HomeMy WebLinkAbout37026-Z O�OSUFFOi Town of Southold Annex 3/23/2012
P.O.Box11,79
54375 Main Road
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35504 Date: 3/23/2012
THIS CERTIFIES that the building ACCESSORY
Location of Property: 577 Pacific St, Mattituck,
SCTM#: 473889 Sec/Block/Lot: 141.4-14.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
1/1/1900 pursuant to which Building Permit No. 37026 dated 2/29/2012
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"reconstruction of accessory shed with roof overhang as applied for.
The certificate is issued to Janet Ciamaricone
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
r
Autho0zed. Signature
F c,��p� TOWN OF SOUTHOLD
BUILDING DEPARTMENT
' TOWN CLERK'S OFFICE
o SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 37026 Date: 2/29/2012
Permission is hereby granted to:
Janet Ciamaricone
PO BOX 1631
Mattituck, NY 11952
To: as built" reconstruction of accessory shed with roof overhang as applied for.
At premises located at: .
577 Pacific St, Mattituck
SCTM # 473889
Sec/Block/Lot# 141.-4-14.1
Pursuant to application dated 1/1/1900 and approved by the Building Inspector.
To expire on 8/30/2013.
Fees:
ALTERATION OF ACCESSORY BUILDINGS $200.00
CO -ACCESSORY BUILDING $50.00
Total: $250.00
Building Inspector
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:
l. 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 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:
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 Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. Z lD' 2—
New Construction: QId or Pre-existing Building: (check one),
Location of Property: C� G ` r,
House No. n Streeter Hamlet
Owner or Owners of Property:vo.o-r\ci v 01 "L I
Suffolk County Tax Map No 1000, Section !� 1 Block Lot
Subdivision b Filed Map. Lot:
Permit No. .Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
��s131� \IAV�i8L jLnO�_'N QLA
Applicant Signature
SO!/Tyolo
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 roger.richert(aD-town.southold.ny.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Janet Ciamaricone
Address: '595 Pacific St ,5 7'? City: Mattituck St: NY Zip: 11952
Building Permit#: 37026 Section: Block: Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: as built DBA: License No:
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 7 Ceiling Fixtures, HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel 1 A/C Blower Range Recpt Fluorescent Fixture 1 Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 2 Twist Lock Exit Fixtures TVSS
Other Equipment: storage shed, 1 paddle fan
Notes:
Inspector Signature: Date: March 20 2012
81-Cert Electrical Compliance Form.xls
ao��,oF so�ryolo -
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 CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
REMARKS:
DATE %�` INSPECTOR
OF SOVr�O�
/ o "LL
o�yc0�N�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION - -
I FOUNDATION 1 ST [ ] ROUGH PLBG:
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING AFINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION-
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE rP-0 INSPECTOR �'
r
FIELD INSPEON REPORT DATE COMMENTS
FOUNDATION(1ST) cp R"
swpw pwwww. wwN. «•M
..yy
FOUNDATION(ZND)
ROUGH FRANliNG& � ,,,•j
PLUMBING
INSULATION PER N.Y.
STATE ENERGY CODE
• 4
• e
.1
FINAL
ADDITIONAL COMMENTS
. m
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MOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST \;
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT 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:
Expiration
Building Inspector
F E B 2 9 2012 APPLICATION FOR BUILDING PERMIT
BLDG.DEPT. Date , 20
TONIN OF SOUTHOLD INSTRUCTIONS
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 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.
0-,
(Signature of applicant or name,if a corporation)
Po x Ili �>k McL,4-,'�,tck, ((RL;S,Z
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
0 W rN e,
Name of owner of premises J c-.n-eA- Ci•-C%-vy-,_c--x- ► c n�
(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 work will be done:
U irne�At
House Number Street Hamlet
County Tax Map No. 1000 Section Block y Lot ',
Subdivision Filed Map No. Lot 'IN
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy rS, 9,r I~nti p-A ImcrvjeA }voJ5 C W%,
b. Intended use and occupancy S & "oaffyOA ( «56 s d 16"
3. Nature of work(check which applicable): New Building Addition , Alteration
Repair Removal Demolition Other Work j e l-
(Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units of Number of dwelling units on each floor
If garage, number of cars 0
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Cd
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories_ 1
Dimensions of same structure with alterations or additions: Front Rear
Depth a5'V 64 Icy' 77v" Height_' Number of Stories 1
8. Dimensions of entire new construction: Front Rear Depth
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�
14. Names of Owner of premises OrAr.,J- C,&inr,a rcc6P9dress9A,%l(A( i1 A jl, Phone No.01cl S S SX?
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 1
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF sugvIic )
being duly sworn, deposes and sa A�s&l 64Leapplicant
(Name of individual signing contract) above named, Notary Public,State of New York
No.01 BU6185050
Qualified in Suffolk County
(S)bie is the cflNv�-e,� ., Min ry
•t
(Contractor, Agent, Corporate Officer, etc.) ssion lty' '
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 D ' -
day of iG�/�.�W10� 20 /,
Notary Public Signature of Applicant
I
I
Town of Southold
y Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM i
o
PROPERTY LOCATION: S.C.T.M.ik THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN
�S Iat" ec on t CERTIFIED BY A DESIGN PROFESSIONAL iN THE STAT@ OF NEW YORK.
i
SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORKASSESSMENT Yes No
a. What is the Total Area of the Project Parcels? Will this Project Retain All Storm-Water Run Off .�
(Include Total Area of all Parcels located within Generated by a Two(2")Inch Rainfall on Site?
the Scope of Work for Proposed Construction) (S.F.Mores (This item will include all tun-off created by site
b. What is the Total Area of Land Clearing )
� clearing and/or construction activities as well as all Z_
and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of i
construction activity? (S.F./Acres) impervious Surfaces.)
PROVIDE BRIEF PROJECT 17FSCRiPTZON (Pro�aaade aural Pries as Needed) Drainage Does the Site Plan and/or Survey Show All Proposed
Drainage Structures Indicating Size&Location?This ✓ ❑
1 Item stall include all Proposed Grade Changes and
Gj Q U 5�e-A tt-6u A Slopes Controlling Surface Water Flow.
3 Does the Site Plan end/or Survey describe the erosion
and sediment control practices that will be used to El �.
control site erosion and storm water discharges. This f
item must be maintained throughout the Entire j.
Construction Period. i
4 Will this Project Require any Land Filling,Grading or i
Excavation where there is a change to the Natural i
Existing Grade Involving more than 200 Cubic Yards
of Material within any Parcel? El
5 Will this Application Require Land Disturbing Activities i•'
Encompassing an Area in Excess of Five Thousand
(5,000 S.F.)Square Feet of Ground Surface?
6 Is there a Natural Water Course Running through the
Site? Is this Project within the Trustees jurisdiction
General DEC SWPPP Requirements: or within One Hundred(1OV)feet of a Wetland or
Submission of a SWPPP is required for all Construction activities Involving soil
Beach?
disturbances of one(1)or more atxes; including disturbances of less than one acre that T Will there be Site preparation on Existing Grade Slopes i
are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to I
including Constriction activities involving soil disturbances of less than one(1)acre where One Hundred(f 00')of Horizontal Distance? !the DEC has determined that a SPDES permit Is required for storm water discharges. I.
(SWPPP's Shall meet the Minimum Requirements of the SPOES General Permit $ Will Driveways,Parking Areas Or Other Impervious
!
for Storm Water Discharges from Construction activity-permit No.GP 010•Q01.) Surfaces be Sloped to Direct Storm-Water Run-Off ✓ r
1.The SWPPP shall W prepared prior to the submittal of the NOI.The NOI shall be into and/or in the direction of a Town tight-of-way? — !
submitted to the Department prior to the commencement of corutniction activity. ..
2 The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material,
required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any
constructed to reduce the pollutants In storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder
compliance with the terms and conditions of this permit.In addition,the SWPPP shall
Identify potential sources of pollution which may reasonably be expected to affect the Area?(rnrs Item will NOT Mau&the installation of Driveway Aprons.)
quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark
3.All SWPPPs that require the post-construction storm water management practice In a Box and the construction site disturbance is between 5,1100 S.F.&1 Acre in area,
component shall be prepared by a qualified Design Professional Licensed In New York a Storm Water,Grading,Drainage&Erosion Control Plan rs Required by the Town of � I'
that Is knowledgeable In the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit.
(NOTE: A Check Mark(4)andror Ans%-ar for each Question Is Required for s Complare Application) I i
STATE OF NEW YORK,
COUNTY OF............................................SS I`
That 1, ..�Q-rj C 1 5 ....being duly sworn de
(Name of individual signing Document) poses poses and says that he/she is the applicant for Permit,
And that he/she is the ,CS �n�........................................
(owner.Ckxttractor.A9emt.Co ...................................................... r.
rparate Oftioer,etc.) i
Owner and/or representative of the 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 min be performed in the manner set forth in the application filed herewith. t
Sworn to before
��me this-
..........� .]�.1................day of� ..... 201. I—
.. ... ,
Notary Public: ....... .. .Y. .l`^: ................ ....
. ............ �1 ....
(Signature of Applicant)
FORM - 06/10 j
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Town Hall Annex Telephone(631)165-1802
54375'Main Road H (631)765-9 5Q02.
P.O.Box 1179 �� roger.richert �t ORsouthOld.ny.us
Southold,NY 11971-0959
BUn DING DEPARTMENT
TOWN OF SOUTHOLD ' `-
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date:
Company Name:
Name:
License No.:
Address:
Phone No.:
JOBSITE INFORMATION; (*Indicates required information)
*Name:
*Address: S ( '(C 4ic'� l� ► �
*Cross Street: ( w rx �d
*Phone No.:
Permit No.:
Tax Map District: 1000 Section: Block. Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
(Please Circle All That Apply).
*Is job ready for inspection: YES / NO Rough In Final
*Do.you need a Temp Certificate: YES / NO
Temp Information-(If needed)
*Service Size: 1 Phase 3Phase 100 1'50 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
82-Request for Inspection Form
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