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HomeMy WebLinkAbout23785-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-25969 Date: 09/15/98 THIS CERTIFIES that the building NEW DWELLING Location of Property: 14905 NEW SUFFOLK AVE NEW SUFFOLK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 116 Block 3 Lot 18.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 3, 1996 pursuant to which Building Permit No. 23785-Z dated OCTOBER 30, 1996 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 FRONT COVERED PORCH, ATTACHED TWO CAR GARAGE & SECOND STORY DECK AS APPLIED FOR. The certificate is issued to PAUL & MAUREEN CACIOPPO (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-95-0076 09/02/98 ELECTRICAL CERTIFICATE NO. N-431434 09/12/97 PLUMBERS CERTIFICATION DATED 07/28/98 BYRON PLUMBING & HEATING Building Ins Ctor Rev. 1/81 FORM NO. D 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) N923785 Z Date ...........1..!f .���.......................... 19..f..� Permission is hereby granted to: ... Q ........................................... f .. �� ✓....he.................................... .cT .l02 al/ .s..�!�l to ..........lG✓<✓..... ....... ;.... 1�;!rj wirfl .....2R4f....AAA..../3r.7A- ......,. .... .. .. i '"i at premises located at ..Tr � f :. r�/...'- ../J.F�-#�: 7r:QQ(a3.,��1�5?f4Zf d /..5�9..Q.�3'.... r r... 1 .... ........................................................ ....................................?f //?.//// ....................................................................................... County Tax Map No. 1000 Section ..11...�P.............p. Block ..... 3......... Lot No. ..�!:.I......... pursuant to application dated ......... ......,t......................... 19/..0.., and approved by the Building/�Inspector. Fee S...(�•• • . ..... .. . . . tiding Inspector Rev. 6/30/80 Form No. b p _f— • TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SEP f 41998 765-1802 LDD APPLICATION FOR CERTIFICATE OF OCCUPANCY WNF SU HOLD This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1� 1. Final survey of .property with accurate location of all buildings, property lines, ,JJ streets, and unusual natural or topographic features. G2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form) . %/ 3. Approval of electrical installation from Board of Fire Underwriters. ✓4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '.'pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 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 Building - $100.00 3. Copy of Certificate of Occupancy - _ .25C. 4. y Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . lew Construction. . I. m. Old Or Pre-existing Building. . . . . . . . . . . ..... .. ocation of Property. ( ,(,�5 . .. ..d:.£Ct/ Su`���C. . v�. . . . . .lu•EG✓.. . ...t. . . . . House No. Street y Hamlet )Ower or Owners of Property.. .. d..( (�L£!� . . �°fU/J (d. .�(.j. . . . . . . . . . . . . . . . . . . :ounty Tax Map No 1000, Section. . //A ......Block. .. 3. ... . . . . . . .Lot. . � (1 . r d� � . . . . . . • subdivision. . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . >ermit No 3.79._.S. ..Z. .Date Of Permit. . . . . . . . . . . . . . . .Applicant.O44L . � td lealth Dept. Approval. . . .. . . . . . . . . . . . . . . . . .Underwriters Approval. . . 'fanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . tequest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . Fee Submitted: $. . ... . . . . . . . . . . . . . . . . . F3.Pc SSJ3 . . . . . .. . . . . . . . . . . . . . . . . . APPLICANT co _2�CW6� L 98 G DEPT.F 5 tJTHOLD BYRON PLUMBING & HEATING, INC. 22 MUNSON LANE W. SAYVILLE, NY 11796 (516) 589-4847 JULY 28, 1997 Town of Southold Maui Rd. Southold, NY 11971 Ref.: Cacioppo Residence 14905 New Suffolk Ave.. New Suffolk, NY 11957 Building permit# 23785 To Whom it may concern: 1, Byron E. Withjack, a licensed plumber in the County of Suffolk, NY, being duly sworn, deposes an say: All of the above copper piping for the potable water supply system, which was installed pursuant to the above building permit has been installed with solder with a composition containing 95 %tin and 5 %antimony. No lead solder was used on this job site for the potable water supply system by me or any of my employees or agent. 4yreohE. Withjack Lic. # 1567-P // Cr•►ONQ NUNWOOK L— No.Notary Pubilc,elateof New Y OtCH6032187,Nasse CommisaionExptros Y/e un THE NEW YORK BOARD OF ,FIRE UNDERWRITERS PAGE 1 1195099 1 BUREAU OF ELECTRICITY 2 F— 85 JOHN STREET, NEW YORK, NY 10038 116 - 3 Date SEPTEROER 12,1"9`97 Application No.on file 13745597/97 N 431434 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicantnamedon the above application number in the premises of PAU CACIOPPO, 14905 NEW SUFFOLk AVE, CUTCHOGUE, PT"t in thefollowing hwation; ® Basement FXJ Ist FI. ® 2nd Fl. GAR/ATTIC/OUT .Section Block Lot was examined on SEPTEMBER 05,x.997 and found to be in compliance with the National Electrical Code. FIXTURE" ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENL FLUORESCENT OTHER AML K W. Amt K W AML KW, ami K.W AMT. H.P. 41 37 45 1 41 ' 4 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ISPECIAL REC'PTj TIME CLOCKS I BELL UNIT HEATERS MULTI-OUTLET DIMMERS NAT. K.W. Oil H.P. GAS H P AMT. I NO I A W G I AMT I AMP I AMT I AMPS I TRANS.I AML I H P SYSTEMS AMT WATTS NO.OF FEET 3 F 1 I DISI 12/ -1 20 1 1 1 SERVICE DISCONNECT NO.OF S E " R V 1 C E METER NO.OF CC GOND. A.W.G. A.W.G. A.W.G. AMT. AMP. TYPE EQUIP. I�"t`M I SW 39 SW 30 aW PER.e' OF Cc.COND NO OF HREG OF HI-lEG NO.OF NE OF NEUTRAL 1 2@@ CB 1 X 1 4/0 1 1 2/0 OTHER APPARATUS: SPECIAL RECEPT. AMP.30-1 WELL PUMP-F-I PADDLE FANS-F-2 5 TON' A/C-1 3 TON A/C-1 MOTORSs1. F H.P. ,2--F H.P. ,1-5 HpP. F1.-3 H,P. i2--F H.P. PANELBOARDS:2-1 CIR. 60 G.F.C.Ic-9 <x< Continued on Paye 2 a>> GENERAL MANAGER S5 Per. This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING ,DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT SE ALTERED IN 'ANY MANNER. THE NEW •YORK BOARD. OF FIRE UNDERWRITERS PAGE 2 1195099 SURF,AU OF ELECTRICITY 65 JOHN STREET, `NEW YORK, NY 10038 6 b J O Date 8EPTEMBfR 12.,1997 Application No.onfile 18745897/97 N' 431434 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the atom application number in the premises of PAU CACIOPPO, 14905 NEW SUL'POLK AM, C-�UTCHOGUE, NY in thefollowinq location; R1 Basement ® I.st Fl. 0 2nd Fl. GAR/ATTIC/OUT Section Block Lot was examined on SEPTEMBER 05,1997 atyd found to be in compliance with the National Electrical Code. FIXTURE KEPTAClES 'SWI7CHE5 FIXTURES RAN fsES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCENT FtUORESCENi I OTHER AMT K.W. AMT. I K.W AMT KW AMT K.W AML N P. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ISPECIAL RECIPTI TIME CLOCKS I BELL JUNIT HEATERS I MULT[-OUTLET DIMMERS AMI K.W OIL N.P. GA$ H.P. AMT. NO. A.W G. AMT. MMP MIT, AMPS, TRANS.I AMT, H.PNO.OF SYSTEMS T AMT. WATTS FEE SERVICE DISCONNECT NO*OF S E R V 1 C E AMT. AMP, ME METER 1)e aW 1 R SW ]d SW S S,AW `NO.Of CC COND A.W.G. NO OF H1 LEG A.W.G. NO OF NEUTRALS A.W.G. Row. pER B OF CC,GOND. OF HI LEG OF NEUTRAL OTHER APPARATUS: JIM NAGE ELEC. INC, LTC.#3835 r �wnat PO BOX 38 GREENPORT, NY, 11944-0038 GENERAL MANAGER sS Per. .11 _.P This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY,FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE"'MUST NOT. BE ALTERED IN ANY MANNER. lyl BLI1 �nsrrc;"rlQtl IIRCnR 1' UA'I V. COM IiNTS PnI RlIIA'I'ION ( IST) J 1 _ . anular r•ltnrut rl.urm t ru; � f � I NSut.n'r r ora rr.lt N. Y . RTA"I'P, 171,1I;RCY COIL I°. '-__—I"i Tint." --�--- -- ------------—i�----_----------- --- -=------------------ ------------- ADDIT1UNA1. i G h\O r17o? - o o..r 0 OgUFFO(,�c EDWARD FORRESTER �p� 00 Southold Town Hall Director of Code Enforcement 53095 Main Road y Z P.O. Box 1179 Southold, New York 11971 Fax(516) 765-1823 Telephone (516)765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD June 23, 1998 Paul Cacioppo 44 Wilton Rd. Cold Spring Harbor, New York 11724 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. XX The check is (not on file. ) $25.00 XX No Health Department Approval on file. No final inspection has been made. XX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 23785-Z Please contact our office on this matter. Thank you for cooperation, SOUTHOLD TOWN BUILDING DEPT. JUDITH T. TERRY Town Hall. 53095 Main Road TOWN CLERK P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS % °•' MARRIAGE OFFICER - �� Fax (516) 765-1823 y - , RECORDS MANAGEMENT OFFICER y U•1 i Telephone (516) 765-1801 FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93)] , and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93) ] . I�-: • �9g !Jr J\3. DEPT . TOWN�OF SOU7NOLD �h��e� Southold Town Clerk August 25, 1993 4 . APPLICATION #19V PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and sign): 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 seasonable 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 MY KNOWLEDGE, TRUE AND ACCURATE. (APPLICANT'S SIGNATURE) DATE SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANTI 6 7- I NAME ADDRESS �J ADDRESS lam- y� TELEPHONE APPLICANT / �y p ( 0�� ��•��'o� �e�.l�/ q JV BUILDER C� � �— ENGINEER _l 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. T �ssJ FDP(93) APPLICATION # _ PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT \ ACTIVITY STRUCTURE TYPE $1 New Structure Residential (1-4 Family) ❑ Addition ❑ Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofing? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- 13 Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT$ B. THER DEVELOPMENT ACTIVITIES: Fill ❑ Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Culvert Work) Cl Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) ❑ Individual Water or Sewer System ❑ 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: ❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the 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: ,6) Ft. NGVD (MSL) ❑ Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional ' 'uc[ions. SIGNED CiiL DATE APPLICATION # PAGE 3 OF 4 SECTION 4:ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL 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 applicable:details for anchoring structures,proposed elevation of lowest floor(including basement),types of water resistant materials used below the first floor,details of floodproofng of utilities located below the first floor and details of enclosures below the first floor. Also, ❑Subdivision or other 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. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofmg protection level (non-residential only) Ft. NGVD (MSL). For floodproofed 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: PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. ❑ Is B. ❑ 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 written 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 # PAGE 4 OF 4 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 application). 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. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE--_ BY: i 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) A Ufa 95-20-1 (8/87)-9d New York State �, Department of Environmental Conservation NOTICE C+" 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. Regional Permit Administrator 6�QBEFd1f A GREFNE Permit Number /-47-?v? � DOOQ�-D Expiration Date // -30 -92 NOTE: This notice is NOT a permit G8\ERA1 OJ\DITIU6 rmpect i ams 1 . The permitted site or facility, including relevant records, is subject to in- spection at reasonable hours and intervals by an authorized representative of the Department of Envirorrmntal Conservation (the Departrrent) to determine Mather the permittee is caTplying with this permit and the ECL. Such represen- tative may order the work suspended pursuant to ECL. 71-0301 and SePA 401 (3) . copy of this permit, including all referenced rreps, drawings and special conditions, rrust be available for inspection by the Department at all times at the project. site. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. Permit Changes and Filananels 2. The Departrrent reserves the right to modify, suspend or revoke this permit when: 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 regula- tions is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) ne+v nsterial information is discovered; or d) enviromental conditions, relevant technology, or applicable laiv or regulation have materially changed since the permit was issued. 3. The permittee rust sutrnit a separate written application to the Departrrent for renenel , modification or transfer of this permit. Such application rrust include any fomes, fees or suppleTental information the Department requires. Any renenel , modification or transfer granted by the Department must be in writing. 4. The permittee rrust submit a renenel application at least: a) 180 days before expiration of permits for State ' Pollutant Discharge Elimination Systern (SPDES) , Hazardous vlbste Nbnagerrent Facilities (PM/F), major Air Pal lution Control (APC) and Solid Nbste Nbnagenent Facilities (SMfl ; and b) 30 days before expiration of ail other permit types. 5. LhIess expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination perviously issued by the Department or any of the tern-s, conditions or requirements contained in such order or determination. Other Legal CbIigat ions of Permittee 6. The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature and bywlwrever suffered, arising out of the project described in this permit and has agreed to indermify and save harmless the State from suits, actions, damages and costs of every rare and description resulting frau this project . 7. Thi s pe mei t 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 irrpaimmnt of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit . 8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required for this project . Pae2of 5 4520 Na(7/92)-25c Tidal Wetland ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34 and 6 NYCRR Part 608 ( _ ) 9 That If future operations by the State of New York require an al- other environmentally deleterious materials associated with the teration m tale position of the structure or work herein authorized, or project if, in the opinion of the Department of Environmental Conservation 13 Any material dredged in the prosecution of the work herein permitted It shall cause unreasonable obstruction to the free navigation of said shall be removed evenly,without leaving large refuse piles,ridges across waters of flood flows or endanger the health, safety or welfare of the bed of a waterway or floodptam or deep holes that may have a the people of the Stale, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources Of the State,the owner may be ordered by the Department to a waterway remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or 14 There shall be no unreasonable interference with navigation by the work evocation of this permit, the structure, fill, excavation, or other herein authorized modification of the watercourse hereby authorized shall not be com- 15 If upon the expiration or revocation of this permit,the project hereby pleled, the owners, shall, without expense to the State, and to such authorized has not been completed,the applicant shall,without expense extent and in such time and manner as the Department of Environmental to the State, and to such extent and in such time and manner as the Conservation may require,remove all or any portion of the uncompleted Department of Environmental Conservation may require,remove all or SUucture or fill and restore to its former condition the navigable any portion of the uncompleted structure or fill and restore the site and flood capacity of the watercourse No claim shall be made against to Its former condition No claim shall be made against the Stale of the State of New York on account of any Such removal or alteration New York on account of any Such removal or alteration. 10 Iflat the State of New York shall in'no case be liable for any damage 16 If granted under 6 NYCRR Part 608, the NYS Department of Envron- or Injury to the structure or work herein authorized which may be caused mental Conservation hereby certifies that the subject project will not by or result from future operations undertaken by the Stale for the contravene effluent limitations or other limitations or standards under conservation or improvement of navigation,or for other purposes,and Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 no claim or right to compensation shall accrue from any such damage (PL 95-217)provided that all of the conditions listed herein are met I I Granting of this permit does not relieve the applicant of the response- 17 All activities authorized by this permit must be in strict conformance bdily of obtaining any other permission, consent or approval from with the approved plans submitted by the applicant of his agent as part the U S. Army Corps of Engineers, U S Coast Guard, New York State of the permit application. Office of General Services or local government which may be required Roderick VanTuyl- 12 All necessary precautions shall be taken to preclude contamination Such approved plans were prepared by _ of any wetland or waterway by suspended solids, sediments, fuels, last revised on _ 9/5/95 solvents,lubricants,epoxy coatings,paints,concrete, leachate or any SPECIAL CONDITIONS 1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas. 2 . 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. 3 . There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activity. 4 . All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion or prior to permit expiration, whichever comes first. The approved methodologies are as follows: a. stabilization of the entire disturbed area with appropriate vegetation (grasses, etc. ) . b. stabilized as per specifications identified on approved plans. C. Temporarily stabilized with straw or hay mulch or jute matting or other similar natural fiber matting within 1 week of final grading. Temporary stabilization shall be maintained until a mature vegetative cover is established. 01 PE RMII NU,61R1 If 1-4732-00632/00001-0 PROGRAM/1 ACILI rY NUMUR — -- Page 3 of _ 5 95-1061(7187)-15c NEW YORK SIAIE DEPARTMENT OF ENVIRONMENrAL CONSERVATION t J SPECIAL CONDITIONS 25 Tidal Wetland For Article ( 5. To protect the values of the tidal wetland, a permanent , vegetated buffer zone shall be established. There shall be no disturbance to the natural vegetation or topography within an area extending 50 linear feet landward of the tidal wetland boundary and as shown on the approved plans. 6. The permittee shall incorporate the following language as a notice covenant to the deed: "Regulated tidal wetlands associated with West Creek are located at Suffolk County Tax Map Number: District 1000, Section 116, Block 3 , Lot 18 , otherwise known as the properties of Paul and Maureen Cacioppo and their heirs, assigns or successors. This property is subject to the provisions of New York State Environmental Conservation Law (ECL) Article 25 or its successor, and the conduct of regulated activities may occur only pursuant to ECL Article 25 if prior approval is given by the New York State Department of Environmental Conservation (NYSDEC) or its successor. Regulated activities include, but are not limited to the erection of any structure(s) ; excavation; dredging; grading and filling; clearing of vegetation; and application of chemicals. " This deed covenant shall be recorded with the Clerk of Suffolk County within 90 days of the issuance of this permit. . A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be sent within one calendar year of the issuance of this permit to: NYSDEC, Regional Manager, Bureau of Marine Habitat Protection, SUNY Building 40, Stony Brook, New York 11790-2356. Supplementary Special Conditions (A) through (F) attached DEC PERMIT NUMBER 1-4732-00632/00001-0 EACIL11Y ID NUMBER PROGRAM NUMBER Page 4 of 5 SUPPLEMENTARY SPECIAL CONDITIONS The following conditions apply to all Tidal Wetlands; Freshwater Wetlands; Coastal Erosion Management; and Wild, Scenic, and Recreational Rivers Permits: A. A copy of this permit, including all conditions and approved plans, shall be available at the project site whenever authorized work is in progress. The permit sign enclosed with the permit shall be protected from the weather and posted in a conspicuous location at the work site until all authorized work has been completed. B. The permittee shall require that any contractor, project engineer, or other person responsible for the overall supervision of this project reads, understands, and complies with this permit and all its general, special, and supplementary special conditions. Any failure to comply precisely with all of the terms and conditions of this permit, unless authorized in writing, shall be treated as a violation of the Environmental Conservation Law. If any of the permit conditions are unclear, the permittee shall contact the Division of Regulatory Affairs at the address on page one or telephone (516) 444-0365. C. If project design modifications become necessary after permit issuance, the permittee shall submit the appropriate plan changes for approval by the Regional Permit Administrator prior to undertaking any such modifications. The permittee is advised that substantial modification may require submission of a new application for permit. D. 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 the permitted work, the bottom portion of that form shall also be signed and returned, along with photographs of the completed work and, if required, a survey, E. For projects involving activities to be undertaken in phases over a period of more than one year, the permittee shall notify the Regional Permit Administrator in writing at least 48 hours prior to recommencing work in subsequent years. F. The granting of this permit does not relieve the permittee of the responsibility of obtaining a grant, easement, or other necessary approval from the Division of Land Utilization, Office of General Services, Tower Building, Empire State Plaza, Albany, NY 12242 (516) 474-2195, which may be required for any encroachment upon State-owned lands underwater. DEC Permit No. 1-4732-00632/00001-0 Page 5 of 5 New York Slate Deparluteal of Rrtvlreru»atial Comervallon llldg. 40 - SUNY, Room 223 Stour Brook, NY 11790-2356 kr t t . Mlohaa D.240010 t Co1nm10010ow i PERMIT NO.t ISSUED Tot CONTRACTOR NAME: ADDRE$St TELEPHONES Dear Sir; Pursuant to SIVPIOme4141Y SpecW Condition D of lite referenced permit, you are hereby notified that the aulhorized activity shall commence otr Wo certify that we have read the referenced permit and approval plans, and fully understand the aulhorizel project and all perndl conditions. We have Inspected lite project site and can cowpleto Ute project as described in the perntfl and depicled oil the approval plans In full cony,ilence will, all pian notes and penult conditions, '13ter Permit Sigh, permit, and approved phots will be available at (lie silo for inspection In accordance with General Condition No. 1. PERM1TTPH DATI3 CONTRACTOR DATE 7711S NOTICE AIUST RR SENT TO TIIR AROVR ADDRESS AT LEAST TIVO DAYS IN AUVANCR OF COAIAIRNCRAIRNT OF 1718 PROIRCT, FAILURR T'O RETURN TIIIS NOIICR, POST T71R pEnjit1T SIGN, OR IIAVR 1118 PERMIT AND APPROVED PLANS A VAII.AEI.R A T TBR WORK SI7'R AIRY SURJRCT 7718 PRItAl17TI111 ANDIOR CONTRACTOR I'0 A1'PIJCADLR SANCI'IONS AND PENALTIES FOR NON COAIPUANCR 0`1171 PERMIT CONDITIONS, Cur dww 1Ab Moo NOTICE Of COMNtETION OF CONcT11 / 170 RETURN TIDS (NORM TOt Regional Massager Bureau of Marine Ilabilal Protection New York State Deparhuent of Luvironmealal Collservoiton Rldg. 40 - SUNY, Room 223 `fid �.` � ,.c-_^`-.."'t'9±°.2'iTMT?",�='._I`T �._:�i,7ati�v i�-'_�i_,'7�'"^r7�^.�•r,Ry,+^Y^i3";v,�."=_7'.•T•�71'^,."�<,-�v';"",.';rivs'!°;- �. Board Of Southold Town Trustees SOUTHOLD, NEW YORK \ I. PERMIT NO. DATE: .. ..6/29/95 , k . 9 ISSUED TO ... PAUL, 9 Pursuant to the provisions of Chapter 615 of the Laws of ` . a the State of New York, 1893; and Chapter 404 of the Laws of the "Y x 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 J LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on 6/29/95 l� 19 95, and in consideration of the sum of $ 150.00 paid by 1 - s ; . Larry ..Cisco for PAUL. CACIOPPO "I ' of New Suffolk ti N. Y. and subject to the „• Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: a +' Construct a one family dwelling with no disturbance to the Ianid on the west side of house and the placement of haybales and sno% fence be done during construction of house. r„ p fy : all in accordance with the detailed specifications as presented in the originating application. - i ( „ IN WITNESS WHEREOF, The said Board of Trustees here- j b by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. j r s�ib1! Trustees A � —'.dis'::@.Gti.•'_w,':+8.`.:.�•!��.M+'.': '�''.w..'ux'.•`�.a:•,�:,:�!.F�" n"�"-:�"�e�-;r.n_..ra v_ �,:a1.ee�.G..w.'_rC"R -_ , :._ ifti � / TERMS and CONDITIONS The Permittee PAUL CAIOPPO residing at 44 Wilton Road Cold Spring Harhor NY 1 724 N. Y., as part of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any oper- ation perforated pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third patties, and the said Permittee assumes 'full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is valid for a period of 24 mos. which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained. 4. That time work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstrumon to free navigation, the said Permittee will be required, upon due notice, to remove or alter titis work or project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work auth- orized, 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. �suFfat�-� .Albert .l. Krupski, President a0� O� 'Town hall John llolzapfel, Vice President = 2� 53095 attain Road William G. Albertson ��" P.O. Box 1179 Marlin 11. Garrell Southold, New York 11971 C' � '� Peter Wenczel ��1p1 $��! Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 30, 1995, Lisco Construction Co. Larry Lisco P.O. Box 439 Jamesport MY 11947 Re: PAUL CACIOPPO SCTM #116-3=18 . 1 Dear Mr. Lisco, The following action was taken by the Board of Town Trustees during its regular meeting held on June 29, 1995 regarding the above matter: WHEREAS, Larry Lisco, on behalf of PAUL CACIOPPO, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated May 11 , 1995, arid, WHEREAS, said application was referred to the Southold Town conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on June 29 , 1995, 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, arid, 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 37-18 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, Y NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of PAUL CACIOPPO to construct a single family dwelling with no disturbance to the land on the west side of house and the placement of haybales and snow fence be done during construction. Permit to construct project will expire two years from the date it is signed. Fees must be paid, if 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 /V;ery truly yours, Albert J. Krupski, Jr. President, Bomrd of Trustees AJK/djh cc. CAC ,$r DCS . ��H M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS-._ o T SrAK DATE A Z INSPECTOR 7r �._ M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] R GH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: ' DATE J INSPECTOR O M-1802 BUILDING DEPT. r "INSPECTION [4-;�OUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ,,] FINAL 4 REMARKS: s r DATE INSPIWTOR ' JIIJ�I 'ql,�A 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ION [ ] FRAMING [ FINAL [ ] FIREPLACES & CCHIMNEY REMARKS: .S�J�� � DATE INSPECTOR �3�7 M-1802 BUILDING DEPT. INSPECTION [ J FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ J IN LATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: am 40 U DATE INSPECT0 M-1802 BUILDING DEPT. INSPECTION r'r . [ ] FOUNDATION IST [ "'ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ✓ FRAMING [ ] FINAL [ REPLACE A CHIMNEY REMARKS: G DATE INSPECTORS + ABOARD OF HEALTH . . . . . . . . . . . . .. .I�lq ��: �''� �'= FORM NO. 1 " 3 SETS OF PLANS . . . . . . . . . . TOWN OF SOUTDOLD —SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DRPAR'1'MENT CHECK . . . . . . . . . . . . . . . . .. . . . . . . . TOWN HALL v SEPTIC FORM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: CALL {$ .C2 y✓.'. �/,x.79 1f/ ...... 19.DJ.J� fQ MAIL TO: . . . . . . . . . . . . . . . . Approved....,/.C/� ..., 19 1�? Permit No, !".. .. / .................................... Disapproved ale .................................. ................,.,................. ...................................................... I • � (IAii I' I .pector) APPLICATION FOR BUILDING PERMIT Date. . . . . . . . . . . . . . . . . 19. . . . INSTRUCTIONS a. This application must lie completely filled in by typewriter or in ink aril submitted to Che Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. U. Plot plan slrvaing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. 'Nie work covered by this application my nut be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will ism-ie a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection througluoat the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. MJACATION TS IJEWHY MAX- to tbe Building Department for the issuance of a Building Permit pursuant to the Building gone Ordinance of the Town of: Southold, Suffolk County, New Mork, and other applicable Laws, Ordinances or Regulations, for the constriction of buildings, additions or alterations, or for removal or demolition, as herein described. 'Ire applicant agrees to comply with all applicable laws, Ordinances, building code, housing erode, and regulations, and to admit authorized inspectors on premises and in bud ling ffoor�necessary inspections. (Signature of a ' .ant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, Iia see agent, arcIdl:ect engineer, general contractor, electrician, phonier or builder. ��..��r� .77.r6re" � ./ /f�/A/. � � ...... I.. f�..............I..........................._ Nare of Owner of premises ....✓. [,. ! :d.:</�Y�4 -•,' ?S-sl.�1!C>......................................... (as ou the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Nam and title Of corporate officer) Builders License No. ......................... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... 1. Location of land on which proposed work will be done............................................................... r .� ....... -0�5110 . %!! ...t...........d✓ C//.."TIMIF©L .............. Ikxuse Nuduer Stre��ee/t// // E®Eanle((t County Tax Kip No. 10()O Section ...11.,�....... Block ., .......... Lot' .1; .•.I-....... Subdivision ...................................... Filed Map No. ............... Int ............... (Na-me') 2. State existing use and occupancy of premises and intmwkx] use and occupancy of proposed construction- -1 onstruction:aExisting; use and occulm. ............................................................................. b. intended use and occupancy ..[•4'..C< IGS�> CSC✓ .F�,..� ��. mv zQ. de6/, [J X1.4?to filfi4� ,:Yi,lfl»I"l$°4z mf .� 1 J&VO4 a�eii 3�aruai FF NAunre of work (check wfuch a� 17)l / • � icOble): M1w lktildinlq ...(/... .. e4klitiou .......... Alteration .......... ftelwir ............ Trioval ....I;.... .... Deniol Won ............ Other Work ..................... ... .......... (Description)..... It. Esl'ineutel Cost .I.J QI .�� fee ............................ (lo lie l)ald oil filing this application) S. If 11wellioll, rxyii)er of (hwellinf; wits .0A14--.. tinf)er of (}welling units on ead) floor ................ If garage, vilifier of cars .../. .�............ ................. G. ff Ixlsiness, c(nmercial or mixer 1 occupacx:y, specify nature a)xt extent: of each type of use....... ............... 7. Ilinxenstaus of existing atrrx:tortlrs, if any: Front......... . .. .... bear ....... ........ Iel)Lh ................. IeigtLL ........................4 Mnber of Stories ...................... Dissensions of sore structure wi}I) alterations or exklit-ions: FrOnC .... .. .... ..... hear ... ............ Depth .................... IleitjuC ... .............. ... Mnl)er of Stories ............... . 0. Dinrnsicxss of entire new a)nstrlxaion: Itrx)L 10711?... . Roar. .............. Depth ... ... ........ lleiiJ)f .� .................. Mrber of Stories ./-IrwQ.. .......... 9. Sire of lot: IgonL............... ....II........ Rear ............. . ...... /Wpptt7l)y..........e./...'...KBD ../� IO. Ibrle of Purchase .... j....... Wlamt of Forner Wrier-W1 G.I�/.'l.r•.�./[lV1.V. Bi 4r,. . .. It. Yxx)e lir use district in whicli I}ranises are siLUaled .................................... ............... ...... .. . .. 12. Zees proposed const rx:Lion viol ate any ux)ing law, ordinance or reguladon. .,410.................. Il. Will lot lie regr.xkd .�. is . ...... .... Will /e4�:ess fill lit r'amVEul fran p1"lliises: YES M) 14. Nrxnes of Owner of etnises101%y+ ��ffA4;"k�4P1AIress7-z Mm11,�,1eS���.�� I"re hk>Q �7y.�Q6. /./. N;nrt of Architecit�l:Q.�jpnz. . r �.5. .y,.• Address� l /l3B' `�� YYY� I xxv,k) gL 76 Nacre of: Contractor ...r ,pm A�L.�/!�O .cklreas���.............. ••r/, 15. is this property within 300 1' I' L of a Tidal wet.lavxll VFB .......... ND .......... x1F YES, Scull(1f1) 'i m 'N )SRLS 11;13,I1'I' PLAY Illi IIIL(PIWO). PLOT NrAGRAM irx:ate clearly acxt distinct lyiall Wildings, wether existing or proposed, six] ivxlicate all set-Deck dimensions fran property lines. Give street: a)ll block amber or description accorling fo deed, and al)ow street- rinses and frxlicafe w1)ell)er interior or corner lot. i I fifNil" Ofr "11J YWK, ss (XI(Iffly (W .Aa ,-..64.)414911P.. .. ... ... ....... ... ..ixting duly ,miro, detxrses avvi says that be is the applicant (Nom of ii"ividual silminh contr)ll) alwve vxnrd, leis live ....... .yl ..../...rt .................. ... .................... ... ............................ (Contractor, alleo� , c:orlx)rat'e officer, etc.) _ of said owner or owners, avxl is dully autl)orizcvl Lo Ixarfonn or have lierfonred file said work ouxl Lr) nuke arxl file this applicaliou; that: all stale+rents contained in this application are true to (lie beat of his kn wrlet1ge a(KI Wlief; a(KI Ibal. the work will Ise perfonsecl in, [liemanner, set forth in the spillicat.ian riled ll)erewid). Sworn Io before lir this 3,k...........day of .... .... .. 19..4.E . 61 MHary I'v)blic (Signature of Applicant.) ROSE"T 1.S T,JR. NOTARY PUBU tate Ot N.Y. N0.47250bq,Suttofk Co Term EX01111e M&V 31. 1$,x"$ �-r SUFFOLK CO. HEALTH DEPT. APPROVAL', H. S. NO. i2(O-95-0©-7f6 I RecaNed Suffcl'r(_""cun" t a JUL 0 9 19'98 i Y Dept.Of i-e6ih S6-dies _ 4 1 r 'Office Of Wastewater hgrF STATEMENT OF INTENT tri THE WATER SUPPLY AND SEWAGE DISPOSAL ' SYSTEMS FOR THIS RESIDENCE WILL / CONFORM TO THE STANDARDS OF THE }►or,L' / r - i' SUFFOLK CO. DEPT. OF HEALTH SERVICES. (S) vvar!! APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH ' SERVICES — FOR APPROVAL FOR V r ,• CONSTRUCTION ONLY DATE. H. S. REF. NC. P_1� -C ?h APPROVED- l y 4- ' r• SUFFOLK CO. TAX MAP DESIGNATION: I t DIST. SECT. BLOCK PCL. ..c "a ,V,4VC OWNERS ADDRESS: tTH'3a,.,ili DEED' L. n� N .i 5��� - ; . ,awe +MAMM>l � TEST HOLE STAMP aM µ ► '?3 bts j j .gyp _, woOcl A fen rr y ,?r. -v } *&NIZ Ilk .• tip 1 Seal of a valid e m aansda�i .......:..........-.. ,." ,. ....,w. ,..:..,sa•,..,:wwwsw. .w •.».-., I I y lid tru I Y C6 n n eas indicated hereon har ar j lo,V person for who 'i `�,' i on Ws a gyp, Jart. 17, r !k7. _ MQ 1�` r 6 , ! f 1c not a + + i � � ° I �• LAJVft r_lev. 100 n D J_ a rakrir►i wa!(� V. 2 ! _R-t fit i. de Tl-�--- - ga 7 ' ,, "�lrtrxt survr_� jG !9 t�q I 1 - . f.. Y' Ste"H AYt1�r1U W. L.ewa�tdaw:�C.t .� rqr O ROD,ERICK VAN TUYL. P.C. 1 4'`9'SEe`itiG tank Nx! ww.k-r- ` LICENSEDLANDSURVEYORS i :' �oR 369800!, T GREENPORT NEW YORK maw °.. VILL;GYM POST N4 1329 . SUFFOLK CO. HEALTH DEPT. APPROVAL H_ S. NO. 1210-9S-OCY7fe I 1 � �PO►ewd in aecordntoe with Bow Review 4t 3 `J� •rr r '-. Fy r tit o t 3 / STATEMENT OF INTENT ''i _ •. THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL �.• ---- —' �` c CONFORM TO THE STANDARDS OF THE SUFFOLK CO DEPT. OF HEALTH SERVICES. .'t i s. - r� T r•i . .._. ' f' s r APPLICANT r SUFFOLK COUNTY DEPT. OF HEALTH s5 O e7 r he 2, a SERVICES - FOR APPROVAL FOR e' � _ �' r •f1 �� �- i ._ CONSTR �: T UC71QN ONLY y U �' ,ti.- ) DATE: ' - - � ` • ` , � i H. S. REF. NO. 1LIQ-�-L?O'jCa a ti 1 7 .• � t, � .,•t � APPROVED r n �`.;< i •f '�-y ""Y"�1 � �Yy ` I SUFFOLK CO TAX MAP DESIGNATION: DIST. SECT BLOCK P)CL. I -" •{, ! �•' . i { , i ` .5 .a t i - _ . - ••,_ ...`fdt "et'/x`, :Va'i{ OWNERS ADDRESS i+ L r 1 .� t ! .! � k z �zz Wt�e'�MyX�10YRli Yf�M'M>1MCilMOFMAL7ilT iiMM S s . ?`S fA .� `} s ;',� ..J,� !#MY■1 ��7FtMi. .1���R��i N�� ,r. 'a,• b DEED: L. <t. i.; P. •�A i ` TEST HOLE STAMP AMOVO 009- J ��yy� i Pi Jc-[� Ltia�!n'.•.'M--"'+a-ys�s •i •i ` ' LLa ri �� j}} ��� ) `c Nb wnwyisevigktun e/ s ._. i _ id' 7 � �•, 4 �r��� � ,'.ktYip,72Ci vt1lMNewYpk 9w. iYY7lrti�•�a1\{i1i ■ UnW VAM0FA�r�i VAL It F,ducatbn laa ,. .J a rf".•: . . i+1i.'� '. _ ._ f.,t i;`•,' .. ., '":T-' Capras Wtld6 snnwYetaOnNb� - )^e!r -,fj.e r,"„ -. - - Mr Wntl suneyofe HatlsWtt f - _ V�Oossad MWMBiMf1Y WroHerxf - � .. f,le aYNWMWeOpK - !' R;:aaMaef 6a7Ceietl MfBpn ahan^. ro ; . ...�..'_.- .r `, _- + • j "to1hepe nfcrwhantlwswvw - r . y- I Is rm�cre0,anpon his SehsHto ba emmantel ewcpyM tlh¢ pea'° L) �• qw F - .r �F. (( tt'P•+r' t oe tlVryyinstl. Jin. 17`19'9lo Aga✓ .- /i* !1. 6.- ( ' o o-ansraaa.w rr•`, fleior F+ -. a. I .. rc ro •sen>eQ•�e.'u �C- f wrr{Cr Yr,nT '9rf.'✓r*e •�L(dr, �t+y'�,:,�"jj �j'i: e(e4 fO.Or ; j re- afnrrfq wail . f i ,,2+°'{ w1,*r«-_-8-1 ^•{tic de SEAL 4,"a 3 r _ ,e J__ 5 3 - L.�_. _a 3 F�, - ,r'`C R`z,�•:,. r�i.->"0: �i�', ',..�,�� 40'PQatJ' .ham - -a8 RODERICK VAN TUYL. P.C. '� 4'+IS'Sef7!'iGfictttk._, .. E'-csrorrrl^-. ,vhYE'r -- 77ov�,. (Jri'Oq gat.) �'''• o ate"" z�¢` LICENSED LAND SURVEYORS •' ° CS 256 }r t-'ovrw vnor `zuu:�' I SUFFOLK CO.,ii)E 4f rFt DLPT. D j STATEMENT OF INTENT 1 / THE WATER SUPPLY AND SEWAGE DISPOSAL ^ S_13•:"� .'S J St/!:1/ZrYb CJ f cT/t. j SYSTEMS FOR THIS RESIDENCE WILL n 6 CONFORM TO THE STANDARDS OF THE l i r"_..r, } '.f j . t,_� SUFFOLK CO. DEPT. OF HEALTH SEf2 VICES. 1. *d n xh - f' ( APPLICANT SUFFOLK COUNTY DEPT_ OF HEALTH y JZ7- ,4^ • y v - f SERVICES - FOR APPROVAL FOR 4 CONSTRUCTION ONLY DATE: H- S. REF. NO.. W 4 art APPROVED' V y�. ' •r"Y � � i. n i "" �'� � � � SUFFOLK CO. TAX MAP DESIGNATION: t }. , g�' ;+ ,�'1 r'S,- . ��i ' ..: ,.•� i�=.+i. t- � DIST. SECT, BLACK PCL. { '> `i I/b .r i :da.aI'+Ad..w# @ 4 OWNERS ADDRESS: Qf //777 r F , . ,.,, :� ,•, ��� O S / yam(` �f / 4/ �/ a Kt �� �'-1[ DEED: L. z.! P. ,G TEST HOLE STAMP llele LA !v, . e'P�d.��J a!F:�•^ul�. _' i��,�J ':'�; ' ��}§".�� %t"<� t ~.t'' !Mt R f i..: 7.* "Iry 1% ' }{ f r�i.e.o-•'r - tom.�s,°.:� �� s Ar. . t. � ...fIII'i: fy /F{, ` 4j!7"_. QCao rsp 7. Af k2 �; rrst fry 1 ; { ire,p coKc ,a�r . 9�185+ art r�, sr E+fev f0 rit ntnidg ixal/ Q , k o uF�.ev SEAL �$.I fin 'dfradr �: � :M B-�" - t P l � L+'F,fi6'7 f7[P 144rT ' fs, "995 8017 'RICK VAN TUY`>;.F'.C. * � • %t� G fw"•3 t?tn fi �414AI 1 LICENSW LAND SURVEYORS 6GCW Ve^1 pYC �J,- P 1, 0 "11; 11., 1, 11 1 r� If I i, ...... Silk' fi 77� ACV 6 �I SII ,12 1"00 Ov .;1TrO4C, 14Y WIVU 17 g MOO'IVRB W. *A .4 * pkJot, To + fh S NA RITO, R lxvo 0 BID PAW - 7- 4 coot" I gj A "'A 30, PA, AW expaxes., - - 7— ------- A simt,*1I T RH _Olt' j J MMI Wj"j�r Ail 45 411k "It" 4 vw Da,;_ rYl X11 4/ WI'C' Bit VOW AT - A. t —7— Lit.FIRE RATED SEPARATION 10 4- - FAKT.717.111)(1)Of A Y.STATE IIIIII. ING CODE' A 7 U H, 0 AN OR, Al" -7 --n-w -T 6 To 89 Ltoosto $460, 4IN00, DOM I , I 0 Y, 4J go "O� 'ks AND -:,**004,044, 1z> .,lrttll * foe ROAI 1 1 , ; A4 f j _C tj pipOi Bli� W" , g ACpGFAN �:a cueI IRV C TO 7 JI iT7 t �q if Co 1 if 9HvW -T- A PROVIDE OPENINGS FOR EMERGENCY ESCAPE AS tz, REQUIRED By PART 714 OF N.Y. STATE BUILDING CODE d: PROVIDE% HR. FIRE �57 RATED SEPARATION To t2AT- 10 PART 717-3 M(1) OF N-V STATE BUILDING CODE j ' ' I' ---- ` - - (- {�- -- --_ - - — OR"=ED W" x OF INOWN LIZATION wsmwmm T�1.�)K raj,� F\5p a,H-1�Kt �5 rod HPo&T14� OCCUPANCY OR aH V10H V I TH �-To'H PLUMBING TE USE IS UNLAWFUL ALL PLUMBING WAS &WATER LINES NEED TESTING BEI�ORE COVERING ).,WITHOUT CERTIFICATE OCCUPANCY A( OF ,7 v X , (� N� T ( PLUMBER CERTIFICATION or -of ILAH ON LEAD CONTENT BEFORE APP OV D AS NOTED CERTIFICATE OF OCCUPANCY DATE: B.P.# SOLDER USED IN WA 7ERBY oz 7J FEE: DEPA MENTAT NOTIFY BUILDING SUPPLY SYSTEM CANNOT 765-1802 9 AM TO 4 PM FOR THE EXCEED 2110 of 1% LEAD. FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMINGE& PLUMBING 3, INSULATION CONSTRUCTION MUST 3&lq 4. FINAL BE COMPLETE FOR If copper tubing Is used ALL CONSTRUCTION SMALL MEET DRAWN for water distributing THE REQUIREMENTS Or THE N.Y. 9 S"IATE CONSTRUCTION & ENERGY Joel CONSTRUCTION STR U CT 0 N M US COMPLETE R C.O.CO CONSTRUCTION N S"ALL MEET'P T C"0 PHI; IL EM E N rS OF THE N 9 CONSTRUCTION I ON ENE-RG System; piping shall be NOT PC L FO )N a CODES. NOT RESPONSIBLE FOR of types K or L only CO ST UC rID 0 SHE" DESIGN OR CONSTRUCTION ERRORS RT, UNDERWRUM I USTIFICATE W-0. WA OF SHRETS: ', ' J '�N, 1XI* g 'yREV ISIIONS p_B,1Yw. 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SHEETS ,K R7 REVISIONS BY Or , - RpSE OF NEIyY jr� IJ(�rury� 9 6�OpG JOy 9 WALT ¢ 056Yp6 I II I I y q p4pFESSwNP` I �I, jll Irl" JI .jJy�l! �-SII ! --- r t 1 11 u� ji 60 I lit KIW 1 j 1- � C1 : " I ., a � , � , I I � T��I •�r�`jL�t.'i�(, . �J�1r-�;fi, � u ! �"� , � t I � �---- '•�-- ty ,. i I � _ Ah : I _ J —t 1 q1 j "�'. I r i , �1 k _ A FROMT EN 7068 6 PANEL„2 SIOEI:ITF.3 � IEA I li t i 20-X64"TRANSOM I EA, \ ' t I "/ � y 'I D GARAGE 2868 9 LITE,2 PANEL PPSC, 1 HA. C DINING/GREAT RM. 50611 ANDkRS VI`150611APLR 2 EA I ANRERSEN AN51 ABOVE. MULLED UNIT, ANDE&SEN'FWHS0611APLR 2EA T i ` CI M. BEDRMJ BEDRM. 2 50611 `� .•.z "r .~''� i' " ✓-' L F D OWING I GREAT RM. " 50611 ANDMSEN FWMS0611PALR 21EA. ANDERSEN A1451 ABOVE MULLED� . NIT _. AL g f_'�k,�,.•" � J" � , � ')� I Irl':J i UI M. BEDRM.A BEDRM. 2 50611 ANDERSHN.N'NRi50611PALR 2EA. S �„� -/ , E GARAGE A MBC:M RM 2868 FPSC 2 E ("J rf�. �n , F LAUNDRY �.868 MASGNITE CLASSIQIJJ; LHA 1� : � Imo' �`��V�U-V �f>;"•- �'.; I/3, �I !y' , syyG G POWDER RM(WIC/BATH 2468 d o_ 3 EA q q H MUD RM/BROW 1 &2 4068 d.o PIFOLD 3 EA, 1� 1 GATE ` I I Y 1 STAIR CLOSET 2468 d.o, BIFOLD I EA, sCALEwI'F7 ,+IC, "t.Z 8 DRAWR,}s, J M. BATH 2468 d n, POCKET DOOR I EA. �{ g K AI,L BEDROOMS2668 d.o. 3 EA SHEET k - L LINEN CLOSET 1668 d o 1 EA, 4, I 9T6CKOR/:P'PJ40;RORM Nor JER04 . -__. .._ _�_ __- __. _.__ _:_—__ .. 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F 8H�T8 yj n q, -P R 1$1 111 13Y j ov'r E j K." 0 MAMARY OF :TOTAL THOMMAL FIA INO if the Total Thermal Rating �is jorq, (0) or gro6iti, Proposed w A design- for the bui,lding,wrivelope 66qip] ies wit the Energy Code, '-Z� E�- ................................ Z TF TiIERAAl TABLE AREA -VAL q qE RATING' ' USED A. ROOF/CEILING B: NET WALLS . 1 C. GLAZING Window MZ: ------ Skyfights Ol. FLooks At% D2— 8 AgMENT/MLAR WALLS Wall P90iraoti Feat ExpostIro, AW%im IG,4do Foot Deptii, of Wah U-VdIve q ow Grodo I rch D3. SL A$ INSQJLArION Slak Pe"'4 meter, Feet Insnldtloh r('V4lve NFILIRAXION CONTROL Conditioned Floor res So, Ft, j F. SOOTH FA64 GLUM "So Lb,olar%t/Tat�1 Glass U Perc"L Aroajr assrWal *r , —40— I Area Percent Cond i t,o Floor Area Sq, Ft.. THEO L RATING 7� 77]7 '7 All ...... ------ -7� 5 - ----- VI -4+r ilk 2 Za� 7 > ---7-77 p Tr 7jJ — t I EV 0 S "'0"' "y M Joe 71o[ A r! 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