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HomeMy WebLinkAbout21317-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23444 Date JANUARY 5, 1995 THIS CERTIFIES that the building ADDITIONS Location of Property 580 BROADWATERS ROAD CUTCHOGUE, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 104 Block 10 Lot 3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 2, 1993 pursuant to which Building Permit No. 21317-Z dated APRIL 7, 1993 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 ADDITION & DECK ADDITIONS FRONT & REAR TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to LOUIS & SONIA SULICH (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-336100 - DECEMBER 12, 1994 PLUMBERS CERTIFICATION DATED DECEMBER 22, 1994-K&K PLUMBING & HEATING X.,l 14~ Bui ding Inspector Rev. 1/81 i "RXNO.s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. ft R . BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLE~I TV10,F :THEE . N°° 21317 Z Dare 19.9. Permission is hereby granted to: .........?.......::......aP............................... to 4 kS 4 ..-It ~cYrYl sQ4-} . at premises located at ....a~+. 4 ~!j°... u County Tax Map No. 1000 Section ....I Block I Lot No... pursuant to application dated (~/~41 j .....z- 19Q.3 , and approved by the Building Inspector. ~J Fee S..n~./. b.: 5 SfV..... zr~ 91~.... Building Inspector Rev. 6/30/80 SEW YORK STATE DFP\RTMFVr OF E`AIRONN%I TAL CONSLR\'+TIO\ DEC PERMIT NU.MIOR ® EFFE E DATE v 1-4738-00527/00001-0 '"W Oct. 13, 1992 FAUUTY!PROCRAM NUMBERIsi PERMIT EKPIRATlO~ DATE Under the Environmental Conservation Law (ECL) C Oct. 31, 1994 TYPE OF PERMIT (Check All Applicable Boxes) El New ?Renewal ?MOdifkation ? Permit to Construct C Permit to Operate Article 15, Protection of Title Watr C~ SPDES 17, Titles 7, 8: HArticle 27, Title 9; 6NYCRR azardous Waste Management 3 Pr Article 15. Title 15: Article 19: Article 34: Water Supply C~ Air Pollution Control Coastal Erosion Management a Article Transport 15. C~ Mined Land Title Water Reclamation C~ F oodpla n Management Title Article 15, 15: Article 24: Articles Long Island Wells C~ Freshwater Wetlands C~ 6NYCRR t380: Radiation Control Wild,O Sc15, enic Title Recreational C= Tidal Wetlands Other: Rivers Article 27, a Title RR 360: 08. C~ Solid Waste Management WNa`CRORua Certification PERMIT ISSUED TO TELEPHONE NUMBER Louis'F. Sulich, P.E. t ) ADDRESS OF PERMITTEE 14-05 156 St., Beechhurst, NY 11357 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER ( 1 NAME AND ADDRESS OF PROIECTiFACILITY Sulich Property N.S Broadwaters Rd., Cutcho ue LOCATION OF PROIECT/FACILITY SCTM 111000-104-10-3 COUNTY TOWNIClTX@rjtWE WATE RCOURSEIWETLANI NO. NYTM COORDINATES Suffolk Southold B E: - N4 - - DESCRIPTION OF AUTHORIZED ACTIVITY Place approximately 80 cubic yards of upland fill to raise the grade of the property around an existing house. Raise house by adding concrete block to existing foundation. Construct 2 new additions to attach to the south side of house and g new deck on north side. All work shall be in accordance with NYSDEC approved plans attached. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the Genera) Conditions specified (See Reverse Side) and any Special Conditions included as part of this permit. Deputy Regional ^ ' 'EG0'tra PERMIT ADMINISTRATOR ADDRESS a;npt OSl f + TMA5. 40 3 T.1 F$ it aatvD-%.1~6 eor a Ha rth rz"'Iy idrocLt rt. V. AU RIZED SIC"T v OnrE 10/ 13/92 Page 1 of 5 ~I r( GENERAL CONDITIONS Inspections 1. The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71.0301 and SAPA 401(3). A copy of this permit, Including all referenced maps, drawings and special conditions, must 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 Rerhewais 2. The Department 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 regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material Informatlon is discovered; or d) environmental!, conditions, relevant technology, or applicable law or regulation have materially changed since the permit was Issued. 3. The permittee must) submit a separate written application to the Department for renewal, modificl- tion or transfer of this permit. Such application must Include any forms, fees or supplemental infor- mation the Department requires. Any renewal, modification or transfer granted by the Department must be In writing.] 4. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. 5. Unless expressly provided for by the Department, Issuance of this permit does not modify, supersede or rescind any order or determination previously issued'by the Department or any of the terms, con- ditions or requirerrlents contained in such order or determination. Other Legal Obligations of Permittee 6. The permittee has accepted expressly, by the execution of the application, the full legal responsibili- ty for all damages,!, direct or Indirect, of whatever nature and by whomever suffered, arising out of the project described in this permit and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from this project. 7. This permit does n;ot 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 Impair- ment of any rights,',title, or Interest in real or personal property held or vested in a person not a party to the permit. i 8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights- of-way that may be required for this project. I Page 2 of S SUPPLEMENTARY SPECIAL CWNU1'1'LONS tThe following conditions apply to all permits: A: LE any of the permit conditions are unclear,the permittee shall con- tact the Division of Regulatory Affairs at the address and telephone noted below. B. A copy of this permit with supplementary conditions and approved plans shall be available at the project site whenever authorized work is in progress. C. The permit sign enclosed with the permit or a copy of letter of approval shall be protected from the weather and posted in a con- spicuous location at the work site until completion of authorized work. D. ,At least 49 hoiltg prior to commencement of the projectj the permittee shall complet6 Acid f6tofh the top portion of the enclosed receipt form certitying.thAt hdA,4.fUlly aware of and understands all provisions and ~conditione of this perMlt. Within one week of completion of the permitted work, the bottom portion of that form shall also be com- pleted and returned. E. For projects involving activities to be accompllshed over a peri.od of more than one year, the permittee shall notify the Regional. Permit Administrator in writing at least 48 hours prior to the commencement of resumption of work each year. F. If project design modifications take place after permit issuance, the permittee shall submit the appropriate plan changes for approval. by the Regional Permit Administrator prior to undertaking any such modi- fications. The permittee is advised that substantial modification may require submission of a new application for permit. G. All necessary precautions shall be taken to preclude contamination of any wetlands or waterway by suspended solids, sediment., fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project work. i H. 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. 1. The permittee is advised to obtain any permits-or approvals that may be required from the U.S. Department of Army Corps of Engineers, NY District, 26 Federal Plaza, New York, NY 10278, (Attention: Regulatory Functions branch), prior to commencement of work authorized herein. J. 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, which may be required for any encroachment upon State-owned lands underwater. Regional Permit Administrator NYS Dept. of Environmental Conservation Bldg. 40, SUNY-Room 219 Stony Brook, Uy 11'190-235A (516) 751-089 - Page 2 f SEOR Negative Declaration Reasons Supporting This Determination: (See 617.6(g) for requirements of this determination; see 617.6(h) for Conditioned Negative Declaration) - The project is well designed to meet the applicant's need to raise the grade of property and elevation of house to protect against flood waters associated with storm tides without causing undue adverse impacts to the adjacent tidal wetlands. - The area of fill will be contained far enough from the high marsh area along the shoreline to prevent filling and sedimentation impacts to the wetland. Appropriate fill containment measures will be employed throughout the construction phase of project and maintained until the fill area is vegetatively stabilized. - Proposal is compatible with the existing waterfront residential character of the surrounding area and should not effect the adjacent properties. - No endangered, threatened or special concern plant or animal species are known to inhabit the site. if Conditioned Negative Declaration, provide on attachment the specific mitigation measures imposed. For Further Information: Contact Person: George Nammarth NYSDEC Address: Region 'I Regulatory Affairs Bldg. 40, SUNY, Rm. 219, Stony Brook, NY 11790-2356 Telephone Number: (516) 751-1389 For Type I Actions and Conditioned Negative Declarations, a Copy of this Notice Sent to: Commissioner, Department of Environmental Conservation, 50 Wolf Road, Albany, New York 12233-0001 Appropriate Regional Office of the Department of Environmental Conservation Office of the Chief Executive Officer of the political subdivision in which the action will be principally located. Supv., T/Southold Applicant (if any) Louis F. Sulich Other Involved agencies (if any) 14-12a j2nM-9c 3E'OR, b17.21 1 Appendix F State Environmental Quality Review NEGATIVE DECLARATION Notice of Determination of Non-Significance Project Number 1-473', 00527/00001-0 Date Oct. 13, 1992 f This notice is Issued',pursuant to Part 817 of the implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental Conservation Law, The N.Y.S. Dept. of Environmental Conservation as lead agency, has determined that the proposed action described below will not have a significant effect on the environment and a Draft Environmental Impact Statement will not be prepared. Name of Action: Sulich House Improvements SEAR Status: TypeI ? - Unlisted Action icoated in Peconic Bay CEA Unlisted ? Conditioned Negative Declaration: ? Yes ®No Description of Action: Placement of approximately 80 cubic yards of fill in the area around an exisitng single family dwelling to raise grade by approximately 1.5 feet. Raise house by approximately 2 feet in elevation by adding several courses of concrete block to the. existing foundation. Construct two additions and a deck to attach to the existing structure. Location: (Include street address and the name of the municiPalitY/countY. A location map of appropriate scale is also recommended.) North side of BroadwTters Road Cutchogue Broadwaters Cove; Town of Southold, Suffolk County SCTM #1000-104-10-3 95~06f (7/87)-25c ` NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS For Article 25 f Tidal Wetlands 5. All fill shall consist of "clean" gravel and soil (not asphalt, slag, flyash, broken concrete or demolition debris). Supplementary Special Conditions (A) thru (J) attached. DEC PERMIT NUMBER 1-4738-00527/00001-0 FACILITY ID NUMBER PROGRAM NUMBER 4 5 Page of -A Form No. 6 BYIJL~ Q7 2~idJC ~3y, 6, d TOWN OF SOUTHOLD (1 4, BUILDING DEPARTMENT ,f "~iV 4 ~9~5 TOWN HALL 765-1802 BLDG. DEPT. TOWN OFSOOTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 in,starllation from Board of Fire Underwriters. 4. Sworn statement from plumber certifyin"hat 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. B. 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. . C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,' Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre_existing Building - $100.60 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date .3 .....1:97.5 New Construction........... Old rOar Pre-existing Building Location of Property........... B)2o~P w4-rtGts ...?.Oi4 L UTC;ffo6UC...... .1 House No. Street Hamlet Onwer or Owners of Property..(7joU.... S W c; r C._./-/ County Tax Map No 1000, Section ...1 6 q ......Block...... 0 ........Lot......` Subdivision ...................................Filed Map............ Lot...................... Permit No. al 6 1.7 Date Of Permit ................Applicant........ . Health Dept. Approval ..........................Underwriters Approval................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate........... Fee Submitted: $ e'f~97~........ C®ta3gv AP LICANT FOL4, t Town Hall, 53095 Main Road Fax (516) 765-1823 P. 0. Box 1179 Telephone (516) 765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD December 22, 1994 Mr. Louis Sulich P.O. Box 1091 Cutchogue, NY 11935 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) XX No Underwriters Certificate on file. XX The check is (outdated/not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. XX No Plumber Solder Certificate on file.z,--~ (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 21317-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. 01 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 10016/71 BUREAU OF ELECTRICITY F 88 JOHN STREET, NEW YORK, NEW YORK 10038 Date DECEMBER 12,1994 85882:394/94 N 335100 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 the premises of LOUTS SULICH, BRO~AryDWATERS ROAD, CUTCHOGUE, N.Y. in thefollowing location- LJ Basement A ist Ff. ? 2nd Fl. ATTIC/OUT Section Block Lot was examined on DEfCEMBER 05,1994 and found to be in compliance with the National Electrical Code. FIXTURE FIXTURES RANGES+ COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT, K. W. AMi. K W M1i K W AMi (W AMT. HP 18 22 20 16 2 1 E DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECPT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K. W OIL H. F. OAS H P AMT. NO A. W. G. AMT AMP "T. AMPS. TRANS. AMT H. P. SYSTEMS 1 30 NO. Of FEET AMT WATTS 1 E a SERVICE DISCONNECT NO. OF S E R V I C E , METER 1 q ]W 1 g 3W ~,B" 3W p IW NO OF CC. COND . "I. AMP TYPE NO OF NEUTRALS Oj NEUTORAI EQUIP- PER a OFA CG W. C G OND. NO. Of H4LEG O F H IEC 1 200 CB 1 X 1 2/0 1 2/0 OTHER APPARATUS: SHED-1 30 AMP.TRANSEER SWITCH-1 MOTORSc2-E H.E. E1,13C. WATER HEATERSti1-4.5 K.W. G.E.C.It-2 SMOKE DETECTOR:-1 G & S CONTRACTOR LIC.#578-E BOX 215 GENERAL MANAGER' SOUTHOI,D, NY, 11971, 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. CONY FOR BUILDING DEPARTMENT. THIS CORY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~T , (20 TELI O Ol$ TOWN OC SO[T HOLD , orriCGor• BUILDING INSPCCTott ! P.O. BOX 728 • TOWN HALL ' rd0~ SOUTHOLD, N.Y. 11971 , f y C tt T I F I C A T I O N .g , Building permit No.~~ Owner p ease pr ntl Plumber i• Ip oase print) f"41 'i Z aortily that the eotdnir usnc1 in the water supply sYstem N ~ ~5 contning 1099 t } han 2/10 of It lead. ~i a ails ~ 1 1 ~ e ! rxx. (plumber's signature) Sworn to beforh this c t° 19 otary Public ffolary t+ubild~ count."•``~' P, 4 JOYCE M. WILKINS 'A'I M Notary Public, State of New York z . . No. 4952246, Suffolk Coin CTerm.ExpiresJunel2, i ~ , ' + ~;,h, 9 IELD I!;SP CTiON JJDkTE COMMENTS m 1 . a CU FOUNDATION (15t) < n(~ c ti FOUNDATION (2nd) m 2. ~ z o~ 00 ROUGH FRAME & o PLUMBING y 3. m H INSULATION PER N. Y. STATE ENERGY CODE x b L l f cn 4, H ?1• FINAL I o l ~ 2 ~ ADDITIONAL COMMENTS: x ro ro•O H \ 9 1\ H "Q 2 , x m b 13 - x c~ m ro H ti JUDITH T. TERRY I i d H; Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS tJ i < Southold, New York 11971 ;c. ' MARRIAGE OFFICER Fax (516) 765-1823 Telephone (516) 765-1801 I OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD fuly-6--7993 JULY 16, 1993 SECOND REQUEST Thomas Fisher, Building Inspector To: 6txrt+s-W:-+7owton,-~enioi BuiFc77rg Fnspeetol~ From: Judith Terry, Town Clerk Re: Request of Michael Zuhoski Attached is a letter from Michael Zuhoski requesting an adjustment of a .Building Permit fee. Please advise the amount of the refund due to Mr. Zuhoski so I may prepare a resolution for the Town Board authorizing said refund. Thank you. Attachment , pq i r William M. Beebe Builders A Division of S & Z Builders P.O. Box 722 • Cutchogue, New York 11935 (516) 734-6681 July 2, 1993 RECEIVED JUL 61993 Southold Town clerk Dear Mrs. Terry, On April 2,1993, I submitted plans for a permit. These plans included additions, alterations and two decks. I explained at the time that only the decks would be built. However, a mistake was made and I was charged for the additions and alterations instead of just the decks. Would you please review the plans and adjust the permit fee accordingly and send the relffuhd to the address above? I would appreciate any help you could give me concerning this matter. The permit number is 213172. Thank you. Sincerely, ~.~1 Michael Zuhoski MZ ` ".x 1t ' ~d 1~~71'-i'~ Partner S+Z Builders) $1 r JUL ooc~~FFOIk JUDITH T. TERRY = = Town Hall, 53095 Main Road P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER yQ O~' Fax (516) 765-1823 Telephone (516) 765-1801 ~77 I ~4 OFFICE OF THE TOWN CLERK Ju. ~I TOWN OF SOUTHOLD DG. TT1°IOka July 6, 1993 To: Curtis W. Horton, Senior Building Inspector From: Judith Terry, Town Clerk Re: Request of Michael Zuhoski Attached is a letter from Michael Zuhoski requesting an adjustment of a Building Permit fee. Please advise the amount of the refund due to Mr. Zuhoski so I may prepare a resolution for the Town Board authorizing said refund. Thank you. Attachment } William M. Beebe Builders A Division of S & Z Builders P. O. Box 722 • Cutchogue, New York 11935 (516) 734-6681 ~>L1trl .5~~ July 2, 1993 ~ JUL 7 1993 RECEIVED TOWN OFI,SQU P 10;t JUL 61993 Southold Town Clerk Dear Mrs. Terry, On April 2,1993, I submitted plans for a permit. These plans included additions, alterations and two decks. I explained at the time that only the decks would be built. However, a mistake was made and I was charged for the additions and alterations instead of just the decks. Would you please review the plans and adjust the permit fee accordingly and send the e'fuhd to the address above? I would appreciate any help you could give me concerning this matter. The permit number is 213172. Thank you. Sincerely, Michael Zuhoski MZ Partner S+Z Builders x(31 7~ E M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ INAL REMARKS: 6~-~ ~r i DATE l L ;11/INSPECTOR E f 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ] ROU PLBG. FOUNDATION 2ND INSULATION [ ] FRAMING [ ] FINAL REMARKS: i DATE D INSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ) FOUNDATION 1ST [ ROUGH PLBG. FOUNDATION 2ND [ ) INSULATION [ "FRAMING [ ) FINAL REMARKS: DATE INSPECTOR y NOW, M-1802 BUILDING DEPT. INSPECTION [ VJ FOUNDATION 1ST ( I ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: l`z9u UyC DATE d-3 INSPECTOR 131 765.1802 BUILDING DEPT. INSPECTION [ FO DATION 1ST [ J ROUGH PLBG. [ FOUNDATION 2ND [ J INSULATION [041RAMING [ J FINAL REMARKS: d~ GO r DATE INSPECTOR TRUSTEES John M. Bredemeyer, III, President SUPERVISOR Henry P. Smith, Vice President SCOTT L. HARRIS Albert J. Krupski, Jr. John L. Bednoski, Jr. Town Hall John B. Tuthill 53095 Main Road P.O. Box 1179 Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES Southold, New York 11971 Fax (516) 765-1823 TOWN OF SOUTHOLD March 6, 1992 Louis Sulich A R 14-05 156 Street Beechhurst, NY 11357 SLDG.DEPT. SOWN OF 541tIi49C9LY7 RE: SCTM #1000-104-10-3 Dear Mr. Sulich: The following action was taken by the Southold Town Board of Trustees on February 27, 1992: RESOLVED that the Southold Town Board of Trustees approves the request for a waiver to construct an addition to existing dwelling as per survey submitted. Please note that permits from other agencies may be necessary, as the Trustees approval does not constitute approvals from other agencies. If you have any questions, please do not hesitate to contact this office. A V ry truly yours, John M. Bredemeyer, III President, Board of Trustees JMB:jmt cc: Bldg. Dept. CAC II i uv, uvn ,vw~iucrc y(ATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION i0INT APPLICATION FOR PERMIT .U.S.ARMY CORPS OF ENGINEERS APPLICATION NO. ALL instructions on back before completing this application. Please type or. print clearly -m.ink. Attach additional information as needed. Will rfCLE 9, TITLE 1, ARTICLE 43 6NYCRR 646 (LAKE GEORGE RECREATION ZONE) ' ' - - riCLE 15, TITLE 3 (AQUATIC PESTICIDES CONTROL) ?6NYCRR 327 (AQUATIC VEGETATION) ?6NYCRR 328 (FISH) ?6NYCRR 329(INSECTS) ARi1CLE tb, TITLE 5 6NY60.R 600 (PROTECTION OF WATERS) . - ,y : . ;1~, r ~OFor the construction, reconstruction, or repair of a DAM or other impoundment structure. [3For the disturbance of a STREAM BED OR BANKS or excavation in or fill of NAVIGABLE WATERS. 0401 WATER QUALITY CERTIFICATION []ARTICLE 15, TITLE 15 ?6NYCRR 601 (WATER SUPPLY) ?6NYCRR 602 (LONG ISLAND WELL). []ARTICLE 15, TITLE 27 6NYCRR 666 (WILD, SCENIC AND RECREATIONAL RIVERS) _ ?ARTICLE 24 6NYCRR 662, 663 (FRESHWATER WETLANDS) ?ARTICLE 25 6NYCRR 661 (TIDAL WETLANDS) ?ARTICLE 34 6NYCRR 505 (COASTAL EROSION) ^ . - - - F [SECTION 10 (RIVER AND HARBOR ACT OF 1899) for structures and work in navigable waters of the U.S. [COASTAL CONSISTENCY CERTIFICATION. E [SECTION 404 (CLEAN WATER ACT OF 1977) for disposal of dredged or fill material in waters of the U.S. D [SECTION 103 (MARINE PROTECTION, RESEARCH AND SANCTUARIES ACT) for the transportation of dredged materials for dumping into ocean waters 1. LIST PREVIOUS PERMIT/APPLICATION NUMBERS AND DATES (If any) s p~G 'M IT Wca1 1041-024o 3/59 -7. 2 APPLICANT IS A/AN Lld'Owner [Operator [Lessee [Municipality/Governmental Agency (Check as many as apply) 3. NAME OF APPLICANT (Use Full Name) L0 L) 'F- . UL C,l~ MAILING ADDRESS 1 ^ 0 IS TELEPHONE (Where can 6e reached during day) POST OFFICE STATE ZIP CODE 3k~ca~U-~R~~f N kt~s 4. NAME OF LsSOwoer []Agen Contaccterson (Check one) ' 0 U1 5 UL C. , 1 MAILING ADDgpSS a Ip I ` n' TELEPHONE (Where can be reached during day) 14 i0 ~V. POST OFFICE ; 1 . TArE ZIP CODE h( k\~~ APR 2 5. PROJECT/FACILITY LOCATION / (Mark location or, map, see Number la on reverse side) Sa> >-0 T e County U L{~•- I -Town or city Village y f STREET ADDRESS (If drfferent from applicant) f ~~vATJW FZrD , POST OFFICE STATE ZIP CODE 60 L~ N 6. NAME OF STREAM OR BODY OF WATER 7. HAS WORK BEGUN ON PROJECT? If YES, attach explanation on starting work without permit, includ dates. 8. WILL PROJECT UTILIZE STATE LAND? [Yes CRNo Show work on map and/or drawings / 0 Yes Yes o 9. PROPOSED USE: LM'Privato 10 PROPOSED STARTING DATE: t,11. APPROXIMATE COMPLETION DATE: I2. FEE OF (NYS Permit Only) ? Public ? Commercial AL~Cre ~~{-V Na~/L kq~2 $ , n~•~Enclbsed' 'I 13 PROJECT DESCRIPTION: (e.g. quantity and type of material to be excavated, dredged or used for fill or rip rap, location of disposal sites; type of structure to be installe/d, Neigh f dam; size of impoundenq caps bets o 5r p se ate L s uSC'~e t4nt of dtstr,bTttt . tem; etc) O SZAISk AA h4 `1( 0e-7.5 2 S z n Gn REV! f y C U g I..;414 ~ 717t ~ qv+a R :)I F110. 6s czVt~lnn 0 1~ x sFV a~~c~~4lrlDrc~C47 14. WILL THIS PROJECT REQ IRE ADDITIONAL FEDERAL, ATE AND/OR LOCAL PERMI S? Yes ? No If yes, please list: TOWtA OF SOU1'401.D J!W)LV N4 fECiMt? 15. CERTIFICATION: , I hereby affirm that under penality of perjury that information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 21045 of the Penal Law. Further, the applicant accepts full responsibility for all damage, direct or indirect, of whatever nature, and by whomever suffered, arising out of the project described herein and agrees to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from said project. In addition, Federal Law, 18 U.S C. Section 1001 provides for a fine of not more than 810,000 or imprisonment for not more than five years, or both, where an applicant knowingly and willfully falsifies, conceals, or covers up a material fact; or knowingly makes or uses a false, fictitous or fraudulent statement ?1 1, b authorize the agent named in Number 4, a ve to submi this appl' anon on my behalf. DATE / SI N T R E ~ TI LE PLEASE READ ALL INSTRUCTIONS ON REVERSE SIDE CORPSpF ENGINEERS saiellt/~t.s~;ejnEaa~30Sdt JaHn Tanfifly 2561 g 1 i VdV l C ~ No . AS 7 of C f Ovalle. roetcr. i ~ - a J-4 i _ Milne!` 79 Te se G-'"" u, z rn r. o lJ) 4 f 1 r, 1 f X ((D 3 w r: a > O z CD =r 03a~mca O ° w * O-~. D CD N :3 =3 O~N - -Z =T CD (0 CD 3 3 0j3)3--c" CD 0 CO CD CD 03 :3 0=3 W m z a CL 1 d m 0 z (a - :3 0) M CD 3 0 (D Q- a - CD . O 3 o'v:3 x ~m=3- O~ 0 r-4- PA nCD CD s`' (D 00 Z G 00cn :3 0 N Cn o G m = 3 ° w N CD CD ~ CD r-i- Al CD CD 0 CD CD .-r O -n C CD h o. O O A) w CD W C: U CD X -0 O O p CD CD =r :3 3 m~0CDC~Dm C/) _ < C) CD o m 3 _ O Cn =3 =3 c-oa3 (Ito D 3 p- s cn o C(D =3 O N a sa. BOARD OF HEALTH APR-,21 93 FORM NO.1 ?3 SETS OF PLANS TOWN OF SOUTHOLD ?SURVEY _ _ _ . BUILDING DEPARTMENT ~IIECf _ . . TOWN HALL SEPTIC FORA SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Y.OTIF'f; pp r~ CALL L'xamined . yU 19?.ti PIAIL TO: Npproved o . 199A Permit No. Disapproved a/c . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 As 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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 .call 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 call 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ',egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ;tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. CPWr9/9c.* dame of owner of premises , , , , (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No . Plumber's License No. Electrician's License No . Other Trade's License No . Location of land on which proposed work will be done. C?N9~YU1vJ/~ G G v House Number Street Ham et d L County Tax Map No. 1000 Section .....I ....J Block f b.......... 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 b. Intended use and occupancy ..~l.~C('fl>CQ , y . t 3. Nature of work eck which applicable): New Building , , Addit'pn (~h y....... . . Alteration Repair emo , val . . Demolition , , • , , , Other Work (Description) I Co 4. Estimated Cost al Ul. Fee 7 ~a: U . g u (to be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor garage, number 6. If business, commercial or mixed.i . . . . occupancy, s'p'ec'if'y' pecffy nature and extent of each type of use . 7. Dimensions of existing structures • • • ' ' ' • ' ' ' ' ' • ' • ,if any: Front Rear Depth............... Height Numt er of stories . Dimensions of same structure with alterations or additions: Front , , , , , , , , , , , , , , , , , Rear Depth • • • • • • • • ..i. Height Number of Stories . 8. Dimensions of entire new construction: Front . Rear . , Depth . . . . . . . . . . . . . . . Height Number of Stories 9, Size of lot: Front , , , , , • , , , Rear ...?J' Depth . 10. Date of Purchase 1 1 Zone or _s. di^tric in which re,l ~r . • ' • ' ' ' • • Name of Former Owner . ing law, , ordinance , , ,dinan, .ce , . or . , , regulation: „ 12. Does proposed ed construction ion violate any ny zoning : 13. Will lot be regraded . . • • 14. Name of Owner of remises P . • • • • • • • . • • ........Will excess 611 be removed from premises: Yes No No Name of Architect . ' ' ' • ' • ' • ' • • • • • Address Phone No............... . Name of Contractor , . . • • ' ' Address Phone No . . , Address • • • . • . Phone No. L5. Is this ProPtY Souwithin thold To'0 feet of a tidal wetland? *yes,f/• „ No......... *If yes, Trustees Permit may be required. 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 whether interiur or corner lot. i i N TATS OF NE R TA OUNTY TS O O Gi. S.S' (Name of individual signing ho. SA, • • • • being duly sworn, deposes and says that he is the applicant contract) )ove named. e is the . (CPagen;,corporate officer, etc.) said owner or owners, and is duly all orm or have performed the said work and to make and 61e this placation; that all statements contained in this application are true to the best of his knowledge and belief; and that the irk will be performed in the manner seta forth in the application filed therewith. +om to before me this 5 day of ..G2 19 tary Public, County CLAIRE L. GLEW ~ Notary Public, State of Navy York • _ No.4979606 Qualified in Suffolk Cou~ty (Signature of applicant) Commission Expires December 8,18 i or. C0V,5 wnafAa~c3 I p" O ~,6 . r D o:a lruo to o i r c o i i^1 rc1 In ~.,'I7/~ry / J cn h h t r to a ~a x - F'c~r ti ,t.AUnm)s or SEJ s,6q,emi M 73.37 Ill 'rte"_ ~%C /I»C~ _ _ ord;=~----~~ _.i3...~._.__:-%=•"'• rmarK, i968~:r-^ MAP C7F ~i2a~4~r`~'7~)'. ha.Y ,p,/ water 1 F o.f7. w.rr.. 0 f A/NASs"'Au earl/N s . pRO ADGCT Tc~wN 0F-Saur N. Y d~ s m 9 @ Srory . C7 Q~ f Lo' nf.rnr/,es, c,jovvvi re. {c-'r o b y - s S'~ZnPn - ' fc, 'Arn 'nc%d Mrxp o/ /~/r~sac{ ,moo/P7~ 7 3 u C$~1T Oh~s__ `4 " N ~/u ~7rc1°~ v nC'1 d !'r9 M' e' Map No, 1,56. c Lot NO. 186 tr) C;J ~f. 1. fJ. /fy Y. M M~- No.. /000 - 109- 10--B, 'arfre/~dc~d Esc. 3'J, /°r-'~t ti o .r' roil iv,~oa~s,k~~~ - / ' o•-i ap/",0) S„ 6"'evaYG''1~`iy"G`''.~:ed 7'0 ' -1-hC r " ~fw u Qti~fJ o~6 ! t a!'1G7~,,.rvLlfe%7Y_;Cd6°1 `L7L~7PrcN~',~?CtVt67G~5 ~lriik Gl: LJYi/Et~e°CY y ar !8, 1968 Van 7Z,~f ai4 'Son lJ ~fJ1~74/ 4-;,C 77'- t :i Lrc.er~~. d Lard c'/,-Veeyor:v. APR - 2 9993 i-; `~'1 - (2)2Xg (^22x8 C2~: (2) 2x~ O Li T• Ir I r-I a E,::: G I I~ I G~ •T i d N z I.i Ne o1= ~X I . Dr1.K, COVE ,.al~-~ L I N is- of NEa-.I tic K. Dt~CvE. GONGRE(~ MD~0I- f;Z' I f"-l E I f~l D C) v.l D ov y~. Y 1, f'()UFEO GONc-F-ATE. S TD 1; GOSr• ON 11N f~lSTU1~P.-E.D SOIL. 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