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Home My WebLink About16533-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17737 Date FEBRUARY 2~ 1989 THIS CERTIFIES that the building. ONE FAMILY DWELLING Location of Property 1625 STILLWATER AVENUE CUTCHOGUE~ NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 103 Block 01 Lot 19.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 14~ 1987 pursuant to which Building Permit No. i6533-Z dated OCTOBER 15~ 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 ONE FAMILY DWELLING WITH GARAGE & ATTACHED WOOD DECK The certificate is issued to MICHAEL & ELIZABETH LADEMANN (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 87-S0-109- JAN. 30, 1989 UNDERWRITERS CERTIFICATE NO. N-045442 - NOVEMBER 11, 1988 PLUMBERS CERTIFICATION DATED NOV. 18~ 1988-PECON~C pLUM~ING & HEATING ~d~n~Inspector Rev. 1/81 FO~ NO. B TO~N O~ $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) D~te ........................................................ , 19. Permission is hereby granted to: ~ ,~ .~...k.~.~. .................................................... ..~~.~,_. ~ ...¥~.,....l...(.~..a,~ .C ......... ,- ....-~ ,o .... County Tox Mop No. 1000 Section ..... j.,..~.....~.. ....... Block ....... ...~).....~ ...... Lot No ...... .~...~..:....~. .... pursuant to application doted ..... ~,~Nk~,,.....~...~. ................. , 19..~,.1.., and approved by the Building Inspector. Fee *.~.~..O..:2...O. ..... Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD ~ ? I ~,,: ~, ~! :3 i ~ Town Hal ~'~[' ; ~_ ~" Southold, N.y. 11971 ~.' ]: ~ I, ~n~v, 765- ~802 ~,~;, '' ~0~ APPLICATION FOR CERTIFICATE OF OCC~PA~ ,,~ ~ ~ ~' Instructions , ~ ~;~ A.This application mus~ be titled in Wpewriter OR inE, and ~bmitted ~ to the Building tor w~th the following; for new buildings or new use: I. Final su~ey o~ property with accurate location of all buildings, prope~y lines, ~reets, and unu~al natural or topograph{c ~ea~res. 2. Final approval of Health Dept. o~ water supply and sewerage d~sposal-{S-9 form or equal). 3. Approval of electrical ~ns~alla~on from Board o~ F~re Unde~riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buUd~ngs and in,alia- rich% a certificate o~ Code compfiance from the Architec~ or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. B. For ex~sdng buildings {prior to April 1957}, Non-conforming uses, or buUdings and "pre-exi~ing' land uses: 1. Accurate ~ey of p~perty showing a~l property lines, s~reet% buildings and unu~al natural or topograph ic features. 2.Sworn s~a~ement of owner or previous owner as to use, occupancy and condition of buUd~ngs. 3. Da~e of any housing code or safety inspection of buildings or premises, or other pe~inent informa- tion required to prepare a ce~i~icate. C. Fees: Add~E~o~s $25.00 ~O0~S ~25.00 A~A~ON l. Ce~{f{cateofoccupa~cy ~e~ 9we~ $25.00,, ~ccesso~y ,~0.00 ~us~ness $50.00 2. Ce~ificate of occupancy on pre-existing dwelHng $ IOO.O0 3. Copy of certificate of occupancy $ 5.00, o~e~ 5 ~ea~s ~10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.C. $ 50.00 Date ~'~ / NewC°ns t~ucti°n, ,, Old or Pre-existing Building ............ Vacant Land ............. ~o~a,~o. o~ ,,o~./~.%C %% ))~tLL ~....~ ¢. :... C ~ ~ ~ Hou~ No. ' ...... Street ............ ~ o o ~p p~y co~w~ ~,~,o. ~000s~tio, .;.Q5 ......... ,,o~ .&.l... ~o,..l~,.G Subd v s on .......................... Filed Map No ........... Lot No Health Dept. Approval ........................ Labor Dept, Approval Unde~riters Approval, ~ ...................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~', Fee Submitted $ Construction on above described building and permit meets all applicable codes and regulations, TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~-~'~- Owner /~Z/~me / ~./~;~J (pl6ase prin't) (please print) I certify that'the solder used in the water supply system contains less than 2/10 of 1% lead. '~ ' ~p~lum~r' s sxgnatu~ ' ~ re) Sworn to before me this Notary Public, :i/:~-fT<K County Notaw Public, S~te of New York Qualifi~ in Suffolk Co~n~ ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ].19~112 BUREAU OF ELECTRICITY ~- 85 JOHN STREET. NEW YORK, NEW YORK 10038 THIS CERTIFIE~ THAT only ~he electrical equipment ~ ~rtb~ ~m a~ intr~uc~ by t~ applicant ~med on the a~e application number in the premises of A~C~AEL ~. LA~A~, ST~L~ATEA AVE., CUTCHOGUE, in the follo~i~ig /ocatlon~ ~ Basement ~ Ist FL ~ 2nd FL Section Bilk Lot n, asexa.llnedon NOVEM~EA 07, t988 andfoundtobei:lco.~pllonce~'iththereq~re~e~s{ff~tHzBourd. FI~RE FIXTURES~RANGES C~KING O~KS O~EN$ DtSH WASHERS EX~UST FANE %5 ~7 86 55 1 7.1 1 9.6 1 ~.2 6 '~' DRYERS ~RNACE MOTORS FU[U}E A~IANCE ~EDERS SPE~IA/REC'PT. TIMB CLOCKS BELL -- SERVI~ D~ONNECT NO. OF S E R V I C E PAN~L~OA~DS:l-34 C'{R~ 200 S]~()KE DETECTOA :-2 SAGE & LADE~ANN INC. ~ ~ P~ O.BOX 1768 SOUTHOLD, NY, 11971 LICENSE NO. 3635E Per This certificate must not be altered in any manner; return to the office of the 5oard if incorrect. Inspectors may be ~ed b~r TOWbl OF SOUTtIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTIIOLD, N.Y. 11971 TEL. 765-1802 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. ~! /~ No Underwriters Certificate on file. /~'~_ Tbs check is (out¢la ted/n0~'~{~'~i~e ~. ~.,~,., ,.,~ , ~ /~ No Health Dept. Approval on file. /~/ No final inspection has been made. Please contact our office on Thank you for your cooperation. Building Dept. ***/~1 No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) this matter. FOUNDATION ~(~st) FOUNDATION (2nd) ROUGH FRAME/ .?LUMBING~'/ 3. INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. REMARKS: FOUNDATION 2ND [ ] INSULATION FRAMING [,~INAL INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. ~t:~NDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: FINAL 765-1802 BUILDING DEPT. /INSPECTION FOUNDATION ~ST ~ ',OUO" ,*LBG. FOUNDATION 2ND [ ]INSULATION F~MING [ ]FINAL DATE_ ~,.. INSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ OUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL DATE /~//~/~ INSPECTOR~__~, FOUNDATION 1ST FOUNDATION 2ND FRAMING REMARKS: ~ROUGH PLBG. INSULATION FINAL DATE INSPECTION ' - [ ] [ ] %B~. / FOUNDATION 2ND [ ] INSULATION [~'"FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FO/UNDATION :~ND [ ] INSULATION FRAMING ,r ] FINAL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING ROUGH PLBG. INSULATION FINAL DATE FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTltOLD. N.Y. NOTICE OF DISAPPROVAL File No~ ............ , ................... .~. ~.~ .... ~:~.,..,.~.7.~.. ,.o~ ~i~,o ~o~t..~.. ~~~.~~ .................... ~ouse No. ~ u Street I Hamlet County T~x ~ap No. ~000 S~io,, ..-..l .~.S ..... mo~k .... m .I ....... Lo~ ...~ ~,.~ ..... ~.~o~o,~..~. ~,~.~,,o. ~ ..... ~o,~o ...... ~ ............ .... ,, , ~_0_ ~ ~./.~.t~ is returned herewith and disapproved on the onow~ ~g grot ntis .~.~. ~. ~,. .,.~ ~.~. .. :!~.: 3....~%~..~. . ~.&. ~ ..~ ..... .,,.. ............ . .................. : .......................... BuiltVmg Inspector RV 1/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG. DEPT. ,,, TOWN OF SOUTH,OLD 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, C, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use ×3. Copy of certificate of occupancy $1 $5.00 Date .. Apr_~ 12, 1985 New Building ............. Old or Pre-existing Building(X) .......... ~/Vacant Land -..,..~ ....... 1547 Right-of-Way east side S~illw~ter Ave. Cu~chog~e Location of Property .................................................. ~ ......... ~ .......... House No, Street Hamlet Gloria Litte%l and Marilyn Blum Owner or Ow,ers of Property ................. - ..................................... 103 1 19 ..6 County Tax Map No. 1000 Section ............... Block ............... Lot ................ Minor Blum & Littell Subdivision ................................. Filed Map No, .2.2,0. ...... Lot No..1 ............ Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~,., Request for Temporary Certificate ..................... Final Certificate ............... 1 .00 Fee Submitted $ ............................. Construction on above described building and permit~mee~,s all app~cable~co,de,s and regulations. ~Q..~O Elizabeth A. Lademann Applicant .; .... ,~ .......,., .~ ...... ~',d ..................... Rev. '/0-I0-78 Southold Town Board of Appeals MAIN ~I'IAD- STATE: I~C3AD ~5 SC3UTHC]LD, L.I., N.Y. 11g'71 TELEPHONE (516) 765.1809 ACTION OF THE ZONING BOARD OF APPEALS Appeal No. 3669 Application Dated September 4, ]987 Te; Mr. and Mrs. i~lchaei La~eman~ 645 Pine Neck Road Southold, NY 11971 Michael Jo Hall, Esq. as Attorney At a Meeting of the Zoning Board of Appeals held on 0ct0ber 8, ]987, the above appeal was considered, and the action indicated below was taken on your [ ] Request for Variance Due to Lack of Access to Property New York Town Law, Section 280-a [ ] Request for Special Exception under the Zoning Ordinance Article , Section IX] Request for VarlanceSto the Zoning Ordinance Article III , Section ]00-3] and Article XI~ Section lO0-llg.2 [ ] Request for Application of MICHAEL AND BETH LADEMANN for Variances to the Zoning Ordinance, Article III, Section lO0-31 and'Article XI, Section 100-119.2 for permission to locate new dwelling with insufficient setbacks from the northerly front property line along a private right-of-way and from the nearest wetland grasses, premises known and referred ~o as Lot No. 1, Map of Blum and Littell, located along the East Side of Stillwater Avenue, Cutcho~ue, NY; CountS Tax Map Parcel No. 1000-103-1-19.6. WHEREAS, a publiC hearing was held and concluded on October 8~ 1987 in the Matter of the Application of MICHAEL AND BETH LADEMANN under Appeal No. 3669; and WHEREAS, at said hearing all those who desired to be heard were heard and their testimony recorded; and WHEREAS, the Board has carefully considered all testimony and documentation submitted concerning this application; and WHEREAS, the Board Members have personally viewed and are familiar with the premises in question, its present zoning, and the surrounding areas; and WHEREAS, the Board made the following findings of fact: 1. The premises in question is known and referred to as Lot #1 on the Minor Subdivision Map of- "Blum and Littell" approved by the Southold Town Planning Board uwder Map No. 220 with frontage along the east side of Stillwater Avenue of 120.79 feet and along the south side of a private right-of-way of 287.54 feet, and containing a total lot area of 40,017 sq. ft. 2. The subject premises is located in the "A-40" Residential and Agricultural Zoning District, is vacant, and is more particularly identified on the Suffolk County Tax Maps as District 1000, Section 103, Block l, Lot 19.6. ~- ICONTINUED ON PAGE TWO) DATED: OcTober 13, 1987. Form ZB4 (rev. 12/81) CHAIRMAN, SOUTHOLD TOWN ZONING BQARD OF APPEALS Page 2 Appeal No. 3669 Matter of MICHAEL AND BETH LADEMANN Oecision Rendered October 8, 1987 3. By this application, appellants request Variances to locate a new single-family dwelling structure with setbacks at not less than 20 feet from its closest point to the northerly front property line along the private right-of-way and not less than 41 feet from the nearest edge of wetland grasses, as more particularly depicted on survey prepared by Roderick VanTuyl, P.C. amended lastly September 3, 1987. 4. Article Iii, Se~ciun i~u-Si ~i ~he Z~,~ng C~a ~-aq~i~'~s minimum frontyard setbacks at not less than 35 feet, or the average established setbacks in the immediate area within 300 feet. 5. Article XI, Section 100-119.2, subparagraph (B) requires all buildings and structures located on lots adjacent to tidal water bodies other than the Long Island Sound to be set back not less than seventy-five (75) feet from the ordinary highwater mark of such tidal water body, or not less than seventy-five (75) feet from the landward edge of the tidal wetland, whichever is the greater distance. 6. It is the position of this Board that the location requested by this application is the most feasible and does meet the "practical difficulties" standards set by the Courts since the circumstances of (a) the land contours and wetland areas limit the buildable portions of the property, and (b) the lot is a corner parcel as defined in Section 100-13 of the Code having dual front yards. 7. Accordingly: (a) the project a~. proposed will not in turn be adverse to the safety, health, comfort, convenience or order of the town; (b) the circumstances are not personal in nature; (c) the relief requested is the minimal necessary under the circumstances; (d) there is no ther method feasible for appellants to pursue other tha'n a variance; (e) the relief requested is substantial in relation to the require- ments, being variances of 43% of the requirement for the northerly frontyard setback, and 45% of the wetland setback requirement. 8. It is further noted for the record: (a) that special attention must be given regarding final grading plans of this site since the property contains ravines, as well as dwelling elevations, via the Suffolk County Soil and Water Conservation District [see September 28, 1987 letter for comments]; (b) that the Southold Town Trustees have waived the requirement for a Wetland Permit on August 27, 1987; (c) that the N.Y.S. Department of Environmental Conservation has issued a condi- tional permit under #10-87-1148 fo~ this project with no clearcutting or placement of fill within 20 feet of "edge of wetlands," etc. NOW, THEREFORE, on motion by Mr. Grigon.i.s, seconded by Mr. Goehringer, it was RESOLVED, to GRANT the relief requested under Appeal No. 3669 for the proposed location of a new dwelling structure as described in paragraph No. 3, supra, in the Matter of the · Application of MICHAEL AND BETH LADEMANN, SUBJECT TO THE FOLLOWING CONDITIONS: 1. There be no further reductions in either the northerly Page 3 - Appeal No. 3669 Matter of MICHAEL AND BETH LADEMANN Decision Rendered October 8, 1987 frontyard area at 20 feet, er the setback from the nearest wetlands edge at 41 feet, as requested; 2. The deck remain open and unroofed at all times, as proposed; 3. Outside lighting shall be toward the ground and not a~verse To ne~ynDorin9 pru~er~s~ the maximum into dry wells 4. The wetlands areas must be protected to extent possible, includin§ rain gutters drainin9 (rather than upon the site); 5. During time of construction, a temporary berm must be placed with the fill from the foundation excavation in order to aid in the prevention of storm-water runoff and in full compliance with the N.Y.S. Department of Environmental Conservation conditions (particularly Condition No. 1 thereof). Vote of the Board: Ayes: Messrs. Douglass and Doyen. (Member Sawicki was tion was duly adopted. Goehringer, Grigonis, absent.) This r~solu- lk Examined. Ot~.. 'Approved ...O~..~..I..~~. ., 1977, Permit No..[.~.'~..~...~..~. BOARD OF HEALTH .~.'.-~:. 3 S TS OF PLANS .o../¢..... 'FORM NO. I SURVEY.~.O.,.,~',. .... TOWN OF SOUTHOLD CHECK - - ~ - BUILDING DEPARTMENT SEPTIC FORM ..........'~' ~' ...: TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL - 7~.~ ~.- ..... , Disapproved a/c ..................................... ... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ... , · .~.~ ...... , i9 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 uhtil a Certificate of Occupanc3 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 o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) 645 Pine Neck Road, Southold, NY 11971 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Michael J, Ladomann and Elizabeth A. Lademann Name of owner of premises .......................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate officer) · ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. /~ a ~-- Stillwater Avenue Cutchogue House Number Street Hamlet 103 1 19.6 County Tax Map No. 1000 Section .................. Block .................. Lot ................... Minor B~um ' and Littell 220 l - Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occnpancy of proposed construction: Existing use and occupancy ...... vacant, land ................... .i~....~..~i:~i;>,.;,~; .': ................. a. b. Intended nsc and occupancy .... residence ~l~ of work (check which applica lc): New Building XX Addition . · · Alteration c .............. Removal .; ..... Demolition ..... Other Work ,timated Cost .................................. i Fee ...................................... .! ' (to be paid on filing this application) If dwelling, number of dwelling units ! ...... .1 ........ Number of dwelling units on each floor ................ If garage number of cars .1~ If business, commercial or mixed occdpancy, specify nature and extent of each type of use ........ ' 42' Dimensions of existing structures, if any: Front ............... Rear ............. Depth .... .3~ '. ........ Height ............... Number of Stories ...... ]-~ .....'. ·. ' ' , i..; ................... Dimensious of same structure with aitleratmns or additions: Front ................. Rear .................. Depth ...................... It~ight ...................... Number of Stories ...................... Dimensions of entire new constructiog: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ...1.2.0...7.9.' ...... ,'. .... Rear ....... 221,707 ........ Depth .... Date of Purchase ......... 5./85.. l .............. Name of Fenner Owner .. b.i~.t.e].l. ~.¢ql. ~.l.u.m ........... Zone or use district in which premise~ are situated... & gg.si¢.e.n.'t.i.a.lr.Ag~.ig.u.l~.u.r.a.1 ........................ Does proposed construction violate afiy zonino law ordinance or r,'~ub*~,,,' 3uly~ 1987 Will lot be regraded ....... '~'.. yp.s .............. Will excess fill be removed from premises: 5Y_%s0 ' Name of Owner of-remises .M~c.hael Lademann --,~ 645 Pine Neck Road ,.. .. 76 69 P ·; · · .. ............. AoureSSSou.tho.ld ....... lqlone INo ................ Name of Architect ~ Address Phone No Name of Contractor J Address ' Phone No Is this property located with'in 300 feet of a tidal wetland? *Yes . J(... No ..... · If yes, Southold Town Trustee? Permit maybe required. ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from operty lines. Give street and block numl ,er or description according to deed, and show street names and indicate whether terior or corner lot. 'ATE OF NEW YORK, )UNTY OF .... .s.u??P.kr ...... S.S .............. .E.l$.z .ab. 9 ~. .h . .L .a .d .e .m .a .n .n ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing ~ontract) eve named. : is the ........ 9¢ng9 .r ............................................................................ [ (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the )rk will be performed in the manner se~ forth in the application filed therewith.' ~orn to before me this . 7th day of ' May 19~7 )taw Public, ..Suffolk .............. NotB~/Publlo, No. ~2 (Signature of applicant) FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE OMB 3067-0077 Expires: June 1984 Thru form is to be used for: 1) New/Emergency Program construction in Special Flood Hazard Areas; 2) Pre-FIRM construction after September 30, 1982; 3) Post-FIRM construct[on; and, 4) Other buildings rated as Post-F~RM ru~es. BUILDING OWNER'S ADDRESS NAME Michael & Elizabeth Lademann, 645 Pine Neck Road, Southold, N. Y. PROPERTY LOCATION (Lot and Block numbers and address ~f available) 1000-103-01-19.6 I certify that the information on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U S. code, Section 1001. SECTION I ELIGIBILITY CERTIFICATION (Completed by Local Community Permit Official or a Registered Professional Engineer, Architect, or Surveyor) DATE OF FIRM DATE OF CONSTR BUILD~NG 360813 0094 6/15/8 ]3,A-4 '87-'88 [~.,.-r,.M~g YES NO ~t is ~ntended that the b~i~din9 described above wig be constructed io compliance with the community's flood plaio [] [] ordinance. The certiher may rely on community records. The lowest floor (including basement) will be at an elevation of ft, NGVD. Failure to construct the building at this elevation may place the building in violation of the community's flood plain management ordinance YES NO The building described above has been constructed in compliance with the community's flood plain management L~ El ordinance based on elevation data and visual inspection or other reasonable means. If NO is checked, attach copy of variance issued by the community. YES NO The mobile home located at the address described above has been tied down (anchored) in compliance with the E0 community's flood plain management ordinance, or in compliance with the NFIP Specifications. MOBILE HOME MAKE MODEL YR. OF MANUFACTURE SERIAL NO I DIMENSIONS X (Community Permit Official or Registered Professional Engineer, Architect, or Surveyor) NAME ADDRESS TITLE CITY STATE ZiP SIGNATURE DAT_E _ PHONE SECTION II ELEVATION CERTIFICATION (Certified by a Local Commumty Parred Official or a Registered Professional Engineer, Architect, or Surveyor.) FIRM ZONE Al-A30' I certify that the building ~.trJ, he property location described above has fha lowest floor (including basement) at an elevation of ~.~feet, NGVD (mean sea level) and the average grade at the building site is at an elevation of ~ · :2 feet, NGVD. FIRM ZONES V, Vl-V30' I certify that the building at the property location described above has the bottom of the lowest floor beam at an elevation of feet, NGVD (mean sea level), and the average grade at the building site is at an elevation of feet, NGVD. FIRM ZONES A, A99, AH and EM ERGENCY PROGRAM: I certify that the building at the property location described above has the lowest floor elevation of feet, NGVD. The elevation of the highest adjacent grade oext to the bugding is_ __feet, NGVD. FIRM ZONE AC: I certify that the building at the property location described above has the lowest floor elevation of feet, NGVD. The elevation of the highest adjacent grade next to the building is__ feet, NGVD. SECTION III FLOODPROOFING CERTIFICATION (Certification by a Registered Professional Engineer or Architect) I certify to the best of my knowledge, iBformatioe, and belief, that the building is designed so that the building is watertight, with wails substantially impermeable to the passage of water and structural components having the capability of resisting hydrostatic and hydrodynamic loads and effects of buoyancy that would be causbd by the flood depths, pressures velocities, impact and uplift forces associated with the base flood. YES El NO CJ In the event of flooding, will this degree of floodproofing be achieved with human intervention? (Human intervention means that water will enter the building when floods up to the base flood level oc- cur unless measures are taken prior to the flood to prevent entry of water (e,g., bolgng metal shields over doors and windows). YES [J NO E] Will the building be occupied as a residence? If the answer to both questions is YES, the floodprooflng cannot be credited for rating purposes and the actual lowest floor must be completed and certified instead. Complete both the elevation and 0oodproofing certificates. FIRM ZONES A, AI,-A30, VI-V30, AC and AH; Certified Floodproofed Elevation is feet, (NGVD). THIS CERTIFICATION IS FOR ~ SECTION II 'EJ BOTH SECTIONS II AND III (Check One) CERTIFIER'S NAME Joseph A. Ingegno COMPANY NAME ~econic Surveyors, P.C. LICENSE NO. (or Affix Seal) 49668 LS TITLE ~ ADDRESS ZIP Dan,y/S~'rvey'or 54.655 Main Rd., P. O. Box 909 11971 SIG?,,C OB?k' DATE CIT .... --ONE ~~m=~ 07/05/88 Southold, New York (516) 765-5020 /~ ~/ The Insurance agent should attach the original copy of the completed form to the floed Insurance policy application, / - the second copy should be supplied lo the policyholder and the third copy retained by the agent ~ INSURANCE AGENTS MAY ORDER THIS FORM FEMA Form 81-31, SEP 83 REPLACES FEMA FORM 81-31, APR 82, WHICH IS OBSOLETE. SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. 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 CONSTRUCT ION ONLY DATE: H. S. REF. NO I~ - E,,O - t09 APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. '~)WNERS ADDRESS: DEED: L.-,'": P.~ " ~"~' "ll:5'"r HOLE STAMP "~,~L' ~ ' ~ "-""' ' SEAL '---_. ~ l(~Of,4 PiPE (JII~EEI, tPORT N~W YORK t SOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 of I~ LEAD. AI~flOVED A~ #OT~D / ~ i I ,f II ~.o_r,!~ Ii I I , I y4 x,~ 'r:e, I _J [ .t