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HomeMy WebLinkAbout28262-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29724 Date: 09/18/03 THIS CERTIFIES that the building NEW DWELLING Location of Property: 580 WILLOW PT RD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 56 Block 5 Lot 29 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 9, 2002 pursuant to which Building Permit No. 28262-Z dated APRIL 12, 2002 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 COVERED ENTRY, REAR DECK AND SECOND FLOOR BALCONY AS APPLIED FOR PER ZBA #5076 DATED 3/28/02 . The certificate is issued to NEVIO BLASKOVIC & ANO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-01-0225 09/17/03 ELECTRICAL CERTIFICATE NO. 028016 08/13/03 PLUMBERS CERTIFICATION DATED 05/14/03 PECONIC PLUMBING & HEAT Authorized Signa V e Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28262 Z Date APRIL 12 , 2002 Permission is hereby granted to: NEVIO & ANO BLASKOVIC 203-29 28TH AVE BAYSIDE,NY 11360 for NEW FOUR BEDROOM TWO CAR GARAGE SINGLE FAMILY DWELLING WITH DEMO. OF EXISTING SFD. AS APPLIED FOR W/ZBA 5076, NYSDEC & TRUSTEE ' S, $100 .FiLD PERMIT at premises located at 580 WILLOW PT RD SOUTHOLD County Tax Map No. 473889 Section 056 Block 0005 Lot No. 029 pursuant to application dated APRIL 9, 2002 and approved by the Building Inspector. Fee $ 1, 411 . 80 Aut oriz Signature COPY Rev. 2/19/98 Form No.6 1 0 �— TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I. 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. B. For existing buildings (prior to April 9, 1957) non-conforming uses,or buildings and "pre-existing" land uses: 1. Accurate surveh of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and 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 appli ant. ��p C. Fees I t00 1. Certificate of Occupancy-New dwelling $25.00, Additions to dwelling $25.00, Altkrations to dwelling$25.00 Swimming pool $25.00, Accessory building $25.00, Additions to accessory buildinH25.00, Businesses $500 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00, Commercial $$1155..00 J Date. // S/a3 New Construction: �((,, Old or Pre-existing Building: (check one) Location of Property: �D� W I LL o r P 1 . Rte. S 0 , 7 k4. t4 Y. House No. Street Hamlet Owner or Owners of Property:N t7_ y t V p L G A 3 L W 5 two V! fi. Suffolk County Tax pNo 11000 Section O '6 Block Lot ;?�! Subdivision R r-P a r w 1t-Lo w P 7 _Filed Map. 443 o2 Lot: e76 Permit No. 2 Date of Permit. !a/OvZ Applicant: I-I S O " "S;760^ 10 - Health Dept. Approval: Underwriters Approval: Planning Board Approval: -115-S _ Request for: Temporary Certificate Final Certificate: _ (check one) Fee Submitted: $ �S. o D dcJ 22 d9_1 a 626- �q�Q to Applicant Signature APPEALS BOARD MEMBERS SOfFO(,� ed Southold Town Hall ( Gerard P. Goehringer, Chairman �� 53095 Main Road Lydia A. Tortora y Z P.O. Box 1179 George Horning Southold, New York 11971-0959 Ruth D. Oliva y� ��� ZBA Fax(631) 765-9064 Vincent Orlando pl �� Telephone (631) 765-1809 http://southoldtown,northfork.net BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF MARCH 28, 2002 Appl. No. 5076 — NEVIO and OLGA BLASKOVIC. Parcel: 56.-5-29 BASIS OF APPLICATION: Building Department's January 15, 2002, Notice of Disapproval under Section 100-33 and Section 100-244B regarding applicants' request for a building permit to locate a new dwelling, for the reason that: (a) a portion of which will be less than 35 feet from each the front yard and rear yard property lines; and (b) the new dwelling location will effect the location of an existing frame shed, resulting in a front yard location instead of a rear yard location. The Disapproval also makes references to the three front yards. APPLICANTS' REQUEST/AREA VARIANCE: Applicants wish to demolish the existing dwelling and construct a new 3,000+- sq. ft. dwelling further south on the property, proposing: (a) a setback of the new dwelling at 20 feet from the property line/right-of- way to the west, (b) a rear yard setback of 15 feet and 22 feet. Also, applicants propose to maintain the existing accessory frame shed in its front yard location. (Ref: survey/site map dated June 6, 2001, updated November 21, 2001 prepared by John T. Metzger, L.S.) FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on March 21, 2002, at which time written and oral evidence was presented. Based upon all testimony, documentation, personal inspection of the property and the area, and other evidence, the Zoning Board finds the following facts to be true and relevant. PROPERTY DESCRIPTION: The applicant's property is located on the southerly side (House#580) Willow Point Road, Southold, also referred to as Lot 26 on the filed Map of Willow Point. The property is improved with an existing single-family dwelling located approximately 32 feet from Willow Point Road 24.9 feet from the westerly property line. REASONS FOR BOARD ACTION: IN ACCORDANCE WITH THE REVIEW STANDARDS SET FORTH IN TOWN LAW 267B-3 "AREA VARIANCES," THE BOARD HAS CONSIDERED THE BENEFIT TO THE APPLICANT IF THE VARIANCE IS GRANTED, AS WEIGHED AGAINST THE DETRIMENT TO THE HEALTH, SAFETY AND WELFARE OF THE NEIGHBORHOOD AND COMMUNITY BY SUCH GRANT, AND DETERMINES THAT: 1. Grant of the area variance will not produce an undesirable change in the character of the neighborhood or detriment to nearby properties. The property contains three front Page 2 —March 28, 2002 Appl. No. 5076— N. and O. Blaskovic Parcel 56.-5-29 at Southold yards and the parcel is pie shaped. Due to flood zone requirements and low contours, the new dwelling is confined to a limited, specific area in which to locate construct the new dwelling. 2. The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance. The proposed location of the new dwelling will meet the minimum requirements for the other setbacks. The shed exists and is in a reasonable location; to relocate it would cause it to be placed on low ground area. This project is similar to other dwellings in the area. This lot has an unusual shape and a low elevation of five feet, which limits the available area for any type of construction. 3. The variance granted herein is not substantial. Only two small corners of the building fall within the required 35 feet minimum front yard setback and 35 feet rear yard setback. The shed can only be placed in the front yard due to the shape of the lot, and has existed for some time. 4. The alleged difficulty has been self-created when the applicant became aware of the size and purchased the property. 5. The variance granted will not have an adverse effect or impact on the physical or environmental conditions in the neighborhood or district. No evidence has been submitted to suggest that this variance will have an adverse impact on physical or environmental conditions in the neighborhood. 6. Grant of the requested variance is the minimum action necessary and adequate to enable applicant to enjoy the benefit of a new dwelling and enjoy the existing shed, while preserving and protecting the character of the neighborhood and the health, safety, and welfare of the community. BOARD RESOLUTION ACTION OF THE BOARD: In considering all of the above factors, and applying the balancing test under New York Town Law, motion was offered by Member Oliva, seconded by Member Tortora, and duly carried, to APPROVE, the area variances, as applied for. This action does not authorize or condone any current or future use, setback or other feature of the subject property that violates the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. Page 3 — March 28, 2002 Appl. No. 5076— N. and O. Blaskovic Parcel 56.-5-29 at Southold Vote of the Board: Ayes: Members Goehringer (Chairman), Tortora, Oliva, and Orlando. (Member Horning of Fishers Island was ent as a rized.) This Resolution was duly adopted (4-0). / % ./ erard P. Goehringer, Chairman Uhl t U U/ � v stHl.:� {Jt �t .L.�. .__ �frJ � i�_L�:.,�fr,« l_�„� "r. nL�'� �ti�f . a A7, ((a � l� l E vIN 51 r ` WN �n��ii � l�P� at� . ��� �% 1�(7{'� � l ^ ' 1m ,- �(Q�➢1[(�� t�l?. l ,,.,fr'i' r�'7: " "w,,� xK �4 "•U ♦ l � � �,� y \ CT< 261 d %� �JlliG ('J}' l I 1 J ��. �,i/"�"J „" �; l- !! L " ( 1G rJ}�l !* �}� I 1 !I J}9"'1 FF04r�Q Town Hall,53095 Main Road Fax(631)765-9502 P.O. Box 1179 Telephone(631)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: Iq Building Permit No. 8a low Z Owner: a. S t< o v L . (please print) Plumber: /�GO/,'IC 1 Z0'1 l hi/kr (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. 1119 u L3 3(Plumbel �gnature) 719 Sworn to before me this /4/ day of 2GCSOCS _ Notary Public, ounty VICKI L.LOPER Mary NoPublic, State at 0d1w� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUIL ING OWNER'S NAME Policy Number E to .k / oLFr'4 BLAST lG BUILDING STREET ADDRESS(Includin Apt.,Unit,Suite,and/or Bldg. No.)OR P.O. ROUTE AND BOX NO. Company NAIC N tuber h/ I[Lory Of'vT 9A.1l� CITY ODE JOtJ'{"li-r9/d STATE j, ZIP //97/ PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) K /000- 6-0 C--Z 4 BUILDING USE(e.g.,Residential, Non-residential,Addition,Accessory,etc. Use a Comments area, if necessary.) LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: IJ GPS(Type): or ##.il>dWR°) LI NAD 1927 L1 NAD 1983 1-1 USGS Quad Map LI Other: SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1,NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME B3.STATE 7VWAI 3 t7pi1 So l� B4.MAP AND PANEL I B5.SUFFIX I B8.FIRM INDEX B7.FIRM PANEL B8.FLOOD 89.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE 2ONE(S) (Zone AO,use depth of flooding) / C_ I PYA q tif, 19 9do A e O 1310. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. 1J FIS Profile 6 FIRM 1J Community Determined 1_1 Other(Describe): B11. Indicate the elevation datum used for the BFE in B9: 1_,1 NGVD 1929 DJC NAVD 1988 1_J Other(Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS)area or Otherwise Protected Area (OPA)? 1J Yes L_1 No Designation Date: SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 1JConstruction Drawings' 1_1Building Under Construction' 1AFinished Construction "A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 7. (Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30, V(with BFE),AR,AR/A,ARAE,AR/A1-A30,AR/AH,AR/AQ Complete Items C3.a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion. Datum uGva 192.9 Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 1J Yes 125,1 No ❑ a)Top of bottom floor(including basement or enclosure) ❑ b)Top of next higher floor ❑ c) Bottom of lowest horizontal structural member(V zones only) Ai ft.(ar) o hF� Eld)Attached garage(top of slab) /% ft.(rs) E g a` 9� L3 a) Lowest elevation of machinery and/or equipment w <pp servicing the building(Describe in a Comments area.) /LL . S ft.(64 E i ❑ f) Lowest adjacent(finished)grade(LAG) 9 .3 ft.(m) 2.2. • ❑ g) Highest adjacent(finished)grade(HAG) I/ . ft.(ey ❑ h)No. of permanent openings(flood vents)within 1 ft.above adjacent grade ❑ i)Total area of all permanent openings(flood vents)in C3.h 112-2 sq. in. (sq.ca* SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer,or architect authorized by law to certify elevation info;ation. l certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code Section 1001. CE rTIFIER'S NAME P ' L 5 LICENSE NUMBER 9GGb TITLE / ' �U av Cp., A. ti o xC a 7 cr�f� ADDRESS CITY STATE ZIP COINE D Lgz-o6 " SIGNATURE DATE TELEPHONE 06 -/ -V3 631-222-20919 FEMA Form 81-31,JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS I IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company:Use: BUILDING STREET ADDRESS(Including Apt., Unit,Suite,e�nd/or Bldg. No.)OR P.O. ROUTE AND BOX NO. Policy.Number iV,LLOkI On� A1' CITYSTATE ZIP CODE Company NAC Number gevO or A,. . // 97/ SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company, and (3)building owner. COMMENTS IJ Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE), complete Items E1. through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed– see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2.The top of the bottom floor(including basement or enclosure)of the building is 1_1 1 ft.(m) L1Jin.(cm) 1_1 above or Ll below (check one)the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is LI-1 ft.(m) 1_1_lin.(cm)above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance?1_1 Yes 1_1 No 1_1 Unknown. The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C(Items C3.h and C3.i only), and E for Zone A (without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements in Sections A, B, C, and E are Correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS IJ Check here if attachments SECTION G -COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B. C (or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. G1. 1_1 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the el tion(no&m,the Comments area below.) G2. 1 co4hlnunity offic191,completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or 01 G3. 1 "The following jnfprmatibn (Items G4-G9)is provided for community floodplain management purposes. G4. IT NUMBER, • G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPUANCF/OCCUP NCY ' • 4 f ISSUED G7. T it has been issyed for: 1_1 New Construction 1_1 Substantial Improvement G8. Elev btl of as-built loyrest floor(including basement)of the building is: _ft.(m)Datum: G9. BFE or Torre AOT epth of flooding at the building site is: —ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I_I Check here if attachments FEMA Form 81-31,JUL 00 REPLACES ALL PREVIOUS EDITIONS BUILDING PERMIT EXAMINER CHECK LIST lf-A-4101" �3A DATE REV I WED: iz/zi /Ol APPLICANT NAME: DATE SUBMITTED:/.zIz, /01 SCTM# DISTRICT: 1_,000 SECTION: BLOCK: S LOT: Z, STREET: ��tcoa✓ �� CITY: c�o��9� SUBDN. NAME: ° PROJECT DESCRIPTION: z�Si/5076 ARCHITECT/ENGINEER: /,yy/te / FAST TRACK? S SINGLE & SEPARATE CERTIFICATION-REQUIRED? % Ila NOTES:_ LATS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),11NDERSD LATS FROM JAN.1997 100-25.Merger.(A nonconforming at any time atter 7/1/8. ZONING DISTRICT: -yo CONFORMING? "/o oc REQ.LOT SIZE: �'° ° ACT. LOT SIZE: REQ. LOT COV. LACT. LOT COV. 771 ° REQ. FRONT -3s PROP. FRONTJ 71, = r REQ SIDE ACT. SIDE / REQ. REAR 3 r PROP. REAR WATERFRONT? NO DESCRIPTION: PANEL # FLOOD ZONE: riouL s�t�� .>o�� �. 3r sv�va ✓ d t" >;.. AGENCY PERMITS REQUIRED FOR REVIEW ,2- l �sf - ?$K -G'� %..q PROVALS RE UREA: SUFFOLK COUNTY HEALTH DEPT: or NO, (BED#): DTE:/2 //9 / a/ PERMIT#:R10-Q/-o r Z NEW YORK STATE DEC: PU EC 9/1/7 or NO SOUTHOLD TOWN TRUSTEES: J L eT/P�2 P sa e/ TOWN ZONING BOARD APPROV 3 0 2 3076 TOWN PLAN. BOARD APPROVAL: V 7� TOWN HISTORICAL PRE (SPLIA): YES o O NYS ENERGY: OR NO"'' EGRESS (18 H mm.?4 sq total) VENT(SQ. FT. x 4%) LIGHT(SQ. FT.x 8%) BUILDING PERMITS OPEN/EXPIRED: BP 9?9 6 -Z/C/0 Z- 15 19 HAVE PRE CO'S : Y OR N BiL.9 -Z/C/0 Z-,-:)).a c NOTES: w FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR —-6-�--SF 2Sa2 SECOND FLR : !� SF /6" �t/ INIT OTHER TOTAL TOTAL: uF f/6SSf FEE FEE FEE 'OT S/' 68 SF)- ( 9-5-'9 +$ I66.qO _$ New Yo' k State Department of Environmental Conservation Division of Environmental Permits Building 40 - SUNY, Stony Brook, New York 11790-2356AM Telephone (516) 444-0365 W Facsimile (516) 444-0360 Erin M. Crotty Commissioner October 12, 2001 Nevio & Olga Blaskovic 203-29 28' Avenue Bayside, NY 11360 RE: 1-4738-02926/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, &ar�ilynPet4r's�on Environmental Analyst MEP/ls Enclosure NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-02926/00001 9b October 12, 2001 FACILITY/PROGRAM NUMBER(S) lqw PERMIT EXPIRATION DATE(S) Under the Environmental. Conservation Law October 31, 2006 TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Permit to Operate ❑ Article 15, Title 5: Protection ❑ 6NYCRR 608: Water OuaLity ❑ Article 27, Title 7; 6NYCRR of Waters Certification 360: Solid Waste Management O Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPOES ❑ Article 27, Title 9; 6NYCRR Supply 373: Hazardous Waste Management ❑ Article 19: Air Pollution ❑ Article 15, Title 15: Water Control ❑ Article 34: Coastal Erosion Transport Management ❑ Article 23, Title 27: Mined ❑ Article 15, Title 15: Long Land Reclamation ❑ Article 36: FLoodpl.ain Island Wells Management ❑ Article 24: Freshwater Wetlands ❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control. PERMIT ISSUED TO TELEPHONE NUMBER Nevio 8 Olga Blaskovic ADDRESS OF PERMITTEE 203-29 28t^ Avenue, Bayside, NY 11360 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Land Use Ecological Services, 2576 Sound Avenue, Baiting Hollow, NY 11933 (631) 727-2400 NAME AND ADDRESS OF PROJECT/FACILITY Blaskovic property, Lot 26 WiLLow Point Road LOCATION OF PROJECT/FACILITY Arshama ue COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold DESCRIPTION OF AUTHORIZED ACTIVITY: Reconstruct and expand an existing single family dwelling, deck,driveway and install a new septic system. All work must be done in accordance with the attached plans stamped NYSDEC approved. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, aLL applicable regulations, the General Conditions specified (see page 2 8 3) and any Special Conditions incLuded as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Roger Evans (MEP) Bldg. #40, SUNY, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE aA October 12, 2001 Page 1 of 4 L I NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, agents, and assigns for all claims,suits, actions, damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits,approvals, lands,easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility,including relevant records,is subjectto inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify,supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg#40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. DEC PERMIT NUMBER PAGE 2 OF 4 1-4738-02926/00001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 ( TIDAL WETLANDS) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work,obstructions,or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State,and to such extentand in such time and manneras the Departmentof Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 2. 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 conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S.Army Corps of Engineers, U.S.Coast Guard, New York State Office of General Services or local government which may be required. 4. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly,without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall,without expense to the State,and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 8. If granted under 6NYCRR Part 608,the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977(PL 95-217)provided that all of the conditions listed herein are met. 9. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved survey was prepared by: Joseph Inoeono dated 6/6/01 last revised 8/20/01. DEC PERMIT NUMBER PAGE 3 OF 4 1-4738-02926/00001 I NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. 2. Necessary erosion control measures i.e., haybales, silt fencing, etc. are to be placed on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good condition until thick vegetative cover is established. 3. Sanitary system (bottom of tank and leaching pools) shall be located a minimum of 2' above seasonal high groundwater. 4. Storage of construction equipment and materials shall be confined to property boundaries. DEC PERMIT NUMBER PAGE 4 OF 4 1-4738-02926/00001 Albert J. Krupski, President g13FF01 Town Hall James King, Vice-President ONO C� 53095 Route 25 Henry Smith h'Z' Gym P.O.Box 1179 Artie Foster o '� Southold, New York 11971-0959 CA 2 Ken Poliwoda Telephone (631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES August 28, 2001 TOWN OF SOUTHOLD Ms. Tanya Lachenmeyer C/o Land Use Ecological Inc. 2576 Sound Avenue Baiting Hollow, NY 11933 RE: Blaskovic Willow Point Arshamague,NY SCTM#56-05-29. Dear Ms. Lachenmeyer: The Southold Town Board of Trustees reviewed the survey dated June 6, 2001 and received in our office on August 28, 2001 and determined that the re-construction and expansion of the existing one family dwelling and deck and associated improvements, as per plans submitted to be out of the Wetland jurisdiction, under Chapter 97 of the Town Wetland Code. However, any activity within 100' of the Wetland line would require permits from this office. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:cjc cc. Bldg. Dept. W20-1 (8/87)-9d New Yarn Sate Department of Environmental Conservation Am N 0 T I C E v low The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information 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. pp / Regional Permit Administrator Permit Number . 0 " 6 ��� JE T W. f'AVAm Expiration Date 10 /31 zocb NOTE: This notice is NOT a permit �o�OgpFFO(,�Co Town Hall, 53095 Route 25 P.O. sox 1179 Southold,New York 11971-0959 EDWARD FORRESTER GOZ Telephone (631) 765-1939 DIRECTOR OF CODE ENFORCEMENT • Facsimile (631) 765-1823 a-mail: ed.forrester@town.southold.ny.us MAR 1 9 2003 TOWN OF SOUTHOLD _J 64rc1i 19, 2003 Nevio Blaskovic 203-29 281h Street Bayside NY 11360 Re: Property at 580 Willow Point Rd Southold, SCTM#1000-56-5-29 Dear Mr. Blaskovic, Please be advised that a complaint has been received concerning conditions at the construction site at the property you own, referenced above. Specifically, mud and stormwater runoff from the site accumulating in the street and on neighboring property. You are responsible for the actions of the contractors working for you. A clean up after each working day should be practiced. In addition a paved or semi-paved access to the site and/or erosion barriers would reduce the damage caused by the traffic at the site. Thank you for your anticipated cooperation. Sincerely, Edward Forrestel' Director of Code Enforcement cc: Supervisor Town Attorney Building Department Albert J. Krupski, President SVFF��� Town Hall James King,Vice-President ��� C� 53095 Route 25 Henry Smith �`Z' Gym P.O. Box 1179 Artie Foster o '� Southold, New York 11971-0959 Ken Poliwoda H x Dy • �� Telephone(631) 765-1892 �jol � dao Fax (631) 765-1366 BOARD OF TOWN TRUSTEES August 28, 2001 TOWN OF SOUTHOLD Ms. Tanya Lachemneyer C/o Land Use Ecological Inc. 2576 Sound Avenue Baiting Hollow, NY 11933 RE: Blaskovic Willow Point Arshamague,NY SCTM#56-05-29. Dear Ms. Lachenmeyer: The Southold Town Board of Trustees reviewed the survey dated June 6, 2001 and received in our office on August 28, 2001 and determined that the re-construction and expansion of the existing one family dwelling and deck and associated improvements, as per plans submitted to be out of the Wetland jurisdiction, under Chapter 97 of the Town Wetland Code. However, any activity within 100'of the Wetland line would require permits from this office. This determination is not a determination from any other agency. If you have any further questions,please do not hesitate to call. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:cjc cc. Bldg. Dept. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE: January 15, 2001 TO Liso Construction A/C Blascovic PO Box 439 Jamesport, NY 11947 Please take notice that your application dated December 12, 2001 For permit for demolish an existing single family dwelling and construct a new single family dwelling at Location of property: Willow Point Road Southold County Tax Map No. 1000 - Section 56 Block 5 Lot 29 Is returned herewith and disapproved on the following grounds: The proposed construction on this non-conforming 19,514 square foot lot in the R-40 Zone, pursuant to Article XXIV Section 100-244B which requires a minimum front yard setback of thirty-five (35) feet and a minimum rear yard setback of thirty-five (35) feet. According to the applicant's survey, subdivision maps approved by the Southold Town Planning Board individual deeds and property cards, the property in question has three front yards. The plans note a front yard setback of twenty(20) feet from the right of way to the southwest of the property ip question and a rear yard setback of fifteen (15) feet. In addition the proposed construction will effect the location of an existing frame shed, which is not pursuant to Article III Section 100-33 which states that which states that"accessory uses shall be located in the required rear yard."The new construction will result in the location of an accessory building in the front yard. Total lot coverage, following the proposed construction is 13 percent. r uthorized Signatur Cc: ZBA, File ' APPLICATION a PAGE I of 4 -- TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be Celled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sien): 1. No work may start until a permit is issued. 2- The permit may be revoked if any false statements are made herein_ 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I,THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, TO THE,BFLST OF MY "O�VLEDGE, TRUE AND ACCURATE. (APPLICANTS SIGNATURE �— DATE SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANn X03/- ,Z NAME ADDRESS TELEPHON 1 E APPLICANT ,( S o o G u Roto �0 �r d�f C, J4 f? ✓ / BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark A sketch attached to this application showing the project location would be helpful. _ WV FDP(93) APPLICATION PAGE 2 OF 4 DESCRIPTION OF WORK (Check all apphcablc boxes) A. STRUCTURAL DEVELOPMENT /ACTIVITY STRUCTURE TYPE Ef New Structure O Residential (1-4 Family) O Addition O Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Flood proofing? O Yes) O Relocation O Combined Use (Residential & Commercial) O Demolition t> O Manufactured (Mobile) Home (In Manu- ❑ Replacement factured Home Park? O Yes) ESTIMATED COST OF PROJECT S 3 G �• ' B. OT EEVELOPMENT ACTIVTTIES: O Mining O Drilling Grading ` fixcavation (Except for Structural Development Checked Above) O Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage Improvements (Including Culvert Work) O Road, Street or Bridge Construction O Subdivision (New or Expansion) Arfn�dividual Water or Sewer System St-*-r57�: Pn vL S O Other (Please Specify) After completing SECTION 2,APPLICANT should submit form to Local Administrator for review. SECTION 3• FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. . Dated The Proposed Development: O Is MOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMrr IS REQUIRED). ❑ Is located is a Special Flood Hazard Area. FIRM zone designation is loo-Year flood elevation at the site is: Ft. NGVD (MSL) O Unavailable O The proposed development is located in a floodway. FBFM Panel No. Dated O See Section 4 for additional instructions. SIGNED DATE APPLICATION d PAGE 3OF4 SECTION 4: ADDITIONAL INFORMATION REQUIRED (To he completed by LOCAL ADMINI TRATORI The applicant must submit the documents checked below before the application can be processed: Cl A site plan showing the location of all costing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑Development plans, drawn to scale, and specihratipas,including where applicable:details for anchoring structures, proposed elevation of lowest floor ('including basement), types of water resistant materials used below the first floor, details of floodproofing of utilities located below the first Door and details of enclosures below the first Door. Alco` O Subdivision or ocher development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. Cl Top of new fill elevation Ft. NGVD (MSL). 0 Floodproofmg protection level (non-residential only) Ft:NGVD (MSL). For Doodproofed structures, applicant must attach certification from registered engineer or - architect. - ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other. SECTION 5: PERL41T DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. O Is B.O Is not in conformance with provisions of Local law # 19 . The permit is issued subject to the conditions attached to and made part of this permit. SIGNED DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a writtea summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from the Board of Appeals. APPLICATION s _ PAGE a OF a APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved' ❑ Yes ❑ No Conditions SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this apphcation). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECIIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION S• CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑ EXISTING BUILDING ❑ VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: C/C(93) M-1802 BUILDING DEPT. INSPECTION Z...-1/FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTO M-1802 BUILDING DEPT. INSPECTION [ ] FO DATION 1ST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR Fdc4:2 M-1802 BUILDING DEPT. INSPECTIO [ ] FOUNDATION IST [ ROUGH PLBG.//4 [ UNDATION 2ND ( ] FRAMING ( ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS:/ f� o jot A,-Ale DATE INSPECTO �Ae� M-lW2 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FO ATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: S ,✓ C DATE ! y n INSPECTOR I M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] R GH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ) FIREPL � CHIMNEY REMA KS• Qx�, DATE / d�� INSPECT 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 LATION [ ] FRAMING [ FINAL ( ] FIREPLACE & CHIMNEY RYEMARK ���✓ ����r DATE .S / S o 3 INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROU H PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE &&� C--HIMNEY REMARKS: eC : ' QF DATE INSPE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO=ATION BG. [ ] FOUNDATION 2ND [ ] IN [ j FRAMING FINAL [ ] FIREPL A CHIMNEY REMARKS DATE INSPECTO � � .t�s3iril • � � i FOUN1 ------------------------------------ FOUNDATION (2ND) 10-ROUGH FRAMING& I PLUMBING • TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets of Building Plans TEL: 765-1802 Survey V/ PERMIT NO. �262 Checkjt 16 5al Septic Form N.Y.S.D.E.C. TrusteesExamined .2002 Contact: Approved /L '2062- Mail to: Disapproved a/c Phone: = —Z{ s� Building Inspector LEG0 APPLICATION FOR BUILDING PERMIT 0MBLDG. DEPT. Date I d 1 aO , 20Q L F s untoLD INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale.Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a 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 what-so-ever until a Certificate of Occupanc} is issued 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. LcSO Go WS . C-oRP (Signature of applicant of name,if a corporation) Ljal ha� I-easD-y o goY4� 3))q pcan P.P -Lr�s �hlf•`4h < (q44 '7 State whether applicant is owner, lessee,agent, architect, engineer, general contractor, electrician,plumber or.builder C;w 'fi'K L A r.%t. CiU ►�. L �. ,a c LU P- Name of owner of premises N V t o + o LG ta. 3 L is S t`y (as on the tax roll or latest deed) If apphQ4tio a corporation, officer (Name and title of corporate officer) Builders License No. vl 3y Plumbers License No. -7&3 P Electricians License No. �S7 Other Trade's License No. 1. Location of land on which proposed work will be done: wLt,L& r R C7. F, 9-5t-1A1-1 R Stec-, Sv✓t►�si n tit �( House Number Street Hamlet County Tax Map No. 1000 Section Block 0.6AW N'u TAS Y" R+�Tt,•q Subdivision .LL w ?v • vZr Filed Map No. 'i. (Name) T 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 0 H a r r L1( D N b. Intended use and occupancy ° '� a �=- ° ✓�%a, — 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal ✓ Demolition ✓" Other Work ^ (Description) 4. Estimated Cost ti a d, Fee (to be paid on filing this application) 5. If dwelling, number of dwelling unitsNumber of dwelling units on each floor If garage, number of cars ; L a r4- 6. z6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures,if any: Front-�Z,a 5"ALi�;y Rear Depth Height — - Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth -- Height Number of Sto 'es - 8. Dimensions of entire new construction: Front 9 Rear 41"? Depth Height 30 , Number of Stories 9.. Size of lot: Front o` 5 Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be re-graded Y C-S Will excess fill be removed from premises: YES NO yyel�,.. ��cb $lasoa.rri, 03�4 a9�A 14. Names of Owner ofpremises Addressi ANsioe4Ky 113660 Phone No. f%lo_97G �sS Name of Architect ll. P,P.,-{ a—L ,Lia _Address G Phone No Name of Contractor 1 Go ne si e A P. Address _I s ` Phone N7 1108,0-7 15. Is this property within 100 feet of a tidal wetland? *YES NO L c-fLTa��jx rP 00-L s- • IF YES, SOUTIiOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY 01SUEq- L» ..++AZ4--mac so , GL being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, ;S)He is the o trL A -k -C OOk (Contractor, Agent, Corporate Officer,etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; hat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be lerformed in the manner set forth in the application filed therewith. worn to before me this day of� c+,e_r���oa-y 20Q (,^�/} Notary Public r Signahrre ofApplicaUt LYNDA M.BOHN NOTARY PUBLIC,State of Now" No.01806020932 Qualified in Suffolk couAV Term Expires March 6,20 Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 12/20/01 Receipt#: 0 Transaction(s): Subtotal 1 Septic Permit- Construct- Resid. $10.00 Total Paid: $10.00 Name: Liso, Construction Po Box 439 Jamesport, NY 11947 Clerk ID: LYNDAB Intemal ID:43422 AL Fl,n A, AL ALE SURVEY OF AL LOT 26 MAP OF WILLOW POINT VACANT AL FILE No. 4652 FILED JUNE 16, 1966 SITUATED AT `wy�` " ' ,IIS ARSHAMAQUE 3L TOWN OF SOUTHOLD " 111 SUFFOLK COUNTY, NEW YORK �LON % D ; 'b x S.C. TAX No. 1000-56-05-29 {\�V\ , e ° Ol + • e •iyGE OF PAVFLPN, e d SCALE 1 "=20' A?d wATE e• 4RD — — — — — —L=167,94' IL JUNE 6, 2001 O //' NAc 03 I JULY 11, 2001 ADDED PROPOSED HOUSE °. WAE E AUGUST 20, 2001 LOCATED WETLANDS FLAGS & REVISED SEPTIC SYS. LOCATION ( � ° • • 59x / / 05•S, 0.3VNOVEMBER 21, 2001 REVISED SEPTIC SYSTEM AS PER S.C.D.H.S. NOTICE v AREA = 19,512.42 sq, ft. R 31 i / A�l 314. 0.448 ac. Na ' 0x "�e5 Thr Hole �8Qp5� / o4z 5 314. t x7.7J `albs`/ 35 w •� e ° o�N�sm n °F 311E 15 c x \ ; $ SEAR \ c a— — — --ba � Q 314 v04E' s— _N • '4�4`a \�4 % i\ LOT 26) \ �O� RUO +4 % O� CEUAR Axc[` I \ CI OGS / ° cOA`' 121 \o \ 95 p0 's 0• \ I \ 8 101y5,� 314 ` TA 1;Ff,67rD �AE� 314 ONES101p4'GP� .r;3ALL� 8 3' N T15'10' E _ _ y . Lc13A.7 70.1N1 _ 1 ��V _ syF/OLX COUN DiFARTMENT OF HEALT IgE_ s \ 5 rtlP Q'fi"d' AL rERMITFORAFP VALOFCONSTRUCTIOAIFOR SINGLE FAM YRESIOENCE ONLY \ ❑O Is,r ANNA z 5.Z '� 2a 'Pry W1N.5FItt 9 �'i = x / 51 314 -. AL APPROVED 1 \ ',�. I - / FOR MAXIMUMOF.. EDROOMO 0xB o ERPIRESTHREEYEARS FROM DATE F ,,pa°OVAL o �� o O AD Is AL PA71'03D lCIX R=26.00' 709P�:n I x 'L �• / 224'14, L=39.27' i O� \ 314. h 311` TEST HOLE DATA (TO- (TEST (TEST HOLE DUG BY MOOD N<� O ON MAY 11. 2001) \ � hry Q 411 Lj 914111 ' _ �k ¢Ev. ao RETx1w1 emvx`CAr w \ —r � As 314 `O �I�i wATu w lmnsx eNowx cur cN �� .. . Fuc /e aY 1 1 WTfA IN QmIN1 FlHE �4pV JWL —: ro cans[ sun �q AL Fun AL AL PROPOSED SEPTIC SYSTEM DETAIL_ HDusE (NOT TO samn NOTES: uwumaR¢ED ALTERATION OR AODmaN E� �'� FlNIEHm pMOE FINISH aAcE TO THIS SUR EY IS A WOWGRI OF EIEV 10.s DU'. SU 1 . ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM SmnON 72CS OF THE NEW YORK $FATE EXISTING ELEVATIONS ARE SHOWN THUS:3 B)UQnON LAW. —r . TpP EL !3 �y NowroP 8- !.]' _ ON. N!• EXISTING CONTOUR LINES ARE SHOWN THU',i: — — — —e— — — — AL THE LAND THIS Evat�s wK�'m HOT oNmNi1 'G sEorc N0 IEHxxH. s "E"N PROPOSED CONTOUR LINES ARE SHOWN THI�JS: lUL To BE m UD 91WL WINE wN9mxm �'. V mmW 1%l%1' T.WN aM. Plrtll 1/e'/1' PaK COSNDD,NT TO 9E A VALD 1RUE COPE. a.5' INN. FL n' b PROPOSED CONTOUR LINES ARE SHOWN THUS: IMI. EL A.]' CEFUFKPGONS INIGTED HEREON SHALL RUR s+--!-} •ar-.;-1 . y 2. SEPTIC SYSTEM STRUCTURES SHOWN THUS: ONLY TO THE PERSON FOR wNaN THE suROEY IS PREPARED. AND ON HIS REIV•1F M nWDin1E TREE COMPANY, WDO& AOINY AND 1•—! x>, LENDING IN$RMWN usfm HEREON, AN PROPOSED EXPANSION POOL To THE ASSONEE9 OF THE LENDING WSR- DuRRIOUPON MOL OF em. EL 8.0' unum ron 314 nR10N. CFRfIFlGIIOHv ARE NOT TRANSPFAABUL 5 POOL SfSNFN E1.sV. ].0' SEPTIC TANK (1) 1.MNNIN STPnc TANK rr»cnNs.A 1 ro 4 OEsOsoR x 6 tAso aAuixAs LEACHING POOLS (5) PROPOSED LEACHING POOL THE E%IBTENCE OF RIGHT OF WAYS 4' W119 DOW 1. WWW 1FRW SOPER FOR A 1 M 4 SUAKOM NaL£ 9 Yn q n 9CEWL IAEA 2. RW]61E SHIM.IMM,A HNEIIN (nIIILQ,T SOLANI 111 OF sA00 W AT xs DAYS a lAVln, 2' DEEP, Id Du. AND OR EASEMENTS NTs OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. x w1L 1� 9wl!E A 1M=OF s. A TDP RE MM N!'Nn A l M THCIOis a'4•. 2, 6vbw= ME ro OE oss,Ann aP Uss R91Cw'm CDHg2TE (ON Eauu) O PROPOSED SEPTIC TANK - FUN; AL My W Y, lIMIDM ANs RED fIMLL gxlFNx RINFaIDND ro Ns1R NI NPNFn fM�Cf.IDD F.F. IFACMNo=W !aW OMit NO/91 NIY. (J w 4.ALL wlwn NVLL!F 4Nlp q TMT 1x9 TNM d WnD111MR. ].ALL OPG!WWL EE OF PREbax RWaRCFD OaNCKFIE(011 FAWO. AL !.THE 4PIM TINY[!NINE!E IMT.Wm AT IEMl a NL )AFLIId6(NM A WK TdEMIILE OF 11/47 4.A td Mn. [6TINfE EINID!IFNMN PD]19 Nw YM1EA IIIE DIME FE WNFIAm. ON A NWYILN s TIICI( Em OF mwiclED SAND aN PFA aNMTT. s.AN .' mn.DmANa lE1wTn1 Al UAcx2n Paas AN sEP1n TANK s1A2E In lwwuxD 3. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD PREPARED IN ALCORDMNCE THE MINIMUM a. A IN aa. DGI OnssolN>FlIC TANK AND Ham 9w1 YE NOMAINEX sPNNEMRDS FOR IDLE SU AS FSTASUSHIM OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. ar THE LIALS AND ADOPTED suaN u STATE EM+D Joseph A. fn9eglAlO 4. THE PROPOSED SEWAGE DISPOSAL SYSTEM '_!HALL BE EFFECTIVELY DUG OUT, DOWN TOT�aEI A SIX (6) FOOT STRATA OF ACCEPTABLE SAND AND GRAVEL, FOR A DIAMETER SIX (6) FEET 1" Land Surveyor THAN THE LEACHING POOL. $ °` \ '•'u o 5. AREA OF EXCAVATION TO BE BACKFILLED WITH ACCEPTABLE SAND & GRAVEL. -x , 6. EXISTING SEPTIC SYSTEM TO BE PUMPED & REMOVED. \ _ Y rn! survey! - Subdivisions - SN. Plane - canswetion LOyoDt •�} • PHONE (631)727-2080 Fax (631)727-1727 OFFICES LOCATED AT AWUNG ADDRESS N.Y.S. Uc. No, 49668 1380 ROANOKE AVENUE P.O. Box 1931 RNERHEAD, New York 11901 RMnhaod, New York 11901-4985 21-176C AIL e S �a,,...ltL•' �t n� -�.h .mo- r�... o,>I �v(� Fuc dt `� AL I SURVEY OFAL 1� _ LOT 26 A p; �120Q2 ,I� MAP OF -- _� WILLOW POINT �I T,.�'y y�'L ;rL'rn FILE No. 4852 FILED JUNE 16, 1966 MAL SITUATED AT ARSHAMAQUE 2a�°"" �"� TOWN OF SOUTHOLD a - a PDAzAL 'm` SUFFOLK COUNTY, NEW YORK e a� , AIL S.C. TAX No. 1000-56-05-29 SCALE 1 "=20' qac'=Tt • EXE av PA"vtiuET+i L - wATrn�n yO-a =167.94 ,cB� AL JUNE 6, 2001 — — ` JULY 11, 2001 ADDED PROPOSED HOUSE ,( _ 'J�� A} AUGUST 20, 2001 LOCATED WETLANDS FLAGS & REVISED SEPTIC SYS. LOCATION'( srur RNL FENCE FeNcc-�" NOVEMBER 21, 2001 REVISED SEPTIC SYSTEM AS PER S.C.D H.S. NOTICEv O.s's oaw JULY 19, 2002 FOUNDATION LOCATION AREA = 19,512.42 sq. ft. '�g 0.u6a wai - / R ' AL 0.448 ac. ur' s e kct n s ISA LOT 26 s Fuc A, -_ � off. OV uTa� 1DF�� E.DNE \V ��OG�� nll� cOH Lo:' Ok O GJ caw t \ zz.O \1 \ �'C Fv `✓ ' R.346.79' 473 N 0715'10., E F20 \_ 12 T' - uY L_13 70.00 � � � N111L �ao,N°`v ryM1y3S \ tO.D' CONCRETE / � d FOUNDATION r TOP OF FOUNDATION EL CRAWL SPACE EL O h \ �o. %P \ NAIL R=35.00' N� \ L=39.27 Or I SL es A \ 65 m T� FTAc As AC 07 AL NOTES. UNAU HORIZED ALTERATION OR ADDITION TO THIS SUIWEY Is A MOIATION OF 1 . ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM SECTION 7408 OF THE NM YORK STATE Ouw EXISTING ELEVATIONS ARE SHOWN THUS:sG COPIES F COF THIS SURVEY LAW NOT BEARING EXISTING CONTOUR LINES ARE SHOWN THUS: — — —s— — — — AL >11L THE SS SURVEYOR'S SEAL SAU INKED SELL ON SI (EXISTING CONTOUR LINES SHOWN ARE AS PRIOR TO CONSTRUCTION) EMBOS6m SEAL SHALL NOT BE CONSIDERED TO BE A VAHD TRUE COPY. CERTFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON NR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TIT-£ COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE (ENDING INSn- ,IL AIL TUTON. CERTINCATIONS ARE NOT TRANSFERABLE, THE EXISTENCE OF RIGHT OF WAYS AND/oR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. UC ye AL PREPARED IN ACCORDANCE H THE MINIMUM STANDARDS FOR TTFLE SU AS [S NBBUSHED BY THE FOR SUCH USE BYNTTN N YORK STATE UND Josephngegno ABS°`MT`°" Land Surveyor Title Surveys - Subdivisions - Site Plane - Construction Layout PHONE (631)727-2090 Fax (631)727-1727 OFFICES LOCATED AT MARLING ADDRESS - N.Y.S. Lie. No. 4956B 1300 ROANOKE AVENUE P.O. Be. 1931 RIVERHEAD, New York 11901 Riverhead, New York 11901-0965 21-176 SURVEY OF LOT 26 MAP OF WILLOW POINT FILE No. 4652 FILED JUNE 16, 1966 _�— SITUATED AT ARSHAMAQUE TOWN OF SOUTHOLD �� SUFFOLK COUNTY, NEW YORK %� S.C. TAX No. 1000-56-05-29 1��° " SCALE 1 "=20' / �R w 51RE 1E Oi PA ME a L= 167. d JUNE 6, 2001 94' j DnDiN' POLE JULY 11 ,WETLANDS ADDED PROPOSED HOUSE V V ��, CLL k�waE _mo--�^—o--b- AUGUST 20, 2001 LOCATED WETLANDS FLAGS & REVISED SEPTIC SYS LOCATION /' vv �--sPUT RAIL F`J+cE as's o.i'w NOVEMBER 21, 2001 REVISED SEPTIC SYSTEM AS PER S C D H S NOTICE JULY 19, 2002 FOUNDATION LOCATION MAY 16, 2003 FINAL SURVEY . - R�.- C AREA = 19,512.42 sq. ff. 4 0.448 ac. • \ •NE>n e M� f S.C.D.H.S. No. R10-01 -0225 NOTES: ° ° i ^ 15 �0�� f Dk G / 1 . ELEVATIONS ARE REFERENCED TO N.G V.D. 1929 DATUM 68 \ L GAN. '" ♦� Cor zs off, a9 A oa"n Nc X5 N1Ne � Q'C Due N� NaT -e1's DeE � s �R� O�Q i�G fDUNN % DA - �Rl= o I 566 NS Yo/ - 221' MASDrvRr STEPS 1 66, 5 <�'/ GAR Ft EL=n s. . �15U /A ENTRANCE WAY E \ �A2 '\ C ICG' �,V� �IO1GP50N ^� Lo13473' N 67'15'10"1 O / 4 mm 70 oA"� s G� �D 1oo�c ry1 ' s l mo2 STORY MASONRY ` 8 <„ �✓ �n' HOUSE & GARAGE LET a \ F e°ONS Nb"s \ P'� yyOGDw�°5�ope' n Go 0 d�`'�y0;ry0 \\ -lC �0�1 \ TP .� �'NE s / WOOD ..EP S , 3P 1A A �7 ti N �� 0Q �� A 2$ �\ WDO\\CR R=25 00' �\ �J1 �� \ L=39 27' �oFc A �V rtio � 4r� � WNa A b I ()2,z5 IP4 O .: j A J, _1I. �\ \ PREPARED IN ACCORDANCE WITH THE MINIMUM . BY THE FOR AND SURVEYS q5 D ADOPTED \ BY hIE LI ALS AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND CO's TITLE ASSOCIATION O CO ^:I1/V6w�� latn O r 1r ,C� �O \ 7AND_ \ NNS UI, No 49660 j ON AHIS S RV ALTERATION DR ADDITION Joseph A. Ingegno TO THIS SURVEY Is A vON ORN OF SECTOR 7209 OF THE NEW TORN STATE EDUCATION AW. COYIC] dY iHIR BURVLY MAY NOT REARING Land Surveyor THE LAND SURVEYORS INKED SEAL OR / N EMBOSSED SEAL SHALL OT DE CONSIDERED EM O A vauA 7FL PY N0 C€"IFICATION9 INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY LOC Surveys - SObdMO ns - Site Plans - CPSstFs,hPD LOyouf Is PREPARED, AND CN HIS BEHALF TO THE TITLE COMPANY. GOVERNMENTAL AGENCY AND LENDING INSTITUTION TESTED HEREON, AND PHONE (631)727-2090 Fox (631)727-1727 TO THE ASSIGNEES OF THE LENDING INrn- MION CERTIFICATIONS ARE NOT TRANSFERABLE OFFICES LOCATED AT MAILING ADDRESS THE EXISTENCE OF RIGHTS OF WAY 1380 ROANOKE AVENUE PO Box 1931 AND/OR EASEMENTS OF RECORD, IF RIVERHEAD, New York 11901 RiVeiheOd, New YOik 11901-0965 ANY, NOT SHOWN ARE NOT GUARANTEED — -- — 21 -176F t , 3 QPT� J W 4 N G O q I4" _ - ® ti� ON Ic i f I Ei — - - - -- - � - Ehx1 � _ _ _ , —I , � - - - —, l I�- 1 lJ i J K1GW" UfOG `� - - - --- - - - ---- - - -- - - - — I I I i I " f trl Fva ow - N • dr✓�4 !� � �an r-:- N sld 2002 J� ; t�OF NEYJ yo I L = -. � L, I- - 1 � �y� R v o pAOFE5510NP 3 p, o � � I a : r 3 � w n w D i --i_`-- I � -^ E m 0 W � � -"-- Ix ( — _ t . 4 U � f _ i -- -� ��' • �! �I -i -- - r � flirt _ it� 1H --- - - - ----- -- - : ._ rr - II I to I is , � n 3 Y I I i 451, ir T Y, ILL.. ( I I '. 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