIGINAL
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown. NorthFork.net
Examined
Approved
Disapproved a/c
Expiration
PERMIT NO. ~ 57)i ?
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
Flood Permit
Storm-Water Assessment Form
Contact:
Mail to:
~/Phone: :
Building Inspector
INSTRUCTIONS
,20
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 pan 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 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, a~d,,r.e, gulations, and to admit
auth°rized inspect°rs °n premises and in building f°r necessary inspecti°ns' Z~ /X///~/
(Signature of applicant or name, ifa corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises ~(D ~ (~: ~-~' 0 6:~1QQ/Q ' ~v~' {3
(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. /q/¢ 2- -7
Other Trade's License No.
1. Location~oJ' la!ld oa which proposed wor}~ will be done:
House Number Street
County Tax Map No. 1000 Section
Subdivision
Block ? O
Filed Map No.
Hamlet
Lot /
Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy S ~'~ .It.t
b. Intended use and occupancy ~¢'~ ~OJ~T~--/'lS.'~.~lr~Of~ (~__~ ~/~/
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
4. Estimated Cost Fee
d~ Ifdwelling, number of dwelling units
If garage, number of cars
Alteration
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
/YK, If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front Rear
Height. Number of Stories
Dimensions of same structure with alterations or additions: Front
Depth Height. Number of Stories
Rear
.Depth
8. Dimensions of entire new construction: Front
Height Number of Stories
9. Size of lot: Front [~ ''J Rear t 37
Depth
...... Re'~r .......
' D pth
10. Date of Purchase
Name of Former Owner
11. 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 Phone No.
Address Phone No
Addres~t,loS- TUT4 .-ge R0 ~?*~Phone
15 a. Is this property within 100 feet ora tidal wetland or a freshwater wetland? *YES
* 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.
NO 3-
16. Provide survey, to scale, ~vith accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at ! 0 feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES__
· IF YES, PROVIDE A COPY.
NO
STATE OF NEW YORK)
SS:
COUNTY OF J
'--'~'~)q .~ /~-'~ l (t~"~ ~I'~ . beingdulyswom, deposesandsaysthat(s)heistheapplicant
(Name o? individuai'signihg contract) above named,
(S)He is the
(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 tree to the best of his kn~ ledge and belief; and that the work will be
per/brmed in the manner set forth in the application filed therewith. /
Swo~ftoffore me this
day of fi-da 20 b'') ~'
V c/cf.K//, [ ~' ' ~ Public. ~ of N~ Yo~
--~ P~blJc No. 0HO6190696
~ot.~ Qualified in S~olk ~un~ , -~
Commission ~pi~ July 28, 2~/~-
i 4nat~ure~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSULATION
[ ]FRAMING / STRAPPING ~<~,,FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT C0NSTRtlC110#[ ] FIRE RESISTANT PENETRATION
~'IF, LD INspECTIoN REPORT, DATE I COMMENTS..
ro~o~ OST)
FO~ATION
, ROUGH ~G &
PL~G
~8~A~O~ ~ N. Y,
STA~ E~R~ CODE
~DmON~ COUNTS
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork. net
Examined
Approved
Disapproved a/c
Expiration
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
Flood Permit
Storm-Water Assessment Form
Contact:
Phone:
$£? 9 2009
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
,2ooq
BLDG I)EPI.
a~ llllllglaq~d)Ql~)0~(~l nm mT b' L completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
s~ts 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 zon'mg 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. Thereal~er, 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 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 inspections.
(Signature of applicant or name, ifa corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises ]~o[9~f]l ~t~,~ottr-to
(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.
1. Location of land on which pmpgsed work will be d,~e: I
House Number Street
Hamlet
County Tax Map No. 1000 Section /g7 ~ Block / g;> Lot
Subdivision Filed Map No. Lot
2. State existing use and occupancy of pre?scs and intended use and occupancy of proposed construction:
a. Existinguseandoccupancy 6,ta,~l~ ~-~a~l,.L,'l~ Cas,[e~wce_ vt,/
J
b. Intended use and occupancy ..~ ~, _
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated Cost
5. If dwelling, number of dwelling units
If 9arage, number of ears
Addition Alteration
Other Work /t~5 -~u/ // ~r'lc
__ . ~e~fi~n)
(To be paid on filing ~is appfication)
~umber of dwelling ~its on each fl~r
6. If business, commemial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions o£existin~ structures, if any: Front /O £ ,./t" Rear
Height ~ ~ O'~ ~//- Number of Stories /
Dimensions of same structure with alterations or additions: Front
Depth.
· Rear
Height Number of Stories
8. Dimensions of entire new construction: Front
Height
9. Size of lot: Front
10. Date of Pumhase
/57 '-0"
Number of Stories
Rear / 3 7.3"/ '
Name of Former Owner
Rear Depth
Depth / 7~7. ~ $- ~
11. Zone or use district in which promises are situated ~ ~"(w
12. Does proposed construction violate any zoning law, ordinance or regulation? YES
13. Will lot be re-graded? YES NO//x~ Will excess fill be removed from premises? YES NO~
14. Names of Owner of premises ~a~ t~tc/~n~ Address /J~4L//~;~/c-~_ Phone No. ~' 7-
NameofArehitect ~.}a/-~44 d'~'rt~/~ra Address /tY],~,:~C~- PhoncNo
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet cfa tidal wetland or a freshwater wetland? *YES NO,~
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY ]~E~4REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO, z:~_
* 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_,~ '
· 1F YES, PROVIDE A COPY.
STATE OF NEW YORK)
COUNTY O F c~tY/'a~/~/]ff?:
signing ~:ontract) above
(S)He is the
being duly swum, deposes and says that (s)he is the applicant
named,
(Contractor, Ag6fi~ 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 tree 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 day of
Notary Public
2O
VICKI TnT~ ~'~
Nota,'y Public, State of New York A
No. 01T06190696
Qualified in Suff01k County
Commission Expires July 28
PROFESSIONAL ENGINEER
725 HOBART ROAD / PO Box 616 SOUTHOLD, NEW YORK 11971
TEL:631.765.2954- FAX:631.614.3516 · e-mail:joseph@fischetti.com
Date:
Reference:
September 17, 2009
485 Raccoon Road SCTM#106-10-9
Building Inspector
Southold Building Dept
PO Box 1179
Southold, NY 11971
Dear Sir,
I have inspected the sanitary system for the above referenced dwelling. I certify that the
system consists of a 1000 gallon septic tank and one 8 foot diameter leaching pool 12 foot
deep. The system was in working order. This type of system is the minimum required by the
County and is adequate for up to 4 bedrooms.
A review of a survey for the property and the system itself reveals that this system is
relatively new and seems to have been installed in place of 2 older cesspools (one block)
located in the same location.
Joseph Fischetti, PE
TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET qFx.~ VILLAGE DIST,
~,ORMER.OWN~R ^ N E ~ ~ o Z~,,,~/~
~,~~ '> Ab~(e ,(',, w VJ.5~ _ . ~ TYPE OF BUILDING
~' ~/O S~S' VL~ FARM ~M~. CB. MISC. Mkt. Value
~ND IMP. TOTAL DATE REMARKS
N~ NO~L BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable 1
Tillable 2
Tillable 3
Woodland
Swampland FRONTAGE ON WATER
Brushland FRONZAGE ON ROAD__
House Plot D~P~H
BULKH~D
Fotal DOCK
COLOR
M. Bldg.
Extension
Extension
Extension
Porch
Porch
Breezeway
Garage
O.B.
' Total
.Foundation
]asement
Wails
Fire ,Place
Type Roof
Recreation
Dormer
Driveway
Bath
Floors
Interior Finish
Heat
Rooms 1st Floor
Rooms 2nd Floor
Dinette )~,~! ,~ ~.~.
IR. /
DR.~
FIN. B.
REScheck Software Version 3.7.3
Compliance Certificate
Project Title: New Addition
Report Date: 06/16/09
Data filename: Untillad.rck
Energy Code: New York State Energy Conservation
Construction Code
Location: Suffolk County, New York
Construction Type: Detached I or 2 Family
Heating Type: Non-Electric
Gla~ng Area Percentage: 4%
Heating Degree Days: 5750
Construction Site:
485 Raccoon Road
Mattituck, NY
Owner/Agent:
Robert Paladino
Designer/Contractoc
Joseph Fischetti
1725 Hobart Read
SOuthold, NY 11971
631-765-2954
Permit #
Permit Date
Ceiling 1: Flat Ceiling or Scissor Truss: 292 19.0 0.0 15
Wall 1: Wood Frame, 16" o.c.: 600 11.0 0.0 51
Window 1: Wood Frame:Double Pane: ~ , 26 0.350 9
Th~prusentad in this [~o.,~J~_~~Om building plans, specifications, and other calculalions
~it application. The~~[deslgned to meet the New York State Energy Conservation
Co~ments. When ~ 0~'~ has stamped and signed this page, they are attesting that
to tbe best of h is/~, be~ ~ ~llF~v.,.¥~ ns or specifications are in compliance ~ith this Code.
Builder/Designer ~~~_ _..~j~,~f ~ Date
New Addition Page I ~f 1
MAP _OF Pr~O PiE,Q_T ¥
TOWN O~ ~'~' '*' ' ·
N
SURVEY OF PROPERTY
A T MA TTITUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY,N.Y.
1000-106-10-09
SCALE: 1'=$0'
· JUL Y 9, 2009
AUG. 6, 2009 (~ddilionsI
SEPT. 2l~ 200-o (NEW SEPTIC SYSTEM)
(OW~u150' *
DANG~-RO
~.,,jC..t.,~ G~[~DN[8(:~
N7%~
r5.65'
am fomi/iar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
ond will obide by the condit[ons set forth therein ond on the
permit to construct.
~he locution of wells ond cesspools shown hereon ore
from field observotions ond or from doto obtoined from others.
Elevotions referenced to on ossumed dotum.
· =MONUMENT
ANY ALIERA~ON OR ADDlllON TO THIS SURVEY IS A ~40LATION
OF SECTION 7209 OF THE NEW YORK STATE EDUCAHON LAV~
EXCEPT AS PER SEO]70N 7209-SUNDIWSION 2. ALL CER17~7OAHONS
HEREON ARE VALID FOR THIS MAP AND DOPIES THEREOF ONLY IF
SAID MAP OR COPIES NEAR THE IMPRESSED SEAL OF IHS SURVEYOR
WHOSE SIGNATURE APPEARS HEREON.
SEP 2 2 2009
BI DG. DEPT.
TOWN OF SOIJTHOLO
AREA=23,372 SQ. FT. (INCLUDING R.O.W.)
AREA=19,768 SO.. FT. (EXCLUDING R.O.W.)
(ssi) m5-
P.O. BOX 909
12J0 TRAVELER STREET
SOUTHOLD. N.Y. t1971
49618
46
?ALADI NO E._51DENCE
EXISTING C,J.
ELEVATION
SCALE. F~"= ILO"
EXISTING F.J.
TO REMArN
fiXISTING SCREEN
NEW 2- I ~" X 52L" LVL
EXISTING DECK ~
ITP-,UCTURE TO P, EMAIN
FLOOR PLAN
h, = I '-0"
5CALF: ~
CERTIFICATION Of
NAILING & CONNECTIONS
RB3UtRED,
VIN'd_ 50ffrT MATERIAL
CEILING FrNISH
2" 5TYP. OFOAM INSULATION,
~" PLYWOOD SHEATHING
I~" X 5~' LVL
ENCLODED PORCH
P3q5TING
~XISTING 2" X ~" ACQ D.J I G" O.C ) REMAIN
FOOTING; ASbUME 36"
BELOW GRADE - V,I,F,
(TYPICAL ALL LOCATIONS)
DUILDtNG SECTION "A"
h, = I '-0"
SCALE: ¥
OCCUPANCY OR
USE IS UNLAWFUL
-'"'""-~THOUT CEE'i'IFIC. ATi-~
OF ,',p,-,~ ,~,...,..,
UNDERWRITERS CERTIROATE
REQUIRED
~P ..t~! .....
.ATE: ;,,
FEE' flO,~O
NOTFy ~dILEINL- L ' ,'RTMENT AT
765'1802 8AM [0 4 PM FOR THE
I FOUHDAf;ON. TWO REOUIRED
FOR POURED J'ShqF;ETE
2. ROUGH - FRF'MIhHi & PLUMBING
3 INSULATION
'L FNAL - C0¢~:¢ bCTION MUST
B~ CC~PLETE FOR CO.
ALL CONS]RUCTION SHALL MEET THE
REQUIREMFN IS OF THE CODE8 OF NEW
YORK ST¢~FE. NOT RESPONSIBLE FOR
DESIGN OR OORS'rRUCTION ERRORS.
RETAIN STORM WATER RUNOFF
PIIRSUANT TO CN,~'H-,~ 236
OF THE TOWN COl]E,
ALL CONSTRUC?ION SI4ALL
MEET THE REQUIRE'qEHTS OF TF
h
PAGE
Uk), ¢'c ,t:~°DA
f
OCCUPANCYOR
'USEIS UNLAWFUL
WITHOUTCERTIFICATE
OFOCCUPANCY
RETAIN STORM WATER RUNOFF
PURSUANT TO CHAPTER 236
OFTHETOWNCODE.
APPROVED AS NOTED
DATE:~ B,P.
NOTIFY BUILDING DEPARTMENT AT
765-1802 8AM TO 4PM 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 O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
ON, LEAD'CO~I~T, BEFORE
(~ERTIFICA~ ~ .~, '~JqUPANGY
:~"~ER USED:IN WATER
SUPPL Y gY~T~.~NOT
EXCEED 2/10 OF 1%LEAD.
ALL CONSTRUCTION
MEET THE REQ ..... SHALL
COOEs Ts O, T E
','-w YORK STATE.
CERTIFICATION OF
NAILING & CONNECTIONS
REQUIFIED.