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FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24995 Date APRIL 18, 1997 THIS CERTIFIES that the building NEW DWELLING Location of Property 1450 TNWATERS LANE ORIENT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 15 Block 3 Lot 19 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 27, 1995 pursuant to which Building Permit No. 23163-Z dated DECEMBER 6, 1995 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 TWO CAR GARAGE UNDER & ATTACHED REAR DECK AS APPLIED FOR. The certificate is issued to ANDREW & MARGARET DUERWALD (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-95-0100-NOV. 4, 1996 UNDERWRITERS CERTIFICATE NO. N-404608 - DECEMBER 3, 1996 PLUMBERS CERTIFICATION DATED NOV. 11, 1996-K&K PLUMBING & HEATING Building Inspec or 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 AUTHO ED) Pp Date.............. .. ..` :... ..................... N2 23163 Z Permission Is hereby grante to: 34 . . .. ....... teaV l ...�. . .. ..............................,. ............. ,��..�......,�.... .�.� ., ..���..- .....��- �. ..... ....... ....... .... ..... ..... - .................... � ......................... .. ............... ....... ......... ..... ............................L.,,.............................................I...�...... ............................... at premises located at... .7. ®.. f4 .'............................................. ........................................../....................... County Tax Map No. 1000 Section ........... Block...........�.q..... Lot No. ..l..l................... pursuant to application dated .......................*.� ...?77...... 19,.,7..-,1......., and approved by the Building Inspector. e Fee S.�3�` .. .... ...... ... . ...... ................. Building inspec Rev. 6/30/80 c c $aoTH O D 7&S IS9y 7014M iALLL 705-:502 a ) i 7 ap,_C __ON .OR CT3T_,_ZCd^'� OF OCCL? A. T'Iis anDlicaz: must be c__ad in by t-roewr_cer OR �$ _ad sucmitt_d _aSD ectoL tJ_t: the collowina: for 1e`.v building oL aeCJ use: _. 31 SUr'7e7 Or pro0ert7 wica accuracy location of 311 buildings, OLODerL7 1�*xeS, screecs, and unusual aacur3_ or aDograpolc features. . 2. 7inal ApDrovai t_om 3e31c: Dent. of 7ater SUDp17 and sewerage-disposal($-9 rorm) 3 . Aonroval of alaccricai _israllacion from Board of __re Mader—vritars_ worn scacemeat from ?lumber carti_7'_ag c^ac .. e solder used i= syscam Concaj�.as Less c:au 2/10 or L< Lead._ J. Commerc=ai Ju_lding, industrial bu=ding, mulci?1e residences and _similar build:nos and inscailations, a certi_ic3te of lode Comffliance _'rom arcnitacc or engineer responsibia for the bu'lding. o.. Submit ?fanning Board Approval of completed stca plan reeuiremears. 3. ?or am�st:Lng buq'diags (prior to April 9, L957) non-conforming uses, or bu+."d'=gs and "pra-e.Yistiaa" land uses: L . kCCl= Sur7ey of prG0ert7 SROW� 311 Oropert7 ilnes, straecs, blli_u�rg and t unusual natural or c000graohic fe3LurZ5. 2. A OrOD erl'T cOmDl2ted aDD licac=0n and 3 consent to imsT7ecc signed by c`xa applicant. L- a Car_i=icaca Of Occ1DamC7 is denied, c7e 3uilding =aspeccar saa11 state tae reasons =Zerefor in r4_Lima to cae aDDlicaac. C. s L? Carti-icata of Occupanc;7 - New dw-elliag S25 .00, Additions co dwelliig 525 .00, A teratians to dweili�g i25.00, $Wi=ina 0001 525.00, ACceSSOL7 blli_ding S25.00, Additions to accessor;T bu±?d_J-a 325.00. Businesses 550.00. 2. Cart__icaca of OccuDanc7 on ?re-existian 3uildins - 5100.00 Copy of Carti icate of Occnnancy - 25r. Jodacad Car_ificaca of Occupanc7 - S50.00 5. Tempor3r7 Cartificara of Occunanc7 - 2esidential /SL5.00, Commercial 315.00 Date . . . . . N9.U. : . . . . . . . . . . . . . . . .. Yew Const_uctian. . . ./. . . . . Old Or ?ra-existing 3uilding. . . . . . . . . . . . . . . . . .ocaciou of ?ropert7. . . . . ! t��. . . . . J.f1 e . . House No. j Street y� Hamlet 7nwer or Owners of ?ropert7. . . . n4fe-C�.�hn.� _ . C �1� �. . . cl�cCrICJ�� . -- • Cauat7 Ta.: dap Yo L00o, Sect'_on. . . -Ir . . . . . . .31oc_c. . . . . . . . . . . . .Lor. . . i.�/ . . . . . . . . . . . . . . . iubdi'74-sion. . . . . . . . . . . . . . . . . . . . . . . . . :i;. . . . . . . . .Filed :4aD . . . . . . . . . . . .Loc. . . . . . . . . . . . . . . . . . . . . . ?ormit OL/2er.Zi`.. ' . . ./ I,. . . . .aoolicanc. .aa1_�1 Oe7 C. Umorovai. . . . . . . . Y. . . . . . . . . . . . . . . . .uade=-rit...rs 1pprova1. . . . . . . . . . . . . . . . . . . . . . . . . 'L-nn_.g 3oard ADDroval. . . . . . . . . . . . . . . . . . . . . . . . / taquest .o r: _ per_r;7 Car-_=icata. . . . . . . . . . '_.al Carticatz. . . . . . . . . . . __ 5Lbm__..--. S . . ..41� . . . . . . . . . . . . . . . . . . . . . C,LNT S�� �� c6 :: � g � r" TOWN OF SOUTHOLD i ! ;c OFFICE OF 9UILbIPIC INSCECiOR N P.U. BOX 729 - `O� TOWN IIALL j �c /O` ► 1 �d0 SOUTHOLD,N.Y. 11971 { ,1 e 'a > A C E R T I F I C A T I O N i Date t Building Permit No._231 _ : owner OLCN6 t ew r Plumber �• (p once pri tl . � - .,. �ces�� �3S\ rar ,e ------------ ; , t; I aortilY that the so the P.containe 10891 t tiler ea(l . in water supply systiat �. than 2/10 of la lead . n (plumber ' s signature) ` { Sworn to before mo this • ' =''^` of f 9�+ r —W /ti f ftolAc• ► tary Publis tI 1 1 ubllo • '�' PPP County � , ,i�`%6'F. .: ,$a• JOYCE M.WILKINS Notary Public,State of New York No.4952246,Suffolk Cou Term Expires Jgne 12, 19.12-7 ;, w( . ., .r.A.i!m5ii'MA-YMhW.x.,.JJ.:a"a�ii¢k...:i••r`I.:� '`'� '' '' I ''I �THE NEW YORK BOARD OF FIRE UNDERWRITERS '` 100107r� V �i 1` BUREAU OF ELECTRICITY j1i+III�� I�r�II��IIM, � f �ddtd,, III I;I�ECIEM$ER 03,1936: �'�gPpltrottonNo.'onjile ;11757696/9 ��'j,1` �0�`6�8-;v I '� tf '(: THIS CEFtTIF1E3 THAT onty theetectrieal ut mane aR I �� �eeen6ed 6etow and introduced by the oppticant"roomed on the ottobe oppheotiok numher in ltheprohhue %'��+ DREW DVERWALD; 14501 THREE WATER LANE, ORIENT N.Y., � � 'in the llowin l� attoh ! h P .> fo q, R n¢ . 1 Basement ,'3 1.tFh.-1© 2nd FL.S, CPAR/ATTIC/OUT t N... . it hl +tI :IH II! Ill ly NOVEMBER'' 25+}1336 Section r+ Burk f} .a t lll __+ 'sm I-x ji n on ,il - "- I. i�,. I+ �`I Eli ,,11 1 and found to be in compttance with aha ATallonat lstecdrttal Code S _..�1-ij1W�-. RXTURi- ' .,: FIXTURES .. RANGESCOOKINGDECK$ i,�OVENS DISH WASHERS '6XHA -pN5^ ouTLETS +I EClITACLlS ,SWITCHES INCANDESCENT PLUORESCENT „ OTHER NAT, K W AMi K W AM} K W NAT ., K W AMT + I N hi 1'll'�ln,I,l ,+-,,, y I I,III kII 1!I I tjCil , DRYERSMOTORS FUTURR APPLIANCE FEEDERS SPECIAL REC'IT TIME CLOCK$ MUlil I `ell/ UNIT NEATER$ OUTLET i 'DIMMERS 1 AMT K W OLL ii N r OAS N P AMT. No �.' A w c AMr AMP NAT AMPS TRANS s $YSTEMS,��� iI II, 111 111' III ill 'J d AM} R P HO OP FEET {!AMi i,-wA1190 dli III J IH II'-111 ilidlV ',flihU� ,ft ; Bi 11 Iu "n il]" 171 !(I li �I i! IIf iA' ail Ilh III 10 I =ill ' �'�. + ill. �i III lil r SERVICE DISCONNECT NO OF I L a i t f—ili a i MRlR S E R V 1 ='^dr a ilA d n TrN i lOUI► T X Rw t,K aw 'MM 3,9 4W No oP cc coND A w of � E�- t 1 PER N OF CC GOND NO OP HI LfG + OP MI LEO �OF NEU}RAl$ 1 ^�°A��+ i I 1+I�t a 11.41 I ! ill s l OTHER A►►ARATUSI I 115 I I , > ........... I+ I li rlllil ,.1 I (lull . IIA �I 111 (IIS ' 111 II A lil !II- --I, l i - U li ifl 111'�11'1�! J!j r Ir III II II !P I 171 h, ilrN(i,� - i 7 �l .I I ul 'III = _� IT Irl: 't + I PI i `- I'I !+i 81 III !II I i _ II �,lil t 1 X11 it I I f I_ II 1 n I r it +I IIl Til 1 V 'Eli ;11 'III la II II! lAj j1111111111ui lilli�lllf Il. �x P �id Irl I'I '11 Ifl i�� i17._�l III_ c I l " I + 1+I III lu illl 111:. III ., ; 6 P - ', Ir! +I€All1u51lII III��llilI I!' ,Iy �I Ili I I� coNTR�cmo I-' 11'1 I NF III li I 1 � I I LTC '#a57f� .L"' IT, -U t1� III 'HzL 1 1111111111 4 i Ilj ISI INo6U'1'1'tO�I bTY, 11171 r i I' —111 II u 1 nt� �{r -I- + '=,i�l III Ill in ill III Ili ' � � �-� Lin UI i GE►1ERAl MAIEA�lRaIIP��I I' it ill III_ �) II III III 1 � � I.. A=1111lII�� u� 113 hl- lII. l� U� I �' fll 11) III Illi Ill Itl I I + 1 1 II 111 Il � � 1 + ,, �� _,Ill-. 'I{ III IIffI I �I'_ f+: +! sl I �; ri Per' II �Blilf 1I j111{111�11� Thir coni IcaK.ihUst D6f"bei alferdd i'n'any olVannefT'rowrR f0 the offlte=oft6IT Board" f'incoheN{lilns`1Seby thmr.lklr�28eR},u{y1IL nl itl i +h .n-9 THE NEW YORK BOARD OF FIRE,`UNDERWRI tiIA�E 1 ! �T 1001071 85 JOHN STREET, NEW _ BUREAU OF ELECTRICITY,, I. ,. YORK,«NY1 10035r!!x'Itl rIl 1( I!1 Ill %�"iLt3�lll y ,I � �, !r �Ili.��li Date DECEMBER 03,1996 APPticotionNo.onf7le 11.7ii5769fi/9� i�i�+,lll(it� iif��Ill��ir-4Q,461��1�I�itlil', - THIS CERTIFIES THAT 1+ gnly the electrical equipment cut described before and introduced by the applicant Homed on the atone opp;srnt�wtf;nl{Stebe+r_in thgprprrfltee q[;, ! +-�+.-E.EW` pVERWALDt 1450THREE WATER LANE, ,ORIENT, N;F r . (,r+,= !l- 111k71llt111�-Iii"��1111Ii'liill'`i(4-i,lrtiil + it:;lp ,e q _llr pl 9+, i11' Itl 1+ 'ji {V i+' fl.lhefollowing location; ® Basement 1st Ft. ® 2nd Ft. :GAR/ATTIC/Ou',� It Seruyn'` Ei Bloah !1' II R ' i 25 examined on NOVEMBER ,1996. andfound to be in complianog el syuh lJtyVattonal Eleq;ri tl OeN; il rfl 1 !�! u!. 'r'FIXTUREI,, FIXTURES RANGES - ' COOKING DECKS > , OPENS_!+! DISH WASHERS :EXHAUST FANS 1.OUTLETS'I' ECEPTACLES SWITCHSS INCANDESCENT FLUCWESCENT OTHER `AMT. K.W." 'AMT:. =:`NJ.= ! I I Ir 88 73 2 rni� It 11 (t ii 3 Ir. , la,i .'i DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTT TIME CLOCK ,.eHUNIT HEATERS; MULTI-OUTLET, 1416r DIMMERS . -u SYSTEMS"'.,,., '.=AMT�I` S'K.W.' +Olt i' '�H.P. OA6 N.P. � AMT.' NO. A.W.G. °AMT; °AMC`'4AMT.= AMY6.`�.TRANS; f'AMY't'::H.R;�i`NO.OF FEET"'+l1WATT6 2 , 20 it}r jll++�IllrillPr a1 li+illi-�!�I H +�rU��if rli5t� '.SERVIC! DISCONNECT NO.OF - S E "' R +' 'V i A,-, EQUIP. lA'2W 1 X SW 2.I;W 2X 4W NO.OPER%GOND. ''i OF C w OND YNO OF Mi IEO,I , H.`E I taO OF NEV[tALS 1150 ,i,CB� . 1X � 22/0 r ;r{ ,, ,r• ,t ti ,'i,.: it ^n�i-- + u u , OTHER+�P►ARATUfI - s. 16III�WH$RLPOOL BATH-1 � ;+ � ,+�'7I Ir l7{ Sri si- IiiTP{ +IIIl1 t�4{�i 111 if.il,l llll16l1iiri1+1,,.=1'i,= ;,- if-MBLI, PITMP 1r;t 611 4. Fal +I ill I13 'I hl i. 1!I -I " - - . ].,,.{„ , (r` {EI,.,al ail 11I;,, Ili +u ilii +l i31 .li+ .EI ;'� ,.qll='4 TON�AIR�CONDITIONER-1.' - � �,: .:-,, _!113, TON AIR CONDITIONER-1 ;',,, :!11MOTORSi1—F N.P. ;2—F'H.P.HP ,1-4 H.P. 1-3 H.P. 60.-u-'PANELBOARDBt2-1CIR. - , ' ,713 F.C.I:-16 . A , il�, DETECTOR:-8 <<< Continued on Page 2 »> This certificate must not be altered in any manner; .return to the office of the Board rf'mcorrecll ;l spectors�' b0 'thsit credIntiati. 44l , 1 � NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMFER Am EFFECTIVE DATE 'r8/ 1-4738-01153/00001-0 August 3, 1995 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental August 3, 1999 Conservation Law TYPE OF PERMIT 0 New 0 Renewal 0 Modification 0 Permit to Construct 0 Permit to Operate 0 Article 15, Title 5: Protection 0 6NYCRR 608: Water Quality ❑ Article 27, Title 7; 6NYCRR 360: of Waters Certification Solid Waste Management 0 Article 15, Title 15: Water 0 Article 17, Titles 7, 8: SPIES ❑ Article 27, Title 9; 6NYCRR 373: Supply Hazardous Waste Management 0 Article 19: Air Pollution 0 Article 15, Title 15: Water Control 0 Article 34: Coastal Erosion Transport Management 0 Article 23, Title 27: Mined Land " 0 Article 15, Title 15: Long Reclamation 0 Article 36: Floodplain Island Wells Management 0 Article 24: Freshwater Wetlands 0 Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control 0 ,Other: PERMIT ISSUED TO TELEPHONE NUMBER Andrew and Margaret Duerweld (516) 765-2446 ADDRESS OF PERMITTEE P.O. Box 494, Southold, New York, 11971 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Linda Bertani 1380 Oakwood Drive Southold New York 11971 (516) 765-1594 NAME AND ADDRESS OF PROJECT/FACILITY 1450 Three Waters Lane LOCATION OF PROJECT/FACILITY Orient COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Long Island Sound DESMIPTICN CF Ain-mizm PaiviTy Remove approximately 110 cubic feet of reinforced concrete boat ramps to an approved solid waste facility or recycling facility. All work shall be in accordance with NYSDEC approved plans. All work landward of the 101 contour as shownon survey by Anthony W. Lewandowski dated July 17, 1995 and revised July 19, 1995 is out of the jurisdiction of Article 25 of the NYSDEC Tidal Wetlands. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Charles T. Hamilton Bldg. 40 SUNY, Room 219, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE y QQ'j � Page 1 of 4 August 3, 1995 GBgEVL 03NDITIC S Inspectilom i 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 bepart-ent of Mw irommntal Conservation (the Departrrent) to determine whether the permittee is corplying with this permit and the ECL. Such represen- tative rray order the work suspended pursuant to ECL 71-0301 and WA 401 (3) . copy of this permit, including all referenced maps, drawings and special conditions, rust be available for inspection by the Department at all tirres 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 R mmis 2. The Departrrent reserves the right to nndify, 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 w,es obtained by misrepresentation or failure to disclose relevant facts; c) newrmaterial information is discovered; or d) enviromental conditions, relevant technology, or applicable laiv or regulation have rrate r 1 a I I y changed since the permit wes issued. 3. The permittee rust submit a separate written application to the Department for renewal , mxlificat!on or transfer of this permit. Such application rrust include any forn-s, fees or supplemntal information the Departrrent requires. Any renenel , modification or transfer granted by the Departrrent rust be in writing. 4. The permittee rrust submit a renenel application at least: a) 1S0 days before expiration of permits for State Pollutant Discharge Elimination Syste-n (SFCES) , Hazardous Waste IVbnagemnt Facilities (VMF) , rrejor Air Pollution Control (PPC) and Solid Waste IVbnagerent Facilities (S*F); and b) 30 days before expiration of all other permit types. 5. lhIess expressly provided for by the Departamnt, issuance of this permit does not rrodify, supersede or rescind any order or determination perviously issued by the Department or any of the terms, conditions or requiremnts 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 da•rages, direct or indirect, of whatever nature and by wtwraver suffered, arising out of the project described in this permit and has agreed to inde-mify and save harmless the State fran suits, actions, damages and costs of every name and description resulting from this project. 7. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted =rk nor does it authorize the irrpairment 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, easerants and rights-of-w.ey that nmy be required for this project . Page 2of 4 95-20-6a(7192)-25c r Tidal Wetlands 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 in the 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 or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State, 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 revocation 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 pleted, 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 structure 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 State 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. That 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 Environ- 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 State 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 11,,.Granting of this permit does not relieve the applicant of the responsi- 17. All activities authorized by this permit must be in strict conformance bility of obtaining any other permission, consent or approval from with the approved plans submitted by the applicant or 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. Anthony W. Lewandou 12 All necessary precautions ;hall be taken to preclude contamination Such approved plans were prepared by of any wetland or waterway by suspended solids, sediments, fuels, xPP..yEd _ on 7/19/95 solvents, lubricants,epoxy coatings,paints,concrete,leachate or any SPECIAL CONDITIONS 1. Any debris or excess material from this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. 2. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than 75 linear feet from the tidal wetland boundary. 3 . Equipment operation below apparent high water is strictly prohibited. 4 . Concrete is to be removed off site to an approved solid waste facility or recycling facility within 30 days of removal. Upon completion of project, a receipt from facility is to be submitted to Region One, Bureau of Marine Habitat Protection, SUNY Building 40, Stony Brook, New York. Supplementary Special Conditions A Thru F Attached. DEC PERMIT NUMBI R 1-4738-01153/00001-0 PROGRAM/FACILITY NUMBER Page 3 of 4 95-20-1 (a/an—sa New York State Department of Environmental Conservation tome _r NOTICE low The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Regional Permit Administrator Permit Number �0 1•0 Expiration Date O' NOTE: This notice is NOT a permit SUPPLEMENTARY SPECIAL CONDITIONS The following conditions apply to all Tidal Wetlands; Preshwater 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. 1-4738-01153/00001-0 Page 4 of 4 .tiiuiL4 na 1.. .r ,h.. M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 SULATION [ ] FRAMING [ V FINAL(L" ) [ ] FIREPLACE & CHIMNEY REMARKS: 4�2z _ C� C../ DATE Ll�h-7 INSPECTOR r 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SOLATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: _ �' DATE 33I F7 INSPECTOR 29 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROU PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE S CHIMNEY REMARKS:(��,A Wei- DATE INSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROU H PLBG. [ ] FOUNDATION 2ND [ SULATION [ ] FRAMING [ } FINAL [ ] FIREPLAC CHIMNEY REMARKS: Ae DATE / INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ } FOUNDATION IST [ ROUGH PLBG. [ ] F UNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: c . C DATE INSPECTOR 3`ET 70-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ) FIREPLACE "?& CHIMNEY REMARKS: C DATE �� INSPECTOR 765.1802 BUILDING DEPT. INSPECTION [ FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: Ae,& G� DATE INSPECTO r i 1\ 1, 1'1 LD 1f1iPIil;CIpN RIiPOIi'f UA'I' ' ----_- COMtMM?hl'1'S En -- . FOUNDATION FOUNDATION n Roucu rRnMlt 5 I 0 rl.urmtNc ,� s�tii o _ - -- r fNS111.A'1'rON YIiR N. Y. I STATE RNIiRGY -- ----------- FA _______________„________ --- � " -- - II F NAl. I --��- 9l ------ -- --------------- __ . �` II �` ______________- ADDITIONAL COMMI NLS ____=_ --- _ - _ --------------- _.....- - ----- -- --- -------- ---- -- -- 1� M , t Albert J. Krupski,President h�o�OgOFFOi k�OG$ Town Hall John Holzapfel, Vice President o 53095 Main Road William G. Albertson y i P.O. Box 1179 Martin H. Garrell O Southold,New York 11971 Peter Wenczel y�ol �a0` Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 29, 1995 John Bertani Builder Inc. 1380 Oakwaood Drive Southold NY 11971 Re: ANDREW DUERWALD SCTM #15-3-19 Dear Mr. Bertani, According to the information given, and a copy of the survey submitted, the Southold Town Board of Trustees have found this project out of our jurisdiction under the Town Wetlands ordinance and Coastal Erosion Hazard Area. However, should there be any activity within 25 ' of the bluff line you will need to submit an application and a fee. If you have any questions, please call our office. /Yours truly, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. CAC 3. Nature of work (check which applicable): New Building . . X , Repair Addition . . . . . Alteration . . . . . .. . . . • • • • • • . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . : . . . . . . . . . Other Work . . . . . . . . . . . . . . ✓, �� (Description) 4. Estimated Cost . . . .cN .Q71 • , • . . . . . . . . . . . . . . . . . . . . . � Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. If dwelling (to be paid on tiling this application) e, number of dwelling units . . . . .1 • , . , , . • • • Number of dwelling units on each floor. . . . . If garage, number of cars . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of-each type of use . .' 7. Dimensions of existing structures,if any: Front . . . . . . ' ' ' ' ' . ' . ' • • • • • • • Height . . . . . . .-; , • • , , Number of Stories . Rear Depth . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front Depth . . . . . ... . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Height Front . . . . . . . :. . . . . . . . : . . Number of Stories . . . . . . . . . . . : :,. . . . . . 8. Dimensions of entire new construction: Front . . . . .(?�;, Height . . . 3,o' 6 . . . . . 1 Rear . . . . 4T. . . . . . . . Depth . . .Y(. . . . . . . . . . Nuptber of Stories . . . . ..z'+ 3, 9. Size of lot: Front . . . . . S . . . y . . . . . . . . . . . . . . . . . . . . . . . . . .�... . . . . . . . . . . . 10. Date of Purchase • /f) ' • ' ' • • • Rear . . . . . ,( ,3, , • , • • . . • . • , , epth Sid/ J / y . . . . . . . . . . . . . . . . . . .J,ame of Former Owner !PCS 01- 11. . . . . . . . . . . . . ... . Zone or use district in which premises are situated . . , K-1 O' " ' �� •�� `fir 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded : (1•o O o• • • • • • • - • • . . . . . . . . . . . . ' • • • Will excess fill be removed from premises: Yes 14. Name of Owner of emises� m .044erWC.� . . . N T 1� Address tq� u �. 164?KPhoneNo. .7Ca�;�V.Vj( ; Name of Architect CQ- �',�Sl, ,1��¢ly„•._ � 0 - • . .Address Name of Contractor •er +? , •F�LI t(cep Phone No. .7jaT,'/�9•t?... 15. Is this Address � —1 lc��f). . , phone No. 761 /h property within 300 feet of a tidal wetland? yes. . . No l�• • • • • *If yes, Southold Town Trustees Permit may be required. J PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whethe'r interior or corner lot. .TATE OF NEYp ZK�I :OUNTY OF . . . • . . . . . .' .S.S ' ' ' '' ' ' ' ' ' ' .&;being duly sworn,deposes and says that he is the applicant (Name of individual signing c tract) bove named. f r eis the . . . . ... . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) • ' • ' ' . said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this plication: that all statements contained in this application are true to the best of his knowledge and belief;and that the Drk will be performed in the manner set forth in the application Sled therewith. porn to before me this . . . . . . . . . . . . f`(( . . . .day of. . . . . . . . .. 199 Itary Public, . . . . . .4�� �'� 1C , , , , , ' • • • • . . . . County - ROBERT I, SCOTT.JR. NOTARY PUBLIC,State.of N.Y. No.4725089,Suffolk Comer - . . . . . . . . . . . . . . . . ��/7erif 9. ay 31, 9Z(p (Signature of applicant) " J`' 11 V/ [t-' BOARD OF HEALTH FORM NO. 1 3 SETS OF LAMS Com. . . . . . . NOV 2i 199a j "" TOWN OFSOUTHOLD SURVEY r .. . . . . . . . . . . . . . . . BUILDING DEPARTMENT CIIBCR s ,ZC . . . . . . . . . . . . . i TOWN HALL Sg�IC F0 an SOUTHOLD, N.Y. 11971 T J TEL.: 765-1802 t:OTIFF Examined . laCALL . . . . . . . . . . . . . . . . . . • .�. . . . . .. Id MAIL TO : Approved . . .R �. . . ISo 'f Permit Ne4.3 �f£?' . . . . . . . . . . . . . . . . . . , Disapproved a/c . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . (Building Inspec r) A LIGATION FOR BUILDING PERMIT Date . . .. . . ... _ � M�. INSTRUCTIONS a. This application must be completely filled in by typewriter Orin ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stieets or,areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied!, or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Buildin"F Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply withiall applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessa spectio s. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) 1/f 7/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . .. . . . . . . . . . . . . I . . . . . . 1<flC,lY�. ( . .C.C/11 dt4: ! . . . .11. . . . . . . . . . . . . . . . . . . . . . . . " Name of owner of premises . . . . . .l��c�.(wJ i2 . . > � CC C�.�. . : ./J Lt, vxX . . . . . . . . . . . . . . . . . ... . . . . . . . . . . (as on t tax roll or latest deed) If applicant a corporation, s- nature of duly authorized officer. (Name and title of corporate officer) Builder's License No.,.-.�01 MI . ,/1 Plumber's License No. . Sly.)I Electrician's License No. .19. . J . . . . . . . Other Trade's License No. . . . . . I. Location of land on which proposed work will be/done. . . . . . . . . . . . . . . . . . . . . ( 2E; (1 ((VcS. .LCS /l.e . . . . . . . . . . . . . . . . . . ('I PnJ . . . . . . . . .. . ]louse Number Street Hamlet County Tax Map No. 1000 Section ', . , . . . . . . .. . . . Block . . . (),3 . . . . . . . . . . . . . . . Lot . . . . �. Subdivision . . . . . . . . . . , . , . . . . . . , ,'. Filed Map No . . . Nainc) . . . . . . . . . . . . . . . Lot . . . . . . . . . . . . State existing use and occupancy ofipremises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . .li. . . . . . . . . 1�c`LCCti/�. ' I4 +.:.- + .a .�,t('tlY°5f,1': ,�,1:ie 'i �'iF i#7t.1✓i. . . . . . . . . . . . . . sa b. Intended use and occupancy . . . .x!32 ,n1'f . . ,,,,d''t•�S�• ai"!`PJy'6..�rY1Jtlt. . LGSN� /JL.9�V0 ,�DC//�✓O '�`' t .� . 1 ✓ of;�.e � `�� ^l _vi tri b y.vx �d pV� ,V 7�i9-�du� � wa�c }veru 17 i l 4S%o LArooeo v6� .y�. 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