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Home My WebLink About16336-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Zt8736 Date JANUARY 24, 1990 THIS CERTIFIES that the buildin~RELOCATE BUILDING Location of Property 395 NORTH SEA DR. SOUTMOLD House No. Street Hamlet County Tax Map No. 1000 Section 054 Block 04 Lot 06 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 10, 1987 ~ursuant to which Building Permit No. 16336Z dated AUGUST 17~ 1987 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 RELOCATE BUILDING ON SAME PROPERTY, AT APPROVED FLOOD HEIGHT. THIS IS A SEASONAL DWELLING. The certificate is issued to WINIFRED AND CHARLES MALLOY (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N016838 JUNE 16, 1988 PLUMBERS CERTIFICATION DATED CHARLES MOLLOY JAN. 23~ 1990 Building Inspector Rev. 1/81 · 0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N_* 16336 Z Dote ..~~...~... ...... ../.o.?. .......... , 19...~..7 Permission is hereby granted to: ~ co-,,,., Tax Mop No. ,ooo s,c,i,~,:,.....~,.~":.~ ....... Bilk ..... ~..':J. ......... Lo, No....~...g. ............ pursuant to application doted ..~.1~.~.....(..~.. ................ , 19.~..~,,, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN HALL SOUT~OLD, NEW YORK 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE .~)~PT. J~, I~9 NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING----~---VACANT LANU ........ ROUSE NO. STREET HAMLET o~er or O~ners of Froper~y..C..~..*'~.~. {?..'.'. !.~.~..~8.U. ~p~ ....... ~o=~ ~ ~ ~o. ,o0o ~c~o~ Pr!. ~o~ ~J... ~o~-.o~. Snbdivi~ion ....................... Filed Map ........ Lot .......... ~6~6 ~ ~/ / ~ ~ ...... Permit No .......... Date of Permi~ . Iq ~--Appl O~N~ 'Ilealth Dept. Approval .................. Planning Board Approval ............ Request for Temporary Certificate ....... Fee Submitted: $ Underwriters Approval ......... Final Certificate ................ ~ 5 rev. 10/14/88 FOP~fNO. 6 TOW OF SOIFrHOLD BUILDING DEPARTH~NT TOWN HALL 765 ~ ]802 ~ev-i 10/14/88 APPLICATION FOR ~ERTIFICATg OF OCCUPANCY INSTRUCTIONS "This application must bi filed in typewriter OR ink and submitted to the Building Inspector with the following; for new buildings or new use: ! Final sUrVey of ~ · property with accurate location of all buildings, property lines, streets, and unusuallnatural or topographic features. 2. Final approval of ~e~lth Dept. of water supply and sewerage-dlsposal(S-9 form). 3. Approval of electrxcal installation from Board of Fire Underwriters. 4. Sworn statement from !plumber certifying that solder used in system contains less than 2/10 of IZ lead.! 5. Co~x~ercial buildings,! industrial buildings, multiple residences and similar buildings and installations, a cnrtificate of Code compliance from the Arcb~tect' or Engineer responsible for the building. 6. Submit Planning Boardi Approval of completed site plan requirements. For existing buildings (iPrior to April 9, ]957~ non-conforming uses, or buildings and "pre-existing" laud ~ses: I. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features, 2. A properly completed application, a consent to inspect signed by the applicant and a certified abstract of title issued by a title company which shall show single and separate ownership of the entire lot prior to April 9, 1957, . If a Certificate of O~cupancy is denied, the Building Inspector shall state the reasons therefor in w~iting to the applicant. 3. Date of any housing c~de or safety inspection of buildings or premises, or other pertinent informationlrequired to prepare a certificate. For Vacant Land Certiflc~te of Occupancy: ]. An application for vacant land Certificate of Occupancy shall be submitted, and a certified abstract of title issued.by a title company showing single and separate ownership ofithe entire lot prior to April 9, 1957 shall also accompany the application. If ~ Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in wziting to the applicant. CERTIFICATE OF OCCUPANCY - New Dwelling $25.00, Additions to Dwelling $25.00, Alteration to Dwe~llng $25.00, Swimming Pool, $25.00. Accessory building $25.00 Addition to Accessory buildings, $25.00 - ~uslnesses.$SO.O0. 2. Certificate of OcCupancy on pre-existing dwelling - $100.00. 3. Copy of Certificate of Occupancy - $5.00 - Over 5 years - $10.00 ~. Vacant Land Certificate of Occnpnncy - $20.00 5. Updated Certificate of Occupancy - $50.00 6. Temporary Certificate of Occupancy - $25.00 Residential $§0.0~ Commercial TOWN OF $OUTtIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 1179 TOWN IIALL SOUTIIOLD, N,Y. 11971 September 21, 1989 TEL. 765-1802 ROMEO BUILDERS, INC. BOX III1 SOUTHOLD, N.Y. 11971 RE: CHARLES' ~LLOY To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the following reasons. /_--// An application for Certificate of Occupancy is not on file. (ENCLOSED) /~ No Underwriters Certificnte on file. /~/ '['he check it;(~_X~not o1% file.) $25.00 No Health Dept. Approval on file. No final ins[~,ection has been made. P]ea:;c contact ()ur office on this matter. Thank you for your cooperation. Ihiild~r;g Permit # I 6 3 3 6 Z Btlild ing Dept. ./ *~*/--_~ Ho Plumber solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) UNDATION UNDATION 2 UGH FRAME & PLUMBING SULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS i 000771 BUREAU OF ELECTRICITY -- 85 JOHN NEW NEW YORK 10038 STREET. YORK, OUNE ~6,1988 51q95987/87 N 016838 THIS C~IFIE~ THAT ~y t~ ~t~ ~u~ment ~ ~ ~ a~ l~t~ ~ t~ ~t ~ ~ the ~ ~t~ numar ~ ~ CH~LES MALLOY~ NORTH SEA DR.~ POLE 3, SOUTHOLD, N.Y. ~ exami~ on a~found to be in compliance with the r~ui~ments of th~ ~. RXTUIIE RXTURE$ RANGIS OV~l~ ~XHAU~T FANS DRYERS FURNACE MOTORS TIMI C~CXS UNIT HiATBIIS DIMMERS SYSTemS NO. Of RIET OTfl~ll APPARATUS: 2 RULAND EI,[C/M.B. RULAND BOX 143 MATflTUCK, NY, 11952 This certificate must not be alte~d , I,IC~NSE NO. 242~ TOWN OF SOUTttOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Owner Plumber (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's siCnature) Sworn to before me this 2_.:~_c_a~, of ~a~ X ,' 19_.qO. NOtary Public, ~l~County Notary Public CI.AIRI~ L. ~1..~ Qtmllfied in Suffolk County Commission Expires De~ember 8. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ,r ~NAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION [ ]/~OUNDATION 1ST [ ] ROUGH PLBG. Iv~] FOUNDATION ZND [ ] INSULATION FRAMING FINAL REMARKS: 765-1802 BUILDING DEPT. ~ INSPECTION [/FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE iNSPECTOR ~/~'~-2 Memorandum from .... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, SOU~ItOLD, N. Y. 11971 765-1802 January 17, 1990 Hr. & Hrs. Charles Malloy 55 Burlington Road Smithtown, N.Y. 11787 Dear Mr. & Mrs. Malloy: Enclosed please find Plumbers Certification to be signed and notarized. As soon as you return it to this office~ the Certificate of Occupancy will be issued. Very truly yours, SOUTHOLD TOWN BLDG. DEPT. encl. Georgia Rudder, Secretary New;York State DepadmentofEnvironmentalConse~afion Regulator~y Affairs Unit Bldg. 40,SUNY, Rm. 219 Stony Brook, NY 11794 (516) 751-7900 Thomas C, Jorling Commissioner July 21, 1987 Charles & Wi~ifred Malloy 55 Burlington Blvd. Smithtown, NY 11787 Re: 10-87-1186 Dear Mr. & Mrs. Malloy: 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. Very truly yours, ~gbert A. Greene Regional Permit Administrator NEW YORK STATE DEPARTNIENT OF ENVIRONJVIENTAL CONsER~AT/ON~ ~ / UNIFORM pROCEDURES ACT Oate: ~ , Region No.: I ,, - , ~ Office' DRA . Stort. R~eceiptNo.~ 63 APPlicant/ ~,.. % I- A, '-~___ v"'"'~lJ' UPOok ~ Amount: !$ t-~ APPlication identification No,: :~c~ o~ ~.0. ~o.: ~ ~ene · JS-20-B (91Bh)--2Sc DEC PERMIT NUMBER 10-87-1186 EACILIIY/PROGRAM NUMBER(s) N/A NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION PERMIT Under the Environmental Conservation law Article 15, Title 3; 6NYCRR 327, 328, 329: Aquatic Pesticides Article 15, Title 5: Protection of Water ArtiCle 1'5, 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 J-----~ 6NYCRR 608: Water Quality Certification [-----~ Artic, e 17, Titles 7, 8:SPDES -----] Article 19: Air Pollution Control* ~ Article 23, Title 27: Mined Land Reclamation ~'] Article 24: Freshwater Wetlands N--New, R--Renewal, M-Modification, C--Construct (*only), O--Operate (*only) EFFECTIVE DATE 7/21/87 EXPIRATION DATE(s) 7/31/92 Article 25: Tidal Wetlands N Article 27, Title 7; 6NYCRR 360: Solid 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; 6NYCRR 380: Radiation Control PERMIT ISSUED TO Charles & Winifred Malloy ADDRESS OF PERMITTEE 55 Burlington Blvd., Smithtown, NY 11787 AGENT FOR PERMITTEE/CONTACT PERSON J TELEPHONE NUMBER I NAME AND ADDRESS OF PROJECT/FACILITY (If different from Permittee) 425 North Sea Dr., Long Island Sound DESCRIPTION OF AUTHORIZED ACTIVITY Relocate existing dwelling 150+ ft. landward of present location as per attached NYSDEC approved drawing. GENERAL CONDITIONS By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compli- ance with the ECL, all applicable regulations and the conditions specil~ied herein or attached hereto. The permittee shall file in the office of the appropnate regional permit administrator, or other office designated ;n the special conditions, a notice of intention to commence work at least 48 hours in advance of the time of commencement and shall also notify him/her promptly in writing of the completion of the work. 2. The permitted work shall he subJeCt to inspection by an authorized representat;ve of the Department of Environmental Conservation which may order the work suspended if the public interest so requires pursuant to ECL §7't-030'l and SAPA §40113). The permlttee has accepted expressly, by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature, and by whomever suffered, arising out of the project described herein and has agreed to indemnify and save harmless the State from su~t~, actions, damages and costs of every name and descrip- tion resulting from the said project, 4, The Department reserves the right to modify, suspend or revoke this permit at any hmo after due notice, and. if requested, held a headRg wheR. a) the scope of the project is exceeded or a violation of any condition of the permit or prowS(OhS of the ECL and pertinent regulations are found; or b) the permit was obtained by misrepresentation or faNure to d~sclose relevant facts; or c) newly discovered information or significant physical changes are discovered since the permit was issued. The permittee is respon~ibJe for keeping the permit active by submitting a renewal apphcation, including any forms, fees or supplemental information which may be required by the Department, no later than 30 days (180 days for SPDES or Solid or Hazarduous Waste Management permits) prior te the expiration date. 6. This permit shall not be construed a~ conveying to the applicant any right to trespass upon the lands or interfere with the riparian rights of others in order 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 a party to the permit. The permittee m responsible for obtaming any other permits, approvals, lands, easements and rights-of-way which may be required for thi~ project. Issuance of this permit by the Department does not, unless expressly provided for, modify, supersede or rescind an order on consent or determmation by the Commissioner issued heretofore by the Department or any of the terms, conditions, or requirements contained in such order or determination. Any modification of this permit ~ranted by the Department must be in writ(n8 and attached hereto. PERM,T ISSUANCE DAT' ¢¢ ¢r X N,STR^TOR ADDRESS. 7/2 '87 ' Robart A. Greene JBldg. 40 SUNY Rm. 219 Stony Brook, NY 117 4 AUTHORIZED SIGNATURE , ' . cc: C.T. Hamilton ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part 608 ( 10, That if future operations by the State of New York require an al- teration in the position of the structure or work herein authorized, or if, in the opinion of the Department of I~nvironmental Conservation it shat] cause unreasonable obstruction to the free navigation of said wateFs 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 ' 15. thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other 16. modification of the watercourse hereby authorized shall not be com- pie(ed, 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. 17. 11. That 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 18. 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, 12. Granting of this permit does not reheve the applicant of the responsi- bility of obtaining any other permission, consent or approval from 19. 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. 13. All necessJry 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. 14. Any material dredged in the prosecution of the work hereiB 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. 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 Article 36, this permit does not signify in any way that the project will be free from flooding. If granted under 6 NYCRR Part 608, the NYS Department of Environ- mental 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. 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 on SPECIAL CONDITIONS 1. Existing sanitary system will be utilized. 2. Place 100± cubic yards of clean fill around new foundation. in from upland source. 3. First floor elevation must comply with lochl requirements. Supplementary Special Conditions (A) through (J) attached. Fill to be trucked DEC PERMIT NUMBER 10-87-1186 PROGRAMJFACILITY NUMBER Page 2 of New York State Department of Environmental Conservation NOTICE The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted on this site. For further informa- tion regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Permit No. _~ ~~1~-//~, Expiration Date ~ Regional Permit Administrator NOTE: This notice is not a permit %,, 375~ $.39°24'W I00.00~ .' 'DRIVE ,S- IB9801'. GUARANTY & MORTGAGE CO, MAP OF':LANDi LOCATED i','?,'"';SOUTHO 'LD,, ~ E~.MALLOY ~AT RlClA FORM NO. 11 TOWN 0~ SOI~HOLD BUILDING DEPARTMENT TOWN HAI2~ SOUTHOLD, NY DEW EL 0 PMI~T PeI~iss~on i~ hereby gPanted to: PERMIT puPsuant to appltoation dated ~__~_, 19~_~., and appeoved By the Building Inspector.. Building Permit No. .j ~a~_ ~__.__..z Building Inspocto~ 4~80 I:LI:VA I IUN (.;bH I IPIL;A I b FEDERAL EME~GI~NCY MANAGEMENT A6ENC¥ NA'rlONAL FLOOD INSURANCE PROGRAM Charles ~. & Winifre~ 195B North Sea Drivs Malloy POLICY NOMBER STREET ADDRESS Southold, ~Y 1000-54-04-06 11971 NO. ROUTE SOX NUMBER OTHER DESCRIPTION (Elock and lot numbers,, etc.) CITY STATE ZIP CODE This form is to be completed by a land surveyor, engineer, or architect who is authorized by state law to cRrtlfy elevation informahon when the elevation information for zones, A I-A30, AE, AH, A(wlth BFE), VI-V30, VE, and V(with BFE) is required. In the case of zone AC, the building official, the property owner or he owner s represen ative should complete the information in Section I and may also complete the certification. Community officials who are authorized by local law or ordinance to provide floodp a n management information may also complete this form. SECTION I BUILDING ELEVATION INFORMATION 1. Using the Flood Insurance Manual or the NFIP Flood Insurance Application--Part 2 Worksheet, ind*cate the proper diagram number__ 2. FIRM Zones A~I-A~0, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of. ~''' .w feet NGVD. (or other datum-see #5) {,~)asemeTlt ~-oor) 3. FIRM Zones V1-V30, VE, and V (with SFE). The bottom of the lowest horizontal structural member of the reference level floor from the selected diagram is at an elevatmn of.__.feet NGVD (or other datum-see #5). 4. FIRM Zone AO. The floor used as the reference level from the selected diagram is [ [ [feet above highest natural grade next to the building (also enter in fine 8). This value must be equal to or greater than the AC Zone flood depth number listed below. If no flood depth number is available, is the building's lowest floor (or reference level) elevated in accordance with the community's f!oodplain management ordin, ances? ~]Yes [~No []Unknown 5. Indicate the elevation datum system used in determining the above reference level elevations;[] NGVD []Other (describe on back) 6. Indicate the elevation datum system used on the FIRM for base flood elevations: ~ NGVD ~]Other (describe on back) (ATTENTION: If the elevation datum used in measuring the elevations is different than that used on the FIRM, then the elevations prowded must be converted to the datum system used on the FIRM.) 7. is the reference level based on actual construction? [] Yes [] No* * A "No" answer is only valid if the building does not have the reference level floor in place. Fill in the elevation based on construc- tion drawings and do not complete question #8. If "No" is checked, this certification will be valid only for buildings in the course of construction. After construction of the reference level floor is completed, a post-construction elevation certificate will be required for continued flood insurance coverage. 8. Provide the following measurements using the natural grade next to the building (round to the nearest foot). a. The reference level is: b. The garage floor (if applicable) is: 10[21~eel []above []below (check one) the highest grade. I I I feet []above []below (check one) the highest grade. ~ feet [] above [] below (check one) the lowest grade. { I Iteet [] above [] below (check one) the lowest grade. SECTION II ~ FLOOD INSURANCE RATE MAP INFORMATION Provide the following from the proper FIRM (see instructions on back-Date of FIRM) and accompanying insurance application: COMMUNITY NO, PANEL NO. SUFFIX DATE OF FIRM FIRM ZONE BASE FLOOD ELEV. I COMMUNITY ESTIMATED BASE FLOO~-' (in A0 Zone, use depth) J ELEVATION ESTABLISHED FOR ZONE A 360813 78 ~. 06/18/87 'A-7 E.T~ 11 OR ZONE V, IF AVAILABLE Elevation referecce mark used appears on FIRM [~Yes ~] No, ,(See ~everse side for details) SECTION III CERTIFICATION This certification is to be s~gned by a land surveyor, engineer, or architect who is authorized hy state law to certify elevation elevation information for zone? A 1.A30, AE, AH, A(wlth BFE), V1.V30, YE, and V(with B~E~ is required. In the case of zone property owner, or the owner s representative can sign the certification. Community officials who are authorized by local la~ fl~clplaitt management information, may also sign the certification. I certify that the information on this certificate represer~*~7~2, I the data available. ~ understand that any false statement may be punisha~!~ by fine or imprisonment under 18 U.S. Code,~i Joseph A. Ingegno, L.S. 49668 CERTIFIER'S NAME LICEN8E NUMBER (or Affix Sea~) ~resident Peconic Surveyors. t~.C. , ........ O,T (5 ' E765-505PO CATE P"ON , ~/~ policyholder and the third copy retained by t~ agent. The fou~lh copy I~ for the local community permit office, I~PrYequlred. FOR OPTIONAL COMMUNITY USE: Is the reference level also the lowest floor under ihe community s floodpla n management ordnances? []YES [] NO If NO the elevation of the lowest floor is. feet NGVD. Application Received1'19_ Disapproval Issued 19 Permit # 19~ FORM NO. 10 APPLICATION FOR DEVELOPMENT PERMIT IN THE TOWN OF SOUTHOLD 1'. Type Of Development PropOse~: New Structure {inclUding;storage tanRs Addition and/or Alteration Flood Proof Below Base Flood Elevation Other (specify) Elevation Data in relation to above mean sea level of: (a) Lowest floor elevation, including basement feet __ (b) In a V Zone, bottom of lowest structural member __ 3. FIRM--Flood Insurance Rate Map, Zone designations 4. Owner of Premises ~Z ~ 5. Location of Property: inches feet inches House $ Street Hamlet County Tax Map No., Dist. 1000, Section O~ Block ~ ~ Subdivision Filed Map# 6. Permission to be granted: ~___ Owner as above __ New Owner Under Contract Lessee Contractor Phone # Lot(s) Lot (s) Name if not given above Mailing address 7. Approval from other(s) before Permit is issued: Health Services Building Permit 8. II Wetlands (Town Board) Planning Board ~J/~ , the applicant, am the Owner __, Co-Owner ~__, New Owner Under Contract , Lessee __, Agent __~ Contractor __, and agree to comply with all applicable sections of the Code of the Town of Southold; County, and State and to admit authorized inspectors to premises 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 my knowledge and belief and that the work will be performed in the manner set forth in the application filed therewith. ~~'i''-~'/-~ ~o---~J STATE OF NEW YORK ~., ~ / COUNTY OF ~F~/~f~ SS ~ Signature SWORN TO THIS /~ DAY OF ~e~- LINDA J. COOPER N(~.~,~ ,, ~ ~%_~+~]~ ~ Notary Public, State of NewYork / c~tar~ ~A,¼~.~3. c' - ,/ rio. ~,~22663,-Suffolk County~f/f Term Expires December31, 19 ~/ 19 Applicant's mailing address and phone ~ if not given ~bove FORM NOo 10 TOWN OF SOUTHOLD BUILDING DEPARTMENT (516) 765-1802 P.O. Box 728 Southold, N.Y. 11971 Town Hall Main Road Southold,N.Y. ADpI.TCA~Tn~ vn~ D~V~T.nPMENT Instructions: The application to the Building Inspector includes (each in duplicate) 1. FormiNo. 10 filled out in ink or typewritten, 2. Sur- vey of premises with elevations above mean sea level, 3. Drawings of pro- posed work. The application must give complete information to show that the proposed can comply to the Local Law No. 1-1980, Chapter 46 of the Code of the Town of S~uthold known as "Flood Damage Prevention Law" of the Town of Southold. The applicant must submit approvals that any other agency requires. General Standards as required in Section 46-17 of the law to minimize flood damage: A. B. C. D. Anchoring of ~tructures, including tanks and mobile homes Use of constructzon material and. methods Design and to~ation of utilities Subdivision p~oposal with drainage, public utilities design and base flood elevations 46-18: ~S_pecific Standards aslrequired in Section A. Residential c0nstructlon B. Non-residential construction C. Mobile homes The applicant must submit plans and specifications as well as any other information requested!by the Building Inspector to substantiate the facts that the structure ha~ or will have 'the lowest floor, including basement/ cellar, elevated abov~ the base flood elevation or; if permitted by the :Federal Regulation, that: 1. such structure is flood proofed in such manner that below thelbase flood level the structure is water tight with walls substantially ahd impermeable to the passage of water, 2. that structural components!are capable to resisting hydrostatic and hydrodynamic loads and effects of buoyancy, 3. applicant must submit certification by a registered profess~Qnal engineer or architect that the standards set forth in Section 46-18B (1) (2) (3) of the Southold Code are satisfied. Coastal High Hazard. ~rea (V Zone) 46-19. Applicant shall submit plans, ~pecifications including the required certifications and such other in- formation, as.the Building Inspector may require in that the provisions of 46-19 are complied wi~h. Mobile homes are prohibited. The lowest portion of the structural members of the lowest floor cannot be lower than the base flood elevation ~ith all space below open except breakaway walls. Sand Dunes. If sand ~unes exist on the premises and the applicant pro- poses to alter same, plans and specification must be shown in detailed nature of any alteration submitted. Building Permit. A B~ilding Permit is also required for any structure. Both a Development and a Building Permit must be issued before any work can start in a specia~ flood hazard zone. A written disapproval or a permit must be issuediwlthin ten (10) working days. During construction, ~he inspector shall be notified in time so he may make the required inspections. Upon completion, the ~equired certification of the final elevations and work must be submitted before the approval to use or occupy can be approved. (Fill oUt the form on the back of this sheet) 11/85 B .-,G, (.,,.~ t. TOWN OF SOU f~40f D $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ' BOARD OF HEALTH ...... 3 SETS OF PLANS ....... 'FORM NO. 1 SURVEY .......... TOWN OF SOUTHOLD CHECK .......... BUILDING DEPARTMENT, SEPTIC FORM- . ............ : TOWN HALL NOTIFY CALL ................ Examine~.~u.~.~.. ! .7.., 1953 Approvea~ ~,q$TT.. ~..'?..', 192.7. Permit No. ! .lC..~..~.~..~..' Disapproved a/c ..............' ................. ' "'D' , , ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT MAIL TO: v"l, c Date .................. ,19 INSTRUCTIONS a. This application must be completely filled in 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued a Building Permit to the applicant. Such 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 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, 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 c(~'~nd regulations, and to admit authorized inspectors on premises and in building for necessary insp~ (Signature of aCplicant, or name, if a corporation) ...'~...~..: !!t...~..¥.-r..~..z ~'t...~. :.-t. ~.! ?.7, ........ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~,~. ~o -' 'r ."-.~ .-e o ~-- ......................... Name of owner of premises .~...tlr. ?1.. ~...lt...g...~...~_t~....c.~-.?../~..A~..~.~..,,/'. .................................. (as on the tax roll or latest deed If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) . ALL CONTRACTOR'S HUS% BE ~FOLK COUNTY LICENSED Builder's License No...%.'~..~.~..~ ................ Plumber's License No. "Z."~ ~ (, ~ Electrician's License No .... . .~tfb..~'.. ~ ......... Other Trade's License No ~ Location of land on which proposed work will be done~ .............. '.. :..~'...' ......................... · ..'5..qt.s.. .................... ........ ................ House Number Street Hamlet County Tax Map No. 1000 Section ..... .~..c{. ......... Block ...... C./ ........... Lot .... E ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy I ~ ,~-~ ~ ...................... b. Intended use and occupancy ~"~A-,.,.-, ~ 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration .......... .............. Removal ..,~ .......... Demolition ............. : Other Work .... ~. .......... Repair ~;~Q0~,.a ~-~J$~,,uq C)O~.Or~C~ LO-a-or l~,~1o~,;%~ (Description) 4. esumarea ~,ost ............ ~ ........................ Fee ............................ · (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ..... 1 .......... Number of dwelling units on each floor..( ............. If garage number of cars i "- 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use':.. '..-- ................. 7. Dimensiofls of existing structur?s, if any: Front..~.'~'~..t ...... Rear . .%..~...':~..?. ..... Depth ."~..~;~.9 .~. ....... Height .... J..~...~...I[ .... Number of Stories ......... I ..... .......... r .......'..' ....... ... ~.' ............ Dimensions of same structure with alterations or additions: Front ...'~ .~..'~..~. ...... Rear '...~..~..'~..~ ........ D pt ................. [... Height ...................... Nuntber of Stones... ! .................. Dimensions of entire new construction: Front , ,~ ,~ ,-~,, .'~.~.,,, Rear ,, ,~,, ,~, ,'~, ,~*,,, Depth .'~...~.."~. ,~ . . Height .... i..'t'.Tg. ~... Nu~mber of Stories ...... L ......... ~; ...................................... 9. Size of lot: Front ...... ~ · .O~97L~. ..........'Rea~ .. :..1..~. :~.e..-.. ~ ....... Depth . .~..%q~.'.~..' ............ 10. Date of Purchase · · · ,' Name of Former Owner 11 Zone or use ...... situated · d~stnct ~n which p[em~ses are ..................................................... 12. Does proposed construction vidlate any zoning law, ordinance or regulation: ...e~..9 .......................... 13. Will lot be regraded ..... ~-"i ................. Will excess fill be removed from Premises: ~es No 14. Name of Owner of premises .~.~ ~ ...~..~. ?. 9.~/... Address .~..~ .~.'T 9. ~..~_ .-~..'.°.~. Phone No. ~ .I..q....'?.~.q/.~.... NmneName of Contractor°f Architect ... ~. . , . Address'~.. ~...~ .I } )..~? .o.~..t~..:?.. Phone No.~'..~5 .'~ .'~.~..'/.%"... 15. Is this property locatedlwithin 300 feet of a tidal wetland? *Yes .~.... No ..... · If yes, Southoid Town Tr?stees Permit may be required. ,/ PLOT DIAGRAM Locate clearly and distinctly a/il 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 NEW<-.YvO I~J~//._ COUNTY OF ."-,-L~[ ;~/../N/O..,, ~'~ ~1 ¢ ~ ~*~"~. ~ ~G,,e~ ~ being duly sworn/deposes and says that he is the applicant (Name of individual sigrung contract) above named. He is the .................................................................................... (Contractor, agent corporate officer, etc.) f 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 con~ained 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 ~n the application filed therewith. Sworn to before me this ELIZABETH ANN HEVILLE (Signature of applicant) Notary Public, State df New York No, 52-8125850, Suffolk Co~v . , Term Expires October 31, 19a_;2~, '4 ,. PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of I% LEAD. OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY