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HomeMy WebLinkAbout21025-z 4 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22464 Date JULY 22, 1993 THIS CERTIFIES that the building ADDITION Location of Property PENINSULA ROAD FISHERS ISLAND N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 10 Block 4 Lot 15.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 27, 1992 pursuant to which Building Permit No. 21025-Z dated OCTOBER 16, 1992 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 TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to PAUL & KATHLEEN COLLINS (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-279372 PLUMBERS CERTIFICATION DATED N/A / jj1dilding Inspector Rev. 1/81 FORM NO. s 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) N°_N° 21025Z Date .r~~. ..../..4~; 19. x. Permission is hereby granted to: . 44- 44 . l ~...../.e ; P...- ,~...7`~...z c~T to ' ...........,~~~...rl~ +~..11 ~0~z~ ~0 . ..........................................'...L:yiY:: :g PrCTI~Y / ..r...... at premises located at rP!'1J~ r(~.(...... ~...,141. A. . j County Tax Map No. 1000 Section f.d........... Block Lot No. ...Y/ pursuant to application dated t<~........cr`..,/.......... 19.,l/Aond approved by the i Building Inspector. Fee $J e 00141~1- . . /~••w•••: Building Inspector Rey. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765=1802 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 installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. 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, Alterat ons to dwelling 25.00 Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date New Construction Old Or Pre-existing Building.. L<~ . Location of Proper ty...Vt. House No. Q Street,„ Hamlet Onwer or Owners of Property.............. ~ , .3~ ~ County Tax Map No 1000, Section.. 0.lQ Block...&.4........ Lot...1:4 Subdivision ..............................//......Filed Map............ Lot....pp....~.........~....... Permit No.? ~ -..Date Of Permit. .Applicant.. , U +ry Health Dept. Approval .............Underwriters Planning Board Approval...... Request for: Temporary Certificate........... Final Certicate...... Fee Submitted: U~ ~$C ` 1~~~~ ~ • • 'mot C C /1a N `r f APPLICANT` cc) I C w _ . o. S F w `V V E" K H ~C 0.. x w 'I E~ ~ ~ SJ.N3WW00 '7VId0LLIaatl pfd o' I ~ 'lVI:I3 7,J2i37d3 3SVS`' F ` *1 'N usa NOIZy W m ~NIaWn~a'd 3I:VH3 1 , o I~ (PUZ) P10LLtla. m co I i Noi.iva. c6 F `^l H V C II fs] G r RUG 26 '92 15:38 TOWN OF SOUTHOLD P.14' TRUSTEES HARR John M, Bredemeyer, .111, SCOTT T President ~~0~ ~ SUPT L. HARRIS Albert J. Krapski, Jr., Vice President r~ Henry P Smith Town Hall John B. Tuthill ~',y • William G. Albertson 53095 Main Road Pd. Box 1179 Telephone (516) 765.1892 Southold, New York 11971 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOID June 26, 1992 Paul and Kathleen Collins 30 Toper Road AEI' I . Plainfield, CT 06371 Re: SCTM# 1000-1074-15.1 Dear Mr. & Mrs. Collins: The following action was taken by the Board of Trustees at their regular meeting of June 25, 1992: RESOLVED that the Southold Town Board of Trustees approve the request for a waiver to construct additions to-existing single family dwelling as per DEC approval dated April.7, 1992. If you have any questions, please give us a call. V ry truly yours, 65John M. Bredemeyer, III President, Board of Trustees JMB/.7mt cc: Bldg. Dept. RUG 26 '92 15:38 TOWN OF SOUTHOLD P. 1/4 gUFFdI(,~ TRUSTEES John M. Bredemeyer, III, President SUPERVISOR Albert J. Krupski, Jr., Vice President SCOTT L. HARRIS Henry P. Smith 7c John B. Tuthill Town Hall G William G. Albertson 53095 Main Road P.O. Box 1179 Telephone (516) 765.1892 Southold, New York 11971 Fax (516) 765-1823 BOARD OF, TOWN TRUSTEES TOWN OF SOUTHOLD June 25, 1992 Paul and Kathleen Collins 30 Toper Road Plainfield, CT 06374 Re: SCTM# 1000-107,41-15.1 Dear Mr. & Mrs. Collins: The following action was taken by the Board of Trustees at their regular meeting of ;June 25, 1992: RESOLVED that the Southold Town Board of Trustees approve the request for a waiver to construct additions to.existing single family dwelling as per DEC approval, dated April, 7, 1992. If you have any questions, please give us a call, V ry truly yours, A4 y John M. Bredemeyer, III President, Board of Trustees JMB/jmt CC: Bldg. Dept. X95-20.6 (10190)-25c NEW YORK STATE DEPARTMENT OF ENVIgONMENTAL CONSERVATION DEC PERMIT NUMBER a EFFECTIVE DATE 1-4738-00489/0000.1-0 'qW April 7, 1992 FACILITYIPROGRAM NUMBER(s) PERMIT EXPIRATION DATE Under the Environmental Conservation Law (ECL) April 30, 1994 TYPE OF PERMIT (Check All Applicable Bres) 12 New ?Renewal ?Moddication ? Permit to Construct ?Permitto Operate v 3. Water SPDES 17, Titles 7, 8: HArticle 27, Title 9; 6NYCRR azardous Waste Management Protection of Title Article 15, Title 15: Article i Article 34: Water Supply Air Pollution Control Coastal Erosion Management Article 15, Title 15: Article 23, Title 27: Article 36: Water Transport Mined Land Reclamation Floodplain Management Article 15, Title 15: Article 24: Articles 1, 3, 17, 19, 27, 37; Long Island Wells Freshwater Wetlands 6NYCRR 380: Radiation Control Article 15, Title 2 Article 25: Other: Wild, Scenic and Recreational % Tidal Wetlands Rivers Article 27, Title 7; 6NYCRR 360: 6NYCRR 608: Solid Waste Management Water Quality Certification PERMIT ISSUED TO TELEPHONE NUMBER Paul J. Collins ( ) ADDRESS OF PLRMITTEE 30 Toper Rd., Plainfield, cT 06374 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECTJFACILITY LOCATION OF PROJECT/FACILITY Peninsula Road, Fishers Island COUNTY TOWNJCI)MIE ME WATERCOURSEIWETLAND NO. NYTM COORDINATES Suffolk Southold Darbies Cove E _ N4 _ DESCRIPTION OF AUTHORIZED ACTIVITY Construct additions to existing single family dwelling. All work shall be in accordance with the attached NYSDEC approved plan. 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 Reverse Side) and any Special Conditions, included as part of this permit. L ut u' e+ "4'''~ Deputy Regional PERMIT ADMINISTRATOR ADDRESS at68sdn a . Eta David DeRidder Brook, Pi•SC. EIy.iYPi+2&~~' lotaftv AUTHORIZED SIGNATURE _DATE 4/7/92 Page 1 of 4 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 D partment 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 Renewals 2. The Department resierves 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 0 the ECL and pertinent regulations is found; ' b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information 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, modifica- 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 requirements contained in such order or determination. Other Legal Obligationsllof 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 J 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 not convey to the permittee any right to trespass upon the lands or Interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the 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. 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 I Page 2 of 95-2"a (10190)-25c ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 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 14 There shall be no unreasonable interference with navigation by the work thereby without expense to the State, and if, upon the expiration or herein authorized. revocation of this permit, the structure, fill, excavation, or other 15 If upon the expiration or revocation of this permit, the project hereby modification of the watercourse hereby authorized shall not be com- authorized has not been completed, the applicant shall, without expense pleted, the owners, shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the extent and in such time and manner as the Departmentof Environmental Department of Environmental Conservation may require, remove all or Conservation may require, remove all or any portion of the uncompleted any portion of the uncompleted structure or fill and restore the site structure or fill and restore to its former condition the navigable to its former condition. No claim shall be made against the State of and flood capacity of the watercourse. No claim shall be made against New York on account of any such removal or alteration the State of New York on account of any such removal or alteration. ! 16 If granted under Article 36, this permit does not signify in any way 10. That the State of New York shall in no case be liable for any damage that the project will be free from flooding. or injury to thestructure orwork herein authorized which may be caused 17 If granted under 6 NYCRR Part 608,theNYSDepartment ofEnvlron- by or result from future operations undertaken by the State for the mental Conservation hereby certifies that the subject project will not conservation or improvement of navigation, or for other purposes, and contravene effluent limitations or other limitations or standards under no claim or right to compensation shall accrue from any such damage. Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 11 . Granting of this permit does not relieve the applicant of the responsi- (PL 95-217) provided that all of the conditions Listed herein are met, bility of obtaining any other permission, consent or approval from 18. All activities authorized by this permit must be'in strict conformance the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State with the approved plans submitted by the applicant or his agent as part Office of General Services or local government which may be required, of the permit application. 12. All necessary precautions shall be taken to preclude contamination Chandler Palmer of any wetland or waterway by suspended solids, sediments, fuels, Such approved plans were prepared by solvents, lubricants, epoxy coatings, paints, concrete, leachate or any & King dated on Jan. 13, 1992 SPECIAL CONDITIONS 1. During construction, no wet or fresh concrete or leachate shall be allowed to escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices be allowed to enter tidal wetlands. 2. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands. 3. Roof runoff shall be directed to drywells a minimum of 50 feet landward of the tidal wetland boundary for immediate ott-site recharge. i 4. No decks, accessory structures, or additions will be permitted without further approval of the Department. 5. There shall be no disturbance to vegetated tidal wetlands as a result of the permitted activity. 6. All excavated material shall be removed to an approved upland site. Supplementary Special Conditions (A) thru (J) attached. DEC PERMIT NUMBER 1-4738-00489/00001-0 PROGRAMIFACILITY NUMBER Page -I_ of __Z_ 1 Q:) co 0 co cz ~ E O c L- 0 E -0 cz ~~~O0N= i .C of c -0 U j> o f Q p CD > O V) ~ I L- a) C O i O.C N a V 00 N co C', C', O 4~ LL 04- a) C cnON N o O o z cz C) N W a c C: r -0 0 O c U) z W 0 2 cz r- 75 o) F- 0= O~ c O O p W C0 'ON Q OCZv(Z oU,c M CO CD 'Q ~cz0~ E 41 E~ N Q~ ~ o co 4-1 N O c C m = 3: .0 co QO COa) -0 Q U) z o co E a a) x a a w N O+ New York State Department of Environmental Conservation Building 40-SUNY, Stony Brook, New York 11790-2356 (516) 751-1389 Thomas C. Jorling Commissioner April 7, 1992 Mr. Paul J. Collins 30 Toper Road Plainfield, CT 06374 RE: Permit #1-4738-00489/00001-0 Dear Mr. Collins: 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 yours, DARLEEN GERBINO Program Aide DG/rw enclosure r Two i Consultant_ vQ ~ Project Namc._SllvKt aiE- OCT 0 c„ SCIPM 9 The Southold Town Trustee office ha y_t?s ix1~ . that your }ala~~a~1.S~Xa_fo a qg§t , ro a at~d pcarini is urisd.:ictic,na k ncanr 1 Jim- a~aa.c E,r th€ fallowing yI"°lcrr <any required return ysubmission: ini~orrn'~ a i:'an bias r qa- 1eNa 0 e e" ' C2,'x:~ist~ee, Re~~ esc;iatative cc: Building DeptAVII Zoning Board of Appeal: Planning Board C'r.. `rm ~[sTasea vat This notice: makes no claim with respect to other jurisdictions within or outside the Town of Southold with respect to permits, permission required. 4/92 §pFFO~,~- TRUST'EES ®i® 2 SUPERVISOR John M. Bredemeyer, III, President SCOTT L. HARRIS Albert J. Krupski, Jr., Vice President y Henry P. Smith Town Hall John B. Ti thill 4G 53095 Main Road William G. Albertson P.O. Box 1179 Telephone (516) 765-1892 Southold, New York 11971 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 21, 1992 Inter-science OBI - I .r„ Research Associates, Inco P.O. Box 1201 36 Nugent Street Southampton, NY 11969-1201 RE: Waiver SCTM #1000-4-6-4.2 Dear Mr. Collins: The following action was taken by the Southold Town Board, of Trustees on Thursday, September 17, 1992: RESOLVED that the Southold Town Board of Trustees grants a waiver to construct a tennis court, swimming pool and pool house as per revised survey dated June 1992 SUBJECT to DEC approval. If you have any questions, please do not hesitate to contact this office. s, V y truly Y-QY to 72C John M. Bredemeyer, III President, Board of Trustees JMB:jd CC: Bldg. Dept. e New York State Department of Environmental Conservation Building 40-SUNY, Stony Brook, New York 11790-2356 (516) 751-1389 Thomas C. Jorling Commissioner April 7, 1992 Mr. Paul J. Collins 30 Toper Road Plainfield, CT 06374 RE: Permit #1-4738-00489/00001-0 Dear Mr. Collins: 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 yours, DARLEEN GERBINO Program Aide DG/rw enclosure ) ba (10190)-25c 24, 25, 34, 36 and 6 NYCRR Part 608 i FOR ARTICLES 15 (Title 5), ITIONAL GENERAL CONDITIONS other That if future operations by the State of New York require an al- environmentally deleterious materials associated with t o teration in the position of the structure or work herein authorized, or project. y without leaving large refuse piles, t ridges across ilcose v said 13 shAny all be removed evenly, , the prosecution of the work herein permitted may CoEnvifree ronmental if, in the opinion of the holes the do of it shall cause unreasonable Department waters anne{s or to the banks of oodpl or flood flows or or cause loss oredestructiony ofr thelnartu al tendene y to causer damage lto navigablec h er the the people of the State, 14 There shall be no unreasonable interference with navigation by the work or hazards caused resources of the State, the owner may be ordered ,the Department to a waterway. remove or alter the structural work, oband If tion" upon the expiration or herein authorized. thereby without expense to the State, or other heart shall, without expense revocation of this permit, the structure, fill, 'excavation, a hall ll n, not be com- 15 lautho authorized has ot been complete revocation d, the app permit, the project here e to the State, and to such extent and in such time and manner as the modification of the watercourse hereby authori ed + Department of Environmental Conservation may require, remove all of the the owners, shall, without expense to the State, and to such pleted to ade against the State of extent and in such time and damn as the D portion of the uncompleted any portion of the uncompleted structure or fill and restore the site all Conservation may require, to its former condition. No claim shall be in structure or fill and restore to its former condition the navigable New York on account of any such removal or alteration. and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 16. If granted under Article 3e, this permit does not signify in any way t will be free from flooding. `0. That the State of New York shat{ in no case be liable for any damage that the projec 5 NYCRR Part 608, the NYS Department Of En virow or injury to the structure orwork herein authorized which may be caused 17. If mental granted under conservation hereby certifies that the subject Project by or result from future operations undertaken by the State for the Clean Water Act of under conservation or improvement of navigation, or for other purposes, and contravene effluent limitations or other r limitations or standards u 1977 met, Sections 301, 302, 303 306 and So the no claim or right to compensation shall accrue from any such damage. } , Granting of this permit does not relieve the applicant of the responsi- (PL 95-217) provided that all of the conditions listed herein are consent or approval from 18 All activities authorized by this permit must be in Iicant or strict his conformance bility of obtaining any other permission, cast permit application.bmftted by the appChandl r Pa1~m~r_ roved the ice U. Army General Ser of Engineers, or local government wlach may beoequhed. oftt the Such approved plans were prepared by n.13 recautions shall be taken to preclude contamination dated Jan. , 1992 All necessary p sus ended solids, sediments, fuels, & King on of any wetland or waterway by pts, concrete, leachate or any solvents, lubricants, epoxy coatings, pain SPECIAL CONDITIONS 1. During construction, no wet or fresh concrete or leachate shall be allowed to escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices be allowed to enter tidal wetlands. project 'shall be 2. Any debris or excess material from construction of this pro] roved completely removed from the adjacent area (upland)iandirem ved to an app upland area for disposal. No debris is permitt 3. Roof runoff shall be directed to drywells a minimum of 50 feet landward of the tidal wetland boundary for immediate on-site recharge. i, No decks, accessory structures, or additions will be permitted without further approval of the Department. There shall be no disturbance to vegetated tidal wetlands as a result of the permitted activity. roved upland site. All excavated material shall be removed to an app upplementary Special Conditions (A) thru (J) attached. PERMIT NUMBER PERMIT00489/00001-0 )GRAMIFACILITY NUMBER Page .3 of 9520-6 (10190)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NWOBER gh EFFECTIVE DATE 1-4738-00489/00001-0 IRW April 7- 1992 FACILITYIPROCRAM NUMBER(S) PERMIT EXPIRATION DATE Under the Environmental Conservation Law (ECL) April 30, 1994 TYPE OF PERMIT (Check All Applicable Boxes) t ®New ?Reaewal EIMOddlcal,oe ?Peam,t to Construct ?Petmrt (o Operate Article 15, Title 5: Article 17, Titles 7, 8: Article 27, Title 9; 6NYCRR 373: Protection of Water SPDES Hazardous Waste Management Article 15, Title 15: Article 19: Article 34: Water Supply Air Pollution Control Coastal Erosion Management Article 15, Title 15: Article 23, Title 27: Article 36: Water Transport Mined Land Reclamation Floodplain Management LotngeIsl 15, Island Title Wells S Article Wetlands 6NYCRR 30: Radiation eArticles I ation Control Article 15, Title 27: Article 25: Other: Wild, Scenic and Recreational D1 Tidal Wetlands Rivers Article 27, Title 7; 6NYCRR 360: 6NYCRR 608: Solid Waste Management Water Quality Certification PERMIT ISSUED TO rE LE PHONE NUMBER Paul J. Collins ( ) ADDRESS OF PERMITTEE 30 Toper Rd., Plainfield, cT 06374 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECTIFACILITY LOCATION OF PROIECTIFACILITY Peninsula Road, Fishers Island COUNTY 70WNICIS4C'NNXKE WATERCOURSEIWETLAND NO NYTM COORDINATES Suffolk Southold Darbies Cove E N4__ DESCRIPTION OF AUTHORIZED ACTIVITY Construct additions to existing single family dwelling. All work shall be in accordance with the attached NYSDEC approved plan. 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 Reverse Side) and any Special Conditionsincluded as part of this permit. De ut Regional flats' PERMIT ADMINISTRATOR ADDRESS tjpgL017 Y+&1IluHI;. 40 Ur 2%P7 David DeRidder ketally Brook, N-y- YY~~®^2aDF6 AUTHORIZED SIGNATURE ~i i - 7 DATE --4/7/92 Page 1 Of 4 i GENERAL CONDITIONS Inspections 1. The permitted site o~ 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 dete'fmine 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 !i 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 Renewals 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; i b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material Information 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, modifica- 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 permlttee mustisubmit 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 requirements contained In such order or determination. Other Legal Obligations II of Permittee 6. The permlttee 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 1J 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 not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the 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. 8. The permlttee is responsible for obtaining any other permits, approvals, lands, easements and rights- of-way that may be'irequired for this project. i I I I Page 2 of FORM NO. 1 i; TOWN OF SOUTHOLD BUILDING DEPARTMENT SEP I TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 I E4amined a4 1. 4. 7.. 19 / ~ .1 ~ ~7 Application No A~proved wl 19/~ermi; No..A.L.~ A J D'sapproved a/c . .~71 (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 19 INSTRUCTIONS i a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building In~pector, 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- 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 issue a Building Permit to the applicant. Such permit sh~ll 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 s, or for removal or demolition, as herein described. Rggulations, for the construction 01' buildings, additions or alteration Tl a applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to a ecessary inspections. emit authorized inspectors on premises and in buildings for n (Signature of applicant, or name, if a corporation) ..l~ (Mailing address of applicant ~~yh gg//yy State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plunl e(Vbihier. ............OwNEQ Nne of owner of premises ..P.A.u~ /<,4 TA le-,e Co as on the tax roll or latest deed) Ifjapplicant 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. ' Scr'%lA 2ofE~ Was .27,T/AND.. N.Y...d 63.$a....... 1.1 Location of land on which proposed work will be done . PeNN~NSra///I ~eA, iSA/ 13/A.~d.,..N ~........F Y House Number Street Hamlet County Tax Map No. 1000 Section ....O /D........ Block Lot • • • • • • • Subdivision Filed Map No. Lot............... (Name) 2.1 State existing use and occupancy of premises and intended use and occupancy of proposed construction: ResdeaTI.4 S............... . a. Existing use and occupancy .s b. Intended use and occupancy /CPS P~Ti/~ 1 S/~.~! le FA~.~y. , , [J(J~Jg. 3,i Nature of work (check which applicable); New Building , Addition Alteration Repair al Demolition Other Work i (Description) Estimate Cost . . . . . . . . 9~67oo 00 r'. Fee 4.1 (to be paid on filing this application) 5.± If dwelling, number of dwelling units Number of dwelling units on each floor : i If garage, number of cars 6. If business, commercial or mixed'ioccupandy, specify nature and extent of each type of use 7.; Dimensions of existing structures! if any !,Front . , y...... Rear /A . Depth ..3A. , Height 342 . , Number of Stories Z:........... . Dimensions of same structure with alterations or additions: Front y~ y Rear ....ZY..~.y Depth . Height 3IP Number of Stories Z................ 8.;• Diinehsions of entire new construction: Front Rear Depth Height Null of Stories , . r 9 Size of lot: Front ?..r? y , Rear S.~a 3 Depth ,9 8 10. I Date of Purchase 97.9 Name of Former Owner 4YN? C.? R. 47 IJ41orNeri 11. Zone or use district in which premises are situated R. y°............ . 12.11 Does proposed construction violate any zoning law, ordinance or regulation: /V . . Will excess be rem ved frort ruses: Yes 13. Will lot be regraded No , . , , . AA. 14.1 Name of Owner of premises §W?; ePa ~°/j~+SAddressJO.TO...Rd• A0,,ufi? ohe No. ,7,43. 3.7.4- i Name of Architect : Address Phone No.' Name of Contractor . Address , Phone No. , . . , . • , , , . . . I 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 interior or corner lot. ill a . D o~ M , 99,a o Al E 9 77.53' ~I ~ Z \ 5 X01 ~o .o V ( Z 30.9¢ ~ °N PIPE W muu/^ o 'R• W I N/ ` . h EAJEMENT -oe FJSHF~S' Neu ~~"scz. /SLA•(!/J ~ST.VTE,$'° /N~.,. ~~Y>- .9) F02 417_14.17-16-S plVE C'FO`` _ \ ~",9y i STATE OF NEW~O COUNTY OF.. S.S . . .....I being duly swor. , deposes and says that he is the applicant (Name of individual signing contract) above named. is the ..............du. tN~.d,_ (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 wojk will be perforated in the manner set forth in the application filed therewith. Swprn to b fore, ter e this ofj19~1 TN A8 P, "WORTY Jij, qty ubllo Steto oowntrk s y Notary P bl' , ' ' d,40061 f N sutlolk Qa p n , . rm Exp(roe 231 ~ . . ) (Signature of applicant) ~ N ~ x= ~l y I M C 8-0 / O d ka) ~,Qo ay ~ ~ ~ ~ N~ Imam Q Oi~ N` Z /~w ~Re 0 O A 6o F,~,TU ~ • ~ ~W~J'HOIYE~S' 2 o~C© z Z tip o , O Q} p p 68 (21 a°X~:gScio. ao.o?f._ 's m^ I -cc ofEr__-- •P, O , 1O b L L 1~ J N it l I 1 m0MS~ R'ta yTOrn0m ~pDmrm TZaTT~~01!" ~ . 0 2inmm0 nDCCaC Go 0 t, \ p P I azZAmm~~SS~Dp~mC e'0 \ O ~-amCn2Tm°~xDOQ \ ` Z a~nm0 a0Oro9y-`- C - - M C m 2 2 ~.i m n Z 'ppl ~O n+l 'A 00 OSAZPC MM~g Amv~ °O .I 0 C/) U3: -midN oD z Fm Q0 i R0m a _l m H~ m m m T r Z C m T'y' mm 3 C sZ m G a y'~ Q mOC1z ma<:~-m{ U) p my O I N ~eow - I I (P IN J ~q h • a~ c~ S ~1yZ)j AO~ CCy`CC G c) (Z~ CO 1 ~9.1 .n gy ARgIES COVE II '1241d ~`,o°~ ~~13.1 ~ol 12 ~,A,, 13 sof 2.1 'lY I5; Id 'b." l 20me n' 21 22.23 14A ~I d ~~NER 9AY :a.A Ewa 0 LOCATION MAP 5CALE I"=200' ry¢RESTarvf (FNOJ \ N~ ~ XICX unTER 9 NOTES 6 LR11T5 of TOPL WETL. 5 1) COORDINATE D15TANCES ARE MEASURED FROM 05 COAST AND GEODETIC SURVEY TRIANGULATION STATION "PROS" S Z) SITE 15 IN THE TOVN OF SOUTHOLD, COUNTY OF 5UFFOLK, TAX MAP 10001 SECTION 010, BLOCK 4, ~O a'S 615' CEph \ 5~9QIi ~ ~1 LOT 151 3) 5ITE 15 IN R-40 ZONE a ~ iR PEE \ ~ 1) OWNER PAUL COLLW5 30 TOPER ROAD / ° \ Phpo-E I PLAIAII`IELO, CT 0G374 N 181750 ° E 97790 5) BA5E FOR LEVELS NGVD i9 I I O 2a" TRIPI~ \ 6) TOTAL AREA - 023'/ ACRES ?ERES~loNE [FNO]\ I PINE V 0 ti O N ~ I J +[St N~JSE 9~ ia° PirvE J o J '~I\ ~ VJ I~ 9 O A \ A \ J O z\~\ 1` OOO O F f i ~ \ m L \ t o w.,EE vn.+e \ rK ~2 \ O / O~ PROPOSED ADDITION olXr Er+ / \ \ \ \ O/H "C- m PTIC ~ nhNXOI-E rz Jo, B \ cuY I e a \ I \ \~2 9 \ Is"¢¢n 00", \ N" TREE E / \~-F~GE t]F WATER III p XIGK WiITM \ L111IT S O1 F TI OPI W GH WATER IITS OF TIOPI VETLAI~~S \ N ~7 0" 200„ \ E /A/ e4pc \R\ D e BENCHMARK ELEV G 88 c 4 OF BROKEN OFF MONUMENT EA5EMENT FOR FISHER'S 7R FISHER'S I ISLAND ESTATE5, INC ATE5, INC FOR UTILITIES. I SITE PLAN ~P o li sr ~ PREPARED FOR PAUL COLLINS FISHERS ISLAND, NEW YORK FO Lql. SCALE zo io o zo ti CHANDLER, PALMER ` KING F- NORWICH, CONNECTICUT f' JANUARY 13, 155 2