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39873-Z
�g�,fFO�,��,� Town of Southold G 7/18/2016 �'�- �� P.O.Box 1179 ��, . o �; 53095 Main Rd , �,a�,��� ��� ' Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38390 Date: 7/18/2016 THIS CERTIFIES that the building ALTERATION ' Location of Property: 2403 Camp Mineola Rd Ext, Mattituck SCTM#: 473889 SecBlock/Lot: 122.-9-7.14 Subdivision: Filed Map No. Lot No. - conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/4/2015 pursuant to which Building Permit No. 39873 dated 6/16/2015 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: ALTERATION TO AN EXISTING FRONT PORCH ON AN EXISTING ONE FAMILY DWELLING, AS . APPLIED FOR � The certificate is issued to Annunziata,Paul&Annunziata,Milta of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUIVIBERS CERTIFICATION DATED � . � a Auth ed Signatur ? ��uFF�� TOWN OF SOUTHOLD �,�o ��'a�� BUILDING DEPARYMENT � TOWIV CLERK'� OFFICE o . �� SOUTHOLD, NY ��ol � �����y ��! BUILDING PERMIT (THIS PERNiIT MUST BE KEPT ON THE PREIV�ISES WITH ONE SET OF APPROVED PLAfVS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) � Permit#: 39873 Date: 6/16/2015 Permission is hereby granted to: Annunziata, Paul &Annunziata, Milta 2403 Camp Mineola Rd Mattituck, NY 11952 To: Alteration to existing porch attached to single-family dwelling as applied for. Additional certification may be required. At premises located at: 2403 Camp Mineola Rd Ext, Mattituck SCTM # 473889 Sec/Block/Lot# 122.-9-7.14 Pursuant to application dated 6/5/2015 and approved by the Building Inspector. To expire on 12/15/2016. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $267.20 CO -ALTERATION TO DWELLING $50.00 Total: $317.20 � Buildi spector , Fa•m No.6 TOWN OF SOUTHOLD � BUILDING DEPARTMENT TOWN I�ALL 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: . 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-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 certi'ficate of Code Compliance from architect or engineer responsible for the building. . 6. Submit Planning Boazd 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: 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$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 - - - - "3: -Copy of Certificate�of Cdccupancy-$:2��- � - - � -- - �----- -� --� --_.-_--- - -- ---------- ---_--------- --,._.._�__ _ 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. � ' � New Constructio : ����� Old or Pre-existing Building: (check one) � / /� � r � Location of Prope : �`T�'� (� od- ` House No. - Street Hamlet Owner or Owners of Pro e o/��, � �i �o✓�� P rtY= Suffolk County Tax Map No 1000,Section �� v� Block � Lot� y Subdivision Filed Map. - Lot: Permit No. J l v� 3 Date of Permit_ Applicant: I-Iealth Dept_ Approval: Underwriters Approval: Planning Board Approval: Request for= Temporary Certificate Final Certificate: (check one) � Fee Submitted:$ �(� '� -� � �� pplicant Signature -____.___�� � �j - �OF SOUr , �l� �� � 'yo . - � �� �o - � � � # # - - � . � _ - . � � �o ��'Y�OUM'I,N� � _� � - - TOWN OF SOUTHOLD �UILDING� DEPT. - _� 765-1802 � � - � � � � � � I�NSPECTION �� �� � - � � - � [ ] FOUNDATION 1 ST . [ ] ROUGH BING [ � ] FOUNDATION 2ND [ ] 1 LATION � � [ ] FRAMING / STRAPPING [ FINAL � [ ] FIREPLACE & CHIMMEY [ z] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION _ . [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: . � , � �.. . � ti i � ^ � , �� � . . _ DATE INSPECTOR �_ � f � o��OF SO�Tyo /� .� �� , , � � �o � ��y�OUMV,�`� . TOWN OF SOUTHOLD BUILDING D�PT. � 765-1�02 � - � - . IIVSI�ECTION � - _ [ ] FOIJNDATION 1 ST [ ] ROUGH PLUMBINC � [ ] FOUNDATION 2ND [ ] INSULATIOIoI - [ ] FRAN�ING / SYR�IPPING [ �AL , [ ] FIREPL.�CE � CHIMNEY [ ] "FIRE SAFETY-INSPECTION [ ] FIRE RESISTA�IT CORISTRUCTION [ ] FIRE RESISTANT PENETF3ATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FIN�►L) [ ] CODE VIOLATION [ ] CAULKING � REMAI�KSi `!��� �� D° � DATE �� l� �G INSPECTOI� ` � i' . � i FIEY.,D 3Q�5�.'3�4"�C}�t ItE�'O�� AAT� � � CO�,NTS , . . . . . . . • �A1 ►e . � �'�U1�iD,�i�'IOI�I(XST) . . . . . . � . . U� a� - — ------------�-s.....,.a_.......... , . .' . , , � . � .� ' � � ' - �� �otrrm��tQN�zr�z>> . . . , , - � (� o . . . . . , . , � O . . � � - . . • , ' , ' ' ' ' � � ROU�rH FRAmENG 8c .. • � • � � � y. PLUMBIlV'G . . • . , , , ` . . . � . , � 0 ',' � . . • ., , , , . • . ' ' ', ' S t� . � , • , • ' ' �� IN�ULATZON PEftN.'�'. � , � �H 'STATE ENE2�G`�.'�0�1� . � , , � � � • � . . .. . . • , . . —C— . � , �, � • �, • . , . �� & , _ , /� . O r . FINAL . . . . , . ' . �' , � • , .. . � A�31t�`I`� T5 � � c� � y� 7 �' � .. . . � �� : . ' . � � ., � � , .�� : �. . � . . . . . . . �, � . . . .. . , �. ' �m � � , � , , . •- . • ' . �O . . . , . , - , . � , . ; - . • � - � . . . ; . . . N � ' , . � . � � ' . � � o , • • t� � ' , � . , . . , . . . . . . • � • ' � � e ,..,. , . . � • � � TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board ofHealth SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval F�X: 631 765-9502 � Surve SoutholdTown.NorthFork.net PEI2MIT NO. � � � Check Septic Form ' N.Y.S.D.E.C. • Trustees C.O.Application Flood Permit Examined ,20�� Single&Separate Storm-Water Assessment Form Contact: Approved ,20� Mail to: Disapproved a/c Phone:llr�l '"�-1 �`� ���� Expirat�on I ,20 � � i,� � ��_' '��'_V��� '_� _ , �~� Buil nspector k�.�,� � I I � i ;�` ��� �4 � ' � APPLICATION FOR BUILDING PERMIT , � T�� Date , 20 ^ '� a;_�,; ,�� �� , INSTRUCTIONS � (l:�'d��,���t ,^��Itl�: !` a. This application MiJST 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 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,if a 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 i � � f01��/1`��� (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 proposed w rk will done: . , , , � - House Number Street Hamlet - ` �"ir��r'�IC3w7 l.�s�g?'�}!{�.��• County Tax Map No. 1000 Section � ��e� {Y�-�=��B�loclt�';``}��'�`" `''"�� Lot � � �� . � ....�� `. '!'�f,8)� , �'�t;iiee. yy9!;Va,t`�',4l=j�i � . ,S�' �1"Ei�`�� .. +*�". .'i d�fai;?ifi'?t;1;r.`t Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use nd occ�ancy of propo d construction: a. Existing use and occupancy � � j �' � �9-�✓I �l . � .r b. Intended use and occupancy ��,��,gf����'U���a�4����71 �?�C/�� 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work ��,�(,r���_����v c��v Corr��� (Description) 4. Estimated Cost Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 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 Rear D��pt,�i ; ;,z i s1 Height Number of Stories 9. Size of lot: Front Rear Depth 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 , n� 14.Names of Owner of premises ��������J���e�ss'� Phone No. Name of Architect Address Phone No Name of Contractor Address 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 ) being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing 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 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. �Swor to before me this � day of ��1,� 20� �• ' � � ������� �oN���D.�u � Notary Public �Og�ry pu�l�c,�tate�Pda Vork Signature of App ' nt No.01 Bll61860�� Qu�iffied In�uitotk�,ntY�� Commisabn Explres A►prN 14,2 � �' Scott A.� Russell �.��°������ ��C'�0�)[�I��l[\�VA\�C']E]E�. SUPERVISOR Q � � I�u1[A\1�A\�G�)EI��/l[]E�7C' .� SOUTHOLD TOWN HALL-P.O.Box 1179 � � 53095 Main Road-SOUTHOLD,NE4V YOIiIC 11971 �� To wn of So u th o l d �o� �y��o�- CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) - - - - - . . _ _ _ . .- --- - - --- ----- -- - -- -- - --- -- - - - - - - - - -- - � _ - _ __ - - - --- - - - - ; ��]� �'��� ������c�' �����t,� ��� ��' �']�� ���[,�[,�����: ; Yes No . (CHECK ALL THAT APPLY) '; ❑�f A. Clearing, grubbing, grading or stripping of land which affects more � than 5,000 square f eet of ground surf ace. � ❑�. Excavation or fillin involving more than 200 cubic yards of material g � within any parcel or any contiguous area. � ❑ C. Site preparation on slopes which exceed 10 feet vertical rise to ' " 100 feet of horizontal distance. � , ❑ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal : � erosion hazard area. � ❑ . Site preparation within the one-hundred-year floodplain as depicted ; on FIRM Map of any watercourse. - � �� Y �� ; ❑ F. Installation of new or resurfaced impervious surfaces of 1,000 square , feet or more, unless prior approval of a Stormwater Management � Control Plan was received by the Town and the proposal includes � in-kind replacement of impervious surfaces. � If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. � If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. � APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. #: 1000 Date 1 a� «,<< �f� G i� NAME m; Z �,� T � �� Section Block Lot u�s"� :kxk` 1,C)�. C3L�it_DI��a I)Ef':;�u"I,:�-it�NT LtiE c)NI_.Y ¢"` Contact InformaUon � " ��J� ;1'e1.pLone v,,,,,�,i � Rev�ewed By: ��%'--r — — — — — — — — — — — — — — — — — — f I �, Date. Pro ert Address / Location of Construct�on ork: — — — — — — — — — — — — — — — — — � � ,�^j� Approved for proce55�ng Building Permit. � F � � Stormwater Management Control Plan Not Required. ❑ Stormwater Management Control Plan i�Required (Forward to Engineenng Department for Review.) FORM # SMCP-TOS MAY 2014 �_. ... � , .. _.___ �� �1�- — T-.. ;��, � S _ i-- j ` � V� ,. . � . —_1__ 4 �� - ��r a'a.. . ��' � �,�--- � \���--^ �4 � �- �� _ ,�r; � . ,� � �'+�, �'`r' `�*" ;� , .. 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