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Home My WebLink About13683-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-22857 Date JANUARY 31~ 1994 THIS CERTIFIES that the building NEW D~ELLING Location of Property 1175 EAST CEDAR POINT DR. SOUTHOLD~ NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 90 Block 3 Lot 18.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 5, 1984 pursuant to which Building Permit No. 13683-Z dated JANUARY 23~ 1985 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 UNDER HOUSE & ATTACHED WOOD DECK AS APPLIED FOR. The certificate is issued to of the aforesaid building. DONNA BAIRD & AMO (owner) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 14-SO-245 - OCT. 30~ 1985 UNDERWRITERS CERTIFICATE NO. N-15316 - NOV. 1, 1985 PLUMBERS CERTIFICATION DATED N/A *THIS UPDATES CO Z-14028 ISSUED NOV. 22, 1985 ~ Rev. 1/81 I~OB~ NO. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PEP, MiT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 i3683 Z ~,~, T~x ~p.~o. ~ooo s,~,~~ .......... e~k .... ~..~. ........ ~o, ~o...~ .......... pursuont to opphcotion doted .~ ........... ~ .................... , l~ and opprov~ by the Building Inspector, Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY NOV 2 11985 BLDG, OEPT. TOWN OF SOUTHOLD Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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 natura~ 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 p~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 requ ired to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 .... New Building ........... .~. Old or Pre-existing Building ............ Vacant Land ............. Location of Property......~'...~.....~.~..~'~.....~. ~...~..~'., .~'..' ....... ~..~...~..~..".~. ....... House No. // . ~ S~eet · ~. Ham/et Owner or Owners of Property //~'/"~/* ! . .¢~. · .~ ;~,~v ...~. ,... County Tax SapfN.o. 1000 Section .... ~..~.o ........ Block ....~. .......... Lot. J.~/~.. J. ?. .... Subdivision.....~.~...~....~..l~...~ ....... ~/.:~./...../__FiledMapNo...~?~ .... LotNo .............. Permit No../. ?..~..~?. DateofPermit..z~.~.J~./.~..~.Applicant . . . .~.~..;~/.~.~..~/..~.~J4-~.~'.'f.q,'?.;..~J~-..-- / Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permi~t[~u~ets all applicable code%a~d regulations. F ............ Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Bo This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A p~operly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in.writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinging pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $i0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 January 31, 1994 Date .................................. . . .. . .. New Construction ........... Old Or Pre-existing Building..~?PA~. ~ ... 1175 EAST CEDAR POINT DR. SOUTHOLD, ~%Y! Location of Property ................................. House No. Street Hamlet Onwer or Owners of Pro~ert~T DONNA BAIRD ~ A~ ty 1000 90 Bi ~ ~ _18.1 Coun Tax Map No , Section .............. ock ............... 2o5 ...................... Subdivision ................................. Filed Map ............ Lot .... Permit No ............ 13683-Z .... Date Of Permit..~.~/~.~. .... .Appl'lcant' ............................ WINDSWAY BUILDING CORP. Health Dept. Approval .......................... Underwriters Approval ..................... .. . . Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate ........... Fee Submitted: 50.00 APPLICANT FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14028 Date November 22 19 85 THIS CERTIFIES that the building ..... qn..e?.f.a.m..i.1y..d?..e.l.l.i..rig.. .................... Pt. Dr. East Southolcl Location of PropertyLo,so;"' .1..1; 7. .5,vo. ........... .C.e. d. .a.r ..... 'S't/o~i ....................... h$d,/ol County Tax Map No. I000 Section .... 9..0 ......Block ...... .3 ........ Lot ...... .1.8 ......... Subdivision..C.e.cla27..B.e.~ql3..P.a..r.k ........... Filed Map No...9.0. .... Lot No....8.2.,.8.3.: .8.4.. conforms substantially to the Application for Building Permit heretofore filed in this office dated · .D.O.c.e~lT~:..5. ........ 19 .8.4. pursuant to which Building Permit No ..... .1.3.6.8.3..Z .......... dated ..... .J.~rlk~r~.. 2. .3 ........... 19 .8 .5., was issued, and conforms to all of the requirements of the applicable pro, visions of the law. The occupancy for which this certificate is issued is ......... ....Pr.~,v.~:.e..qn..er.f.a.m..i.ly...cl.~.e.~.% .i.n~... ........................................... The certificate is issued to ........... IqIND8 IqAY BLDG. CORP. .......... io¥~o'~, ~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ................. 1..4:'.S.O. T .2.4.5. .............. UNDERWRITERS CERTIFICATE NO. 517 1 5 3 16 Building Inspector Rev. 1/81 ~ Ca 'olann Fletcher Reality 2760 MODLE COUNTRY ROAD LAKE GROVE, NEW YORK 117,55 FA;(: (516) 471-6710 PHONE' (516) 471-5800 Licensed eal ~state Broker - Residential & Commercial N.Y,B. T,U. F. ORM 33-00( 33-00( December 23, 19~ De~ember 23, 1955 ~4~-$ ,000.00 $300,000.00 Name of Insured: DONNA BAIRD and KENNE~ PILLIPPO Th¢¢st~t¢orimerestlnsur~db~ bk ~lieyis Deed made by WZNDS WAY duly recorded in the f FEE SIMPLE BUILDING CORP. %o the INSURED, dated !2/23/B5 lice Of the clerk for the County of Suffolk. Iveste~:Ji. ~*,insur~ by mear~ of and The premae~ in wh,ch the insured annezed, 7. MORTC-A~E made by and duly recorded by the INSURED tO 3/28/85 in LiberlO~ mortgages were INSURED and the SOl which mortgages we~ of $300,000.00. 8. SUBJHCT to 198~/86 9. SURVEY made by Rod~ shows Dremises haw MARGARET W. TOOKER Aum~ SCHEDULE A , Ibc e¢.t~t~ or k".t¢~cr, t covered by this pot}c.v is described on the dc,~cription sheet SCHEDULE a INSURED to SOUTMOLD SAVINGS BANK dated 12/23/85 ~ =he amount of $25,000.00 and anothe= mcr%page ~ade 1o SOUTMOLD SAVINGS BANK, dated 3/14/8!5 and recorded i? Mp 357 in the amount of $275,000.00; which two ~ded and Consolidated by Agreement made between :he 'UOLD SAVINGS BANK dated 12/23/85 and duly recorded. · extended and consolidated to ~or~ a .';ingle limn ,,cond half taxes, lek Van Tuyl, P.C. dated 11/26/84, last dated 10/15/~5 been improved by a one story dwelling.: ~eck at rear continue~.. NOTE: ~,TTACI-IEiD MER. ET(I, ADDED THE NEW YORK BOARD OF FIRE UNDERWRITERS lO00V7± BUREAU OF ELECTRICITy THIS CERTIFIES THAT DRYERS R V I C ~ 2/0 OF HI-LEG GENERAL MANAGER Per This certificate must not be altered in any manner~ return to the office of the Board if incorrect, Inspector~ may be identified by their credentials. COP ~ FOR B, UILDING DEPARTMENT. THIS COPY O1~ CER',rlFJG~,TE[~i~T~JOT B,E~ETERED iN ANY MANNER. FIELD INgFEC°T FOUNDATION ( FOUNDATION ( 2 o ROUGH FRAME & PLUMBING INSULATION PER N STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: TO~N OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 BLDG. DEPT. TO\NN OF SOUTNOLD CERTIFICATION Date Building Permit No. Owner '~' ' (pleasfe print) Plumber f TZ~J/~A/ ~3 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (p~u~er' S signature) Sworn to before me this ~ ~ day of 0ce-- , Notary Public~~=:~ County Notary Public ~W YORK STATE DEPARTMENT OF E~"~IEONMENT3~ CONSERVATION Building 40, Star~ Lkuiversity of New York Stay Brook, New York 11794 516-751-7900 September 25, 1984 Winds Way Building Corporation Glenn Road Southold, NY 11971 Re: 10-84-0226 D~ar Sir: In conformance with the requirements of the State Lkxiform Procedures Act (Article 70, ECL) amd its implementing Regulations (6NYCRRPart 621) we are enclosing your permit. Please read comditioms carefully. If you are unable to comply with amy condi- tions, please con~act the Regional Regulatory Affairs Office, Department of gnvlrenme~tal Conservation, State U~iversity of ~ew York at Stony Brook, Building 40, Stony Brook, New York 11794. Also enclosed is a permit sign which you are to conspicuously post at the project site, protected from the weather. very truly? , /? DJL:ll Encla. H. DEC # SUPPLE}~.~TA_~Y .~.PECI~J~ C.O~ITIO~S The following conditions apply to all permits: If any of the permit conditions are unclear, the permittee shall contact the Division of Regulatory Affairs at the address and telephone noted below. A copy of this permit or approval and approved pro~ect.plan.s and supplement- ary conditions shall be available at the project site whenever authorized work is in progress. The permit sign e~closedwith the perm.it or a copy of approval letter shall be protected from the weather and posted in a conspicious location at the work site until completion of authorized work. At least 48 hours prior to com~encement of the project, the permittee shall complete and return% the top portion of the enclosed receipt form certifying that he is fully aware of and understands all provisions and conditions of this permit. Within one week of completion of the permitted work the bottom portion of that form shall also be completed and returned. For projects involving activities to be accomplished over a period or more than one year, th~ permittee shall notify the Regional Permit Administrator in writing at least 48 hours to the commencement of resumption of work each If project design modifications take place after permit issuance, the permittee shall submit the appropriate plan changes for approval by the Regional Permit Administrator prior to undertaking any such modifications. The permittee is advised that substantial modification may require submiss- ion of a new application for permit. All necessary precautions shall be taken to pr$clude contamination of any wetlands or waterway by suspended solids, sediment, fuels, solvents, lubricants, epoxy coating, paints, concrete, leachate or any other environmentally deleterious materials associated with the project work. Any failure to comply precisely with all of the terms and conditions of this permit, unless authorized in writing, shall be treated as a violation of the Environmental Conservation Law. The permittee is advised to obtain any permits or approvals that may be required from the U.S. Department of Army Corps of Engineers, Mew York District, 26 Federal Plaza, New York ~ 10007~ (Attention Regulatory ~uuctions Branch), prior to commencing work authorized herein. The granting of this permit does not relieve the permittee of the responsib- ility of obtaining a grant, easement, or other necessary approval from the Division of Land Utilization, Office of General Services, Tower ~ulldiag, Empire State Plaza, Albany, I~ 12242, which may be required for any encroachment upon State-owned lands under water. Regional Permit Administrator 5~S Department of Environmental Cons. Bldg. 40, S~f--Room 219 Stony Brook, l~ 11794 (516) 751-7900 10-84-0226 NEW yORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 10-84-0226 PERMIT UNDER THE ENVIRONMENTAL CONSERVATION LaW ARTICLE 15, (Protection of Water) [] ARTICLE 25, (Tidal Wetlands) ARTICLE 24, (Freshwater Wetlands) [] ARTICLE 36, (Construction in Flood Hazard Areas) PER~f ISSUED TO Winds Way Building Corporation Southold, NY 11971 LOCATION OF PROJECT (Se£t~on ~ stream, tidal wetland, dam, building) Cedar Point Drive East, Pleasant Inlet and Cedar Beach Harbor, Bayview DESCRIPTION OF PROIECT Subdivide 3.0 acres into two lots, where Lot #1=1.7~ acres and Lot #2=1.3 acres. On each lot construct a. single family dwelling a minimum o~ 7b' landward of ~he tidal wetland boundary and install a sanitary system greater than 100' from the tidal wetland boundary as per supplied plan received September 13, 1984. Approximately 300 cubic yaras of c±ean iiii will be placed on Lot #1 and 500 cubic yards of clean fill will be placed on Lot #2. For both slteSt~on~mnued/.the fil :OMMUNITY NAME (City, Town, Viltage) TOWN Bayview Southold COUNTY FIA COMMUNITY NO. J DAM NO. PERN%ITE×PIRATION DATE Suffolk I . December 31, 1986 GENERAL I. The permi~tee shall file in the office of the appropriate Regional Permit Administrator, a notice of intentmn to commence work at least 48 hours in advance of the hie of commencement and shall also notify h~m promptly in writing of the completion of the work. 2. The permitted work shat) be subject to inspection by an authorized representative of the Department of Environmental Conservation who may order the work suspended if the public interest so requires. 3. As a condition of the issuance of this permit, the applicant has ac- cepted expressly, by the execution of the application, the full legal respon- sibility for all damages, direct or indirect, of whatever nature, and by whom- ever suffered, arising out of the protect described hereto and has agreed lo indemnify and save harmless the State from suits, actions, damages and costs of every name and descrmtJon resulting from the said project· 4. Any material dredged in the prosecution of the work herein permitted shall be removed evenly, without leaving large refuse pi)es, ridges across the bed of the waterway or flood plain or deep holes that may have a tendency to cause injury to navigable channels or to the banks of the waterway. 5. Any material to be deposrted or dumped under this permit, e~ther m the waterway or on shore above high-water mark, shall be deposited or dumped at the )ocality shown on the drawing hereto attached, and, if so prescribed thereon, within or behind a good and substanbal bulkhead or bulkheads, such as will prevent escape of the material into the waterway, 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7-. That if future operations by the State of New York require an alteration in the positron of the structure or work herein author[zed, or it, in the opinion of the Department of Environmental Conservation it shah cause unreasonable obstruction to the free navigation of said waters or flood flow~ or endanger the health, safety or welfare of the people of the State, or loss or' destruction of the natural resources of the State, the owner may be ordered by the Depart- ment to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State; and if, upon the expiration or revocation of this permit, the structure, fiji, excavation, or other modiflcatmn of the watercourse hereby authorized shall not be completed, the owners shaH, condition the navigable and flood capacity of the watercourse. No claim shall alteration. CONDITIONS §. 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 by or result from future operations undertaken by the State for the conservatmn or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 9. That if the display of lights and signals on any work hereby authorized is not otherwise p~ovtded for by law, such lights and signals as may be pre- scribed by the United States Coast Guard shall be installed and maintained by and at the expense of the owner, 10. All work carried out under this permit shall be performed in accor- dance with established engineering prachce and in a workmanlike manner. 11. If granted under Articles 24 or 25, the Department reserves the right to reconsider this approval at any time and after due notice and hearing to contloue, rescind or modify th~s permit in such a manner as may be found to be mst and equitable. If upon the expiation or revocatmn of this permit, the modification of the wetland hereby authorized has not been completed, the applicant shell, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservatmn 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 12. This permit shall not be construed as conveying to the applicant any right to trespass upon the lands or interfere with the riparian rights of others to perform the permrtted work or as authorizmg the ~mpa[rment of aoy r~ghts, title or interest in real or personal property held or vested in a person not a 13. The permJttee JS responsible for obtaining any other perm)is, ap- provals, lands, easements and rights-of-way which may be required for th~s 14. If granted under Article 36, this permit is granted solely on the basis of the reqmrements of Ad)cie 36 of the Enwronmental Conservation Law and Part 500 of 6 NYCRR (Construction in Flood Plain Areas having Special Flood Hazards - Building Permits) and in no way s~gnifies that the project will be free from flondrng, 15, By acceptance of thi~ permit the permittee agrees that the permit is conhngent upon strict compliance with the special conditions on the 9S-~0-4 (9/7B) (SEE REVERSE SIDE) Description of Project, con.tinued '* will be trucked in from an ~pland source and placed a minimum of 50' landward of the tidal wetland boundary. SPECIAL CONDITIONS: 1. There shall be no dist~ubance to the vegetation or topography within 50' of the tidal wetland boundary~ 2. House construction mus~ meet local and federal flood plain ordinances. SPECIAL CONDITIONS A T}LROUG~ J, ALSO SPECIAL CONDITION M ATTACHED. ~P,~iTISSUEDATE ~PERMITAD~INISTEATOR j'~ September 25, 198 Daniel Jo Larkin ' ',.--~ . . Th~ rolls, n§ co-~t/zms sb~ll a~ly if -~hecke~- ae..app)~e-bla bF the ~le~on free of ~ds or hol~. ~ spo~ ~e~ s~ll be disposa~ of either in the Atl~c Oc~n or at an app~ed U.S. ~e~nt ~g Gro~, as directed b~ the D~trict ~g~eer, U.S. Departs= of the A~, Co~s of ~g~e~. ~y spoil ~te~l not in=ended for s~h water dis- posal s~l be r~d fr~ the site ~d disused of up~ ~ fi~ and ~oil ~t~ s~ be s~l~ ~n~d at the work site so as ~ ~t its ~E, i~ ~ p~ip~ ~p~p be~, cofferdam, ~k bu~ds, etc. s~11 be c~leted p~or =o placket of ~ fill ~ter~ be~d.such st~ctur~. O. - AlL reps/rs to existing struc~res shall he confined to replacement.. of..extst~nE structural elements ~tth no change in d~s/~n~ or mater~, unless specifically authorized herein. ~P~__ The 'fo11 owing Water Quml ~Ty Certific~tio~ shall'~a~. 13~f: ~qUtred by one or more agencies of the United States' C~ve~.,~ and if .... -che~e~ as-applicable b~ the Regio~¢~ Permit ~n -accordance with .Sect/on ~01(a) (1) of the Clean. Water "' 1977 (PL 95-217) ~he ,~w York S%ate Departmen~ of ..Conservation'hereb~f'Certifies :hat the subject project, proposal not contravene effluent limi~c/ons or other --' .- un,er-Sections JO1, 302, 303, 306 or 307 or the Act. S. eptember 25, 1984 -_ 10-84-0226 Daniel J. Larkin, P.E. Division of Regulatory Affairs Stony Brook, NY 11794 (516) 751-790~' ' 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. Regional P~rmit Administrator Permit No. 10-84-0226 Expiration Date December 31, 1986 NOTE: This notice is not a permit -i¸ STATEN'~Ef'4T OF ~ THE WATER SUPPLY ANDS~ SUFFOLK COUNTY D~P~ SERVICES -- FOR A'~ SUFFOLK CO. TAX DIST. SECT. ~Li OWNERS ADDRESS- DEED: L. ~,~' ';; TEST HOLE FORM NO. %0 TOWN OF SOUTHOLD BUILDING DEPARTMENT (516) 765-1802 P.O. BOX 728 TOWN HALL SOUTHOLD, NY MAIN ROAD 11971 SOUTHOLD, NY ~' APPLICATION FOR DEVELOPMENT PERIiiT Instructions: The application to the Building Inspector includes (each · n dup~) 1. Form No. l0 filled out in ink or typewritten, 2. Sur- vey of premises with elevations above meau 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. p£ th~Tow~ of Southold known as "Flood Damage Prevention Law" of the Tow~So]~t~i~ The applmcant must submit approvals that any.other ag~hc~'~quires. · ~.eneral.~'tandards as required in Section 46-17 of the law to minimize flood damage: A. B. C~ D. Anchoring of structures, including tanks and mobile homes Use of construction material and methods . Design and location of utilities ~' Subdivision proposal with drainage, public utilities design and base flood elevations ~peciftc Standards as required in Section 46-18~ A. Residential construction B. Non-residential construction C. Mobile homes ~ The'applicant must submit plans and specifgcatiOns as well as any other information requested by the Buzldzng~I~ect~r~t~ s~b~tantia~e, the facts that the str~t~e ~as or will-.have the 'l~est~FIoor.'~ ~h~lud~'*ba~ement/ cellar, ele~'~$~ij~bov~k~e4'~lood elev~t~'~n ~r; ~5~ermi,Ct~d by the - Federal Regulat~h, ~'~ I~'"suhh struc6d~is~ ~I~d~'proofe~ Sn such manner that below t~e base flood level the structure is water tzght with walls substantially and impermeable to the passage of water, 2. that structural components are capable to resisting hydrostatic and hydrodynamic loads an~ ~ffects of buoyancy, 3. applicant must sub~it certification by a registered professional engineer or architect that the standards set forth in Section 46-15B (1) (2) (3) of the~aut~old 9ode are satisfied. ~oastal Hi~h'~rd ~q~ (V Zone! 46-19. Avpl~2~ha!l submit plans, specifications including the required certiflca~ions alad such other in- formation as the Building Inspector may require in that ~he provisions of 46-19 are complied with. Mobile homes are prohibited'. The lowest portion of the structural members of the lowest floor cannot be lower than the base flood elevation with all space'below open except breakaway walls. S .an.d dunes. If sand dunes exist on the premises and the applicant pro- poses 6o alter same, plans and specification must be shown in detailed nature of any alteration submitted. ~uildin~ Permit. A Buildin~ Permit is also required for any structure. Bo~h a Development and a Buzlding Permit must be issued before any work can start in a special flood hazzard zone. A. writte~ disapproval or a permit must be issued within ten (10) working days. During construction, the inspector ~hall be notified in time so he may make the required inspections. Upon completion, the required certification fo 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) 4/80 Application Received Disapproval Issued FORM NO, lO APPLICATTON FOR D.~ELOPMENT PERMIT In tho Town of Southold 1. Type of Development Proposed: Addition and/or ~lteration[] Other (specify) I 2. Elevation Data i~ relation to above mean sea level of: (a) Lowest floor ielevation, including basement ! 5' feet New St'ructure (including storage tanks~/ Flood. Proof Below Base Flood Elevation~-~ (~ ' inches (b) In a V Zone, ?ottom of lowest structural Eem~e----~ feet inches ~.FIRM--Flood Insurance RaCe Map, Zono designations ~t.. Owner of Premises ~'/~ o . 5. Location of P~opepty. County Tax Map Ng., District, 1000, Section ~f~ Block L Lot(s) Subdivision ~~ Filed Map ~ , ¢~ Lo~(s) 6. ~mission to be ~gpanted: ~wne~ as above~New Owner .... ..... /--[ ' · . ' ' c t. 7. .Approval f~ofi othe~(s) before Pe~it is ~ssued: DEC W~LANDS own Boar HE~TH SERVICE ' ZBA~ BUILDING PERMI~ PLANNING BOARD___~//~ 0~ne~, New~ Owr~er---~, Un~e'~'-~ntractl-~., Lessoel-~, Agent[~--I, 'Con- tractor,--I, and igree to comply with all applicable sections of the Code 0f the T-6-~{~ of S~uthold; County, and State and ~o admit authorized in- specters to premises authorized to perform or have performed the said work and to make i and file this application, that all statements contain- ed in this appli.~ation are true to the best of my knowledge and belief and that the work will be performed in the mannerset forth in the application file~ therewith. SWORN T~ TtIIS Ii/ ~ ~ .DAY OF ~-'-~ '," 1~ ,_ Nota~ Publmc i · ' mai%ing ~ppl~cant s address and phone # if not given above: k/So,' liEl.£N K DE VOE NOTARY PIJBLJC, Sta~e of Nmv York Nn 4707 ~78 Sulfolk (;otHItv Term Explr~, [~arch 30, 19~% 'FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 .... ,,:: · ~~~J~ ~ ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,~9... INSTRUCTIONS a. Tins 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. e. 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. ¢. 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections., ~ ~, .... ~..,~.,..bJ.~.. !d.~,~:~ ~..~9. (Signature of apphcant, or name, if a corporation) ·, ¢ .).,.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ............. [3uD'.~.~.~ ..... ~0r.,-~,~...... ............................................................. Name of owner of premises .... ~.4... . t..s~,.. 2 .......................................... (as on the tax roll or latest deed) If applicant is aJ;J~l~ora~tion, sig~atu~ of~uly authorized officer. / (Name and title of corporate officer) Builder's License No .......................... Plumber's LicenSe No. ~. ~ .~..??.~..9~....~.-~..~e..~... Electrician's License No. ~. . . .~. . . . .~. .~. [. . .gt~. . : . . Other Trade's License No ...................... 1. Locationoflandonwhichproposedworkwillbedone..~./~....~.'....~?...~...~.~.~ .......... .... ~.~. Z.~:. ................................................ .~..'~.~.,'.~ ....................... House Number Street Hamlet County Tax Map No. I000 Section .... ~ ?..?... ........ Block... ~. ............. Lot..~.~.o...~(Z ........ Subdivision ~..d..~,~..~: K.~. · ? ......... Filed Map No..~.~. ........... Lot .~.77'(~.~.. 7'.d..~.~... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: t a. Existing use and occupancy .... i~...-~-~ .......................................... ? b. Intended use and occupancy ........................ ~ ............................ 3. Natu~ofwork (check which~.a¥olicable~· New Buildin,,Fr' a,~,m;,,, . ~teration Rep~r . . ~ ~.~ Re~val ..... Demolition . . . Other Work . . . ~d~¥ ~ ~ ~2~ (Description) 4. Lst~mate~g3~, .i,-~.,:l~y, ~P: ................ Fee ~ t~ 1;)~'~'~ ~0~ :':;.~ .iV ~'~t T~ ................................. . ~.r ................ ,*- ~' (to be paid on filing this application) 5. If dwelling, number of dwellingiunits · ~ ~ ... Number of dwelling units on each floor ................ If garage, number of cars ....~... ~ .................. 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use ..................... , . . I . ~ 7. D~enslons of ex~stlng structures, if any Front ............. .. Rear ... ........... Depth ............. .. Height ............... Number of Stories ........................................................ D~ensions of same structure with alterations or additions' Front Rear Depth ................... !.. HeiSt ...................... Number of Stories ......... ~ ' t '~ ...... 8. Dimensions of entire new const~ction: Front · .~.~ ....... Rear ... ~ ....... Depth . .~.~..~ ....... Height .1.~ ~. . Number of Stories ... Op~. . ..... //(~ ~ ~ · .... . ~.< .; .................. ~_ :.~ ............... 9. Size of lot: Front ...~...~. o: ~ .~ .~ · .~ .... ~ear ...... ~.2~ .......... De~th . .~ ................ 10. DateofPurchase .~..(~..~. ........... Name of Fomer Owner ...~9~.~o&~ ..... 11. Zone or use district in which pr~mises are situated ............................ 12, Does proposed construction violate any zoning law ordinance or re~ulatio-' ~ .. 13. Will lot be regraded ...... ~.~ .................. Will excess fill be removed from premises: Yes ~ 14. Nme of Owner of premises .~'.~.~.~'J~'D~Address . 1~..~JS~ ~, ..... Phone No. ).¢~-~.$$~ .... Nme of ~chitect .. ~ '/'..,.... '/ ............... Address ........... ~$~1~0 Phone No ................ Nme of Contractor ~.&d~. ~tg~. ~. Address.., .....,t.. ]. ~} ~ ~ ] ~ Phone No.. & .... q ...... PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, ~nd, indicate all set-back dimensions from ?operty 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 YORK, LS countrY oF,, ............ .......... ~N.~m~ee ~ i~.n~· .~.''. .......... ~.~ ......... being duly sworn, deposes and says that he is the applicant x ' ividual signing contract) above named. He is the .................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulg authorized to perform or have performed the said work and to make and file this application; that all statements contahed in this application are true to the best of his knowledge and belief; and that the work will be performed in the mannerlset forth in the application filed therewith. Sworn to before me this N.O.TA~.Y_ P_.U~[C_,_SI~_t~ ofN~ Yo~ ~' (Signature of applicant) t RODERICK VAN TUYL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL SUFFOLK COUNTY DEPT O ~ ~ CONSTRUCTION ONLY ~OLK CO. TAX MAP DIST. SECT. BL~K PCL. OWNERS ADDRESS: TEST HOLE STAMP SEAL