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FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No E-24926 Date MARCH 17, 1997 THIS CERTIFIES that the building ADDITION Location of Property 425 EAST CEDAR POINT DRIVE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 90 Block 3 Lot 19 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 19, 1996 pursuant to which Building Permit No. 23572-Z dated JULY 11, 1996 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to ALEXANDER H. WILLIAMS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-411580 - FEBRUARY 20, 1997 PLUMBERS CERTIFICATION DATED MARCH 7, 1997- HARDY PLUMBING & HEATING 0 it ing Inspector Rev. 1/al FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24927 Date MARCH 17, 1997 THIS CERTIFIES that the building ACCESSORY Location of Property 425 EAST CEDAR POINT DRIVE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 90 Block 3 Lot 19 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 19, 1996 pursuant to which Building Permit No. 23572-Z dated JULY 11, 1996 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 ACCESSORY TWO CAR GARAGE AS APPLIED FOR. The certificate is issued to ALEXANDER H. WILLIAMS (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N-411580 - FEBRUARY 20, 1997 PLUMBERS CERTIFICATION DATED N/A �G ui ding Inspector Rev. 1/81 "RX NM 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N4 23572 Z Date .............. /.,l/.I................................. , 19.6f Permission is hereby granted to: �/��9Lt�L✓ � o7S 3-5- r W� AV. ..................................... r , ...... . ......//.1� ........ .f to .Ji f � .:....'�uL7�., ....►nl�ialR rj at premises located at .....1��r .. � /......... ................... ......................................................................, ���................................................................ ................................................................................................................................................................. County Tax Map No. 1000 Section ....�Ie............Black � . ...Lot No. Z ............ pursuant to application dated ..[.ellA. ...... 19✓.. l&., and approved by the Building Inspector. /�.ta�.�!/.✓cam —JS.f. _ Fee $....J�. /Budding Inspector Rev. 6/30/80 RR IRR 0 9 i;�! Form No. 6 E� ��1��pp rri7 a TOWN OF SOUTHOLD "Sly. lM9ti —Z �e ( r+ BUILDING DEPART*1ENT TOWN HALL BLDG.DEPT. 765-1802 TOWN OF SO.THOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of prcperty with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from. Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 12 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 4, 1457) non-conforming uses, or buildings and "pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 0. 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 - .25c. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . ::.1c.-. 1.�. . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . .. . . . . . . . Old Or Pre-existing' IB-uilding. . Location of Property. ..�°� . . C1 �'r �t'f{ r. .�.: . . . . U4^>T?�'�?r . . . . . . . . . . . . . . . . . . . . . . . . . . . . House No. I r Street f ( Hamlet Onwer or Owners of Property. °'. 1e �Y �1. . .1.'.: . ! t �( ([Z;c�s . . .//. . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. .O. 0. . . . . . .Block. . . . . . . . . . . .Lot. . 1. � . . . . . . . . . . . . Subdivision^^..,. . . . . . . . . . . . . . . . . . . . . . . . . . . . .-. . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . .`.y.... . .. . . . . . . . . . . Permit No. � J 5 1. . i�Date Of Permit. . 1'7.1u.I. 1g.t. . . . .Applicant . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s . . . . . . . . . . . . . . . . . L 0 a y +a APPLICANT 15 I5 V l5 ` Farm No. 6 i? TOWN OF SOUTHOLD -7 IM BUILDING DEPART= TOWN HALL BLDG. DEPT. 765-1802 TOWN OF SOO'%/OLD APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be -Fled 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 Dent. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of i„ lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. _f a Certificate o_ Occupancy i.s denied, the Building Inspecror shall state the reasons therefor in writing to the applicant. Fees Certificate of Occupancy - -Newdwelling 525.00, Additions to dwalling 525 .00, Alterations to dwe'-ling $25.00, Swimming pool $25.00, Accessory building $25 .00, Additions to accessory building S25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occuparcv - .25x, L. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial 515.00 C. Date . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . .:. . . . . . . . Old Or Pre-existing rBuilding. . t .. . . . . . . . . . Location of Property. . . .`. �r . . . . . . . . . .` �d r. R :. . . . g p?. �?'. . . . . . . . House No. [ Street 1 f Hamlet Onwer or Owners of Property. .,5� .. • . ' L `1.. . .`.',: . 4 .I. �`:s: . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, section. .0.7(Q. . . . . . .Block. . .G . . . . . . . . .LOt. . 1. I . . . . . . . . . . . . . . . . Subdivisions. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . ..7. . . ./.FGiled Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . ?ermi t No. sr n�5. . 1. .2-Dace Of Permit. . 4^- health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . ?lanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . r Q,.pr..5a6 .3 3 <, APPLICANT. eo.e .2ypa -7 FAU) 'IN3SPECTION REPORT DAT. _ COMME 'S 11 FOUNDATION e ) I FOUNDATION (2ND) ------ -- --- - --------------- - - -- --- ---- - - = ROUGH FRAME 6 ---^------ PI.UMRINGAt- INSUT_ATION PER N. Y. STATE ENERGY I II it LeZk CODE II 11 � FINAL. u n n O ADllITIONAT. COMMENTS:-------------------- _---- -----__- ___-----_ .ro H O z ---------- ------ — r ------------------- ra ro o��gyFFO(,�co �o = Town Half, 53095 Main Road p - Fax (516) 765-1823 e9y � Telephone (516)765-1802 Southold, NewYork 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD February 11, 1997 Alexander H. Williams III 25235 Main Rd. Cutchogue, N.Y. 11935 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: XX An application for Certificate of Occupancy is not on file. (Enclosed) 2 Applications - 2 CO' s required. No Underwriters Certificate on file. XX The check is (not on file. ) $50.00 No Health Department Approval on file. No final inspection has been made. XX No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 23572-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. `^1 r TEL. 763-1802 TOWN OF SOUTHOLD � A.,. J _ < OFFICE OF S3UILDI;t INSPECTOR / . P.Q. C30:' 128 `f' TOWN Ii..LL SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date 31712 -7 Building Permit No. � �) 5 `7 -D.- Owner— Vel l l I t ot. m 7S (please print) Plumber HAi-d .j (please print) I certify that the solder used in the water supply system contains less than 2!10 of 1% lead. (plumber ' s signature) Sworn to before me this r day of �46k (-e P-� yy < 19 f Ilotary' Public Nota_* Pv ,:.ic COuR1.y HAMILL Notary Public,State of'New York No O1HA5059984 0�alffied in l commission Expires May 06 ount THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000121 BUREAU OF ELECTRICITY F— 85 JOHN STREET, NEW YORK, NY 10038 Date FEBRUARY 20,1997 Application No.on file 12897896/96 N 411580 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the promises of A. & C. WILLIAMS, 425 CEDAR POINT DRIVE EAST, SOUTHOLD, N.Y. in the following location; ❑ Basement ® I st FL ® 2nd Fl. GAR Section Block Lot was examined on FEBRUARY 12,1997 and found to be in compliance with the National Electrical Code. RXTURE NXTURS RANOES COOKING DECKS OVEMS MbmwWASNlRS I EXHAUST FANS OUTLETS RKIPIACUIS SWITCHES INCANDESCENT[FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. MAT. K.W. AMT. I H.P. 40 30 29 40 1 F DRYERS WRNACE MOTORS PUTUN AMUANCE MORE$ SPECIAL REC'FT TIME CIQCKS NU UNIT MEATREE; MULTI-OUTLET DIMMERS AMT. K.W. Oil H.P. GAS H.P. AMT. NO. A.W.O. AML AMR AML NO:OF RIFT AM►S. TRANS. AMT. -. H.P. SYSTEMS AMT... WATTS 2 - 2 600 SERVICE DISCONNECT NO.OF S E R V 1 C p E AHM AMT. AM►. T1TE - .� 1�'41N 1,/51N S/31N 3/4W NO.OF CC OF CC..O. NO.OF NMLEG OF MI.LE NO.OF NEUTRALS OF NEUTTRAI OTHER APPARATUS: PADDLE FANS F-1 .ATORS 11-F H.P. G.F.C.I:-3 SMOKE DETECTOR:-4 TRACK LIGHTING:-6 ' I I ' IIII L � PAUL R. BURNS LTC.#3097 - P P.O.BOX 1061 ODOM IMANAGN SOUTHOLD, NY, 11971-0932 Drr 11 This osrti,; t must no be Mored in any manner; return to the office of the Board if incorrect. Inspectors Wray;be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN .ANY *AMNER. 4 . :1 1 �gUFFO(,�C Albert J. Krupski, President h�0 �Gy Town Hall John Holzapfel, Vice President o= 53095 Main Road Jim King � P.O. Box 1179 Martin H. Garrell ,y • - �� Southold, New York 11971 Peter Wenczel �Ol ��O Telephone (516)765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 29, 1996 Samuels & Steelman Architects Thomas C. Samuels 2523514ain Road Cutchogue NY 11935 Re: ALEXANDER WILLIA,S SCTM X90-3-1.9 Dear Mr. Samuels,, According to the information given, and an on-site inspection of the property, and a survey, the Board of Trustees agreed that the house is out of the Trustee jurisdiction, under the Wetland Ordinance under Chapter 97 of the Town Code. However any activity within the 75 foot area of wetlands, would require a permit from this office. If you have any questions, please call our office. Yours truly, // Albert r�sk1 Jar. �I President, Board of Trustees AJK/d j h CC. Bldg. Dept. CAC " Arrf 2 51996 LL ! �t�a EPI. 1 SAMUELS & STEELMAN ARCHITECTS �r n 25235 Main Road CUTCHOGUE, NEW YORK 11935 (516) 734.6405 FAX (516) 734.6407 nq TE I( na NO. gTTENTION �j NS FC To JiUT(cxUN C/ � RE !;Faw Ole �I'7c Ul fJoc /( �l ra WE ARE SENDING YOU V Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION X4.19 � 96`i_7,V1hr& /�IeS7 L54K.999 �Ev / 4 i9 p Ft Oft�N F/LV ii4♦./V / 'ed2 (7- , THESE ARE TRANSMITTED as chocked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ F your use ❑ Approved as noted ❑ Submitcopies for distribution > As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE_ 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS (�NDCz- ' �S'r�PPr�/1 1E Cho lY7�Y,�S7"�—'zS IsT 4� Caff�r' _ e_1_6701 F c i"iA�G �T ii�GfX,yG Pt�'l�rlT . r"_"____ COPY TO z'rarr, :-,,- -�;,', SIGNED: onocvxrs.o> mut.,rrm.,as mal It enclosures are not as noted, kindly notify us at once. APPLICATION #_ PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION p NQW This form is to be filled out in duplicate. Ji�i i 9 SECTION 1: GENERAL PROVISIONS (APPLICANT to read and_sim): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. 1,THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, TO THE BEST OF MY DGE, TRUE AND ACCURATE. (APPLICANT'S SIGNATURE) DATE Q// — '--'� SECTION 2: PROPOSED DEVELOPMENT (To be, comnleted by APPLICANT) NAME ADDRESS TELEPHONE avv�e 4 16Ad�FT,+SL /Jh'�� circa s e06e AzuTQ2.CM r BUILDER ARCH ENeffqeEft .{lAiftut2SS STET <fr/�/1� 61i7TeN0606- /V� 3 (w� PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be. helpful. ctl`' e fi hou a 5 r o ` orrve E routAl 6—o&daiurt/vH i�M!rrr oma,7b. FDP(93) APPLICATION # PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY U /STRCTURE TYPE O>ew Structure l/Residential (1-4 Family) (3 Al Addition ❑ Residential (More than 4 Family) teration ❑ Non-residential (Floodproofmg? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- 0 Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT s B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill ❑ Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) ❑ Individual Water or Sewer System ❑ Other (Please Specify) �((d After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3: FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. Dated The Proposed Development: ❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ❑ Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable ❑ The proposed development is located in a floodway. FBFM Pmel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3OF4 SECTION 4:ADDITIONAL INFORMATION REOUIRED (To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: • A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑Development plans,drawn to scale,and specifications,including where applicable:details for anchoring structures,proposed elevation of lowest floor(including basement),types of water resistant materials used below the fust floor,details of floodproofng of utilities located below the first floor and details of enclosures below the fust floor. Also ❑Subdivision or other development plans(If the subdivision or other development exceeds 50 lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofmg protection level (non-residential only) Ft.NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: SECTION 5• PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. ❑ Is B. ❑ Is not in conformance with pro%isions of Local.Law # , 19 . The permit is issued subject to the conditions attached to and made part of this permit. i SIGNED DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked. the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION # _ PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved? ❑ Yes 0 No Conditions SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Comniiance is issued) The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual(As-Built) Elevation of the top of the lowest floor, including basement(in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofng protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES 0 NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8• CERTIFICATE OF OMPLIAN E(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: ELEVATION CERTIFICATE O.M.B. M y31, 7997 1 O.M.H. 0306 /993 I EAERAL E=MERGENCY MANAGEMENT AGENCY tCJI_{;I 19 �CKj6�j I NATIONAL FLOOD INSURANCE PROGRAM ATTENTION:, se of this certificate dols not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevatidn intounatioa:.necesaary to ensure compliance with applicable community floodplain management ordinances,to determine the pro er% r,�g1{um rate,and/or to support a request for a Letter of Map Amendment or Revision(LOMA or LOMR). T� JCtronm8 for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING-OWNER'S NAME, POLICY NUMBER Alexander Williams STREET ADDRESS(Indudng Apt..Unit,Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER . Cedar Point Drive East OTHER DESCRIPTION(Lot and Block,Numbers,etc.) 1000-090-3-19 CITY STATE ZIP CODE Southold NY 11971 SECTION B FLOOD INSURANCE RATE MAP (FIRM)INFORMATION Provide the following from the proper FIRM (See Instructions): 1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX <.DATE OF FIRM INDEX S.FIRM ZONE S.BASE FLOOD ELEVATION 360813 079 D 8/16/93 A-4 (In AD Zones.use depth) 8 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations(BFE): ®NGVD'29 ❑Other(describe on back) 8. For Zones A or V,where no SFE is provided on the FIRM,and the community has established a SFE for this building site, indicate the community's BFE:III I I .IJ feet NGVD(or other FIRM datum—see Section B, Item 7)• SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation CertificateInstructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 2 2(a). FIRM Zones Al-A30,AE,AH, and A(with BFE). The top of the reference level flogr from the selected diagram is at an elevation of[ I 1 1 151.0 feet NGVD (or other FIRM datum—see Section B, Item 7). (Basement) (b). FIRM Zones V1-V30,VE, and V(with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram,is at an elevation of I I I I I I.0 feet NGVD(or other FIRM datum—see Section B, Item 7). (c). FIRM Zone A(without BFE). The floor used as the reference level from the selected diagram Is W.0 feet above❑ or below❑ (Check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is U_I.IJ feet above❑ or below❑(check one)the highest grade adjacent to the building. If no flood depth number is available,is the building's lowest floor(reference level)elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations:Y NGVD'29 ❑ Other(describe under Comments on Page 2). (NOTE., It the elevation datum used in measuring the elevations is different than that used on the FIRM (see Section B, item 71, then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears an FIRM: r I Yes ®No (See Instructions on Page 4) 5.The reference level elevation is based on: ® actual construction ❑ construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A past-construction Elevation Certificate will be required once construction is complete.) 6.The elevation oLihe lowest grade immediately adjacent to the building is:II 1 1 19 L6 feet NGVD(or other FIRM datum-see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level Indicated In Section C, Item 1 Is not the"lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest floor"as defined by the ordinance is: I I I I I I.0 feet NGVD (or other FIRM datum—see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81-31r MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATIOtt J SECTION E CERTIFICATION This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones At—A30,AE,AH,A(with BFE),V1—V30,VE,and V(with BFE)is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones AO and A(without a FEMA or community issued BFE),a building official, a property owner,or an owner's representative may also sign the certification. Reference level diagrams 6,7 and 6- Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment,area use,wall openings, or unfinished area Feature(s),then list the Feature(s) not included in the certification under Comments below. The diagram number,Section C, Item 1, must still be entered. I certify that the information in Sections B and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIFFI S NAME LICENSE NUMBER(or Affix Seal) Roderick_ Van Tnvl T,g2962.6 TITLE COMPANY NAME - Licensed Land Surveyor Roderick Van Tuyl, P.C. ADDRESS CITY STATE ZIP 218 Front St. P 0 Box 8 Greenport NY 11944 SIGNATURE IC? j, Y DATE PHONE June 18, 1996 516-477-0170 Copies should be made of this Certificate for:1)community official,2)insurance agent/company,and 3)building owner. COMMENTS: "Bench mark for elevations established by Suffolk County D.P.W. referenced to NGVD. Elevations observed: basement 5 . 1 ; all utilities at el . 9 .0 first floor 13. 7 ON wm1 ON PILES, SLAB BASEMENT PIERS,OR COLUMNS A V A A v ZONES ZONES ZONES ZONES ZONES REFEPE00E PfFERENCE N�.SE LEVEL REFERENCE LEVEL FLOOD LEVEL ELEVAnON ..: , FLOOD ••\','`::: AQ ENr . REFERENCE F ELEVATON REFERENCE AWACEM aMCE LEVEL AVON LEVEL OMOE bap_r �•t:! 4 ij p: jl: O�MGE The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2 New Yntk State DepartMbnt of trivirant"Ofital Conaerltatlon Building 40 - SUNY, Stony brook, New Vork i 1190-2366 Telephone (516) 444-0366 Aft Facsimile (516) 444-0373 Michael D. Zagata commitsioner May 22, 1996 Alexander H. Williams 2035 West Charleston Street Chicago, IL 60647 RE: 1-4738-01269/00001 Dear Permittee : In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit . Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address . Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather . Very truly yours, t Laura J. Scovazzo Environmental Analyst I LJS/ls enclosure rEJUN1996 If I BLDG.DI-PT. B -TOWNJT IOOLD-..5 95.20-6(91861-35c NEW YORK STA`rt DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1413 -000 Davol. iq�y+{. M1ztea 11ii FACILITY7PROGRAM YOUMRERW r'CtfnF1I 1 EXPIRATION DATE(s) Und@f the trivitoiltiifitltal ConShtvation Law -rw5P— 6 NAY 3/, 1997 Article 15, Title 3; 6NYCRR 27 R608: Article 25: 328, 329 Aquatic Pesticides Water ouality Certification tidal Wetlands Article 15, Title 5: fel Article 17, titles ;j, 8: Article 27, f do `/; 6NYCRR 360: Protection of Water u SPDES Solid Waste Maii2pemont` Article 15, Title 15: Article 19: Article 29, tido 8; ONYCpk 373: Water Supply u Air pollution Control` Haiafdoue W66116 MaPlaoornont Article 15, Title 15: Article 23, f ltlo 27: Articlo A Water Transport u Mined Land Reclamation Coastal l I`661611 Metagement Article 15, Title 15: Article 24: Article 36: Long Island Wells I Freshwater Wetlands Floddplain Management Article 15, Tltle 27: N—Now, R—Renewal, M—Modification, Articles 1, $. 11, 19, 27, 37; Wild, Scenic and Recreational C—Construct ('only), 0—operate ('only) 6NYCRR 880: Radiation Control Rivers P RMIT ISSUED t0 fle�ctr e H. wf�l�a L T ADDRESS O' ;E TEE �%DrA 51-"f.j,C�1ca o Y1— 647q 003 FOR PWERMt f-15 Ml.I_TTEE/�,f 1tM,lW=TrAt1'1Q/�H ON STC s Eft r (. tf�0 tt'� y III 35 5 ELEP7 NE NUMBE-44c)R NAME AND ADDRESS OF PROIECTIFACILItY(If differeht ffonk P&mittee) J! L CATION OF PROIECTfFA ILITV s COUNTypr TOWNICITYNILLAC UTM COORDINATES q,?$ 635fi �rit!{ wt 1f.)11C So1,k,+halo DESCRIPTION OF AUTHORIZED ACTIVITY Construction ex6ansion d f an qxistinq single-familysinglerfamity dwollitiq And mord than 75 ft. latilawatrid.from tho tidal wetiand i boundar or restoration r@co tOuttion of An t! W fi fun t naait . cyte rNc} q t DvIS 10 � 15{tr1� w-01tio ti dt�}Gc,Ijri ( Yl:tcy�. All Wv& c Rc .WI a 5 a R I UNNAl trJNblfI6N9 By icgep(ilite at hill 04ffall,rfhl plfRtitlst Aljfm that fail 0lf6slt it ofilinigal 0060 gifitt eaetyil., Ahce*14h 166 liCL,illipplitiliie fijlli ultdol iad thi ohilliflrthl ittkilled htfetn at#tfithEd ts6flf0. 1 The permittee shall file in the office of Thi ApotopHA%65116011106mllt iciNnis&itbi,al 6t6lt dificl d6iinit6A iR the tbriciil tondiElons,f t164itl br ififePfltiR EB tbrhfnenc! work at least 48 hours In advance of the flint 61 toin(tiltltetKEnf ihd shill alt6 Adtify lithifher proinyk[y 16 Wtlfial of thl'ttimplOCIA of the Work. 2 The permitted Work shall be subject to Inspice6h by AR AuthpHted tEptesenkdfiJl of the bepirkment of t6biloKffllhtil t6fliWafibh Which rhiv 6HIat tNE Work suspended if the public Interest to requires pursuant to kt. $71.6101 AM 00A 1401(1). 3 The permittee has Accepted expressly,by the execution of the applIcAbon,the full fetal responsibillty for ail damages,direct or indirod,bf whativet eAkule,ihd bywhoorrei suffered,arising out of the project described herelo And has Agreed to Indemnify and save haenless the State from sults,action;,damAles add c6it1 of EVEty himl and desttip- tion resulting from the said pro[eck. 4 The Department rrserves theright to modify, suspend or ftwlib this permit it any time After due notice,and, if fequestld,hold A hitting When: a) the scope of the projeyct is exceeded or A viotafion 6f any tonditioo of the permit or provItions of the ECL and pe6Hn4nt regulitioni AM found;or b) the permit Was obttined by.misrepre#nlAticin or failurl to discldie televeNt facts; or c) newly discovered information or signifitiht physical chioges are dls60fi d tinge the pehnit was Hided. 5 The permittee Is responsible for keeping the pe8hik Actibe by lubfnittiht A rineshil Appplicitloh,including thy foh6s,fees of iupplemihtil fdformitiob Which may be required by the Department,no later than 30 days(ted days for SPbES or Solid br Hakarddodi waste Manilemedt pinnits)prior tb the 690141:16A 419%. 6 This permit shall not be construed as conveyinl l.6 the tpp)rcarif shy right to treijIAO dffbil the lands or ihtertefe With the r10itlih Hghti 8t 6ih1H its otter to perform the _ permitted work or As authorizing the impaitrhent 6f any tllhd,title or interiSt fit tEAI or peHonal property held or vested th Is peri6R hat A pAfly to kh@ permit. 7 The permittee Is responsible for obtaining Any other pemillis, Approvals, [Ands, easkinott ihd r1gk1s.61-WiV which MAV be rettuired for this project. A Issuance of this permit by the Department does Rot,uhlaii 6pretsly ptovided for,en6dily,iuothocfa or restihd Ah 6f8hr d8 tonsaht c r defittminalldn by the Cofhnriislonet issued heretofore by the Department of Any at the tenni,bo6diflons,of reiTditemeRts c intAined In Such order or det6huffiitloh. 4 Any modification of this permit granted by ihi bepirt i rill r9ust be in Writing and attached hereto PERMIT ISSUANCE DATE PERMIT AbMINISTh�TOR ADDRESS , i,/ 6 Jaii5 AUTHORIZED SIGNATURE C=age 1 df �'_ ADDITION NAIL 25c ADDITIONAL GENERAL CONDITIONS h0R ARTICLES 15(Title 5), 24, 25, Sd, 36 And 6 NYCkk hart 609( Tidal Wetlands ) 10 That If future operations by the State of New York require an al- other environmentally deleterious materials associated with the teration in the position of the structure or work herein authorized, or project ifin the opinion of the Department. of Environmelital Conservation 14 Any matenat dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to the free havfgation of said shall be removed eveniv,without leaving large refuse piles,ridges across waters or flood flows or endanger the health, safety or welfare of the bed of a waterwav or tloodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the bank+ or resources of the State,the owner may be ordered by the Department to a waterway remove or alter the structural work, obstructions, br hazards caused 15 There shall be no unreasonable interference with navigation by the work thereby without expense to the State, and if, upon the expiration or herein authorized revgc4tion of this permit, ,the, structure, fill, excavation, or other % If upon the expiration or revocation of this permitthe project hereby modification of the watercourse hereby authorized shall not be com- authorized has not been completed.the applicant shall,without expense pleted. the owners. shall, without expense to the trate, and to such to the State, and to such extent and In such time and manner as the extent and in such time and manner as the Department of Environmental Department of Enviromilental Cohservatibn may require,remove all or 'Conservation may require.remove all or any portion df the uncompleted any portion of the ubcompleted structUre of fill and restore the >ite structure of fill and restore to its former condition the navigable to its former condition. No claim shall be made against the State of and flood capacity of the watercourse.No claim shall be made against New York on account of any such removal or alteration the State of New York on account of any such removal or ajteratioo 17 If granted undet Article 36, this permit does not tigmfy in any wav 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*Rich may be caused 18 If granted under 6 NYCRk Hart 609, the NY5 t3epartment of Environ- by or result from future operations undertaken b>i the State for the mental Conservitioh hereby tertlfres that the subject project will not conservation or improvement of navigation,or for dther purposes,and contravene effluent limitations of othet Ilmitatltihs of standards under no claim or right to compensation shall accrue from any such damage Sections 301, 301, 303, 306 and 307 of the Clear1 Water Act of 1977 12 Granting of this permit does not relieve the applicant of the respond- (Pt 95.217) provided that all of the conditions fist@d h@reln are met bility of obtaining any other permisood, consent or approval from 19 All activities authorited by this p@tmlt rFiUst be IR Ofltt conformance the u!i Army Corps of Engineers,U 5 Coast Guard, New York State with the approved plans submitted by the applltAt or his agent as part Office of General Services or local government WbI6 may be required of the permit application. �r ls13 All necessary precautions shall be taken to precldde contamination Such aproved plans Wer@ prepared by� CIS of any wetland or waterway by suspended solids, sediments, fuels, l ,,,F solvents, lubricants,epoxy coatings paints,concrete, leachate or any on .312.04 ��F�17 ph �" 7 slitcIAL CONbithoNs 1. A copy of this permit with supplem@ntary conditions and appwav@d plans must be AVailAble sit- the prajett site Whenever 11.1th6rited Ii is in. progress. 2. The permit sign ent,lo§ed With the permit or a copy at letter 6f AppraVAl must be protected frofi the w@athew Aiid posted in A tonsPitueu§ l6tation at the work site uritis tompi@tion of authorilod work. 3. At least 48 hoot§ prior to COMMeneement of the praj@ct, the perfeittee must complete and r@iurn the top. portion of the enclosed receipt form certifying that he i§' fully AWaf@ df and ander§tands all pw6006ns and conditions of this p@rmit, Within on@ we@k of coltiipl@tics 6f the permitted work; the bottom portion of that fowls must also be rtampieted and returned. 4. If the perroittee intand§ to undertake any project design m6difitations after permit is§UAnt@, the permittee must submit the appwopriAte plan changes for Adproval' by the Regional Permit Adfffinistwatdr pricw to undertaking any such modifications. The p@wmitte@ is Advi§@d that substantial Ihddlfieation may require §ubmissian of A new appiitatian fow permit. 5. Ali repairs to exi§ting structures must be confined to replAteffl@nt of existing struttural @l@meat§ With no change in design, dire@n§ion or materials unl'e§§ §pecificAlly Autharit@d herein, 6. Discharge of Wet or 'fresh coHcret@t leachate or wA§h water from mix trucks, mixer§ 60 othdr d@Vic@s to tidAl Wetlands is pwahibitod, DEC P RMIT NUMBER -Ura 90 a ao i '• PROGRAMIPnY NUMZA WlL page 2 of / 4 95-3661176A-75c YEW v,ORK,Sif,tE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 3Pi:tiAL tdNbitll7N5 For Article 25 ( . . 7idA1 Lletlands i j 7. Contamination of tidal wetland§ And the watof§ of Now York ttAte by 'suspended §slid§, sediments, fu@i§, lubricant§, opdxy e6ating§, paint§, concrete, leachate 60 any otnef environmentally deletoriou§ materials associated with the conduct of the permitted Activity is prohibited, 8. Any debris or @xcd§§ Matoeial from tdnstfuction of thi§ project must be immediately and eompidtoiy a@moved fforn the adjacent Afoa and di§060d of at an apprdved upland site. bi§pd§al of debris in tidal wetlAnds is prohibited. 9. Construction equipment and materials must be stored in upland areas more than 75 ft. landward' of the most landward edge of the tidal wetland boundary. lo. All areas of §dii disturbAhce fe§uiting from this project Must be seeded with an appropriatep@renniai grass seed and mulched with hay or straw within one week of final grading, Mulch must be maintain@d until a suitable veg@tative tdv@f is a§tabli§hod. 11. if seeding is impratticable duo to the time of y@ar, a tempdrtry mulch must be appli@d and final §ooding perfdrmad at the earliest opportunity when weather tondition§ favor gorminatidn and growth; but not more thin six months after projett completion. 12. All disturbed ar@a§ where Oil it tempdrafily etrpdsod or §todkpiled for longer than one month Mu§t be §tabilited with a temporary hay or straw mulch. Mulch must be maintained until A suitabio. vegetative Covet is established. 13. 'Bales' of hay' at 6thor meant to tdntrbi efdsion are to be plated on the downslope edge of any' di§turbod area: This sediment barrier is to be put in ,place .before anyl di§turbAnee of the ground Wur§ and It to be maintained in good ltdndition until all disturbed land is heavily vegetated. 14. Disturbance to the nllturai v@gdtation or. topogfap.hy greater than �S foot seaward of the Apprdvdd §tfuti:06 it prohibited, 15. Driveway And parking krda§ mu§t be constructed of p@rvidu§ material , 16. Roof runoff mutt be difoeted to drywells a minittum at i0 linear feet landward of the tidaliw@tland boundary. 17. Backwash frolril pool filter mu§t be discharged to a dfywoii located a mini mum of io0 iinoar feet landward of the tidal w@tiaiid boundary 18. Draining of swimming Oddi water dif6etly or' indireetiy into tidal wetlands is prohibited, 19. Road, drivewa and/or parking aeon§ frust be graded to diet runoff away from tidal wotlands, 20. Construction of Any decks, accessory §tructure§ or additions that Are not specifically Authoeitod by the Approved plaits that are part of the permit is prohibited., Regional 156tmit Administfatdr NYS Dept, of trivifonmental Conservation Ouilding 40, SUNY = Room 2k 5t6hy Brook, NY 11194 DEC PERMIT NUMBER (tig) 9t1119D6 l- -o►aW oachil FACILITY ID NUMBER _ PROGRAM NUMREA (.�$ P�6 peas 3 of �( IUMWITARt IPbCfAB CONDIt4 The following c6nditi6fis apply to all Tidal *dtiandst krashwatat Wetlands; Coastal i;eoglon hAnAtJeI6ntt and Wild# godhioo and iiedfitationai iti�tata isermits s A. A copy of this pde iAf ihcluding all conditions and approved plandj Shall be dvaiiable at the pfbjedt site whenever authorized wotk iS in ptolrese, the permit signn -encidaed with the parmit shall be protected frbm the weather and pd@ted in a conspicuous location at the work site until all auEhorited work hag been completed, B. The permitted ahall f@quita that any Cdhtradtotp project engineer Ct bthet tarson tfidptit3gibig tot the overall 6 11 00-tvialdn of this pfojadt' teadg, Uhdakgtandg, And complies with ;this paftit and all its gansrai, special, AM gu p93amehtA" spddidl donditiortss MY failure to tromp *Pr@diddiy with Ail of the terms and conditions at th�a psi-mit' uni+agg authotitad in writing, shall be tt@dtdd as a vidiatidh of the Environmental Cons`@rvAtion haw, if Ahy of the ga it conditions Are uhtilsar, the permitted ghali ddittadt the Division of 3teguiatory Affairs at the Addresg on page ' ppe ,or telephoxta , (518) 444-0385, Ce It project ddgigh Iddificatiohs become haegAgAty after permit issuand@, the pa"Atee shall aubtlit the appropriate Plah chdnges tot appedvai by the Regional Permit Adffiih gtrAtdf° pfisf to Uhdattaking any gush moditicatibAss the pefnitt66 is advised that substantial modificatiaA may t@quite Subtingibn at d hew application tot pdtkit, D. At least 49 hours �kidk to commencement of the prejoet, the permitted and tafittadtor &hail sign and taturn the top portion at the' dtiiidadd itotifidation faf certifying that they Std fully swatd of and uhdetatand all terms &hd oohditibhs of this permits Within 30 days of domplgtioh' of the permitted work, the bottom portion of that f6i'm &hail also be signed and return+ad, along with phot89tApha of the completed work And, if required, a SurVey'L E. For projects involving activities to be undertakeh in phases over a peribd bf more than one ydaf, the permittee shdil Notify the Pbgidhal Permit Administrator ih t&iting at least 48 hours prior to recommenaing work ih subsequent years. r. The granting at this permit does hot taiiava the patmittea of the regpohgibiiity of obtaining a t#dfit, ' dademefttr or other hadegdAfj► apVroV&l frof the bivigien at tand Utilization, Offidd of cen@rai Setvides, Tower buildingo Empire State Plaza'r Aibahy, MY 12242 (g15) 414-21051 which may be required fot: any dfldtdAChmaht upon Statd&Milled iandg _, underotaters )) ,1 ` DEC Permit 14e3, I-q rI,50((JJ'�-d/� /Q 1VQQo 1 ytlt}L ,(7 A35 7,92 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: Ae ' DATE ?' INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [/,,�OIUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE r / INSPECTOR a3c�a 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ j INSULATION [ kf FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS,.- A& ' DATE -INSPECTOR "VC,i 765-1802 BUILDING DEPT. INSPECTION [ OUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY RE R a.z4,, 4A"., — i DATE INSPECTO t BOARD OF REALT11 . . . . . . . 7 FORM NO. 1 3 SETS OF PLANS . . . . . . . SPR P 5 TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . BUILDING DEPARTMENT Ct1ECK . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . L TOWN F Tt+OLD SOUTHOLD, N.Y. 11971 -- TEL.: 765-1802 NOTIFY ; (� CALL Examined . . . . . . . �.IL . . ., 19 Y( HAIL TO : . . . . _ . . . . . . . . Approved . . . . . . . . ���. . ., I*95 Permit No. 7L Disapproved,a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )filigns cto r� APPLICATION FOR BUILDING PERMIT Date . .... . . . . . . . . . . .. 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wi 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 str or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this al 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 peg 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 Occup: 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descril The applicant agrees to comply with all applicable laws, ordinances, building cpde,-]�qusing code, and regulations, am admit authorized inspectors on premises and in building for necessary insp6ctions. (Signature ot applicant, or name, if a corporation) 25235 ///,/ice 12041f C-1 TO . . . . . . . . . (Mailing address of applicant) %(43- State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or buil, �./. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . L C��� � .T' LJf�U//r S . , , , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . r.: . . . . . . . . . . . . . 1. Location of land on which proposed work? will be donee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �7. -/ ®lh!•�.� [!iG . . . . . . . . . . . .�v !'T�!�f� . . . . . ... . . . . . . . . . . . . Mouse Number Street Hamlet q County Tax Map No. 1000 Section . . . . . . . . . Block . . P.3 . . . . . . . : . . . Lot . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . (Name) 2. State existing use and Occupancy of premises and intended fussee and occupancy of proposed construction: a. Existing use and occupancy, . .�'! .�7� fi¢f14�GY. � S/®� ��. . . /�� �.} ° . . . . . . . . b. Intended use and occupancy N��� �fFd9(L y . . . . . . .` �'/. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i . -3. Nature of work (check which applicable): New Building . . . , . . . . Addition . . /<, • • • • Alt sti Repair . . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition . . . . . . . . . Other Work .. .. � Viption) 4. Estimated Cost . . . �-`",0e.0 D . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . / (to be paid on fi`'li g ) 5. If dwelling, number of dwelling units . . . . . . . . . . . . . . *Number of dwelling units on each hdio . . . . . . . . . . . . . . Ifgarage, number of cars . . . . . . . . . . :L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of•each type of use . . . . . . . . . . . . . . . . . . . 7. Dimensions of�xisting structures, if any: Front 5G. i7. . . . . Rear. . . .s� . !�Y . . Depth Height Z' %.z, r, . . Number of Stories . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front cr lA .r . . . . . . . Rear . Depth . . . . . . . . . Height . . . . .?. . . . . . . Number of Stories . . . . . -. . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . .Height . . . . . . . . . . . Number of Stories . . . . . . , , , , , , 9. Size of lot: Front . . . l �-I. . 7.: . Rear . . . .�7.-.v. !`:7. . . . . . Depth ✓' �.4?!:".T . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . ... . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . :. . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . © . . . . . . . ... . . . . . . . .. . 13. Will lot be regr4ded . . . . .4-?O . . . . . . . . . . . . . . . . . Will excess fill be removed from re i s Yes �o 14. Name of Owner of premises A'.W!�4!A!�! . . . . . . . Address V. .3.5 4?� ? SI'h `T" '. .. Y9 Name of Architect 641M! f t9 �!'/W . . . . . .Address Phone No. Mo.6:P``e5. . . . Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . Phone No. . . . . .—:`. . . ... . . . t5. Is this property within 300 feet of a tidal wetland? *Yes. .. • . • No. . . . . . . . . *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from ' property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S :OUNTY OF . . . . . . . . . . . . . . . . . (1�OfYJff S �, /Y�.LJ E L S , , , , , , , . , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ibove named. le is the . . . !��/f. !.TES./. . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said,work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief;and that the Cork will be performed in the manner set forth in the application filed therewith. worn to before me this . .day of. . .GGA . . . . . . ., 19 .y6 . . . . . . . . . . . . lotary Publi Count a \ y LN FOPOM . . . . . . . . . . . . . . . . . . . � wk (Signature of applicant) . Ta EVko SVL 3,191-1 SUFFOLK CO. HEALTH DEk. APPROVAL (\j H. S. NO. I'3"5Q'i06 P20PI_i�TV co cNf �f j�_ STATEMENT OF INTIENT p flE 0"E) 97.55 ALEV NDE 4 4 �..('�y�wf��...� f `J THE MATER SUPPLY AND SEWAGE DISPOSAL N.85 05 E. rC TLAN -- - t --___ .... SYSTEMS FOR THIS RESIDENCE WILL DogW_V I L �..-. . At � � � CONFORM TO THE STANDARDS OF THE AT c '1'1_#,J (� SUFFOLK CO. DEPT. OF HEALTH SERVICES. 2UINAS21( of u} o'y% a -mW 15F - 7U- f-lQLL) N.Y. (S) APPLICANT ` i SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF ` CONSTRUCTION ONLY DAT' -TEST HOLE V VACANT) i c H. 5. REF. NO.: /. z•Y' APPROVED- TV+k SUFFOLK CO. TAX MAP DESIGNATION: 1` , SECT. BLOCK PCL.DIST. tt 2AME 'A 'j TF t OWNERS ADDRESS: aa,2. "c"! 2-s RESfUk h I- p!P:v 1 -ry r. Al, CA°27562�5.F l 10 TIE LfNF-,, DEED: L.-74?1 P. $'*.o .-'FZEFF-? TItST HOLE c e SfxM ` jFl S , servevic lh bNo on,iF ��,` , .._ •4atim 7208.f he New VaK Ab/e F.'.vicelian law. + ` Ceptes alhis mmy map nM MaiiM , f I `b, tielari.aseNwnsnwbaconslm se LOAM l beavaAOtnnxp} � �l f � ,�� GuereMeeetndMedhrpwon Meer, WytoftpsrmforwhoretheseNey , � y .-.----.. -. _ 4/E a"GrePart4 AnI1Mh4 belulf:o Np ELEVA RDN5 11E=f_E__ .O MEAN SEA LEVEL. +'pa �.yarw E� onNerry•9owmmeMel rc SANG le-dmg Institution listed hereon and tut G.s.nl prthe wittanf.ru tut c uara Icc.ara not trensfereEp VVV { F 4 'C•JOv^prbUbSegUNll { - kp � \ its 4;< �� MAF RNENG'kG D(C.I8}19$6 �D23,I6e Q . � ✓ �� �' ; `' j ` L� JLI Y-231957. APR.9 1496; SEAL iii L,, Z L, l JUhIE to 9% x•-, ,. GC! TEED TO NORM R3RK K cKTO ly _ fiYJI"C; - FtF1 °G��� aG<s S i.l.(?T NQ;L QEF'Eg 7TJ.._. P QFC—VAR- 15 ___. .!{� f 1AY1 . 6 II BEACH PA V—, THE 5 R ED IN UF'F CO >)� RQ{� I `K VANTUYL. P.C. --�'i CLEF 5 OFFICE'A5 P Itit99i3. LICENSED LAND SU—! 5E ` --• --- ` KW Oita °IANv s�P°yL �.f;LWE) ZCJ�IE OATA; CQt-MUW ,FANEL. I 1 i r'"'�� GftEt#*OR,T NEW YORK ir `^ 6nG1I 1 fyt *.., Lq G �J m2GR3 Qe -104" SCJ l�-- vis PA NECI „i• •n'it. - t`5; `?e'�el. .h;"L.=7�y�, � I W t 'I tiLr. D �FffL } p� n �` 1� r - l T ✓A -) Z 3 �j 1 /' z li I I r I�'�. �jx.-. �s1u.3C'ww'. �cJ'��• ` 0 pr�.v l�.l A:�y Hlu-•I Q O SITE DATA t C/) U) N e3 or• ' c ' ' 06 w SCTM # 1000-090-03-19 f L'n Z ° 0 0 PROPERTY: 425 East Cedar Point Drivel? V) 'C � O ADDRESS Southold, NY 11971 ci Q CCL nIi > c O OWNER: ALEXANDER H. � Z WILLIAMS 0 r ( N 2035 West Charleston Street 1 LU (•-) Chicago, IL 60647 Tel # (708) 990-13701 JCU fl W SITE: 27,562 square feetLO I AREA II �->'-1 N SURVEYOR: Roderick Van TuylI ry Greenport, N.Y. 11944 License # LS 25626 _ _ -----'(- Dated: 5/19/86 _ _- — - - -- L� ,;--r M Amended: 12/23/86 - - NOTES: Elevations shown are based on NGVD , Flood Zone Data Commun Panel #360813-0079C - Zone A4 j. rat '.•� T �. E-XI=:.r' rJc Z _ F.�I`�TINGI L.bO� SHEAT- ' _ SYr2•�';_I-1 ro F(2^t-/'INCA G 61 DIN CT �• �'�I CT � � / I 'NEW l7EG:: Fu-_,.1,e. ,.. - - _ y-,P, lav, IVIN aoI\Ti � w < r - L CxISTIIJy FlNlgrl L'C7 ,�- �� -TYPE 'x" We" c1-+P, w. -� k3�5E Td M>.7'O-4 - v oN GXISTINy FINI51-1 � G+:ISTINCy Z / - �\ m., J \ r 5 =T 711 . r c+�FLP GTI NIy - � 3/4" F>LY L�on+o I .�, �F'ti,aaLP Gxl STING q �- l a IST r v u wig a 'TF , mar 2,� 1836 $ T P �>" '� r OF t' _ l Pr act No: FOLINCA(:itE �^• ten\\ �� c's Drawn By: T ooTINU V3 •. G rLo.L.i L_ a- - Q Checked By: Date: 3 .i2��90 \� 7r0 y� �� I F..:-l�P•JJ Scale: u = 2cp1 �.] I ��%•���� _� C1�_ J Sheet Tit le SITE �° THc , coNp, PLUMBERCERTIF/CATION PLAN e��3 ON LEAD CONTENT BEFORE APPROVED AS NOTED_ PROVIDE OPENINGS FOR -DATE: IA- s.P.# �L CER CATE OF OCCUPANCY EMERGENCY ESCAPE AS FEE: a 390 -- ev: PLUMBING SOLDER USED IN WATER REQUIRED BY PART. 714 OF NOTIFY BUILDING DEPART ENT A ALL PLUMBING WASTE 765-1802 8 AM TO 4 PM FOR THE t4 WATER LINES NEED SUPPLY SYSTEM CANNOT N.Y. STATE BUILDING CODE. FOLLOWING INSPECTIONS: ` TESTING BE1'ORE COVERING EXCEED 2/70 OI 1%LEAD. 1. FOUNDATION - TWO REQUIRE FOR POURED CONCRETE Sheet No: OCCUPANCY OR 3. IR SULATIONRAMING & PLUMBIN If Copper tubing isuswd PROVIDE%OR.FIRE USE IS UNLAWFUL 4. FINAL - CONSTRUCTION MUS 'BE COMPLETE FOR C ALL CONSTRUCTION SHALL MEE for water distributing RATED SEPARATION TO WITHOUT CERTIFICATE THE REQUIREMENTS OF THE N. 11r—� ,� system; piping shall be PARL 717.3(f)(1) OF L I V�N� f� L��� of types K or Lon OF OCCUPANCY STATE CONSTRUCTION ENERG N.Y. STATE BUILDING CODE. cocas. NOT RESPONSIBLE Fo IIIYn a I,_Q„ UNDERWRITERS D�F%ATE DESIGN OR CONSTRUCTION ERROR R EQ 38• lo" V,LF1 38 -10" vI.F. ---------- --- ?� O 2-"C, s - 4•-0„ .Icl_o1' k. ,41_0,1 �,� i.�, 1;y , P(LO r-A,1S n J 5 n w <s WocE W O z- 210 y.�7oLfd LE _ l JK.K 5 LJpO i.�.1GN- _ / v P¢o v110 o -N F1NI6N o NIhLL el oE,�1a1Ci '' A F- 5vE+' TYi°- K ' YR. by I: � 0 _ 5 IIT �4: - - - o / -�� : BETWr=rIN G4 — C ALU 3lvl biti +� U°*X, vL 3 _ 3 \ u1 �- o 'Neal ' _ Fl PL•1c C LJ� � . _ \ ., a 1 4.doo TLl✓ TR_IPF_ F,L, d_� T21PLE- F,J ,-v z - ' ' vv .V- 1a v = s C'6 6 c FJ6}VI / —tea. <LL v /p W bJALL OW N I ELoW L 6 Nfil.Fl \ X\></ ri v x N 2n10 oIF" 2 to 010 s Y" / 1 � - _ /I \ g'_a" Yeo ALlvlll N FLO R- PVt,..Ml l ,1 DN /\ v v� , ' .• / / /� / \ / . .mF ,,dt H1 W Lr - J r La - � 3Vi LLY _: Is N PLus E T1V1JE I' v T +.1PLE k1NG1 sTiJV� My \TRv�ti= d •-/ .. /,' `�i TO Tow DF ry. 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R, PLYW� i I � - -4 - \- 4 i Project No: q 4 19 / - SHEF1-IWC ) - O 44 �MfJ� r Drawn By: u �4D IL PRO�/IOC f�LJTTCh-- ¢ l9 I �h �'I HVfs IZU� IJ IE �� �� FI=17 � vEJT "TrI� aoNc I � t N Checked By: TB f7l14o1�n�1 �b�N ,�I cup6 TYN �� - - - __ �r'IzoN w/ " �� 1;11 r-4 r, E�.M _ _ - 2.8 0 48"o.c _ Date: I ARA L-. - 11 Ct `Y o.l',ov� I i I Scale. I/#,i� ��� .�i� I � I I�� IIII lil 1 a I C RN tdL E. N, GA2aGc 24 !' I' n YI Sheet Title: 'I U II'I I' i I, ' V I 1 I roc+R 0' 1 L ' SII F'� � � I I FIRST I/II I I Zr4 CYF I I Trio= F.orJC, IW/ 6kC. /,e I.J W NreA PI2otiJ aSAP L � F - r---- FLOOR PLAN I III III �_ I I I I I iI III I i I ---- - — - - - --- -;� � BUILDING <'Zc�Jc, FaUJrTION &" rNt coNc, j SECTIONS & FoaTIELEVATIONS r 4' N4 OIJNI ION - Sheet No: 2Z-O " I vOUTI —I ELE�/.�.TION E3LIL- C:;,IT-- 1G 6EcTION FLOC? F2 PL_ AI�I