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HomeMy WebLinkAbout42355-Z � °suF nim o Cpp Town of Southold 2/3/2022 y� P.O.Box 1179 x 53095 Main Rd �4, �a 5' Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42747 Date: 2/3/2022 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: Pvt Rd Off E End Rd,Fishers Island SCTM#: 473889 Sec/Block/Lot: 12.-2-6.15 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/16/2010 pursuant to which Building Permit No. 42355 dated 2/12/2018 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: dormer additions to existing single family dwelling as applied for. The certificate is issued to KVT 1 LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42355 3/8/2018 PLUMBERS CERTIFICATION DATED Au or zed g ature SSU , TOWN OF SOUTHOLD BUILDING DEPARTMENT z TOWN CLERK'S OFFICE SOUTHOLD, NY � r=m 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#: 42355 Date: 2/12/2018 Permission is hereby granted to: Bailey, James C/O Cambridge Assoc LLC 125 High St Boston, MA 02110 To: DORMER ADDITIONS TO AN EXISTING DWELLING AS APPLIED FOR. Replaces BP#35378 At premises located at: Pvt Rd Off E End Rd SCTM # 473889 Sec/Block/Lot# 12.-2-6.15 Pursuant to application dated 2/12/2018 and approved by the Building Inspector. To expire on 8/14/2019. Fees: PERMIT RENEWAL $100.00 CERTIFICATE OF OCCUPANCY $50.00 Total: $150.00 Cj Buil ng Inspector 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. 35378 Z Date MARCH 8, 2010 Permission is hereby granted to: JAMES BAILEY 100 SUMMER STREET BOSTON,MA 02110 for DORMER ADDITIONS TO AN EXISTING DWELLING AS APPLIED FOR at premises located at PVT RD OFF E END RD FISHERS ISLAND County Tax Map No. 473889 Section 012 Block 0002 Lot No. 006 . 015 pursuant to application dated FEBRUARY 16, 2010 and approved by the Building Inspector to expire on SEPTEMBER 8, 2011 . Fee $ 200 . 00 Authorized Signature ORIGINAL Rev. 5/8/02 o��OF SOpr�o! h O Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Q ro-ger.richert(aD-town.Southold.ny.us Southold,NY 11971-0959 Q a �yl4UM`1,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF.;ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: James Bailey Address: 474 Wilderness Point city:Fishers Island st: New York zip: 06390 Building Permit#: 42355 Section: 12 Block: 2 Lot: 6.15 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Connected Systems License No: 45453-ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor 1st Floor Pool New Renovation X 2nd Floor X Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 4 Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment: Dormer Renovation Notes: Inspector Signature: F�Za,4-Y--4�tL� Date: March 8, 2018 0-Cert Electrical Compliance Form.)ls A,R&T Architects,Inc. 262 Washington Street,2nd floor Boston MA 02108 (617) 451-5740 27 February 2018 Michael Verity Building Department Town Hall Annex Building 54375 Route 25 P.O. Box 1179 Southold NY 11971 Re: Bailey house Wilderness Point, Fishers Island NY Suffolk Co. Tax Map #1000-012-2-6. 2 Permit #42355 (replaces #35378 from 2010) Gentlemen: This is to let you know that I was in touch with the contractors from HP Broom Housewright, Inc. and made periodic site visits during the construction in 2010 of the dormer on 'the east wing of the Bailey house. To the best of my recollection, I saw the framing, strapping, and, insulation during the construction process. The work was done as specified, and to the best of my knowledge, in accord with applicable New York State codes. Very truly yours, C� `�oenoeo����,�,a Jacob D. Albert �e•6���eRtOARC//jTFO&P oe���ti6 B�ooeUeooe�e�O�s l Ao`. Architect m°o•GO� e�9o� ,o Copy to: HP Broom Housewright � � �• �`� ;:� m �� `90�0, ""HE 0 4� �AAAOA��' BOE soul, olo �o ���'YOOUNTI��e TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [. .] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] I SULATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL UGH) [ ] ELECTRICAL (FINAL) REMARK G C". ?/ is2a4n?v-* f� Ei ov✓ • Ci Y' V fi�'1 'Pi `� �i � t►i� 4 DATE INSPECTOR FIELD INSPECTION REPORT DATE lCOADIENTS FOUNDATION(1ST) -4-3 --------------- ... ....... FOUNDATION(2ND) z O ROUGH FRAMING& y PLUMBING _ Ix INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS O � Iz rn O z d TOWN 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)765-9502Survey SoutholdTown.NorthForknet PERMIT NO. / .379 Z-- Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined 3 �,20 Storm-Water Assessment Form Contact: Approved ' 20 Mail to: Disapproved a/c Phone: Expiration 20L Building Inspector APPLICATICN FOR BUILDING PERMIT Date /a & ,2001 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. A 90 1 Ic. (Signature of applicant or name,iT a corporation) G'o ew �70 /42 f mv/?o, 11410 (Mailing address of applicant) `r— State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises_ iLIAme ��A/GLsY (As on the tax roll or latest deed) If applican a corpora' ,s' ature of duly uthorized officer. ® (l('J' S r (Name and ti of corporate officer) Builders License No. ku06 -AC, FEB 16 2010 Plumbers License No. Electricians License No. Other Trade's License No. BLDG.DEPT, TOWN OF SOUTHOLD 1. Location of land on which proposed work will be done: YN A)1&4Vh2W Poste House Number Street Hamlet County Tax Map No.1000 Section /Z Block 12, Lot 6,.z v 5 Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Irlw Le b. Intended use and occupancys/it,U-le `,A&14K /?"40 " 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work (Description) tLPf�.371 00 Fee e20014" (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 A Rear 126 Depth a41— Height Number of Stories Dimensions of same structure with alterations�ro�r additions: Front •0mo- Rear XM� Depth �.CAA99- Height SAMAr Number of Stories c FfA1-9- i 8. Dimensions of entire new construction:Front Rear AIA Depth Height -75'4/- ABoVar gr.W'Number of Stories S 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 /Z/20 12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO� 13.Will lot be re-graded?YES_NO—All Will excess fill be removed from premises?YES_NO G'�/YJBR/d��/ st9TK3' 9 14.Names of Owner of premises c�f1h1 ,BA/L6� Addres.V/00 4MMrd�A�t111 'hone No. '6/'�4d� Name of Architect_Z771 ®.ALQ0r, Address810A JV- AQXWr�G4Phone No Cil7 Name of Contractor AA Gi?oMn-fWoTW&dW- Address1,6.2 Phone No. J60-S.U-?AJC �yrr�i 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.PERMITSYAY 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 ) ,yj&Y'40 been7" die being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the CdAM4710k' (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. Sworn to before me this c day of 1L _-`.. 20�l Notary Public Signature licant Jill M. Doherty,President QF souryo Town Hall Annex James F. King,Vice-President ,`O l0 54375 Main Road P.O.Box 1179 Dave Bergen J�[ Southold,New York 11971-0959 Bob Ghosio,Jr. G Q John Bredemeyer Telephone(631) 765-1892 C011Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #0565C Date: August 16, 2010 THIS CERTIFIES that the removal of the two existingLdormers and replaced with two larger framed.dormers At 474 Wilderness Point, Fishers Island. New York Suffolk County Tax Map#.12-2-6.15 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 12/22/09 pursuant-to which Trustees Administrative Permit#723 1 A Dated 1/20/10 was issued and conforms to all of the requirements and conditions of the applicable provisions of law.The project for which this certificate is being issued is for the removal of the two existing dormers and replaced with two larger framed dormers The certificate is issued to JAMES BAILEY owner of the aforesaid property. tv Afithorized Signature' ` NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION . DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-00524/00005 I_ .. February 8, 2010 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental Conservation Law February 7, 2014 TYPE OF PERMIT■New ❑Renewal ❑Modification 0 Permit to Construct ❑Permit to Operate ❑Article 15,Title 5:Protection of Waters ❑ Article 17,Titles 7,8:SPDES ❑ Article 27,Title 9; 6NYCRR 373: Hazardous Waste Management ❑ Article 15,Title 15:Water Supply ❑ Article 19:Air Pollution Control ❑ Article 34:Coastal Erosion ❑ Article 15,Title 15:Water Transport ❑ Article 23,Title 27:Mined Land Management Reclamation ❑ Article 15,Title 15:Long Island Wells ❑ Article 36:Floodplain Management ■ Article 24:Freshwater Wetlands ❑ Article 15,Title 27: Wild,Scenic and ❑ Articles 1,3, 17, 19, 27,37;6NYCRR Recreational Rivers ■Article 25:Tidal Wetlands 380:Radiation Control ❑6NYCRR 608:Water Quality Certifica- ❑ Article 27,Title 7; 6NYCRR 360: tion Solid Waste Management PERMIT ISSUED TO TELEPHONE NUMBER James Bailey 617-457-7500 ADDRESS OF PERMITTEE c/o Cambridge Associates, .100 Summer Street,Boston,MA 02110 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER H. P.Broom-housewri ht,Inc.,PO Box 70,Hadl me, CT 06439 860-526-9836 NAME AND ADDRESS OF PROJECT/FACILITY Bailey Property,474 Wilderness point,Fishers Island,NY COUNTY TOWN WETLAND# NYTM COORDINATES Suffolk Southold Block island Sound E: N: DESCRIPTION OF AUTHORIZED ACTIVITY: Construct additions and hip roof dormers to an existing. dwelling. All work shall be done according to the enclosed plans prepared by Richard Strouse last revised on 01/18/2010 and stamped NYSDEC approved on February 8, 2010. By acceptance of this permit,the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified and any Special Conditions included as part of this permit. DEPUTY PERMIT ADMINISTRATOR: ADDRESS Region 1 Headquarters, SUNY @ Stony Brook, 50 Circle Road, Stony Mark Carrara Brook, NY 11790 - 3409 AUTHORIZED SIGNATURE DATE � � February 8, 2010. page 1 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. During construction, concrete or leachate shall not escape or be discharged,nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas. ...: .2. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland)and removed to an approved upland area for disposal. No debris is permitted in freshwater wetlands or tidal ;.wetlands-and or protected buffer areas. 3. There shall be no disturbance to vegetated,wetlands or protected buffer areas as a result of the permitted activity. 4. All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion or prior to permit expiration,whichever comes first. The approved methodologies areas follows: Stabilization of the disturbed area with appropriate vegetation (grasses, etc.). 5. If seeding is impracticable due to the time of year,a temporary mulch must be appliedand final seeding performed at the earliest opportunity when weather conditions favor germination and growth,but not more than six months after project completion. 6. The storage.of construction equipment and materials shall be confined to within the-project work site and or upland areas greater than 100 linear feet from the wetland boundary. 7. All disturbed areas where soil will be temporarily exposed or stockpiled for longer than one*(1) week shall be contained by a continuous line of staked hay bales/silt curtain (or other NYSDEC approved method) placed on the seaward side between the fill and wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 8. Necessary erosion control measures i.e., haybales,silt fencing, etc.are to be placed on the downslope edge of any disturbed area. This sediment barrier is to be.put in place before any disturbance of the ground occurs and is to be maintained in good condition until thick vegetative cover is established. y.9. Disturbance to the natural vegetation or topography greater than 25 feet seaward of the approved structure is prohibited. DEC PERMIT NUMBER PAGE 2 OF 4 1-4738-00524/0000$ NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION i NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts-Legal Responsibility and Agrees to Indemnification The permittee,excepting state or federal agencies,expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York,its representatives,employees,and agents("DEC")for all claims,suits,actions,and damages,to the extent attributable to the permittee's acts or omissions in connection with,or operation and maintenance of,the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims,suits,actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions,or to any claims,suits,or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors,employees,agents and assigns of their responsibility to comply with this permit,including all special conditions while acting as the permittee's agent with respect to the permitted activities,and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits,approvals,lands,easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights,title,or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility,including relevant records,is subject to inspection.at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation(the Department)to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit,including all referenced maps,drawings and special conditions,must be available for inspection by the Department at all times at the project site or facility.Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede.or rescind any order or determination previously issued by the Department or any of the terms,conditions or requirements contained in such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal,modification or transfer of this permit.Such application must include any forms or supplemental information the Department requires.Any renewal,modification or transfer granted by the Department must be'in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System(SPDES), Hazardous Waste Management Facilities(HWMF),major Air Pollution Control(APC)and Solid Waste Management Facilities(SWMF); b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: Regional Permit Administrator,.SUNY @ Stony Brook, 50 Circle Road,Stony Brook,NY 11790-3409 General Condition 4: Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to modify,suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification, suspension or revocation include: a) materially false or inaccurate statements in the permit application or supporting papers; b) failure by the permittee to comply with any terms or conditions of the permit; c) exceeding the scope of the project as described in the permit application; d) newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e) noncompliance with previously issued permit conditions,orders of the commissioner,any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity.. DEC PERMIT NUMBER Page 3 Of 4 1-4738-00524/00005 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION. ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5),24,25,34 AND 6NYCRR PART 608 (FRESHWATER WETLANDS) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State,or cause loss or destruction of the natural resources of the State,the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed,the owners, shall, without expense to the State,and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by.the State for the conservation or improvement of navigation,or for other purposes,and no claim or right to compensation shall accrue from any such damage. 3. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids,sediments,fuels,solvents,lubricants,epoxy coatings,,paints,concrete,leachate or any other environmen- tally deleterious materials associated with the project. 4. Any material dredged in the conduct of the work herein permitted shall be removed evenly,without leaving large refuse piles,ridges across or along the bed of a waterway or floodplain,deposits within any regulatory floodway, or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 5. There shall be no unreasonable interference with navigation by the work herein authorized. 6. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 7. If granted under 6NYCRR Part 608,the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302,. 303,306 and 307 of the Clean Water Act of 1977(PL 95-217)provided that all of the conditions listed herein are met. 8. At least 48 hours prior to commencement of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project,the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 9. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by Richard Strouse last revised on 1/18/2010. DEC PERMIT NUMBER Page 4 Of 4 1-4738-00524/00005 ,1 n ii n n u n n n II II II II V) II II II BEDROOM II II II II II IIC, II II II 202 II NOTE BEAM OFFSET TO II II II II w II II - II II I, II II MISS OPENING BELOW II II II II II II II _ ' I - II II II III IF IF II II -IF IF II II �I II II IF III .................. ......... I II I I J J J 1 1 o _ II II ' I I - - I II r (0 I I II N � N N II x II N V I I I l0 2-14 " LVL I N I zlm. 1 _ UJ F 3" PLYWOOD I I KS-3 C. CUgl� ' - r SEC FLR FRAMING- `o 083885 SCALE: 1/4"=1'-0" SI A�- NOTE: FRAMING SIMILAR AT OTHER-DORMER NEW DORMERS DRAWING REF: GNCB 1/ BAILEY RESEIDENCE SCALE: cbbleNorden Champion Bmwn FIJSHERS ISLAND NY ConsJting Engneers,Ina iso ELM STREET DATE: SHEET POST OFFICE BOX 802 OLD`�EC CT CONNECTICUT 0064 5 DRW:CCB PHONE: BAILEY RESIDENCE DORMERS _ SKS-1, CNC0388 613 BENCIN ERS.COM CHK P:,\+PROJECTS\+Active Projects\2005 Projects\05001 Skip Broom Consul tinq\Boiley Res FI\05001.BoileyDormer.dwg 11/12/2009 2:41:09 PM r�"'Y►hl 94) volt ( BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX(631),765-9502 roper.richertfflown.sauthold,ny.us _ IMPLICATION FOIA ELECTRICAL INSPECTION [RE6rUEST ED BY: Z�e.�/'t!. date. I mny Name: Cor_nwed L msc Ze.lek- _ License No.: email@ C0n ncIcC 0�-�Y5 - — Address: j5 D G( Li r CT 00.3 _ Phone No.; [�o. �F x,17 S 3 .. JOB SITE INFORMATION: (All information Required) Name: "IN 'lLn r) IAC4) —7 R Address: / C.�i h _. J Cross Street: i AGI '1Vs� _ ( 611JIA -.. Phone No.: 8&QLj . '-� ��17 i 5 Bldg.Permit#: &jdee-S 3537 email Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK(Please print Clearly) QI 5";W W,Ye-- >'►_ ert'r _ r� ° Circle Ail That Apply: Is job ready for Inspection?: Q/ NO Rough In <Final Ido you need a Temp Certificate?: YES / NO Issued On rTmm"p Information: (AII Information required)vice.Size 113h 3 Ph Size: - ____ A # Meters _— -_-- Old Meter# New Se-Mice-l=ire Reconnect- Flood Reconnect-Sen►ice Reconnected - Underground-Over hoaSe-Mice Underground Laterals 1 2 H f=rame Pole Work done on Service? Y N Additional Information: - I - - PAYMENT DUE WITH APPLIOATION MAR _ 7 2018 16Cq u TowN OF soumom o�OFF64�OG BUILDING DEPARTMENT- Electrical Inspector a TOWN OF SOUTHOLD = Town Hall Annex - 54375 Main Road - PO Box 1179 o��o�' o�� Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX-(631) 765-9502 roger.richert(c_town.southold.ny.us APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: 1k)IC[JQL0C_, C, �QU-)pSP-J)1<0 Date: Company Name: A/7 :G� L LLC Name: License No.: email: 1g7c- MIC & HOirMOiL C010 Address: R jz4 NL= OLS `/rwL:�--- , C' 71 Phone No.: L? ff_90-G Z 5 3 2 3 c JOB SITE INFORMATION: (All Information Required) Name: K Vri L�LcG Address: E 1VE-95 A-)T Cross Street: Phone No.: - - '7077 Bldg.Permit#: 4- email: Tax Map District: 1000 Section: �- Block: Lot: ; BRIEF DESCRIPTION OF WORK (Please Print Clearly) LP G421ib E- Q 15 L N 6- [ x-12 I-,�) Wi PLS � l�J;� WJ i!4 C C-)ML30 "'5 M 6)1Z_[c 0, Circle All That Apply: Is job ready for inspection?: YES NO Rough In Final Do you need a Temp Certificate?: YES issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A # Meters Old Meter# New Service- Fire Reconnect- Flood Reconnect- Service Reconnected -Underground - Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION V 7t 82-Request for Inspection Form As �p ,.� � � 29 HARRY P. BROOM P.O.BOX 70- 162 FERRY RD. HADLYME,CT 06439 (860)526-9836 FAX (860)526-2647 LETTER OF TRANSMITTAL Date: 12/14/09 To: TOWN OF SOUTHOLD BUILDING DEPARTMENT - TOWN HALL P.O. BOX 1179 53095 Main Road SOUTHOLD, NY 11971-0959 ATT: PAT CONKLIN Re: BAILEY RESIDENCE FISHERS ISLAND, N.Y. WE ARE SENDING YOU X Attached Under seperate cover via the following items: Shop Drawings _ Prints _ Plans _ Samples _Specifications _ Copy of Letter _ Change Order _ Other Copies Date No. Description 1 APPLICATION FOR BUILDING PERMIT 4 12/4/09 A-1/A-5 BUILDING PLANS (INCLUDES SITE. PLAN) 4 11/12/09 SK-1/3 ENGINEER PLANS 1 2/08/10 COPY OF BOARD OF TOWN TRUSTEES PERMIT 1 1/20/10 COPY OF NYS D.E.C. PERMIT 1 12/17/09 #14228 CHECK IN THE AMOUNT OF $200.00 THESE ARE SUBMITTED as checked below: _ For approval T Approved as submitted _ Resubmit_ copies for Approval X For your use _ Approved as noted — Submit _ copies for Distrib. _ As requested _ Returned for corrections _ Return_ corrected prints For review and comment REMARKS: ENCLOSED YOU WILL FIND THE DOCUMENT(S) NOTED ABOVE TO HOPEFULLY SATISFY THE REQUIREMENTS FOR A BUILDING PERMIT. PLEASE NOTE THAT IN A CONVERSATION WITH A SUFFOLK COUNTY DEPARTMENT OF HEALTH REPRESENTATIVE ON 12/10/09 AT 10:46 A.M. IN CONVERSATION THEY STATED THAT A DEPARTMENT OF HEALTH PERMIT WAS NOT NEEDED AS THERE WHERE NO ADDED .BEDROOMS, BATHROOMS, AND/OR SINKS, WITH THE CHANGE OF ROOF DORMERS. SHOULD THERE BE ANY QUESTIONS PLEASE DO NOT HESITATE TO CALL ME AT 860- 526-9836. THANK YOU, REED NEWTON — PERMITS H.P. BROOM—HOUSEWRIGHT, INC. --• --• ---- -w�...-.—_� —..__" _.. . u��.,�•i nuu��wr�l�an i I"Hlat b1 H.P. BROOM - HOUSEWRIGHT, INC. P.O. BOX 70 - 162 FERRY RD. HADLYME, CT 05439 PHONE (860) 526 -- 9836 FAX (860) 526 - 2647 12/10/09 To Whom It May Concern: H. P. Broom--HousewrM&hjInc., P.O. Box 70,Hadlyme, CT - 06439, is authorized to act as my agent to conduct and apply for all necessary permits pertaining to the alteration of a residence located at 474 Wilderness Point, within the Town. of Southold, Fishers Island, New York. Signed: ' DeftIv 1`� 0 Date Owner(s)of record: James&.8miley Address: Cambridge Agggigig 100 Summer Street Roston,MAl l0 APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: =/&(,S[f"N2/G6!r_A-ZVC�, (Last name,first name,.rpiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building �. Variance Trustee Y Change of Zone Coastal Erosion Approval of plat Mooring- Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial.ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this ay oL icle C 200 Signature Print Name Form TS I Page 1 of 1 Conklin, Pat From: hbroom@comcast.net Sent: Friday, March 05, 2010 8:58 AM To: Conklin, Pat Cc: broom e-mail Subject: Bailey permit= Fishers Island Attachments: Bailey-Albert Righter Tittman Architects - Declaration letter- Egresss & Insulation 3-3-10.pdf; Bailey- GNCB revised Structural Plans --SKS1-4- 3-4-10.pdf H. A Broom - Housewright, Inc 162 Ferry Rd. P. O. Box 70 Hadlyme, CT 06439 Telephone (860) 526-9836 FAX (860) 526-2647 Email: hbroom a,comcast.net TRANSMITTAL SHEET TO : TOWN OF SOUTHOLD—BUILDING DEPARTMENT ATTN: PAT CONKLIN—BUILDING PERMITS EXAMINER pat.conklin@town.southold.ny.us FROM : REED NEWTON DATE : 03/05/10 RE : BAILEY RESIDENCE—FISHERS ISLAND NY —ADDITIONAL PLAN INFORMATION FOR RENOVATION ATTACHMENTS : pdf—Albert Rigthter Tittman Architects— Letter addressing Egress &Insulation specifications pdf- GNCB Engineering— Revised Structural Plans- SKS-1,SKS-2,SKS-3, SKS-4 dated 3/4/10 ADDITIONAL MESSAGE : Per our phone conversation of March 3, 2010, attached are two pdf file documents containing information from the architect and the structural engineer to address your concerns . Please feel free to contact us with any questions or if any further information is needed. Thank you for your help. 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FIJSHERS ISLAND NY ConsWfug Engineers,Inc SHEET 130 ELM STREET DATE: POST OFFICE BOX 802 CLE)SAYBROOK CONNECTICUT 06475 DRW:CCB ci,(c_2 PHONE:860 038B 613 BAILEY RESIDENCE DORMERS SKS-2 FAX:860 388 467 3 GNCBENGINEERS.COM CHK: P:\+PROJECTS\+Active Projects\2005 Projects\05001 Skip Broom Consultinq\Bailey Res FI\05001.BoileyDormer.dwq 11/12/2009 2:41:44 PM Z"y=�ooW �4 2x8 RAFTERS p AXOzrip ^ m 22Onmz orm[' "$ C, Z s' N ZWof��m+ 'Cow$AO+ 0oDAo '(AZ :. 75, 2-7j" LVL HEADER FRAME 11 o TO DOUBLE RAFTER EA SIDE W a D C, mEX CEILING JSTS 2X6 CEILING -_ o o ,i co H2.5 HURRICANE F3 , D m CLIP TYP AT RAFTERS 3 m = m TO SUPPORT n p 2-5j" LVL cn m O RAFTER UP TO 3-2x4 HEADER RIDGE EA SIDE TYP o m m OF NEW DORMER ID I rn � m cn 70 ID Oo�s��ll (D z 2-7j° LVL CD N0 BEAM BEYOND I \ � c"), T � a a 2 I _ 0 a cn 0 NMo�O N m > O o n m z i o W m N 71 EX CEILING JSTS N m CD = ff 9: 1 SECTION HEADER VOVEROENING c/) KS- 3�8,. = i _o BLOCK DOWNO HRU W CEILING i I f /I�Islr•r! 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ARCHITECTS, ,ENGINEERS & SURVEYORS �o 02/*,2 c$ p-ao�- �� 110 BROADWAr, NORWICH, CONNECTICUT 06360 (209) 889-3397 .I, C3 N O so FAX # (203) 886-7801 X DATE: JANUARY 17, 1990 SCALE: 1"-- 20' SHEET 1 OF 1 BAILEY DORMERS oc FISHERS ISLAND NY 11 1-1 � '� �_4 u oz L_ TABLE OF CONTENTS ° w A1.0 COVER SHEET 10/20/09 12/04/09 = A2.0 2ND FLOOR PLAN 0 0 A3.0 EXTERIOR ELEVATIONS 0 0 A4.0 DETAILS 0 0 A5.0 --INTERIOR ELEVATIONS 0 0 ------------------------------------------- -------------- ------------- ------------- 77 aA r — ---—--------- — --—----------------------- \------ -—---------------------------- -ED- -Aw —---- -------------- ----------- ----------- ----------------------- -'------- --------------- ------- ------------ ---------------------------------------- ------ ------------------------- -- -------- ------------ —-------------- _ _ -—----------------- —--------------------- ------------------------------ - __--_ -------------------------- ------ FF 00 :LL1 I -------------- ----------- IF ----------- 11 1 1 1 U -------- ----- ❑ Oil] :IEEE -IPI IF- ------- IMF ----------- ----------- ------- ro co �4 WEST ELEVATION SCALE: 1/4" = 1'-0" r-j LU LU im cn C) CD CD CD cn cn CD C4 C3 LIJ _j Zi L A E31 c\j x _LLJ —LLL] I] (o O TOP OF 2ND FLR. 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ON 6 2 x COPPER DRIP STRAPPING 7" CEDAR COVE, 2" RAD. CV ti\ z 2 2Al 1 x CEDAR FASCIA WINDOW CASING TO a a a l x CEDAR SOFFIT a®eeem°5° ee�mno ;�, n®0. * 'kp oaq MATCH EXISTING CEDAR BED MOLDING, TO ° w 1 R 4 F'• a® or ` MATCH EXIST'G DORMER "A" * ° `' jx CEDAR FRIEZE BD., la =.i N BLOCK OUT AS REQ'D TO ' OVERLAP CASING COPPER FLASHING jx CEDAR CASING F—i I rT, 0 W V) •r-II BOTTOM OF s�z WINDOW R.O. co jx CEDAR CASING COPPER FLASHING w R-19 MIN. OPEN—CELL Q B A C cli FOAM INSULATION W rn m 0 0 WINDOW ELEVATIONS DETA L �'Cn CN C-4 C) ASCALE: 1/2" = l'-0" SCALE: 1-1/2" = l'-0" C) C14 Yr „i A b U C O O N X O O fD M N N N a WINDOW SCHEDULE WINDOW NOTES: SASH FRAMES, JAMBS, SILLS TO BE MAHOGANY. ALL NEW WINDOWS TO HAVE STORM WINDOWS, WHITE BAKED ENAMEL FINISH. ALL WOOD EDGES TO BE SHOP-PRIMED. N KEY # W x H W x H DOUBLE HUNG WINDOW TO HAVE TRIPLE-TRACKcn GLAZING TO BE 1/8" CLEAR, SINGLE GLASS. STORM/SCREEN. 0 co A CUSTOM DBL. HUNG 8 / 8 4'-0 1/2" x 5'-0 1/2" 4'-3" x 5'-3" " " WINDOWS TO BE MADE BY ONE OF THE Q'_ o BALANCES FOR DBL. HUNGS TO BE CONCEALED SPRING-TYPE PULLMAN BALANCES. W Q B CUSTOM FIXED 3W x VARIES 2'-5" x VARIES 2'-7 1/2" x VARIES HORIZ. MUNTINS TO ALIGN W/ A " " FOLLOWING COMPANIES: � O MUNTIN PROFILE TO BE SHAPED TO MATCH EXIST G. DORMER A WINDOWS, VFY DETAIL W/ ARCH'T. r w C CUSTOM FIXED 3W x VARIES 2'-5" x VARIES 2'-7 1/2" x VARIES HORIZ. MUNTINS TO ALIGN W/ A ARCHITECTURAL COMPONENTS, INC O Z a EXTERIOR CASINGS TO BE CLEAR, VERTICAL GRAIN CEDAR, 26 NORTH LEVERETT ROAD NOTE: 0 FLAT STOCK. MONTAGUE, MA 01351 1. MAX. U-FACTOR FOR NEW SINGLE GLAZED PHONE: 413-367-9441 SASH LIFTS TO BE BALDWIN, DE-IAQUERED BRASS, MODEL JTBD, WINDOWS & STORM WINDOWS TO BE 10.56 2 PER DBL HUNG SASH. SOUTHSHORE MILLWORK 7 MAPLE ST. 2. PROVIDE PRE—CUT STRUCTURAL PANELS FOR NORTON, MA 02766 WINDBORNE DEBRIS PROTECTION. PAINELS • o PHONE: 508-226-5500 SHALL BE MADE OF 1/2" THICK CDX PLYWOOD. CONTACT PERSON: DOUG EDWARDS INSTALL WITH 2 1/2" #8 WOOD SCREWS 16 ON CENTER. 0 �T� o Uz I o H � w Lij kr) w G4 U U zF ti le 17L L t v. w W _cd 1 1 B BEDROOM202 BEDROOM 202 SCALE: 1/2" 1 —0 A C S /2 —0Q� W A4.0 A TI LIL JJ w Q, o LJ CD 0 cn (n o d N O O N LJJ Q J � A 'd U C O O .4N X ' ^ co M z U ON Q7 BEDROOM 208 BEDROOM 208 SCALE: 1/2" = 1'-0" BSCALE: 1/2" = 1'-0" a WJ o W �I _o �/r'� I I co C"l 0 N W O N a E— a ci o 0 a ' cz 0 m ir U • m VO O a