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HomeMy WebLinkAbout16725-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. z16852 Date .~.a.y 9, 1988 THIS CERTIFIES that the building .... .C.o.rqm..u.n.i.t.y...r.e.s.t..d.e.n. qe. ..................... Lru'atlt~nmf'Prr~-hr 700 Skunk Lane Cutchogue House No. Street Ham/et County Tax Map No. 1000 Section ...9.7 ........ Block .... .3 .......... Lot ..... 1.0. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated .... J..a .n.... 8. ~ 1988 pursuant to which Building Permit No. 16725 Z dated ...a.a.n. :..1.2. ,...1.9.8. 8. .......... 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 ......... .... C. 9.m.m.u.n.i..ty' .r.e..h.a.b.: ......................................................... The certificateisissuedto AID TO THE DEVELOPHENTALLY DISABLED INC. ..................... ?o¥.'o;, irit~,~*~r;~iX ..................... of the aforesaid building. Suffolk County Department of Health Approval ....... ~ /.A ................................ UNDERWRITERS CE RTIFICATE NO ............... P. e. ,n.d. kn' g..4./. 2. ] ./.8.8. ................. PLUMBERS CERTIFICATION DATED: North Country Plumbing 5/6/88 /' ' uilding ............. / Rev. 1/81 FOBM NO. ft TOWN OF $OUTHOLD BUBLDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG PER'iT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 16725 7_ Permission is hereby granted to: at premises located at ............................. , ................................ · ............................................................. ................... .~..~ ............... .s..~ ......... ~.~ ........................................ ...................... .c..~....., ...... ...v..,......~ .......... //.....z~,~ .............. County Tax Map No. 1000 Section ....~.....~,.. ......... Block .....g ............ Lot NO .....1...~.. ............ Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 :ATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I I 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property 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. C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling,$25.Q0, AccessorT,~$10.O0 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 ~ ?.~..~. 5.Updated C.O. $ 50.00 Date .. Y..~./. ............ NewCons truc tion.. ...~existing Building'"~. .......... Vacant Land .. ........ . . . Location of Property . .7.49..~). .~'.A".q,~J//~..~. d,&/~,~ . . .~..~...~.~y~<~'. ............................. House No. ' .... ' Street Nam/et Owner or Owners of Property ?~. ~.-'/.~...'~.". '.,7~..~F',~:.~..,~.~.~.~..~?./z~..f.. '~. ~G~.~.~J ................... County Tax Map No. 1000 Section ..... ,~,'.?, ...... Block ........ 3. .... Lot .... ~,.~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No /-~-~,~,~' Date of Permit ........... Applicant ................................ Health Dept Approval ~ r ..... ~/.,~ ............. ........................ Labo Dept. Approval . Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Cer~:ificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 MENTAL HYGIENE LAW § 41.34 § '41.~4 Site selection of communit~ residenti~d facilitie~ ~a) ~or thc pu~]m~es of th~ ~e. tion, thc follow/nfl dofln/tions shah apply: (1) "Community reMdentlal ?aeility for the disabled" means · suppof tR-e IR. in~ facility ~vitk font to font*teen re~idcn~a or a aupmwiaed livin~ facility subjee~ ~o liee~sura by the orfiee of mental health or the office of men,al re;arda6on and developmental dlaabilitiea which pro.des residence for up to ~ou~aea mentally disabled perone, including reM- dentin[ tre:ttmant facilities for ~Hdreu ~nd youth. (2) Sponsonn~ agency" means an ~ency or unit of gove~ment, a voIunta~ agency or any other pe~on or o~anization which intends to establish or operate a .ommuni~y ~sidential facility for the disabled. {3) "SIunictpality' means an ineo~orated village i~ ~ facility ta to be located therein, a town if the facility is to be loeat~ therein and ao~ simultaneously w~thia an ineo~orated ~llage or a city, except tha~ in the city of ~ew York, the eommuni~y hoard with ju~sdietion over the area in which snch· facility ks to he located shall he considered the muntetpali~y. Conum~sione~' means the commissioner of the office of the (4)" ' depa~ment responsible for issuance of license and ope~ting ¢:ertifica;e to ;he proposed community ~aidential facility. (h) If a sponso~ng a~em:y intends to satabllsh a residential facility fo~ ;he disabled within a municipality but does not have ~ specific site selected. [~ may nodr'y ~he chic[ executive oft'leer of ~e munieipaiky the nature, size and community zuppog requirements of the Pro~qded. however, nothia~ ht thin subdivision ~hall preclude the pro- posed estabii~hment o[ a si~e pu~uant to su~diviaioa (e) of this (c~tl) When a site has been selected by the aponsoring ~eney, and fnciude in such notice the specific address of the site. the t~e of eo~nmuni;¥ residence, the number of residents and the communit~ sup- po~ reqmremenra of the prog~m. Such notice shah also contain the most r~ently published dare comviled pu~uan; ~o section four hundred sixty-three of the social se~.icea law which can reasonably be expected to permit the munimpality to evaluate ail such facilities affecting the nature and character of the area wherein such p~posed facility ia he located. The municipality shall have {'o~y days after the receipt (B~ surest one or more suitable si;es wikhin its ju~adietion ~vhieh could ~ceonunodate such a faeilRv; or ((,, ble t to the astabhsh ant or a raeilitv of the kind described by the =pon~onng agency because to do so woul~ result in such a ¢onee~- tmtlon of community ~sidenti~ facilities for ~he mentally disabled in the municipality or in the area in proximity to the site selected or a combination o~ such facilities with other eommu~ty real'de'cea or simi- an;urn and character of the areas x~6thia the municipality would be subs;anriaily al~en,n. ~ue~ response shad be :'o~varded ;o :he sponsoring a~eney and commissioner. Ii' ;ha rmmicipality does no~ ras.ond within fo~y days. the ~nonso~:~ a~eney may establish ~ t'ommu~i;y residence at a site (2) P~or to t'orwardiaw a t~s~nse to the aponaodn~ ~eney and commissioner, the mun~dpality may hold a public healing pu~uan: local !aw. (3) [f the-municipality aplu'Ovea Cbc site ~eom.mended by thu somn~ ~cncy, thc sponsorin~ agency shall seek to ~stabii~h the faedRy a; :he approved 129 § 41.34 ~ENTAL HYGIENE LAW (4) If tile site or si~es su~Imtud by tim rI,Ltn{aipa|~ty are wi~h re~nrd [o ~hn nature, ~'ze a~rt" communiLy support mqui~ment~ of ;he proxram of the proposed f'n~ilJ~y anti the are~ in which such or sites are Ioeated does not ab'nndy inch:de an excessive tremor community residential facilities for the mtmtally disabled or similar facilities 'licensed by other state agencies, the ~ ' . , .ponso~ng agency shall see< to establish its facility a~ o~e of the s~tea designated by the If :he municipality suggests a a/ia or sires which are not aatisfacto~ to ~he sponso~ng ~eney, the agency shall so notify the which shall have fifteen days to suagest an alternative aiie or' sites for :he proposed community ~esidantial (5) ~n the even~ the municipality ob.ieats ~o estahlishmen~ of a facility in ~he municipality because to do so would result in such a ~oneentm~ tioa of community residential facilities for the men~allv'dlsabled or combination of such facilities and other facilities licensed by other state ~encies that the nature and character of areas within the muniei- palicy '~ould be substantially altered; or the sponso~ng ~eney objects to :he establishment of · facility in the area or a~aa suggested by the murAe~paii~y; or in thn event that the municipality and ~eneM cannot ~e u~n ~ alia. ei[her the spohsoMn~ ~eney or the munie~maiigy may requesg mn ~mediate hearinff hefora the commissioner to resolve the {ssue. The ,:omm:ssioner shall pemonaHv or bM a hea~ng officer condue~ such ~ heamnz '.vtthln flf~een ,Jmvs o~~ such a ~ouest. In :eviewln~ any ~uch obleetlon~, the need for'such t=uil[cie~ [~ the mun~c:maJ[cy ~hall he ,:ons~dered as shah the ex:stin~ concentration of such fae:iit~es and other ~im:lar faeilit~e~ licensed by other state e:es ~a ;he mumclpality or in :he ~rea ia proximity ~o the si~e selected and ~ny other :'aedities in ~he municipality or in the area in proxi~tv to :~e sxte selected providing residential scm'ices to ~ signii~cant number of Demons who have formerly received [n-oatiene mental health {n ~e~ities of the office of mental health or the offiae of mental m- tardatxo~ ~nd developments disabiiities. The commissioner shall tarn ~ze oojeet~on if he dete~ines tha~ the nature ~nd chaunter of ~he area in which the facility is to be based would be substandailv aieered as ~ ~suJt of estabiishmen~ of the ~aeilltv. The comm~sslone~ shail make ~ determination w~thin thirty days of th~ heating. (d~ ~.eview oi' · decision renderod' by a commissioner sumuan~ to this seetioa may he had in a pro~eedinL, pumuant to a~i~ie seven.- of :he dete~ination of the commissioner. ' ' (e~ .& licensing zutho~ shall not issue an ope~ting ~o m spq~o~ng ~eney fdr op~tion of ~ faeiliiv if the agent7 ~oes not notiYy the municipality of its i~tention to establish ~ proem ~ required by subdhnsion (e} of :his ~ee~ion. Any eer::f!e=te issued ',vithou~ ,~omDilanee with the mrovisions of ~hi~ section sha:I .be ,:onsxdered null and voxd ~nd eontinued'ol)nration of :he (f~ A eommumty residence established pursuant to this s~fion and fami[7 ,:are komes shail bu de~med a famtiv unit. for the pu~oses of local .&dded ~1978, e. 488. ~ ~ amended L.1981, ~. 947, ~ 9; L.I98L e. 10~. ~ Z: L.1981, e. 1025, ~ 1. ~;ubd. (a), par. (1). 102~, § 3. eff. on the ~]Oth da~' after ~"lov. 11, 1981, without ~corvo~radng changes made by L~198I. 130 MENTAT.' :I'IYG~E,NE LAW § '41.34 N0te Suit:lid. ,~Jh*~irhiu ifs 133 § 41.34 1982. 8.~ A.D.2d 958. 451 of ~he Office of ~ental Rumrdadou 1981. 84 A.D.2d 906. 446 ~d. flee of ~Ieu~at Ret=rdatmn and croup, 1981. ,~ l,D.2d $~, Y.S~d 202. sufficieu:iy isolated ~rom o~her 'Coughliu, 1979, 73.i.D.2d 672. N.X.~--d .09. flee of Meutai Rerurdntion and De- 84 ,%..D."d 77N, 443 N.%-'.S.2d 9~6. 607. v. Comu;isstoner. Stare of N. Y. 0f- State. 1979. 102 Misc.2d 501. 423 Y,S.2d 608, 7a. Time of hearing aiouer of State Office of 5[ental 134 MENTA~ .'HYGIENE § 41.~4 Note testimony indieatin~ rhac detrimental wkhin muoicilmlity would be altered. anti Development Disabilities thac es- the State Office of Mental Retarda. fion and Deve[o0menml Disabilkie~ Stare oi X. Y. Off{ce oi Men~l Re- ~es. IBgO. T3 .~.D.2d 6TT, 432 A.D~d 559, 452 ~,C.S~d 113. § 41.34' er 40-~ uv pez'~od had ela{lued ou Newark ?. Iutroue, 1981, 84 v. futroue, 1982. ~8 .k.D.2d 958, ~1 within the rov-n would cuuae overcon. ]36 MENTAL HYGIENE LAW S.2d 407. mentally eetarded ehildr.n, th. Com-' v. Incrone. 1981. 81 A.D.~d 7~0. 438 ~.Y.S~d 407. S.2d 407. § 41.36 § 40..26 Com:mmnt~ residential facilities (~) .ks used in ;his section: 1. "Commum:y residential t"aeili~y" means any ~'aeiHgy subjec~ ~ li- ~usure by the o~fh~e o~ mental retardation and develo,mentai disabiii- for mentally disabled pe~ons. Such ce~ does not include'family ~are ~ '~eimbu~able settees" me'ns se~'iees, other ~h~n inte~ediate c~re servie~. ~o~Sded ag a community residen~al facility described by ~ai disabiiides for which fees may be paid to a provider of sea, ices put- 3. "Income" means revenues received by a provider of se~ees inet- hied person, exciudina the: portion of such revenue ape fieaily in'ended to offse~ capital (il) t'as ~ceived from ~siden~ or on their behalf f~m ~hird pa~ (iii) other funds received in the operation of the community ~siden- eommunky reaiden6al facility. and developmental disabiliti~s. 137 JAMES M CAMPBELL ARCHITECTS _' TOWN 380 WEST MAIN STREET BABYLON NEW YORK 11702 516-587-1984 Jalllla1-y 6, 1988 Mr. Victor Lessard Town Hall, 53095 Hain Road P.O. Box 1179 So~thold, NY 11971 RE: ICF CC~S~I'I'Y RESIDENCE 700 SKUNK IANE O3TC~OGUE, NEW YORK Enclosed please find three (3) sets of plans and the required applications for a building permit. If you have any questions, or we can be of any service to you, please call our office at 587-1984. Very truly yours, JAMES M. CAMPBk'7,'r, ARC2~TECTS ancls. (including check #8000) cc: Mr. Donald L. Rieb 8719 EXPRESS MAIL JAMES M CAMPBELL AIA STANLEY J LINDVALL AIA TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit NO. ///~' ~' 'J~'''' Owner ~/~) (please print) (please print)/ I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this &~ day of ~y 19 ~ Notary Public, (plumber' s signature ? County Nota~Public Aid to the Developmentally Disabled Inc. POLICY The residential program will be operated to conform with the applicable Federal and State Laws, Regulations and Proced- ures contained in Part 249.10 and 681 of the Mental Health Laws. DESCRIPTIVE CRITERIA OF PROGRAM The A.D.D. Inc, Intermediate Care Facility seeks to serve amaulitory, multlhandlcapped adults with dual diagnosis, functioning within the severe to profound range of mental re- tardation, requiring intensive care and habilitative interven- tion in the areas of their critical and basic self-help deficits. In every case clients will have significant impairment in overall basic functioning and adaptive behaviors. The A.D.D. Inc; Intermediate Care Facility will not find acceptable those profoundly to severely retarded clients found to have a chronic severe medical problem, who are of extremely tenuous physical constitution, who are at a high risk to be transported daily to day programs, and who require ongoing nursing services and frequent medical attention. A.D.D. Inc, Intermediate Care Facility will attempt to offer the following: To insure proper coordination of the clients pro- gram (ICF/DAY program) through the development of a continuing individualized treatment plan for each resident delineating specific functional deficits, with recommendations for interdisciplinary remedia- tion. To conduct quarterly re-evaluations of the treatment plans by the day program and ICF residential staff in order to review and each resident's individual progress toward meeting program objectives. Make Fully Available(as needed)to eachresident a range of habilitative services in recreation, pre- vacational training, family services, social work, psychology, psychiatry, speech, audiology, physical therapy, occupational therapy, optometric, nursing and dental hygene. 4. Staffing patterns within the Facility will include relief, peak-hour and full-time staff. The Facility will ~dmit only that number of in- dividuals that does not exceed:~l) its rated capa- city, 2) its caDability to provide adequate pro- gramming. A.D.D. INC: utilizing and integrated approach with day pro- grams will provide meximum stimulation and a measure of stim- ulation and success for each client. It is the objective of Page 2 A.D.D. Inc; that the ICF will be consistent with the basic concept, that as individuals and members of society, and residents, are entitled to all privileges, dignities and the respect we expect for ourselves and others in Society. TOWN OF $OUTHOLD OFFICE OF BUILDING INSPI~CI'()I~ P.O. BOX 728 TOWN ttALL SOUTHOLD, N.Y. 11971 TEL. 765-I 802 TO: FROM: SUBJECT: September 14, 1987 Francis J. Mnrphy Supervisor Victor g. Lessard Exec. Admin Proposed Commnnity Residence ?00 Skunk Lane, Cutchogue PROPOSED FIRST FLOOR PLAN Size and type of windows not indicated No indication of proper stairs change Indicates ~ire alarm (pull). Will it be attached to station off premises? See page 3, 9,]7{. PROPOSED 2nd FLOOR PLAN 2 ways.,out by stairs--Exterior stairs over stove Need window sizes and [ypes i.e. Crank out or double hung etc. High percentage of bathroom added. Shoald have system cleared by Health Department for capacity required and existing. Shows nine clients but fail to indicate where the supervisory personnel reside. TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 Sept. 1, 1987 TEL. 765-1802 TO: FROM: SUBJECT: Francis Murphy Supervisor Victor C. Lessard Exec. Admin. Potential Commuuity Residence Site Potential Handicap 700 Skunk Lane, Eutchogue, N.Y. I sent Mr. Curtis Horton out to look at the building; from the street, and report back to me, his impressions of the building. Research shows Building Permits and Certif]cutes of Occupancy for the building. The building, in it's present forln would have the following problems: By todays code standards; the windows are too small for legal access. The stairs (interior) are too narrow by code. Based on the size a disaster to try capped people. Main Building 18 X 26] Extension 7 X 14 566 Extension 20 X 24] 760 Extension 10 X 28 Total envelope 1326 Attached garage' 406 Pool and shed Property is 3/lOths of an acre. of the building it would be to accomodate up to nine handi- I realize the end that they ute trykng to acbieve; but the safety of these people should be upper- most at all times. I certainly would recommend getting permission for the Building Department to enter the premises and do a thorough over-view of tbe entire structure. VGL: h dy :'i~L i~;S,'2CTiON COMM£NT~ FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & .FLUMBING INSULATION PER N. Y. STATE ENERGY CODE ADDITIONAL COMMENTS: DONALD RIEB Aid to the Developmentally Disabled Inc. ~ ~_~.~, 5.~0.~.~S.~.~i~ ..S. tr~et · Riverhead, Long IsJand, N.Y. 11901 · (516) 727-6220 %~ ~: ~g~ 3 I !gS~ ~ ?0rig ....... ~us.t. 27, 1987 Bono~ab~e ~ane~s ~. N~,~;~-~ · Supervisor Main Road ~Je ~~ ....... Southold, New York 11971 ~ SUBJECT: POTENTIAL COMMUNITY RESIDENCE SITE 700 SKUNK LANE, CUTCHOGUE, NEW YORK (SOUTHOLD TOWNSHIP) APPROXIMATELY 621 FT. SOUTH OF MAIN ROAD, WEST SIDE Dear Supervisor Murphy: As provided in Section 41.34 of the Mental Hygiene Law (copy enclosed') please consider this letter as a formal notification of the interest and intent of Aid to.the Developmentally Disabled Inc. to establish a community residence for nine (9) mentally retarded a~d developmetnally disabled persons at the above address. The immediate neighborhood around the site has been checked with reference to the presence of ex~sting residential programs to preclude saturation of the area. A site evaluation has been conducted by the New York State Facilities Development Corporation which determines the suitability of the site for use as a community residence. The attached fact sheet outlines the specific nature, proposed size and community requirements of the proposed community residence. Also attached is the most recently published data compiled pursuant to Section 463 of the Social Services Law which contains listings of all licensed residental facilities in the municipality. The goal of our agency is to provide residential and rehabili- tation services to mentally retarded individuals so that they may~ reside in local communities close to family and friends and have opportunities for normal life-enriching experiences. The community residence program offers supervised living, meals, companionship, social activities and training in the activities of daily living. During weekdays, residents attend various day treatment, vocational, prevocational or educational programs outside the home. Recreational activities are planned for evenings and weekends. There will be supervisory and support staff available on site 24 hours a day. A Neighborhood Advisory Committee will be estabilished for the residence so that there can be a meaningful liason between the Page 2 community and the sponsoring agency, and so that the intergration of residents into community life can be facilitated. As per Section 41.34, you are required' to forward any comments of your municipality concerning this site within forty (40) days of receipt of this notification. Please note that under state law, if you do not forward a response within the forty day period, Aid to the Developmentally Disabled Inc. can proceed with development of the proposed residence. We look forward to working closely and cooDerativety with your community to develop quality residences so that mentally retarded '- and developmentally disabled persons can reside in a community setting. I would be pleased to meet with you at your convenience. Very truly yours, Donald L. Rieb Executive Director DLR/kr Enclosures cc: Hon. Kenneth LaValle (State Senator) Gregory Blass (District Legislator) Jean W. Cochran (Councilman) James A Schondebare (Councilman) Paul Stoutenburg (Councilman) George L. Penny IV, Jr.(Councilman) John Ackerman (Director SCDCMHS) Deborah Gray (Executive Director) Ivan Canutenson (Director LIDDSO) Ira Zimmerman (Dir. Office of Community Serv. Hon. Joseph Sawicki, Jr. State Assemblyman) Joseph Consolo, OMRDD LIDDSO) SITE SELECTION FACT SHEET SPONSORING AGENCY NAME AND ADDRESS: Aid to the Developmentally Disabled 540 East Main Street, Riverhead, Nee York 11901 TELEPHONE NUMBER: (516) 727-6220' SITE/AREA INFORMATION GEOGRAPHIC AREA OF INTEREST: Cutchogue, New York Southold Township PROPOSED SITE OR AREA: 700 Skunk Lane, Cutchogue, New York 621 ft. south of Route 25 PROPERTY DESCRIPTION: West side of Skunk Lane 621 ft. to Main Road Route 25 It is the intention of the agency to acquire the two story frame building to be used as a community residence. This home affords ample space for parking and will give clients the oppbrtunity for outdoor leisure time activities. This home, once minimally rehabilitated will meet all of our program needs. REASONS FOR PROPERTY SELECTION: (property compliance with OMRDD regulations and standards; normalized setting per program needs and proximity to community support requirements) PROGRAM INFORMATION NATURE OF PROPOSED PROGRAM: A community-based intermediate care facility for developmentally disabled persons tall of whom will be ambulatory) providing housing, meals, companionship and continuous supervision in all ~esidence activities. SIZE OF PROPOSED PROGRAM: A community-based intermediate care facility for a maximum of 9 developmentally disabled adults. COMMUNITY SUPPORT/LOCATION REQUIREMENTS: In order to ensure that the prospective clients receive all necessary support services, the above location is selected with attention to proximity and/or accessibility of the following community services: ~ -Transportation provided by 12 passenger van -Community recreational/cultural opportunities -Shopping facilities -Religious services -Medical seryices -Other specialized services -Adult sheltered employment workshop -Adult day training/day treatment services Director DONALD RIEl] Aid to the Developmentally Disabled Inc. 1149 Old Country Rd., · Riverhead, N.Y. 11901 · (516)727-6220 BLDG. DEIq'. TOWN OF ,SOUTHOLD January 21, 1988 Curtis Horten Building Department Town Ha11-53095 Main Rd. P.O. Box 1179 Southold, N.Y. 11971 Dear Mr. Horten: It was a pleasure meeting you and Mr. Lessard. As requested, I have enclosed a description of our program and a copy of the formal notification sent to the town government. The residence in question will have nine (9) mentally retarded individ- uals living in the residence with 24 hour supervision as described in the enclosed program outline. I have enclosed an additional copy of the mental hygiene law-4134, which indicates on page 133, paragraph 2, "That a community resid- ential facility site selected pursuant to 41:34 must be treated as a family unit and must comply with local laws and ordinances governing family units." I thank you for your help and assistance. If there is any other information you might require please don't hesitate to call. uonald RieD Executive Director Enc.: 2 mi 765-:i802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST {- ~ ROUGH PLBG. FOUNDATION 2ND [~SULATION [ ] FRAMING [ ] FINAL REMARKS: DATE FOUNDATION 2ND [ ] INSULATION / [~'~RAMING [ ] FINAL REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST r~/~OUG" PLBG. [ ] FOUNDATION ZND [ ]INSULATION FRAMING FINAL DATE~/~I~(~ INSPECTOR 76.5-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL REMARKS: DATE INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS ~00110~ BUREAU OF ELECTRICITY ~'- 85 .JOHN STREET. NEW YORK, NEW YORK 10038 53~74888/88 N 012329 12 1988 Da~ ' Applic.sion Mo. on THIS CERTIFIES THAT 700 teas ex.mined ~ P~GE l 55 38 45 1 3 ~I~VlC! ml~eR~qRCT S E I~ V ! C POWER CIRCUIT-FIRE-SMOKE ALARM EMERGENCY LIGHTS- ] G.F.C.I:-5 cc. ¢;o~o. WILDWOOD ELECTRIC 4th STREET P.O. BOX 8 R WADING RIVER, NY, 11792 This certifigat~ must not be attered in manner; return to tim office of the Board if incorrect. Inspectors may be /dentif~l by their cr~dentiak. HISTORY GOALS IN-HOME SERVICES PROVIDED Family members of the developmentally disabled established ADD ~n 1980. They ~ere concerned about the physical and emotional decline of patients commited to live in crowded institutions ,3, here the care was custodial and the staffing and program- ming insufficient and inadequate. These family members were firm in their conviction that approp- riate treatment and training in a warm. sheltered. homelike environment would enhance their phys~- cal and emotional growth. ADD, with the support of New York State's Offices of Mental Retardation and Developmental D~sabilities (OMRDD) and Mental Health (OMH), set about the task of prov- ing the concept. A DD's primary goal was to bring se r',ices ti) those who were previously denied the opportunmes to live in a community residence because of their severe disabilities. tn March 1984, ADD opened/ts first group home. It ~s located ~n Northville in Suffolk County. It is called. Dan Karry's Place, named in honor of the late husband of Mary Karry, founder ofA DD. Dan Karry'~ Place demonstrates that programming, im- plemented in a homelike environment and tailored to the needs of its residents, bring? about dramatm improvements in their physical and emotional growth. ADD'x success story continues to be writ- ten at the group homes in Flanders and Riverhead sponsored by New York State's OMH and at the OMRDD group homes in Calverton and James- port. In addition an OMH residence in Aquebogue is scheduled to open in the Fall of 1987. Other group homes are in thc planning stages. ADD believes that all individuals have the right, to the extent of their ability, to live in the community and enjoy the benefits and amenities of living in society. ADD's purpose is to recognize and identify the special needs of the men- tally ill and developmentally disabled persons and to provide them with a superior professional system of care and services in a homelike environment. ADD's group homes offer improved services and innovative programming and treatment techniques so that each resident may be given the opportunity to: --Develop active daily living skills --Develop creatively, motivated by the need and desire for self-improvement --Develop inter-personal relationships that promote social trust and per- sonal growth --Live in dignity in a minimally re- stricted setting so as to enable them to function independently and con- structively. · PSYCHOLOGICAL EVALUATIONS '~ NURSING SERVICES ~' SOCIAL SERVICES * NUTRITIONAL GUIDANCE · RECREATIONAL THERAPY * SPEECH THERAPY · CR1S1S INTERVENTION · TWENTY-FOUR HOUR SUPERVISION COMMUNITY SERVICES ADD contracts with professional facilities in the community to provide medical dental, and other related services to its residents. ADD conforms to the New York State regulations by making arrangements for its residents to attend appropriate day treatment or day training centers for up to 30 hours per week. A place to be themselves loving place to grOW Yes, I'm interested in ADD. I would like to: A. Serve on Committees [] B. Become a Member [] C. Make a Contribution of [] Name Address City/State/Zip Phone ( ) Date Signature Please complete and return to: AID TO THE DEVELOPMENTALLY DISABLED, INC. Adm&istratipe Office 540 East Main Street, Riverhead, NY 11901 Mental health experts will tell you provid- ing a productive environment for people who are mentally retarded and/or mentally ill is among the toughest challenges they face. Aid To The Developmentally Dis- able& Inc. (ADD) is meeting that challenge every day. Since 1984 ADD has been providing a the- rapeutic home environment for people in group homes on Long Island. They are homes in every sense of the word ... comfor- table and loving environments that stimu- late a productive life. The homes are com- plete therapeutic facilities. They are staffed by professional mental health cam personnel. In addition to being complete care facilities in a true home setting, ADD's homes are also cost effective. The homes save taxpay- ers thousands of dollars a year providing ~uperior care for the developmentally dis- abled and mentally retarded at a far lower cost than institutions. ADD plans on continuing its success with more homes in the planning stages. You can be a part of its exciting future. Please write or call. AWARD Thc Ncxx York State Office of Mental Health (OMH) has cited ADD with thc SUPt'OR TIVE RES1DENTIA£ t'ROGRA~I Award for its dedication to create outstanding service pro- grams that proxide humane and e~ffective care for individuals with mental disabilities. A loving place to grow, A place to be themselves. AID TO THE DEVELOPMENTALLY DISABLED, INC. Administrai~'ve Office 540 East Main Street, Riverhead, NY 11901 Telephone (516) 727-6220 ADD AID TO THE DEVELOPMENTALLY DISABLED, INC. A loving place to grow A place to be themselves. ..... 9 PermitNo. )isapproved a/c (Building Inspector) APPLICATION FOR BUILDING PER{VllT BOARD OF HEALTH ..~.... a ~* ~ 3 SETS 0F P~NS'~' '. · FORM NO. 1 SURVEY · a,cTOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ' TOWN HALL NOTIFY SOUTHOED, N.Y. 11971 CALL ................ TEL.: 765-1802 MAIL TO: Date . .D~..6...e~..r..3. ....... 198.7.. INSTRUCTIONS a. This application must be completely filled'in by typewriter or in ink and submitted to the Building Inspector, with 3 ets 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 ir areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ration. ~ 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 ~hall be kept on the premises available for inspeotion throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever uritil g Certificate of Occupancy !hail have been granted by the Building Inspector. APPLICATION IS I-}EREBY 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, land other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for re~noval or demolition, as herein described. the applicant agrees to comply with all applicable laws, ordinances, building code, housing code.,,4n~l regulations, and to ~dmit authorized inspectors on premises and in buliding for necessary inspections. ~/k ~ / ,, ~..~..f':?'. ~..' ............ .~J"g. .~. .............. ' ........... .. (Signature of applicant, or r~me, if a corporation) . 5579.2 ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engin'eer, general contractor, electrician, plumber or builder. Name of owner of premises Aid..,. · . . · · · . · · · . · .Icj' e_he Develo.~¢~...n.t,311. y.... . D..is..alp. le~...IB9,, $40. F.~$g .M~iB. Street,. Riverhead, NY (as on the tax roll or latest deed) If appI~is a corl~ation, signature of duly authorized officer. , .....MA. ALL C0hlTRACTOR~S MUST BE, S~FFOLK COUNTY LICENSE,B Builder's License No .... ~j ~. 7'.'~ .-~. ........... Plumber's License No Electrician's License No... { .~.~. .............. Other Trade's License No ...................... Location of Iand on which proposed work will be done .................................................. 700 Skunk Lane Cutchogue . blouse Number Street Hamlet County Tax Mai> No. 1000 Section . .9.7.. Block ...... 3. ........... Lot .... lQ ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) ' State existing use and occupancy of premises and intended use and occupan~,y of 15roposed construction: Single Family Occ. u.p..a~..c~. a. Existing use and occupancy ................ · .......... · Community Residence b. intended use and occupancy .................................................................... Repair .............. Removal $125,000 4. Estimated Cost ................ 5. 6. 7. Nature of wgrk (cheek whmh applicable): New Building ...... Addition ... ....... Alteration .... X, ..... ........ Demolition ........... i. · Other Work ............... , ~ (Descriplion) " (to be paid on filing this application) One If dwelling, number of dwelling units ......... Number of dwelling unit~ on each floor .............. If garage number of cars If busine[s ' ': ......................................... ~ ......................... , commercial or mixed occupancy, specify nature and extent of each typo of use ................... Dimensions of existing structures, if any: Front .A. p2qr. qx.-..6.8. .... Rear .A, Dpr:oZ..I .6.8.... Depth ...Z .... Height .Al°p.r. qx....2.4. .... Number of Stories . ...TAro... ' Dimensions'of same structure with alterations or additions: Front '~ Rear Depth ...................... Height ...................... Number of $tories ................ $ 'Dimensions of entire new construction: Front ' Rear : Depth Height ............... Number of Stories ............................. i ..................... 9. Size of lot: Front .... 19.0. ............... Rear ...... 3,a0. ............. aqpt, h .... 1,5.0. .......... 10, Date of Purchase ...1.1/.1.9/.8.7. ............. -- Name of Former Owner ...19:qr...ar. cl. Sh..eYn~.. 11 Zone or use district in which premises are situated Residential . .a, qd., ~cxx, i,qm.l.t, ur.a,:k ... 12. Does proposed construction violate any zoning law, ordinance or regulation: .N.O.i 13. Will lot beregraded ............,.............,.NO Will excess fill be removed from premises: Yes 14. NameofOwnerofpremises AI.D. Address 5.4.0. Ease Main s,t:.. PhoneNo. 22.7:-.622,0, Name of Architect ...J..a~.,s..M.., .C..aqq.~..1.1. ....... Address .3.8.0. .W... Fa3.'.:i,n..S.t...J... Phone No...5.8.7.-.1.9.8.4, Name of Contractor Addiess' ' i Phone No 15. Is this property located within 300 feet of a tidal wetland? *YeS ..... No .~., · If yes, Southold Town Trustees Permit maybe required, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, iht icate all set-back dimensions from property lines, Give street and block number or description according to deed, and shou street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. James ............... M. C .~..bg. ll being duly sworn, deposes Jnd says that lie is the applicant (Name of individual signing contract) 'above named. , , Architect He is the ...................................................... (Contractor, agent, corporate officer, ~ltI~.'): ~ ,- 11 [[~ ~ ' of said owner or owners, and is duly authorizerI t? perform or ha~e performed the ,said work and to m,~al:l~i~d file this application; that,all statements contained in this ~al~plicfition are true to the best of hli?n'ow,ledge to;nd b6ti'i!~[~ta'd that the work will be ,performed in, the manner set forth in the application filed therewith. Sworn to before me this · ..~.~ ........... ;.dayof.~...., ..... ,19.,~~ ~ .~..~.,~..~.~... Notary Public, .~~ ...... ~ounty OLAIRE H. STUBBE '. NOIARY PUBLI0, S~ate of New Y,, -' No 4747941 ........... O(~lfl~ I0 ~dtOIkjuly 31,C°untyF ~'19 Cemmaaa, ~ _'}:-, ' .., ~/ (Signature of applicant) d ~Z>T~- 0 NEW 'SUFFOLK PECONIC JAMES M CAMPBELL ARCHITECTS ~52 E MAIN ST BABYLON NY 11702 515-58741984 I14 'F 'i It M,:x-~-.t~.lqlzB~ L.-UMISLt.¢:, -dby OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY MO~D P¢~TO I- -rilE: ~,¢,'ITF-~,1D¢ 614AUU Pil:.Ll.) ¢4,~6.¢t-/ Alii)VL-¢Jr'T' ALI. mllOlTI6,1l© ! JAMES M CAMPI~ELL ARCHITECTS 252 E MAIN ST BABYLON NY 1'1702 516-587-1984 DATE yL,y~ -- -I F---'l I H~ P,~IHT F,~l UT ~INT p,~l Hq' i~A,i H-F F;,~l H T p/~lHT 12-~l NT ~kl~ P p~l~-r[ P~l~-IT j::)2,1 d T JAMES MCAMPBELL DI~AWNBYTRP CHECKEOB¥ JMC J 0 B.'~- 8 7 19 ARCHITECTS 252 E MAIN BT BABYLON NY 11702 516-587-1984 FIRST FLOOR PLAN/ TITLE FINISH SCHEDULE OATE12/I 4/87 II II OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY J~ ~ l~l ~ ! f-AL4-...~,O ~:~' ~0 p~o~ To fsi' IY4" T¢'Ir~l:L PLUMBER CERTIFICATtON ON LEAD CONTENT £'EFORE CERTIFICATE OF OCCUPANCy ' JAMES M CAMPBELL B.A,,.'..,' T~ o..c,,:,:o.,, J~C ARCHITECTS 252 E MAIN ST BABYLON NY 11702 516-587-1984 DATE1 2/'! 4181", SECOND FLOOR PLAN TITLE DOOR SCHEDULE ,~T 4,¢:/' (,¢) ,z", e," h,,q rrJ, ~,p OF--TA L SUMMARY OF TOTAL-THERMAL RATING:. If the'To~al Thermal R~Ltng is zero (0) or greiter. Bhe proposed design for the butldtng envelopF complies w{th the Energy Code, THERMAL TABLE AREA U-VALUE RATING USED C. GLAZING 'Wt.do~ ~ ,~!~ "H~ ~"~ · Window Skylights D2. BASE~[NTJCELLAR ~ALLS WAll Perimeter Feet Exposure Above Grade Feet Wall U-Value Depth of Wall U-Value ,~ Be]~Grade Inches b3~ SLAB INSULATION" Slab Perimeter Feet Insulation R-Value ~ E. I~FILTRAT)O~ C~mL Conditl0ned F~oor Araa Sq. Et, ~ F, SOUTH FACING GLAZING ~uth Glass/Toro] G]ass Percent Gl. Area/Gros~ Wall Area Percent C6nditiuned Floor Area ~ Sq. Ft, TOTAL TXERMA[RAT]NG ~ CERTIFICATION OF 9~E ~kNU~I6~D ~ TO T~E ~ OF ~-~ ~I(~D,$ OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY c,e~+!T M¢'~T ~ bE. VA-FI o I-.J ,I PL-¢',VA'T I kl ddt T¢ JAMES M CAMPBELL DRAWN BY TRP ARCHITECTS 252 E MAIN ST BABYLON NY 11702 516-587-1984 CHECKED BY JMC SECTIONS/ TITLE ELEVATIONS DATE I 2/ I 4/87 -i / fcOLJ ~J OA"T SOLDER USED iN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of I°./o LE.-1D. I! copper t~abing is use~ {or water' distributing system; p'ripiog shall be o't types ~ PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE CERTIRCATE OF OCCUPANCY JAMES M CAMPBELL O. AW. BY TRP CHECKEOBY jMC ARCHITECTS 252 E MAIN ST BABYLON NY 11702 516-587-1984 JOe,~719 TIT'LE CELLAR PLUMBING O O O O' I~lNiid~r ~ KITFJ-~F~kl f ~ L~UWQ ~ It N tt .... 11 If copper tubing IS used for water distributing system; piping shall be of types K~or L onl_j~ :FLOOiZ ' 0 PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER ,USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2f./lO of I% LEAD. JAMES 252 E MAIN ST BABYLON NY 11702 516-587-1984 M CAMPBELL D.AW. BY TRP CHECKED aY :dMC ARCHITECTS FIRST FLOOR T~T'E PLUMBING r DATE, I SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of 1% LEAD. PLUMBER cERTIFICATION OIN LEAD coNTENT BEFORE cERTIFICATE OF OCCUPANCY copper tub!~g stet JAMES 252 E MA~ ST M CAMPBELL ARCHITECTS BABYLON NY 11702 '516-587-1984 DRAWN BY TRP JOB,~,8? 19 CHECKED BY JMC .SECOND FLOOR T"rLE PLUMBING' DA'r~ 2,/.,~