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FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22520 Date_ AUGUST 1Z, 1993 THIS CERTIFIES that the building NEW DWELLING Location of Property PRIVATE DRIVE OFF EAST END AVENUE FISHERS ISLAND House No. Street Hamlet County Tax Map No. 1000 Section 8 Block 2 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/20/93 Pursuant to which Building Permit No. 20144-Z dated 9/25/91 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ONE FAMILY DWELLING WITH ATTACHED PORCHES AS APPLIED FOR The certificate is issued to NATHAN SAINT AMAND & WIFE (owner, lessee or tenant) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 8/9/43 UNDERWRITERS CERTIFICATE N0. N.284106 - 7/27/93 PLUMBERS CERTIFICATION DATED 6/21/93 ~~._a8 42° ) . off„ ~~Z~ Building Inspector Rev. 1/81 cosec xo. 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) 0 N - 2 014 4 Z Date ...~1.~ ~.~t 19.9: Permission is hereby granted to: to ............~1:1.l~rlli!.Gr~-.,Pi... ...~1->~(... ....,G.l~Z7.l~f.~..D..,. at premises l'oc^ated at .....,/...../.~ri~t%:`.?.(!l~rt.~..~......~?~ ...~....k~~...... County Tox Map No. 1000 Section a O.Gt........ Block/...:..... Lot No.....~:l pursuant to application dated y2~~~..,,1..:,/ 19.,/...~ and approved by the Building/Insjp`ector. l Fee 3...12.i1..G ...~~..d Building Inspector Rev. 6/30/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD~ NEW YORK 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Date...June 8, 1993...... NEW CONSTRUCTION..X..OLD OR PRE-EXISTING BUILDING.....VACANT LAND..... Location of Property........Chocomount Beach Road Owner or Owners of Property .....Nathan E. Saint-Amand County Tax Map No. 1000 Section ....8... Block ...20... Lot...5....... Subdivision .....................Filed Map Lot............ Permit No...20144Z..... Date of Permit .9/25/91.. Applicant.A.J. Gada.. Health Dept. Approval ................Underwriter Approva1.N253871... Planning Board Approval Request for Temporary Certificate ...........Final Certificate...X... Fee Submitted: $...25.00......... Applicant A. John Gada General Contracting, Inc... . 'Pr YY~.Y11~~~d~y [t ? r x . p d._....._,._,. ne~.~ .M,~ ..=i4' ~ .;-MTi is ~~d THE NEW YORK BOARD OF FIRE UNDERWRITERS ~='t=~~ 7 Pl~yll l'2 BUREAU OF ELECTRICITY SS JOHN STREET, NEW YORK, NEW YORK 70038 Date ,T 1f~f"~ 2,~yr7.993 gppliraNonNo.onfile k3ti6539'3/9'~J R7 :tS~kt6fi THIS CERTIFIES THAT only the electrical equipment as described below and introduced 6y the opplicont named on the above opplicotion number in the premiaea of tJATHAW SATN'P AMAlID, k'RTVATL R[}Ah, F3SN2;RS 15LANU, N.Y. in thefollowinq location, ~ Basement ® Iat F'I. ®2nd Fl. ATTIC/Ot77" .Sertion Block Lot I was examined on ' ' r r 7 and found to be in compliance with the National Electrical Code. fIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ECEPTAClES SWITCHES INCANDESCENT FWORESCENI OTHER AMT. K W. AMT. K.W AMi K.W AMi K.W. AMT. H.P. N0 d9 92 79 1 t I2.2 1 1.k 6 h DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMi K. W. Oll H. P. GAS H. P AMT. NO. A W. G. AMT. AMP. AMT AMPS. TRANS. AMT H P SYSTEMS MAi WATTS NO.OF FEET 1 90 18 h06 SERVICE DISCONNECT NO.OF S E R V i C E AMT. AMP. TYPE METER r TW T S. TW 39 3W 3 A 4W NO OF CC. COND. A W. G. NO. OF M4LEG A. W. G. NO. OF NEUTRALS A. W G. EQUIP. PER 9 OF CC.COND. Of M4lEG OF NEUTRAL ! 200 (".tt 7 X 7 3/0 7. 310 OTHER APPARATUS: SURGE ARRt"ISTOR~1. 71I(9NTt~ICNG t'R0T;~1C'PQR SY,$TEM°i. IfEAT TAERPtOSTAT;i-3 M01'{)RSaI~F 11. P.r1~9 7f. P. PAMEI,UQAROSI7.-7. CtR. 60,7••1.3 CT.R. 100,7, 3G C,tR'~~~20@ C.F.C.T;-26 - GAI]A I".GNTRACI'OR G!~~~~ DF,AWFR - B Ir%SItERS 7StIAIdQr NY., @G3~0 GENERAL MANAGER 21 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. _ _ I THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ 107509.2 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 70038 Date f)G~{I 9(1, 29y2 APPlicatian No. on file ?cJ {S i+{i~~~'r~9' ~ THIS CERTIFIES THAT only the electrico! equipment as described below and introduced 6y the applicant named on the above application number in the premises of p tdATt1AN SATNT ANAN91, C$OCOHOUtd7' 93f;Af'h' tt0Al1, F.78HT,R T.3LANOr 41.'T. in thefollowinq bTCation• ~ se t ? lat FY. ? 2nd FT. 011T Section Bloek Lot 0C2~t)BfIR ~`~,~t~~2 uns examined of and found to be in compliance with the requirements q(this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS ECEPTACLES SWITCHES INCANDESCENT FIUORESCENi OTHER AMT. K.W. AMT. K W AMT KW. qMi K W AMT. H.P. SSyy C DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS UNIT HEATERS MULTI.OUTLET DIMMERS ~ BEII SYSTEMS AMT. K. W. Oll H. P. GA$ H. P. AMT. NO. A. W. G. AMT. AMP. AMi AMPS. TRANS. AMT. H. P. NO. OF FEET qMi WAiiS SERVICE DISCONNECT NO.OF S E R V I C E METER NO.OF CC COND A W G A. w. G A. W. G. S# AMT. AMP. TYPE EQOIP I ~ TW 1 ,e' 3W D,e' ~JW 3,9' 4W pER % Of CC. COND NO OF HLLEG Of HbLEG NO OF NFUTRAlS OF NEULRAL i a.e~ c~, 1 s ~ ~ a OTHER APPARATUS: 3 - GAI)A C0N4RAC9'0R LxC.~295-F pRAWEF - fl FTSIiBRH IflTIANDr NYr 06;390 GENERAtMANAOER ~ 79. i~ Per V I 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. C E EDI Y MAN ER. TEL. 765-1802 S~FFOCkC o N OG TOWN OF SOUTHOLD ~c OFFICE OF BUILDING INSPECTOR P.O. SOX 728 u~., _ - 4~~01 ~~0~ SOUTHOLD, N Y 11971 C E R T I F I C A T I O N Date ~-,~f Building~Permit No. rXCJ/~~~ owner /V?~TF/~a~/ G~,9irvf -~/.~7A•t1 i~ (please print) ~ _ Plumber ~~UyN ~~DA ~~.Jz:~'~+L ~n'r~/}~'7"/~j (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1°s lead. (plumber's signat re) Sworn to before me this o2/St day of June c.~y,~ ~ /J otary Public Notary Public, S~~/..p~~( -County ~AFgy D, PANKIEWff;~ ~U7RRY PUBIJC, STATE OF IVE16 .EO. 52-5L87~.5U - `3UEFlBO.S A9R91S~urN Prk4;~RfS Y~B~~Fy ,1r:LJ I;::,'. c ..J;i ~ ~ IIJn:., jI :;i;?ti4LNTC . m Q ~ • I H - H 'OUtIDATION (1st) I - 'OUNDATI011 • • I ~ ~ ~ (2nd) m • I 2 0 OUGH FRAi'lE & ~ PLUMBING ~ H m • ~ IISULATIO;! PER N. Y. ~ y ~ STATE EPIERGY CODE I ~ ' ' a ~ ~ ~ . H FI;IAL ' I • I o V ADDITIOPIAL COMMEPlTS: ~ ~ • . M b F-/ ~ rf~^^ • ~ v1 H F{ _O /gyp W ' T ~ 1 r H - T m .a ~I _ ~ i INSPECTORS Princi'pal tBuiding Inspector O~pSUFFO(~-COG Curtis Horton y~ SCOTT L. HARRIS, Supervisor Senior Building Inspector y Z Southold Town Hall Thomas Fisher P.O. Box 1179, 53095 Main Road Building Inspector O • ~ y Southold, New York 11971 Bui ding Inspector ~~l ~ Fax (516) 765-1823 Vincent R. Wieczorek Telephone (516) 765-1800 Ordinance Inspector Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD July 21, 1993 Mr. Charles Brigham Board of Health Dept. Riverhead County Center Room #N204 (North Wing) Riverhead, New York 11901 Re: Premises at Chocomount Beach Rd. Fishers Island, N.Y. Owner: Nathan E. Sanit-Amand Suff. Co. Tax Map # 1000-8-20-5 H.S. Ref. No. 91-SO-37 Dear Charlie: Please expedite this application for a final bcard of health approval as soon as possible. If there are any problems, please contact me at once. Please send final approvals to this office. Very truly yours, SOUTHOLD TOWN BUILDING DEPT. Thomas J. Fisher, Building Inspector TJF:gar encls. ~ f J.M.O. CONSULTING ' p.o. box 447 ouoc~ue, n.y. 11959 (516) 653.0607 ;aro'Cc::arrrLri:rn•' :•.'.~i,: :3.''r'ti1 ''I I"'~~ 'J:A. 1',: 'I: L:I I". i... ct fSi'iii i;:U"C:I ..L.C:/4JI"I c:r'r` fii cat..t ta•'u:.a .l r..i EiC:r1..4 I': I'1Cr .I. 4:1 ~~I~~f.:)VJ I"r £sr,A a. 7. ra .i.nca C}c~r'La<::u'"rrrrrrn'!'. J,:){}~~),:] Iel<':1 :A. I"I I"i f.:rflfa tEiat_t'l".I°rc~1r.1„ I',IY i..l.'~'7:1. (ici,, ;'rita:i.rri':.° Flrrrcarrc9„ p a.,:il-u:~l"!::. :I'*s'i h;:a~.:u"' it . L..aarsrar"r,.l.. (:::nc::a.t:~<:u_aca hc_~r°c:rw.a.'ha°, ga.i.r::~tusa:_~ 'P'.inca rz c:aagry rag l;:I'x_z r~r-,iy.d.rt~a'i. "Ir-a<a7.1_I'~ Sit_+I><ar t:roe-,rt'h. lll::rrrr.r'rv<::i.i. al'Ir~ r:::crhy c.r#' 1':.I°rr:"= 1~!„`>refi:r„t).E:,,C7,. Icrr:~r-m:i.'P: I~a-_~cl~ar"e.l.i.nr,;! i:a-rr^ axl:rt:avfn mr:;rr','P::i.c:rr',r=eJ ~.as•ra~acar (::y„ C f yr.:rl..r <.:~Puau:3.r.1 I-r.:3ve:r e:a•ry t~r.u~ssta:i.c:rr'r:a I•t+r~<u'-{al:i.ru:! '(:.Ir.i..<.=; rrre3l q c:.,l •i ~'.~.i.r-r<::l:::i e:! c.lcr r'rtar:. i'rs±ss:a ~<:rP:f_~ a.r'r cazrr','h~:u:t::A.r'rg t.l°ra.<s CrI`'f'a.r:::e:!„ I'i"1.::41'Ih. yfJiA,. Ci:A. f"i C:af l""S~? .I. y y ~ J~ (.iP~:Y r ri'C LI"I G. r ~ 1 P.r 1 ,...~33ti,, i r ~ 1s °•E 1 ~ ..o_ ~ . : 5EP 2 51991 T'QNJAd (7r SUUTF?~f_fJ New York State Department of Environmental Conservation Building 40-SUNY, Siony Brook, New York 11790-2356 (516) 751- 1389 ~ Thomas C. Jorling Commissioner May 15, 1991 Nathan E. Saint-Amand P.O. Box 597 Fishers Island, NY 09630 RE: 1-4738-00212/00001-0 Dear Mr. Saint-Amand: In conformance with the requirements of the State Uniform Procedures Act (Areicle 70,ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all leasetcontactrusuatythelf you are unable to comply with any conditions, p 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, Qh,~C.uun~,1~ Roge"r Evans~N`~" Environmental Analyst enclosure RE :sic u SAP 2 51391 TowR~ ~g ~~c~~-trto~t 95-20.6 (10)90)- 25, NI W YORK STAID UE PARIMCNI Or hNVIRONMhNTAI CONShRVATION DE(" I'hRMll NUMe1R w hR LC11VE DnTI I-4738••00212/00001-0 Ma 15 199 hACll nY/FROG RAM NUMIiI K(s) PER~~T EXPIRATION DATE Under the Environmental Conservation Law (ECL) Mdy 31 1 994 , 1YyyI'h~1OF PI RMI7 IChttk nll Applienbie coxes) ~~II 'LINew ?Ronewal _ ?MOdrfiralion ?PrrmtltoConstru~t ?PermntoOperate U Proftect on of ItWater ~ SPDES 17, Titles 7, 8: ~ Hazardous Walste Management 3. 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 L~J Lotng Island IWellsS ~ Frelshwater Wetlands ~ 6NYCRRI3 0: Rad ation Control Article 15, Title 27: Article 25: ~ Other: Wild, Scenic and Recreational L ^ ~ Tidal Wetlands Rivers Article 27, Title 7; 6NYCRR 360: 6NYCRR 608: ~ Solid Waste Management Water Quality Certification I'k RMl l ISSUED lO r61.1 PI1ONr NUMnI R Nathan E. Saint-Amand I T ADORCSS OF PCRMITTE t. PO Box 597, Fishers Island, NY 09630 CONTACT Ph RSON FOR PERMITTED WORK TF.I EPHONE NL'MRER S-U-1-t.i..rln-Ph Rnv 447 rltrq~Ae~__N.t(_]IQFQ 1 1 NAMI AND AUDRI SS OI PROp (7/fACll.l I V R.O.W, of Oriental Avenue, Fishers Island Watercourse -Tidal Pond LOCn110N OI PROM CT/TACIT I7Y Fishers Island COUNTY TOWN/CITYIV ILI AGr WATERCOURSE/WhiLAND NO NYTM COORDINATPS Suffolk Southold E _ wa_ Df SCRIP110N Oh AUiIlOft171D ACiIVI rV Construction of a single family dwelling, porch pervious drivewa and sanitar s stem. All work shall R{ i! it SE6' J 31 i I i q ~gg Is 4 k~~ - _ ~,-n~li° m.a3 3~~'. y..l~~ a3..~ 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 De~~i~~lt~e ~iOnaYded as part of this permit. PERMIT ADMINBFBATOR AUDRFSS David DeRidder ' nurHOR¢rD su:Nnruar /n 5115 91 Page 1 of 95-ZO-6a (70/90)-25c ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (iitle S), 24, 2S, 34, 36 and 6 NYCRR Part 608 ( ) 9 That if future operations by the State of New York regmre an al- other envnonmen[ally deleterious materials associated with [he teration in the position of the structure or work herein authorized, or project rf, m the opinion of the Department of Enviromnental 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 heahh, safely or welfare of the bed of a waterway or floodplain or deep holes that may have, a the people of the State, or cause lose or destruction of [he natural tendency to cause damage to navigable channels or to the banks of resources of the State, the owner may he ordered by the Department to a waterway. remove or alter the structwal work, obstructions, or hazards caused 14 ihcre shall be no unreasonable interference with navigation by the work thereby without expense to the State, and if, upon the expiratlon or herein authorized. ' revocation of this permit, the structure, (ill, 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 apphcant shall, without expense pleted, the owners, shall, without expeme to the Slate, 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 Department of knvironmental 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 (ill and restore to its former condition the navigable [o 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 Slate of New York on account of any such removal or alteration ib If granted under Art¢le 36, this permit does not signify in any way 10 That the Slate of New York shall in no case be liable for any damage that the project will be free from flooding or injury to the structure or work herein authorized which may be caused 17 If granted under 6 NYCRR Part 608, the NYS Departinent of Environ- by or result from future operations undertaken by the State for the mental Conservation hereby certifies that the subject project wdl 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. Sertions 301, 302, 303, 306 and 307 of [he Clean Water Act of 1977 11 Granting of this permit does not relieve the apphcant of the responsi- (PL 95-217) provided [hat all of the conditions hs[ed herein are met bilitY of obtaining any other permission, consent or approval from 18, All activities authorized by [his permit must be in strict conformance the U S Army Corps of Engineers, U.S. Coast Guard, New York Stale with the approved plans submitted by [he apphcant 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 p of any wetland or waterway by suspended solids, sediments, fuels, Such approved plans were prepared by IC tf ~1i1?C f~• ~ f% 0 UJC solvents, lubricants, epoxy coatings, paints, concrete, leachate or any _ _ on 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. All necessary precautions shall be taken to prevent contamination of the tidal wetlands and or waters of New York by silt, sediment, fuels, solvent, lubricants, epoxy coatings, concrete leachate and any other pollutant associated with project work. 3. 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. 4. The storage of construction equipment and materials shall be confined to within the project work site and/or upland areas greater than 75 feet distant from the tidal wetlands boundary. 5. Prior to the ultimate expiration of this permit the permittee will cause all fill and exposed faces to be vegetated to prevent erosion. 6. A row of staked hay bales or approvable erosion control devices shall be placed (at the landward edge of the buffer area at commencement of regulated activities and remain in place until project is completed and all disturbed areas stabilized with vegetation. 7. All areas of soil disturbance resulting from this project shall be seeded with an appropriate perennial grass seed and mulched with hay or straw ithin one week of DEC PERMIT NUMUFR final grading. Mulch shall be maintained until a suitable - ~ 'l~' j- lvegetative cover is established. PROGRAM/FACILITY NUMUER Page 3 of f 9.-2U-Gf p1n71-2;c NtW YORK SLATE OkPARTMEM OF ENVIRONMENTAL. CONSERVATION ~ SPECIAL CONDITIONS f-or Article_ ( ~ 8. To protect the values of the tidal wetland, a permanent vegetated buffer zone shall be established. There shall be no disturbance to the natural vegetation or topograph within an area extending 75 linear feet landward of the tidal wetland boundary. 9. Driveway and parking areas shall be constructed cf pervious material. 10. Roof runoff shall be directed to drywells a minimum of 75 feet landward of the tidal wetland boundary for immediate on-site recharge. 11. Road, driveway, and/or parking areas Shall be graded to direct runoff away from tidal wetlands. 2. No decks, accessory structures, or additions wi11 be permitted without further approval of the Department. 3. Project must comply with all local and federal floodplain regulations. upplementary Special Conditions (a) thru (j) attached. ~s s~Pz~iss~ DEC PCR MIT NUM OER T'`~~'~I FACILITY ID NUMflER PROGRAM NUMIIER Page of SUPPLEFiE1dTARY SPT,CIAL CONDITIONS •The•following conditions apply to all permits: A. If any of the permit conditions-are unclear, the peraLtttee shall contact the Divieion of P.egulatory Affairs at the address and telephone noted below. B. A copy of this permit or approval androved project plans and supplement- ary conditions 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 approval letter shall be protected from the weather and posted in a conspicious location et the work site until completion of authorized work. D. At least 4v hours prior to commencement of the project, the permittee shall complete and return the top portion of the enclosed receipt form certifying - that he is fully aware of and understands all provisions and conditions of this permit. ilithin one week of completion of the permitted work the bottom portion of Chat form shall also be completed and returned, E. For projects involving activities to be accomplished over a period or more than one year, the permittee shall notify the Pegional Permit Administrator in writing at least 48 hours Co the commencement of resumption of work each year. F. If project design modifications take piste after permiC issuance, the permittee shall submit the appropriate plan changes for approval by the Regional Permit Administrator prior to undertaking any such modifications. The permittee is advised that substantial modification may require submiss- ion 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 coating, paints, concrete, leachate or any other environmentally deleterious materials associated with the project work. fl, 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. I. The permittee is advised to obtain any permits or approvals thaC may be required from the U.S. Department of Amy Corps of Engineers, Flew York District, 2G Federal Plaza, New York IIY 10007, (Attention Regulatory Functions Branch), prior to commencing work authorized herein. J. The granting of this permit does not relieve the permittee of the responsib- ility of obtaining a grant, easement, or other necessary approval from the Division of Land Utilization, Office of General Services, Tower Building, to Plaza, Albany, I1Y 12242, tohich may be •required for any ~ nt upon State-owned lands under water. Regional Permit Administrator SEP 2 5;9gI NYS Department of Environmental Cons. , Bldg. 40, $UITY-Room 213 stony Brook, NY L'1790-2356 t`.''''°'~'_ (516) 751-1389- DEC 0 ~ ~ ~ - ' ~ (~l (`><7~) t - l ) sCHARLES 'P. HAM]:LTON Chief, Marine Regulatory Section NYSDEC, Bureau of Marine F}abitat Protection Bldg. 40, SUNY, Room 225 Stony Brook, NY 11'790-2356 Re: Permit No. Issued To: Contractor's Name: Contractor's Address: Contractor's Phone No. Dear Sir: Pursuant. to General Condition Number 1. of the above referenced permit you are hereby notified that the authorized activity shall commence on This notice is to be sent at least two days in advance of-commencF'ment of the project. The permit siyn will be posted at the site and copy of permit will be available at site for inspection. Submitted By: Date: FAILURE TO NOTIFY OR POS'.P SIGN WILL LEAVE OWNER AND/UR L'ONTRACTOR SUBJECT TO APPLICABLE PENALTIES FOR NON-COMPLIANCE WITH PERMIT CONDITION. CHARLES T. HAMILTON Chief, Marine Regulatory Section NYSDEC, Bureau of Marine Habitat Protection Bldg. 40, SUNY, Room 225 Stony Brook, NY 11790-2356 Re: Permit No. lssued 'I'o: Contractor's Name: Contractor'a.Address: Contractor's Phone No. Dear. Sir: Pursuant to General Condition Number 1 of the above referenced permit you are hereby notified that the authorized activity was completed on _ Submitted By: _ Date: T}3IS NOTICE, Wi'PH PFIO'POS OF COMPLETED WORK AND/OR COMPT,ET'ED SURVEY, IS TO BE SENT TO ABOVE AUURESS PROMPTLY UPON COMPLETION OF PP.OJECT. FAILURE TO NOTIFY WILL LEAVE OWNER AND/OR CONTRACTOR SUB.TECT TO APPLICABLE PENALTIES I'OR NON-CUt9FLIANCE W1TH PERMIT CONDITIONS. ref: BMHP rLC~~~~~~tr~(.~~ SEP 2 5 l991~~~ ~ 4~~ . ~rW~.~~ a3~ ~E~.. ',i m 'Ci ~ C N o N ~ ~ ~ ~ ~ C ~J~O~~ ~ _ ~ ~ c ~ ~ ~ ~ (cS ~ i ~>-~~oE Q N ~~~oUQ ~ ~ ~ ~oiaoC~ a U p ~ c~ N _ ~ ~ RS ti5 O Y O ~ E ~ N ~ c~ ~ (n N r-~ N ~ •a- ~ ~ ~ C i ~ U~ U O U O o z .O ~ W~ X C a ~ C ~ ~ N ~ O ~ W ~ c~ U ~ v~ ui Z O U O ~ ~ f- -F-+ ~ ~ O ~ O ~ C ~ ~ U C U_ O 1 C~ ~ ~ ~ N i U ~ m N "r ~ ~ Q j Y = E ~ ~ N 0 'D ~ ~C C N 9 ~ ~ Q O N ~ Q ~ Z O j N F ~ i Q r~((~~' N X ~~.~I~uVi,u>i,, d W ~ 4 I~ TOWN (SF~;T(_itl`r F'f i SHOPE RENO WHARTON ASSOCIATES O~ ~G3LaG~J~Gu"~051 1JG~L~ 18 West Putnam Avenue GREENWICH, CONNECTICr~UT 06830 TEL. (ZO3) H69'7L5O DATE JOB NO FAX: (203) 869.2804 September 11, 1991 8911 ATTENTION TO Mr. Curtis Horton Mr. Curtis Horton -Building Inspector Building Inspector RE Southold Town Building Department P.O. Box 1179 Saint-Amand Residence Southold, NY 11971 Fishers Island, NY Express Mail 516-765-1802 WE ARE SENDING YOU t~ Attached ? Under separate cover via the following items: ~ ? Shop drawings prints ? Plans ? Samples ? Specifications ? Copy of letter ? Change order ? COPIES DATE NO. DESCRIPTION 3 se s 5-1-91 13 (3) Signed & Sealed Sets of Drawings Consisting of: Tl, Al through A7, Cl, E1, E2, SP1 and SP2 for building permit application process - THESE ARE TRANSMITTED as checked below: ? For approval ? Approved as submitted ? Resubmit copies for approval C~FOr your use ? Approved as noted ? Submit copies for distribution ? As requested ? Returned for corrections ? Return corrected prints ? For review and comment ? ? FOR BIDS DUE 19 ? PRINTS RETURNED AFTER LOAN TO US REMARKS ~ i~~~~ COPY TO SIGNED: J - PPUWCi 2M1~ln<, Groton,Mass 0011 io OrUer PNGNEiOIL fflEE 4AE0Qf6GfB0 II enclosures are not as noted, k/ngry notity us al once. - - rs- ~ J. r k i 1 ty :~.c. 1 v:HUPE F~.EN V W Hr.R T GN r' - Ei 11UQ. J~ 111 •L~I.J IJNJCJkJ ,\WMM~.V 4 ~$1~Rt? ~C*~art1"~GI~~ p'f ~11VIkq~7~Q 2356~~t18ery~tf©C1 NaW Yp~D~,sUN"~, Stnnv'~raax, IVew Yor 4' ~u+(ding ~ r a (518th 751 1389 °Chnmse Jar~Cing ' Commlua64nor, ' May 15 ~ 1991 lyathan ,a~~,,t-Amend P,O. 9ax 59l P'1 shers Ss1 and~A NY D963D w R~; 1473$-DD212/DDDD1..p 17ear mr, Saint-Amend: the4tate Urii~orm pxaca~duree ,ti, > u~.rNmenes of ulc+tinn® (61d`tCR'i~t Part g2,1) I T.n confarm+~ncg mitl~ the req Our pormit. Please read a'll nnnditi.ona carefully. ~ ,4at (artie'in 7D,ECL) atld 3ta 3.mp7,ementing re$ ]ease contacC us aG the ws arc e~~claain6 y conditions, P• yo,u are unable to comp7.y with any z Dated at ybuvs e,ddrese• ' Also encl~naed is a permit ®i$l~ which ~.s to be coagP•vuou®ly P the Project aiGa a'ad Protaatr~d from t11r weather, VeryC~truly yau7's, A~ qe~ Cvan~ ~nvlydnmantal Analyst , , encleaure ' ~ ~~r" 2TU :t.~F~,r 1 - ~ ~ _ _ ~ ,ti f ~ rJ G W H r-i r=.~r c. r-a f i)CC PI'In141T NUMaGR F• _ ._a 3 G 1^A738'»pC2T2/OOpp7,-0 Ew'u<nrloN unYE rncil•Irvlr'IinoRnM Nurnu~ F.Rtti ~ PERM{Y Under the Environmental Canx(<rvatioA Law (E~t) Mdy 31 , ~ 99~ Yl'uP-PypF P[RMIY (Chlvr;~k All AI1pI1Cd6L, BOxcY)r~ ~ -nn [~Pd1'nllt t0 CJpafatC ' 'CJNdW L,.J kHndtv;d ~M1lhdlpe,np,p 1.~IY 'hfm111o Canibuat Article 15, Title 5; Article 17, Titles 7, 8; h'~1 ArCiCle 27, Title 9; 6NYCRR 373; L_~,J Protection of Water ~ SPDES L,,,„-1 Hazardous Waste Management Article t5. Title t5: I'"""`~'l Article 19. ~ Arkicls 34; Water Supply I I Alr Ponution Contrta Coastal Erosion Management Arilcie 15, 71t1e i5: Article 23, Title 27; Article 38: Water Transport ~ Mined Land Roclamatlon I~1 Fleodptaln Management Artlole 15, Title 151 Article 24; I"`""-'1 Artlcle6 1, 3, 17, tg, 27, 371 Lang Island Wetla ~ FreahWater Wetlands L._,J BNYCRp 390; Radlatlon ponttpl Article 15, Title 27; Article 25: r"" ~ Ether. Wild, Bcenic and Recreational ~ Tidal Wetlands I 1 Rlvora ~ i Arficlo 27, Tltlo 7; 6NYCRR 380; 6NYCRR 608; L~,.I 5olid Waste Management ' ~ Water Quality Cortifloatlon . _l I'ItMIT ISS f1 IU TE6EI'H9NE NUMOVR t>ra~han SaT nt-Amend ( f - ' AI)17RItS$ t)F PERMIT'I EE Pp Dax 597, Fishers Island, HY p963~ _ _ _ TELEPHpNC NUMBER ' t10NTACT PI'RRC)N FAR PI!RMITTEO WUlik ' p.g{A~.,...~y.Y.~..1..d5.9~ cGT.^-~r8 t~F..~v""~(~-~••-- NAME ANP ADI8Ik5E P pRU 1:CT'1FACIUYY R.O.W. oi' Orien'~a~ Avenue, Fishers Island,• _ Waterceurss -Tidal Pond _ ' I~pCAT10N OP Pltt)IECY/FACII~ITY Fishers Island COUNTY TgWN CIYYNILI AtiP WAT@RCUIIREEIVJEYLANh Np, N1'TM CpURI)INATES, Su~F~o1k Soui;~told E:,_.,„..,_ Nla_ Cnnstruct9onTaf(IaE sin~lie,_family dwe'111n orch, e.rvious dr9Yewa a d satiitar.v ~ n l„'fin eccnrda,nrP k11't!h rh~A.'h1'nnhA~d~IYS.D.F,dI_,.a~.p~a~e~--p~1an tea' `ro n ,y raE~P 2 p 6991 ~ ~ I { ; "r$J f77ff 6,41 !r"si S~ ~y aoceptance ok this permit, khe permllkoe agrmes'that the pbrmik la oontingbnt upon atrial compliance with the ESL, aU applicpble repufatlon5, the Csaneral Candiklons specified (Sea Raveree 51de) and any Spbpla! pp It~y I dad els pert of this permit, f" 1 ~(~'r,n."s:,,rf.'/' r.~+;'alrtrt D2 U Q K4 Q rl to t _ ~ r, r ~ f t f1r'.S.'J.~7c' V E+ PEp.M1Y AnMINISTRATOR AL)URE55 tTl'!;'f'1't i,; b71Y.'f.'1. F'1't"/ C)dr p;livv ;°(',fYt7,f David DeRiddar ,I:~r'r,~.rtt;.la.~;• AUTHORITfn %iGNAYURE ~ fJ 1)A~f H , • - ( L. N. Ic. IY 4J Yf H 1 •J ,'1 ~ r_, ~-F ryiJ JV J} ~ .li~l ~ VV4,r.1~ ,~v.n~~~r ~~i i • / 1 ~~Y d ~ '1 r4 q~~1,1~~\/, `~vf A ~rr,~V-W-JM,AL G~NER~A.y, l:Ch1pITIONS FOR ARTICFkS 7G (THIo S>, aA, 'u5, 34, 9f and d NYCRR Part Gt18 (,That If,ftvrzrilCu7o~ieratlona by !hn Stake of New York rxqulrv nn ab other anvlrnnmental{y delotorlous mntarlals aasociotod with rho terP tpftfr6'finsltlon n4 kho•slructurn nr work horam auNtorizod, nr prolnot. t>`~a+~f.~otSinton of the pnpartn,ont of Envfronmxntnt ConFervxtion 99, Any matxrtal drodr~od (n thn proaoeutlon of khe work hernia pormlttvd t.gl$a~t~auso unrxasonabla obetructloa la khx fruu nnvlgatlen of laid shall bat rnrnovad avnnty, without Inaving Largo rofuao pllua, rtdgos across ~ ~s or flond flows or andangnr the health, outcry or walfurn of thu bed of a wntarway or floodnlain ar chop holes that mny have a o poopln of dto 9tato, or unusc lass or dastruotlon of thu natural londancy to eauan damaeu to novlgahla r.Mnnnals or Co the banks of raaourrxl of d,o 5rata, thv owner ntay he ardvred by thx Uxpaftntant to a watarwvy. romova or alter rhx structural work, obatructinns, ur hazards cnulvd 14. Thortl shall bo no unraaaonabio Intorfarenca with navigation by tho work n,nraby withvut axpanla to the Slats, and ff, upon Q,a exptrution or hnrnin Irulhorizad. ravocntlon of thlA pnrmll, rho srructura, fish augavatfon, or a[hxr 19 If ?pnn the oxplratlnn yr rovocatlon of khla porntlt, thx proJock horcbv mndlfinatlon of the wntorcourax hereby authorlxxd shall not bx A.orrr' uutharired has nut boon completed, the apphcpnt shall, without expanse plaod, lhP c+wnxr/, aha11, without oxponw to thu 5tnto, and to svnlr to ri,a 5tnty, and to such extant and In such time and manner pa the extent and In such tlmo and munnnr as rho t7xpurtmentof fnvuonmantal ~ynpanrnrnt of fnviramnantal ConsxrvaUOn mny rcauirm, removo all nr Consnrvatdon moy rayutra, ramOVa All nr any pnftlVn Of thx uncnnlplatxd any portion of the uncolnpfot.ed atructura or till aa,d roltoro the sits strucrorn Or (111 and rnst6ra to Itr furlnar cnndltlvn 1110 navigable to its farmer condltlan. No claim 7hn11 bu made against fho State of and f1Vnd CapPalty of lha WPiRrCVVfAe~ NO Claim YhPII btl n,adx nyQhAbl Nnw York on acaqunt of any such ramoval or alteratton• rho Stato of Nnw York nn account of any suult ramoval nr nltelatirn,• q(,, If prantvd undor Arkirlu 9U, fhb permit Boos not signify In any way 14. That the Stara of Nxw York iltall In no case ba hahla far any damage thn! rile prolnat w111 bo free from flooding. or Inlury to the sGuchurn or work huraln nulhorlrxd which may hn cuusod 17 if granted under G NYCRR Parl 649, Ehn NY$ aapartmont of Envlron^ by ar robust from tutus npemtlons tmdartnknn by thtl Stnln tot the mxnlal Consarvatlun horaby certtflxs that rho snbloct ptol®at wilt not conbnrvatlon or lmprovumont at navigation, or far other purposaA, and euntravane ntaluont Ilmltatlnns or other ilmttndnns or standards under no claim or right to cvmponsatlnn shall accrue fmm any buoh dnrnuge, Scotian, 941, 942, ,3n:i, 306 and 307 of the Clean water Act of 9977 t 1 Granting of this permit does not rallove thu aNNIICa+,t of the robpvnAl• (ML 99.217) prnvldnd that all of the condldons Ilated haroln aro mot. hletU 5{ Arny Coma vt Eniy,lnalerA,tUP9. CoastlCulu[rd,rN w York 9t~tC 13 w11th thevxpprUVtld plane submitl'ed bYlthx ANN~cant orihl6cngont as pee Offlco of L'anar~l Snrvicas or Inral government which n,ay bx ruyulrad. of thx pcrn,lt ppplicntlon• tz All necessary precautlona shaft be taken to procludn rontaminatlun Sash npprovad pions were prvpnrod ~Y ~iC.h vf+iv-~a u of any wetland or wntnrway by suspended solids, sedlmxntx, fuels, on aolVnnlb, IUbrlCn nk/, epoxy coatings, polntA, cVOC'Yeta, PAf,hntC Or any saeclA~ cp(vr~IxlaNs 1~ escape oQnberdischarged,wnor T+hallswashingstfrom transitemixatrucks,lmixers~,oor other devices be allowod to enter tidal wetlands. 2. A71 necessary precautions sha11 be taken to prevent aontaminatian of the tidal wetlands and or waters of New ,York by silty sedim~ant, fuels, sal vent, lubricants, epoxy coating~~•; concrete leaafiate and any other pollutant associated with praJect work. 3. Any debris ar excess material from construatien of this pra3eat shall be camp1et~lly removed from the ad,~aaent area (upland) and removed to an approved upland area for d9~posal. No debris is permitted in tidal wetlands. 4, the pro,~est workositeuand/areuptandnareas greatbrlthanai5 feet distanttfromthin the tidal watt ands boundary. 5 andoexposedefacesn[toebexvegetatedototpreventmerosianpermittee will cause ~.1~1 fill 6. A raw of staked ha,~„~ba1es or approvable erosion control devices sha11 ba plaoed (at the landward edge of the buffer area at commencement of regulated activit9.es and remain in place until pro3ect is completed and all disturbed areas stabilized with vegetation. 7, A11 areas of soil disturbance resulting from this prajeat sha11 be seeded with an appro riate erennial rass seed and mulched with hay or straw i'tltd~n one week of I,EC aeph,lt'NUM9Ep final grading. Mulch sha11 be maintained unt91 a su9table ~ ve eCative saver is established. PRaC%rtAM1FACllITV NUMBER Pa 2 ~ Of I. CONFSI71pNS For Article_ ( J 8, To protect the vatues of the tidal wetland, a permanent vegetated buffer zone sha11 be established. There sha11 be no disturbance to the natural vL:getalian or tapograph, within an area extending 75 linear feet landward of the tidal wetland boundary. 9. Driveway and parking areas shall he constructed of pervious material. 14. hoof runoff shall be directed to drywalls a minimum of 75 feet landward of the tidal wetland boundary for immediate on-site recharge. Z1. Road, drivewtty, and/or parking areas~51ad11 be graded to direct runoff away from tidal w©tlands. 2. No decks, accessary structures, or additions will be permitted without further approval df the Department. • 3. Prd,lect must comply with all local and federal flaodplain regulAtions. upplementary Special Conditions (a) thru ~5) attached, rt ~~r~~~ D ~ ~ ~ ~t~g~ ~ n F ~N lt. k C~i`~.~w ~ DfG PcRM1T NUMBER I'AYII 17v IE1 NUMBCR PRDriRAM NUMBER !'nga ~ of I ~ J v I Yw91.-...»r~ ~ =~c ~s w , ~ ~ " S£Q2~1'3~l ,~,~I' ~ f a ~\ti ~ , . f1, 1. f.'.. o, i ' ~~,'~~i~•~'ko~]:Zaw'lug candit~,ana~ apply Co alz paxxd.ts: ~ if aay of Che perttd.t, aamdi.tioms• arc usscl~.x', Che permititea shall cnbt+soC the T)~.viaion of Tiagulatnry Ak£airs' at th'e' addx~arsa amd GaLephaYSC~'. naCed Uelaw. A. !b ao n£ th~,a c'r7nit aY e,,,,~t'avaJ. and a ra~wt,+n~OCC p1?~ma sr~d 6tt ~i+a„ arY a~t~~~, a all be aVai~.able~ at t e pro~aaC g~,~te whenever authaxir~r~d warts is ~,n°•prngresa. c, xhe permit sign e~.e7.ased Wif,Ck~ Ghe parait ox a Dopy a£ appravaX lettex' shffill be pxatected Pram tha waachex and pnstad in a conapiaions laaaCiam at khe work site unCil cnraplatiam o£ authorized work. p, At 1easC 40 riours priax to cnrnmexiaemexst of the pxa~ect, tha ps~Ctae uhall nnmpleta and z~atuxn the top pnrt~.on of the'e~talaaed receipt R'oxra nexCi£yi~ng that he is fully s~rare of and unde>:atar~ds all pxov~,sinris and conditions a£ this permit. Within one weak aF aompl.etian of tha permitted waxk tha tsattam poxtiom of that Form aha,ll also be comp7.eted amd rsturn4d, p, £'nr pxajecCa invalr~~.ng aativitiess Co be accompl~.shed avax a peri,ad ar rnaxa than one yeax, the permittea zha7.l notify tha Acgianal part Adrnira,S.stratar in writing at l~aast 48 hnars Co the cn~vmenaement of reaumptian of wnxk emch year. p. If pxajanC design modi£iCat3ans Cake p~.aae afte>: germSt isausaae, Cha perm,~.ttee shall submit the appx'npriate p~.an changes £or approval by ktte Regional Eermi.C Admizti.dtxator pr~.ex to. under.ta3eing any such modifioati~ona. 'xhgi permi.ttee is ad'viaad Chat aubstamC~l md'd3E~aation may raqu~.re eubmiea~ ion of a new app].L,raCSan for permiC, G. A7.1 netesGary precmutiona aha~.1 Ise 't0,kett Ca pz'ealudr~ cantam~maGion of atnp wetlands or waCgrway by suspendad an7.ida, aedirnen~, fuels, saTvants, 1ubr~.aanta, epoxy noatingr paints, canazate, leachata nr 'atty other ®nvirnnmentallY deleterious materi.a~.s assaaiated with tho project woxk. Pt, Any Failure to caarply preaigely with all o£ the Caxma god candiCions of thi.a pora~it, unless aatharizad in writing, shall be Cxeated sa a violatiazt a£ she Enairantal' Caaaervatian T.aw, T, '.Che permittee ~.a advised to obtain any permits ar approvals~tlist lacy ba requ~.red from the t1. S. Department a£ dray Corps .af En8lneera, Raew Fork Aiatrict, 2U Federal plaza, blew Xork P~ 1Op07', {ACtentiori RCgulataxy . Funatiana Branch?, prior to aor,~mencing wank aut'horized'har.e~.n. J. The granting of t3x3.~ permit dace not ral~.ave the pexmitCee of the reaporiaib~ i.].ity n£ tlbCainimg a giant, easeraerir, ~or, other, necassury app~aval From the Aivisian of Land u'tildsat~.oa, Offi'na a£ Cenmral Services, Towar wilding, a+mp~,xe~, 5tata plaza, ~A.7.bany, AYY 3.2.42, which may berequired ~Enr' any gncraaahment uposl gtata»awned 7.anGta,undox wares, Regional Permit Adbaim~iatrata'x N't8 t7epartmcrit a;E Envirovtmantnl Comsr Bldg. A0, Sui~'«-~-ttooa 2I,9 Skotzy prook;~ t9X' ,1'7750^Z~arb (S76) 753.-1389'- . a , ~ i _ ~ ~ ry ,J F-' t K G r'i lJ 4~! H H N: 1 U f4 .9 . Auq,3N "91 1~t69 06P©. ROGERS ENT, Inc. TEL 5A6-653-063 P• E a_ rt~ ...x ~ ~ I, ~~.ti ' f , Pt~l q SAP 2 0l99f €€4€€4 !'f f?t4 Ul ,'T i~~M~~,gq~atory Secitat Protection a ...,..7~'~",s~' ic~1~~~csF~ CkJ.ARLICS T . b$ Nax Ss~B HR~~ ~ „ ~.-=A , Chi.e~ r N~urgau ~xso~a4Q SUNxr ~toom x2356• 'P19g. Sraokr Nx 11.'79` .r-.-r-.._^r"..r Re: Permit No• ,~---~~""w Cont'ractor' a Name: .~---W-~-^_'~""~--~~'~•-~"M".. Contr'aCtar'g i~,ddreas: Contractor' a Phone No. Aear 6ir: Number 1 of the above referenced notified triat the authorized activ7,ty eha11 Pursuant to General Conflation Thi6 notice is~ to be sent at 3.east permit you are hereby ro ect. commence an anim na cF~ment of the p 7 two days in a vanes d~' a ermit will be The permit eiyn will be posted at the site and cagy of B available at site for inspection. Aate: .._..,,__._._.r,.-. Submitted Hy: _ VL" gWNl~TTt ~1D/Ql~ CpNTFtAC'1`o~ ~c.~x.:SC+m ron ~~nm7RV fiR Pd&'~ SIGN WzLL LJ~A .,,,~.,,..,,.n+rt urTmC! n~'~MTm x w,~,,,,r~ w, W.,n.r ~r.,~rwr ~.~w.x+u,w M^~ rw• ~~.,.ti,.. rrwr,.r+„r.n,~...w~r~ .r .n,YYM,~.,~~,.nw,nrrw~.x~.~iw,.~.n~,w.IT W,.rr~...~w CXiARL~S T'. HAMILTON .t „ ur T3 Ar'tttl Ff1P~/ SP(^Y•i~an CI~XARLT~S H~IILTON Section Ghiefr Marine Regu'Latoty NYSl7ECr Bureau of Marine Habitat Pretectian g1dg. 40, SttNY, Room 225 . Stony Brack, NY 11790-2356 Fte; Permit Na. _ ,r Issued To: ~ _ Contractor's Namat ConY.ractar' a ~ddre55 a ...,_,.,..-r--~...r... Contractor's Phone Na. Dear Sir: Pursuant to Ger~erak Condition Number 1 oP the above regerenCeGX permit you are hereby notifies? that the authorized activity wes completed on Submitted Hy: _ Uatec - , r _ r+ 7:'~ID WVRK P.NA/OR COt+t'PTaL'1'LI? SY7RVE;Y. I '~'S'.~5 1b7E'1'xxCg. Vq'C"1'14 I?I~UI"Q.~ qP' CGtrl. LF. 'S!Q SE S.~1m 7'O' Vtr Ak~AIt~SS P120Mi1:'TLx X7kp1v COMPY.Y:a7,'TC1Yi Q>± 81iAJL~CT. 1rAILDRE 2'b NO'SxP'Y WxLL LF.AvE IJWN~t ,p,N'T3/C1R CONxR.P,C'SUR Sl'YH~7'7s'C'P Tq !'~FPLIC.~~+E Prt:I.4LTIIa3 1`'OR N(7N••CGt4F~Is;t1~NC.L WI'i`Y3 PE):+.MI'~ CpNDa:'i'IONS. ,ref: AkXR17' J E ; w SEP 991 ° ~ ~ is P, MM ~ '.t ,may, ~~+~1 ~ ~.W~~~~Cy N ~ ~ ~ cr ~ ~ ~ ~ r~ o ~ ~ ~ ~ Q ~Q~,cn~~ ~ ~ ~ ~ ~ a ~ ~ ~ r..,. ro ~ ~ ~ Q? ~ ,>s ~ ~~~~~Q V1 << b~Q~'~~1 ~ ,9. c M~ v Q. ~ ~ p^ rya ~~M1d ~ r^M ~ ~ ~ ~ ~ , r ew ~q 1C 1 rl Q ~ ~ "MM ~ 7w F+ i1. "1 r~ 1'"~' ~ J~ Cj1 ~ Y'~ v~ ~ ..,^;A,, r BOARD OF HEALTH j(~~(~/7 6^ 3 SETS OF PLANS l~Ll\1~'='~~I~~~ PORMN0.7 SURVEY TOWV OF SOUTHOLD CHECK Crn201991 'it BUIL"D.TOWNHALLMENT SEPTIC FORM a7G1" ~OUTHOLD, N.Y. 11971 NOTIFY ~t I TEL.. 7G5~1802 CnLL • • Fll.r c:~T^ i " YC~tiA~n' ~ F., p MAIL T0: Exarnltlcd' ~ ~ '19 ~ //f/~ r~pprovcd~~~~~~,~'.,,~, 19 ,Permit No..p-/, PG.: f Z Disapproved a/c l•F (Buildin; Inspector) APPLICATION FOR BUILDING PERMIT Date `~`-~.`'!'s~.`•"• ~ 9.., 19 !l • • 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 cress, and giving a detailed description of layout of property must be drawn on the diagtam which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy tshall have been granted by the Building Inspector. APPLICATION IS HEREBY Iv1ADE 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 applicant, or name, if a corporat~n) ,~~,~Q~r.~,t/~~~.~~t~.?~~.1~~, ~Z~ oG39g... (hfailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name oC owner of premises ~ l~wc~ ~C.12~ ...............L'•.f........................... (as on the tax roll or latest deed) !f applicant is corporation, signature of duly authorized officer. . (Name and title of corporate offi crc~ ) ALL COt7TRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. °t~~ Fl.7 Plumber's Liccnsc No. , , , , , , , , , , , , , Electrician's License No. ...°?r~O"~ OtltcrTradc's License No. ...~9!~;A~' 1. Location of land on which proposed work will bu done. ~/yt~~~-2~ ,i~/ ~~'c~ G~Lu¢/ House Number .......................Street ~j AI// L , Hmnlet County Tax Alap No. 1000 Section .....~~8 , , , Block , Lot ~ . . Subdivision Filed \fap No. Lot . (Name)' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...........~Q'~-?•; , , , , , , , , , , , , , , b. Intended use and occupancy ...../X-~4d~r.~;~;~!~~4~, , ,a'~ ; . • . • . . 3. Nature of work (check which alpplicable); Ncu• Building . ~ , gddition Alteration Repair 'oval • • , Remy Demolition . , ,Other 1Votk . 4. Estimated Cost pop , , , • • . • • • Fe y/ /p•~~•J• . (Des ription) ~ • (to be paid on filing this application) 5. If dwelling, number oC dwellin 6 . ' g uni s ~ . , , , , , , Number of dwelling units on each floor . If arage number of cars , ~ • , , 6. If business, commercial or mixetd occupancy, specify nature and extent of each type of use . ~ ~ ~ • 7. Dimensions of existin; structura~s, if any: Front . .Rear ~ Depth . Hci~ltt ...............Nun~berofSto rtes , , , Dimensions of same structure with alterations or additions: Front Rear . • • ~ • • • • • • Depth Height . Number of Stories . 8. Dimensions of ent}}'re new construction• Front . • >~;i3~ `j,", , , , Rear ..~',9" ,Depth rya' ~ • Height ~~!!o. Nun%ber of .a . . 9. Stories..... Size of lot-. Front Rear . • • • D pth • 0. Date oC Purchase ! Name oC Former Owner • • • I, Zone or use district in which premises are•situated . • • 2. Does proposed construction violpte any zoning law, ordinance or regulation: • • ~ • • • • • 3. \Vill lot be regraded ~ • Will excess fill be removed from premises' Yes • N 4. Name of Owner of,p emises ~t4C' Address , ° Name of Architect " ••••••••••••••••••PhoneNo,a~??;7,.{~;~/,{g,33 ~ ~ ~~-~e';:~. Address . .Phone No. Name oC Contractor ~~4:/~Q,(,px C~,Address .Phone No. ~~e: i,`~:7,;Z3w• No 5. Is this property located within 30D feet of a tidal wetlandY *Yes *If yes, Southold Town Tru~tees Permit may be reqyu~ired. PLOT DIAG1tAM Locate clearly and distinctly all (buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ;tenor or corner lot. • 'fi 1 i • • i 'i `y II i "ATL• OP KE~ti' 1'ORl:, S.'S ]li\TY OF . • •~~"•~gi • • , being duly sworn, deppses and says that he is the applicant • • • ~ ~ • • ~ .(tiaf~~of~ individu~~ajjhsi~nin~• f ~ contract) ove named. I : is the ......................~GC.~p-f,~............ . (Contractor, agent, corporate officer, etc.) • ~ • • • ~ ~ ~ ~ ~ ~ • • said owner or owners, and is duly ~uthorizcd to perform or have performed the said work and to make and file this alication: that all statements contained in this application are true to the best of Itis knowledge and belief; and that the rk will be performed in the manner slit forth in the application filed therewith. orn to bc(orc me this _ c~ ......day of}. II, • tar)• Public, , ,~t• ,~,,1;)Q-:?R.,, , , , , , , County i , M1oy Public, SfaY• pi Niw NA ' • ' • ' ' • No. 524509185 ($lgnatur0 f a Leant) QudNird in 5uffo~k CouMyd Z PP • • #irm buM Mfr fq. N..._. G~c.~} .