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HomeMy WebLinkAbout29674-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29736 Date: 09/29/03 THIS CERTIFIES that the building ALTERATIONS (aka 2 Bay Road) Location of Property: 20 BAY ROAD GREENPORT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 43 Block 5 Lot 14.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 15, 2003 pursuant to which Building Permit No. 29674-Z dated AUGUST 26, 2003 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 ALTER EXISTING PORCH TO SCREENED PORCH AND CATHEDPJkL CEILING "AS BUILT" ON AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. CONSTRUCTION CERTIFIED BY ENGINEER. The certificate is issued to ROBERT A ABRUZZO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELRt-rKICA~ CERTIFICATE NO. PLUMBERS CERTIFICATION D~r~a3 Rev. 1/81 N/A N/A N/~ FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PEP34IT NO. 29674 Z Date AUGUST 26, 2003 Permission is hereby granted to: ROBERT A ABRUZZO 36 BROMPTON RD GREAT NECK,NY 11021 for CONSTRUCTION OF AS BUILT ALTERATIONS AND DEMOLITION OF AN EXISTING AS BUILT DECK AS APPLIED FOR WITH FLOOD PERMIT at premises located at GREENPORT County Tax Map No. 473889 Section 043 Block 0005 Lot No. 014.002 pursuant to application dated AUGUST 15, 2003 and approved by the Building Inspector to expire on FEBRUARY 26, 2005. ~ / Fee $ 462.90 ~ ~/~ Auth :~d Signature Rev. 5/8/02 COPY Tf~VVN OF ~C}I'}'THfH ,1~ Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT ,~C,F,, ? 6 ~03 TOWN HALL i ~ 765-1802 ........ ~ '...'~2 ~ ~)~_..~A~PLICATION 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: 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. C0~rnercial building, industrial building, multiple residences and similar buildings and installations, a certificate o~ode Compliance from architect or engineer responsible for the building. ,,- 6. Submit Planning Board 3~p~ov.al of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land ~/sd~.. 1. Accurate survey 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 thc reasons therefor in writing to the applicant. . ~. ' C. Fees 0'"' 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming po~l $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $58~00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy- $.25 4. Updated CertificateofOccupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: Old or Pre-existing Building: Location of Property: ~O "~i~ (checkone) House No. Street Owner or Owners of Property: ~ ~ ~.~e,- /~.. ~-~'*~a;~"l,.~9 Hamlet Suffolk County Tax Map No 1000, Section Subdivision Permit No. '/_.a[ l,~ -[ ,,{ Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ,'h~<~ ~ Date of Permit. Block --~ Lot Filed Map. Lot: Applicant: C.,. [~.~ f~ ~.~4J'~ O [ ~, ~,*-~ Underwriters Approval: Final Certificate: (check one) PROFESSIONAL ENGINEER 1725 HOBART ROAD / PO Box616, SOUTHOLD, NEWYORK 11971 TEL631-765-2954, FAX631qi14-3516 · e-mail: joseph@fischettLcom Building Inspector Town of Southold Main Road Southold, NY 11971 Date: Reference: September 25, 2003 2 Bay Avenue / Abruzzo Dear Sir, I have inspected the screened porch and the vaulted ceiling completed for the above referenced property. To the best of my knowledge the work has been completed in accordance with the New York State building codes at the time the work was completed and in accordance with the submitted plans to the Building Department. Joseph Fischetti, P.E. AUG-29-2003 09:32A FROM: TO: 183176S9S02 FEDERAl EMERGENCY MANAGEMENT AGENCY NATIONAL F~'OOD INSURANCE PROGRAM ELEVATION CERTIFICATE .Important: Read the instTuctlom; on pa~les I · ?. SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER'S ~ BUILDING STREET ADDRESS (including Aket., Unit, Svi~o, and/or B~. No.) OR P.O RO~ ~D PROPER~ DESCRI~I~ (Lot and B~ N~m, T~ Par~l Numar, L~I D~p~, ~.) -- BUI~ING USE (e.g., ~nflal, Non-~entlal. A~i~, A~O~, ~. U~ a ~ ama, ~ ~a~.) ~TI~ D~ONG~DE (O~IONA[) HOR)ZO~AL ~M: SOURCE'. ( ~.~'.~.~ or ~.: ........ ~ ~D1927 ~19~ ~ USGS Quad Map P:2x2 IO.M.B, No. 3067-0077 ExpiresJuly31,2002 Ft~ tm.u~aP~, cempa.y use:.. Policy Number C, oml~fly N/dC N,~mlc~, , .:: 71p CODE J I Other: SECTION B - FLOOD INSURANCE RAT.,E, M. AP {FIRM) INFORMATION bbl.NFIP COMMUNITY NAME S CoM~U-N'i;I~"N-U-M~ER J SS. STATE ~.~ COUNTY NAME $o ~. ~ AND P~EL BS. SUFF~ ~. FI~ IND~ B7. FI~ PANEL ~. FL~O I B~. ~E FLeD E~VATION(S) NUMAR ~TE EFFECTJV~$ED ~ ZONE(S) J (Zo~ AO. ~ de~h of floWing) B10- IndJ~te ~e SO~ 0f the Base Flood Elevaton (GFE) data o~ base fl~ deP~ ~nter~ in ~ PiS ~ro~Je ~ FiRM ~ Communi~ getemined U ome~ B11. Indicia ~e elevation ~tum u~ for~e BFE in Bg: ~ NGVD 1~9 g ~VD 1988 ~ Other B~ 2. Is the building Io~l~ in ~ Coss~l B~ier ~our~s Sy~Jem (CB~S) ~a or Othe~s8 Prol~ ~a (OPAl? ~ Yes J~J No Designation Date'. S~CTION C - BUILDING ELEVATION INFORMATION (SURLY REQUIRED) C1. Building elevations are based on; ~Cons~cfion Drawings' J~Building Under Constm~n' ~FJnJshed 'A n~ Eleva~on Ce~ficate will be ~uired ~en constm~ion of the building is ~mplete. C2. BuilOing D~g~m Numar ~ (Sel~ ~e building ~iagram most similar to the building ~or whi~ ~is ~F~te ~ being ~pleted - see pages 6 end 7. If n~ diagram a~u~tely repms~ts ~e building, p~ide a ~et~ or photograph.) C3. Elevations - Zones A1~30, AE. AH. A (with BFE), VE. V1-V30, V (with BFE), AR, A~A, A~AE, A~A1-A30, A~AH, Co~ple[e Items C3.a-i ~1~ a~rding to ~e bui~ing diagram s~5~ Jn Item C2. State ~e datum u~d. If the datum is dl~nt the datum u~ ~r ~he BFE In S~lon B, ~n~ ~e datum to that used ~ the GFE. Show ~eJd measurements and datum ~nve~on ~lculation. Use the spa~ provi~ or ~e C~mcn~ area of Se~on D or ~Uon G, as appropriate, to ~ument ~e datum ~nve~on, Datum M~ I~ ~ Conve~i~Commen~ Elevation refemn~ ma~ u~ed ~ea ~e elation mferen~ ma~ us~ ap~ar on ~e FIRM? I_1 Yes ~ No U a) Top of ~U~ floor (In~udlng ba~menl ~ e~losum) O b) Top of ne~ higher O c) B~om of ~west ~dzon~l stm~uml ~mber ~ z~es only) O d) AEa~e0 garage (top of slab) O e) L~esl eleva~n of ma~ine~ an~or ~ulpme~ sewi~ng the building (De~be ~ a Com~ ama.) Ofl Lowest adja~nt (~nished) grade (~G) O g) Highest adja~t (fin~he~ gr~e (HAG) U h) No. of ~anent o~nings (~ ven~) ~thln I R. a~ adja~nt grade O i)T~lamaofall~ane~o~lngs(~n~)inC3.h ~/~ sq. in.(sq.~ SECTION D · SURVEYO~ ENGINEER~ OR ~CHITECT CER~FICATION T~ls ~Uon is to ~ sign~ and ~aled W a land suweyor, engin~, or a~ a~o~ by law to ~ e~va~n I ~ that the Ink.aEon in ~ectiona ~, B. and C ~ ~is ~iF~ele mpm~ my bezt e~ to mte~mt~e date avalla~o_ I undc~t~d that any fal~e sta~menl may ~ puni~he~e by fi~ or impSsonment u~er 18 U.S. ~e Sec~ CITY ZIP R I V ~.'~ ~'a]~ · 7Z7 SEE RE~E ~IDE FOR CO~INUATION REP~CES ALL PREVIOUS EDITIONS AU~-2D-200~ 08:44~ FROM: TO: 16~17659502 p:~x~ August 27, 200.3 Ch~o'! Mulho[laad For Abruzzo, ~ al. 2G&-28 73rd Ave S,,it~ 2 0l~ Ouka, NY 11004 Dear MulhollancL This letter is to ~rti~ that th~ cxilt!in~_ dc~;k that |$ toc. atcd at the r~r of thc above refetenclxl prop~r~y caa not mcat the rcquir~uclaks of thc FIdMA zcgulatiom; heinff, installed belo~ the Va ¢l~ltdon of I I fee. C.. If you ba~c any cluc~ion~ re~arding this molter, ' BUILDING PERMIT EXAMINER CHECKLIST APPLICANT: ~ZEo SCTM# DISTRICT: .1,000, SECTION: ~3 _, BLOCK: ~ ADDRESS: ~Z)o~ ~oc~ CITY: Gp-r-. BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N BP~-Z / C/O Z- '2q lg ,1NFO .rc/d _/BP BP '~'g .'tO _-Z/C/0 Z- ,~'g ~, INFO ,orO~ /BP SINGLE & SEPARATE CERTIFICATION-REQUIRED DATE REVIEWED: ~ L25'/03 DATE SUBMITTED: ~' /j~/03 , LOT: }~.Z SUBDIVISION: ZONING DISTRICT: p,.tlO_ CONFORMING?~ -Z / C/0 Z- INTO -Z / C/0 Z- INFO NOTES: LOTS 40,000SF -100-24. Lot recognition(CREATED before June 30, 1983), UNDERSIZED I.OTS FROM JAN.1997 100-25. Merger.(A n0nconfonning at any time after REQ. LOT SIZE: ,'/viz;. ACT. LOT SIZE: ~ REQ LOT COV. ~ACT. LOT COV. REQ. FRONT jPROP. FRONT · REQ SD/I~ /' ACT>.SDE / PROP. REAR ~ ~ ./ PROP. tIEIGHT.,~-'/ REQ. REAR PROJECT DESCRIPTION: ~'1'~^_./~ ~}~ .1~, ESTIMATED PROJECT COST: ~t_~_ ARCItlTECT/~: ! WATER FRONT? ¥~"~ DESCRIPT1ON:~ ~PF, ~lk!0..~a'x~ ~ PANEL # APPROYALS REQUIRED SUFFOLK COUNTY IIEALTII D~'T: YES or ~(BED #): TOWN SEPTIC RECEIPT: Y o~_~/ NE~¥ YORK STATE DEC: !,1~4)~c ~/~/vs YES or NO DTE: SOUTHOLD TO'WN TRUSTEES: ~ES orO DTE: TOIVN ZONING BOARD APPROYAL: 5 ,E,S o~.~ DTE: TOVCN PLAN. BOAR1) API'ROVAL: YES oI'~_,,~ DTE: TOWN ItlSTORICAI. PRE (SPLIA): YES o1~ . FLOOD ZONE'~ ~- DTE: __/_.__/._~ PEiLMIT #: / / / / / / / / PEPdvl IT #: PERMIT #: PERMIT #: P EE2M lq' #: NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2): YES or NO ~,~t~. oohto ~' NOTES: FEE STRUCTURE: FOUNDATION: _-lji~P' SF FIRST FLOOR: _,29._~-7D SF SECOND FLOOR: ~/,~' SF OTHER: SF TOTAL: ~~ SF 1.(5-q?_ SF)-(_ ~ SF): ~ SFX$ '~ =$ 3. ( SF)- · SF): SF X $ :$ +$ INIT OTHER TOTAL FEE FEE FEE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGHP~. [ ] FOUNDATION2ND [ ] INS~ATION [ ] FRAMING [ ~/"FINAL ] FIREPLACE & CHIMNEY JUL-23-2003 1E:15P FROM: "'~ OF ~OU'fHOLD RIm~DINC DEPM~TMENT TOWN ~LL ~OUTHOLD, ~Y 11071 TEL: (~31) 7~]802 FAX; (631) 76~9502 TO: 1631614::5516 BUILDINO PERMIT APPLICATION CHECKLIST phm~i~ Bo~r4 approval N.Y gD B.C. AUG Dam .. ,2~ .... LNSTRUCTIONS ~ of plato, a~q'~ plot plan to h. PIo{ plan c~ ~e w~k cuv:~ by ~ aa~licuhon ~y not bo commenced betbre Jgq~ll~ Of ~O~d~ P~l~L. ad~tion six [n~ Slate whether appliolmt is 0wR~r, l~t'~, ugcmL architect, engineer, gene. ral mmtnuelor, clcclriei~m, pImllber or builder (As on the .,x roll c~'~ ~ deed) JUL-~3-~005 l~:15P FROM: TO:lG~lG14551G P:5~5 2.' .~mte ex4sting mm md uuuupanuy u £ im,'mJsc~ and intun~od we m~upmcy u£ propoa~l uueslruotion: Acidifies _Other ~ ....... A. Itcration (Description) ('1'o he paid on filing this appliuation) Numbs' of dwelling units on each floor If buMna~a a~mmcv.'ial ur mixtxl o~.~upmey, ap~.'ify nature and exLant ofu~h type of u$¢, 7. Dimcatsions of existing str~ctm~s, if re{y; Front Rear Height Number of Stories. Dimensions et same structure with alterations or additiona: Front Depth Height 8. Diill¢ll$iOtl$ et' ¢atire new construction: Front Hel0tlt ..... Number 0f Stories 11. Zone or usc di~rict in which prmisc, s sro situates .... Depth Rear Number of ~tortoa Rc~ _Do'pt h __ _Depth 12. Dous pti,posed cunslru<iion ¼elate any zoning law, oalinanc= ~ regulMhm? YE~ NO~ 13. Will Iol hu r~adcd? YES NO ~ Will cxccss ~ll be r;~ovcd ~om p~isga? YES .... NO Name ofMchitecl%/~ ~ ~~ Addre~_{~O~/~ Phone No ........... 15 a. is tMs propeety within 100 fca of a tidal wetland or a fxc. zhwatcr wetland? *YES__NO __ * IF YES, SOIITIIOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REC)IIIRED. b. la this prop~.'rty wilkin 300 feet of a tidal wugm~d? * YES NO * IF YES, I').~.C. PERMITS MAY I~E REQI~RED. 16. Pl'ovid¢ survey, to $c~1¢, witlt accurate f0~ldatiOtl pla:x and distances to propezcy lames. 17. If clcvafion at any point on property is at 10 fcct or hclow, must pm'vldc topn&maphical data on survey. of said owner or owner% mat is duly au~odzed tu perform ur Imv ~ laS.to mi~. th~ said wurk md to muk~ and file th.ia application timt all atutentcnta ~:uniuined itl tiffs application arc tra~ to thc Ix~t ~tf h]~kT, owlcdRo and belier] and that the work will he p,xformcd m thc wag~¢r Set fuulll in ~hc application tiled iherawith.~ ~ Swm-nto.befolemetlfis/'~ k k ~ No. 01 B06020932 Qualified in Suffolk Counly . Term Expires March 8, 20 07 AP?LICATION # PA©E Iot 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMFT A~PPLI(iATI()N This form is to be filled out in duplicate. ~LE(.'TIQN 1: GENERAL PROVIS~IONS (APFLICAJTF to read and 1.. No work may starl until a permit ii issued. 2. The permit may be revoked ff any false statements are made herein. 3. If revoked, all work must cease until permit ii re-issued. 4. Development shall not be used or occupied until a Certificate o( Compliance ii issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby iMormed that other permits may be req~h-ed to flfll',ll local, state a~d federal regulatory requkcmeats. 7. Applicant hereby givei comse~t to the l.a>=al Administrator or his/her representative: to make ~easonable inspections required to verify c~mp!l~-c& 8. I, TIIE APPLICANT, CERTIFY TI-1A.T ALL STATEMEN'I'~ HEREIN AND l/q ATTACIiM .ENT$ TO . THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGF~ TRUE AHD ACCURATE. SECTIQN 2: PROPOSED DETVELOPMENT (To be completed by APPLICAihW} NAME AJ'P LICAIqT BUILDEI~ ~GI~ ADDRESS TELEPHONE 7/$- ~6',,7 -?~¢,) To avoid delay ia preceding the application, please provide enou.~h information to e.a.sily identify the project location. Provide the street addre.sa lot number or legal description (attach) ~nd, outside urban areas, the dkta~ce to the ncai'est ~ters¢ciing road or wcll-know~ l~dm~rk. A sketch attached to this application showing thc project loaadon would be helpkfl ARPLICATION ~ PAGE 2 OF ~ DESCRIPTION OF' WORK (Check all applicable boxcs): A STRUCTUR~AL DEVELOPMENT ACTIVITY O New Structm-¢ [~dditioa teration Delocation em01idon [] Replacement ,STRUCTURE Zesidendal (1-4 Family) [] Residential (More than 4 Family) [] Non-residential (Floodproofing? [] Yes) [] Combined Use 0~esiden6al & Com~nerdal) [] Manufactured (Mobile) Home (In Manu- factured Home P~k? C] Ye~) cJ E.TFIMATED COST OF PROJECT $ ~'g~°,50/'~'O~ .,,4,5 ,~ /x~' /ocSxO../~/r",5' /' B. O~ER DE~LOPME~ El F'dl El Mining El Drilfiug r'l Grading El Excavation (Except for Structural Developmeut Checked Above) · {3 Watcrcourae AItexatiou (Including Dredging and Channel Modillcatio~ I-I Drainag= lmprovementa (Including Culvert Work) El Road, Street or Bridge Coustructiou [] Subdivision (New or Expausinn) [] Individual Water or Sewer System [] Other (Please Specify)_ After completing SECTION 2, APPLICANT should submit form to Local Admktistrator for rdvia-w. ~ECTION 3: FLOODPLAIN DETERMINATION rte be completed bv LOCAL ADMINISTRATOR) The proposed development is located on FI3RaM Panel No. , Dated The Proposed Development: [] Iz NOT located in a Special Flood Hazard .~rca (iqofi.Cy the applicant that the appLication rc~4ew ix complete and NO FLOODPL,AdN DEVELOPMENT pER/vflT IS REQUDq. ED). [] I~ located in a Special Flood Hazard Aa-ea. FIRM zone de.qignatlon is 10e-Year flood elevation at thc site b: Ft. NGVD (MSL) [] U uavailablc [] The proposed development is located in a floodway. [q3FM Panel No. Dated [] Sec Section 4 (or additional ins~rucllons SIGNED DATE APPLICATION PAGE 3 OF 4 .q_ECT[O~' 4: ADDI~TIONAL!NFOP'%4AT!ON RE~QUIRED~(_To be com~D~3.1e~cd by LQ~CAL ADMINI~ Thc applJctm must submit thc documents checked below be[ore thc applica6on can bc procez, sed: A site plax, showing the location of ail c~stmg struclm"es, water bodies, adjaccm roads, dimensions and proposed development. [] Development plans, dravm to scale, and spedficatkotm, iacludiag where appEcabl¢: details for a~choring structures, proposed elevation of lowest fluor (including baaement), tS,~es of water resistam materials used below the fLrst floor, details of floadprooPmg of ud/~ties located below Lbo £u'st floor a~nd details of enclosures below the t-u-st fluor. Alsa~ Subdivision ar other development plans (I[ the subdivision or other development exceeds 50 lots or 5 acre~, whichever i~ the lesser, the applicant mutt provide tOO-year flood elevatiohs it' they arc not otherwise available). El Pla~ showing the extent of watercourse relocation and/~r landlorm alterations. Top of new fdl elevation Ft. NGVD (MSt). Floodproo£mg protection level (non-residential only) Ft.' NGVD (MSL), For lloodproofed structures, applicant mu~t attach certification {rom registered engineer or architect. Certification from a registered engineer that the proposed ac. ljv/ty in a regulatory floodway will no~, re4ult in ~ increase b. the height of the J.00-ye~r flood. A copy of all data and calculations supporting this £mding must also be submitted. [] Other: ~ECTION 5: PERMIT D[TI~R/vIIHATION (To be .complc~ed bY LQ(TAL ADMINISTRATOR} I have determined that the proposed activity:. A. ~ L~ B. [2] Is not in c~ofotraance with provLqion$ of Local Law # , L9 attached to a~d made part of tiaa permit. SIGNED , DATE · The permit is i~ued subject to the conditions [f BOX A i~ checked, thc Local Admimstrator may L%ue a Development Permit upon payment of designated ff BOX 13 Jt check&_d_d, thc Local Administrator will provide a wrltleu summary of deficiencic& Applicant may revise and resubmit a~ application to thc Local Administrator or may request a hearing (rom the Board of Appeals. APPF_~d~S: Appealed to Board of Appeals? [] Yes [] No Hearing date: Appeals Board D¢ciMoa - Approved? [3 Yes Coaditioms APPLICATION PAGE 4 OF d ~;EQ'TION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance k~ issued/ The following iaformafoa mtmt be provided for project structures. This section must be completed BY a registered profe~ional engineer or a liceused land surveyor (or attach a certification to this application). Complete 1 or 2 below. Actual (A~-Built) Elnvatiou of the top of ihe lower lloor, including basement (in Coastal Hi,th Hazard Areas, bottom of lowe,~t structm'al member of the lowest floor, excluding piling and columns) L~: Fr. NGVD (MSL). Actual (~-Built) Elevation of floodproo£mg protection b, FF. NGVD (MSL). NOTE: Any work performed prior to submittal of the above inlormation b at /be risk of the Applica~'t. ~ECTION 7: COMPLIANCE ACTION (To be completed Dy LOCAL ADMINISTRATO.W} Thc LOCAL A-DbllNISTRATOR will complete th~ section ~s applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? CI YES IZI NO DATE BY DEFICIENCIF-.S? Ul YES C] NO DATE BY DEFICIENCIES? CI Y-ES CI NO SECTION 8: (:ERTIF1CATE OF COMPLIM4¢EqT9 De completed DY LQC~AL ADMINI$'TKATOR'I Certificate o£ Compliance issued: DATE: BY: Attachment B SAMPLE CEKTIFICATE OF COMPLIA/~CE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZAJLD 32LEA (O%rI~ER MUST ILETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE O~NERS NAME AND ADDRESS: CHECK ONE: · '~,,~ A~f,~c>z~/) ~--/~ z, cO.b%'W BUILDING ~EXIS~NG BUILDING 0 VA~ ~D THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # _, 19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH TILE REQUIREMENTS OF LOCAL LAW #__~, 19__, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93)