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Home My WebLink About18291-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-19120 Date JUNE 7, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 27756 MAIN ROAD ORIENT, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 018 Block 06 Lot 21.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 7, 1984 pursuant to which Building Permit No. 18291-Z dated JULY 12, 1989 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 GARAGE AS APPLIED FOR. The certificate is issued to JOHN & LINDA SABATINO ~ (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 89-SO-58-JUNE 1, 1990 UNDERWRITERS CERTIFICATE N0. PENDING - MAY 15, 1990 PLUMBERS CERTIFICATION DATED MAY 7, 1490-TERRANCE TAUB L uilding Inspector Rev. 1/81 roses xo. s TOWN OF SOUTHOLD BIiILDiNG DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLErtION OF THE WORK AUTHORIZED) N° ~g~~~ Z Date ...........~......~.L 19.~.~ Permission is hereby granted to' ...~~y.M.~.....~... :mot............ ~:1.~......~....~.d........~9...A ~ to .~M:".:~Xi1,.....~'•!:...8~0.:.. ....!.:?.!~^:4r~hvR.,..~5?1...~.4f.4.C.~{~. ~1-~4~Q~4, . Q i , r . . . . . . . . . . . . . . . . . . ..1. . . . . . . . . . . . . . . . . . . . . . ...1... . ct premises located of . °~;7 ~7.~~R.........I:!1.a:'-n... :........Q..^ ...........................................................~.c./..........p ~.°.......~.°..a~!?L.~-k.~.a-...t... a County Tax Map No. 1000 Section .......Q.~.~....... Block .......5~.~?....... Lot No....~c~ pursuont to application doted .......~..la.~.~.}.....~ 19..~.~., and approved by the Building Inspector, 1 1 Fee r1~...`~.~~..:5.~~*..... Bu ding lnspector Rev. 6/30/80 I'o rm ~o. 6 Si?(S~i fA.dS"a TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 D ~ ~ a~ ~r~, APPLICATION FOR CERTIFICATE OF OCCUPA ~ ~ ~ 6 hry A. This application must be filled in by typewriter OR ink and o the bu ~ g inspector with the following: for new building or new use: WfBVtOFSOUT~ 1. Final survey of property with accurate location of all s, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-4 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 17 lead. ' 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for-the building. 6. Submit Planning Board Approval of completed site plan requirements. 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 - $100.00 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 - ResidentialJ$15/.00, Commercial $15.00 Date ..,~~,'/'`~F•~~ New Construction....~X...... Old Or Pre-existing Building! Location of Property ~~1 wIJTE jw/f,t~,............G?2iEi~ri............ Souse No. Street Hamlet Onwer or Owners of Property.. ~O"~~' ' St3(S/t"^'o . County Tax Map No 1000, Section...... .....Block.... 6..........Lot..~~4/...~'~: 3 . Subdivision.S:1L:':~.f.. Hsl:A::.~'.....Filed Map......:.....Lot....T Permit No.. ~ $ z~~~ .......Date Of Permit.. Z.yl$, L ....Applicant. L~.,~. ~~o...~: s~5; f.,.,, Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate....,~..... Fee Submitted: $ ~-`t' ° ` ~ ~ ~ APPLICANT eo~191a~ s aj (,~R I° I Ad ~ ~S~Ff~ULk~''~ TeL.7cs-1FOz ~~~t~ ~ ! ti~dl4~,.1tt~~~ ~ Of S'tCti OP TlU1LUING ItdSPECTOR ~ ,~f, t1 r C1~ rl~ ' ' Z' 'COI.'iJ UALL ~ti.,~f -1'~^s~+'~•<'~` S0Ui7f0t.i),N.Y.11971 April 12, 1990 JUN - 61N~ , LYNCH HOMES, INC. _.A~f 321 CODNTY ROAD ~39A BLDG. DEPT. SOUTHAMPTON, K.Y. 11968 MOWN UFSOUTHOLD To V•lhom'This t4ay Concern, Ore .ire unable r_o complete your Ccrtificatc o~f Occupancy because of the folloo~ing zeasons. ~ /~I 11n :.application £or Certificate of Occupancy zs not nn file. `to tlnder.•rriters Ccrtificatc on file. A~~`- ~~/r` •I'hc cl;ec}: is ( $25.00 ~ ~~w~ a51 _ /not on file. /t/ t:o iiealt}r Dept. Approval on file. C:o final inspcct•ion has been made. Plc.i:;c contact our office on this matter. Thank you for your cooperation." i3uildinr, Permit 8 1 p~ ~ ~ Z fto Plumber Solder Certificate on file. ( all permit:: involving plumbing being issued after April 1,19fl9 1 'a. :'i~LD i;:°,: iv;: II'Jn i ^ CCCIMLNT.^, I~ ~ 1 . - Q t m o4 s I ¢ H H ?OUIlDAT2021 ~ ( 1st ) ~~I ~ ~ ~ c ?OU1lDATIOIJ (2nd) _ m 2. / 3 ~ v o ~ • HOUGH FRAME & C - v PLUMBING _ 6 N 3. ~ ~ IIJSULATIOf! PER N. Y. - ^3 STATE EfJERGY ....ryry C O D E ~-^^i' a M r 4. ~ y FZidAL f' i ~ o ADDITIOfIAL COMMEIJ S: m S c o~ S~3 o Cv o~ P ' X b H y H ~ O ~ m o0 y ,p r ~ y fA 4 b r- r .p OO a y TEL. 7G5-1802 5~FF0(/; TORN OF S01iJT~Ob.D ~ ~ OFFICE OF IIUILDIIQG IN5PEGTOR ~ ~ P.O. BOX 728 ~ ' T04VN HALL '..~""°,.."a~...~w... ~~~j~'~lk SOUTHOLD, N.Y. 11971 ~"'~f~''. ~ ~~~,,f I } ~ ;fit • ~ JUN - 61990 `1 j I~ . " pG. DEPT. L;J C E R T I F I C A T I O N TpwN OF ^~OUTHOLD - Date . Building Permit No. /8~9~ Owner 'SoHti S~¢/3/}'j~N® (please print) Plumber ~EjtR,gn~cE T,¢ua (please print) I certify that the solder used in the water supply system contains less than 2/iQ of lo~lead. " ~ (plumber's si~natXlre) Sworn to before m this ,_~day of C~ ~ ~ ' ~ Not>$ry ~uf~lia Notary public, Cou, ty,/ ~ ~ • gpggRfY P 6 C, Sta a of New YaA3 Q~mflfled In Suffolk C~ . No. 52-4Q01884 's,~ Commission FkpMea~.".,.,. ,Gf~~~ I CCU a 19snaa THE N'E11V YORK BOARD OF FtRf UNDERWRITERS PASF 1 r EUREAU OF ELECTRNZITY !6 JONN 6TREET. NEW YORK, NEW'YORK 10030 JUNE U5,199U 66427`L9U/90 N 133269 Mete AppNcetion No. on Jile THIS CERTIFIES THAT only tke eleatrlcel pnipmsnt a dsscri4ed below cud twtteduced 6y the eppliceut ttemsd sn tAv chore eppNaNon numMr in tM ptrrmleee ~ SABATTNO, MATH ROAD, PGLC 8139, ORIENT RT., N. Y. ~ E in theJellowinR kteotton; ®Besetnent ® Irt Fl. ®Ynd F1. 6AR/Oll'1 StrNon 81oek (ot ttw examined on MAY 15 , 1990 and found to 6e in rnmpltenre trick. the rcyniromentA of this Buord. 11RTIM!- At]B SVYITCMK R11T{IRK NO RROIS iXKAUIT MNK OUTIRif NCANDlSClNT rlUOtltCENT OTNER AMT. K. W. AMT. t. W. AMi.. K.W. AMT. r. W. AMT. N. r. z3 3a 2D 2a s 1 1.2 s F DlTYI RSNACR MOTORS ItRWR ANiIANp RRRRK SfRGAI RRC/T TM1R CiOCRR RNt UIIIT IIRATMf SIRIRIi1.{){IIIRT OIMMlK AMT. r. W. 01l N. t. OAS X. t. AMT. NO. A. W.O. AMT. AMr. MIT.. AMH. }RANI. AMT. Ni P. 1~RT ~T AMT. WAiT6 2 F 1 30 et. RRRVICf OMOONNRtt MO.Of S E R V 1 C E AMT. AIN. TTlF ~ I I ]W 1 / 7\V ] / 7VI 3 / I\V NO.O~~C. COND. A~W. O. NO. q N41E6 n0, pNEDI11AlS Oi W. G 1 l0U CB 1 X 1 a 1 a tmRIR ArrARATUS: PANELBOAR05:1-17 CTR. SUO ELEC. WATER HEATER5::1-4.5 K.W. G. F. G. 1':-5 SMOKE DETECTOR:-2 s IfIL ?i:., SCHARADIN EI.F.C.'rRTr: LTC,.M'S540 BOX 1077 MA.TN RI)AD CUT"CH06UE, NY, 11435 ~l'IIiAMMEK 11 ~;1`~ Psr Thit grlificaro mint not lfe oM«ed in any manewr; rNurn ro tM office ot'Mp d ifiRCatM.,..' t ns~r:bR . - - COPY Pdt flt~LDi1K: OEtARTfa1R1T.1'i~[ COPY OF CE~'iflG1 - , °~'l/ 765.1802 BUILDING DEPT. 1 NSPECTIt~N [ ]FOUNDATION 1ST ('ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION 1 [~RAMING [ ]FINAL REMARlKS: /fir V ~ t 1 ~ ~r _ ' k --~-~.J DATE ~3 INSPECTOR ' 765-1802 BUILDING DEPT, INSPECTION [ ]FOUNDATION i5T f ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ INAL REMARKS: ~~_~~_,~-~~a.~, ~ ~~Mit.~ ..5~~~ T~c~ --r"~,~'?.~1~;-L~l~-.~~ _ ~ ~ ~ DATE U INSPECTOR ~ i ~ ~ Tss-1so2 BUILDING DEPT. 1 NSPECTIt'N [ ]FOUNDATION 1ST ( ]ROUGH PLBG. [ ]FOUNDATION 2ND [z,,]~-tN~SULATION [ ]FRAMING (]FINAL RE.~'-~ . ,tea .p..,...,z., DATE Iz'" . / ~ INSPECTOR '6 ( ~ T65-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~ ] !ROUGH PLBG. [ ]FOUNDATION .2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: --~----c----- ~ DATE D INSPECTOR C ~ ' . ~ T6S-1802 BUILDING DEPT. INSPECTIC'~N [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [v]'~NSULATION [ ]FRAMING (]FINAL REMARKS: ~ DATE ~ INSPECTORS J ~ / T6S-1802 ` BUILDING DEPT. INSPECTION [ ] FOU DATION 1ST ( ]ROUGH PLBG. [ FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: DATE ~ INSPECTOR I' 1 y y~ ~ ~ 765.182 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] IN ~ TION [ ]FRAMING [ FINAL " ~ REMARKS:. ~iu~rv~-~ I~y~-~-~~~•~`~^-aa.~,~,> /~Q - - ~ I " Iv/µ ~ ti DATE ~ ~ ~ INSPECTOR ~ si ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: _ ~,~-P~~~~~ ~ DATE ~ ~ INSPECT ~ I } } . New York State Department of Environmental Conservation $egulatory Affairs Unit Bldg. 40, SUNY, Rm. 219 Stony Brook, NY 1 1794 Thomas G Jorling (516) 751-7900 Comm/ssloner June 23, 1988 John & Linda Sabatino 503 Front St. Greenport, NY 11944 Re: ]0-88-0359 Dear Mr. & Mrs. Sabatino: 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, ~a~~.ph~ -~1-' Joseph B. Hall Environmental Analyst enclosure 95~I06 (9/86)-25c HEN' YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DFC ^E RAiIT NUMBER EFFECTIVE DATE 10-88-0359 r 6 2 FACT IlTV/PROGRAM NUMOE R(s) PERMIT EXPIRATION DATEfs) Under the Environmental Conservation Law N/A 6/30/90 328c1329: Aquas c Pesticides 27 ~ Water Oua~ y~ Certification ~ T dal Wetlands Article 15, Title 5: Article 17, Titles 7, 8: Article 27, Title 7; 6NYCRR 360: r~,Proiection of Water ~ SPDES ~ Solid Waste Management L~J Watelr Supp~y0e 15: ~ Arti?ollution Control' ~ Hazardous Walste ~Management3~ Article 15, Title 15: ~ Article 23, Title 27: ~ Article 34: Water Transport Mined Land Reclamation Coastal Erosion Management Long Island IWelisS~ ~ Freishwater Wetlands ~ F oodpiaio Management Article 15, Title 27: N-New, R-Renewal, M-Modification, ~ Articles 1, 3, 17, 19, 27, 37; Wild, Scenic and Recreational C-Construct ('only), 0-Operate ('only) 6NYCRR 380: Radiation Control Rivers PERMIT ISSUED TO .john & Linda Sabatino ADDRESS OF PERMITTEE 503 Front St., Greenport, NY 11944 AGENT FOR PERMITTEf)CONTACT PERSON TELEPHONE NUMBER NAME AND ADDRESS OF PRO)ECT)FACILITY (If different from permlttee) Hallocks Bay SCTM ]000-]8-6-p/o 21.3 LOCATION OF PRO)ECTIFACILITY COUNTY TOWNICITYNILLACE UTM COORDINATES Orient Suffolk Southold DESCRIPTION OF AUTHORIZED ACTIVITY Construct a single family dwelling, septic system and drive in accordance with the NYSDEC approved plan (attached). GENERAL CONDITIONS By acceptance of This permit, the permlttee agrees that the permit is contingent upon strict compli- ance with the ECL, all applicable regulations and the conditiosn specified herein or attached hereto. a The permlttee shall file in the office of the appropriate regional permitadministrator, or other office designated in [hescecial COnditions,anotice of intention. to commence work at least 4B hours in advance of the time of commencement and shall also notify him(her promptly in writing of the completion of the work. 2 The permitted work shall be subject to inspection by an authorized representative of the Department of Environmental Conxrvation which may order the work suspended if the public interest so requires pursuant to ECL §7t-0301 and SAPA §40tD). 3 The permlttee has accepted expressly, by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature. and by whomever suffered, arising out of the protect described herein and has agreed to indemnify and save harmless the State from suits, actions, damages and costs of every name and descrip• lion resulting from the said project. a The Department reserves the right to modify, suspend or revoke this permit at any time after due notice, and, if requested, hold a hearing when: a) the scope o! the project is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations are found; or b) the permit was obtained by misrepresentation or failure to disclose relevent farts; or c) newly discovered information or significant physical changes are discovered since [he permit wet issued. 5 The Dermntee is responsible for keeping the permit active by mbmitting a renewal application, including any forms, fees or supplemental information which maybe required by the Department, no later than 30 days (180 days for SPDES or Solid or Hazarduous Waste Management permits) prior to the expiration date. 6 This permit shall not be construed as conveying to the applicant any right to trespass upon the lands or interfere with the riparian rights of others in order to cerform the permrtsed work or as authorizing the impairment of any rights, title or interest m teal or personal property held or vested in a person not a party to the permit. 1 The permlttee is responsible for obtaining any other permits, approvals, lands, easements and righ[sof~way which may be required for this protect. 8 Issuance of this permit by the Department does not. unless expressly provided for, modify, supersede or rescind an order on conxnt or determination by the Commissioner issued heretofore by the Department or any of the terms, conditions, or requirements contained in such order or determination. 9 Any modrfica bon of this, permit granted by the Department must be in writing and attached hereto. PERM T 15 CE DATE PERMIT ADMINISTRATOR ADDRESS 61.2~r~'~ Robert A. Greene Bldg. 40 SUNY Rm. 219 Stony Brook, NY 1]79 AUTHORIZED SIGNATURE ~,l~ (mss - Page 'i of 4 cc: BMHP. 95-206a (1iB6)-ZSc ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part 608 ( I 10. That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the teration in the positron of the structure or work herein authorized, or project. If, in the OpinlOn of the Department of Environmental Conservation 14 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 15. 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 16. If upon the expiration or revocation of this permit, the protect 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 [o 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 Environmental Department of Environmental Conservation may require, remove all or Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable any portion of the uncompleted structure or fill and restore the site 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. 17 If granted under Article 36, this permit does not signify in any way 11 ~ 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 the structure or work herein authorized which may be caused 18. It granted under 6 NYCRR Part 608, the NYS Department of Environ- 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 307, 302, 303, 306 and 307 of the Clean Water Act of 1977 12. Granting of this permit does not relieve the applicant of the responsi- (PL 95-277) provided that all of the conditions listed herein are met. bility of obtaining any other permission, consent or approval from 79. 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. 13. All necessary precautions shall be taken to preclude contamination R. Van Tuyl 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 rasri cart on S/ 1 q/ fiR . . SPECIAL CONpIT10NS 1. There shall be no disturbance to vegetation or topography a minimum of 50' landward of the eastern property line. 2. Septic system shall be constructed a minimum of 2' above seasonal groundwater. 3. Project must conform to local flood plain regulations. Supplementary Special Conditions (A) thru (J) attached. Additional Supplementary Special Conditions (M) attached. DEC PF&MLT,NUMBER PROGR'AUMItP 2A5CILUIT3YyN`JUMBEft 2 4 N/k1 Page of SUPPLEMENTARY SPECIAL CONDITIONS The following conditions apply to all permits: A. If 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 or approval and supplementary 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 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 48 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. 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 accomplished over a period 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. 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. I. 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, NY 11794 (516) 751-7900 DEC 1( -Sij~_~S' n"3'~ Q Page 3 of TF~ FOLLOYlIL?G COP.DITIOt?S SIi~1LL APPLY IF CIIECP.ED AS APPLICABLE BY TL',E REGIONAL PERt4ZT ADI:It?ISTRATOR; I:. All dredging shall be conducted so as to leave a uniform bottom elevation free of mounds or holes. _ L. All spoil material shall be disposed of either in the Atlantic Ocean or at an approved U.S. Government Dumping Ground, as directed by the District Engineer, U.S. Depart- ment of the Army, Corps of Engineers. Any spoil material not intended for such water disposal shall be removed from the site and disposed of at an approved upland site. 1:. All fill and spoil material shall be suitably contained at the work site so as to prevent its eroding, leaching or oner- wise entering into ad3acent wetlands and Graterr~ays. P~. All peripheral rip-rap berms, cofferdams, rock revetments, gabions, bulkheads, etc. shall be completed prior to placema::t of any fill material behind such structures. 0. All repairs to existing structures shall be confined to re- placement of existing structural elements with no change 1n design, dimension, or materials, unless specifically authorized herein. REGIONAL PERP~IT ADI"ILIISTRATOR Division of Regulatory Affairs DATE; LIYS DeFt. of Environmental Conservation ~'D ~ Bldg. 40, SUP?Y, P.oom 219 Stony Brook, P?Y 11794 DEC~p-5„~'('k~~ 9 <S1G) 751-7900 Page 4 of 4 19J7 ' CIIAP.LES T. I'lAI:ILTOTI Chi€f, Pil~.INE F.EGULATCI_Y E3^TIO:i _ PIYS DEG, fiureau of i:arine P~bita.t Protection Bldg. 40, SUPTY, Rm. 225 Stony Brook, I•I. Y. 11794 Re: Permit IIo. Issued To. _ _ Contractor°s Address. Contractor's Phone Il Dear Sir: Contractor°s Ilame Pursuant to General Condition No. 1 of the abor~ referenced permit you are hereby notified that the authorized activity shall commence on . This Notice is to be sent at least two days in r::- vance of commencement of the project. The Permit sign Trill be ~ostr~d at the site and copy of Permit toill be available at site for inspec;:3nn. Submitted by Dt~TE: Fnii.iTP,E TO TIOTIFY OP. POST SIGT' i7ILL LEAVE Oi]ETER/AP1D/OR CCIITP.ACTOI: SUB JECT TO APYI,ICABLE PEI:ALTIES FOR NOTT-COI,'FLIAbICE i?ITII PEPSIIT CODIDITIOI?S. CITAI',LES T. IIAIiILTON Chief, I:arine Regulatory Section IIYS DEC, Bureau of Tlarine Ilabitat Protection Bldg. 40, SUIdI', Rm. 225 Stony Erook, N. Y. 11794 Re: Permit TTo. Issued To. Contractor°s Address. Contractor°s Phone it Dear Sir: Contractor°s Plame Pursuant to General Condition ido. 1 of the above referenced Permit., ycu are hereby notified that the authorized activity was completed on Submitted by DATE: TTTIS T10TICE, IIITII PITOTOS OF COP?'LET T? T?OPSC AND/OF COT'TLETED SUP.VEY, IS TO bE Si;IIT TO ABOVE ADDRESS PROD^1LY UPOTT, COcB'LETION OF PROJECT. PAiLURE TO IIOTIFY I]!.LL LEAVE OTRTER AS?D/OR CCY?TRACTOn SUBJECT TO APPLICABLE PEIiALTIES FOR IIOD?-COT'.PLIAITCE FIITH PEP.I"IT COT'DITIO;~IS. N ~ O C ~ ~ ~ 0 ~ J ~ ~ ~ ~ ~ - c ~'ao- ~ c~ ~ o ~ _ a i ~>~~~E _ ~ w °v; ~ 'o ~ ~~,~~.a~Q- ~ O ~ Q ~ N a. U ~ V o ~c~m~ s ~ ~~oY.,...o ~ ~ ~ ~ cE:~o~~' o occn o Z Uo~~~~ _ c i NW x ~d0 °c ~ ~ ~ o ~ N I- U ~ ~ ~ O ~ W V Z ~ o cts U ~ O ~ C ~ ~ V _ O C ~t-+ L ~.C ~ O i C C ~ ~ ~ ~ Q. ~ ~ ~ ~ .C ~ ~ ~ ~ ~ Z c a Q i. ~ Q (A ~ I ~ W ~ i W i 'Q a w j~y1 r BOARD OF HEALTH . ~.V.t ~c?-Sc~ 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM J/ ' TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY ~+~•y a+•-'~-~ TEL.: 765.1802 CALL ..??:?.-.°z3- t • • • • 11. , 19$g MAIL T0: Examined.. • Approved . 199. Permit No.j. ~.~9.< m~..-.-a...,..'.w;x-,~ ~,~1 Disapproved a/c ~ ~~,1°,1.~,r_~;1~ 91 ~ ~~g; ~~>:Pt. k9 Building Ins ector OWN Ur SOUT49UL0 .Na ( b P ) T APPLICATION FOR BUILDING PERMIT ' Date 15 . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 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 appiicable 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. 1_ H ~t ~..4:~ . (Sig~atu a of applicant, or name, if a corporanon) 3 2 ~ • CA wh"E•..~ 3a1 p. Sow~e~w,~'t'o n..... . - . (Mailing address of applicant) • State/ whether AAap//p~~licant is owne/r, `le^ssee, a4geQn~t,, architect, engineer, general contractor, electrician, plumber or builder. ~•,.y.4,..0.X ~.61'e~^4 ~"For.3.\.4~n:`Y:" Name of owner of premises ....~-~?~..~..?^.^.-~..L.,~v.~,n..!P!:. ~l1oq~;ho (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. a ? . Plumber's License No. ...1 :3.~?.'P . Electrician's License No. ...3.5''t° ~ Other Trade's License No. . 1. Location of land on which proposed work will be done . House Number Street Hamlet ~ County Tax Map No. 1000 Section 8 Block Lot . 'B: ' ' r Subdivisionl"~;Hors,..~i~iy:~;o~,r.c;9a.;lo..•S.w~;N.,-to:~~FiledMap No. ..!~o;~.-e....... Lot..`.'1........... • (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a.Existin use andoccu anc ~.`:`.~?`•''^~••`g~•••••••••••••••••.. ~`~ixte s.:: ylr4 ~ "~'t`td96 b. Intended use and occupancy ~',^w~°•- • ~q..,.,."•'•\~• •~y"~~'y?~ Ylrai~.9°l~ t,' +1'4'~ a~'! 3. Nature of work (check which applicable): New Building , , , Addition . , , Alteration , . Repair Ren4oval , Demolition , , .Other Work . (Description) 4. Estimated Cost °Lo, 0 00 Fee , . 'I (to be paid on filing this application) 5, If dwelling, number of dwelling units Number of dwelling units on each floor , . , , , , , , , , , If garage, number of cars ....i, ~ . . . . . . . . . . , , 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . _ Dimensions of existing structutes, if any: Front Rear Depth a . , , , , , , , , , , Height . Nu,nber of Stories ' Dimensions of same structure with alterations or additions: Front . . Rear i': Depth:- ..............,..Height.,-„ ,,,,.,,,,,,,,,,NumberofStories.- " 8. Dimensi~~'e~tinew construction: Front . 3 i: Rear . , 5 Depth ? $ Height , , . Number of Stories ~ 9. Size of lot: Front ...z5i ; , Rear ..$,~t\. ~ 5 . .Depth . . 10. Date of Purchase ..lp.~ Z1 ~ ,g`,? , , , , , , , , , ,Name of Former Owner S? s°"~t~ K~4:\:~ Dpr;~,n ;.;c~, 1 I. Zone or use district in which premises are situated Ai S ° ~ • 12. Does proposed construction violate any Zoning law, ordinance or regulation: . 4~1 Q . . . . . . . 13. Will lot be regraded ~ , , , .....Will excess fill be removed from premises: ~ No 14. Name of Owner ofpremisesa°1,yg~:~h9qS..~~.}~y,oAddress~t~~:-:~:-.p.~:t.!J~,...PhoneNo..y~~-°3?~ Name of Architect ......Address ........Phone No.. Name of Contractor ~:.~.~-~+.l~laHS~~ ~~c.; ,Address .Sn:':'~^'-.^;~~P:t?;^, , , , ,Phone No.?a3'°° °9 IS.Is this property looted within 300 feet of a tidal wetland? *YES....NO,..,.~ *If yes, Southold Town Trustees Permit may be required. ~ ~ PLOT DIAGRAM Locate cleazly 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'wheth~r interior or corner lot. , ~I .aft. ~ % ' li ~ ~ - ~ <; - tr . . i i , i STATE OF NEW YORK, COUNTY OF . . ~IS.S Ni~ ~of/individ~ i nG-sQ1v ~ ~ ~ ~ ' ' ' ' ' • being duly sworn, deposes and says that he is the applicant g ing contract) above named. ~ I [~~Ie~is~the , ......ll. i.t, xa .~~.5/•G~~.<~/.f:......... y. v. ,O, !?n e. s~ . r (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 work will be performed in the manner set forth in the application Cled therewith. ~ . ' Sworn to before me this ~uN~ ...........ra............day of'.... . . 19 Notary Public, S~ ~FoiG/C . . . . County ~7,, tIdMRY M" A~EW • • ' 'l/~G'`04-, .112. „rC/, lf-'~..""--.. TERM E~XWR'~SfEg~j i (Signature of applicant) -z r-.~ .#T r';".+e.-_.~-,':--•.•-nit. w'r' nr^.+~s'-':~ rn °;'T-: ~ r„~s ,1~•.3s..sw-;•aT--. "RF".~-0~°'~+c :r(;*^r"°'~i~F ^s°L°w - '"r'A'°-~. 3~ c ,:ac.'S~.; -t~„'k - t z k. i ' . n _ ! t ~ R 4. ~ e~ ~`j .t-...: . - ° 1 - ~ Y k 7 ~ ~ • ' 'H : - s'ue' s ~ < ~r'. rt W i i w a i _ f ~ ; _ • r ~ " 4 r L s ; ~ , - ~ ~ ~ K~ , r'~.cAS~ NOTE ~ ~ ~ ~ ~ * ~~eq.~ septic tank. ~ ,~-~~y ~ W~ tFr v`_'~ul 1 ~ m°47w .a PJ~as a. .,Y l~r~ :3 r. .hea _ ~ ~ J } ' n ' ~ ~ ~'4 y ~Yti i _ ~ - A, _ 1. \ ' c. ~ • ~ w / r I d r . ~ $~R1I'~:G~S -'#,~0~ Eat/ ~~1ti . 1 ~ ~ ~ _ ~ ' ~ ~ ~ ~ ~ ~A%66i3i EASE NOTFr ~~,,,,,yy~~y + , " ~ d. ~ ~ ~ L ~ ' ' ~ - tt e pplicant's responsibil;ty to d . , ' 'in to ade gate sa~7+tar distah~::a -'4 r i ~ Z , l~ ~ een ail ester Supply and sa~,~a~,a ~ ' ~ ' - sposal facitities.• 7 ~ _r Y rU - r - ,1 TT - - ~ ~ W .i .~,~p k 0 .x~ .(.~x, l 1 . ( , i i y v~ t t b •,4 tic ~ r - °a ' ~ "~F > c~ D r, 9u~ n • 'M t ~ ,r"~ ~ ~~Cir rn ti,~ ~i ' a ~ ~ y ~ twRut° h y i ~ ~ t1 ,~~.F~1~~1~I< ~f-+A Lf~. V E L. e z.. ~ ~Gr h a 5 ~tv - ° ~ a.. A rnit~ StsL° ~ . t~N - ~ x _ y ~ ~i*1 xeys ~s.r'g +~k''p r . _ . iRIME qA MMW - - - - _ _ _ _ _ - __„r ~,n~ t i _ ~ S1FFOLK CO. ~1'1f b~lT. Al ~ ~ ~ L . d ,,f H. f. NO. ~E z co~t~~i~ ~ { '~Fil4p+TQ ~ <esa - so- I ~ + \ ~ C" t~~ ~t. ~ . i'~-~~T~. THE ~fi4'i'ER ItMRL.Y Af~ilkl~WllflE Id- a~ s M ~ ' g~~ 9YSSEMi FOR TMIS 4l~E~lf~! 1IW1;.L MIBLL GCMIF'ORM TO TFf[ ST~ffOfARD6 OF 'kf~' \ _ y A ~ EttFEOLK ca. atPS. OF M/illl.Tld !R'iRVtCE'~. , 'p.-- PPtDa. w6t~L ' \ ~ . ; - K ~,{ti1V`~'Y #'~P'f. 1~ r Spit" ` M ~~~l~t@EE - FAR IYPPRd11F~'t~ DX' O / 3 ~IFFpLK CO. TAX M11k? 2 ~ ~ ~ ~ OIrST. 9[CT. ~.OCIC ~ Mitt.;; a ~ ~ d _.~fit'i. , . ~ b ' ~ t ~ ak ! n 1 ( - 4 j 1 i ~ 4 HI ~ vAT,?~+k th0 M0M'~f~t.~ r. 0 it 1i 7 ~ a t.~W cep J.'~ . J! ° z is , s,Mm `rea` n~p'`"x °auh~ ror s inaeq ~ ~ 7 ~ o i v' st .i whaA no[ b~p~ ~`O 2~ ~ ~ ahd truce cq~~. r v*~gg~ / ~ 'r .Han, ei6.e h"(~tu..1 . '1~ t ~ ~ t"' ~ t 9~'~xenbr;v.-hr~+tho l~ / r M ~~v mrt>~t~hsl ~uetxY B/I/ ,r ~ ~!il ~ ~ aen a ~tl 6r c'te anc'.ns n;& ~.s~ ~y Y~ Nipen CaO tirdh~ V'.Q~~ e, ( V ~ i ~ S~nr 9ut~uelt( ?ak~ k f G~'~.O D ~ F?fAk~ ArNl~'N.P~ - MAY 1~, IS~BS - • . , _ _ _ ~SIG.P3,1'~g - • I.~t~T'I~N~, l2EFEQ ~D ME1AN SEA L~V`L , ocwa ` `+a ° t . - 2. t5 Sj~Q4uthd @v5 I.QT~ QM~ MtW pF A N}tNOf~' SUt3C3tvt5t~N - ~ _ • e A ~ r a " °w ; MAD@. ErQFP ~?!5E"PH ~7f1+,FA Nf.TA1.ER. Fy ~ cszg6JB,Y OFD LANG rT'~k ~ `1 ~ ' SUFFOLK CO. HEALTH DEPT. APPROVAL ~C;^E~NEt. ~ ~ i NOEJSE UNDER CUNSTfz~ I i ~ !,88- _O-~SIo~ i n is i ~ au ~ ~ ~ ~ - t` N 59'33 ~U'E 27(3.2.7 STATEMENT OF INTENT t+ ~ ~ I ~ w, L) ~ ^1~~ ~ ~r 7f { T 4 THE WATER SUPPLY AND SEWAGE DISPOSAL 4 _ - _ - - SYSTEMS FOR THIS RESIDENCE WILL ~ DUI ~I l ~ .r., WE..L ; _ _ CONFORM TO THE STANDARDS OF THE tV I ~ N, ~ , L T N.DM ~ j SUFFOLK CO. DEPT. OF HEALTH SERVICES. I ISI j ~ o' ~Af3AT f _NO ~ APPLICANT 1 ~ AT SUFFOLK COUNTY DEPT. OF HEALTH ~ _ '"y' ,~,yELL ~ (f(E j' ! SERVICES FOR APPROVAL OF y I ~ ~ CONSTRUCTION ONLY 3 ~ ~ C1~} ___j'/"Y t l . N DATE: pr~ ~ ~ H. S. REF. NO. ~+7-SD~SS / ~ i APPROVED '1 ,Q~ f ~ ~ / a'r , J i ~ r~3~ ~ ~ - ~ p.. / SUFFOLK CO. TAX MAP DESIGNATION: ~~1 -`~I - ~ ~ 1 DIST. SECT. BLOCK PCL - ~ ; - ~ ~ OWNERS ADDRESS 3 i ~ .T~ 503 FG'a?*~ b DEED: L, ab~6 P.d n~~ R / Q~ f (2~/tV i~~ ~tw TEST HOL ~~s ArcEh 67 Ei38 S.F o c ~ , SUFFOU( COUNTY DEPARTMENT OF HEALTH SERVICES - ~ ~s- e - - ? ~ ~ SINGLE FAMILY DWEl11NG ONLY . ~ ~3 c _ ~ ? - J UN 0 1 1990 R 9-S'~ 5$ ropsoi ~ DATd H.S. REf. N0. M~ + The sewage disposal and water supply facilities far this ~ ` i; ~ location have been inspected by this Department and/or , . - other ag ~ies nd foggd to,he.Satisfap~gty. ~ L~f yi ~ q SZ , Chief o Bureau of Wastewater Management ~ _ r ~ I ~n , s ~ I`~jAl% Af~ l c I t"t: WI~a.Y 19 1 c ' ti.\ MAY 2211989 ~ ~ ' A1JG.23,1989 SEAL - i _ _ - - _ FEB. Z,1~ _ ;F y~ . I F;. t¢¢~~ ii GUAfWJTEED TQ 1~,lQC,~fyiA~tPTQN NATIOfvAL wATEI ~ P~K'y k\,` ' I E'IrVA fG+~ F~Ef t(G `v M(=A~; I ~ _ = E~_1 ~ 4.; :r'..-Lvo~~o I gMN1C f`tR DER CKIVAUY~~.C~~ c ~~oo~ a~~ '2~ ~ ;.ir1 - ~;~~'+r 1`., A' -a~ i iN Q ~~~r1 !t , i h„ ?~C .:~'tf~x :Z`S+P ~ ~ lS 6,~ro ~~~,9 _MAY_E. i~ ti IL ,w°,E i f~? ! L A HA i A e. ~ ~ . ! LICENSED LAND SWRVEYORS GREENP'ORT NEW YORK tuvmwier~ar roan - ~ _ Euilding Design by Acceptable Practii_e Part 5 hJew 4brk State Energy Conservation Cnnstructinn Coilc 4/1/87 Suffolk County 6000 Degree Days Minimum 7hermalPerforrnance Values ror f40N Electrical Heating Roof/ceiling ;:OSU R19 floor ASU R19 Exterior walls OS U R19 Glazing 58 U not to exceed 23% of gross wall) .Entrance door .40 U A~ OF Irf\ 5s MAS TA\ V G ? a~ `<t ~ ~ ~ ~ r t~ ~•Tt y ? ~3 ~ ~ t ~ , 4 ~aa F- - - '~I - ~ f I - ~ - ~ - Li.l = ~ J a - u lug ~ ~ iii ,i ' ~,:e? - F-I - - _ _ ~4~ T ~ - ' a ~ i 1 ~ ~5 ~ ~ ~ o ~J Q r ~ _ ~4 ~ ~ i f ~ A ~ z ^^o// N ~ 1 ~ L~~~ 1iiiLLLL . i- I ` I c = - M sGg ~Jw _ { ~ r _ ~Q ~ V ~ ~ ~ Q _n J F, I ~dt ~yi v~ h ~ c s _ J C G ' ' ~ ~ ° i f _ I I ~ - ` . ~ ~ ~ , p 4 j 7 ~ ~ a ~ „ i~ J ~ i~ U ~ - _ ~ V~ ~ C. lL .o - 5p W - Y ~ o~ 8Z ~ v . „z,v ~ ~ arc H ~ i ~ ~ tea $FxTh otJ 0 y v 0 ~ ~ ~ ~ ~ a• ~ J C a ~ II~y .n ~ _ M ~A w t Ii, Z~. 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