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Home My WebLink About28001-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29433 Date: 05/14/03 THIS CERTIFIES that the building ADDITIONS & ALTERATIONS Location of Property: 850 BUDDS POND RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map do. 473889 Section 56 Block 5 Lot 15 Subdivision Filed Map No. __ Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARy 9, 2002 pursuant to which Building Permit No. 28001-Z dated JD/~UARY 10, 2002 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 ADDITIONS P/qD ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. · ~ne certificate is issued to ANDREW NIKOLICH & ROSE kNN SCISCENTE (OWNER) of the aforesaid building. S~FF~LK COI~TY DEPART~4ENT OF ~3~TH APPROVAL N/A ELEC'ERICAL CERTIFICATE NO. 02-4567 02/10/03 PLUMBERS CERTIFICATION Rev. 1/81 )4/03 ROBER__T V~ ETTE~N Authorized Si~ature 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. 28001 Z Date JANUARY 10, 2002 Permission is hereby granted to: ANDREW NIKOLICH 850 BUDDS POND ROAD SOUTHOLD,NY 11971 for : ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING WITH FLOOD PERMIT AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 056 pursuant to application dated JANUARY Building Inspector. Fee $ 250.00 850 BUDDS POND RD SOUTHOLD Block 0005 Lot No. 015 9, 2002 and approved by the ~ ~/~ut h~rf~l z ~~t ure ~ COPY Rev. 2/19/98 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: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval fi-om Health Dept. of water supply and sewerage-disposal (S-9 forn0. 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 sinfilar 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. Ifa 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, Swi~m~fing 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, Cmmnercial $15.00 New Construction: Location of Property: Old or Pre-existing Building: Date. g4,~/~ 2.003 v~ (check one) House No. Street Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Hamlet Block Subdivision PermitNo. 2o°OE>/ Z Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Date of Permit. Filed Map. ¢o/200~ Applicant: Underwriters Approval: Final Certificate: Lot: C~,-/ :t oz'-4,.5-67 (check one) Town Hall, 53095 Main Road P.O. Box 1179 Southold, New ¥6rk 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Fax(631) 765-1823 Telephone (631) 765-1802 Building Permit No. 2 o° C ¢'!- ~. Owner: ,,~'~)~zt~vq /~/1~'o ~ I C ~' (please print) Plmnber: ~'~ ~__(~_ _ ~ c.,~ ~]--7'-e_~J (please print) Date: ,,4 ?git- I certify that the solder used in the water supply system contains less than 2/10 of 1% lead, g~0~ to before me this dayof -~e~ , (Plumbers Signattire) Notary Public, ._ _~_ {//~ax)-~ County MARYBETH i;~,SCALE ~ISCENTE ~W Public, S~te ~ N~ Y~ No, 02SC~3553 Oualifi~ in Nas~u ~unW Electrical Inspectors, Inc. Fa,x: (5 ~6) 79n. Sg54 Electrical Design & Construelima/ASAP William Ch0dkowsld 2341 Westley Koad Westbury, NY 11590 Lieense~ 4650E Centare ~r: 02-*~567 Mun~pal#'y: Soultlokl, Town Of Inspector: lssueD~te: 2/10/2003 Pmper~ Addmaa: Nikolieh Southold, NY AREAS LISTED BELOW AND FOUND TO BE IN £ NO visual d~fec[$ were found for the eleetrleal i~ herein below Only. INSPECTION ~LECTRIC CODE ~ found in ~he areas 3rdFloor' Office~ RougA 7/$0/02 Final 2/6/05 EHAg~t Richard M. Bivcae Philip F. (}oela'~$ President Chief Elee~ieal Inspector FROM : F GESUALDO ARCHITECT ---'F I~ A N K t-,.. PHONE NO. ' 516 423 0889 7~02-02 Damon Rallis, Plan Examiner Town of Southold 53095 Main Road P.O. Box 1 lq9 5outhold, 1N ¥ tlg/t Jul. 82 2002 11:45RM P1 Re: Nikolic, h Residence 850 Budd's Pond Road Southold, NY Bldg Pezrait # 28001Z Dear Damon, In regard tn the above captioned project, I was contactod by the contractor to rcclucst a minor change in the framing of the bedroom over the garage. He wished to relocate thc 2)12" Micro-Lam beam ~o aposition above the window linc, spanning from wall to wall, and installing 4} 2x 1 o as a header at the tloor lcv¢l. Since thc 2 micro-lams are still taking the roof load and are properly supported, I calculated that the 2 x 10s were sufficiem for the remaining loads. Enclosed is a copy o£the revised section. Thank you for your cooperation in this FGC/rg Enc]. ¥ i. 2 2X6 C.J, l X 12 ~A~ FC~f.9I~ Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. DATE: ~55' 21' ~Qpl ISSUED TO ANDREW NIKOLICH Authurizali.n Pursuant fo the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter ~ of the Laws of the State of New York 1952: and the Southold ToWn Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUGTIONS IN AND ON TOWN WATERS AND PUBLIG LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERSr% and in accordance with the Resolution of The Board adopted at a meeting held on ~°0].__L, and in consideration of the sum of $...~..0..~.~.0 ...... paid by Andrew Nikolich T~rms and Conditions listed on the reverse side hereof, Wetland Permit to install 125 linear ft. of C-Loc Series 4500 vinyl sheathing on inalde of the existing bulkhead. Extend second-story wa/1 of the existinl~ bedroom garage. Install accessory bldg. (10~X $~ shed), and restore~circt~iar driveway. Ail improvements approved with the condition ~f a 10~ non-turf buffer installed landward all in accordance with the deteiled speci~lca?lons as presemeu m the oHginating appllcatlom IN WITNESS WHEREOF, The said Board of Trustees here- by causes, its Corporate. S.e. al to be affixed, and these ~.resent~ to be subscribed by a malordy of the sa~d Board as of th~s dar~. Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 21,2001 Mr. Andrew Nikolich 89 Kingsbury Rd. Garden City, NY 11530 RE: 850 Budd's Pond Rd., Southold SCTM#56-5-15 Dear Mr. Nikolich: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, December 19, 2001 regarding the above matter: WHEREAS, ANDREW NIKOLICH applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated November 28, 2001, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on December 19, 2001, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and doctanentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of ANDREW NIKOLICH to install 125 linear fi. of C-Loc Series 4500 vinyl sheathing on inside of, the existing bulkhead. Extend second-stoW wall of the existing bedroom and eliminate second-stoW balcony. Construct second-stow addition over existing garage. Instal/accessory building (10'X 8' shed), and restore circular driveway. All improvements approved with the condition of a 10' non-turf` buffer installed landward of the bulkhead and the driveway improved xvith a permeable surface only. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of'said project. Fees: None Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/lms DEC Bldg. Dept. New York State Department of Environmental Conservation Division of Environmental Permits Building 40 - SUNY, Stony Brook, New York 11790-2356 Telephone (631) d~.~.-0365 Facsimile (631) 444-0360 Erin M. Crotty Commissioner December 27, 2001 Mr. Andrew Nikolich 89 Kingsbury Road Garden City, NY 11530 RE: 1-4738-02966/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, ~Sus~n~ Environmental Analyst SVA/ls Enclosure NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMgER 1-4738-02966/00001 FACILITY/PROGRAM NUMgER(S) PERMIT Under the Environmental Conservation Law EFFECTIVE DATE December 27, 2001 EXPIRATION DATE(S) December 31, 2006 TYPE OF PERMIT · New [] Renewal [] Modification ~ Permit to Construct [] Permit to Operate · [] [] [] [] Article 15, Title 5: Protection of Waters Article 15, Title 15: Water Supply Article 15, Title 15: Water Transport Article 15, Title 15: Long Island Wells Article 15, Title 27: Wild, Scenic and Recreational Rivers · 6NYCRR 608: Water Quality Certification ArticLe 17, Titles 7, 8: SPDES ArticLe 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamation 0 Article 24: Freshwater Wet[ar~Js J Article 25: Tidal Wetlands Article 27, Title 7; 6NYCRR 360: So[id Waste Management Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management Article 34: Coastal Erosion Management Article 36: FLoodplain Management Articles 1, 3, 17, 19, 27, 37; 6N¥CRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Andrew NikoLich (516) 746-3437 ADDRESS OF PERMITTEE 89 Kingsbury Road, Garden City, NY CONTACT PERSON FOR PERMITTED WORK 11530 TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Nikolich pro~ertyf 850 Budd's Pond Road, Southo[d LOCATION OF PROJECT/FACILITY SCTM #1000-56-05-15 COUNTY I TOWN Suffolk SouthoLd WATERCOURSE I NYTM COORDINATES I Buddls Pond DESCRIPTION OF AUTHORIZED ACTIVII"f: Install 120 finear feet of new sheeting landward of the existing bulkhead. Construct second floor additions over the existing garage and deck. Construct 10' x 18' shed. Modify existing bluestone driveway. All work must be done in accordance with the attached plans stamped NYSDEC approved on December 27, 2001. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, a[[ applicable regu[ations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: Roger Evans (SVA) AUTHORIZED SIGNATURE ADDRESS Bldg. #40, SUNY, Stony Brook, NY 11790-2356 December 27, 2001 Page I of 4 NEWYORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVA'nON NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, agents, and assigns for all claims, suits, actions, damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. Item B: Permittee's Contractors to Comply with Permit The permittee is responsibJe for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including apl 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 G: 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 Inter[ere 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 pady 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 (HVVMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY BIdg #40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a) the scope of the permitted activity is exceeded or a violation of any condifion of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. DEC PERMIT NUMBER 1-4738-02966/00001 JPAGE 2 OF 4 ~ . NEWYORK STATE DEPARI~4ENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES '15 {TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 ( TIDAL WETLANDS) 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 resoumes 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 man nar as the Department of Environ mental 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. 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. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local government which may be required. APl 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 environmentally deleterious materials associated with the project. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 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. If granted under 6NYCR R 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. 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. 10. 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: A. Nikolich '11/20/2001 (sheets 1 & 2) DEC PERMITNUMBER I ~ PAGE 3 OF 4 1-4738-02966/00001 NEW YORK STATE DEPARI~IENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. 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 tidal wetlands and or protected buffer areas. 2. 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 are as follows: a. Revegetate area to its pre-existing condition. 3. Driveways and parking areas shall be constructed of pervious material. 4. This permit does not authorize any alteration, expansion or replacement of existing septic systems. 5. Roof runoff shall be directed to drywells on the landward side of the house. t DEC PERMIT NUMBER I PAGE 4 OF 4 1-4738-02966/00001 APPLICATION TOWN OF SOUTHOLD FLOODPL N DEX LOPMBNT L ~vm 9F ~ 90~nL0 form is to be filled out in d.plicate. SECTION 1: GENERAL PROVISIONS (APPLICAFUF to read and siffM: 1. No work may start until a permit is is~sued. 2. The permit may be revoked il' any false statements are made herein_ 3. If revoked, all work mu_st cease until permit is re-issued. 4. Development shall not be wed or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced with~ six montba of issuance. 6. Applicant is hereby informed that other permits may be required to fulfiU local, state and federal regulatory requh'ements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make t:easoaable inspectio~ required to verify complitmce. 8. I, THE APPLIGANT, CERTIFY 'I'HAT ALL STATEMENTS HEREIN AND IN A'I'FACH3vLENTS TO . THIS APPLICATION ARE, TO THE BEST OF MY KNO',,VLED~GE, TRUE AND ACCUP,.ATE. / SECTION 2: PROPOSED DEVELOPMENT (TO be comoleted bv APPLICA/~'F) NAME A. PP LICAIWI' ADDRESS TELEPHONE BUILDER ENGINEER To avoid delay in processing the application, please provide enough information to e.~tsily ideutify thc project Ioc~tion. Provide 0~e street address, lot number or legal description (attach) Md, outside urban ~eas, the dist~mee to the nearest intersecting road or ,,vell-lmown landmark. A sketch attached to this application showing the projecx loc.~tion would be helpful. FOP(g3) APPLICATION PAGE 2 OF 4 DESCRIPTION OF WORK (Check all appScablc boxes): A STRUCTURAL DEVELOPMENT [] New Structure AddRion Alteration O Relocation [] Demolition [] Replacement ~TR UCTURE T'~,E esidcntial (1-4 Family) esidential (More th~n 4 Fatally) Noa-residential (FloodprooFmg? [] Yes) [] Comb~ed Use ('Residential & Commercial' [] Manufactured (Mobile) Home (la Manu- hctured Home Park? [5] Ye.s) F~TIMATED COST OF PROJECT B. OTHER DEVELOPMENT ACTIVITIES: Fill [] Mi~ng [] Drilling ~Grading Excavation (Except for Structm'al Development Checked Above) Watercourse Alteration (Including Dredging and Channel Modific-atio~) Drainage Improvements (Including CUlvert Work) Road, Street ore'igc Constru~ion Subdivision (New or Expansion) Individual W~,ter or'Se,~r System Other (Please Specify) Alter complethag SECTION 2, A_PPLICA3x~ should submit form to Loea~ AdmbJstrator for review. SECTION 3: FLOODPLAIN DETERMINATION fTo be complete.d bv LOCAL ADMINI~FRATOR) The proposed development b located on FLRM Pmael No. , Dated The Proposed Development: [] la NOT located in a Special Hood Hm, urd Area (lqotify the appllcmat that the application rex4¢w i~ complete and NO FLOODPLAJ. N DEVELOPMENT pF_.R.MIT IS REQUIRED). n la located in a Special Flood Ha'tarSI Aa'ea. FlR.M ZOne de.xignation ia I00-Year Ilood elevation at the site is: Ft. NGVD (MSL) El Unavailable U] The proposed development is located in a floodway, FBFM Panel No. Dated [] Sec Section 4 for additional instructions, SIGNED DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST /~ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ~X~FRAMING [ ] FINAL RE_MARKS. ~/ ~ * ~ 765-1802 BUILDING DEPT. INSPECTION INSPECT~ [ ] FRAMING [ ] FINAL [ ] FIREPLACE& CHIMNEY RE~qARKS~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] ROUGH PLBG. [ .] I~ATION [//]' FINAL [ ] FIREPLACE & CHIMNEY REMARKS/~,)~/,~_~,//~-~ ('~_~/~ ~ ~,~, ~_~ INSPECT~ 765-~.802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING RO~H~BG. ~JLATION FINAL [ ] FIREPLACE & CHIMNEY FIELD INSPECTION RE. PORT DATE ~ COI~IENTS FOUNDATION II II (~ST) Il TI- FINAL C TOWN OF SOUTHOLD BUILD1NG DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 Approved / / Disapproved a/c BLDG. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying Board of Health 3 sets of Building Plans Survey / Check~., 5 I'~- Septic Form N.Y.S.D.E.C. ~ ~ Trustees ~ Contact: Mail to: Building Inspector Phoneu~/~ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS 200~ a. This apphcation MUST be completely filled hi by typewriter or in ink and submitted to the Building Inspector with 3 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 Peimit. 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 a Certificate of Occupancy is issued by the Building Inspector. 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 adm/t authorized inspectors on premises and in building for necessary inspections. (signature of applicant or name, if a corporation) (Mailing add--ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises 8.3-0 23r-,'DD--~ t°t~ A//_) ,A~O,,4/) (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) ~r,~c 7 Builders License No. Plumbers License No. Electricians License No. Idtl-~n/'~ c~4>~ou~,.,;~'¥ q66-~-~ Other Trade's License No. 1. Location of land on which proposed work will be done: House Number SWeet CountyTax Map No. 1000 Section Subdivision Hamlet ,-~-'~ Block 1~) ~ Lot /-.~ Filed Map No. Lot (Name) State existing use and occupancy of promises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~'~x,n~'r~ ~ 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 garage, number of cars Addition Other Work Fee Alteration (Description) (to be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions or existing structures, ifany:Front /-/o~ZJ"~'' Rear~. t~_eoo_,o,~`' Depth Height 2 ~' ~- ~'" Number of Stories ~ Dimensions of same structure with alterations or additions: Front pg Depth g ~_L~; l, Height. 2 ~o C7 '/ Number of Stories 9. Sizeoflot: Front 10. Date of Purchase 8. Dimensions of entire new construction: Front Height Number of Stories /00 11. Zone or use district in which premises are situated Rear /.24 / Name of Former Owner Rear .Depth Depth / ~73 z 12. Does proposed construction violate any zoning law, ordinance or regulation: fi/c> 13. Will lot be re-graded N~4 Will excess fill be removed from premises: YES 14. Names of' Owner of premises ~or~- ~o~' .rcmc~ Address ~t~ c>r~ /~.y- Phone No. cS-/g Name ofArchitec;- ~ ¢ ~o,~,~OO . 7~ ,--~o~ ~,~. ~ Ad&ess~Pho, e No g'2~'- Name of Contractor Address Phone No. 15. Is this property within 100 feet of a tidal wetland? *YES J NO · IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. /?-/~20 NO 17. If eleVation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COLrNaW OF ) //db ~C'~ /~I/Z~/_ l ~2/'/ 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 anthorized to perf`orm or have performed the sa/d work ?~ud to make and fi3e t~s application; that ali 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 t%before me this ~ dayof l~0~L~rv{.~3~ 20 ~[ MARYBETH PASCAL/ Notary Public, State o No. O2S C5043,~¢~ ....... ,x~on Expires May Sipture of Applicant SURVEY OF PROPERTY AT ARSHAMOMAQUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 1000-56-05-15 SCALR: 1"=30' OCT. 11, 2001 NOv. 27, 2001 (FLOOD ZONE) ~ L =,79 76 LOT LINES ARE REFER TO 'H~? DF '~ILLO~ POINT* FILED JUNE I6~ I966 IN THE DFFIC£ OF THE SUFFOLK C~UNTY CLERK AS FILE FLOOD ZONE AE (el 81 FLOOD ZONE F'ROM FIRM # 36103C0150 G Moy 4,1998 gREg=16,720 S,F, TO FILE NAP LINES ./ · =HE1NUNEN T · =PIPE R~SE ~NN SC/SCENTE CNICAGO ~TLE INSURANCE C~ 1230 T~4VELE~ SDUTH~LI?. NY 11971 r 76~ I797 0t-266