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Home My WebLink About25658-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, CERTIFICATE OF OCCUPANCY No: Z-27482 Date: 12/19/00 T~IS CERTIFIES that the building ADDITION Location of Property: 1652 BRIDGE LA CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 118 Block 1 Lot 4.1 Su]~division Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 17, 1999 pursuant to which Building Pezmit No. 25658-Z dated MARCH 29, 1999 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 DECK ADDITIONS, ALTERATIONS AND SECOND FLOOR ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WALTER SILBERNAGEL & ORS. (OWNER) of the aforesaid building. SUFFOLK CO~I~T~Z DEPART~%~T OF ~AL~{ ~_PPROVAL R10-98-0157 07/13/00 ELECTRICAL CERTIFICATE NO. N 537304 09/21/00 PLUMBERS CERTIFICATION DA'I'F~3 07/31/00 PERFECTION PLUMBING ~ ~gthoyized Signature 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. 25658 Z Date MARCH 29~ 1999 Permission is hereby granted to: WALTER SILBERNAGEL & ORS. 26 OLD WOODS ROAD SADDLE RIVER~NJ 07458 for : CONSTRUCTION OF A 2 STORY ADDITION & ALTERATIONS FOR AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. $100.00 FLOOD PERMIT INCLUDED IN FEE. at premises located at 1652 BRIDGE LA CUTCHOGUE County Tax Map No. 473889 Section 118 Block 0001 Lot No. 004.001 pursuant to application dated MARCH 17 1999 and approved by the Building Inspector. Fee $ 451.00 ~Au~nature 2/19/98 ORIGINAL TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Th£s application must be filled in by typewriter OR ink and submitted to the buildir inspector with the following: for new building or new use: 1. Final survey of .property with accurate location of ali buildings, property linea 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 i% lead. 5. Commercial building, industrial building, multiple residences and similar buildi 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 a Vpre-~xisting" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applican 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, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate ~of Occupancy on Pre-existing Buildinm - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ..... ....... ..................... ' .......... i .... ..... ..... cunt ~ It~b ~OOJ ~.0 o y T Map No 1000, Section .............. Block ...... ......... Lot..~.~ ~.~,¢;n~ ....... Subdivision .................................... Filed Map ............ Lot ................... Permit No ..... Date Of Permit ................ Applicant .......................... Health Dept. Approval .......................... Underwriters Approval .................... .. Planning Board Approval ...................... Request for: Temporary Certificate ..... Fee Submitted: $ ....................... APPLICANT New York State Depart' =.nt of Environmental Conservati Division of Environmental Pe~,,,~ts ............................. "~ ............. Building 40 - SUNY, Stony Brook, New York 1.1790-2356 Telephone (516} 444-0365 ~'~ Facsimile (516) 444-0360 John P. Cahill · Commissioner October 28, 1998 Walter a Mildred Sibernagel 26 Old Woods Road Saddle River, NJ 07458 RE= 1-4738-01891/00001 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 a~ the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather.' MEP/ls Enclosure Very truly yours, Marily~/~. Peterson Environmental Analyst DEC PERMIT RUMSER 1-4738-01891/00001 FACILITY/PROGRAM NUMBER(~) TYPE OF PERMIT · Mew YORK STATE DEPARTMENT OF ENVIRONMENTAL CON~ PERMIT Under the Environmental Conservation Law ~AT[ON EFFECTIVE DATE October 26~ 1998 EXPIRATION DATE(S) October 31, 2001 [] Renewal [] Nodificatlon [] Permit to Construct [] Permi~ to Op~ratq. J [] [] [] [] [] ArticLe 15, Tit[e 5= Protection of Waters Article 15, Title 15: Water Supply Article 15, Title 15: Water Transport Article 15, Title 15= Long island Wells Article 15, Title 27: Wild, Scenic and Recreational Rivers Other: [] 6NYCRR 608: Water Quality Certificatibn [] Article 17, Titles 7, 8: SPDES" [] Article 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamation [] Article 24= Freshwater Wetlands · Article 25: Tidal WetLands I~~- *A~ticLe 27," T'itt~?; 6NYCRR ............... 360= SoLid Waste Management D' Article 27, Tit[~-~i'6NYCRR 373: Hazardous Waste Management [] Article 34= Coastal Erosion Management []Article 36= FLoodplain Management [] Articles 1, 3~ 17, 19, 27, 37; 6NYCRR 3SO= Radiation Con[rot PERMIT iSSUED TO Walter and Mildred Sibernaget ADDRESS OF PERMITTEE TELEPHONE NUMBER TELEPHONE NUMBER (516) T54-6405 26 OLd Woods Rosd~ SaddLe Riverr NJ 07458 CONTACT PERSON FOR PERMITTED WORK Sarm~ets & SteeLmanr 25235 Main Road~ Cutchogue NAME AND ADDRESS OF PROJECT/FACILITY .... SibernegeL propertyr 1652 Bridge Lane LOCATIOR OF PROJECT/FACILITY Cutchoguer NY 119~5 COUNTY T~N WATERCOURSE J NYTM COORDINATES Suffolk Southo[d DESCRIPTION OF AUTHORIZED ACTIVITY: Construct an addition to an existing single family dwelling end install a new septic system. accordance to plans stamped NYSDEC approved. ALi work shall be done in By acceptance of this permit, the permit[ce agrees that the permit is contingent upon strict compliance with the ECL, alt applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. . ............. 'i ........... ' PERHLT ADMiNiSTRATOR: Roger Evens (MEP) AUTHORIZED SIGNATURE ADDRESS Building 40, SUNY~ Stony Brook, NY 11790-2556 October 28? 1998 Page 1 of 4 95-20-1 (8/87)--9d New York State Department of Environmental Conservation Permit Expiration NOTICE 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 iegarding the nature and ext~ent of work approved and a.'ny Departmental conditions on it, contact the Regional Permit Administrator listed below, please refer to the permit number shown when contacting the DEC. Number Date Regional Permit Admini:strator JOHN W. PAVACIC NOTE: This notice is NOT a permit KEY MAP HOG NECK BAY I.ITTLE llOG NECK CUI'CHOGUE HA~?BOR SITE NASSAU POINT Z LLI rt" SAILOR---y/ LA ZONE ZONE X WUNNEWETA ZONE X CLUB ZONE X HOG NECK ZONE AE (EL 8) LIT~ BAY BAYBERRY RD ZONE ZONE / ZONE AE (EL 8) ZOt ZONE X X NASSA[ COASTAL BASE FLOOD ELEVATIONS APPLY ONLY L~NDWARD OF O O NGVD ELEVATION CERTJFICA' ) O.M.B. No. 3067-0077 J~ FEDERAL EMERGENCY MANAGEMENT-AGENCY Expires July 31, 1999 [ . NATIONAL FLOOD INSURANCE PROGRAM ; ' AI-~ENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to pro- vide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper insurance premium rate, and/or lo support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME POLICY NUMBER STREET ADDRESS Includin~ ~,~ Uht~,. ~ulte an~or Bldg. Number OR P.O, ROUTE AND BOX NUMBER COMPANY NAIC NUMBER OTHER DESCRIPTION Lot afl~lJ~fock Numl~ers, etc,) SECTION B FLOOD~NSURAN~.RATE~_(FIRM) ~NFOBM~T~gH ..... ZIP CODE Provide the following from the proper FIRM (See Instructions): 1, COMMUNITY NUMBER 2. PANEL NUMBER 3, SUFFIX 4. DATE OF FiRM INDEX 5, FIRM ZONE 6, BASE FLOOD ELEVATION (In AO Zones, use depth) 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE):~'NGVD '29 []Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the (~ommunity has established a BFE for this building ~ite, indicate the community's BFE: I I I I ' J.L ~ feet NGVD (or other FIRM datum-see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 2(a). FIRM Zones Al~A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of I I I I I~I.IPJ feet NGVD (or other FIRM datum-see Section B, Item 7). (b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of l I I I I I.J [ feet NGVD (or other FIRM datum-see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is I I I.~ feet above [] or below [] (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is I I I.~ feet above [] or below [] (check one) the highest grade adjacent to the buildipg~ ..l_f. qo fJoo~l. ~lej~_th rlumb~_r [_s..~{a!lable, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance.'? [] 3. Indicate the elevation datum system used in determining the above reference level elevations:~ NGVD '29 [] Other (~.e.s.~ribe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on the FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: [] Yes J~ No (See Instructions on Page 4) 5. The reference level elevation is based on: [~ actual construction [] construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is:l I I [ I~--l.L~ feet NGVD (or other FIRM datum-see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1. if the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, item 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: I I I I I I.L~ feet NGVD (or other FIRM datum-see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81-31, MAR 97 REPLACES ALL PREV1OUS EDITIONS SEE REVERSE SIDE FOR CONTINUATIC~',I SECTION E CERTIFICATION This certification is to be signed by a land Surveyor, engineer, or architect who is authorized by state or lecal law. to certify elevation information when the elevation informatiofi for Zones AI-~AS0,-AE, AH, A (with.BFE),V1-V30,VE,.and_V.(with BFE) is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones AC and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the ~ertification. ' ..... Reference level diagrams 6, 7 and 8 - Distlinguishing Features-If the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not .~ The diagram number, Section C, Item 1, must included in the certification under Comments below, s~.~ I certify that the information in Sections B ~nd C on this certificate represents my best efforts to inte.~~. I understand that any false statement ~entunder18U, S,/~.~,_~,~f~_~ CERTIFIER'S NAME LICENSE NUMBER (or Affix ~) [ ~1~.~V I ~' I Copies should ,b§ n.e'ade of this Certificate for: 1)community official, 2)Insurance agent/company, and 3)building owner. /-- COMMENTS= ON SLAB A V ZONES ZONES I WITH ON PILES, BASEMENT PIERS~OR COEUMNS A A V 'ZONES ZONES ZONES BASE FLOOD ELEVATION The diagrams above illustrate the poi Elevations for all A Zones should be Elevations for all V Zones should be ~ts at which the elevations should be measured in A Zones and V Zones, neasured at the top of the reference level floor, neasured at the bottom of the lowest horizontal structural member, Page 2 :Albe~t J. KrUpski, President, Jamee King, Vice-President Henry Smith Artie Foster Ken Pollwoda Town Hall 53095 Main Road P.O. Box' 1179 Southold. New York 11971 Telephone (516) 765,18~[2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD November 19, 1998 Samuels & Steelman Architects 25235 Main Road Cutchogue, NY 11935 RE: SCTM#1000-118-1-4.1. Walter & Mildred Silbernagel Dear Mr. Samuels: The following action was taken at the Southold Town Board of Trustees meeting on November 18, 1998. RESOLVED, that the Southold Town Board of Trustees grant the request for an Amendment to Permit #4888 to construct a new, relocated sanitary system as requested by the DEC. However, this does not constitute approval from any other agencies. If you have any questions, please call our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:lms cc: DEC Building Dept Dept. of Health Dept. of State. Albert J. Krupski, President James King, Vice-President Henry Smith Arkie Foster I~en Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-18152 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 30, 1998 Samuels & Steelman 25235 Main Road Cutchogue NY 11935 Re: WALTER & MILDRED SILBERNAGEL SCTM #118-1-4.1 Dear Mr. Samuels, The following action was taken by the Board of Town Trustees durin'g its Regular Meeting held on March 25, 1998, regarding the above matter: WHEREAS, WALTER & MILDRED SILBERNAGEL, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated March 5, 1998 and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendatiD~,~w~ ......................... WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on March 25, 1998, at which time all interested persons were given an opportunity to be heard, .and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, dRESOLVED, that the B of Trustees approves the application of WALTER & MILDRED SILBERNAGEL to do renovations to !existing house and garage and construct an addition to housle with condition that applicant place haybales at the edge of wetlands during Construction. BE IT FURTHER RESOLVED that this determination sh6uld not be conside~ed a determination made for any other Department or Agency which may also have an application pending!for the same or similar project. , Permit to construct and complete project will expire two years. from the date it is signed. Fees must be paid, i~ applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: .None VerY'~rui¥ y~U~ Albert J. Krupski, Jr. President, Board of Trustees AJK/dJh cc. DEC ACE Dept. Bldg · of State Dept. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK ,EMIT NO. DATE: ISSUED TO ....... WA~bTER &. MILDRED S!LB.ERNAGEL Antl arizatian Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en~ titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted afa meet'lng held on . 3.!25/98 .... 19 98 , and in.consideration, of fhe-sum~of $ Samuels & St~elman for WALTER SILBERNA.~~ ...... o~ ...... ¢utchogue . . Terms 8nd Conditions Ii'fed on the reverse s~de hereof, o} Soufhold Town Trusfees ~ufhorizes end permifs fhe }ol]owing: Wetland Permit to do renovations to existing house and garage and construct an addition to house with condition that applicant place haybales at the edge o~ wetlands during const~uc~iQn. ~ll in ~ccordsnce wi*h fhe detailed specifications IN WITNESS WHEREOF, The s~id Board of Trusfees h~re- by csuses ifs Corporafe Ses[ ~o be 8ffixed, and fhese presenfs be subscribed by 8 msiorify of ihe Trustees _. TERMS and CONDITIONS WALTER & MILDRED SILBERNAGEL The Permktee residing at 26 O[~D WOODS ROAI3: gADDT,E PTV~P N,I flTAg~. .~. Y.~ pa~ of the co~iderad,)n for-~e ~ of. ~e Pe~t~d~ ~de~n~.~ p~ to ~e fo~ lowing: : 1. That ~e s~d B~d of T~t~s ~d ~e Town of ~u~old m ~l~ed from ~y all damages, or da~ l{or dmag~ of ~ta ~g ~y or in~r~y ~ a r~t of ~y o~- afion ~rfo~d p~t to ~s ~ ~d ~e ~d Pe~ w~l, at ~ ~ her o~ ~e, defend any ~d all su& ~ ~dat~ by ~d pa~ and &e s~d Pe~tt~ ~ ~ ~ wi& respect thereto, mi ~e ~mplete ~clusion of ~e ~d of T~e~ of &e Town of ~old 2. That ~s Petit h v~d for a ~ of 24 m~. w~ h w~d~ m ~ ~e es~ated time r~uired, w complete the work ~volv~, but ~ould dr~t~c~ w~t~g r~u~t for ~ ~enslon may ~e made to ~e B~d at a lat~ dam. . $. ~mt ~is Petit shoffid be reta~ ~definitely, or as long ~ &e s~d Pe~ ~ to maintain the stmc~e or pwje~ involv~ to provide evidence to ~yone ~ncem~ ~at or~ation w~ ori~lly obt~ned. 4. ~at &e work,I ~volved wRl be subj~ to ~e ~sp~on ~d approv~ of ~e ~d or its agents, and non-compHance with the ptovhlom of &e ori~na~g applicatio~ ~y ~ ca~e for revocation of this Pe~it by t~oludon of the said B~rd. 5. ~at &ere wR~ be no ~sonable interference wi& navi~don ~ a t~t of. ~e work herein aufl~or~ed. ~ 6. That there sbaU ~ no Mtefference wi& the right of ~e public to .pass ~d rep~ Mong · e beach be~een hi~ and low water m~ks. 7. That ff furore }operations of ~e Town of ~old r~u~e ~e r~oval and/or ~t~o~ in the location of ~e ~otk her~ aurora, or ~, ~ ~e opl~on of ~e Bo~d of T~e~ work sh~ cause unre~onable obs~on to free navigation, the s~d Pe~Ree will ~ u~n due notice, to remove or alter &is work or project herein stated wi~out ~ma to ~e T~ of Sou&old. 8. ~at ~e s~d Board WHI ~ nofifi~ by the Perigee m ~e cmple~on of ~e work or~ed. 9. ~at the Per~ittee will obt~n all other p~ and comen~ .~at ~7 ~ t~ ~ plemental to &is petit which ~y ~ ~bj~ to revoke upon f~um to ob~ sine. SOUTHOLD TRUSTEES Issued ~To/dli~._z.~Jte~A3~.J~ Date~P~' Address THIS NOTICE. MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y.! 11971 TEL.: 765-1892 corners or at approved intermediate locations. INSULATION Insulation to meet all requirements of NYS Energy Code, installed by a qualified subcontractor. Provide foil-faced fiberglass bart insulation of R-values noted. Comply with manufacturer's instructions for each type of insulation. Seal joints between units and around pipes, conduits, etc., to form an air tight seal and vapor barrier. Provide access for ventilation at all edges, and provide approved vents at soffits and as required. Provide 3-1/2" batts in walls between bedrooms and around bathrooms. Provide 6" batts in ceiling of first floor under bedrooms and baths. Carefully insulate around overhead plumbing waste lines to minimize sound transmission. BATT INSULATION Provide foil-faced fiberglass batt insulation of R-values noted. Provide access for ventilation at all edges, and provide approved vents at soffits and as required. WINDOWS Provide vinyl clad units by ANDERSEN, Inc. in white, with High Performance insulating glass, insects screens and all required hardware and fittings with a primed interior. Provide "New Andersen full divided light" with natural wood interior grilles and exterior grilles on all windows, with patterns as shown on elevations. WINDOW SCHEDULE TYPE UNIT Remarks A TW 2446-3 3 wide 6/6 B TW 21046 6/6 ~/C TW 21046-2 2 wide 6/6 D TW 2046 4/4 E custom arch top to match 21046 6/6 F TW 24310-3 6/6 G TW 20210 6/6 H custom arch top 1'-6" x 2'-6" J TW 2446-2 6/6 K C13 L Custom arch top transom to match width of assembly below, 7-5" unit width DOORS EXTERIOR WOOD DOOR Provide solid core wood door and jamb unit #5512 by SIMPSON, w/insulating glass and 7 SILBERNAGEL SAILOR-'-~/ LA ZONE ZONE X WUNNEWETA CLUB ZONE ZONE X HO~ NEOK X ZONE (EL 8) LITTI BAY RD ZONE / ZONE AE (EL 8) ZOI ZONE X X NASS~ COASTAL BASE FLOOD ELEVATIONS APPLY ONLY LANDWARD OF O.O NGVD SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to cattily elevation information when the elevation information for-Zones AI--.-AS0, AE, AH, A (with BFE),Vl-V30.,¥E,.and3/~(with BFE) is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. - Reference level diagrams 6, 7 and 8 - Distinguishing Features-If the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, Item 1, must~still be . I certify that the information in Sections B and C on this certificate represents my beet efforts to inte)~~. I understand that any fa/se statement may be punish~ CERTIFIER'S NAME LICENSE NUMBER (or Affix ~lr~ TITLE ~ COMPANYNAMB ~.~ I CITY / / ' / ' - S.'~-E''~ ZIP AgORBSS SIGNATU RE ~.._ gATE ~.r~. ~2~ _~ Copies should .b~'r~/de of this Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner. /-- ON SLAB A V ZONES ZONES WITH OH PILES, EASEMENT PIERS, OR COLUMNS A A V ZONES ZONES ZONES The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones, Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member, Page 2 , i ELEVATION CERT, IFICA', , O.M.B. No. 3067.0077 FEDERAL EMERGENCY MANAGEMENT AGENCY Expires July 31, I999 NATIONAL FLOOD INSURANCE PROGRAM A'I-rENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to pro- vide elevation information necessary to ensulre compliance w th applicable community f oodpla n management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). You ere not required to respond to this collection of information unless a valid OMB control number is displayed In the upper right corner of th s form Instructions for sompleting this form can be found on,the following :~egee. SECTION A pROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME i ~ POLICY NUMBER STREET ADDRESS (Includl~.~,~'t.,~ dnl~ Su~te and/or Bl!g. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot efi~l~lock Numbers, etc,) ZIP CODE 7. Indicat* tho olovatlon datum ~ystom used ~n th~ FI~M ~or Ba~o Flood ~lovattons (gFfi):~OVD '20 ~ Othor {dosertbo on 8. For Zono~ ~ or V, whoro no BFfi is provided on tho FI~M, 8nd tho community ha~ o~ta~li,hod ~ 8F~ ~or this bulldin0 ~ito, Indicato the community's BFE:[ [ I I ' ~.L~ fe~t NGVD (or other F RM datum-see Section B, tom 7), SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject bud ng s reference eve . 2(a). FIRM Zones Al-A30, AE, AH, and A (wi?h BFE), The top of the reference level floor from the selected diagram is at an elevation cfi I I I I~I,IP__J feet NGVD (or otheriFIRM datum-see Section B, Item 7). (b), FIRM Zones V1-V30, VE, and V (with BFE), The bottom of the lowest horizontal structural member of the reference level from the selected d agram, is at an elevation of I I I f L_J.~_] feet NGVD (or other FIRM datum-see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference eve from the se acted d agram s I I J,L~ feet above [] or below [] (check one) the highest grad@ adjacent to the building, (d). FIRM Zone AO. The floor used as the reference lave from the se acted d agram is I I I.~ feet above [] or below [] (check one) the highest grade adjacent to the b~ildl~g._ ..I)'.r!0_~l.o. od.~.e~!h r~umb_e._r !_s..~¥..a!lable, is the buildlng's lowest floor (reference '" level) elevated in accordance with the community's floodplain management ordinance? 'E~";Y~r-l'~Jo [] Unkh~)wh TM 3. Indicate the elevation datum system used in determ n ng the above reference eve elevat ons:~ NGVD '29 [] Other (descr be under Comments on Page 2). (NOTE: If the elevation datum used in measuring th~ elevations'is ~fi~ferent than that use~l~- the FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears onI FIRM: [] Yes ~ No (See Instructions on Page 4) 5. The reference level elevatlon is based on:~ actual construction [] constructlondrawlngs (NOTE: Use of construction drawings is o~ly valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid forth? building during the course of construction. A post-construction Elevation Certificate will be required once construction Is complete.) 6. The elevation of the lowest grade immediately adjacent to the building Is:l I I I I-%-J.L_~ feet NGVD (or other FIRM datum-see Section B, Item 7). i SECTION D COMMUNITY INFORMATION 1. If the community official responsible for ve¢ifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the "lowest floor" as defined in the cDmmunity's floodplain management ordinance, the elevation of the building's "lowest floor" aB deflned by the ordlnance is: I I I.LJ feet NGVD (or other FIRM datum-*see Section B, ItemT). 2. Date of the start of construction or subBtar rial improvement FI=MA Form 81-31, MAR 97 RERA( ES AU. PRE~OUS EDITIONS SEE REVERSE SIDE FC~ CONTINUATION 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] I~JJ.ATION [~'~INAL REMARKS: ] FIREPLACE & CHIMNEY DATE I NSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~'~ ~.~OUGH PLBG. INSULATION INSPECTOR 765-/.802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ R~~OUGH PLBG. [ ] FOUNDATION 2ND [ [ ~/~FRAMING [ ] INSULATION ] FINAL [ ] FIREPLACE & CHIMNEY DATE: INSPECTOR~~ f~,~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [//]~OUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY I NSPECTOR~~ 765-1802 BUILDING DEPT. , N PECTION [//J FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY DATE ~/~/~'?~~' INSPE~TO~ Is'r) UI~IDATION= (_2_Nl)_~) ..... ,UGH FRAME & PLUMBING ISIILATION PER lq. Y. STATE ENERGY CODE __Il FINAL ADDITIONAL COI~4ENTS: Town Hail, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Fax (516) 765-1823 Telephone (516) 765-1802 July 21, 2000 Thomas Samuels 25235 Main Rd. Cutchogue, NY 11935 RE: silbernagel, 1652 Bridge Lane, Cutchogue. To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: ~ for Certificate of Occupancy is X__~_X An application not on file. (Enclosed) '~d XX xx No Underwriters Certificate on file. The check is (not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 25658-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. TOWN OF SOUTHOLD APPLICATION PAGE 1 of 4 FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. ~_~CTION 1: GENERAL PROVISIONS (APPLICANT to read and sigm): 1. No work may stun 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 C(3mpllance is issued. 5. The permit will expire if no work is commenced witkin six months of issuance. 6. Applicant is hereby informed that other permits may be reqtfired to ftdFdl local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasouab'le inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO . THIS APPLICATION ARE, TO THE BEST OF M~UE AND ACCURATE. SECTION 2: PROPOSED DEX/ELOPMENT (To be completed by APPL1CA/,FFJ. NAME ADDRESS TELEPHONE BUILDER ENGINEER ._PROJECT LOCATION: To avoid delay ia 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. l(,~'z ~,~/D~z~ ,a6W~ ~/d~a,~ ,~,~. '~4~ ,'ffz¢,o ~ /.o~ - ?/~ - /.-- ¢, I FDP(93) AI'PLICATI ON # PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY ID New Structure ~Addition [] Alteration [] Relocation [] Demolition [] Replacement STRUu-~FURE TYPE ~Residential (1-4 Family) [] Residential (More than 4 Family) [] Non-residential (Hoodproo£mg? [] Yes) [] Combined Use (Residential & Commercial) [] Manufactured (Mobile) Home (In Manu- factured Home Pm'k? [] Yes) ESTIMATED COST OF PROJECT B. OTHER DEVELOPMENT ACTIVITIES: UI Fill [] Mining [] Drilling [] Grading [] Excavation (Except for Structural Development Checked Above) [] Watercourse Alteration (Including Dredging and Charmet Modifications) [] Drainage Improvements (Including Culvert Work) [] Road, Street or Bridge Construction [] Subdivision (New or Expansion) )~lndivldual Water or Sewer System [] Other (Please Specify). After completing SECTION 2, APPLICANT should submit form to Local Administrator for rev/ew. ~SECTION 3: FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: [] Is NOT located hi a Special Hood Hazard Area (Notify the applicant that fine application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). [] Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft, NGVD (MSL) [] Unavailable [] The proposed development is located in a floodway. FI3FM Panel No. Dated [] See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 S_ECTION 4: ADDITIONAL INFURIATION REOUIILED (To be completed by LQCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: [] A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. [] Development plans, drawn to scale, and specifications, including where appl~cablo: deta/ls 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 ['~rst floor and details of enclosures below the first Boor. Also, Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant mud;t_ provide 100-year flood elevations if they are not otherwise available). [] Plarm showing the extent of watercourse relocation and/or landform alterations. [] Top of new Fill elevation Ft. NGVD (MSL). [] Floodproofing protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certiflcatlon from registered engineer or architect. [] Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in ~ increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. [] Other: S~ECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINI$'I'I/ATOR) I have determined that the proposed activity: A. [] Is B. [] Is not M conformance with provisions of Local Law # , 19 attached to and made part of this permit. · The permit is issued subject to the conditions SIGNED , DATE I_f BOX A is checke~d, the Local Administrator may issue a Development Permit upon payment 6f designated If BOX B is check~d_, the Local Administrator wl]l provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from' the Board of Appeals. APPEALS: Appealed to Board of Appeals7 [] Yes [] No Hearing date: Appeals Board Decision --- Approved? [] Yes Conditions [] No 'APPLICATION PAGE 4 OF 4 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 application). Complete 1 or 2 below. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal Hli~h Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (A~-Buil't) Elevation of floodproofing 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 tiffs section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? El YES [] NO DATE BY DEFICIENCIES? [] YES [] NO DATE BY DEFICIENCIES? [] YES [2 NO SECTION 8: CERTIFICATE OF COMPLIANCEfTo be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: I;ORH RO. I 'I'O}/N OF SOIJTIIOJ.I) BUII.IIlNO I)EI'ARTHENT 'l'Olilq lIMA. SOUTIIOIA}. N.Y. 11971 TF, I.: 765- lBO2 BOARI) OF IIF, A1,TII ............... 3 SETS OF PLANS ............... SURVEY ....................... ; CI1EGK ......................... SEPTIG FORH .... ,r .............. NOTIFY'- CA1 .l ................... HAll, TO: .................... ' t I N.qTRUCTI ONS ic~ mint be c{a~letely {:illc~l in by ty~riter or in ink m~l mllnnitL~ to the I~tilding lnsl~eLor 3 ~ts oF plans, ac~rate plot IRan Lo ~ale. F~ according to ~d~;le. b. Plot plan ~h~ I{ratlm of lot ~1 of l~dldiigs ~ proni~s, relatlon~dp to mljoln{ng pr~iseg or sit. ts or areas, m~l glvl~ a ~tall~ {~scr;ptlo~ of layott of pro~rty mist lm drmm ~ the tha~m c. 'lhe ~rk e~r~ by this al~flm~t~ ~ t~)t I~ c~tm~l I~fore ~smml~e"~[ ~dldi~ Pe~mit~ d. UI~ a~r~al of this nl~licati~, tl~ l~dldit~ Ins~ctor uill ismm a ~ilding Pemit to the applicant. ~<h I~[[l[g. MmlJ. I~ ~pt ~ tim ~l~fi nvailM)l'e '~¢ lns~tlo~ rhro~x~t the x~rk. e. ~> lmildls~ rJmll Im ~o}pi~l or u~l in O~le or in ~rt for any ~t~)~ ~mt~er ~:til a C~rtifleate of {~o}~y ~ml] hm¢ I~n granL~ by ~ ~ilding Insurer. . .................. , ' " ' ~ for the i8~q~e of a ~tilding Pemit ~;rm;ant to rite ' 1 I~lld'r;g 7~ ~imatme of tl~ T~ of ~tlmltt, ~[folk ~mty~ ~ Yo~ n~ other a~lieab e I~8, ~di~k~es or ~lati~m, for tim c~ast~ti~ of hdldi~s, ~Miti~s or alterati~s, or for r~al or ~mlition, ns herein . ~, l~slng e~le, nmi '1 {~8crl ~. ~ applicant a~s to co~ly with all a~lleable 1~, ordl~eS, Imildi~ relgdati~m, at~l to ~uit mstl~ri~ insl~tora ~ I~r~ti~a ami in Imildin 'or (Sig~ture of a~licant, or m~, if a co~ratlon) (roiling ~ress o[ a~licm~t) //~ ' . ' ' ~ l~hler StaLe O~eO~r a~liem~t is.~r, les~, agent, arclnt~t~ engi~r, g~ral cq~tractor, elecrrmim .$~.~ : .......................................... ~& ~ ~~ ~~~ .......................... ~e of ~r of ~l~s ............. '" (as ~ tl~ tax mil or latest de~) If al]*llc*nr is a ~r~rati{m, si~ature of duly ~tlmri~l officer. (~.~ m~l title of corporate off me ) l~dlders l,icense No .......................... Plt~d>ers 13cerise I~o .......................... F. lecrri.cians l,Jceuse Ho ....................... OOmr 'l¥,~e~s 1,icmw~ ~ ..................... I. ' hxm~i~ o[ la~l ~ ~d~h ~xm~l ~r~ ~ill I~ ~ .......... = ........ ' ............................... ~ ......... . ~ ~.'~ ~ ~ ~ ........... ~(~.~ ............................... - · - ............................................... I~et 1~ B~l~r St~t ~,,,,,~ ~ ~,~ No. m, ~, .W.~ ......... ,"~ ...... ( ......... '"~ '"~'~ ....... ~lxlivisi~.. ..................................... Fil~ gap ~ ................ l~t ............... 2. SI.ate existi~ u~ md ~o~a~ry of ~i~s a~l.inte~ use m~l ~ of propel e~stmct~on 3. IX~t)l i t ica1 O{Imr l&n k · '. (l~x~ of iiKllvhhml algnh~g e.(mLraeL I~~. J!t IlK; .................................................................................................... ((k~llractor. nl;elll', }iix,ale of[Jeer, cie.) nlq)l iv~itle.; thnl. all ~tamr~rJta, , ilhorJzed Lo I~forul or hnve i~rl'or,led the ,.mJ(I ~)rk taxi to nuke inK), file Iht, iix,(I i. Lhl.q nlq)l i(:nt:ion ale I t~K~ Lo tile Ira,i: el-Ilia kixwaledj;e mKI IX~I ief~j),m~l lllaliIK~r .qeL [orLh ii~ tile nppllt:et:ion riled therewiLh. (,~il;.nl.ure o1~ ^ppi Jenut ) ~ clearly m~l (llstit~ctly ~ i)rolmty linea. Give street nix ihteri'or or comer lot. ' ' ~,-i,,,,~ (~,.,: ..-....~ .... , ......... ~ ..... : ........................................ · : / l[ ¢~lJJnJ]. l~ilJ~r of {~lll~junila ............ tl~d~r of {~JJJn8 tndl'a Jul each fl{x~r ................ KmJmr of 8lorJea ..................... . d<k [~mi~r or (bscripti~ 8ccotdin8 to ~1. m~ ~ street [~$ arRI ialicnte