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17250-z
FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-18412 Date SEPTEMBER 26, 1989 THIS CERTIFIES that the building ONE FAMILY DWELLING Location of Property 40100 MAIN ROAD PECONIC N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 86 Block 4 Lot 1.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 2, 1988 pursuant to which Building Permit No. 17250-Z dated JULY 26, 1988 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 JEFFREY & CYNTHIA OVSIANIK (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 88-SO-92-SEPT. 22 1989 UNDERWRITERS CERTIFICATE N0. N-061139-MARCH 2 1989 PLUMBERS CERTIFICATION DATED JULY 7 1989- JEFFREY OVSIANIK uilding Inspector Rev. 1/81 F013M NO. A TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF 7HE WORK AUTHORIZED) N~ Q 17 2 5 Q Z Dote .,.r~`~...~~ 19~~ Permission is hereby granted tt~o: ......r~.. to .fin. ~/.•`.~,~~n~°G.~'.~...~.....~1frc... . ~C.l~... ..~?yl.....1~, . ct premises located at ..'r~C..Cl/.C?..<.7........~...~~ r~~...~~.......................................................................................... County Tax Map No. 1000 Section ....,.~:~a....... Block Lot No.....,<..e..~..... pursuant to application doted .........7~.~ 19 and approved by the Building Inspector./~ Fee $...il.~:l..l.!... ~Buil g Inspector Rev. 6/30/80 k_ _ ~ ' 6z, TOWN OF SOUTIIOLD cf6/oD ~'w''~- ' ` r q c` BUILDING DEPART2IENT SLP `Y TOWN HALL ~ SOUTIIOLD, NEW YORK 11971 ~ 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE NEW CONSTRUCTION .,.?.....OLD OR PRE-E%ISTING BUILDING......VACANT LAND........ ~{;0 I c7 0 ~ CI.~~C! !Z GQ. ~ ~ Location of Property.. e~~~ U,..,... HOUSE N0. STREET HAMLET Owner or Owners of Property.S~~~'U ~~««V "{J,~~~'~/!-~~(..IY~V.s{(.t;l,~:t~t! County Taa Map No. 1000 Section ..4!~. Block Lot , , F Subdivision..E~~~': ~1~.~4??~:. Filed Map .~~.`T ~Lot...:~ D1,,7~,,~-~~~ppp~5/0~7 V ~ Permit No. ':'~~F~~!`:.Date of Permit .7~y~1~8.Applicant ~ A-LL_1Y'!d~!~~-~~"° Health Dept. Approval Underwriters Approval.............. Planning Board Approval Request for Temporary Certificate Final Certificate Fee Submitted: $ o e s/ ~ ~ APPLICANT . . . (~~~~.~7~,~~Cl-!!4a/`.i C o ? 841 ~ rev. 10/14/88 THE NEW YORK OARD F FIRE UNDERWRITERS PasE 1 B O 1425023 BUREAU OF 8LlCTRIGITY 88 JOHN STREET. NEW YORK. NEW YORK 10038 Date MARCH 02,1989 gpppcottonNo.onjtle 37b38588/88 N 461134 THIS CCRTIFIES THAT only the elactricd equipment a. deurihed he/oto and introduced 6y the applicant named on the o6ooe applteatton number in the prerateea of OVSCANTK, 40-100 5. MAIN ROAD, PEiiONIC, N.Y. in thefdbletnR location; ®Baeement ® Ixt Fl. ®Pnd NT. Sertion Block lot met eiemined on FEBRUARY 17,1989 andfound to 6e in compliance with the reyutrementa of this Buord. RXTURR RX RANDlS COOKING DICKS OVENS DISH INASMlRS OfNAUST FANS twTIRTF AgES SWITCNK INCANLeSCEM PlUORESCEN7 DINER AMT. K. W. NAT. N. W. AMT. K.W. AMT: K. W. AMT. H.I. 38 34 32 3B 1 1.2 2 F DRY95 FURNACE MOTORS FUTUK ANMIANq REMK SNK:IAL RlCFT TIMRCIOCKS Rµi UNIT NEATlK MWi1.O11TIRT DIMMERS AMT. K. W. pl N. r. OAS N. r. NAT. NO. A. W. G. AMT. AMr. M1T. Nnr3. TRANS. AMT. N. r. SYSTRA1f AMT. WAITS NO.OF R!T 2 F 1 SBiVIQ OgCONNRCT NO.01 S E R V 1 C E AMT. AAV. T11t R., 1 / tV/ 1 J TV 3 / t\4 ] X AW ~ER ICOND. OF [C. CD D. NO. Of N4lEG Of' µ NO.Or NEUTKAl3 q ',~U1GIUl i 150 CF i r 1 <<"JO 1 210 OINK AFFARATtIi: fEEDERSil-2 M 12 BASEMENT TO 2NU fLOtIR FEEUERSti-3 4 t4 BASEMENT fO ?NU FLOOR 3. F. C. [1-2 SMOKE BETECTORt-1 y HANK'5 ELECTRIC LIC.N2b75 E - 121 SHEEP PASTURE RU SETAUKET, NY, 11733 11 Psr This artificaN tnUM eat be alNred in any manner; return to tM offiu d the fbard if incorrsd. Inspectors may bs ideMiHad by Moir cretMMals. .DOPY POR EUILDINO DEPARTMEIIT. THIS COPY OF CERTIFICATE WtT NIGT EE ALTERED I!l ~+tr-AAA`-°~ TEL. 765-1802 0 SUFF~L/t-c0~ TOWN OF SO'UTIIOb,~J --~N~- _ . ~ r~ < OFFICE OF B[JILDING INSPECTOR ~ P.O. BOX 728 ~ " O ~ SOU HOLD, N.Y 11971 ~~~1 ~ BLDG. Gc~y...._.<,~:~: '1'~~1~(~ U(' (lll ~i'b'.~(_f? C E R T I F I C A T I O N - Date, ~ YU 7 Building Permit No. ~7 Z ~J Owner~~_ (c _~~i,,~IIAALt) SI/P.YIR.GU lea e print) Plumber J~t~~ l~VSlClnl~(~ (pleas print) I certify that the solder used in the water supply system contains less than 2/10 of l~ lead. ~/~NA~,~ ' (plumber's signature) Sworn to before me this ~~h day of -,IU~~ _ ' \ 19~. Q f, otary P.tirb is Notary Public, (~-f- ~ County ~OR~x1AA.Aagy Notary Puhiir, 8fin£s Wf Pdw;v !'ark C'va';~ J., ~ ~f~ TEL. 7G5-1802 ~U~FOLKC`~, ~,o , off; ~ro~vN or souTr~o~,n ::a. G3;~&`~1 ~ UI~F}CL' OP BUILDING INSPECTOR o `.`,rr,t~ .z P.O. BO\ 728 ~ ~ ~ TOtVN kIALL ~ t' SOUTfIOLD, N.Y. 11971 yff~l ~ 5- 9-8 9 JIFF Cy1.AT411W ~VSiwrlilC t /~~EW ~wE~Linl6 1`I o5 ~ITr~E_ Nx~K ~~I yv~oo . ri1 ~4 iiv C~1TCh1OGUE ~Y I(Q35 1ECOnlfc To Whom This May Concern, ~E ~z ~"'I'" ~ I "/a SO2 We are unable to complete your Certificate of~Occupancy because of the following reasons. /yV1 An application for Certificate of Occupancy i:: not on tile. jJ/ No Underwriters Certificate on file. The check is (outdated/not on file.. )~a5'.GC, No tlcalth Dept. Approval on file..<1t,am~ra IN 62~-6n1 Nu final ins.pecCion has been made. Please contact our office on this matter. Tlialik you for your cooperation. Iluildin~; Permit it ~ ~ ~ ,5 ~ 2 [3u.ilding Dept. ***/~DIO Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) ~8G ~ ~?~'Rovn~ ~lc.s~s IZG4Vt~Ed. p. > 41~ I R f` F~`9 ~ I ~w~ ~ , ~h V .~~„w~°'~ ~ JUL ' 61989 I ~ S S STATE OF NEW YORK BLDG UEi'T. DEPARTMENT OF TRANSPORTATION TOVti'~' ~F !;S~UTHt7Lt7rr 1900 RTE. 58 RIVERHEAD, N.Y. 11901 MICHAEL J. CUDDY FRANKLIN E. WHITE REGIONAL DIRECTOR COMMISSIONER ~~~y Date:1(,, Z~ 8~ permit ~-fi ~r`>r~71-~ Sf~~ Cad"' S~UTti- 2 ~ ~-~®RlJ~ Building Department tt~tvii`1 0~ Soc~n~oc~ Gentlemen: We have no objection to the issuance of a Certificate of Occupancy for the ~o~~S~~ ~~P~t~1>4 TNT e©rinn~arJ ~ILiU'~uvn-Y ~`~S t 1 located at the above noted site. Sincerely yours, r,~. JOHN UNG N Resid ncy Permit Engineer Suffolk County East JY:KT . - t yq,. C / ~k `''~,~{~,i, alOHll103d0NMO1 7. 9 1d30'JOl9 r Pr`y' d ~ ' ~ ~ a' .I~ Y , ~ ~~~.~~ma9 st ~ ".ten G ~ JI IV , t!> STATE OF NEW YORK ~I ~ x ~ DEPARTMENT OF TRANSPORTATION ~ ~ ~ Sl Gl y'7 VETERANS MEMORIAL HIGHWAY 21 N/ PJ HAUPPAUG E. N.Y 117ae ' MICHAEL J. CUODY FRANKLIN E. WHITE REGIONAL DIRECTOR COMMISSIONER August 8, 1988 Town of Southold Office of Building Inspector Town Clerk's Office Southold, New York 11971 Dear Sir: Applicant for Permit Jeffrey & Cynthis Ouskianik Lot 86-4-1.5-40100 Main Rd.(Rt.25) Peconic, N.Y. Reference is made to your letter dated July 15, 1988 asking for this Department's comments on the above noted applicant permit. We have no project in our 5 year program within the subject area. Sincerely yours, ~?~A. UZ I Supervisor Planning & Development Attachment ~ ~ ~ - F3L[iG ~;tpr STATE OF NEW YORK TOVi/N nr ~'auTNOLp DEPARTMENT OF TRANSPORTATION uE~'E.FiAPI S_ MEN1QRlAL..F3 LGH1M,9,X -FFAtFPP.41j FrE -hd-Y - t t3~8 8- MICHAEL J. CUDDV 1900 Rte. 58, Riverhead, NY 11901 FRANKLIN E. WHITE REGIONAL DIRECTOR COMMISSIONER Victor Lessard Town of Southold Building Department Box 1179, Main Rd. Southold, New York 11971 Dear ~qr. Lessard, There is presently construction in progress of a nely residence on the south side of Route 25, approximately 300' west of Indian Neck Lane, Cutchogue. A Highway IAork Permit has not been secured from us for con- struction of an entrance to the State Highway. I request that no Certificate of Occupancy be issued by the Town of Southold without approval from this office. Thank you for your continued cooperation on these matters. Yours t ly, j~ J hn You maI esidenc Pe it Engineer Suffolk County East 727-1731 JY:KT cc: Jeffrey Ousiank 1405 Little Neck Rd. Cutchogue, New York File =~y~FFOL,y~Op TOWN ?F SI]UTHOLD ?FFICE ?F BUILDING INSPECTOR N "°yjj~!*,~~o~ TOWN CLERK'S ?FFICE SDUTHOLD, N. Y. Dote ....~~J.~..r0~ Mr. Commissioner of Public Works Suffolk County Yaphank Ave., Yaphank, N. Y. Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Laws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that ~~:......a has npplied to t//he Town of So/uth~old^ for a permit to constructpa/buiplding c~ on~~......~p."......~..:..!1a.e~?.....~:...~O~OCS...~~./C,d,~elJ, 2~~•p'/p'~cv~ os shown on the attached plot plan, submitted in tri licote dated ..'t/.7.r ~~j P , and titled .~k!..... We shall withhold further action on this application f(((oot ten days or as otherwise provided in the aforementioned Section 239K. Very truly yours, ~ Building Inspector Town of Southold, N. Y. ~IP:LD i;;SPc,^.;iU,J (~llAiE %Of4MENT° ~ ro v _ y FOUNDATION (1st) FOUNDATIOtd ( 2nd m 1^ - r 2. f ~t'Pd,O Z ROUGH FRAME ~ / o O PLUMBING/ ~ f ti Jl lj y , ?7 ~ , 3 . ~ m ' t y IIJSULATIOft PER N. ' STATE ENERGY CODE I,\ m a~ -.may fi 4. ~ FIidAL ~ ADDITIONAL COMMENTS: _ x~ ' _ _ ~ ~ ro H~ p ~ H \R O c~ix~ 9 r M ` O / z . ~ ro o~ A c- H - 5 . ~ 0 [T] H 'D ~i ~ o ~ed~ 7°~- 5~a Ate t 91988 c ~,r c~tCrur~ ate` ~ r. .?.c~a,~.~ y ~ o;;,; , `~~~F: j~~Y~~`~` yT,. ,~f~___ifiCN/Z.4 1. if i o~~ . ~ ~:~~.5~ytF"rt+~iR /J~ ~ ~ ~ iti_mY.. v 8~~~~~ ~r9~r~ C/~r_~D~ cQ ~ - 7 ( 1 F----------- ii( y~ x '>e I r~;. '+x~ r1~e I I1lLtyJ V , L'I yi ^ai 'd A v ~ ~ v ~f r v R/j^63 lYJ k1 II{Y AS , Y r~ l 1 " b t I < f I ) f J i~ th I I. y ~P r'.pNF ~ x ~J lV.is Y4~">'~~ <~1 R>dAf ~<t, ~4f~°I~i4 i ~ ~ 'r 5rp F, tir f{.~.~/r~7 C~1'y, C. ~F~'S., stV tr ~.~nJ kf~"~~ xry. fC ~ s tti 3 t~tJ t £ I r" r l s ~V,<<. hur f~"w-l. ~k~ SPfrT~ti f~s>.. fr o}Si ~(f 11 At Y..r"f" ~ 11 aVS't r(,x i Is y f !'i iR nt t / A y"w b ~„s~F ~F, t4 f ~'j, 14 . r I t. ;1H my A. vF J+~~~ t r X .q,. 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Requires septic tank ~;,,tir p~.~~s,~ i~©tiw x ~ ~~er to grade. tt is the applicant pansibiiity tct: _ _ ~j ~ maintain adepWtte sa~ta~y distances . °~,,,;F~ ` ! between att water up and sewa- - ,o! dieposai fiacitities. ~ ~ ~T~' r ~ N ~ ~ ~ ~ j a`~ ~ ~ ~ ~ . ~ ~ e L~°~~~ ~ ~ ~ ~;q ~ ~ ~ ~ ~'o ~ ~ ~ ~ ~ O ~ f_ : c ~ r ~ ~ ~ ~ ~ l~ l~lp ~ w C,w ~Y. ~ ua J 6o I ~ ~;o wtl w to u_ \ r'\ ~ w L2. N hi U ~ a,w ~ u. n ea ~ Q~ c o Lor ~ ~ ~ ti ~ a ~ ~ f ~ ~ t~: u: -"F- SSG ° cb s~/ ~ f~i5'.f~K ~fL~'Y'r;~.Efirut/u ~ Lar_5Y ?''~Yv~t.,c'D.f='• -TEFF.C~c("Y CY,~i.':;-%.fy c~JY.,"/sr~.t/~ Lor• 3 f~ zzwic - ° ~ ~ ~ ~sor~.~rE ~,~~rrf~.~iHon~•ZI~Y ~,~u~~~',~• "~,e , c:ocv~icu~• ~?e*c ~,u~< jasr~v of- • UrnvG ~o,ti -----_-1".4.~_-r1--~...-._9f~I.YY.S'r:.u_,~ivvi~y~~v..~..~~~'~.;.,~'~f_''EC~~'YLS~.!~f~Y_>~iC'~'~T..I~IC,, ~_-*T--"~..-p J V" ~ / S1NCI..E ~'~l!41~Pz Y ~a~°~'I..I t~l~ 'r~~ t`,_~~ ,°N~ ~izrG~.l!o ~'~-.5~ sy`a~.- pAC~ , ~ ~r ~ ~ ~ ~ ~ ~ ~ i~ ° vj v ' ~ ~ r+e , 1 ~j N ' ~ f ~ i- ~ .w ~ ~ ~ti I, ~ ~ ! ,g'~~rgc~rv ~ P~ - - a ~ ~ Gor .3 Ion ~ ~ f; ~ _ ~ ~ V , 1~, ~ ~ ~ /~i. ~i 1/v ~ ~ Lose- f is ~ G'dr~s' ~ NY'r~aA,f~.ob7s~s,„_,. f o , a ~ C ~ ~ ~ ~ P ~ P~ ;~.ilK4i-. /?~~'asy$c~ ~ Tt,<.. , 3 6 9 _ NOTICE 24 HR, NOTIFICATION REQUIRED PRIOR TO START OF ANY PERMIT CONSTRUCTION WORK LANE CLOSING OF STATE HIGHWAY MUST BE REPORTED TO NoY,S, AUTHORITY FOR ROAD WORK CONTACT 7~~~ ~~3~ FOR LANE CLOSURE CONTACT 360-6777 CONSTRUCTION SPECIFICATIONS FOR HIGHWAY WORK PERMITS 19• direct burial ablesutconduitbopullboxesia and nequipmentitcabinets rthat have been or are being installed for traffic signal power, • Interconnection, or as part of the Integrated Motorist Information System (IMIS). The Permittee will be responsible for any damage done to such underground State facilities. Prior to beginning any excavation work or installation of posts, signs, etc., the permir.tee shall locate, markout, and protect, all traffic signal and IMIS underground facilities within his work site in a manner approved by the State. The permitCee'shall avoid interference wherever possible. Where underground facilities are encountered, the permittee shall hand excavate and use whatever precautions are necessary to avoid interference of. any type. All underground facilities damaged by the permittee or the permittee's contractor shall be replaced or repaired as permitteeysha 1 be responsiblecfornalldcostsrtosmakeosu h repairs. The State will determine what contractor (and not necessarily the Permittees contractor) will make the necessary repairs or restoration on State traffic facilities. Yermittees are cautioned that abandoned cables exist in many areas, which may tend to mislead tone-out operations. The permittee or the permittee's contractor shall immediately notify the Permit Department if any interferences are encountered or anticipated. In order to advise the permittee and the permit tee's contractor of the extent of possible costs which can be incurred for damage to existing IMIS cable plant by his operations, it is noted that (a) direct burial splices are not permitted and (b) no more than one repair, which usually consists of. two splices, is permitted between two originally installed pullboxes. If additional splices are required, the complete buried cable run of sometimes ' one-half mile shall be replaced. Upon testlprocedures andathe repairbmustsbedfoundcacceptableito therStateIMIS Additionally, if a permittee fails to theaState additionaldcharQes interference, the_ permittee agrees to pay incurred by the State` including engineering, inspection, integration, maintenance, and operations charges_,_-, , _ IMIS As-builts will be made availab7.e for permlttee's review at the IMIS Control Center in the Region 10 office (phone (5161 360-6733). The as-built plans show the approximate location of IMIS facilities. The permittee or the permittee's contractor shall _be responsjble to field locate all IMIS und~ypd'~'~"°`a~i es ai[hin the--per~~ttee's-work-site which mav~4A~ed by his operations. ~ ~1AY 1~, IyB3 rr`` - /o~ Q~ X4°[22~~//~!/~.~i~~;~ .~rr`er _~2~ ~~£cri 'ice ~ ~ - =~a»- i/, /F-,s' ~ On d7laE`~a'[?', L1a.7_f ~~rcli,noJ an x/4!2 ,.?ifaar~. '-qs p~s2~GrE0 ay O ,v. y. S PER» ~T Q . , 19a+. /0., J'ai' v.W ~ r" .et' cr'.m ~~cc~ccr~ off' ~ ,r~9^J ..~i"OP ~trsrq = 0 " ~ Ru. ~ ~D age ~ v N fit. oaf ' ~ ~ / ~ ~ ~~~I mac? 1.~. ~ I P~'t`o TLl] ' ~.f ~9~ Y ~ n ! / r rG0'm~• 2, ~,6paa,~io~1'~: a e Fnor~ ' ~ ,GS'o7~di17 GY' ~cs/'~"~ V _ F ti e c'u~ - J. --1.- - p_- ~ ~ _ / 3._ _ _ _ ~ _ +.va ~w.w,w.....a~rr ~m»~a.,n+.«rowns~a.sudc..ca.,w~ns x. ~ /l:~~ ~a ~A ~ ~ W o ~ oawev ~C~ ~ ~ ~ `i i r@' ~ ~ 8 a = as \ ~ g ~ -y § t pia r, a 5a ~ W o ~ 5 ee t E ° ~"3ezc~ s §a E: °g ' y Y ~ o a ~ ~ a ~&~5ze 3 ~5°°- i F 4s ~ g eY Q § G d °B~e add a 6a 3 g. . i'• a B y ~9 ~§e§§ ~ d :eel"~ "3 E:5 ~ A~ R 2: ~ve - 9 'hx ala@a ~ e 33~:n~ °i-5 3 a ga 9. R = @x _5 2 § a p~. ~y '9> 8~a § @ a ~ae ~xa"~ a § ~@~ g'a a „g ~e~ a $ @~ .°-'ra ~ 75 a e _ ~ ~ ~ p gg 2 a ~•g ~3'~g z ea aq a iy ~ g za $ 3'~ ~ z" 52? ' ~ ~ ~ ' ~ ° Sea E ~ @y 2 ~ ::6ec3 ~ @'t m~ c a@ R. ~I ~ e ~ e a @.g ~ . a e§ a.{ 8e§ e _ d ~ d .d a .y _ ~ ~~Wt ~ • - . maid - " ' ~ Stu ~ ~W ~ ~.ar:- I U 4 ° d 'ggN ~ ~ N-- U ~ I ~ Q(•j1 3 1 W W IW~ 3 S~ ~ r l Q 1 WQ dl p_ .lO W F 1 b . - ~ i I pQ r 20 n' i g3 ~ N OF ~ W2 Zn FAO ' , p ' O~ W , o I 8$~ ~ B r _ i 3" - ' ~Y fir., ~ ~ `soot - ` ~ ~ b~ m ;~~a ~W ~ rte` % ,a ;3 ` s i 4 ~a~ ~ o~ i I ~ ~ "W4~ _ 'y ' ~ ~ ~ a- o s r23 b3 y W= f O ~ h m p m Gi *q 1 ~ ~ ~ i al a ~ ~ ~ I to a ' ~ ,.w. ~ , ~ I ~ 4.,=.-n ,a.a k .ssfw ~ iu..~....:.:.. , Z. . ~hu.:#iaaM;"r:ri .u..[: e e / `/i! Y /O'J{i - " I ~ I r, 3 ~ ~ a ~ ~ ~ rr~ir _ x> 3F'.C~ ~ V "...a ~ ~ Cr n t .~'inrsd ~ ~ c§' ; `>i,~ n, 1114 Q ~ 0 4~t ~ f ~w M1, ~ ~'e4.^fsno/ p ~ o ~ c y~ e~ W ~i 1' ~ 3, V ~ 4. eo 1 ai N ~ ~"q° /Gf. y0' i~ ~ ,as~,t~,e f~',wY~.c~rculo ~ ~ . DoT EP }RAry S f`, J~~~r~C~wr~ri.Q 4~a~r~.~r.~, ~?.eitr~av ` ,t-.~ aararusw• ~'c_~ r ~av cam' ~+.r~r~ ~ ~ f i ~ GU n9 / * ~ 7C t~~ ~n ~ ~ T fuA~L~HYTip%f/3~ia ri;/.99~ ~h1b, ~ ~ ~ - r i~zv~kvr~~~grrov?~rt~,~y&€/~s(3fit ~,~a ~ 9x ~369~: ~ z~ G~Wo~-a'~ ~sr~9.rc,~ i f ~b 7~5-1802 BUILDING DEPT. IIVSPECTIOIV [ ]FOUNDATION i5T ( ]ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL RnE~MARKS: ~'~l' B'2 ~-C, --~~s'~ / r~,~ DATE ~ INSPECTO ~ L,... w~...1__,.._ ' ~gc~~~ 765-1802 BUILDING DEPT. IIVSPECTI®N [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [ ]FINAL REMARKS: ~ c~sd` n 1 Gl/~ ~/~~f2 _ s DATE ~ t) ~ INSPECTOR 1)~s~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [f~ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [~RAMING [ ]FINAL REMARKS: ~ . - ~ Wwv~o DATE INSPECTOR ~7 z3~o ~ 76r5-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION i5T [ ]ROUGH PLBG. [v]~FOUNDATION 2ND INSULATION [ ]FRAMING [ ]FINAL REMARKS: r~' i ~ ~ ' c t i DATE ~~INSPIECTOR ~1Uu , ~ ass-isoa BUILDING DEPT. f NSPECI'IC~N [ ]FOUNDATION i5T [ ]ROUGH PLBG. [ ]FOUNDATION aND [ LATION [ ]FRAMING [ ]FINAL REMARKS: ~ ' - - "K II~OX 1 k i DATE ~ 3 INSPECTOR Y /7z~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST ( ] ROUGH PLBG. FOUNDATION 2ND IN ULATION [ ]FRAMING ~ FINAL REMARKS: ~ . , DATE ~ INSPECTOR Q „r-.~,• C~,~ll,~."/ L~~ BOARD OF HE<\LTH v. 3 SETS OF PL<1NS 2 X988 FORM NO. } SURVEY ~ SOD TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM F3LOG. Derr. m` TOWN HALL TOWN OF SOUTHOLD c .,OUTHOLD,N.Y.11~J71 NOTIFY TEL.:765.1802 CALL " MAIL TO• ~~~+C,th tiVSt Examined .7~1v, , , 19~~~. 105 Lt~L~GJ~GrC.~d~ <\pproved 19~PcnnitNo.~7~~0 ~,3`~ ~*~ov~~N~ ~ ~ ~plG3s Disapproved a/c ~ ~ ~ ~ /.e11,6t'1 0 ~ e~ i~ ~ , ( tilding Inspector) - ~n~ti/ APPLICATION FOR BUILDING PER IT~~' ~~t% 1 r Date ~~rL 15 INSTRUCTIONS a. Tltis 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 applicable Lavvs, 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 La admit authorized inspectors an premises and in building for necessary i ections. - ^ (igg tore of applicant, or name, if a corporauon) ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~J~''~':'':I.t:l!!~!• ~j . • (as o th~ tax 1 or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate o/fficer) ,J~ Builder's License No. . ,,/!.:-.t~~ Plumber's License No. ...........x~. 3J. 1" Electrician's License No. t~. tD..7 Other Trade's License No. . 1. Location of land on which proposed work will be done . . House Number ~ Strcet~ Hamlet' 1 , County Tax ibtap No. 1000 Section BI'gck ) Lot , , , , , • , , • Subdivision ~'~.~Ud.~`!t! . `'S!°• F.ilcd Atap No. ;1,?,~ , , Lot cyl.. (Nance State existing use and occupancy ~of,,p~r~emy i~ses and intended use and occupancy of proposed construction: a. Existing use and occupancy . {'.w: Yr„• , sin.... . 11 / € v,,, sp;~'i b. Intended use y' and occupancy ..l.. 1~... j~L~~! ~~.~`^f(.. , , . - y __~.~._v__ .a..• e 3• Repa~c of wor}, (check whichmpplicable): New t3uilding , Addition agget R~ oval Demolition Othe~`r't1~rR .~1.~.?......... . 4. Estimated Cost ,~,C~1 ~ , • , , , , • ; • (Description) • Fee.......... t(( (to be paid on filing this a lication) 5 ~ . If aaragennumbcr of carsvellin~ units . ~ Number of dwelling units on each floor .Je,l,?~'~,?"Yl e y,~ 6. If business, conunerctal or mixrrd occupancy, specify net tre and extent of each type of use ~ ~y`C, 7. .Dimensions of exi ting structures, if any: Front . , , .t Height r)-Q ~ . c3r . epth ..°Za Y , , Q, . Number of Stories , , ' ' Dimensions of same structure With alterations or additions: Pr ~ o~.,S ~ Dc th... ~ .rP.°.L•. Rear.~.~,........... p • • • • . IIcight . gn~~... Nurttber f Stories . . 8. Dimensions of entire Sew cons~n~ction: Front ,(o,~t, , ' ' ' ' Heigh J- 1f~. Rear ..~Ga':p:....... Depth ~C!~-c~Q~~pt~7~ ~ • • • Nut4tber of Stories'! 9. :iizeoflot:Front ((rt:~~.. Rear.A.(o.0,...• 10. Date of Purchase u"" „9,oj / 4&~, • • , • • • • . • ~"Name of Fo cr Owner Depth ~,z; ~P, , , , , , • • 11.lonep r Pse district to which remises are situated , ,1~~(.~R,httC~.1-~ ~•`~~~'~"t~• • • • • 4 12. Does ro osed construction vi o late any zoning law, ordinance or regulation: Y1~,~SY4.~j, • • • ~ • • • 13. Will ]ot be regraded • • ~Vifl excess fill be removed ro 'ses: Ycs 14: Name of Owner of premis No Name of Architect - • ~ • ABdress .~!~qS; ~tf~erlPtk toe o. , ,~~~-;Y,'~?'~, , -GCI1Wz(-~ ::address ; :v_._--.-~_ Name of Contractor • ~ • hurre-No: ~ C~ri'I.~aV~, . Address2~y s: ~I~°h"~~Y.t:Q Gone No. ~`7, ~J~ IS.l.s this property located with in $00 feet of a tidal wetland? *YL~S....NO, *If yes, Southold Towp Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate al[ set-back dimensions from property lines. Give street and block'~number or description according to deed, and show street names and indicate whether interior or corner lot. J ~ ~ b~~ i - f a, ~ ~o r STATE OF NEN O COUNTY OF ~U`~C~i~C.~ • $.S, abp~o~`v~~te~/,"n`~}a~m~e~ld., ~ rte' ~t • ' • bC1°g duly sworn, deppses and says that he is the applicant T(Na c of individual sip ~tg contract) I Ie is the . ~ (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 contai{ted in this application arc true to the best of his knowledge and belief; and that the work will be performed in the manner i;et forth in the application filed thcrcwitlt. Sworn to befpre me this .............~a, .....day of 19 Notary Fublic, , , , ,~(Q,~ • • 62.• • • • • v County //QJ i 'J/eI A/r~ NQ~,,~~ IC, ,qt MrN Yblk . X78, (Signature of applicant) ~I Case 89-21 STATE OF NEW YORK PREPARE 3 COPIES PERM 33g (2/88) r DEPARTMENT OF TRANSPORTATION HIGHWAY WORK PERMIT APPLICATION FOR NON•IfTILITY WORK Application is hereby made for a highway work permit ~ Highway Work Permit No. ~ n-89-9849 Name Cyrithig_& sTOf_f~ EftectiveDate x+/28/89 Address an 1 nn Main Road Applicant Telephone H Contact person In case of emergency City P.~e__~n:C_- Slate NY Zip 119 58 (include telephone number) RETURN PERMIT TO: (If different from above) J RETURN OF DEPOSIT/BOND TO: Icoaeiere oew iF Oirresem Faom esamnresi Name Name Address Address City State ZIP City State Zip 1. Requested duration from 19 ihru 19 _ , to apply to the operahons(s) checked below 2. Protective Liability Insurance covered by Policy No :expires on 19 3 Workers' Compensation Insurance Policy No. expiring 4. Disability Benefits Coverage Policy No. Permit Show Ins Fea In Amt. Total Amount Guarantee Checker CNECK TYPE OF OPERATION Fee or PERM 17 or of Fee and/er Deposit Amount Bond Undertaking on ills Insurance and/pr Bond Number 5 Single lob ~ Permit Issued for each job a Dnveway or roadway Q Residential s ,5 2.50 17.50 2000. N4606419 ? Commercial -Minor 150 ? Commercial -Major 500 ? Subdivision Streel 300 ? Temporary access road or street 25 ? b Improvement _ ? Residential 15 ? Commercial 25 Check additional description below ? Install sidewalk, curb paving, stabilized shoulder, drainage, etc. ? Grade, seed, improve land contour, clear land of brush, etc. ? Resurlace existing roadway or driveway ? c. Tree Work ? Residential 15 ? Commercal (not required for pruning d utility has annual maintenance permip 25 Check additional description below ? Removal or planting ? Pruning, applying chemicals to stumps, etc. ? d. Miscellaneous Consirucnon ? Beautifying ROW ~ Ifor Civic Groups only) NC ? Temporary signs, banners, Christmas decorations 25 ? Tralfic control signals 500 ? Warning and entrance signs 25 ? Miscellaneous 25 ? 6. Compulsory permit required when work performed at the request of D.O.T. ? a. Building demolition or moving requested by D.O.T ? Demolition ? Moving NC ? b Improvement to meet Department standards NC ? 7. Miscellaneous 25 WORK MAY BE DESCRIBED BRIEFLY AS FOLLOWS; Open S/s/o Rt 25, approx. 362` w/o Tndi an ~Ck Lanr Peconic for the ur ose of constructing a 16'0" residential driveway.Driveway to be paved rrom ah oaT'pcFT 7y~to Rt•0 W 'linty cith 4" asphalt A1T c,oQrk gt^nc~+}~ie arrnrdanCe W/NY$Add~i~itCdl$w6rk Qd5criptl0tY i5 ~Pacn~d; c • P13~'d aS deS~~~.~gl~. On N~~p i~Jttr'a~ledSattoWing SJOtIE t&Ve p~rrormed at: LOCATION (on along across ) State Route 8229 between Reference Marker and Reference Marker in the Town of SOUtllOld County of Suffolk known as Parnnir SEOR REQUIREMENTS: (Check appropriate box) ? Exempt ? Ministerial ? Type II ? EIS or DEIS Lead Agency If project is Identified to be ministerial, exempt, or TYPE II, no further action is required. If project is determined to be other than ministerial, exempt, or TYPE II, refer to M.A.P. 7.12-2, Appendix A SEAR REQUIREMENTS FOR HIGHWAY WORK PERMTS. Acceptance of the requested permit su%bje~ctrs-the permittee to the restrictions, regulations and obligations stated on this application and on the permit. Applicant Signature ~~a1tn~ ! r//~Ul[MI~Z Date 19 For Joint application and work, note name and address of Second Applicant below: Second Applicant Signature Dale 19 _ . Approval recommended 19 By Resident Engineemmr - Residency No. Approved April 2$ 19~_~, By Regional]1pP@~gr[Engioeer U (~~~RegionNo. 1-D . PERMIT IS ISSUED CONTINGENT UPON LOCAL REQUIREMENTS BEING SATISFIED. t PERM 42h (tI87) s r,'a STATE OF NEW YORK -DEPARTMENT OF TRANSPORTATION ` _ ' ~ ~ ~ - , , r~,.a~~,~ 7009849 Permit Fee $ 15.00 Permit No. 10-89-9849 Ins. Fee $ 2 . 50,~ ^ • ~ ~ Est. Compl. Date ~ , a~ ~ Total Received $ 17.50 ~ ,HIGHWAY WORK PERMIT ~ , Check or M.O. No. 157304 _ ' SH No.8229 . Liability Insurance ` - 'Deposit Rec. for $ Policy No. .f Expiring Check or M.O. No. Disability Benefit Coverage ~ ~ ' ~ - Dated Policy No. - _ , f?erm~ttee:aCynthia & Jeffrey,Ovsianik Charge to BondNoRN4606419 ($2000.0__0) , 40100 Main Road or Undertaking on File Pecouic, New York.`~11955 - `a ~ ' Workmen's Compensation ' d ; ~ _ Policy No. s ~ _ ` " r ~ r Billing Address for Return of Bond/Deposit-;. t Return of Deposit Made Payable to: (Complete if different from above) 5 r (Complete If different from Permittee) - i s ' ~ ~ i~ < ~ ~ ~ : , ~,f tt °3 r ~ ~ r , x ~ Y ~ ~ ~ ~ ~ . v, u~ t r . ~ L . ~ ~ , Under the rovisions of the Highway Law or; Vehicle & Traffic Law permission is hereby granted to the permittee to: Open s s/o ~t. 25, approx. 362 w/o Indian Neck Lane, Peconic for the purpose of constructing a 16'0" residential driveway':` Driveway do be paved from shoulder to R.O.W; line with 4". asphalt. All work to be ixi accordance,w/NYS specs. or "ASOBE'etc., &~as described on NYS perm 58`,~~attached. ~ THE PERMITTEE IS RESPONSIBLE FOR THE MAINTENANCE AND PROTECTION OF TRAFFIC. IN ADDITION,~ANYBODY WORKING IN THE RIGHT OF WAY IS REQUIRED TO WEAR A HARD HAT AND A REFELCTIVE SAFETY VEST.. County - Municipality - Route # - Suffolk ~ Southold;. 025 , as set forth and represented in the attached application at the particular location or area, or over the routes as stated therein, if required; and pursuant to the conditions and regulations whether, general or special, and methods of pertorming work, if any; all of which are set forth in the application and form of this permit. . Dated at Hauppauge, NY CommissioTrans tation ~ ~ _ Date Signed 4/ 2 g/ g q IMPORTANT This permit, with application and drawing (or copies thereof) attached shall be placed i in the hands of the contractor before any work begins. ' 4. yea ~ . + F : ; NOTICE: Before work is started and upon its completion, the permittee absolutely must notify the Resident Engineer R. J. SCHWARZ, F ~ (516)727-1731~.~ ~ ~ ~ UPON COMPLETION OF WORK AUTHORIZED, THE FOLLOWING WILL BE COMPLETED AND SIGNED BY THE PERMITTEE AND ` ' DELIVERED TO THE RESIDENT ENGINEER. ; WorKauthorized by this Permit was completed on (Date) ~ ~ Refund of deposit or return of bond or reduction of amount charged ,against bond or deposit on"file for this permit , y. whichever is appropriate, is requested:,` Date' ~ ~ pERM~ITTEE AUTHORIZED AGENT (IF ANY) ~ s,,. _ ~ t ~ r t' Upon acceptance of work performed as satisfactorily completed, the Resident Engineer will sign the following and ' forward to the Regional Office. - Work authorized by this Permit has been satisfactorily completed and is accepted s v ~ , s: i'~` y rf ~ qwS~; is N vx ~;rr a ' Date ~ f`, . , ff a t ' ~ _ RESIDENT ENGINEER ` ,a ~y~,i , ut3 E npcx r a~ k~ The Regional Office will forward this form to the Main Office with the appropriate boz'checked~ ~ ; t. ~ , r~ r: ~ z To :HIGHWAY PERMIT SECTION. [ ]Refund of Deposit on this Permit is authorized ' [ ]Return of Bond furnished for thSs Permit is authorized. r ` ' [ ]Amount charged against Blanket Bond for this permit may he cancelled ' ~ a; n'~x , r [ ]Retain Bond for future permds: - < ~x~fix x ~ . ,.r . ,r , ~t S 4qx E, Date ~ , r.. ' I, s ~ ~ 4 REGIONAL TRAFFIC GINEER ' ~ ~I (r` ' ~ mss= ~ a 1 ~~5 .X t K The issuing authority reserves the right to suspend or revoke phis permit; at tts discretion without a hearing or the necessity of showing cause, either before or during the operations authorized t s; , The Permittee will cause an approved copy of the application to qe and remain attached hereto until all work under . the permit is satisfactorily completed, in accordance with the t rms of the attached application. All damaged or:. disturbed areas resulting from work performed pursuant to thi permit will be repaired to the satisfaction of the , Department of Transportation. ~ / " t"~ ~ ~ ' .4 t.. ti.• ' Upon completion of the work within the state highway right of-way authorized by the work permit, the person, firm; corporation, municipality, or state department a ency, and his or its successors in interest, shall be for ,;`~st~,~ ssE maintenance and repair of such work as set forth wit m the terms and conditions of the work permit. ~ ur s E PE1tM 58 (7/8Q) NEW YORK STATE DEPARTMENT OF TRANSPORTATION CONSTRUCTION SPECIFICATIONS FOR HIGHWAY WORK PERMIT 1. Highway pavement is not to be opened unless authorized on front sheet (Perm 42b) of this Permit. 2. Sleeves shall be jacked under the highway for all highway crossings, unless permission to cross in any other manner is given in writing by the Department of Transportation; and jacking and receiving pits must be kept a minimum of 5 feet from the edge of pavement. As a general rule, the "open cut" method for crossing a highway will not be permitted,; the need for any such open cut must be substantiated by the permittee and permission granted from the Depart- ment of Transportation on the basis of satisfactory sheeting, maintenance and protection of traffic, compaction equipment, etc. 3. Any excavation in excess of 5 feet in depth must be sheeted in accordance with Code Rule 23 and OSHA. Any excavation closer than 5 feet to the edge of pave- ment must be sheeted as directed by the Department of Transportation. All backfill must be compacted in a manner satisfactory to the Department of Transportation. 4. Adequate signs, barricades, and lights, in accordance with the standards of the New York State Manual of Uniform Traffic Control Devices, Subchapter G, shall be provided. Barricades, whether in sidewalk or roadway area, shall have prominently displayed, for police convenience, the address and telephone number of 24-hour availability of someone who can reset the lights and barricades if it should become necessary. 5. Pedestrian and vehicular traffic is to be maintained and protected at all times. There shall be no unprotected or unlighted drop-offs or obstacles. No pavement openings will be permitted to remain open overnight. They must be backfilled or plated at the end of the workday. Open holes outside the pavement shall be fenced or guarded. The permittee agrees to pay all costs incurred by the State, including man-hours and equipment use, necessary to correct any unsafe conditions on a Permit site. 6. In the event that the permittee has permission from the Department of Transpor- tation to open the pavement, only one lane at a time may be opened provided safe two-way traffic is maintained at all times, with adequate signs and barricades to warn the public whenever work is performed on the highway. As stated above, no pavement area may be left open overnight or on weekends. 7. Adequate access to adjacent properties must be provided. 8. Pavement and Paved Shoulders - Minimum size replacements in finished concrete or asphalt on concrete base shall be 10 feet X width of panel. In all cases, if the replacement is within five feet of a joint, or five feet of a major crack, the replacement must extend to the joint or crack. Any opening in con- crete pavement shall be saw cut and final restoration must be done with High Early Class F concrete mix. In the case of an opening in asphalt, the minimum size replacement shall be 4 feet X 4 feet or at least 18 inch cutback beyond the size of the hole. Asphalt restoration shall be made by cutting, with a wheel or jackhammer the existing adjacent asphalt square, painting the exposed face with hot asphalt, placing the new asphalt, and compacting with a ten-ton roller. Surface variations in excess of 1/4 inch shall be eliminated or the pavement relaid. Unless otherwise directed by the Department of Transportation, asphalt shoulder restoration shall be 4 inches Item 403 (2 1/2 inch Binder and 1 1/2 inch Top) on a sound base. 9. Sidewalk, where disturbed, shall be replaced to full panels of a minimum size 4 feet X 4 feet or as marked when found. Concrete curb where worked on, as in the case of the installation of a new curb cut in an area of existing full curb, or vice versa, shall be removed to its full depth and replaced in accordance with Typical Sections from the Department of Transportation. PERM 56 (7/80) I REVERSE 10. Cold Patch - A mil~nimum of depth ,of 2 inches of asphalt concrete, whether cold patch or hot asphalt is used, shall. be placed as a temporary surface in any pavement, shoulder,lor sidewalk opening that must be restored to use prior to permanent restoration. Where temporary asphalt is required, the edges shall be cut square and the temporary asphalt placed on a well-stabilized base. It is the permittee's responsibility to,~~aintain any temporary patches in a safe and useable condition. 11. Drainage - There 'shall be no co~,tribution to, nor interference with, drainage along the State Highway, either during the permit work or after, as a result of such work. Drainagg along highway is not to be obstructed. Profile of drive- - ways and the cross-section of thQ finished shoulder shall be such as to follow the drainage cross-section of the highway shoulder. Initial slopes shall be away from pavement Qf highway. Finished driveways which block or otherwise interfere with the Normal flow of drainage shall be removed and replaced by the permittee to the proper grade, or, if permitted in writing, the permittee shall construct the necessary leaching basin to relieve the adverse condition, all to the specifications of the Department of Transportation. 12. No trees within the~I,State right-of-way may be cut or trimmed, either above or below ground without permission in writing from the Department of Transportation. The Regional Landscape Architect will be given 72 hours notice and a joint inspection arranged!, if the work in any way jeopardizes the trees. The permittee agrees, by acceptance of this Permit, to replace any trees damaged without permission of the Department of Transportation. As a general rule, trees will NOT be permitted to~be planted in the grass area between curb and sidewalk. 13. The permittee shalll,keep the roadway free of foreign objects, such as rocks, timbers, and other items that may fall from transporting vehicles, Spillage of material carriedlby, or dropped from the undercarriage of any carrying vehicle resulting f~^om the permittee's hauling operation along or across the public-traveled way shall be removed immediately and such roadway shall thereafter be maintained free of such spillage. 14. All materials must dome from State approved and inspected sources. All con- crete delivered by ransit mix must be shipped in an approved carrier. Asphalt concrete must be wi~hin specification temperatures and the load properly covered with a canvds. 15. No official State Department of Transportation signs may be disturbed without approval from the Permit Unit. If it is necessary to relocate such signs, the Regional Traffic Section must be contacted for the new location. 16. In State Contract areas the permittee must conduct his work in conformity with the schedule of theState's Engineer-in-Charge and contractor, and all work must be done to the'~,Isatisfaction of the State Engineer-in-Charge. 17. The permittee shailifurnish the Department of Transportation with a telephone number of 24-hour availability, where a demand for emergency repairs will be immediately honored; Furthermore, the permittee agrees to assume all responsi- bility for emergency repairs required, whether the need arises as a result of his contractor's work, by storm damage, or by any other means which renders his contractor's work area unsafe in the opinion of this Department or the Police Department. In theievent that it becomes necessary to call out State Highway Maintenance forces iro restore a permit site to a safe condition, the permittee will be back-charged for all manpower and equipment charges involved. 18. All work must be done in accordance with New York State Department of Transportation specifications. I I II i PERM 41.1d 14186) METHOD OF PERFORMING WORH WITHIN THE STATE HIGHWAY RIGHT GF WAY I. GENERAL CONDITIONS These conditions and regulations apply to Highway Work Permits authorizing work within the State highway righ[~of~way far water mains, gas mains, sewer lines and miscellaneous structures. General conditions apply to telephone and telegraph installations as well as specific conditions an the setting and resetting of poles. These conditons, and any special conditions which are added to this form, are enfarceahle by the Department at Transportation. A. TIME 1. Work under the permit shall he commenced within thirty 1301 days from the date of permit issuance unless a later starting date is approved by the Regional Traffic Engineer. B. flEOUTAEMENTS All the current regwrements at the IoUowing shall apply: Occupational Safety and Health Admmrstratmn, Federal Department of Labo{, Safety and Health Sta~ards {29 CFR 19261191 Oh Part 131, Title 17, New York Code of flutes and Regulations, Accommodation of Utilities Within State Right~of~Way; New Yark State Department of labor, Industrial Code flute 23, Protection of Persons Employed in Construction and Demolition Work, Industrial Cade flute 53, Construction, Excavation and Demolition Operations At Or Near Underground Facilities. Temporary soil erosion and water pollution controls shall be used as required. The final decision on the method of underground installation will he made by the Regional Director or his representative. 1. Work Within Pavement and Shoulder Areas a. Installations that cross the pavement and shoulder area. Wherever practical, all underground installations shall he placed beneath the pavement and shoulder areas without disturbance to these paved surfaces. 11 Bprlilg, Jacking, and Tunneling Methods DESIGN al The location of all excavations (jacking pits, etc.) shall he shown in plan and profile. hl The soil profile and groundwater conditions shall he determined by adequate subsurface exploration. c) The location of all other existing utilities shall be shown. d) The construction equipment and procedures to be used shall be described in the permit application. el The design of all excavations, including ground and surface water control where necessary, shall be made available for review by the Department. fl The underground installation shall be described in detail, i.e. size, length, depth, material, provisions for grouting, etc. 91 Pipes shall generally he enclosed in sleeves ar larger pipes. Small diameter services 12 inch I.D. or smaller) may he placed without sleeving at the d'uaetion of N.YS.D,O.T. h) The limits of an open excavation shall net he closer than 10 feet to the edge of the pavement unless approved 6y the Department. Open excavations shall be protected with the required controls for safety and far the maintenance and protection of traffic in accordance with the New York State Department of Transporta- tion, Manual of Uniform Tratlic Control Devices. CONSTRUCTION al Grouting operations may be required if surface settlement, loss of soil or voids around the pipe develop. When grout is required, it shall consist of 1 part cement to 2 parts sand, by volume, and sufficient water to produce a consistency suitable for placing the grout. b) Backfill of open excavations shall be as required under 2.1 fl Open Excavation Method. 21 Open Excavation Method DESIGN al The location of all pavement crossing by the open excavation method shall be shown in plan and profile. bl The sail profile and groundwater conditions shall he determined by adequate subsurface exploration. , cl The location of all other existing utilities shall be shown. dl The design of all excavations, including ground and surface water control where necessary, shall ba made avaiable for review by the Department. el When requested, the construction equipment and procedures to he used shall be descrihed in the permit application. fl Pipe installations shall be done according to the requirements of the appropriate New York State Department of Transportation's Standard Sheets. The required granular material shall meet the material requirements far Select Granular Fill in the current New York State Department of Transportation's Standard Specifications including addenda. Exceptions will only he allowed if prior approval is granted by the Regional Sails Engineer. UI Pavement shall be saw cut at termination points of pavement replacement. CONSTRUCTION al Pavement and shoulder removal shall be done in a manner that provides far proper restoration of the replacement section. Straight, vertical cuts of the pavement will he required. Pavement suriaces that become undermined shall he cut back and removed. Alternative repair methods may be used if prior approval is granted. b) The backfill material shall he placed and compacted according to the requirements for backfilling structures, Culverts, pipes, conduits and direct burial cable described in Section 200, Earthwork, New York State Department of Transportation's Specifications, including addenda. cl Generally, cuts shall be filled at the end of each working day. With prior approval, steel cover plates may be used. Recessing of these plates may be required. dl Temporary pavements and shoulders shall he placed as soon as a crossover installation is completed. b. Installations that are longitudinal to the pavement. 11 Open Excavation Method DESIGN al The location of all open excavations shall be shown in plan and profile. bl The Boll profile and groundwater conditions shall be determined by adequate suhsurfaca exploration. c) The design of all excavations, including ground and surface water control where necessary, shall he made available for review by the Department. d) The location of all other exlstin_g utilities shall he shown. e) Pipe installations shall he done according to the requirements of the appropriate New York State Department of Transportation's Standard Sheets. The required granular material shall meet the material requirements far Select Granular Flll in the current New York State Department of Transportation's Standard Specifications, including addenda. Exceptions will only be allowed if prior approval is granted by the Regional Soils Engineer. CONSTRUCTION al Pavement and shoulder removal shall he done in a manner that provides for proper restoration of the replacement section. Straight, vertical cuts of the pavement will he required. Pavement surfaces that become undermined shall be cut hack and removed. Alternative repair methods may be used if prior approval is Aran[ed. b) The backfill material shall he placed and compacted according to the requirements far backfilling structures, culverts, pipes, conduits and direct burial cable descrihed in Section 200, Earthwork, New York State Department of Transportation's Specifications, including addenda. c) Generally, cuts shall he tilled at the end of each working day. With prior approval, steel cover plates may be used. Recessing of these plates may be required. d) Permanent ar temporary pavement shall be placed immediately as sections of the total installation are completed [o subbase elevation. Gravel surfaces in shoulder areas may he used if prior approval is granted. -21 Boring, Jacking, and Tunneling Methods DESIGN a) All the requirements of B.1. a. 1.1 DESIGN al through gl shall apply. CONSTRUCTION a) All the requirements of B.1 a. 1.1 CONSTRUCTION a) and hl shall apply. b) Open excavations shall he protected with the required controls for safety and for the maintenance and protection of traffic in accordance with the New Yofk State Department of Transportation, Manual of Uniform Traffic Control Devices. cl The requirements of 8.1. b. 1.1 CONSTRUCTION dl shall apply. 2. Work Outside the Pavement and Shoulder Areas a, Open Excavation Method DESIGN al All the requirements of 6.1. b. 1.1 DESIGN shall apply. bl Open excavations shall he protected with the required controls for safety and for the maintenance and protection of traffic in accordance with the New York State Department of Transpertauan, Manual of Uniform Traffic Control Devices. CONSTRUCTION al The hackfill material shall be placed and compacted according to the requiremee+s for backfilling structures, culverts, pipes, conduits and direct burial cable described in Section 200, Earthwork, New York State Department of Transportation's Specifications, including addenda. k PEflM 41~1tl 141861 REVERSE b. Boring, Jacking, and Tunnaling~, Methods a) Ap the requirements of 8, 1, a. 1.1 DESIGN a1 through f) shall apply. b) Open excavations hall ba protected with the required controls for safety and for the maintenance and protecbon of traffic in accordance with the New York State Department I f Trensportationn, Manual of I~niform Traffic Control Devices. CONSTRUCTION al All the requirements of B. 1. a. 1.1 CONSTRUCTION shell apply. C. SUBBASE, PAVEMENT AND SROULOEfl~ REDUIflEMENTS lincluding manhelesl 1. Subbase ~p 1 s. The suhbase course shall be a minimum of 12 inches thick un~rtL4 otherwise approved. The materiel shall meet the requirements of current Department or Transportation suhbase course item as specified by the flegional Sails Engines""ff b. Under the permit, construction which adversely affects the suhsurfa' idrainage of the pavement structure shall he corrected by the addition of surface or subsurface drains, as required. 2. Pavement and Shoulders I a. Permanent The replaced pavement shall be similar to the existing pavement in camposdion end texture. The selection of the material type and compositon shall be sublect to the approval of the flegional Directs( or his representative, Tha limit of pavement replacement shall he such that the replaced pavement is supported by thoroughly compacted subbase materiel and the pavement is restored to the proper grade, cross~slape and smoothness. When bituminous concrete mixtures are required far the pavemem replacemen6 the layers shall consist of one ar a combination of mixture types contained in Ta61e 4011, Composition of Bituminous Plan; Mixtures in Section 401 of the New Yark State Department of Transportation's Specification, including addenda. The mixture shell he placed at the proper temperaturee, without segregation, and compacted thoroughly. When Portland cement concrete mixtures are requred for pavement replacement, the mixtures shall consist of either Class C or Class F as contained in Table 5013, Concrete Mixtures in Section 501 of the New York State Department of Transportation's Specifications, including addenda. Class F is a high early strength mixture and should he used when early opanmg to traffic is desired ' The concrete mixtures shall he placed without segregation, then consolidated, finished to the proper elevation, and textured, Coring the concrete pavement shall be in actor dance with one of the methods permitted in Section 502 pertaining to curing, Pavement shoulders, curbs, gutters and other incidental features shall he rep~oced in kind unless otherwise approved by the Regional Director or his representative. b. Temporary Pavement that is replaced Temporarily may 6e paved with either a hot bituminous concrete mixture mentioned shove or a cold hituminous patching mixture. When a cold patching mixture is used it shall cpnsist of aggregate and hituminous material proportioned end mixed in a bituminous mixing plant er rotating peddle shaft pugmill. flegardless which patching mixture is used i~ shall 4e laid on a prepared foundation and thoroughly compacted. Since cold hituminous patching mixtures are subject to distortion by traffic, the temporary patch shall 6a maintained to provide a smooth surface until the pavement is permanently replaced. 3. Manholes Manhole frames and covers shall havg sufficient structural adequacy to support the roadway traffic. The type of manhole frame and cover shall he approved by the Regional Director or his representative. The manhole frame shall he set flush with the surlece of the roadway unless otherwise permitted by the flegional Director or his representative. D. MAINTENANCE AND PROTECTION OF TI~AfFIC 1. Traffic is to be mainmined at all times during the progress of this work and adequate signs, barricades and lights shall 6e provided in accordance with the provisions of Suh~chapter H of the N.Y.S. Department of Transportation's Manual of Uniform Traffic Control Devices. A maintenance and protection of traffic plan may he required. No lanes shall be closed without prior approval. 2. Tha applicant shall erect and maintaid suitable barricades around all trenches while work is in progress far the protection of the public, and they shall ha suitably lighted by yellow lights et night. The work shall be carried an in such manner that not mare than 100 feet of trench in earth remains open at end of day's work. 3. No pavement cuts me to he left unhll~d over night, except in emergencies, and in such cases, adequate precautions must ba exercised to protect traffic. Prior approval must he obtained to use steel plating. 4. No construction materials or equipment shall 6e left on the shoulders or pavement after working hours, nor shall any construction equipment or material be placed in any manner or location that will obstruct highways or railroad warning signs. 5. All open trench in the highway right~el~waV shell he barricaded. There shall he conspicuously displayed bright red flags no less than 24" x 24" attached to such barricades and illuminated at night with flashing y¢gow fights. If in the rydgment of the representative of the Commissioner of Transportation, flagmen era necessary, they shall he employed by the permittea and on duty at sll times during the progress of the work so es to direct traffic end maintain yellow flashing lights, etc. 6. Soft shoulder signs of adequate size, not less than 24" square, shall 6e erected and maintained on all hackfill trenches within the shoulder area until the hackfill is thoroughly sealed. These signs shall ba located ~t the beginning of each section of work at intersections and at a distance not greeter than 1000 feet apart. 7. During winter conditions highway shoulders shall he maintained free of obstructions which would interfere with snow removal end ice control. 8. The permittea shall keep the traveled ~vay free of foreign objects such as rocks, timber and other items that may fall from transporting vehicles. Spillage of material carried by or dropped tram the undercarriage of any carrying vehicle resulting tram the permittee's haulin8 operations along ar across any public traveled way shall be removed immediate ly and such traveled way, bath within', and outside of the work limits, shall he kept free of such spillage by the permittea. E. COMPLETION OF WORK 1. All work is to be performed in a man~jer approved by the Resident Engineer of the State Departmem of Transportation. 2, All disturbed areas shall be returned tq their original condition in a manner satisfactory to the Commissioner of Transportation or his representative 3. The permittea shell be required to restore shoulders end ditches and clean up the highway as his work progresses. All driveways shall 6e restored with material in kind end to their original conditions. I 4. All surplus earth end rubbish shall 6a cleaned up end removed from the highway righhof~way upon completion of the work, and the highway left in a neat and orderly condition. 5. As built plans showing final grade of new installation and existing underground facilities encountered shall be provided to N.Y.S.0.0.T. if variation from approved design plans occurred during construction. F. NECESSITATED FUTURE WORK • 1. The applicant agrees, that any present for future injury to or disturbance of the highway, its slopes ar gutters, caused by placing mains and service pipe shell be repaired by the applicant at his own expense and in accordance with the requirements of the State Department of Transportation. 2. If necessity arises in the future 6ecaus~ of the work on the State Highway system andlor its structures, requiring the removal, relocation or replacement of the installation authorized by the permit, said work shall 6e done es directed by the Commissioner ar his representative, end all cost and expense sa incurred shell be the obligation of the said permittea or his successor in interest. II. TELEPHONE . TELEGflAPH INSTALLATIONS A. SETTING OF POLES 1. All poles shat! be set outside the diteA lines se that the proper drainage of the highway will oat 6e interfered with. In case it is impracticable to set poles so as not to interfere with the flow of water in the ditches, the shoulder, ditch and space around the poles shall he paved by the applicant to protect against wash. 2. There shall he no obstruction to private driveways, connecting highways ar roads, paths or sidewalks. 3. In case it is found necessary to trim tretjs within the boundaries of the highway, the least possible amount shell be done, end in all cases the consent of the shutting property owner must he secured before the poled are set and trees trimmed. 4. Poles shall he of sufficient length to provide a clearance of not less than eighteen feet between the wire and the crown of the highway, under the worst condtitians of temperature end loadings They shell 6e set in line and properly plumbed. They shall 6a wall guyed. No guying to trees, unless by special permission of owner. Special precautions shall be taken on curves and where line$ cross from one side of highway to the other. Poles shall he straight, sound, end the fittings shall he of sufficient strength to carry wires under the worst condition of loed~ng (ice, wind, e[cl. 5. Where telegraph and telephone wires crgss high tension power lines, electric light or trolley wires, spacial precaution shell he taken to maintain proper clearance under the worst condition of temperature and loath ng, B. flESETTING POLES 1. If necessity arises in future, because of work on the highway, to relocate, replace or ra~set poles, cables or conduits, said work shall be done at the expanse of the applicant. III. SPECIAL CONDITIONS I A. In addition to the aforementioned conditions, ~~,if it is found necessary 6y this Department to add to ar otherwise modify the same, it is to be understood such changes shall farm a part of the permit and be complied with immediately upon notice. IV. ADDI710NA! SPECIAL CONDITIONS ANO SKETCHES ~ See gttached Sheet. (o � � 3 ' 0 I j ! ' i I ' - - --- a a,N fo PLUMBER CERTIFICATION OCCUPANCY OR µ RE CEftHFXATE OF OCCUPANCY YSE IS UNLAWFUL - - - - - T— _ SOLDER USED /N WATER SUPPLYSYSTEMCANNOT WITHOUT CERTIFICATE -- XCEED211OOf1% LEAD. _ _ ____ __ _ . _. - - OF OCCUPANCY _ now M�OPi�F�/Y uvltMi 1 I r�M.F #tMo 0 MMMC tlIBM - DA1E:�K1tI � I � I K M+u ar L -FEE. _- 7/6-1�-0 4 Ftl 1Z FOLLONRNO MSFECIIOM: 1. FOUNDARM - 1gIOII N FOR FOURIMCONCIIIi 2. ROUGH - RIMING K F11NAM 9. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. / y STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ��,�Q(/f O /" uAff I,� .rrfonoa oAvm q I I II t 17 - r IAI tri I In - 'C U i � ���ct � .�I`L 1�(J I. U�o �IJ - L_AlU CL VU(? Ur`1F^.y __ __ ' • ' ^^'^*-'r tttttt -"^ (ii v q� F4TG�•l `'�� }. T - N " __ - •-'. Z �, '� 1.[IV' Y VJ/i - Ij GI (YFCFJLih� i Cb] rE:•_�.�,-: `Uvn1Cv '. 1= vEi2 u,• ;,r, � yg .� ��° -7�1 R.Ari ALt ' upKsc•_ r � I , Ir,,, `\s�-.. �� ,��� — �`..��(=_�t'-_. ...=:mss�-t-i-t•..� ;; �t i.__.i�: F� •� — D2" P ,�.Nri� - 5 -O-(3 Lki�t.l M-s vtM1tL t t-% I 2-6 R Z''ai7u, 13 �. tt " � C� _ 2— ( �• �7�' - IY�I r... t'.r .7._h��ll'� .f,,,y'fE.u✓ �_ 3 _• 4 . .E i 7 ��� r I � ����. ��\ Imo'`.-£MG-I.Li � '"L.�j�✓j _i 5 ,71.'..G�,,�-L�-,_-l�-b+,...1-.. �1.th�:hl, S71F''. Ul�l� -. ._. ;�'�--�_� � - , Y A • • � 04WIN6 • • I �`S E J 9 ; ^� :; r ( .� -`p-c,— a= rr��_I •�c r�lsr�. a � I y � - � -- � � _tj Vf iT - -- irk IV _ r I � I i - II 1 F IN!! Ul/NSi.p O Ftp Nm-.e �SSU(iL oAAWI°B . ( . . .k .51- lPlflA ,fi 0.** c', Py6I+ lsil IN�RE.gSE AW 1 (17 9YA6$6 VOW. C(Mm"o- j t ' ,. TALU-T'T CI$NPI:?Ii WTH THE YOWL STATE UNIFORM FIRE � n *,1WTQN AWII. p1U - SNA ry�T�yyL.�--C'ONFIORM�WIITH THE NEW YORK ,STATE YlV" IiVRETTiEgf DIAVEA�, OA�, AFRI9'IL I• 87. wVLOL, R. 'iD I,M!R � ! : 1bi4 iff T" A MINIMUM FAtSVNP_TI,Mt "INS, .F, Alm", i4 Nx riM4 b.tlF 3 FT=: BPI O{iFINISH GOAM ftp AILEIgIrISf �� N JrMo TO SB eE%t F¢I IN NO pis AM PARFU..M PS [IriDliS,' log, "CTRILoftwy 00"W' .0. FAY S"K lospEctlow GAF` STH rI eNTS.. — e 1'R #. - WZT14 MSW YORK STATE IOSLDINS t - N ♦ WFD\Y AWN _ " ', qAy�f. EI7 ,CEIR�pTR�IIN._. W411A' _ 1�1F, D� IAV THE N6W Yaw BSAWL! wFI'AE - 4 ?I�,EEE•Rc nITpA: .._ DAU .I HENS NOT NO" �DApSI,F . r USH WRI*fiN UIMENS?ONS OWLY. 3� "0 � l _ _ _ it • a - f. _ 2 PLUMBER CERT®F®Ci4T®Ql1/ OCCUPANCY x�, ON Lam® ®NTEIVT'V EF®RE OR ...-. - .. ...... .,.._r - .... x. .- -.... .. _.._ ._ � _. . ..........-._, .... ..x .u�._.a.- .., ..v.... ....,.,.>_ �M_ � 'e +n�;+'i�W'Y2'°uayses.wv'.er wr�. ,....».�,_.u..�..�.-.s.,_ i f CERT/F/GAT USE UNlUjIN E CYSa LDER USE® _,...� b LY IS ys 7,Em cA NNor ITHOUT CERTIFICATE EXCEED 2110 Of 1% LEAD. P u� _ 4 arms f 0000, ftdft } 2 blow , for tit dwbutkv71 'a1�a' / � 50 1py Pkft shah be DATE: i.R 1 of45oftKerL � � ' FEE: �' S1f: , NOT" AT 785-IV=- ! AM 10M PM TME FOUA"NG INSPEC71ON8: 1. FOUNDATION - TWD RRIAND FOR POURED CONCRETE 2. ROUGH - FRWNG & ANG 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHAD. MEET THE REQUIREMENTS OF THE N.Y. i STATE CONSTRUCTION A ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS M �� .� SCAtE APPQQVEp by GiRAV.N;;t3--,-.-_. DATE w _ ..__......r..,. es REVISED a.,w_,..m,_�............... _.._. -- - DRAWING NUMBER _......,....,_.,... N J k G_ cn r � - 3 'k w x e ,y T , i R F r j r t } s 3 a , s • t� x _ t f h i j Y i { $ r '4 i s y r ' ' k , v, j&4 oll IW If -lo'e -'I U4/ 44 rl Fry r A" , r ` � O r r (f q A'2, WL2 r.. 1 x < r. F a� r ref• R r ,. .:• gyp` f} ,t � };$ .a $`'-,, f-.-.-. 3 5,�,,.,-:="'w« �`,,,.. .,.,, ,4.,.0. `' � .,,»r �,c..tir..: 1.>eo--�_.-,.o�,:�' ,✓'Y 'E''.'�'�_�.,.� �v _ ._...... , .fi , , s. 7"" 4 _ y : w � i i GALE: APPRf7Y�tJ$� DRAWN 6Yz-w a .f DATE E + T A DRAWMMG NUMBER r V r1 .. 1 ., - 3 } 4''t t ly Y Jk CA 1 't ,. , ,jr a S t (j F , r AI e LL F RAM I NG L t M13 R TO BE fXXJOLAS F=IR k_ CIS No .2 VISUAL UHA l Nt PSI MIN. E= lw700000 PSI - Al-10W 1 1. INCREASE IN UNIT SIRES( OR SNOW L LAD I N6 LL CONSTRUCTION S#iALL COMPLY W111-4 .1"#IT;° aW YORK STATE UNIFORM FIRE 'REVENT I ON ANIS BUILDING CODE. WINDOWS � � � CONFORM �1Tf � YORK STATE DOORS, i I L _A� r — i NERGY CONSERVAT I ON CONSTRUCT ON CODE DA'TED D A RIL. 1 , 1987. ILL. FOOTINSS TO REST ON VIRGIN GOIL WITH A MINIMUM PRESUMPTIVE fWARiNG APAC TY OF 2 TONS/S.F. AND RI. A M I N I Mi_IM OF 3 FT. REk:10W FINISH 6HAIIL I I N I MUM ALLOWABLE CONCRETE~ DEfSIGN STRESS TO BE 29500 PSI IN 28 DAY' . )CIIIRL E FRAM I NO REQUIRED AT A i ORS N I NG AND RARAI_I._ .L.. PARTITIONS. iMOKE DETECTORS TO HE S I L. ("'TA I I ON, ELECTRICALLY IIRERA IL a ENGINEER HAS T BEEN RET I r C TRUCT I t N F"ROV IIE RAILING IN CONFORMANCE WITH CODE REQUIREMENTS. ALL PLUMBING TO BE IN COWORMAMCE WITH NEW YORK STATE I33E.ITI...IIIN "i v . CONSTRUCTION CODE- REQUIREMENTS- scut EQUIf EMEN+TSsc AP"OVED$Y 04AWN ALL. ELECTRICAL WORK SHALL RC APR IVED BY THE NEW YORK 130ARD OF FIRE NDERWR I TERS. DATE R NOT SCALE DRAW I NRS, USE WR I I E'N II I MENS I ONR ONLY. DRAW 4G Nl AhKR