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Thomas C. Wolpert, P.E.
315 Windsor Avenue,Brightwaters,New York 11718
631-727-2303
r o nt r, s
rrint
S22-5 1'50"E 1463.00"
ENGINEER'S CERTIFICATION
I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SI.'WAGE
O DISPOSAL SYSTEM(S)FOR THIS PROJECT WERE DESIGNED BY ME OR
UNDER MY DIRECTION.BASED UPON A CAREFUL AND I HOROUGH STUDY
OF THE SOIL,SITE AND GROUNDWATER CONDITIONS,ALL IACHATIES,AS
tt SEE SHEET NO.4 PROPOSED,CONFORM TO THE SUFFOLK COUNTY DEPARTMENT OF
HEALTH SERVICES CONSTRUCTION STANDARDS IN EFFECT AS OF THIS
DATE.
0
SO 'FHOMAS C.WOLPERT,N.Y.S.P.E.NO.61483
S20024'20"E 404.64'
N20024'20"W TOWN OF SOUTHOLD 752.65' HARBES PUMPKIN FARM
N26�'IffW-20""W TOWN OF RIVERHEAD
2195.26'
coo�
S69"59'51"WAt Jamesport,Town of Riverhead
�b Suffolk County,New York
77.32' )Q o -7
00
00 County'rax Map District-W Smtior~03, Blork'11, 1,,,i?72�t3
F-
SANITARY DESIGN
MAP PREPARED APRIL 20,2013
SCALE: AS NOTED
JOB NO 13-57
DWG.13-57-1' 1 of 5
Thomas C. Wolpert, P.E.
�t Y
315 Windsor Avenue,Brightwaters,7New York 11718
631-727-2303
Proyress
rwft -0'A
S22-5 1'50"E 1463.00' Fri [
a
00
ENGINEER'S CERTIFICATION
01 << 1 HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE
DISPOSAL SYSTEM(S)FOR THIS PROJECT WERE DESIGNED BY ME OR
UNDER MY DIRECTION.BASED UPON A CAREFUL AND THOROUGH STUDY
11 OF THE SOIL,SITE AND GROUNDWATER CONDITIONS,ALL FACILITIES,AS
---- SEE SHEET NO.4 PROPOSED,CONFORM TO THE SUFFOLK COUNTY DEPARTMENT OF
HEALTH SERVICES CONSTRUCTION STANDARDS IN EFFECT AS OF THIS
DATE.
0
o THOMAS C.WOLPERT,N.Y.S.P.E.NO.61483
�tIJ S20024'20"E 404.64'
TZ420"W TOWN OF SOUTHOLD 752.65' P
N2&f 8 20 "W TOWN OF—RIVERHEAD HARBES PUMPKIN FARM
2195.26' (z)
S69059'51"W At Jarnesport,Town of Riverhead
77.32' `0 Suffolk County,New York
-7 13
00
01� County Tax Map District-W Sectio`I) Iuok'l-, 1'.'
SANITARY DESIGN
MAP PREPARED APRIL 20,2013
SCALE: AS NOTED
JOB NO.13-57
DWG.13-57-1 1 of 5
...............
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
DATE: January_ 24, 2014
TO: Edward Harbes
PO Box 1524
Mattituck, NY 11952
Please take notice that your application dated December 20, 2013
For permit to relocate buildines for the purpose of farm labor housing at n R
_ N A
Location of property: 25 Sound Avenue. Mattituck. NY
County Tax Map No. 1000 - Section 120 Block 1 Lots 13
Is returned herewith and disapproved on the following grounds:
The proposed farm labor use is subject to site plan approval from the Southold Town Planning Board
and Special Exception approval from the Southold Town Zoning Board of Appeals, pursuant to Article
III, 280-13 B. (9).
You ma npply to these a�encics directly �- �y
Authorized Signature
Cc: File, ZBA, Planning
Note to Applicant: Any change or deviation to the above referenced application may require
further review by the Southold Town Building Department.
LY FbFINTERNAL USE ON
LY
SITE PLAN USE DETERMINAT
ION
initial Determil atioIf
a Date Sent,—� ( � �=
Date: 1 U�
Project Name. ' s
a
v
Project Address:
Zoning District:
Suffolk County
Tax Map No.:1000'-
Request: R
------------
(Note: Copy of Builds -g
Appli ton and supporting doournentatior 'as to
;ermit
proposed use or uses should he suhrnitted.)
ilk
Initial Determination as to whether use is permitted:
'
I Determination as to whether site plan is re fired:
Initia
Signature of Building Inspector
Department (P. .) Referral:-----
Planning Dep'ar� D , - � �
Date of Comment.—
----
e
P.D. Date Received: ]AL
i
c
Co risen
E
_
VY) I
} . - R
Sl store of Plan g Dep eviewer
Finaltinson
Date: j=-
Decision:
ginnafiirn of Rnildinci InsnPctor
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL: (631)765-1802 Planning Board approval
FAX: (631)765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined 120 Storm-Water Assessment Form'
%0 Contact: �f
Approved >20, Mail to: .>�cf r Lt
Disapproved a/c /
Phone:_ I
Expiration 20
Imple-tely
Building Ins ector
PPLICATION FOR BUILDING PERMIT
,IIDEC 2 0 Date 1 20 JINSTRUCTIONS..� filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 waterways.
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 issue a Building Permit to the applicant.Such a 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 what so ever until the Building Inspector
issues a Certificate of Occupancy.
f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months.Thereafter,a new permit shall be required.
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 inspections.
(Signature of:pplicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises �, I I � ae ✓ r4 S L C
(As on the tax roll or latest deed)
If appy ant is a c poration nat e of duly authorized officer
( �a �;�t�cLltle$���ori; te off��er)
Builders LicetkseWo`:4;0 n suC
Plumbers License No £,
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
House Number Street O Hamlet
County Tax Map No. 1000 Section Block Lot
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work
4. Estimated Cost (Description)
Fee
lX 7 b a , (To be paid on filing this application)
5. If dwelling,number of dwelling units �f{ tttiaer of Belling units on each floor
If garage, number of cars JJ
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use, (1/1-".A. /i" K$ 4c1
1} 1
7. Dimensions of existing structures,if any:Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
r,r n
8. Dimensions of entire new construction:Front Z- Rear 7C-> Depth
Height Number of Stories
9. Size of lot:Front 312 D T Rear Depth
10.Date of Purchase 2–oo -) Name of Former Owner
11.Zone or use district in which premises are situated
12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO
13.Will tot be re-graded?YES_NO—Will excess fill be removed from premises?YES_NO
14.Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO
* 1F YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED.
b.Is this property within 300 feet of a tidal wetland?*YES NO
*IF YES,D.E.C.PERMITS MAY BE REQUIRED.
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
18.Are there any covenants and restrictions with respect to this property?* YES NO
* IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF�
being duty sworn,deposes and says,that(s)he is the applicant
(Name of individual signing contract)above named, CSE 0.BUNCH
Notary Pic,State of Now York
(S)He is the 01BUG186050
(Contractor,Agent,Corporate Officer,etc.) vourity Commisslon Expires A A 14,2 Otl to
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 work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me �{is�
�1 ) day of-L3 20/
Notary Public �� Signature of Applicant
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL:(631)765-1802 Planning Board approval
FAX: (631)765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check llt
Septic Farm -
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined 20 Storm-Water Assessment Form'
Contact: I
Approved 20 Mail to: { ILC
Disapproved a/c g j
Phone:t3/ S�' ` ��Z�
Expiration 20 T 11 /
a � � Building Inspector
APPLICATION FOR BUILDING PERMIT
DEC 2 4 2013
Date l� 20 ( S�
INSTRUCTIONS
u ompletely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 waterways.
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 issue a Building Permit to the applicant.Such a 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 what so ever until the Building Inspector
issues a Certificate of Occupancy.
f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months.Thereafter,a new permit shall be required.
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 inspections. 4104
(Signature of dpplicant or name,if a corporation)
P0,4 lS2� 0�41`/Yr// 1✓,C 4
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer;general contractor,electrician,plumber or builder
Name of owner of premises A �e r ra I-" A I I t�e L 41c eY �4 S r L L �
(As on the tax roll or latest deed)
If appy .ant is a c potation_ gnat e of duly authorized officer
(Nameacltalc
NCP tt ;cort ,oficer)
.
Builders Lice€�aey' ra-, Ai--
Plumbers ns'-�
Electricians License No.
Other Trade's License No.
1. Location of land on which roposed work will be done:
��
House Number Street a O Hamlet 1
County Tax Map No. 1000 Section Block C - Lot t j
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work
4. Estimated Cost �Lo Fee (Description)
t yk � 6 (To be paid on fling this application)
5. if dwelling,number of dwelling units lht�X f, 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.
{I ,
7. Dimensions of existing structures,if any:Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction:Front 70Rear 70 Depth 72o
Height Number of Stories
9. Size of lot:Front 32 0 t Rear Depth
10.Date of Purchase mor, ') Name of Former Owner
11.Zone or use district in which premises are situated
12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO
13.Will lot be re-graded?YES_NOWill excess fill be removed from premises?YES_NO
14.Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a.Is this property within 100 feet of a tidal wetland of a freshwater wetland?-*YES NO
* IF YES;SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED.
b.Is this property within 300 feet of a tidal wetland?*YES NO
* IF YES,D.E.C.PERMITS'MAY BE REQUIRED.
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
18.Are there any covenants and restrictions with respect to this property?* YES NO
* IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF )
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named, CONNIE D.BUNCH
(S)He is the Notary No.01SU61855060 York
(Contractor,Agent,Corporate Officer,etc.)
C����
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 work will be
performed in the manner set forth in the application filed therewith.
Sworn to before meis
� t day o 0_ 20
�—f ��alU 44,
Notary Public �— Signature of Applicant