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Home My WebLink About17507-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 219165 Date JUNE 22, 1990 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property PIRATES COVE-INNER HARBOR FISHERS ISLAND House No. Street Hamlet County Tax Map No. 1000 Section 10 Block 11 Lot 1.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 29, 1988 pursuant to which Building Permit No. 175072 dated OCTOBER 6, 1488 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 - The certificate is issued to JOSEPH & LUCIA HENDERSON (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-119 JUNE 5 1990 UNDERWRITERS CERTIFICATE N0. N132211 MAY 31, 1990 PLUMBERS CERTIFICATION DATED TOM BUEHLER PLUMBING MAY 3, 1990 Btu dincj Inspec or Rev. 1/81 FO1Bafi NO. 8 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MU5T BE KEPT ON TI1E PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ G"17507 Z Date 19.CT.C~ Permission is hereby granted to: "Ull,+~.~..~...~...,..o.~.1~.11..~~ . ct premises lotated at ..../::*Z.::~~-~i.~~`~,.....1...0..'..If.-~....:.~'~.~~.s~Nts~ ~~~%'-~.........j...~..~............................. l"..~ ..1................/....................................................... Caunty Tax Map No. 1000 Section ....1. Bloyck .....,~.4...........pLot No....~F....~`.~,...... pursuant to application dated ....G~2 19~1,,,.~ and approved by the Building In7specto~~rjj. Fee $...7...1...~f...O.:l Building Inspector l Rev. 6/30/80 TEL. 7G5-1802 dSVF~~LS~C~r Town or sou~r~o~a j'%' ,'c OFFICE OF BUILDIPIG IN5PECI'OR ~ c-,''., ~,~r8 r„ P.O. BOX 728 ?it' 3 cb" cn ~ ~ ~ .,c TOWN HALL "p/~~ SOUTHULD, N.Y. 11971 , C E R T I F I CAT I O N Date Building Permits No. Owner ~1oS~~pdt >~P.v~/PVS~~ (please print) Plu^ zr l~~ue~/~~ ~~>~bin~cY (please print! I certify that the solder used in the water supply system contains less than 2/10 of l~ lead. _u 6.~t - (plumbez's signature) Sworn to before me this day of t ~ .q. 19~• (J Notary Pub~li/c , rotary Public, County ALLEN DUPON7 NOTARY PUBLIC R~yCOMAAISSION IXPIRES MARCH 31,1994 Form No. 6 TOWN OF SOUTHOLD ` ~ ~ ~ ~ ~ ~ a ~ f p~ :J;~ t i BUILDING DEPARTMENT a ~ , ~ J ~ ~ TOWN HALL ; s~ JUN I ~ ~ ; ' f ~ 765-1802 ~,J (Llt OWN OF 8~~ g APPLICATION FOR CERTIFICATE OF OCCUPA 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-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 2J10 of 19, 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: L• 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 - Residential $15.00, Commercial $15.00 Date SANE l`l`1D New Construction...'x........ Old Or Pre-existing Building Location of Property ii6ilSe No. Street (Hamlet Onwer or Owners of Property ~O~p~ ~ ~!~:~:~pt...N~Np~ {LBON • • • • • • • County Tax Map No 1000, Section..... `,~.....Block...•~ ~......•..Lot.....~.!..1•.~.......... Subdivision ....................................Filed Map............Lot...................... Permit No ................D~Jjate l,Of Permit................Applicant. `H,,~a/~ER''a.o N••••..-••• Health Dept. Approval. ~.ff.:.t.l.U ~..(~.......Underwriters Approval.~Y../..~~~.~ • ri'' . Planning Board Approval Request for: Temporary Certificate........... Final Certicate..~....... Fee Submitted: $ „25:00 • • • - • • • • • • • • , , ~ 3 `I ~ _ C'o z/I/G S' APPG ~ /may/ 9e :1ELD i!:SPLC+;iU7 ,DATE ~ OOMMENTS ro ~ ~ U( 1 . , ~ H _ - - H r'OUt1DATI0N ( 1st ) N ~ x ~ r'OUNDATION (2nd) - ~ d 2. 02. ~ • L ~ ROUGH FRAME & A R PLUMBING Z ~ n c H 70 ~ ~ 4 3 . ca IIJSULATIOP7 PER N. Y, ' ~ ~ STATE ENERGY Z'1 CODE ~ NN T ._1 ~ .mv 4 . 1~ FIidAL I/ o z rh ADDITIONAL C E S: x or ~ x H q H O z ~ ~ A 4 r H x e ~ m ti H \Q t ~ --~.~,a,,,,~.~~.°.-.nom A,:~ ~ ~ii~,~~ sr~ _ _ - ~~Ty. ter°~hsi t~:r~`trao-°a~ ................................~3~~i~r~,.,,............,,..,,....,...,,......,,~°9~~raiw~q k$r-. C:rar t Flarr~~tc~ra B~uitriint~ 8rr~tr~s~~r~r' ~~soar~ rra~ ~a~rsth~als~ i~aa5arr Ft~#b ~a~stl-s¢~Nctx ~@ar l1~`~~ C9~~r" Fir°. #-l~sev_ t~arr° Erea~ls~~e~ ~r~~~ fitar~~: Yr:$u ~f r-~~i~~~~t r3s,~~~osr~~3 ~strz:~$s d `i~ #zsc~ ~1~~ FI~h~C9Ck~C9~d N-i~~~E aax ~"a~P~s°a~:~ i:~~as-~r~. ~h~ r~°~i~arxaZ~ ~e~~e ~lu~ `t±s c.3a~rte~iss€~ fitr~ ~crtrn~i~ t i~rr~ B r-cassa rr~~arr~e~ t~ ~a~rs~~ ter p~a~r~d ~:a~r~ti:e~s~ta~, ~l~~~q ~rl~~ irsr;~r-•p~sr~~r#~ ~ral~rr-~~irrg tta~ C~a~rs~rra~r~~t ~tr,:rc:r~ rrrra~~s-- tk~~ rre~s~~~r, tsrarir~r~a~x~a t#ws~ krs ~i~.e~ r::ryfiYa~i$9~3ri~. S='i~:~?~a< r ~sa`t i-rr:~,it t~ r~a~! a$ flh~s,rs ~r_~; i~~-st~ s~a.~~~#icaar~. snrc~r~ lG~: araro~~ ~lr-rr~ ~~-arler ~mea ~9i-°"~i~~ °~t9"~'^4 i TEL. 765-1802 pS~~F~~Cp TOWN OF SOUTHOLD Z ~ OFFICE OF BUILDING INSPECTOR ' ' L P.O. BOX 728 TOWN BALL ~ • " 'YO 50UTHOLD,N.Y.lly71 ~Ypl ~ y`a n V ~ 8L 6. EPT. '(OWN OF SOll7HOLD July 22, 1988 To: Hoard Of Trustees From: Victor Lessard, Executive Administrator Re: Joseph Henderson Proposal F.I.D.C.O. Road, Fisher's Island, N. Y. (S. C.T.M. No. 1000-10-11-1.2) This office finds no evidence of a legal subdivision through the town on the above referenced property. ~c~ u~. ~ n..l rre- c.c. Zoning Hoard of Appeals Planning aos¢p~t. W. 3{ender5on P.O. 673 f'%shers 'LsLand, New LJorfi 0390 t~t¢pkane: 5 L 6-788-7613 Mr. Curt Horton Town of Southold Building Department Town Hall Southold, N.Y. 11971 August 27, 1988 Dear Curt: Thank you for helping expedite this. i am nervous about not being able to enclose the house this fall, and thus not being able to have work proceed during the winter. So, your help is greatly appreciated. Enclosed are three sets of plans, a building permit application signed by my wife, the owner, and a blank check for the fee. As you can see, the lot, and its neighboring lat which we also own, doesn't easily fit the rectangular front yard, side yard definitions of the code. The nearest road is very far away, as is the only neighbor, The shore has many shad trees which we would like to save, It also has a fairly steep incline. Our objective is siting and designing the house has been to work with the site to minimize disruption to the site habitat. We are trying to keep the house as far back from the water as possible. We have also tried to minimize the amount of dirt to be moved. These objectives are in keeping with Southold Town's and DEC's interest in minimizing disruption of the shoreline. I will call you on Monday to see that you received this package. I would then like to either show you the site in person, if you are on Fishers next week, or have a conference Gail with the architect to get your thoughts. Thank you, oc~~EFOIKCOG VICTOR LESSARD ~ ~ Town Hall, 53095 Main Road PRINCIPAL BUILDING INSPECTOR = = P.O. Box 1179 Is16) yes-1802 ~ ~ Southold, New York 1 197 ] PAX (516) 765-1823 ~ 7~0~ y OFFICE OF BUILD*ING INSPECTOR TOWN OF SOUTHOLD May 22, 1990 Charles Brigham Suffolk Co Dept. of Health County Center, Riverhead, N.Y. 11901 Dear Charlie: Enclosed please find papers on the Henderson job on Fishers Island. This is the job Clarence Dixon looked at but he died before signing the papers. Bobby Wall has now checked the job out. Please return the necessary signed maps to me as soon as possible. Thanks again. Yours truly, Curtis W. Horton CWH:hkd Senior Building Inspector p.s. Let me know when you want to take a trip over there. J.M.O. CONSU~TINCi box 361 • NORTIi COUNTRY ROAd WAdINC~ RIVERS N.Y. ~ ~ 792 (516) 929.3575 TEIEFAX (5 ~ 6) 929.5621 September 30, 1988 /p DCT - 4 ~ Gf Town of Southold gpyUN~~ . pipT Building Department 50U7yp~D Main Road Southold, N.Y. 11971 Attn: Mr. Curt Horton Re: Suffolk County Health Department Henderson - Fishers Island Dear Mr. Horton: Enclosed please find 1 copy of the approval from the Suffolk County Department of Health Services. If you have any questions, please feel free to contact this office at your convenience. Very truly you s, r Glenn E. Just '-7-~ G' GEJ/te E n" 1 i L' / ~ ' / C ~ ,!I. ~.arry Penny/John Aldred nvironmental Consultants o Fisher's Island for TOWN OPSOtR lOLO out hold Town Board 453 Noyac Road Sag Harbor, N.Y. 11963 Mr. Frank A. Kujawski, Jr. President Board of Town Trustees Attn: Joseph.Henderson Proposal Town of Southold F.I.D.C.0. Road, Fisher's Is1a~d,N.Y. Town Hall, 53095 Main Road P.0. Box 728 (S.C.T.M. No. 1000-10-11-1.2) Southold, N.Y. 11971 Dear Mr. Kujawski This parcel was inspected on tcao occasions, the last time occurring when there was foliage on the trees. Because of the steepness of the slope where it enters the waters of Inner Bay, and because the soils are relatively well drained, the wetland vegetation is confined to the very bottom of the bank save for occasional outliers. Taking a cautious and conservative view it is our view that the wetland vegetation is confined to below the 6' contour line. Consequently, the proposed building in all places is more than 75' back from the wetlands according to measurements made on the Richard Strouse survey for the site dated 26 of May, 1988. Thus it would appear that the project structure is outside the jurisdiction of the wetland permit your Board administers under the Town code. However, we find that the proposed additional contours requiring fill and/or regrading on the site northeast side (see above survey) intrude upon the 75' separation between edge of work site and wetland, said work seemingly requiring the permit. It may be possible for the applicant to ' limit this site regrading such that the part of the parcel to be disturbed is at all points at least 75' from the wetland edge. (We should remind the Board that in the majority of cases, the proposal of Pir. Henderson would not require a N.Y.State DEC tidal wetlands permit in that all of it is well above the 10-foot contour line.) In any event, we would recommend that 'a project limiting fence (i.e., snow fence)and staked hay bales be employed around the perimeter of the work site such that sediments are not washed from the site into the jurisdictional area and into the waters of Inner Bay during the work phase of the project. Should you require any more information with respect to this proposal please don't hesitate to get in touch with us. Sincerely, Larry Penny v~ "7 ii 7L ~ ' ~ ~ S~FFOt,~~o~ FRANK A. KUJAWSKI, JR., President ~ ~ TELEPHONE ALBERT J. KRUPSKI, JR., Vice-President ~ ~ ~\V($}~ 2 JOHN M. BREDEMEYER, III ~Oy ~ ~ D i !`s' HENRY P. SMITH KI JR ~O~ ~ ~~O ~ ~ ~ ~ ' i 1988 lIJ BOARD OF TOWN 1'RU5TEES TOWN OF SOUTHOLD TOWN pF SOU11iOtp Town Hall, 53095 Main Road P.O. Box 728 ' Southold, New York 11971 July 26, 1988 Mr. Glenn E. Just J.M.O. Consulting North Country road Box 361 Wading River, New York 11792 Re: 1000-10-11-1.2 Dear Mr. Just: Pursuant to the request made by Mr. Joseph Henderson for a determination of jurisdiction for the above property, please be advised that this matter has been reviewed and it has been determined that as proposed the work will be out of the Trustees jurisdiction as long as all work is kept 75` back from the tidal wetlands and that a snow fence and staked hay bales are to be employed around the perimeter of the work site to prevent any leaching of sediments into the wetlands. Please be advised that this determination is not meant to be a determination that this property is an approved building lot. (See attachment from the Bldg. Dept.) We would suggest that you contact that Department at the earliest possible date regarding this property. Should you have any further questions, please contact this office at 765-1892. Very truly your , Frank A. K 'awski, Jr. President Board of Town Trustees FAK:ip cc: Bldg. Dept. l~ew York State Department of Environmental Conservation v Regulatory Affairs Unit D ~ ~ 'v° _ Bldg. 40, SUNY, Rm. 219 a' Stony Brook, NY 11794 '(homasGJorlTng ~ t Commissloner (516) 751-7900 KI_::~ BLDG. DEPT. 'POWt3 DF SOUTW(~l.D ~ July 21, 1988 Lucia Bosque Henderson sss\ P.O.Box 673 Fishers Island, NY 06390 s i i i Re: Permit /110-87-1882 i Dear Ms.Henderson: 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 i above address. i Also enclosed is a permit sign which is Co be conspicuously posted) at the project site and protected from the weather. i J Very truly yours, ' - - ' 1 ~ti~~ Q New York State Department of Environmental Conservation 1 RECEIPT i~ i r 1 LION NO. __1___ DATE 7'I CATION • DIVISION ~ IZ.(~ --1-~ ~EIVEDOF Qn L R• lye,Dll.. rHEAfv1OUNTOF - Tar) $ ~ - ~a -rr,~l H DEpP.ARTMENT REPRESENTATIVE CK L7 NUMBER a31gOy~-' TITLE /e dEY ORDER ? ~ i43Htn 10-87-1882_x' 7/21/88 e FACILITYIPROGRAM NUMBERIs) PERMIT EXPIRATION DATE(s) ~ Under the Environmental Conservation Law NIA 7/3I/93 S 328c1329: Aquat c Pes I ides327, ~ Wat r OualOity~ Certification ~ Tidal We lands P otelctlon of itWat ~r ~ SPDES 17' Titles 7, 8; ~ Solid WasteTiManageme tRR 380: t: WatetrSUSppiyUa 15: ~ AUIpollu0on Control' ~ Hazardous Wafste~M nagement3~ WaterTran poet15~ ~ Mlneid Land IAeclamation ~ Coastal Erosion Management J Long !stand IWeiisS~ ~ Freishwater Wetlands ~ F ocdpla Management Arilcle 15, Title 27: N-New, R-Renewal, M-Moditication, ~ Articles 1, 3, 17, 19, 27, 37; Wild, Scenic and Recreatlonaf C-Construct ("only), 0-Operate ('only) BNYCRR 380: Radiation Control Rivers f{, PERMIT ISSUED TO 4 Lucia Bosque Henderson [k ADDRESS OF PERMITtEE ~ Y P.O.Box 673, Fishers Island, NY 06390 X( AGENT FOR PERMI7TEEICONTACT PERSON TELEPHONE NUMBER I J.M.O. Consulting (Glenn Just) (516 929-3575 NAME AND ADDRESS OF PR0IECTIFAtltITY pf different from Pmmitt¢e1 ~ Peninsula Point -Inner Harbor ~ LOCATION bF PROJECT/FACILITY COUNTY TOW N/Cngj64@L7EOJE UTM COORDINATES Fishers Island Suffolk Southold DESCRIPTION OF AUTHORIZED AC71VI7Y Construct single family dwelling; sanitary system location as ro osed is landward ' of tidal wetlands jurisdiction and therefore does not require a ermit. GENERAL CONbITIONS / sy acceptance of this permit, the permittee agrees that the permit is contingent upon atricl compli- ' once with the ECL, all applicable regulations and the conditions specified herein or attached hereto. 1. The permittee shalt file in the o7fi<eof the appropriate regional permit administrator, or other office designated in th¢special condilions,anotice of intention to commence work at least 48 hours in advance of the time of commencement and shall also notify himlher 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 Conservation which may order the work suspended if the public Interest so requires pursuant to ECL §71-0301 and SAPA 4407(3). 3. The permittee has accepted expressly, by the execution of the application, the lull legal responsibility for all damages, director Indirect, of whatever nature, and by whomever i suffered, arising out of the protect described hereto and has agreed to indemnity and save harmless the Slate from sulfa, actions, damages and costs of every name and descrip• tion resulting from the said project. 4 The Department reserves the right to modify, suspend or revoke this permit at any Ume after due notice, and, if requested, hold a hearing when. a) the scope of the protect 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 misr¢presentation or failure to disclose relevant facts; or d newly discovered fnformatfon or significant physical changes are discovered zinc¢ the permit was Issued. 5. The permittee is responsible for keeping the permit active by submitting a renewal application, including any forms, lees or supplemental information which may be required by the Department, no later than 30 days D80 days for SPDES or Solid or Hazarduous Waste Management permits) prior to the expiration date. b. 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 perform the permitted work or as authorizing the Impairment of any rights, title or Interest In real or personal property held or vested in a person not a party to the permit. 7. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-oE-way wfiich may be required for this project. B. Issuance of this permit by the Department does not, unless expressly provided for, modify, supersede or rescind an order on consent or determination by the Commissioner Issued heretofore by the bepartment or any of the terms, conditions, or requirements contained in such order or determination. 9. Any modification of this permit granted by the Department must be in writing and attached hereto. PER ~/21U~BNBCE DATE NISTRATOR ADDRESS Bldg, 40, SiTNY,Rm, 219 bert A. Greene Ston Brook NY 11794 AUTHORIZED SIGNATURE Page 1 of 3 cc: BMHP 95-10ba 11186)-25c ADDITIONAL,CENERAL CONDITIONS FOR ARTICLES 1S (title P), 24, 25, 14, 36 and 6 NYCRR Part 606 ( ) 10. That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the ' teration in the posit(on of the structure or work herein authorized, or project. if, in the opinion 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 yr 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 wftfiout expense to the State, and if, upon the expiratlon or herein authorized. revocation of this permit, the structure, fill, excavation, or other 16. If upon the expiratlon 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 pieced, 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 suds time and manner as the Department of Environmental pepartment 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 yr 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 whicfi maybe caused 18, If 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 protect will not conservation yr 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 12. 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 obtafnfng any other permission, consent or approval from 1g, qll 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 Such approved plans were prepared by Richard M. of any wetland or waterway by suspended solids, sediments, fuels, solvents,lubricants, epoxy coatings, paints, concrete,leachateorany Strouae,L.S. on 1/13/88 reVl~ed 5/26/88 SPECIAL CONDITIONS 1, There shall be no disturbance to topography or vegetation seaward o£ elevation 30 and 24 as shown on plan highlighted in yellow. 2. Aaybales shall be installed and staked along buffer zone on the landward side of yellow highlighted area on plan. ' Supplementary Special Conditions (A) through (J) attached. DEC PERMIT NUMBER 10-87-1882 PROGRAMIFACILITY NUMBER ' NIA ~ Page _2_ of __3.__ r--- ~ ' . ;l * SUPPLEMENTARY SPECIAL CONDITIONS' ~ ~ i / ~ Ac The .following conditions apply to all permits: we ya A. If any of the permit conditions are unclear the permittee shall con- ~ P a tact the Division of Regulatory Affairs at the address and telephone ~ noted below. .y i a ,B. A copy of this permit or approval and supplementary bonditions shall be avaiiable at the project site whenever authorized work is in progress. n~ 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. a 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. ~ OF E. For projects involving activities to be accomplished over a period of % i OU more than one year, the permittee shall notify the Regional Permit J) Administrator in writing at least 48 hours prior to the commencement ~I of resumption of work each year. ~ i F. If project design modifications take place after permit issuance, the f'~ ~ permittee shall submit the appropriate plan changes for approval by NU the Regional Permit Administrator prior to undertaking any such modi- RD 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 i any other environmentally deleterious materials associated with the project work. H. Any failure to comply precisely with all of the terms and conditions '~l 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 ~ /~i be required from the U.S. Department of Army Corps of Engineers, NY ~ Di~'.~ict, 26 Federal Plaza, New York, NY 10278, (Attention: Regulatory ~ FUni:~lOnS Branch), prior to commencement of work authorized herein. J. The granting of this 'permit does not relieve the permittee of the _tI responsibility'of obtaining a grant, easement, or other necessary - approval from the Division of Land Utilization, Office of General Services ,..TOwex Building, Empire State Plaza, Albany, NY 12242, which may be required for any encroachment upon State-owned lands underwater. -z,~ '~c ~ Regional Permit Administrator _ NYS,Depts of Environmental Conservation - Bldg. 90;"`SUNY-Room 219 ~ tS~, Stony Brook, NY 11794 ~ I~ (516) 751-7900 t 4~. ~ ~ ~ ~ ~1~ DEC ~ 10-87-1882 ~ ~ ,i' ~ Y~, ~ ._...'r' ~ t~' Page 3 of 9 ~ - L', ; !a L b 3 G G ~ ,S~ 7 J O ~ ~ ~ c cn ~ -a p. ~ .E ~cE~. G Nor`a`~~= a. .`c~c~o~ E t~S U a~ m o cU a" a N GU,~ «S ~ ~ O L.. x ~ a~i cs U ZcLL'3~°~ z N O a? G ~ N ~ tU G O O N j"i1~ ~ O N ~ c tn' N ~ ~ ~ ~ ' Cy03- ? '.N'c O ~ E. v -c= -n v, 0 0 ~ ~ CLOG C ~ ~ 1T z 7" 7 O U~ Q Sj, . F N111 W ~O~sO?o' O c~ U G U V ~ 'fir ,r•.. C N, ~ O rc4 O G ~ ~N N 3 m m c6 C G A O 't7 3 ~ o CCS p 3 ~s fl' -~o ~ Z ~L N ti- ~ O N..~- ,x ~ ~ ~ o p Q D ~ w a x .y~ ~'f,f • • " CNARLE6 T. HAt4ILTON '~~~'N;;~u, ~ Ch1~f, NAItI1dE REGULATORY SECTIOCT ~ ~t~ ' ~~"•'''"r NY5 DEC, Bureau of tlarine habitat Protection Bldg. 40, SUNY, Rm. 225 ~ Stony Brook, N. Y. 11794 'f• f ~~~yg ;r.rt~~ff, ~ Ra: Permit IIo. " ` - ' Issued To. .il+';. .3A~~ Contractor a Add~reae. ~ - ~ ~ Contractor a Phone { Dear Sir: Contractor's Name Pursuant to General Condition t1o. 1 of the above referenced permit you i • era hereby notified that the authorized activity shall commence on . This tlotice is to be giant at least two day» iu vance of cov~encement of the project. The Permit sign evill be poat:nd at ~ the site and copy of Permit will be available at site for inspection. ;G1O Submitted by ECEI Ynie.tlr,E TO CIOTIFY OR POST SIGtI LULL LEAVE OSR~tER jAtiD/OR COIITRACTOIt SUB ~ NT ' JECT TO APYl.ICABLE PECIALTIES FOR NOCI-COPIPLIANCE NITtI PERti1T COIIDITIOI'S. 'rOR ~I { ~ ~ } , • ' X ~ CHAPyE6 T. t1A11ILTOCI l`'1,k ~ ~ Chief, Marine Regulatorq Section ~ IIYS DEC, Bureau of Marina Habitat Protection r ~ A Bldg. 40, SUtIY, Rm. 225 , s ~ ~ 6tony Brook, N. Y. 11794 i ~ ~ Res Permit Ilo. j Issued To. Contractor eAddress. - i I ? ~ Contractor s Phone ~ 1 Dear Sir: ~ Contractor's flame / Yursuant to Genetal Condition No. 1 of the above referenced Permit, you _ I are hereby notified that the authorized activity eves completed on i 6ubmitted by a :t;+; ~ DATE: r' THIS t10TICE, WITFI PICOTOS OF COCO`LETED 410RR AND (OR GOt1PLETED SUP.VEY, IS i ' TO BE SE41T TO ABOVE ADDRESS PROCB'TLY UPOtI COI'•II'LETIOt1 OF PROJECT. FAILURE TO NOTIFY ll1LL LEAVE 04IItER AC'.D/OR COCTTRACTOF. SUBJECT TO APPLICABLE at P_EIIALTLES FOR CIOt4-COtB?LIAt1CE WITH YEPJIIT CONDITIONS., i v 33 ~ 3 lid ~t~ ~ - 1 ~ ~t ~t= ~:33' ~ ~ ~ ~ ~ ~d ~ / ~l} ~.y. - - ' X I 'r' 71' ~ 3' ~~vw ~ ~~y..~. ,y ~ I 5 3 ~ .fit x ~a ~ - ` , _ ~-f o ~ ~ 3 ~ a ~ ~ . b ~:x~ ` . THE NEW YORK BOARD OF FIRE UMDERWRITER~ FA(;F 1 1r235U1i' BUREAU OF ELECTRICITY 83 JOHN STREET. NEW YORK, NEW YORK 10038 I Date MAY 31,199D APPlicationNo.onfile 6'l4?2A89/N9 N 13'I`I13 THIS CERTIFIES THAT only the alectrlcal equipment a described below and introduced 6y tAs eppGcent nerved on the obooe opplicotion number in the premieee of Iu5t: F'H Hk NDERSUN, F'RTVA7E ROAR, F13Ht'.RS TSLaNp, N. Y. in the following location; ® Basement ® /At Fl. ®Pnd Fl. A T 17 f ~ UI17 Section Bloek Lot wos a:omined un N A 1 O S , S y 91l and found to 6e in compliance with the requirements of thu Board. NXIURR AglS SWIiC11K RXTURfS RANOK COOKING DKCIIf OVEVS qSN WANINS MAUST MNS OUTIRTS INfiWDESCFNT FlefM1ESCEM OTHEfl AMT. K. W. AMT. N. W. AMT. K.W. AMT. K. W. AMT. N. P. t)6 )21 105tf & 1 lfi.b 1 1.? 9 F' DRYlRS RJRNACR MOTORS IVTUK! AMtIANq IRRORRS SflgAI RRCfT TIMl CLOCKS pLL UNIT NRATRRS ~T~ OIh1M[!S AMT. K. W. dl N. P. GAS M. P. AMT. N0. A. W.O. AMT. AMP. AMT. AMPS. TRANS. AMT. N. P. ~ INT AMi. WA115 ~ F' 1 so -r eon SRRVKR DISCONNlCT NO.tN S ! R V 1 C E AMT. AAV. tTPE ~ 1 w tw i w Sw 3 w SW 3 w AW NO' PER 1COND, aP CC ~ a+D. ~ N4lEG Os M0. OP NEUT11ALi Oi 'NWt11flAl ) 26U C.8 1 X 1 ilU 1 3/Q OTNKR AMPARATUS: 5 ION AIC I1NIT-1 NU'fURS: i-. 5U H. P.,2-. 75 H.N. EAIV F.LP~OARUS: 1-39 CTR. 20C),1-14 CTR. 2C)I9 .F.(:_I:-1:S E_ .['o'~ WAL:>H SERVTf,p; L.TC.M926F NUNTAUK AVF. FISHERS 1S'LAND, NY, i)63Y0 Ol~ALMAIIMi~ i1 R Per This,cerfiiicab must not be altered in atry manner; rNurn to fhe office of fM Board if incorrM.: Mspactors bs ideMifisd by •tMir credeMah. COP1f ~INNLDINf DE NOT 6E ALTERED IN MAINER. i_ ` ~ BOARD OF HEALTH , 3 SETS OF PLANS FORMN0.1 SURVEY TOWN OFSOUTHOLD CHECK ~Q BUILDING DEPARTMENT SEPTIC FORM ' TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765.1802 CALL ./J/ ~ r, MAIL T0: Examined . ( • • , 19l~~ - Approved~~.~.~......, 19CY~. Permit No..~./-.~/..Q./G-- ~ Disapproved a/c . • • • . • 'rKCr BLDG. DEPT. . pfj~p• ~ OF SOt1Tt{OLO (Buildin~g''ZZI~~n~spector) ' APPLICATION FOR BUILDING PERMIT Date f? ~ 19~ 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 commence before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wilissued 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 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 inspec tons. 06` ~ 1?,~fZ`;-t-~/,~tv~ ,t,~j o (Signature of applicant, or name, if a corporatton) YVAS~<-.~~>o~i, j~.f. ,/~d•6~3, 1~Z3rfB~s.~sc~~v /2!Y a2 oUO (Mailing address of applicant) ~S~f'® fa: .to 2 - N-Bs- z885 ~«z: :rib - ~~k - g~i3 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ t'1//?/J 2.........../............/ . Name of owner of premises .....~^F!Gy:`~..~?~ "ADC=25onr (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 . . 'Plumber's License No. „Electrician's License No. ..C~. ay• V ' Other Trade's License No . . I. Location of land on which proposed work will be done. /~;7"eS L "~'~'30K- - House Number Street Hamlet County Tax Map No. 1000 Section ~ ~ Block ~r Lot Z; Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises an~d/intended use and occupancy of proposed construction: a. Existing use and occupancy t' G.~? N j L F,+N> . b. Intended use and occupancy S` ~v~cc-~ `~~"`~Y /~o~s~y ~ i i N w 3. Nature of work (check which applicable): New Building Addition Alteration . epair , , • f Val Demolition ~ Other Work . emo * 4. Estimated Cost r ~ (Description) ,~po ioao Fce.....~~.I•r.a~ g g I (to be paid on filing this application) - 5. If dwellin number of dwellin units Number of dwelling units on each floor . . . If garage, number of cars ~ 6. If busi[tessreer~Y c e upancy, specify nature and extent of each type of use . . 7. Dimerisi~Ps~f ~Xjs - any: Front . . . ....'Rear Depth , , , , , , , , , , , Gip,=1 ~ t. . Hc1 ht 1 fStorics • terations or additions: Front Rear . , , , , , , , . DD pth sJO'ys+o............ w I fight . Number of Stories , . ' 8. Dimens~ions~pf en(Jre n~}v Gonst cti :Front Rear ............Depth . eight ~....~.;rT.r:~.!,•,.. 9. Size of IotrFront , I f Stories . . . 10. Date of Purchase , ,C7~~?y3~??, • • ~ ~ • ' : Rear Depth . • ,(9, ~?b' ..Name of Former Owner . ~r,!-6-~~`?:. . 11.' Zone or use district in which premises are situated . . . . 12.' Does proposed construction viol~~e any zoning law, ordinance or regulation: , . ~O........... . i3., Will lot be regraded I ~~5 . . .Will excess fill be removed from premises: Yes o 14. Name of Owner of premises .~.v. q,!!i~:?~~?-•s@y, Address S~~ ..Phone No.~~'~":~'3'2t•.~ . Name of Architect ~tfc^.~ ,'~!~n: o~a,SpN. , , , , , , , Address a 3>~?-~F^:~ P<; ire., ,Phone Nod!?.:?Pz.:~(~,rf, , Name of Contractor , it.~. 2 ! . ..........Address !"~si!~+s ,Phone Nosi6; ad; d's 7?- IS,.Ts this property located within 300 feet of a tidal wetland? *YES.x..NO.... *If yes, Southold Towrv,Trustees Permit may be required. PLOT DIAGRAM i Locate cleazly and distinctly all I~buildings, whether existing or pro osed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to eed, and show street names and indicate whether interior or corner lot. j/~,5~ F~or~ ~~.v-.zit. ~I ~L rat=~2.~, o~-T /d-PF~+-d v~ I II I STATE OF NEB YORK, I~ COUNTY OF . ~?4t f~'P.I,~.... , , . 5'S I .....h: f ~ Name of individual s gni ~ ~ ~ ~ • ' ' ' ' ' ' • • ~ • being duly sworn, deposes and says that he is the applicant ng contract) above named. i Ca?i~•ruc'~-oY Helsthe ......................i..... (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 ltis knowledge and belief; and that the work will be performed in the manner` set forth in the application filed therewith. Sworn To before me this ~ .........day of'i ,(rc;~~,-gtiP.~......., 19SX Note Public, ~ , ~ rY ~--A-~... ,~r~ County 05 v S3NId%3 NOISSIWWO:I E ~a~ AINNOJ N10dd05 05b137,8•t5 'O~i j (Signa[ure of applicant) 1~1'OA M3N d0 3JHLS '01'1804 A1ld!"4 I _ r31A~"'lvP1'.~,~. 'f" J~Z~H~S I