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HomeMy WebLinkAbout26457-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27988 Date: 10/05/01 THIS CERTIFIES that the building NEW DWELLING Location of Property: 1240 GLENN RD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 2 Lot 30 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 29, 1999 pursuant to which Building Permit No. 26457-Z dated APRIL 20, 2000 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 COVERED FRONT ENTRY, REAR DECK AND ATTACHED TWO CAR GARAGE AS APPLIED FOR. The certificate is issued to JOHN DEVEAU (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-99-0011 08/27/01 ELECTRICAL CERTIFICATE NO. N 563673 07/11/01 PLUMBERS CERTIFICATION DATED 10/02/01 CHARLES SANDERS Authorized S' nature Rev. 1/81 i 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. 26457 Z Date APRIL 20, 2000 Permission is hereby granted to: JOHN DEVEAU 37 GLENWOOD ROAD GLEN HEAD,NY 11545 for CONSTRUCT NEW ONE FAMILY DWELLING W/ATT. 2 CAR GARAGE COV. FRONT PORCH & REAR DECK AS APPLIED FOR & TO CONDITIONS OF THE TOWN TRUSTEES. at premises located at 1240 GLENN RD SOUTHOLD County Tax Map No. 473889 Section 078 Block 0002 Lot No. 030 pursuant to application dated JULY 29, 1999 and approved by the Building Inspector. Fee $ 792 .40 Above fee includes $100.00 Flood Permit C c Authoriz Signat ORIGINAL Rev. 2/19/98 Form No. 6 3/_ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 .property with accurate location of all build ' gs property lines streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerag D , 3. Approval of electrical installation from Board of Fire Underwr ter'. 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. 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 Buildin2: - $100.00 3. Copy of Certificate of Occupancy - .25V 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. . . . . . . . . . . . . . . . . . . . . . . . . r . . . . . . . . . . . Location of Property. ./cR.V42. . . . . . �,�tvc`. . �. . . . . . . . . c?���1 l�v��. . . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property..butt.�C. : ,/ :�i�y/f�GY.� Y.�q�4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. .. ?VI . . . . .Block, .p f d. a. . . . .Lot—Q&.0 . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. .R76Y: . Za.Z. . .Date Of Permit. ��v0O . . .Applicant- 4)//�►:�::��'4��I�!� � �4 r Health Dept. Approval. . . . . . . . . .. . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A.PPLICANT Town Hail,53095 Main Road C* Z Fax(516)765-1823 P.O. Box 1179 Telephone(516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: O Building Permit No. 6 �_S 2— .7-owner: (please print) Plumber: f�li.rt%j (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before this day o 39 Notary Public, County everly J. Perkowski Notary Public, State of New York No. 01 PE5G11 uff t County Term Expires THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1001290 BUREAU OF ELECTRICITY 40 FULTON STREET, NEW YORK, NY 10038 Date JULY 11 ,2001 Application No. on file 10772100/00 N 563573 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of JOHN DEVEAU, 1.240 GLENN ROAD, SOUTHOLD, NY in the following location; ® Basement O 1st Fl. ❑ 2nd Fl. GAR/ATT'1C/OUT Section Block Got was examined on JUNE 26,2.001 and found to be in compliance with the National Electrical Code., FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 31 3] 35 29 ?. l 10.1 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT-7 WATTS 3 F SERVICE DISCONNECT NO.OF S E R V I C E METER AMT. AMP. TYPE EQUIP. 1 1 2W 1 1 JW J a 3W ®4W NO.OF CC COND. A.W.G. NO.OF HI-LEG A. A.W.G. PER/ OF CC.COND. OF HI-W'LEGG' NO.OF NEUTRALS OF NEUTRAL 1 200 CB 1 X 1 3/0 1 3/0 OTHER APPARATUS: 1 CO DETECTOR-1 PADDLE FANS-4 WELL PUMP-1 G.F.C.T:-7 S14OKE DETECTOR:-4 L L C-CAT CO. /DAVE CHESHTRE ELECTR LIC. #953 E 92£30 SOUND AVE GENERAL MANAGER 14ATTMICK, NY, 1 l q 9 2 Per TiThis certificate certificate must not be altered In any manner;return to the office of the Board If Incorrect. Inspectors may be identified by their credentials. p C I JUDITH T. TERRY ; .~ F„?•.- '' :'� Town Hall. 53(195 Niain Road N P.O. Rox 117() t TOWN CLERK Southold. Ncw fork 11071 REGISTRAR OF• VITAI,STATISTICS O� Fax (516) 765-1923 MARRIAGE OFFICER _ . �j �� TcicPhonc (516) 765-1801 RECORDS MANAGEMENT OFFICER Ol I FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD 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) ] . --, DEPT. TOWN OF SO:-(MOLD ,�/�Judith T. Terry Southold Town Clerk August 25, 1993 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 sign): 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,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO _ THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE,TRUE AND ACCURATE. (APPLICANT'S SIGNATURE DATE J d SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICAN'n NAME ADDRESS TELEPHONE APPLICANT !'fi fLyiy471 0ZetyV �d��tc �'7 �.L�'�/wo07 BUILDER ENGINEER PROJECT LOCATION: • To avoid delay is 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. so 4'C i�oli7 FDP(93) APPLICATION r PAGE 2OF4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE 'New Structure CWResidential (1-4 Family) ❑ Addition O Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofmg? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured (Mobile) Home (In Manu- ❑ Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECTS O 0, 69 0 B. OTHER DEVELOPMENT ACTIVITIES. ❑ Fill ❑ Mining O Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) 9Individual 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: ❑ 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). O Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) O Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3OF4 SECTION 4• ADDITIONAL INFORMATION REQUIRED fTo 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 first floor,details of floodproofmg of utilities located below the 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). ❑ Floodproofcng 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 an 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 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 # PAGE 4OF4 APPEALS: Appealed to Board of Appeals? ❑ Yes O No Hearing date: Appeals Board Decision --- Approved? O Yes ❑ No 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 floodproofing 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 fTo 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? OYES ❑ NO DATE BY DEFICIENCIES? OYES ONO DATE BY DEFICIENCIES? OYES ONO SECTION 8: CERTIFICATE 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 # , 19AS MODIFIED BY VARIANCE # DATED ' SIGNED• DATED: C/C(93) SUFFoc/r Town Hall Albert J.Krupski,President 53095�/1, 53095 Main Road James King,Vice-President 1 P.O.Box 1179 Henry Smith y Z Southold,New York 11971 Artie Foster p Ken Poliwoda A O�� Telephone(516) 765-1892 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 29 , 1999 John & Marilyn Deveau 37 Glenwood Road Glen Head, NY 11545 Re: SCTM #78-2-30 Dear Mr. & Mrs . Deveau, The following action was taken by the Board of Town Trustees during a Regular Meeting, held on March 24 , 1999, regarding the above matter: WHEREAS, JOHN & MARILYN DEVEAU, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated February 23„ 1999 and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations , and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on March 24 , 1999, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of JOHN & MARILYN DEVEAU, to construct a single family dwelling 75 ' back from wetland line as described in application, a 50 ' non-turf, non-fertilized buffer landward of wetland line and haybales place at 50 ' contour line during construction of house. Located: 1240 Glenn Road, Southold. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES : None Very truly yours, ae �. 1444e"- oq� Albert J. Krupski, Jr. President, Board of Trustees AJK/djh CC . DEC Dept. of State Bldg. Dept . TOWN OF SOUTHOLD PROPERTY RECORD CARD � . lova � 3 � � tw( o OWNER STREET /1 VILLAGE DIST. SUB. LOT sa4� r ' FORMER OWNER E ACR. z` i S W TYPE OF BUILDING 74 RES. �/ SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS / S rte C _ z 60 e v 5 Iro 91167ce 25oo ,39 •o7/oO I 8,500 ,! ` Aj Tillable 1 Tillable 2 "illable 3 Voodland wampland FRONTAGE ON WATER ; rushland FRONTAGE ON ROAD louse Plot DEPTH BULKHEAD 'otal DOCK ■■■■■ ■■■■■I■■■■�l���l■■■■■■ ■■■■■■■ ■■■Oii■■■■i■i■■■■■■■ ■■■■■�■ ■■■■■I■■■■■■■■■■■■■■ ■■■■■ ■ ■■■■■I■■■■■■■■■■■■■N E ■■■■■■■�■■■■■■■■■■■■■■■ �■■ ■■■■■■■ ■■■■■■■■■■■O■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ Foundation EMM Basement '-Ext. Walls Interior Fin ish 'Fire Place �■c R1� L:�TTLiIAl>1�1�11 �- -'�i ./wVA1AY�G� i•.r -• , •• , 1� r .. • : ype Roof Rooms I stFloor Rooms 2nd .. © MM e MEN_ ONE -MEMEMENSIONMEN Foundation Basement Ext. Walls Fire Flace Rooms I st Floo Wo" ZQ 00 _ _ TOWN OF SOUTHOLD PROPERTY RECORD CARD o ' r OWNER _ STREET �3 VILLAGE DIST. SUB. LOT, FORMER VWNER 1 N E ACR. I c S W TYPE OF BUILDING RES. =,2/c SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS o Ivo IZ2 • G jg/� 1 a D-o 7 e -v ,l 7 1/17 F`/ 4,1' J 9 FSlf 0-tn l.- 'hew alw v ll �r 1"77, 0 s O WOOO BUI DING CONDITI N N EV& ORMAL L W ✓ B FAW Acre Value Per Value .,f Acre Tillable 1 Tillable 2 Tillable 3 JVoodland 3wompiand FRONTAGE ON WATER 3rushlond FRONTAGE ON ROAD -louse Plot DEPTH BULKHEAD LOP Total DOCK WN OF SOUTHOLD PROPERTY RECORD CARD (� 'F-9,') - _p 0 t 0 Lr 7 77 O��ER STREET VILLAGE DIST. SUB. LOT SJJ 76'ao FORMER OWNER.,,, wi N E ACR. 12-1 V, Z, jf 7�C S W TYPE OF BUILDING ES. SEAS. VL. FARM Comm. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS i1000000o b) Q Ar- A 'y 7 2— 23 -'to F 94-nf 4,4. F A0'y q.,;,e 4 w 5-po -�Clo AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value v Acre -illable I 'illable 2 'illable 3 Voodland wompland FRONTAGE ON WATER rushland FRONTAGE ON ROAD louse Plot DEPTH BULKHEAD oto I DOCK COLOR TRIM �. 01J_ Bath Dinette Floors K. Interior Finish LR. Heat DR. Rooms 1 st Floor BR. , oo Rooms 2nd Floor FIN. B. BUILDING PERMIT REVIEW CHECK LIST Applicant/ Date Owners Name Reviewed: 17, If, Architect/ Date Engineer: Submitted: 02 SCTM#: b District: x,000 Section: 1O Block: Lot: 3� Project /fj� Subdivision Location: �� �,d/ Name: Single&separate Required ��/��� certification: (Yes/No) LL ) Req. Req. Zoning District: [Lot size: Actual: 1 [Lot coverage Proposed:_ Req- Req- I! p i�� Req' / [Front Yard IE Proposed: / 1 [Side Yard Proposed: [Rear Yard �s Proposed: Project Description: AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YDS/ Number Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plage Elevation ??? Awl ' Flood Zone: / GC to • zo v ,� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE- Important: ERTIFICATE_Im ortant: Read the instructions on pages 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number John Deveau BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 1240 Glenn Road CITY STATE ZIP CODE Southold New York 11971 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) 1000-78-2-30 BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) Residential LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: (_)GPS(Type): or ##.#####°) LJ NAD 1927 LI NAD 1983 LJ USGS Quad Map LI Other: SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1. NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE Town of Southold 360813 1 Suffolk I New York B4.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX B7.FIRM PANEL 88.FLOOD 69.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVEIREVISED DATE ZONE(S) (Zone A0,use depth of flooding) 36081300166 G May 4, 1998 May 4, 1998 AE 8 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. I_I FIS Profile 1 X FIRM lJ Community Determined U Other(Describe): B11. Indicate the elevation datum used for the BFE in B9:X_J NGVD 1929 IJ NAVD 1988 LJ Other(Describe). B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? JJ Yes [—]t No Designation Date: SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: I lConstruction Drawings' IJBuilding Under Construction' IFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 3 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations—Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARAE,AR/A1-A30,AR/AH,AR/AO Complete.ltems C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B,convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate,to document the datum conversion. Datum Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 1J Yes I X I No ❑ a)Top of bottom floor Including basement or enclosure) 10 1 ft.(m) ca ❑ b)Top of next higher floor n ft.(m) a ❑ c)Bottom of lowest horizontal structural member(V zones only) _ft.(m) o o ❑ d)Attached garage(top of slab) —ft.(m) E ❑ e)Lowest elevation of machinery and/or equipment W d servicing the building 10 1 ft.(m) E ❑ f)Lowest adjacent grade(LAG) ft.(m) Z ❑ g)Highest adjacent grade (HAG) ft.(m) �N ❑ h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade 8 ❑ i)Total area of all permanent openings(flood vents)in C3h sq.in. (sq.cm) J SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. I certify that the information in Sections A, 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 tine or imprisonment under 18 U.S. Code Section 1001. CERTIFIER'S NAME LICENSE NUMBER John C. Ehlers 50202 TITLE COMPANY NAME T.and S„rvavnr John C Ehlers, Land Surveyor ADDRESS CITY STATE ZIP CODE Riverhead . NY 11901 SIGNATURE DATE TELEPHONE W Ortaher 1, 2001 631-169-8288 FEMA Form 1- 1,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number 1240 Glenn -Road CITY STATE ZIP CODE Company NAIC Number NY 11971 SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) Coy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company, and (3)building owner. COMMENTS 1_I Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed– see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) E2.The top of the bottom floor(including basement or enclosure)of the building is I—L-1 ft.(m) I_L—Iin.(cm) I_I above or 1-1 below (check one)the highest adjacent grade. E3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is I-I-I ft.(m) I l lin.(cm)above the highest adjacent grade. E4.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 1 I Yes 1_1 No 1_1 Unknown The local official must certify this information in Section G SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or community-issued BFE)or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE - DATE TELEPHONE COMMENTS I_I Check here if attachments SECTION G'-COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B,C(or E),and G of this Elevation Certificate. Complete the applicable item(s)and sign below. G1. 1_1 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. 1_J A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO, G3. I_I The following information(items G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEiOCCUPANCY ISSUED G7.This permit haa been issusd for, LI New Construction 1—I Substantial Improvement G8. Elevation of as-built lowest-floor(including basement)of the building is: _ft.(m)Datum: G9. BFE or(in Zon6' * 'JVPi4 61fkoding at the building site is: t _ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I_I Check hee if,adadhments FEMA Form 81-31,AUG 99 s REPLACES ALL PREVIOUS EDITIONS FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number John Deveau BUILDING STREET ADDRESS(Including Apt..Unit,Suite.and/or Bldg. No.)OR P.O. ROUTE AND BOX NO. Company NAIC Number 1240 Glenn Road CITY STATE ZIP CODE Southold New York 11971 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) 1000-78-2-30 BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) Residential LATITUDE/LONGITUDE �.(//O�PyT.µI�OyNAL) HORIZONTAL DATUM: SOURCE: U GPS(Type): or ##. 0) [_J NAD 1927 LI NAD 1983 LI USGS Quad Map LI Other: SECTION B-FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER 82.COUNTY NAME 63.STATE Town of Southold 360813 Suffolk New York 134. MAP AND PANEL B5.SUFFIX 66,FIRM INDEX B7.FIRM PANEL 68.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) 360813CO166 G May 4, 1998 May 4, 1998 AE 8 B10. Indicate the source of the Base Flood Elevation (BFE)data or base flood depth entered in B9. 1_I FIS Profile I X J FIRM 1J Community Determined IJ Other(Describe): 1311. Indicate the elevation datum used for the BFE in B9:X_1 NGVD 1929 1_1 NAVD 1988 U Other(Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 11 Yes I-g No Designation Date: SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations,are.based on: I_IConsiruction Drawings' 1_1Building Under Construction' I XIFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number (Select the;;building diagram most similar to the building for which this certificate is being completed - see. pages 6 and 7 If no,diagram accurately represents the building, provide a sketch or photograph.) C:3. Elevations T Zones A.1-A30,AE;AH,.A(with BFE),VE,V1-V30, V(with BFE),AR,'AR/A,,AR/AE,AR/A1-A30, AR/AH,AR7A0 ' Complete Iterrls.C3a-i below according to_the building-diagram specified in Item C2.State the datum used`. If the'dat6rn is different from the;datuR used forahe BFE in,Section B,convert the datum to that used for the BFE.Show field measurements and datum convorsior,' calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? I_J Yes I X I No ❑ a)Top of bottom floor(including basement or enclosure) 10 1 ft_(m) ; ❑ b)Top of next higher floor n �a ft. (m) a ❑ c) Bottom of lowest horizontal structural member(V zones only) —ft.(m) N ❑ d)Attached garage(top of slab) 00 —ft•(m) E ❑ e)Lowest elevation of machinery and/or equipment w ° servicing the building 101 ft.(m) ❑ f)Lowest adjacent grade(LAG) ft.(M) z ❑ g) Highest adjacent grade (HAG) ft.(m) ❑ h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade �� C1 i)Total area of all permanent openings(flood vents)in C3h sq.in. (sq.cm) J SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. I certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code Section 1001 CERTIFIERS NAME LICENSE NUMBER John C. Ehlers 50202 TITLE COMPANY NAME DT.R4„r�raynr Tc,hn C ADDRESS Ehlers, Land Surveyor ESCITY STATE ZIP CODE SIGNATURE NY 11901 DATE TELEPHONE 2nOl 631 -369-8288 FEMA Form 1- 1,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS(Including Apt., Unit.Suite,and/or Bldg. No.)OR P.O.ROUTE AND BOX NO. Policy Number 1240 ._ ciad CITY STATE ZIP CODE Company NAIC Number 11971 SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Cody both sides of this Elevation Certificate for(1)community official, (2) insurance agent/company, and (3)building owner. COMMENTS 1_1 Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed– see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2.The top of the bottom floor(including basement or enclosure)of the building is LII ft.(m) 1_1_Iin.(cm) I_I above or 1_1 below (check one)the highest adjacent grade. E3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is I_I_I ft.(m) L—I_Jin.(cm) above the highest adjacent grade. E4. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 1_1 Yes 1_1 No 1-1 Unknown The local official must certify this information in Section G SECTION F-PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME --- -- ADDRESS CITY STATE ZIP CODE -- SIGNATURE - — DATE TELEPHONE .COMMENTS _ e`P Check,here If attachments f SECTION G­-7 COMMUNM, INFORMATION (OPTIONAL) 1_ IThe local official who is authorized bylaw or,drdinarice to adminisfef the,communi s flood Iain mane ement ordinance"ca com tete ty p g p Sections A, B,C(or E),and G of this Elevation Certificate. Complete the applicable item(s)and sign below. G1. 1 I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. Lj A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO, G3. 1_1 The following information(Items G4-G9)is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEiOCCUPANCY ISSUED G7.This permit hoe been issued for: , 1_I New Construction �I Substantial Improvement G8. Elevation of as-built loyn est,floor(including basement)of the building is: —ft.(m)Datum: G9. BFE or(in Zone* h Oct flooding at the building site is: ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I_I Check here if,adadhments EMA Form 81-31,AUG 99 ` —, 4, REPLACES ALL PREVIOUS EDITIONS � l� l., � � l�.'$ .�C+�•. `V �lr• ! l � T`s=/1a' 'Sr,.rw��—� �/• lTs�/�/'�-��7�j��J��:;3 7. iiTt _. w. •�F`:,�a�L �2�Tf�"J.�►:ac_.__.— —=�'::•L�C.moi�_-�n�.._ �.r'.s� .-.•n,_ -•nrt:-_ -n � i^ 4Board Of Southold Town Trustees f SOUTHOLD, NEW YORK PERMIT NO. �. 7 � DATE: ......_3/24/99. . JOHN &...MARIL.Y...D..EVEAU................. ..........._.... _........... ~� . ISSUED TO .............................. Auf4nrtzafiun .h Pursuant to theprovisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the 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 ..31.2.4/.99........ 19...9.9..., and in consideration of the sum of $...1.5.0..QQ ... ... paid by lti ........ ....J.OHN....&....M.ARIi,.YN_ DE.V.EAU . ........... of .........soutnola......................_ _ ._....... . N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: f Rr` Wetland Permit to construct a single family dwelling 75' back �- from wetland line as described in application, a 50' non-turf, non., !; fertilized buffer landward of tt wetland line and haybales placed at ` 50' all in ec ordancerwih ct�iesde ei`ea sp°eci�ications as presented in the originating application. ` IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. i oma, p ..... .c «. ! w CJ Trustees ,. % _ .a:._r .,.. ♦ .a.-t--..._.f�.•�F_y—F-'*sn_�1..+*F+.�.-�-�:- ��..—F..�. v.-�.. fit„!: �QSVFFO��C Town Hall Albert J.Krupski,President �•Z.� �l/,y 53095 Main Road James King,Vice-Presidento 1 P.O.Box 1179 Henry Smith Southold,New York 11971 Artie Foster p �� Ken Poliwoda y Telephone(516) 765-1892 1 �a0 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 22, 1999 John & Marilyn Deveau 37 Glenwood Road Glen Head, NY 11545 RE: SCTM #78-2-30 Dear Mr. & Mrs . Deveau, The following action was taken by a poll of all the Southold Town Board of Trustees on April 21, 1999 : RESOLVED, that the Southold Town Board of Trustees grant the request for an Amendment to Permit #4970 to add onto the rear of the house as shown on the survey dated 2/4/99 . Located: 1240 Glenn Road, Southold. However, this determination is not a determination from any other agency. If you have any questions, please call our office at 765-1892 . Sincerely, ae4.A.j 9 Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. ti ELIZABETH A.NEVILLE,TOWN CLERK RECEIPT 074819 Town of Southold Southold,New York 11971 g hone:516-765-1809, DATE RECEI ED OF: 4 FOR: -A ❑CASH CK � I � BY. LETTER OF NON-JURISDICTION John F. DeVeau 37 Glenwood Rd. Glen Head, N.Y. 11545 Date: January 8, 1999 Re: 1-4738-02131/00001 DeVeau Property Glenn Road Southold, N.Y. 11971 SCTM # 1000-78-2-30 Dear Mr. DeVeau: Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that: The :property landward of the 10 foot elevation contour as shown on the survey prepared by John C. Ehlers on November 18, 1998, is beyond the jurisdiction o= Article 25 (Tidal Wetlands) . Therefore, in accordance with the current Tidal Wetlands Land Use Regulation-c (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act . Please be advised, however, that no construction, sedimentation, or disturbance o an-.- kind may take place seaward of the tidal wetlands jurisdictional boundary, a= indicated above, without a permit. It is your responsibility to ensure tha= all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i . e. a 15 ' to 20 ' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that this letter does not lieve you of the responsibility of obtaining any necessary permits appr als from other agencies . Jr ' truly y s, j V Jo -A. Wiel De uty Permit Administrator CC: BMHP , File Town Hall Albert J.Krupski,President �.�.0 �/ 53095 Main Road James King,Vice-President o 1 P.O.Box 1179 Henry Smith CO* = Southold, New York 11971 Artie Foster p Ken Poliwoda A ��� Telephone(516) 765-1812 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 22 , 1999 John & Marilyn Deveau 37 Glenwood Road Glen Head, NY 11545 RE: SCTM #78-2-30 Dear Mr. & Mrs . Deveau, The following action was taken by a poll of all the Southold Town Board of Trustees on April 21, 1999 : RESOLVED, that the Southold Town Board of Trustees grant the request for an Amendment to Permit #4970 to add onto the rear of the house as shown on the survey dated 2/4/99 . Located: 1240 Glenn Road, Southold. However, this determination is not a determination from any other agency. If you have any questions, please call our office at 765-1892 . Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. AP­ .��T.�J,.� ^Y•.t_'L_-s•i _sus-.�C�.._ ..r r..Y s'F�- - ..,aT.' 'trlRL:-_ Y.'�--. ... Board Of Southold Town Trustees , ; :w SOUTHOLD, NEW YORK PERMIT NO. DATE: ....3./24/99 JON & ! ISSUED TO ...... . ....... ...H. MAR.ILYD. EVEAU_ .. .___.. __. _. Y' !9 f A Pursuant to the provisions of Chapter 615 of the Laws of y;p the State of New York, 1893; and Chapter 404 of the Laws of the 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 ..V.2V.9. 9........ % 19...9.9..., and in consideration of the sum of $...1.5.0..0.0 .. .. paid by �• JQHN.... C...MARIL.YN.. D.EV.EAU _ ....................................:..................... }E, of ........squthold................................. ................... 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 construct a single family dwelling 75' back from wetland line as described in application, a 50' non-turf, non., !; fertilized buffer landward of tt wetland line and haybales placed at w 50' ell in eccordancerwiFh ct�iesde ade�sp°eci�icafions as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these Presents to �* be subscribed by a majority of the said Board as of this date. • .ry Tal o . .... ............ . . �........ . ............ ��........ ... : Trustees 1 r C OMCE OF THE TOWN CLERK {Otl� TOWNOFSOUTHOLD Application No.a a ELIZABETH A.NEVUI..E,TOWN CLERK P.O.BOX 1179 Construction SOUTHOLD,NEW YORK 11971 a Alteration Telephone O,j� Q`c $10.00 -Residential (516) 765-1801 �Ol �� $25.00 -Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for JUL 2 9 1999 CONSTRUCTION or ALTERATION PERMIT [own Clerk Soutnold SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE 7 APPLICANT NAME: ,, O -v- APPLICANT ADDRESS:& 2 D SEPTIC CESSPOOL_1,:�-_ DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION ejL_L ► Kk LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: ?/ J,Ef/L�,�/ OWNER MAILING ADDRESS: s`�/�e -c-s ez_, c c/� OWNER PROPERTY ADDRESS: ,-/J/ /f D Lt 710 1,D IV )l TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section 7 Block Lot CROSS STREET:- BUILDING TREET:BUILDING PERMIT NUMBER CROSS REFERENCE: 1 Si ature of pplicant RECEIVED BY: Town C erk's Office DATE: T65-1802 BUILDING DEPT. INSPECTION [ FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: e3 01 DATE 4J INSPECTOR �-�' T65-1802 BUILDING DEPT. INSPECTION /FOUNDATION DATION iST [ ] ROUGH PLBG. 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPL CHIMNEY RE KS: DATES 4� INSPECTOR ass-ieo2 BUILDING DEPT. INSPECTIO [ ] FOU ATION IST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ , FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: aAl-o-,j Al�� fo DATE INSPECTOR �� M-1802 BUILDING DEPT. 2 INSPECTION �6 [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 SOLATION [ ] FRAMING [ FINAL [ ] FIREPLACE A CHIMNEY REMARK ( -- O` l/ SPECTO M.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ NSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR 4 suanINc DE". INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING Ae 14 FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ol C� vZtl�c DATE IN8PECT0 .i " - i - - - - - - - - - - ONMW "— lilitilill MA e ► -� L� ✓ i i �r� • i la��. • TOWN OF 'SOUTH&,D SURVEY 1/ . . . . . • , , , , _ , ", BUILDING DEPARTMENT CHECK . . .' . . �.��. . . . . . , , . TOWN HALL SEPTIC FORM . . . . . .. . . . .. . . . . . . . SOUTHOLD, N.Y. 11971 - TEL: 765-1802 NOTIFY: n CALLu-- Examined. WOD ... �. .., .... MAIL TO .7. Approved. �•.1• ...W. Permit No. ................ (.�f�ig:.lT.. �.�............ Disapproved a c .................................. ...1.�..,1... �l:?.. ..... ..................................................... _ ....�Buildi .... ........... . .or) 2 9 'I0 APPLICATION FOR BUILDING PERMIT Date. . . BLDG. DEPL INSTRUCTIONS TOWN F S UTHOLD a.� 'lois application mist 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 must be drawn on the diagram which is part of this application. 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 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 BEREBY MATE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances-or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. the applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. . ..................................................... (Signature of applicant, or name, if a corporation) -d.7 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ......0-44� ............. / ,�y� ............... Name of owner of premises ��7i?�,/C, /. .. 4. � ..................... 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............. ................................................ ...............r....... c). !J......................�:o..u�:Tt.��?.�.................. House NumbeStreet hamlet County Taos Map ND. 1000 Section v.7 e....... Block ...0 .2— ............. Lot 3 0 � " 11 _ ...... Subdivision .lull ;5 �jc ,C ,�.5'�1.`�( XFiled Map No. .... Lot .../.1....... (Name) 2. State existing use and occupancy of premises and intended use and ,,/ icy of proposed construction: a. Existing use and occupancy ....../v 0/�. .............. ............................................ b. Intended use and occupancy .....S//���`... !�! L/..................... .F!L,TTY'OO2.l IS-1 ,3 ftY wvO to 91s,3.w1d 19 y-iAtoN VlnuoO JllottuO ni beild&aQ I Nature of ° work (dieck which applicable): New Building Addition Repair ............ Removal ............. Demolition ............ Other Work .�........Alteration............... 4. (Description) estimated Cost ......................... fee ...... ...... .. ..... ...... ............ to be paid on filing this application) S. If dwelling, number of dwelling units ............ If tkvber of dwelling units on each floor ................ �r�, number of cArs ........s ............... 6. If business, commercial or mixed occupancy, specifynature and d extent of each type of use. 7. Dimensions of existing structures, if any: Front................ Rear •-............... ... ' ..... Depth .:. .......... .. Neigh .`....., Height ......................... Number of Stories ...... ..i,, Dimensions of sane structure with alterations - or additions: Front ............... Rear ...... Depth .................... Height ......... .................... Number of Stories .............;;+ ; 8. Dimensions of entire new construction: Front ........... 7 ..... Rear .......... .... Dep Height ......................... Number of Stories ......... ... 9. Size of lot: � :1� 7 F�ron ..;! t Z.-1/2 -7.... Rear .................... Depth 10. Date of Purchaseo ....�/..�.,�...... Name of .................... Dormer Owner .zv% 11. Zone or use district in premises are situated ., .,fA-:� lJ.,�t�r,R ... ......... 12. Does proposed construction violate any zoning law, ordinance or /1/ ......................... .. regulation: ... D,,,,,,__,.,.••., 13. Will lot be regraded ...... ;E s......,_ Will excess fill be removed from premises: YeS NO v- 14. Names of Owner of premises� ,E�W 0--?Z)SP.�r,� L /d . q- .,.,7 Name of Architect fj% / OrE.7>................. Address .............................. Phone No. .�. `; .... Nave of Contractor ...C�. ..!��!�.................. Address ............................... No. .... 5. Is this Property within 300 feet of a tidal wetland? * YES .......... NO .�.... *1F YES, SQT1lM 1Cl[a TRDSIEES pMUT MAY BE IST M. 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. fAlT; (r- NISI YU, WNIY Or S V�lV_ SS .......... ..y`��/ .��l:L,y/�''.����'•��.�T. � being duly sworn, deposes and says Name of individual signing contract) po Ys that he is the applicant bove named, e is the ............ ...ow v.�.a,(- ....... ............................. (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 hat the work will be performed in the marnerset forth in the application filed therewith. worn to before me this .......FQ�...day of 19.Q9 Notary Public .. ......... .. 0013ERT QuoWNed In Su(follt . -G� wry Publk.Ststa of (Signature O Applicant) ... ...... No.01 lbnn Expir s May 31 SURVEY OF LOT # IAF MAP OF WEST GREEK E5TATES 51TUATE: BAYVIEW N TOWN OF 5OUTHOLD SUFFOLK COUNTY, NY w e E SURVEYED II-18—q8 / 0 AMENDED 02-04-14 SUFFOLK GOUNTY TAX # S 1000 — 78 — 2 —30 GERTIPIED TO: / - 0a Ci I JOHN P. DEVEAU A,;F 11 i Wf;ll � � exte, .1nc� dwelling 150' from pr000vv-16� V4611- 0 110,� Test Hole obtained 12-8-98 at hi tide Yy/ (not Voltscale) "cicA IC - 0.0 0.8 'I brow 6 05e Pt„9ht i brow i SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES 11.5' GROUND e 1 , WATER �,ght PERMIT FOR APPROVAL OF CONSTRUCTION FOR A ..no 6INGLE FAMILY RESIDENCE ONLY s�6DATE -^ 0-- HS REF NO. 1 0�54�O �� 1 APP90VED I 49 .16 r FOR MAXIMUM OF—*BEDRO S q WIRES"THREE YEARS FROM DATE OF APPROVAL •, NOTES: 0 MONUMENT POUND- -/' .� 'Unauthorized alteration o atldition[a a Survey O PIPE POUND k F�/�/ map bearznog a eCcenned 1andraurveyor s seal is a .v vimetlan r 9 do 7209. sue elvision 2. of the G [(' New York State Education Law G`7 S }✓' ) 'Only copies irpm the original of this survey HEDGE .� � L�'� <,° ,Z� �F9 �.p m n �o �tAA �*` arked wlcn a oMginal at the lane au veyar e stamped seal anal]be considered to be valid true 1 1(� copies' AREA = IG,8g7 SP OR 0.46 AG 'Certifications indicated hereon elgnify that this e ngCode ofrP Practiepared ce accordance adopted by the Naw York State Association of Profeaeionai ELEVATIONS RIPER TO NGVD '2a "` * ;z Land SNrveyors. Said certifications shell run only Y f b p`� O to the person for het the survey]a oreparetl. '+. and on nls behalf to [he clue company governmen- "� tai agency antl lending institution listed herepn, and N to the assignees of the landing In stl tutlon. Certzflon- 50202 J4i dens are not transferable to addicinnal in cat pa- tiS�Q LA NQ SJP " N.Y.S. LIC. NO. 50202 GRAPHIG SCALE I = 30' JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REFERENCE # 96-277D SURVEY OF LOT # 14 MAP OF WEST GREEK E5TATE5 51TUATE: BArYVIEW N TOWN OF 5OUTHOLD SUFFOLK COUNTY, NY e W _ -_ E SURVEYED II-18-a8 v AMENDED 02-04-aa 02-23-aa, 07-28-aa S r;1-1 1.I SUFFOLK GOUNTY TAX # 1000 - 78 - 2 -30 / Glen n 1?0ad GERTIFIED TO: �j JOHN F. DEVEAUe / tK I I i ` O \A Flood Zone Designation �+��� Zone nX F - o zo 7-7/-- -- -- ----------- pr Flood Zone O O� 0,1\ 00, l `� X50-�� - Designation / l Zone AE (8) Test Hole obtained 12-8-98 Zq,tide (r (nott Eo sca)e) 0.0' Loam - W 2.0, PrP brawn � � o6;W _ �we�ling sand —0 p 11� 45 0, deck 0 s.o • q3.0, -~ tight bray«, ,oe � 1F;AAAr�C'f rw i 7� pnc�W O 6 r C1� 16ROUND 1.5' WATER tight W,r 60\54, is S� 4916 o.E e t43 '( NOTES: oN � MONUMENT FOUND O ``.•• 'Unau[noriie0 alteration o edd I11,n to a urvey PIPE FOUND 0� NF mapo beer a C ce sea ]anar surveyor s sealals a /- violation f s[tion 7209. sub-division 2. of the /+ ,/�YJ/ New York S[8[e Education Law HEDGE _\ C, Fh, ` 'Only copies from the original Of this survey erke3 wif$a .aB-ra de the land s veyor'8 stamp etl eal hal lobe ttlerea to be valid true aO t2. ,e1 copies' AREA = la,8a7 SF OR 0.46 ACRES ' a I _ V Certifications intlicatea ner eon signify tnat this ..4 surrey was prepared in appprdanCe with the ex iBt Ing Code or Practice for Land Surveys adopted ELEVATIONS REFER TO NGVD '2a y * by the New York State Association of Professional Lana swverora. saga cern r�cations seal]run only to the person for whom the ey als prepared. /� 1� and an his behalf to the title any. governmen- BLDG.DEr r Q tai agency anC lending Institution listed hereon, and j[f[ / to the assignees o/[he lending institution. Certifica- C-+.•.-. TOWN OF �O Ott �O tion,are not transferable to additional institutions `i^O LvPJIV•` GRRAPHIG 5GALE "= 3Q' LAND N.Y.S. LIC. NO. 50202 JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REFERENCE # 98-277F SURVEY OF LOT # 14 r MAP OF WE5T GREEK E5TATE5 � 51TUATE: BAYVIEW N TOWN OF 5OUTHOLD SUFFOLK COUNTY, NY SURVEYED II-Ib-qb i, , AMENDED 02-04-4q 02-23-G4, 07-2b-a9, 06-06-2000 7 2(0 SUFFOLK COUNTY TAX # ; . UtPT. 1000 - 7b - 2 -30 F SOUTHOLD GERTIFIED TO: JOHN F. DEVEAU ,. 00® � '0 Flood Zone Designation � Zone X 70 Flood Zone Designation Zone AE (8) \" 220 a e y I00 to 21GONGR�� u F��; TION 0 1roundat;°n 4 1 1 4 x - , o.bW 1 S� 0" 4701 F� 4916 NOTES: �� r MONUMENT FOUND F NEH/ mapnb ear 11 S,1:1 l icenseo l landIS!rvedo11�Stsea1s19vad violation of section 7209. sub-dilili.h z. of the ONew York State Education Law.' �q m'Only copies from Che original of[his survey 11 a ketl wlth an orig inal of [ne land surveyor's stamps seal snail be t:nsidered to oe slid true [:pies' AREA = la b97 SF OR 0.46 ACRES co 'Cer survey[ions indicated i hereon ance fy hnet this survey des preparetl in or Land Su with the te- 16ting Code o/Practice far Land Surveys atl:ptetl by the New York State Asa:ciat ion.f Prof...loneI Land Surveyor.. Said car tifica[ione scall run only to the person for whom the Survey is preparetl. antl on hie behalf to nse title[listed. governmen- +' tel tgenty antl lending Ithe titles listed sere:n, and !� oe to the assignees of the ]ending Institution. Certlflca- tions are not trans fared Is to additional Institution. LAN 9 GRAPHIG 5GALE I11= 301 JOHN C. EHLER-LAND SURVEYOR N.Y.S. LIC. NO. 50202 6 EAST MAIN STREET RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REFERENCE # 98-277F SURVEY OF LOT # 14 MAS' OF YE5T GREEK ESTATES 51TUATE: BAYVIEN N TOM OF 5OUTHOLD 5UFFOLK COUNTY, NY SURVEYED II-18-q8 W E AMENDED 02-04-qq 02-23-qq, 01-28-qq, 06-06-00, 05-20-01, Oq-18-01 SUFFOLK GOUNTY TAX u 1000 - 18 - 2 -30 5GDH5 # RIO - qq - 0011 GERTIFIED TO: JOHN F. DEVEAU A �• WELL OO O �P\ \A \' O > � J ® Flood Zone _ Designation Zone 'X"17 — — — �� , NO 1 301 Q.. Flood Zone �'',J � Designation Zone AE (i3) p 3 � w 2\ 2 5tpod f O p90 p.b HoVy6'00Semefyt -0 N F\Oof E\e moo/ V�6' VO.3 end ytor 60(,\f. l� �J X 06W v 154,0 S1 6p"5 49 .16' C' O NOTES: 'Unautnor lzetl altton or etltlltlon to a s vey ■ MONUMENT FOUND P.`<(,`a Cw Eye yO �J map pearfng a it teraens:d lantl surveyors seal is a J` violation of section 7209, sub-'i'i"on z, of the N[w Yofk Stat!Etlucat ion Law.' cap f esnfrom[he of lglnel of this survey arketl kttn a orlgf na] of the lentl s rveyor's 03 Stamped seal snall be considered to Its valid true c'Pi p lea' AREA = Iq,8g1 5F OR 0.46 AGRES * * der t,f,pet kine tntltpatetl neredn etgn,fY roar e,a 1 survey w a prepared fn a orde- Cotl[of Practice fort .r.wttLand Surveys an thde opted /1.. oy the New York State Association of Professional Lend Sur,eyors. sato cer[Nlcet ton!shell run only to the person for venom the s vey is oreperetl. and tln his behalf to the title tdmpany, governman- V tal agency end lending lnstltutldn listed hereon, end �L O IPJ to the:1 t�a�sfe�ao°d"9a'additional inatit.t bas � AND `��- 6RAPHIG 5GALE 1 50 JOHN C. EHLERS LAND SURVEYOR --r- -m 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 110L S _ _ _ _ _ RIVERHEAD,N.Y.11901 369-8288 Fax 369-8287 \\Hp server\d\PR0S\9B-277m.pro SURVEY OF LOT # 14 MAP OF 1NE5T CREEK ESTATES 51TUATE: 13AYVIEN N TOM OF 5OUTHOL.D 5UEEOLK COUNTY, NY SURVEYED II-I5-018 \ W E AMENDED 02-04-qq 02-23-0101, 0-7-28-0101, 06-06-2000 FINAL 08-20-01 SUFFOLK GOUNTY TAX # 1000 - 18 - 2 -30 'Glen 5G1?H5 # RIO - qq - 0011 n R04ad GERTIFIED TO: ^ JOHN F. DEVEAU A tC WELL OO . O� N 9y v tK O� v \ \ `\ \`\ 0 ® Flood Zone Q De5ignotion ` X. Zone Q. Flood Zone ��\J De5ignotio Zone AE (8) J 3 � " 5 2 2 St°ry From&0'r°9e obW Houye °nd ,O� N P 10 5, w I6 03 (J///J 2nd ytor deck 4>. x C i S166,,54 4' 4916' O E ..,..,.d �( 1 O i� p y 1♦ O p NOTES: \;K 1� 'llnau[hoN 2etl alteration o .d%tlon to a vey MONUMENT FOUND map bearing a ,iden�etl l.ndra uryeypr a sealsi a Violation of section 7209. sun-Gists ion'. ofathe New York State Education Lau.' "tlnly copies from the orlg incl of [his s vey marker with an consideredof [ne lantl s rveyor'S stamped 1 hall be Co be valid[rue copies' AREA = Iq,Bq-1 5F OR 0.46 AGRES "Certifications indicated hereon signify that this x �iF y survey'a' p...are' in accord...with the ex )1 1stln9 Code of Prac[Ice for Land Surveys adoptetl O by the New York State Association of Professional Land Surveyors Said certlflcatl h ll fun dnly q ))) [o [he person for whom the s y prepared •� u�,W and on n1s behalf [p Che title c p y govern.,,- 15 veeosnmen tai agency antl lentlin9 ins[ltut ion 1St tl h antl to the:.,:Icy of the lentl ing lns[it [- C rtifioa tionsarenot transferable to additional institutions GRAPHIC, 5GALE 1°= 50 JOHN C. 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