HomeMy WebLinkAbout27788-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28156 Date: 01/09/02
THIS CERTIFIES that the building ADDITION
Location of Property: 1077 BAY HOME RD SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 56 Block 5 Lot 39
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 29, 2001 pursuant to which
Building Permit No. 27788-Z dated OCTOBER 15, 2001
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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
ZBA #4988 DATED 9/20/01.
The certificate is issued to KEVIN M SHANNON
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
u or' ed Signature
Rev. 1/81
FORM NO. 3
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)
PERMIT NO. 27788 Z Date OCTOBER 15, 2001
Permission is hereby granted to:
KEVIN M SHANNON
1077 BAYHOME RD
SOUTHOLD,NY 11971
for
REAR DECK ADDITION TO A SINGLE FAMILY DWELLING AS APPLIED FOR WITH
ZBA, DEC AND TRUSTEES CONDITIONS AND FLOOD PERMIT
at premises located at 1077 BAY HOME RD SOUTHOLD
County Tax Map No. 473889 Section 056 Block 0005 Lot No. 039
pursuant to application dated MAY 29, 2001 and approved by the
Building Inspector.
Fee $ 250 . 00
h&r-ized Signature
ORIGINAL
Rev. 2/19/98
Form No.6
TOWN OF SOUTHOLD r��
BUILDING DEPARTMENT +,
TOWN HALL i, r .JAS► 7 ;oi?
765-1802 L
f�t_tst1—��--
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-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 1%lead.
5. Commercial building, industrial building,multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses,or buildings and"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic
features.
2. A properly completed application and a consent to inspect signed by the applicant, If a Certificate of Occupancy
is denied,the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$25.00,Additions to dwelling$25.00,Alterations to dwelling$25.00,
Swimming pool$25.00,Accessory building$25.00,Additions to accessory building$25.00,Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Photocopy of Certificate of Occupancy-$ 0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential$15.00, Commercial$15.00
Date.
New Construction: Old or Pre-existing Building: f (check one)
Location of Property: 1 0-7 40 M E. R,t, _SO L TH p v„p
House No. Street Hamlet
Owner or Owners of Property: K I (; 4 P,N N 0 10
Suffolk County Tax Map No 1000, Section OSI. Block O o cos Lot 0 3R
Subdivision Filed Map. Lot:
Permit No. p j'7 8$-Z.- Date of Permit. I v - Applicant: K�.i (`'�. }��toN o N
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ 0 0
�� 1510
G U,�'�Cl�/ Applicak ignature
APPEALS BOARD MEMBERS O�OSVFFO��►C
OG Southold Town Hall
Gerard P. Goehringer, Chairman �� y� 53095 Main Road
James Dinizio, Jr. y Z P.O. Box 1179
Lydia A. Tortora W_ • Southold, New York 11971
00Lora S. Collins y�0 a�! ZBA Fax(631)765-9064
George Horning Telephone(631) 765-1809
BOARD OF APPEALS
TOWN OF SOUTHOLD
FINDINGS, DELIBERATIONS AND DETERMINATION
MEETING OF SEPTEMBER 20, 2001
Appl. No. 4988— KEVIN SHANNON PARCEL 1000-56-5-39
STREET & LOCALITY: 1077 Bay Home Road, Southold
DATE OF PUBLIC HEARING: September 20, 2001
FINDINGS OF FACT
PROPERTY FACTS/DESCRIPTION: Applicant's property consists of 24,733 sq. ft. The property
is 104.76 ft. wide x 224.72 ft. x 109.42 ft. x 229.30 ft. The June 6, 2001 map prepared by Peconic
Surveyors, P.C. show the stone rip rap and wood platform area along the beach area and the
existing single-family two-story frame home, situated approximately 87 feet from the Bay.
BASIS OF APPEAL: The Building Inspector's July 5, 2001 Notice of Disapproval disapproved
applicants request for a six ft. deck at the rear of the house for the reason that the deck addition is
less than seventy-five (75) feet from the rip rap/bulkhead, citing Section 100-239.4B of the Zoning
Code.
RELIEF REQUESTED: Proposed addition at the rear of the dwelling, extending 6 ft. from the
existing porch area, and extending for a length of 42+- feet wide. The setback is proposed at
roughly 62 feet from the rip-rap.
REASONS FOR BOARD ACTION, DESCRIBED BELOW: In considering this application, the
Board finds that:
1. Grant of an area variance will not produce an undesirable change in the Character of the
neighborhood or a detriment to nearby properties. The
proposed uncovered deck addition for a new deck will increase the depth of the existing porch by
six feet and lengthen it by 14 feet.
2. The benefit sought by applicant cannot be achieved by some method, feasible for appellant to
pursue, other than an area variance. The rip-rap structure is functional as a barrier between the
waters edge and upland property. The deck will be 75 feet or greater from the Bay.
3. The requested area variance is not substantial. The amount of relief requested is 14 feet at its
closest point, which will meet 81% of the requirement.
4. The proposed variance will not have an adverse effect or impact on the physical or
environmental conditions in the neighborhood or district. No evidence has been submitted to
suggest that the proposed uncovered deck and porch extension will have an adverse impact on
physical or environmental conditions in the neighborhood.
RESOLUTION/ACTION: On motion by Member Dinizio, seconded by Chairman Goehringer, it was
Page 2—September 20, 2001
' Appl. No. 4988—Kevin Shannon
1000-56-5-39 at Southold
RESOLVED, to GRANT the variance as applied for.
VOTE OF THE BOARD: Ayes: Members Goehringer (Ch ' n), Dinizio ortora, Collins, and
Homing. This Resolution was duly adopted (5-0).
ERARD P. GOEHRIN ER, CH RMAN
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVAL
DATE; July 5, 2001
TO Kevin Shannon
1077 Bay Home Rd
Southold NY 11971
Please take notice that your application dated May 30, 2001
For permit for deck addition at
Location of property 1077 Bay Home La . Southold
County Tax Map No. 1000 - Section 56 Block 5 Lot 39
Subdivision Filed Map# Lot#
Is returned herewith and disapproved on the following grounds proposed construction not permitted
pursuant to Article XXIII Section 100- 239AB which states;
All buildings located on lots upon which a bulkhead, concrete wall,riprap or similar structure exists
and which are adjacent to tidal water bodies other than sounds shall be set back not less than seventy-
five(75) feet from the bulkhead.
Deck addition scaled at+/- 62 feet from riprap.
Authoriz ignature
PM Or 5OUTHOLD PMPERTY M CARD
^OWNER STREET V GE DIST'( I j SUB. LOT
vpj
FORMER OWNER E ACREAGE
•t:i� �' Z��C1v
S WTYP E OF BUILDING
RES. I SEAS. I VL I RM I comm. IND. CB. I MISC.
LAND IMP. TOTAL DATE REMARKS
t Dd 3 cJ aQ
37
v
}:
a-t> v o O L�o
X
AGE o a DING C NDIT ON 7 ' r
NEW NORMA BELOW ABOVE
Farm Ar r/ Value Per Acre Value
Tillable 1
Tillable 2 '
Tillable. 3
Woodland
Swampland I S—
3rushland
House Plot
-' TOWN OF SOUTHOLD PROPERTY RECORD CA"A D
OWNER STREET {;? "` VILLAGE DIST. SUB. LOT
t,
FORMER OWNERZ'`2.�- Kkaf fny N E ACR.
SSL U3. 1 f, �eCU to-JI , i7
Pei el0stan Le S -• W TYPE OF BUILDING
RES. c;7!Q SEAS. VL. FA , COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL ATE REMARKS
sn ' au
FRONTAGE ON WATER
Tillable 11Q
vVoodland FRONTAGE ON ROAD
Meadowland DEPTH
-louse Plot BULKHEAD
rotaI
ppi
Board Of Southold Town Trustees
SOUTHOLD, NEW YORK 1
li
7�D
DATE: Feb. 22, 2001
PERMIT NO.
r
KEVIN SHANNON
ISSUEDTO ----------------------•-...-...-....._....._.. ._.- ....-"--"...-
. �
t Pursuant to the provisions of Chapter 615 of the Laws of
A the State of New York, 1893; and Chapter 404 of the Laws of the
x State of New York 1952; and the Southold Town Ordinance en-
titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
_ REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;':.`: and in accordance with the
Resolution of The Board adopted at a meeting held on --Feb. 212
2001:--, and in consideration of the sum of $....50.00 paid by
.Kevin.Shannon.............................................................................-..........
....._....
Southold- N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
Wetland Permit to expand the existing deck.
r
_ all in accordance with the detailed specifications as presented in
.the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and thesepresents to
be subscribed by e•majority of the said Board as of this date.
Alberti. Krupski, Jr.-Absent
Ln
Artie Foster - Absent
j -� �•l•!�t �� Trusties
APPLICATION
PAGE 1 of 4 --
TOWN OF SOUTHOLD
FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
This form is to be filled out in duplicate.
SECTION 1• GENERAL PROVISIONS (APPLICANT to read and siQn):
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. I,THE APPLICANT,CERTIFPEB
ALLTATEMENTS HEREIN AND W ATTACHMENTS TO
_ THIS APPLICATION ARE, TF MY KNOWLEDGE,TRUE AND ACCURATE.
(APPLICANT'S SIGNATURE) DATE 10 O
SECTION 2: PROPOSED DEVELOPMENT(To be completed by APPLICANIn
NAME ADDRESS TELEPHONE
APPLICANT
BUILDER
ENGINEER
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.
FDP(93)
APPLICATION.
PAGE 2OF4
DESCRIPTION OF WORK (Check all applicablc boxes):
A. STRUCTURAL DEVELOPMENT
ACTIVITY STRUCTURE TYPE
O New Structure O Residential (1-4 Family)
❑ Addition O Residential (More than 4 Family)
❑ Alteration O Non-residential (Floodproofmg? O Yes)
❑ Relocation ❑ Combined Use (Residential & Commercial)
❑ Demolition F ❑ Manufactured (Mobile) Home (In Manu-
0 Replacement factured Home Park? ❑ Yes)
ESTIMATED COST OF PROJECT S
B. OTHER DEVELOPMENT ACTIVI'T'IES:
O Fill ❑ Mining O Drilling O Grading
❑ Excavation (Except for Structural Development Checked Above)
O Watercourse Alteration (Including Dredging and Channel Modifications)
O Drainage Improvements (Including Culvert Work)
❑ Road, Street or Bridge Construction
❑ Subdivision (New or Expansion)
❑ Individual Water or Sewer System
❑ Other (Please Specify)
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:
O Is MI located in a Special Flood Hazard Area (Notify the applicant that the application
review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED).
• O Is located in a Special Flood Hazard Area.
FIRM zone designation is
100-Year flood elevation at the site is: Ft. NGVD (MSL)
❑ Unavailable
O The proposed development is located is a floodway.
FBFM Panel No. Dated
❑ See Section 4 for additional instructions.
SIGNED DATE
APPLICATION #
PAGE 3OF4
SECTION 4 ADDITIONAL INFORMATION REQUIRED (To he completed by LOCAL ADMINISTRATOR
The applicant must submit the documents checked below before the application can be processed:
O 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 specificatipns,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 floodproofing of utilities located below
Che first floor and details of enclosures below the first 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. O Is
B.O Is not
in conformance with provisions of Local Law . 19 The permit is issued subject to the conditions
attached to and made part of this permit.
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 bearing from the Board of
Appeals.
APPLICATION a
PAGE 4 OF 4
APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No
Hearing date:
Appeals Board Decision --- Approved? O Yes ONO
Conditions
SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance
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 floodproofmg 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 ❑ NO
DATE BY DEFICIENCIES? ❑ YES ❑ NO
DATE BY DEFICIENCIES? OYES ONO
SECTION 8: CERTIFI _ TE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR)
Certificate of Compliance issued: DATE: BY:
Attachment B
SAMPLE
CERTIFICATE OF COMPLIANCE
for Development in a Special Flood Hazard Area
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA
(OWNER MUST RETAIN THIS CERTIFICATE)
PREMISES LOCATED AT: PERMIT NO.
PERMIT DATE
OWNERS NAME AND ADDRESS: CHECK ONE:
❑ NEW BUILDING
❑ EXISTING BUILDING
❑ VACANT LAND
THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW:
A. COMPLIANCE IS HEREBY_ CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_
SIGNED: DATED:
B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LOCAL LAW # , 19_, AS MODIFIED BY VA.RiANCE # ,
DATED
SIGNED: DATED:
CIC(93)
lown
�ITEi T. TERRY t �— " - t\lau, (toad
1 ; rr .S�-�i hV VV\ P.O. Roy 1 174
TOWN CLERK ~ "�
� � •'�: Southold. Nckv Yt,rk 1 I')71
• .✓ �.- Faa (516) 765.1R'_1
!t);GISfRAR OF VITN.STA-IlS'IICS � - ,O
MARRIAGE•.OFFICER _ y� 7 Tcicphonc (5 1 6) 765. 1 HO 1
(kECOR!)S MANAGEMENT OFFICER / I
FREEDOM OF INFORMATION OFFICER 1 �=
OFFICE OF THE TOWN CLC/RK
TOWN OF SOUTHOLD
i
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 :
RESOLVED that the Town Board of the Town of Southold hereby adopts
two (2) new forms to be used under the Flood Damage Prevent regulations
of the Code of the Town of Southold: "Floodplain Development Permit
Application" [FDP(93) ] , and "Certificate of Compliance for Development in
Special Flood Hazard Area (C/C(93) ] .
_ - V
SL:✓G. DEFT.
TOWN OF SO?JI�+OLD
f�
Judith T. Terry
Southold Town Clerk
August 25, 1993
BUILDING PERMIT EXAMINER CHECK LIST
DATE REVIEWED: lO /h'/O1
.DATE SUBMITTED:s /x/01
APPLICANT NAME: � a �� ovroflgy_ 9��/
SCTM# DISTRICT: 1,000 SECTION: BLOCK: LOT:
STREET: 14 y cnn .�� , CITY: SUBDIV. NAME: N A
PROJECT DESCRIPTION- (ReA;Z-) A-5 '?4-�7 R 01-1,k )bcctj-Pvs7p�
ARCHITECT
/ENGINEER: LI/A FAST TRACK? Nc /
SINGLE& SEPARATE CERTIFICATION-REQUIRED?—15[—NOTES:
LATS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LATS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83;
ZONING DISTRICT: CONFORMING? A10
REQ.LOT SIZENotOOO ACT. LOT SIZE:ay tI REQ. LOT COV. .a� ACT. LOT COV. G o/
REQ.FRONT `f0 PROP. FRONT t 0 Q SIDE /-T-/3 ACT. SIDE 7"
REQ.REAR 300PROP. REAR
�ior" e;p2�"«d
WATERFRONT? K 01!:� DESCRIPTION: npu -ca(I
PANEL #: FLOOD ZONE:T
AGENCY PERMITS REQUIRED FOR REVIEW
APPROVALS RE UIRED:
SUFFOLK COUNTY HEALTH DEPT: YES 00MIPED#): DTE:—/—/ PERMIT#:R10-
NEW YORK STATE DEC: PRE TC 9/1/7 or NO
SOUTHOLD TOWN TRUSTEES: or NO
TOWN ZONING BOARD APPROV or �� _ 0/off
TOWN PLAN. BOARD APPROVAL: YES of
TOWN HISTORICAL PRE (SPLIIA): YES o1�O
NYS ENERGY: YES ORO: NIS
EGRESS (18 H min.?4 sq total)4*4
E VENT(SQ. FT. x4%) N LIGHT(SQ. FT. x 8%)BUILDINGPE OPEN/EED: BP -Z/C/O Z-
HAVE PRE CO f�R BP -Z/C/o Z- ,
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR : SF
SECOND FLR : SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE
'OTT SF)- ( SF)= SFX$ _$ +$ /�d +$ /_$ i �v
. 802
B
WING DEPT.
SPECTION
[ UND ON 1ST [ ] ROUGH PLBG.
] F DATION 2ND [ J INSULATION
[ ] FRAMING [ ] FINAL
[ J FIREPLACE HIMNEY
REMARKS:
_-T
DATE O` �� IN8P
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS CATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE 8 CHIMNEY
REMARKS:
Ajo
DATE � DY Q v INSPECTOR �j
rISLD INSPOCTION`"PORT •- MATS - .� _ COMMENTS r J
��•-�•-•�----•+C�'L�ai�- -x��t'xaL-ice e�T•"-1F�=�a�Cr�=ice=� ---sbCxs�•�---�aisaax:��SCL^=aST�O--LCCiaOt
00
FOUNDATION OST)
iDATION (2ND) L a
r . .
kOCH FRAME &
PLUMBING '
QQ
INSULATION PER N. Y.-* .
(a
d
STATS ENERGY
CODE P�
O
zz
FINAL Cn
ApDITIONAL COHMMS:
7Z
o
JL
Ck
o
LA)
BOARD OF HEALTH . . . . . . . . . . . . . . .
-FORM NO. 1 —3 SETS OF PLANS
TOWN OF SOUTHOLD ---SURVEY . . . . . . . . . . . . . . ... . . . . . . .
BUILDING DEPARTMENT —CHECK . . . . . . . . . . . . . . . ... . . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971 DEC . . .. . . . . .. .. .... ... . ...
TEL: 765-1802 TRUSTEES . . . . . . ... . . . ...... . . . .
NOTIFY:
CALL
Examined.................. 29.... MAIL TO: . . . . . . . . . . . . . . . . . . . .
Approved..............II... ....... Permit No. ................ ...................................
Dia/c .............. .............. ...............................
................................
. • .••••• .
(BuildingInspector)
30
APPLICATION FOR BUILDING PERMIT
.. Date.npfy. . . . . . . . . 20E?I. .
INSTRUCTIONS
a. 'This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wi
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 mist be drawn on the diagram which is part of
this application.
c. The work covered by this application my not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such
permit shall,be.kept on the premises available for inspection throughout the work.
' e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein
described. The applicant agrees to cc"Vly with all applicable lawstture (-
nanrPs, betilding cam, lam+_Lsinb code, anc1
regulations, and to admit authorized inspectors on premises and inng for necessary inspections.
�. .................f applicant, or name, if a corporation)
(Mailing address of applicant) 1 k1-7 l
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
.......avzrY%.R1\'_� ....................................................................................................
Name of owner of premises 14A M.4!N3........................................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.........................................................
(Name and title of corporate officer)
Builders License No. .........................
Plumbers License No. .........................
Electricians License No. .....................
Other Trade's License No. ....................
1. Location of land on which proposed work will be done..............................................................
...!o:2Z........ . y....l oM�...� .......... :..........Lk.. .1..................
House Number Street Hamlet
County Tax Map No. 1000 Section ......5(a...... Block ...PS........ Lot ..-?..l..........
Subdivision ...................................... Filed Map No. ............... loot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .......� ...............................................
b. Intended use and occupancy ...... ¢:5.��? ?.t..!g :..............................................
�•.,u,.c ui wuta ku pt:cx miiva a14)►icao►e/: New Wilding .......... Addition .......... Alteration ........
Repair ............ Removal ............. Demlition ............ Other Work FeNT"15J v n1.,A1�... It>.Fi.Cr.
(Description)
4. Estimated Cost .. . I S,jst): ..... fee ..............................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............ Number of dwelling units on each floor ................
Ifgarage, number of cars ......................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use......................
7. Dimensions of existing structures, if any: Front..a�0�.�'��...... Rear .��.� ��..... Depth g....�1..........
i
Height ....A!�..4.1!44:N...... Number of Stories .................
Dimensions of same structure with alterations or additions: Front .AA..Q....... Rear
Depth ...PM.9' "Q�.... Height .....1A............. Number of Stories ...............
8. Dimensions of entire new construction: Front ................ Rear ............... Depth ..............
Height ......................... Number of Stories .....................
9. Size of lot: Front ....1.0`fr.77b....... Rear .....t"t 41'...... Depth .aa: ..........
10. Date of Purchase ....�.+.`� ......... Nacre of Former Owner .I F(�kr... i R;Y..l' oR N y _........
I. pone or use district in which premises are situated ........ o..... o�..„��ES i�. ,J`f 1-AL.....................
12. Does proposed construction violate any zoning law, ordinance or regulation: .................
13. Will lot be regraded ....t,�Q............ Will e3wess fill be removed from premises: YES NO
14. Names of Owner of premises �i£hal tJ. :S+)r'!NNOt ., gess ���...fly 6MF 4D1 o�ITN o�D Phone No, 7 6 S.at�$.
Name of Architect .................................... Address .............................. Phone No. ..............
15*11;-
Name of Contractor Q.F-X .4-R...�•.!.Pl�l�s....... ... Address�:�°.O R.....C .......... .Y .Phone No. ...
..
15. Is this property within 300 feet of a tidal wetland? * YES ..�/...... NO .......... X31- 987-461s
*IF YES, 9MMD MM TRIMMS PEFMT MAY BE MQUIRFD.
-TVLuST VE-5 °r J�bEx— Q Ui-m fl--S
PLOT DIAGRAM C-V�GL-.DsE t,
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
from property lines. Give street and block amber or description according to deed, and show street names and indicate
whether interior or comer lot.
SfAlr of Nil Yom,
SS
comfy of .S.L1xpo: ..
i ........
.....lak j[J....'..I t..Jam.t-�l=}t�2 N a'�.................being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract-)
above named, ,�
lieis "lie .......... !u 5J-1. ...............................................•----......................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
......:3 0........day of .....�AA4 ....-.20 O.1
Notary Public .. .....
...... .1,......,t... .. ...........
(Sr , tune ofMCAAppli.c• t)
I Ol> 152 Stab"of w
..... ......... .. ter.
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER EFFECTIVE DATE
1-4738-02869/00001 18 May 2001
FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S)
Under the Environmental 18 May 2006
Conservation Law
TYPE OF PERMIT■New ❑ Renewal ❑ Modification❑ Permit to Construct ❑ Permit to Operate
❑ Article 15,Title 5: Protection of Waters ❑ Article 17,Titles 7,8:SPDES ❑ Article 27,Title 9; 6NYCRR 373:
Hazardous Waste Management
❑ Article 15,Title 15:Water Supply ❑ Article 19:Air Pollution Control
❑ Article 34: Coastal Erosion
❑ Article 15,Title 15:Water Transport ❑ Article 23,Title 27: Mined Land Management
Reclamation
❑ Article 15,Title 15: Long Island Wells ❑ Article 36: Floodplain Management
❑ Article 24: Freshwater Wetlands
❑ Article 15,Title 27: Wild,Scenic and ❑ Articles 1,3, 17, 19, 27, 37; 6NYCRR
Recreational Rivers ■ Article 25:Tidal Wetlands 380: Radiation Control
❑6NYCRR 608:Water Quality Certifica- ❑ Article 27,Title 7; 6NYCRR 360:
tion Solid Waste Management
PERMIT ISSUED TO TELEPHONE NUMBER
Kevin M. Shannon (631)765-2978
ADDRESS OF PERMITTEE
1077 Bay Home Road, Southold, NY 11971
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
Kevin M. Shannor (631)765-2978
NAME AND ADDRESS OF PROJECT/FACILITY
Shannon Property, 1077 Bay Home Road,Southold 11971
LOCATION OF PROJECT/FACILITY
SCTM: 1000-56-05-39
COUNTY TOWN WATERCOURSE NYTM COORDINATES
Suffolk Southold Southold Bay E:718.0 N:4550.0
DESCRIPTION OF AUTHORIZED ACTIVITY
Expand existing deck, approximately six (6)feet seaward. All work is to be done in accordance with the attached
plans stamped NYSDEC approved.
By acceptance of this permit,the permittee agrees that the permit is contingent upon strict compliance with the ECL,all applicable
regulations,the General Conditions specified(see page 2&3)and any Special Conditions included as part of this permit.
PERMIT ADMINISTRATOR: (KSW) ADDRESS
George W. Hammarth, Deputy Permit Region 1 Headquarters
Adminstrator Bldg.#40,SUNY, Stony Brook, NY 11790-2356
AUTHORIZED SIIG RE/NAT DATE l
� Page 1 of 4
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SURVEY OF PROPERTY
16,o
A T SO UTHOLD
ti
TOWN OF SO UTHOLD
Alp ti_ SUFFOLK COUNTY, NEW YORK
NQS o �G �►„✓ -.� 1000-56-05-39
SCALE: 1"=30'
�f '�� MARCH 2'7, 2001
,9<� 1 FA F �� APRIL 30, 2001 I revision -
J'0,4� Q lune 6, P001 lodditionsJIV
JUN 13 2001 L�
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FIRM ZONE AE(el.8)
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TO TIE LINE
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ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VZOLATION rycl PECON I(I F.C.
OF 3ECT117N 7209 OF THE NEW YORK STATE EDUCATION LAW (631) 76 FAX:(631) 765-1797
EXCEPT AS PER SECTION 7209-SUBDIVISIDN 2• ALL CERTIFICATIDNS P ❑. BOX 909
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF ■ =MONUMENT �
�? 1230 TRAVELER STREET 00 - 2
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 40 =PIPE i SOUTH�LD, k Y 11971
WHOSE SIGNATURE APPEARS HEREON,
Y
. �° SURVEY OF PROPERTY
A T SO UTHOLD
' F�2
TOWN OF SO UTHOLD
SUFFOLK COUNTY., NE W YORK
s
I•,,. 0- 1000-56-05-39
�
� � ,�,� SCALE: 1 "=30'
• � QQ �� / ��� GL. MARCH 27, 2001
F
APRIL 30, 2001 f revision 1
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ANY ALTERATION OR ADDITION 70 THIS SURVEY IS A VLOLATION PEC�NIC SURVEY S,;� 70 0631) 765 - �0 �C' FaX� 65-1797
OF SECTION 7209 OF THE NEw YORK STATE EDUCATION LAW. f/jr
EXCEPT AS PER SECTION 7209-SUBDIVISION 2 ALL CERTIFICATIONS P, Ll, BMX 909 fD LAN
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF ■ =MONUMENT
� 1230 TRAVELER STR � 0
SAID MAP 17R COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 0 =PIPE r SCUTHOLD, N,Y. 11971
WHOSE SIGNATURE APPEARS HEREON
Y
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1
APPR VED AS NOTED
B.P# 2 S
i FEE. BY:
NOTIFY BUILDING DEPARTMENT AT
/X�f flEG+k/Nli E X/ST!/VG fb RG/f 765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
I. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2 ROUGH • FRAMING & PLUMBING
r x sr/•,A/4 e-04fl.,{s - 3 INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION
THE REQUIREMENTSHALL MEET
OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE
DESIGN OR CONSTRUCTION ERRORS
fj -1 f f/T"IlI1� DEGrrC
/ ly"x I /YANGakY
OCCUPANCY
USE IS UNtAWFUL
WITHOUT CERTIFICATE
.mac, CN 2X8 ..p5e_,k OF OCCUPANCY
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