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Home My WebLink About12483-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. Certificate Of Occupancy N^Z12143 DECEMBER 12 83 u ......... Date THIS CERTIFIES that the building NEW DWELLING Location of Property 495 NORTH PARISH DR. SOUTHOLD h&;s ........................................ Street Hamlet 005 County Tax Map No. 1000 Section ....0.7.1. ..... Block O1 .Lot ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY. 26 198.3.. pursuant to which Building Permit No. 12483Z dated . .A.U.G.U..ST..1.0. ................ 19.8..3, 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 ......... · ~QT. ,% q~W c2n..e f.a..m.i.lX dwelling The certificate is issued to ...SJ41~LDON SALZMAN ............... ?o¥.'o;, ...................... of the aforesaid building. Suffolk County Department of Health Approval 13-sc2-118 UNDERWRITERS CERTIFICATE NO... N,2,32 88~1 ...................................... Building Inspector Rev. 1/81 FOu~ NO. ~ TOV/N 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) N? 12453 Z Permission is hereby granted to: ......7 ......... .... ................... ...--~'.e/.of_~...z......~...~..~ ............ : .... ........... ~-.~. ~... ...... .~.~......,~.~.,~...4. ....... ~.~.~...,..7_.,~./.~....~ /:o..~? .... ............... ~.~./~,Z. z2~z~z......._~.,~zL~..~.~. ~. ...................................................................... at premises located at ...~.~. ........ /.'~ .'~/.~.....2~.~....~.~ ....... ~_~./~fi~/~.~..~..?...~.~...~ · County Tax Map No. 1000 Section ..... .~....7../. ........ Block ...... .~../. ......... Lot No....~....O?.~.~. ......... pursuant to application dated ......... ~..~.~-...~.. ....... .4 .............. , 19Z..~., and approved by the Building Inspector. Fee $.Z, .~.~.'..~ / ~uilding Inspector Rev. 6/30/80 FIELD t~S F~E~ TI ON FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY C DE COMMENTS FINAL ADDITIONAL COMMENTS: FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"_ land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .............e ~ ~o~ ~ ~ House No. Street Ham/et Owner or Owners of Property ............ ~ County Tax Map No. 1000 Section . ~ .~. )... Block ,/. Lot. ~ .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..~...3~..~.~.. Date of Permit ~/l?.°../.~.~. .Applicant ............. ~.~ ........... :.-~ ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .................... Fee Submitted $ ............................. Con stru etlon o n above desc ribed bu lid lng and/ge~m.....ee~ap~plic~a~ regulations. //-~ nn,,r .t ..... Rev. 10-10-78 ~EW YORK STATE D~PARTMENT OF ~NVIRON~NTAL CONSERVATION Stony Brook~ New York 11794 516-751-7900 Winds Way Building Corp. Glemn Road $outhold, NY 11971 July 7, 1983 Re: 10-83-0645 Dear Sir: Procedures Act (Article 70, ECL) ad its implem~ting R~ula~iona . (6~.C~ Par~ 621) we are ~nclo~g your pe~t. Pleaa ~oad all conditions cace~ully~ If you a~e unable to comply with a~ condi~ ~ions, please contact the Regional ~g~ato~ Affa~r~ Offiae~ ~S Also encloaed is a permit sign which you ar~ to conspicuously post at the project ~it~, protected f~om ~h~ weather, DJL:ll NEW YORK SIATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION PERMit 'PERMIT NO. 10-83-0645 UMBER tile ENVmONMfMTAL cONsERvATION LAw j ARTICLE 15, (Protection of Water) [] AgTICLE '"g, (Tidal Wetlands) ARTICLE 24, (Freshwater Wetlands) L_J ARTICLE 36, (Construction in Flood Hazard Areas) PLRMIT ISSUED TO ~ 1 enn_Jlaad~Son~. Y. __ LOCATION OF PROJECT (Sed~on of stream, tidal wetland, dam, ~ESC~IP~JON De vrolecr -- ~t~u~--~~y ~e~~m,,~ 75'~~de_~~~ 100' ~rom_a~.~a~Appr~e]y ~00 ~.-ya~ raise the Erade for house construct, Southo]d J T°Ws;utho ld ( OM~AUNITY NAME (Clly, Town, Village) uffolk Fla.,COMMUNITY NO. ~[ DAM NO. GENERAL CONDITIONS 1. lhe permiHee shall file in Ihe office of tile appropriate Regional Pt, rm~t Admimstrator, a notice of intention to commence work at least 48 h,,d ol the waterway or fl~ plain or deep holes that may have a tendency to Iht. reon, within or beJnnd a good and subslantial bulkhead or bulkheads, such 6. there shall be no unreasonable inlerference wHh navigation by the 7. That if future operations by the State of New York require an alteralion obslructmn to the free navigation of said water5 or flood flows ,or endanger the health, safety or welfare of the people of the State, or loss or destruction Ihe~eby wilhoul expense lo {he Stale; add if, upon lhe expiration or revocau0n (ond~Hon the navigable and flood capacity of the watercourse. No claim shall 95-20-4 (9/75) iPeEp% ~m~ ~el ? T ;?, D A[~ 8 4 8, lhat 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 resull from future operat~ns undertaken by the Slate for the conservatmn or improvement of navigaHon, or for other purposes, and no claim or right 9. That if the display of lights and signals on any work hereby authoriz, is not otherwise provided for by Jaw, such lights and signals as may be pre.: scribed by the United States Coast Guard shall be installed and maintained t0. All work carried out umfer this permit shall be performed In accor dance wHh eslabllshed engineering praclice and in a workmanlike manner. lo reconsider this approval at any time and after due notice and hearing continue, rescind or modify this permit in such a manner as may be found be just and equHable. If upon the expiration or revocahon of this permit, modification of the wetland hereby authorized has not been completed, th~ applicant shaH, without expense 1o the State, and to such extent and in sucf s~te Io its former condition. No claim shall be made against the State of Ne~ 12. This permit shall not be construed as conveymg Io the applicant right to trespass upon the lands or inlerfere with the riparian rights of others to perform the permitted work or as authorizing the impairment of any rights title or interest in real or personal property held or vested in a person not parly to the permit. 13. The permittee is responsible for obtamm§ any other permits, ap provaJs, lands, easements and righls*of-way which may be required for )hi project. 14. If granted under Article 36, this permit is granted solely on the of the requirements of Article 36 of the Environmental Conservation Law and Part 500 of 6 NYCRR (Construction in Flood Plain Areas having Special Flood Hazards - Building Permits) and in no way signifies that the project will be free from flooding, 15. By acceptance of this permil the permittee agrees that the permit is contingent upon strict compliance with the special conditions on the reverse side. (SEE REVERSE SIDE) PP~.F,~E..~TAP~Y .ePF~CIAL CO~ITIO~Lq D. J. following conditions apply to all permits: If any of the permit conditions are unclear, the permittee shall contact the Division of Regulatory Affairs at the address and telephone noted below° A copy of this permit or approval and supplementary conditions shall be available at the project site whenever authorized work is in progress. The permit sign enclosed with the permit or a copy of approval letter shall be protected from the weather and posted in a conspicious location at the work site until completion of authorized work. At least 48 hours prior to commencement of the project, the permittee shall complete and return the top portion of the enclosed receipt form certifying that he is fully aware of and understands all provisions and conditions of this permit° Mithin one week of completion of the permitted work the bottom portion of that form shall also be completed and returned. For projects involving activities to be accomplished over a period or more than one year~ the permittee shall notify the Regional Permit Administrator in writing at least 48 hours to the commencement of resumption of work each year. If project design modifications take place after permit issuance, the permit- tee shall submit the appropriate plan changes for approval by the Regional Permit Administrator prior to undertaking any such modifications~ Tile perm~ttee is advised that substantial modification may require submission of a new application for permit. Ail necessary precautions shall be taken to preclude contamination of any wetlands or waterwey by suspended selids~ sediment, fuels, solvents~ lubric-- ants, epoxy coatings~ paints, concrete, leachate or any other environmental- ly deleterious nmteriala associated with the project work. Any~ailure to comply precisely with all of the terms and conditions of this permit, unless authorized in writing, shall be treated as a violation of the Environmental Conservation Law. The permittee is advised to obtain any permits or approvals that may be re- quired from the U.S. Department of Army Corps of Engineers, New York District~ 26 Federal Plaza, New York~ NY 10007~ (Attention Regulatory Functions Branch), prior to commencing work authorized herein. ~]e granting of this permit does not relieve the permittee of the responsib- ility of obtaining a grant~ easement, or other necessary approval from the Division of Land Utilization, Office of General Services, Tower Building, Empire State Plaza, Albany~ NY 12242~ which mey be required for any encroach- ment upon State-owned lands under water, Regional Permit Administrator NYS Department of Environmental Conservation Bldg. 40~ S'~.~Y--Room 219 Stony Brook~ NY 11794 (516) 751-7900 The following conditions shall apply if checked as applicable by the Regional Permit Administrator: Ko All dredging shall be conducted so as to leave a amiformbottom elevation free of mounds or holes. Ail spoil material shall be disposed of either in the Atlantic Ocean or at an approved U.So Government Dumping Ground, as directed by the District EnEinee~, U.S, Department of the A~my, Corps cf Engineers. Any spoil material not intended for such water dis- posal shall be removed from the site and disposed of at an approved upland site. All fill and spoil material shall be suitably contained at the work site So as to prevent its eroding, leaching or otherwise entering into ad~ace~t wetla~ds and ~ste~ays. All peripheral rip-rap berms, cofferdams, rock revetments, gab!one, bulkheads, etCo shall be completed prior to placement of any fill material behind such structures. All repairs to existin~ structures shall be confined to replacement of existing structural elements with no change in design,.d~m~nsion., or materials, uzlless specifically a~thorized herein. ..p.oT~?~xe foll~wing Water Quality Certification shall-apply'if required by one or more age2~cies of the United States Gover~me%t a~d if checked as applicable by the Regional Pe,~m/t Administra~ors': In accordance with Section 401(a)(1) of the Clean. Waters. Ae~-of- t977 (PL 95-217) the New York Stere Department of Environmental Conserw~tion hereby certifies that the subject project-proposal will not contravene effluent limitations or other limitations~'or"sC~ndarda' under Sections 301, 302, 303, 306 or 307 or the Act. Daniel J. Larkin, Regional~Pe~mit.Administr~.or ...... Division of Regulatory Affairs 5~S Department o£..E~v~rorm~at~l Conservation ''~B~,~lding 40, $1R~f--~Loom-Zlg' Stony B~k, NY 11794 (516) 751-7900' ~ee Attached Additional A through J, M. (i) There is to be no disturbance of vegetation or topoggaphy with in 50~ of Tidal Wetlands~ (2) There is to be no filling any closer tham 50' from Tidal Wetland. (3) All areas are to be vegetatively stabilzed with in two weeks of final grading. DATE ]~RMIT ADMINISTRATOR Bldg 40, S~ room 219 Stony Brook, N.Y. 11794 PERMIT SIGN has been issued to: ~ ~ ~ ~o~..o ~ ,=~ ~ ~o~ address: ~= ~-~o~o~. ~-~* Location: North sid~ of north parish Drive approximatal 422' east of ~a~eiw Rd. for' ~ ~C ~ ~e fA~ly ~elli~ a m~ 75' from Tid~ Wetl~d~ ~d the s~ita~ system 100' from 8~d wetl~ds. ~pro~tely 1000 cubic yards of all fill will be brou~C und~~ the EnVironmental Conservation [--]Article 15, (Protection of Water) T--]ArUcQe 24, (Freshwater Wettandsl ~ Article 25, (Tida~ W~tlands} ~ Article 36, (Construction in Fgood T'o New York State Department of Environmental Conservation Hazard Areas} Per,it Administrator July 7, I983 Date Issued : , . . _STATEMEN~'~ THE WAT~.R ~,JPPI. Y ,~ SYSTEMS' FOR THI CONFORM COUNTy SERVICES -- FOR CONSTRUCTION ON.[.' DATE: ..s..Er. No.: [~- APPROVED: su~-. co. ~x DIST. ' -SECT. 1~". ' :-'0~1" OWN[RS ~DRE~: .~B A ~E~ TEST HOLE CLAY~ GR£ENI~QRT FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ..................... ,~proved.~.,~....../.~ .................... , ,~-- ",'m,t No .................. Disapproved a/c ............ ~ ...............~. .............: ...................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............................. ~/:~ ........... ,, ]9 ............/~ INSTRUCTIONS a. This aPPlication must be completely filled in by typewriter o¢ in ink and submitted in tripllcote 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 giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 Bu ding Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the worE. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted 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, SuffolE County, New YorE, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, end to admit authorized inspectors on premises and ir~ buildings for necessary.,.~....~..~..~..?,..inspections.....~...% ~x'~/i~/~ ,V~/~ ~ i ...... "i ........................................................ (S gnature of apphcant, or name, if a corp~'ration) .../.~.~ ....... ~../.~....~.:~ ........ ~.~...~.....~..~ ...... (Address of applicant) / State whether applican~,J~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................... ~9.~.~.!A~.. ...................................................................................................................................... Nameo, owner ofprem,ses ...... ~'.~.1..~..~ ...... ~..~..~..~.~..~. ............................................................................... If ~ppJicant is~o~ate, signature of~ly outh~ize~cer.. ......... ~ ....... w:::;'"'": ....................................... /~ ~ ~ (Name and title of co,orate officer) Builder's Lic~se No ..................................................... Plumber's License No...~ ~ .~/~ b.,~. ~ ~ Other Trode's License No. ~;d~. ) O ~a ~u~, ~ ~o~ ~c~ 1. Location of land on whichDroposed wore will be done. Map No.: ......................................... Lot No ......................... Street and Number ..~,.~.~..~.....~.~}~..~......~.~ .................................... ~.q~(~.~.~ ......................... 2, Store ex~st[n¢ use ~nd occupancy o{ premise~ ~nd in~ended use ond occuponcy of proposed construction: o. [xisffin~ use ~nd ~cupanc~ ........ ~~.,.~,~M .............................................................. · I b. Intended use ~nd occupancy .............................. ~, .......................... ~ 3. Nature of work (check which applicable): New Building,. ......... Addition .................. Alteration ................. Repair .................. Removal .... : .............. Demolition .................... Other Work ................................................ , 4. Estimated Cost : . ,Description, ....................... ," ................ ' : (to be paid on filing this application) 5. if dwel!ing, number of dwellingiunits ...... ,,~,.,~,.~ .......... Number of dwelling units on' each floor ............................ If garage, number of cars ........ .Cr,..~,...(~,...~......~..-~-.~'~. ........................ : ................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structure~, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure ~vith alterations or additions: Front .................................... Rear ............................ Depth ................................Heilght ............................ ,N_u/r~ber of Stories. .......... ~'-"i ............. 8. Dimensions of entire new const,ruction: Front ........... .&....~ ................... Rear ............~, .............. Depth ...~ ................... ~ ~/d.%~, ............................................................. Height ........ ~ ...... Number df Stories .......... 9. Size of' lot: Front ..... ~ ........ I....~.,,.o. ................................. Rear ...........t...°...~. ...................... Depth ,,..~.,.~..,.~,,. ............... 10. [)ate of Purchase ....... ~.....'~%.....,' .................................... Name o( Former Owner ...~.....: ....... : ..................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12, Does proposed construction viol, ate any zoning law, ordinance, or' regulation: ....... .~,...O.. ................... ~ ........... 13, Will lot be regraded ......~.~ ............ Will excess fill be removed from premises: ( ), Yes ( ~ No Name of Owner of prem,ses ........ ~.. ...... ..~........~..~,..~....~,.~...!~. ..... Addrel ....... .~....~ ................. .~hone No ....................... Nam~ of Architect ................. i ............................... : ............. Address ...~.~.~.'~.....~..~..¢~1..,.~...~.! Phon~ No ....................... ~ame of Co.tractor ..~.'.'~ ,.. ..8..~r.m.:~.k. . AJa'dr~ PLOT DIAGRAM ~'~/J~ ~'t2 LocQte clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according, to deed, and show street names and indicate whether interior or corner lot. STATE OF NEX,'~K~I~ -- COUNTY.OF ~..... f ~'" ~:~% ~:~'(_-_-~1;~'-10-3. (J~L~--eJO~-) he n~ duly sworn, deposes and says that he is the applicam ....................... ~.~.; _: ...7.~%...:...:.~..:.....~ ................................ (N~me of md~wdu~l s~gnmg contr~cf) ebove n~med. ~ ~ t~ ................................. ~.....~'..~ ...................................... ;;. ................................................................. of sold owner or owners, ~nd is duly~i~perform or have per¢ormed the s~id work ond to m~ke end file th s ~ppficetion; that ~11 stotements contained in this ~pplicetion ore true to the best of his knowledge ~dd belie{; ~nd th~t the Work will be performed in the m~nner set fo~h in the opp~ cation f ed therewith. Sworn to before me this ...... o, ................ . ...... .......... ......... ....... .............................. ~o, 52-8125850, Suffolk Term ~pir~ ~arch 20, 19~ J KfO TH 6.4 NO. tff AN ~C, LICENSED LAND suRVEYORS GREEN~RT NEW Y~K SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. DZ. ~, ,~m STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS Of ThE SUFFOLK CO. DEPT. OF hEALth SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: ..% H. S. REF. NO,. APPROVE D: __ SUFFOLK CO, TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL OWNERS ADDRESS: SEAL J 6.4 18 ~.V,,,xC ~ ?4 T~ 9 EXCAVATION LICENSED LAND GREENIK)RT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. , STATEMENT OF INTENT THE WATI~R SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM, ~T~../TI~IF.., STA/~D/~R~D,S~OF THE SUFFOLK~~F ~ ~'CES SUFFOLK COUNTY DE~T,~ HEALTH I S[RVlCES -- FOR APPROVAL OF CO--RUCTION ONLY DATE: ~-- ~$ -- C.,LA\dEN~' If copper tubing is used for water distributing · 'system; piping s~aJJ be of types_K or L onJ,.y ~/ ~.PPROVED AS 'NOTED NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ,1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4, FINAL ~ CON'ETRUCTION MUST BE COMPLETE FOR C, O, ALL CONSTRUCTION SHALL MEET THE REOUIREMENTS OF TI4~ N,Y, STATE CONSTRUCTION & CODES. NOT RESPONSIBLE DESIGN OR CONSTRUCTION ERRORS, f, ti, / / 1 t 1_