HomeMy WebLinkAbout22082-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24180 Date FEBRUARY 22, 1996
THIS CERTIFIES that the building NEW DWELLING
Location of Property 8579 NEW SUFFOLK AVENUE CUTCHOGUE NY
House No. Street Hamlet
County Tax Map No. 1000 Section 116 Block 1 Lot 1.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NAY 3, 1994 pursuant to which
Building Permit No. 22082-Z dated MAY 25, 1994
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 A ONE FAMILY DWELLING WITH ATTACHED GARAGE AND DECKS AS
APPLIED FOR.
The certificate is issued to JUDY DIBLASI
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-94-0027 1/3/96
UNDERWRITERS CERTIFICATE NO. U361062 8/17/95 Q M373512 12/20/95
PLUMBERS CERTIFICATION DATED 12/6/95 HARDY PLUMBING Q BEATING NORTH
4K, &K
Building Inspecto
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)
Date % 19...1~J`•
N® 22082 Z
Permission Is hereby granted to:
o...-P,....
to .........................ow 4~7-
U /
l.CJ ~ C7,L`~' 7 7
at premises located at.... J~ ..h.........1/.i
County Tax Map No. 1000 Section 11j(P......... Block ......0. / Lot No.
pursuant to application dated 19.0~4...., and approved by the
Building Inspector.
'70
Fee $.../Q0
..O!Lr.
Byr~ding Inspector
Rev. 6/30/80
Form No. 6
U 15 U ~ r
TOWN OF SOUTHOLD
BUILDING DEPARTMENT pp~~~~
TOWN HALL JM ` 9
/ 765-1802
z . ^X z7 %1/ iG__4 Ikol-o(~/J' TOWN OF §OU , 01
-o
APPLICATION FOR CERTIFICATE OF OCCIIPANCY
A. 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. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 17 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.
9. 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 Buildine - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date .....:.(L/~ll[tl.J....`C... Jr1!?
ew Construction....... Old Or Pre-existing Building..................
.ocation of Property
House No. 4 t Street Hamlet "
nwer or Owners of Property ~~,dhcka, ..4JAm L
.ounty Tax Map No 100`0,,,11Section I,1.~....... Block ......Y.~........ Lot.... 1" 1
ubdivision...r.W,li ~ W ..................Filed Map............ Lot......I.
ermit No...4~.°?L1~ Date Of/Permit ................Applicant...........`....................
ealth Dept. Approval........ ? ...............Underwriters Approval ......Y
lanning Board Approval
equest for: Temporary Certificate........... Final Certicate........... JAN - 9 1996
Submitted:
R2C~4r 5D8ul w ofso_ tio,
dLl OV APPLICANT
I I
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1000121 BUREAU OF ELECTRICITY "
85 JOHN STREET. NEW YORK, NEW YORK 10038
Aif(:If'T 1" 4:Li a +S "a5 N 3610622
Dole Application .No. on file -
THIS CERTIFIES THAT
1 only the electrical equipment as described below and introduced by the applicant named on the above application number in the promises of
x
WINDSWAY BUTIDING, NEW SUFFOLK AVENUE, CUTCHCC31JE, N.Y.
in thefollowing location; ® Basement IT Ist Fl. ® Pad 1-1. ATTIC; OUT 3ertion Block Lot
was examined on AUGUST 14 , 1995 and found to be in compliance with the National Electrical Code.
RXTUlE ECBTACIES SwrtCHES RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K. W. AMT. K.W. AMT. K.W. Mr. K. W. AMT. X.P.
45 159 54 45
DRYERS FURNACE MOTORS FUTURE APPLIANCE RIDERS SPECIAL REG'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTIET DIAEA RRS
AMr. K. W. OIL H. F. GAS H. F AMT. NO. A. W. G. AMT AMr. Mr. AMFs TRANS. AMT. H. F SYSTEMS AMT. WATTS
NO.OF REi
1 F 2 -
SERVICE DISCONNECT ND. OF S E R V I C E
AMT. AMP. TYPE METER 110 3W 10 3W 313W 3,s Kw N0. OF CC COND. A. W. G. A. w. G. A. W.G.
FDW?. NR8 OF CC.CONO NILEG I OF NFUO NO.OF HFUnAlS OF NFU
2 150 CB 1 X 2 2/0 2 1/0
OTHER APPARATUS:
CEILING FAN -F-6
G.F.C.It-10
SMOKE DETFCTORF-2
PAUL R. BURNS LIC-0897-E
P.O.BOX 1061
SOUTHOLD, NY, 11971-0932 O MMM MANAGER
11 i
Per
This ceriifkase nw# not be altered in any morner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BURDMIG DEPARTMENT. Tft COPY OF OER MATE MUST NOT W ALTER NN ANY MAMIER.
-l t•t
of t) e) M
THt NEW YOM BOARD OF FIRE UNDERWRITERS PAGE 1
alM_ i
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
DECI•~iIiEP 1':1z'" 10774295,'95 N 373512
Date Application No. on file
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number in thepremises of
RICHARD 117 BLEST, PRVT.RII. OFF NEW SUFFOLK AVE., CUTCHOGUE, M.Y.
GAR/OUT
in lhefollominp location• FX~]] gg meat lxt Ft. ? 2nd F1. Section Block Lot
DECEAfRER~S . 199.
was examined on and found to be in compliance with the National Electrical Code.
FKTURE ECEPTACLES SWITCHES RXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INUNCEXENi FLUORESCENT OTHER EMT. K W. AMT. K W. AMT. K.W AMT. K.W. AMT. K. P.
a.i
50 57 51, 50 3 F
N-
DRYERS FURNACE MOTORS FUTURE APPLIANCE REDERS SPECIAL REC'PT TIME CLOCKS ULL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. N. W Olt H. P. GAS H. P AMT. NO A. W. O. AMT. AMP. AMT. AMPS. TRANS. AMf. M. P. SYSTEMS AMT. WA1T5
- - No. OF PEET
2 F 1 - 12/ 3 - 1
SERVICE DISCONNECT No.GF S E R V I C E
Iti
AMP roe mum. I F 3W I At 3W13 At 3W 3 R sW NO. OF C 80OND. OF CC. COND. NO. OF MI-LEG Of. MI.0. NO. OF NEVTRA~ OF NEUTRAL
FtE 1 150 CB 1 X 1 1/0 1 1/0
Q ` OTHER APPARATUS:
WELL PUMP-1
WHIRLPOOL BATH-1
t MOTORSil-3.5 H.P.,2-F H.P.
PANELBOARDStl-1 CIR. 6
G.F.C.II-11
SMOKE DETECTOR:-2
;ate
=12
PAUL R. BURNS LIC.i3897-E
P.O.BO% 1061 00pK MARIAOM
SOtTfHOLD, NY, 11971-0932
:y
Per. 11
This certificate must not be abered in a manner; return to the office of the Board if iscorrecl. Impedors may be k6nfi ed by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
Print Key Output Page 1
5738SS1 V2R3M0 931217 SOUTHOLD 02/22/96 14:24:58
Display Device . . . . . . X5
User . . . . . . . . . . . CLAIRET
NYSRPS ASSESSMENT INQUIRY DATE 2/22/96
473889 SOUTHOLD SCHOOL MATTITUCK SCHOOL ROLL SEC TAXABLE
PRCLS 1 FAMILY RES TOTAL RES SITE
116.-1-1.1 TOTAL COM SITE
8579 NEW SUFFOLK AVE ACCT NO 13
OWNER & MAILING INFO ===1=MISC ASSESSMENT DATA
DIBLASI JUDY !RS-SS ! **CURRENT** RES PERCENT
360 BAYVIEW DRIVE ! 1 !LAND 2,200 **TAXABLE**
EAST MARION NY 11939 ! BANK !TOTAL 7,600 COUNTY 7,600
**PRIOR** TOWN 7,600
! !LAND 2,200 SCHOOL 7,600
! !TOTAL 7,600
==DIMENSIONS SALES INFORMATION
ACRES 3.40 !BOOK 11744 SALE DATE 09/06/95 SALE PRICE 181,000
!PAGE 682 PR OWNER WINDS WAY BLDG CORP
__=====TOTAL EXEMPTIONS 0 TOTAL SPECIAL DISTRICTS 4
CODE AMOUNT PCT INIT TERM VLG HC OWN CODE UNITS PCT TYPE VALUE
!FD029
!PK090
!WW020
!SWO11
F1=NEXT PARCEL F3=NEXT EXEMPT/SPEC F4=PREV EXEMPT/SPEC
75.10- 03-013 F6=G0 TO INVENTORY F9=G0 TO XREF F10=G0 TO MENU
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
( ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING NAL
REMARKS: C20
DATE o °PO 4?,6 INSPECTOR
765-1802
UILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARK
-ems
DATE INSPECTORt-
F2
M-1802
BUILDING ING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ OUGH PLBG.
ION 2ND [ ] INSULATION
[ ] FOU t
[ [
] FINAL
MARKS: GYL 41
DATE INSPECTO
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [(/1 ROUGH PLBG.
[ J FOUNDATION 2ND [ J INSULATION
[ ] FRAMING J [ ] FINAL
REMARKS:
DATE INSPECTOR
M-1802
BUILDING DEPT.
SPECTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
.9 Q
2 l
DATE l2 INSPECTO
d4--oe;nZ7
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ INAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE jL INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] RO H PLBG.
FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
4=
DATE IN8PECTOR
New York State Department of Environmental Conservation
Building 40-SUNY, Stony Brook, New York 11790-2356
(516) 444-0365
FAX (516) 444-0373
Thomas C. Jorling
Commissioner
December 3, 1993
Winds Way Building Corp.
1020 Glenn Road
Southold, NY 11971
RE: 1-4738-00868/00001-0
Dear Permittee:
In conformance with the requirements of the State Uniform
Procedures Act (Article 70, ECL) and its implementing regulations
(6NYCRR, Part 621) we are enclosing your permit. Please read all
conditions carefully. If you are unable to comply with any
conditions, please contact us at the above address.
Also enclosed is a permit sign which is to be conspicuously
posted at the project site and protected from the weather.
Very truly your/s, /
/V' ~fL4114~t1~ ~yr
Robert N. Thurber 4
Environmental Anaylst 1
RNT/ja
enclosure
n
I
printed "recycled Mpei
TEL. 763-1802
TOWN OF SOUTHOLD
OFFICE OF BUILDIMG INSPECTOR
P.Q. BO;:.23
TOWN I::.LL
SOUTHOLD, N.Y. 11971
• ''Q' 2s ~b0
C C R T I F I C A T I 0 N
DateQeg-- Cq\" \S
Building Permit No, 2zogFZ
c
Owner
t (please print)t
Plus ~er~-1(af61" l~u~rv~ ldgJ 1~. c Kam.
(plec sc- u~rinty'
I certify that, the solder used in the water supply system
contains less than 2!10 of 1% lead.
(plumber's signature)
Sworn to befor me this
-2" ziay of
19Q~- Notary Public
Nota.•. PLeh_ic,~ County
HELENS 1). HORNE
Notary Public, Stage of Now York
No. O SuHol County
l4 Qualified
Commission Expires May 22, 1 AG
~ ~.a JAN ° 9 1996 ;
6LD°"° DF
Tf!NIN o S§Q061.
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER EFFECTIVE DATE
1-4738-00868/00001-0 December 3, 1993
FACILITY/PROGRAM NUMBER(S) pE IT EXPIRATION DATE(S)
November 30, 1997
Under the Environmental
Covaervation Law
TYPE OF PERMIT 0 New ? Renewal ¦ Modification 0 Permit to Construct 0 Permit to Operate
? Article 15, Title 5: Protection 0 6NYCRR 608: Water Quality 0 Article 27, Title 7; 6NYCRR 360:
of Waters Certification Solid Waste Management
0 Article 15, Title 15: Water 0 Article 17, Titles 7, 8: SPDES 0 Article 27, Title 9; 6NYCRR 373:
Supply Hazardous Waste Management
0 Article 19: Air Pollution
? Article 15, Title 15: Water Control 0 Article 34: Coastal Erosion
Transport Management
? Article 23, Title 27: Mined Land
0 Article 15, Title 15: Long Reclamation 0 Article 36: Floodplain
Island Wells Management
? Article 24: Freshwater Wetlands
? Article 15, Title 27: Wild, ? Articles 1, 3, 17, 19, 27, 37;
Scenic and Recreational Rivers ¦ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control
? Other:
PERMIT ISSUED TO TELEPHONE NUMBER
Winds Way Building Corp. (516) 765-1335
ADDRESS OF PERMITTEE
1020 Glenn Rd., Southold, NY 11971
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
Land Use Company; 2576 Sound Avenue Baiting Hollow, NY 11933 (516) 727-2400
NAME AND ADDRESS OF PROJECT/FACILITY
New Suffolk Avenue, Cutchogue
LOCATION OF PROJECT/FACILITY
SCTM M 1000-116-1-1
COUNTY TOWN WATERCOURSE NYTM COORDINATES
Suffolk Southold Great Peconic Bay
DE9MIFTIUI (F 011fHRIZID ACTIVITY
Subdivide 11.88± acre parcel into 4 lots; each to be in excess of one acre. Subdivision is to be in accordance with
attached plans approved by NYSDEC and Special Conditions.
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.
REGIONAL PERMIT ADMINISTRATOR: ADDRESS
Robert A. Greene
Bldg. 40, SUNY, Room 219, Stony Brook, NY 11790-2356
AUTHORIZED SIGNATURE DATE
December 3, 1993
4" Page 1 of 5
GENERAL 02DITICKS
Inspections
1. The permitted site or facility, including relevant records, is subject to in-
inspection at reasonable hours and intervals by an authorized representative of
the Department of Envirommntal Conservation (the Department) to determine
whether the permittee is complying with this permit and the ECL. Such represen-
tative may order the work suspended pursuant to ECL 71-0301 and S4PA 401(3).
copy of this permit, including all referenced maps, drawings and special
conditions, nest 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 Rene I s
2. The Department reserves the right to rrodify, suspend or revoke this permit when:
a) the scope of the permi ed 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) nevrruterial information is discovered; or
d) envirom ental conditions, relevant technology, or applicable law or
regulation have rreterially changed since the permit ms issued.
3. The permittee rrust submit a separate written application to the Department for
renenel, modification or transfer of this permit. Such application crust include
any forms, fees or supplerrental information the Department requires. Any
renenel, rrodification or transfer granted by the Departrrent crust 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 System (SPDES), Hazardous V\bste NbnageT2nt Facilities
(FVVJF), major Air Pollution Control (APO) and Solid V\6ste IVbnagemnt
Facilities (SVJF); and
b) 30 days before expiration of all other permit types.
5. UnIess expressly provided for by the Department, issuance of this permit does
not mxiify, supersede or rescind any order or determination previously issued by
the Department or any of the terms, conditions or requirermnts contained in such
order or determination.
Other Legal Obligations of Perrnittee
6. The permittee has accepted expressly, by the execution of the application, the
full legal responsibility for all damges, direct or indirect, of whatever
nature and by Wxn-ever suffered, arising out of the project described in this
permit and has agreed to indamify and save harmless the State from suits,
actions, dareges and costs of every nam 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 v\ork nor does it authorize the irrpaim-ent 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,
easarents and rights-of-my that mey be required for this project.
Page 2of.~
I 5 _u 6.i 17If-I- '
ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34 anti 6 NVCRR Part 608 1 )
9 Ilia( it injure operations by the Slate of New fork require an al- other environmentally deleterious materials associated with the
te,auon it, the position of the structure or work herein authorized. or project
it, in the opinion of the Department of Environruenbd Conservation 1 1 Any material dredged in the prosecution of the work herein permitted
d .hall (eo,o unreasonable obstru( bon to the tree navigation of said shall be removed evenly, without leaving large refuse piles, ridges across
, ilnod Iluss, end.inp•i Ibi• heallh, Mcly or w•Ifan• of the hed of a walonvay or floodplain or (jeep boles that may have a
the people of Ilu• Stole of ( dole It's' or desbnm Iron of the n,llural leudencs to cause damage to navigable channels or to the banks of
iesoun es tit the State, the ovwnem may he oulered by the Department to a wale no ay
re mo,e or nlb•m the <trUCtUral work. obstruct rns. or hazards caused
thereby without expense to the State. and if. upon the egnration or W t here shall be no unreasonable interference with navigation by the work
mso(eboo of Ih.s permit. the strut tore. lilt. ext ovation, or other herein authorized.
nuxhfn at-on of 111, water( nurse hetehy aolhorzed shall not be cool- 15 If upon the expiration or revocation of this permit, the project hereby
Ideted, the owners :hall. without expense to the State. and to such authorized has not been completed. the applicant shall, without expense
exlenl an(] in such note and manner as the Department of Envuonmerta l to the State. and to such extent and in such time and manner as the
l mnrervatlon mas requite. reolrle all or iris polbmm pl the unCnnmpleted Department of Environmental Conservation may require, remove all or
,hu(IUre or fill md re,tr>n• to its former enndainn the navigable any portion of the uncompleted structure or fill and restore the site
nod flood c,fw( is or the water rnir%e No m Iaml shall be made against to its former cund,tion No claim shall he made against the State of
the Slate nI New lnrit on a( (punt of any ,uCII memmal m alteration New fork on ac(ount of any such removal or alteration
la I hal the >Iat, or N,-, \oik hall of it, m i,,, be liable foi nry ddumge 16 If granted under 6 NVCRR Part 608, the NVS Department of Envlron-
or 1111(uy In ill(, LrUCILlo' nr work herein authorized which may be (aused mental Conservation hereby certifies that the subject project will not
Ill or result hum future operations undertaken bs the Slate for the contravene effluent limitations or other limitations or standards under
( onservahon or nnpro,ement of nd(mgation, or for ether pm poses. and Sections 301, 102. 303, 306 and 307 of the Clean Water Act of 19,'7
no clown or right to compensation shall accrue Irom ens Such damage (PL 45-1171 provided that all of the conditions listed hereto are met
I I Granting of this permit does not rebeve the applit ant of the response- 17 All activities authorized by this permit most be in strict conformance
hdtls of obtaining oils other pernuss in n. (omen I or ipprov aI fr. ifI with the approved plans subnulted by the applicant or his agent as part
the LI S 4rnmy Comp; it f nginC•ers. U S ( oa,t Guard. New ) mk SL,te of the permit application
Office of General Seni,e%or local goverment whit h Inas be required R. W. Ponaek
I? All nee ea4ars pre[ aubnn; shall be taken to preclude m onlanuna lion Such approved plans were prepared by
of any wetland or waterwes by suspended solids, sediments, Inels. latest revision) on 5/27/8.6
snl(•nh lit brie anti, -po,s r net in ga. pa In I, I ontn•I. - lea, hale o, ans
SPECIAL CONDITIONS
1. There is to be a 100' wide undisturbed natural vegetated
buffer extending landward from the tidal wetlands line shown
on referenced plan for Lot 4. For Lots 1, 2 & 3 the
undisturbed buffers are to be described in a covenant on the
deeds prepared for these lots.
2. There is to be no more than 20% lot coverage by development of
the upland area of Lot 4. For computation purposes the upland
extends west of a line 5' landward of "wetland line" shown on
reference plan. This lot coverage limit is to be included in
a covenant on the deed for Lot 4.
3. There is to be no filling, excavating, grading, clearcutting
or construction on Lot 4 below (east from) the 10' contour
line, on Lot 14 until additional application and plans have
been submitted to DEC and approval has been issued for such
work. Such activities below the 10' contour line on lots 1,
2 & 3 are precluded by the above required convenants for these
lots.
I ill )91LxnI Ntioa nlR
PRI M;R \R1n II I I1 NUAihI R
Page of sL_
95 2U hf 1-18'1-2.r NEW TORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
SPECIAL CONDITIONS
For AI-tide ( )
4. "Deeds will be drafted at the time of the sale of each lot
with covenants for lots 3 and 4 that no construction or
disturbance to vegetation or topography will occur below the
10' contour elevation on lot 3 and no such work woll occur on
lot 4 below the 101contour elevation until additional
application and plans have bPAn submitted to and approved by
NYSDEC.
Supplementar; Aal Cond. ins (A) through (F) attached.
DEC PFRMIF NUMBER
/-'12.3b1 vvPbX 0000/
FACII ITN ID NUMBER PROGRAM NUMBER
Page of
r.
m C
a ~
h
V-3 V,-1
W-V, - -
OUIIDATIO'I (1st) - \
\
OUtlDATIOf1 (2nd) m
~ 1
3 NO i
.OUCH FRAME &
-PLUMBING
:11SULATION PER 11. Y.
STATE ENERGY
51:16 y
CODE
Oi pyr r.~
o.
FINAL L
/t 5~
'ghy
ADDITIONAL COMMENTS. x
6~)
H
Q
• m Q
• r
-o Q
. _ v
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . . . .
BUILDING DEPARTMENT CHECK
TOWN HALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL.: 765-1802 MOT I FY
~~~rrr~ CALL S. _ .
Exantined(%!Z- .~........lq:pT MAIL TO:
Approved 19.l Oermit Noo2.2-0 R R
E., l5 IS
Disapproved a/c~j
/ NAY - 31894
~X~
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 5~3..., 19C4.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
c gtion.
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 Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary ins`p.~ctio s.
(Signature of applicannnt^^~or nam , iforporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..~d.rli~
II..11
Nance of owner of premises . W i N . LJ jo
~j
(as on -he tax roll or latest deed)
If applicant is a r ti .n, signa re of duly ut Polized officer.
............~A..
(Name and title of corporate officer)
Builder's License No. .
Abe
Plumber's License No. ! w A,
Electrician's License No. /ruTr~¢ . , , ,
Other Trade's License No .
1. Location of land on which proposed work will be done. v,
....ilr~,l>~ ..........................C \s.Gu~~rt
House Number Street Hamlet
County Tax Map N . 1000 Section ..../..S Block Lot .
Subdivision ) Filed Map No. . Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . a-evzze
b. Intended use and occupancy
U/...
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal , Demolition Other Work
n (Description)
4. Estimated Cost... O . . . . . . . . . . . . . . . . .
~
. Fee
(to be paid on filing this application)
S. If dwelling, number of dwelling units d h-4 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 existing7t7mre;% if any: Front Rear Depth
Height ..............;;_(•WmberofStories
Dimensions of same structure with alterations or additions: Front Rear
Depth YAM Height Number of Stories ...............d
8. Dimensions of en t new construction: Front A Rear Q
Depth . i~G.. ?
Height a ' of Stories #'-1.
9. Size of lot: Fro Rear ......S .l, .'.`E.`{.`..... Depth -).q
10. Date of Purcha@ Name of Former Owner . Eo.4~wL~.. O .
11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zyn~'ng law, ordinance or regulation: . ~o .
13. Will lot be regraded j tP~ . ca., ? Will excess fill be removed from premises: Yes
14. Name of Owner of pre ises fed ..+Qa: { Address Phone No.').46 : ! ?-T f .
Name of Architect ..W4r4 . 1t+nr4~,e..GV%... Address .r':.VM4u,na Phone No. ')3~i. X: q's.......
Name of Contractor ..0.'- 04 .c:). b-r Address Phone No
Q
15. Is this property within 300 feet of a a tidal J tidal . . . . . . wetland? *yes........ No .
*If yes, Southold Town Trustees Permit may be required. Arp"wQ. a_
PLOT DIAGRAM rl•v~u~ f~..f, sue(
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frora
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK,
^~S.S COUNTY OF ( f
, , , , , , , , 6CIv~ W 4 . f,1.lO t~ .`.1.......... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the....... .~Gd~
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
wo-k will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
f ~ ........day of... . ti c~...........1 1 4~
Votary Public, County
El 17AR NEVILLE (Signature of applicant)
Futlic.St to 0; {'~vvYork
_ Suffolk Co
October 31, 19 .
t
W-94'" NgW_'SI,~FC, f~K,,. _
P - a5' 0-1(;w of wxy
t
ell- X
3 Z c
coo !~`t
D 'L r f 40
cn 73 r ; UY
<
G' ' =i }Itn t
C C7
Fr.
Apr
Mtn \ ~ ~ ~
- ~f \j
.96
0
a So ~QRIAl -
~ 8 `
OOUNTY DWARTMENT OP s
° HEAUH 30
IN= MANLY DWEUJW 2
4
ApPowl0{CO Wnttcba ONLY
o Orr.IAN 3 1996
tt8. pd.
ar sua ; , tt+gIII1N
N $ Q ?IM have oven
y o>~ ~e~•:. J
a ' R n
io to be BVA*OCNNY.
-P-n
A. Cane, P.E., C W
wry .1 N1..• _
i a~Tf _ -.1 11 [ ~
~~3 ujn ni~ ~Z8<i yC1
IrAZ p ~ w w$I~R Lri
A
r ~
N t1 bN~ 0C A
1115
.W VO^O Z I C
Q.. > =Oi 1
X14 s a ~o ~tT a Z e
p ri x
-Zi w r t IA
* • L
gr'~~ +;a\l {app
r > z' nA~ 1~1
21
113
54
u ~ g?e ~ ~a t '
r
o a ,
^r..
966.94IONEVJ 5i,)f=FQL1G 4/ENue _
_ 25' QIG14T OP WAY --al
I~ - - - -
It
41 N _ `gyp/{~~
Z C T', - f iR~{{IOI~ IRS 6.
m Z P!~ ` a n of No
F
71
i x
W ~
\ .
co
I/ ~,t e I ,E. o i I ~ j
Sl 37'E
4 t4d•ai ~ ~ ~ I ,
(NI .
' :7 I
_ FA W i
Z C
taC. r ~j ~ ~ f
F I
%Ws
1~3 96-
a 5 c 44 08
3p r sTQ~ ' -
-wra
~1 ( > ` V
i>
- 41' z
r D OOUMTY DEPAFiTFAg1T Of HEALTH BERVICE8 y0a
1 A. 'alz
a =r m SINGLE FAMILY DWEUIM ONLY - g2 m'
k M(aft
O v fm u1 Z Apporai fad Cansbuaed
/Q-
H.S. Rat
n wl=
t' I I p I ~1 71N sAs~Oan+ si a : - sua.; . !(41111W Ln '1)
fton have o 3n.4
3;~9ci.:. ~4id/bf
a f o D i ~C5 by ihls Oa x~r'.:,dnt v other raWan
ar uh Im ' t .end fauna to be aafla mory.
a. ak-
Phan A. Cash, P.E. ChM
< 14
f > > O m c O v 3~ M -4 = 0 in n Z m H
mz~ U A 1 w O a!^--4<O yQ~ O; 'r
O In M r f!i
Lnxr w a O cnx ->i O
O O O n Os i
-4 D Oi -8 I 2
} N 1~ ur Z
10
s m 9 8319 " g G~Z < a x> 1
r
# R x r >
'Z\1 - O G 3 e a' > O O i 0_ o
33 - li -n 1t - '1
~yn\ Jai
r ~d~~d t v C A p -ri M c>i Z p
~R > < #
r r xr
14 x a r r
J J W ~A b Z U. a m
J J I W F O ePo i3
u J J _ , 2~5 aim
~9 T
4C J fr I53 c$ Ec:~ Q~.
W iL Hoop
z 9? ~ G < O M gs" ga ~ m
i~ F ^ O 0 ' l ' Sn E I' ( L= ¢J~a
1- ~11 < T Y O; ° > J1
o d6.
W
I O Z V ro c a Sg s~$sta l~. s
VI / < Z ~$V)j U5m3 (7 o.05mo~o
~ * N
<r0 a r~ Zo
> x wj 4
u
v'~'- fa[ O < et :_r
S <0~ ' O
u
u W Y O tll QI ® J 0~
J w
O f- Y Y _U 41
3Yf W W Wr IL 6J
' W z tL ~j fY b Z
X0uu~ VitlOZ Fd
I ~
r
o ~
f ZS w
CL j
Awl
96
I -
\ 1
44
fTv~
9,, (1 J
~ _ x'31 a a w .
SIT Lu
O I a
CL U)
is - _ Jl`~" 2D --Ltivm ~z
RP
2" cadre
*1
< v
4'
, I
~I E
,a4 +Y.~{4IK
1 i
~ ~ADe
x.. rve. .~M...~.,:•;v d.s.. ~ . 'f iurq.r4 ~.,~...r~-..~^„e*r^~M1~kr'M' +tik+iww++erv+Y...np
P PLUMBER CERTIFICATION '
Or ON LEAD CONTENT BEFORE
CE CERTIFICATE OF OCCUPANCY Y
SOLDER USED
SUPPLY SYSTEM CANNOT
EXCEED 2/1,0 OF 1 % LEAD'
M 9000 tubing Is wW
f« WOW dlatribudna
Mil"; piping shah be
atyp.aK«Lon
DON QQT PROCEED
UNTIURVEY OF
HAS BEEN APpROVEO
ti
_ wlusl
,t , OCCUPANCY OR
USE IS UNL 4WFUL
f,. OF WITHOUT CERTIFICATE,
OF OCCUPANCY
APPI APPROVED AS NOTED .
DATE: DATE: B.P. p'
k FEE: _T_ FEE: BY: .
t NOTIFY BUIL NOTIFY BUILDING, DEPARTMENTAT
765:1'802'0 765.1'8029 AM, TO 4"0M,FOR THE
~ A.-'~ x ~ ar i ryNa r ~y~ .+tu?ka^+s dim " J rv+" i r . FOLLOWING FOLLOWING-INSPECTIONS;
a j FOR POUR 1. FOUNDATION TWO REQUIRED FOR POURED CONCRETE
2•' ROUGH, - 3. INSULATIC ROUGH, '-FRAMING"&PLU M
BIN - G 3. INSULATION '
4. FINAL . 4. FINA S . L - CONSTRUCTION MUST
COMPI, f --~--t I, t , C~Aw\~~wwc*c I;a' AL BECONSTR BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET
'c.. ru. a ~`f~•'m +s -~:.x }Fr-..,,ii " THE REQUIR1 THE REQUIREMENTS. OF THE N.Y.
2TI STATE CONS STATE CONSTRUCTION & ENERGY
}I k CODES. NOT CODES. NOT RESPONSIBLE" FOR
'w j+.r? riyrT~rw~4 ~ `y~'F`M's'+"MWMIrv4H^W'~IY DESIGN OR CC DESIGN OR'CONS TRUCTION ERRORS
v rr r M~'XU,+nH^Y~^ ~a.1:~~4F'rtr~M-wuw;Na+,+w rr .`W~vm-er+N^una.«,x~.la~.,aN,b ~ ~Mem"f+?'^. :nm.{~r"w.p~ ,
l
ea AS NOTED
DAT . ]AT f44ROD B.P.HQ -
SI~.eu..~~i ) FE0TIF1fE.,
111 BY; -EE g01IFY BUILD! G DEPART T AT
M1802 ~4 AN ?65.78412 ?4 AM TO 4 PM FOR THE ;
FOLLOWING INE FOLLOWING INSPECTIONS:
I, FOUNDATION _ I - FOR POUREC Y. FOUNDATION - TWO REQUIRED FOR POURELICi''GRETE - k
.1. _ 2 ROUGH- FR 2 ROUGH - FRAMNG & PLUMBING
3 INSULATION 1 INSULATION
4 FINAL - C pot ALL CONSTRUI 4. FINAL CONSTRUCTION MUST
BE CONIPLET AZ7 THE RE i RE COMPLETE FOR C.O.
ALL CONSTRUCTION'SHALL MEET',ll THE REQUIREMENTS OF THE
_ STATE CO NSTF STATE CONSTRUCTION; &:,ENE~iGY
CODES. NOT RESPONSIBLER -
-7 CODES. NOT DESIGN OR CONSTRUCTION 110E R RS
71~ DESIGN OR Cpt eve
+ f
,
!P G Fe5ah,..
WARREN A. SAMBACH NBACH
CONSULTING ENGINEERS iINEERS
r r _ P.O. BOX 1033 COX Lane x Lane
Culehogue, N.Y. 41935 7 41935 "
516.7347482 D2 .
,
S
2s
r
6 ~v
0 40
,
~a
CWA
6 _
4 fJ~J
E d I I
l 4 Ir , k I
- d _ ~•¢lo'~"y~nt.fiiw 4b~`JC'f~:,, Il' ~ ~ (•s)3;via".l~'a..v alb, tt. ` vla auL ~;kHYb milrw ! I ~a ~ a ' Q
I }-.r T
- 1 f
1
I ti E
41 all KG, josch I
i
i ~h I
1
i
i
1~
i
l '~I
I
JI
Y
6
I I `
- / 32,/7 Zc 2,'7
i - --q L
?a
- - - 63 'X3-z-= 7- - 2 -1-~-
-12
1;
-74 1/
- L-5- 2~
a j ~45- 7
4-
73 5 5
'37/ WARREN A. SM
MEN A. SAMBACH rrou~ ~
- - CONSULTING ENGI SULTING ENGINEERS I. Box 1933 Cox Lana '
P.O. 809 1093 Co)
Cutchogue, N.Y. Ichogue. N.Y. 11935
- - - - 51&734-749 @1&7347492
har~r~
I
j3
N
7
I r+y +o Sr .pu qr.,1 ~~QrtCl [1L cTWu TW , RI X
J', 'C'wG CU'.3~ Cif Aft c
--7-~ i j
I I
i (C'nT~tule~\ r { W.10' 'IN,
II 1 ~ r ~ ` ~ S1
,r lrr• QyiS'-~-~ l 'o. ~{tif tii. ~_)C~1 \.~e~.; Ii L~~. ~~7 1
r; ]
_rj
a
1 t t_, • c I,
~Y Smewx~;F1
4 { ~ i
f 11 4A~kLY } _ _ -
n
~i Jl t; ~ v l - G L q' _ IT
C\ ty
~h'~f t7!r aEt l:~A9 {,c ~scka.» ~ I
t q t
y n
i loft~!,1 G ~ I vC~ 1'eb ~~,yry Jl- OIL PA
I I
i ~u c,Prsc ~~~z -
~'n i' 1 LS nTµ.-V
( \t
i ~
fI
IF
I:
i
I~
li
{
' u I
A.lrs
WARREN A. SAMBACH MBACH
CONSULTING ENGINEERS P.O. Box 1033 Cox Lana 31NEERS
Culchogue, N.Y. 11935 )x Lane s_,'~.h~r~ x 11935
516.734.7492 19'2 +
II
I
a
tea-
.
rn' Q
.
i
i I i
I
i`
r
. L-
c.~
~ F 1
1
~ .~~alo' ~~ENT
U C•~a tilh-t d 7 ~YiY Y+W i y,J ~ ~ ~ ~ Ii
11r~~f` Si4'•.i~l~t ^a~~„"'ta Ir5`~a'~ ~ - WL- ~ ~Gsn....s a„~I~ 's~~: .
t
i
r f. 1 ~ ~u p
1 i
TXL
yy if 4,
1104
I S
4 f; ~ ~ f f ( I
y t I
1-VNln ~'4,~ C~ '~'ih~lbt.,+ Dpi n.. 3f',.v I i t,~)-`,r 4e C{o-_ i•, '.R
eic
°i I ' c4.Crc c _
iI i
~yo,,dMircc~~~i
WARREN A. SAMBACH pppti eACH
- CONSULTING ENGINEERS, JEERS
- P.O. Box 1033 Cox Lane Lane
Cutcho0ue, N.Y. 11935 I 1985 - Nate
S1&734-7492
klOv