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HomeMy WebLinkAbout27893-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28481 Date: 05/31/02 THIS CERTIFIES that the building ADDITION Location of Property: 1050 TRUMANS PATH EAST MARION (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 31 Block 12 Lot 5.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 9, 2001 pursuant to which Building Permit No. 27893-Z dated NOVEMBER 13, 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 ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to WILLIAM H BRENNEN & WF. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1049330 05/02/02 PLUMBERS CERTIFICATION DATED 03/06/02 ROBERT VAN ETTON Authorized S' nature 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. 27893 Z Date NOVEMBER 13 , 2001 Permission is hereby granted to : WILLIAM H & WF BRENNEN 48 SPRING LANE LEVITTOWN,NY 11756 for . CONSTRUCTION OF AN ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 1050 TRUMANS PATH EAST MARION County Tax Map No. 473889 Section 031 Block 0012 Lot No. 005 . 001 pursuant to application dated NOVEMBER 9, 2001 and approved by the Building Inspector. Fee $ 183 . 00 uthor zed Signature ORIGINAL Rev. 2/19/98 , 1 631 *-7-7- Form No.6 L�"�� TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ? 765-1802 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. 10), New Construction: Old or Pre-existing Building: V (check one) Location of Property: 10 50 . TR VMA N S PA T N EAST MA R 1 OAJ House No. Street Hamlet Owner or Owners of Property: W ILOAAA EI• T3REN WE-" 4t PATRic(A 13 RE iv N 6N Suffolk County Tax Map No 1000, Section Q 3 Block p O iy— Lot 00S. 601 Subdivision Filed Map. Lot: Permit No. 27,gcI 3 Date of Permit. I I , i I 0 I Applicant: W/ti IAA'1 N $' WF $RE/vN6�Iv Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: 1,-' (check one) Fee Submitted: $ Z S C— (V Applicant Signature TEL. 765-1802 �pS�FF���pG TOWN OF SOUTHOLD y�c OFFICE OF BUILDING INSPECTOR c z P.O. BOX 728 TOWN HALL ooh ���� SOUTHOLD,N.Y. 11971 it C E R T I F I C A T I O N Date Building Permit No. �� 3 Owner Ad/ D/'PuveAl (please print) Plumber obelr+ Va-,,E4 ( ef) (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 day of , S�4� e . U Notary Public Notary Public, County JANET E.STAPLES Notary Publiq S ,o ct Now York No.4831949,Suffolk Courtly nE1�"July31.T0_J O �P�PrJ�rJ�rJ�rJrJ�c PrJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�PrJ�rJ�rJ��PrJ�rJ�rJ�rJ�rJ�cPrJ�rJ�rJ�rJ�cPrJ�rJ�rJ�rJ�r PrJ�rJ�rJ�rJ��PrJ�rJ�rJ�rJ��PrJ�rJ��PrJMPE PLI PRIE 5� 5 BY THIS CERTIFICATE OF COMPLIANCE THE S 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 BUREAU OF ELECTRICITY 5 5 5 40 FULTON STREET -- NEW YORK, NY 10038 5 CERTIFIES THAT 5 Upon the application of upon premises owned by 5 5 5 5 J.H.S. ELEC SERVICE CO. " BRENNEN 5 5 1863 NEWBRIDGE ROAD 1050 TRUMAN PATH CCeS C5 N. BELLMORE, NY 11710, EAST MARION, NY 11939 CC Located at 1050 TRUMAN PATH EAST MARION, NY 11939 5 SApplication Number: 104933U Certificate Number: 1049330 5 5 5 55 Section: Block: Lot: Building Permit:27893 BDC: NS11 Described as a Residential occupancy, wherein the premises electrical system consisting ofc� 5 electrical devices and wiring, described below, located in/on the premises at: 5 First Floor,Outside, 5 5 5 5 Swas inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5 found to be in compliance therewith on the 2nd Day of May,2002. 5 55 Name QTY Rate Ratine Circuit Type Alarm and Emergency Equipment 5 5 Sensor 1 0 Carbon Monoxide 5 5 Sensor 3 0 Heat 5 Appliances and Accessories 5 5 Range 1 0 11 KW Dish Washer 1 0 1.2 KW C 5 Exhaust Fan 1 0 F H.P. 5 5 Wiring and Devices 5 5 Receptacle 28 0 General Purpose 5 r5] Switch 29 0 General Purpose 5 5 Fixture 12 0 Incandescent 5 5 Fixture 1 0 Fluorescent 5 Paddle Fan 4 0 5 5 Receptacle 1 0 30 amp Dryer 5 5 5 Receptacle 3 0 GFCI 5 Service 5 5 1 Phase 3W seal 5 5 Service Disconnect: 1 200 cb 5 5 Continued on Next Page I of 2 5 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 5 LPrJrJ�rJ�rJ�r�rJ�tr�PrJ�rJ��P�PLrr PrJ��PrJ�Pc P�P�PrJ�rJ��P�PrJ-rJ�rJ��P�Pt P�PrJ�[:[:Ir I�PrJ�cP�nrJ�rJ�rJ��P�P�PrJ�cnrJ��P�PrJ�rJ��PtJ��PrJ��PrJ��PrJ�rJ� L7 O rJ�i_nrJ�rJ�rJ�cPrJ�cnrJ�rJj_nt_r arJ�rJ�rJ�rJ a�lrJ�rJ�rJ�cnrJ�rJ�t:PrJ�rJ�t PrJrJ�r1t nrJ�rJ�rJ�i_nrJ�rJ��ncn�lrrrJ�cnrJ�rJ�rJ�cPrJ�rJ�rJrJ�rJrJr PrJ�rJ�r rrJ�rJ��nrJrJ�r n o 5 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 4 BUREAU OF ELECTRICITY 5 5 0 FULTON STREET -- NEW YORK, NY 10038 5 CERTIFIES THAT 5 Upon the application of upon 5 premises owned by 5 5 5 5 J.H.S. ELEC SERVICE CO. * BRENNEN 5 1863 NEWBRIDGE ROAD 1050 TRUMAN PATH 5 5 N. BELLMORE, NY 11710, EAST MARION, NY 11939 5 5 Located at 1050 TRUMAN PATH EAST MARION, NY 11939 5 Application Number: 1049330 Certificate Number: 1049330 Section: Block: Lot: Building Permit:27893 BDC: NS117C Described as a Residential occupancy,wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 First Floor,Outside, 5 5 55 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below, was �5 found to be in compliance therewith on the 2nd Day of May,2002. 5 5 Name QTY Rate Rating Circuit Type 5 Meters: 1 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 seal 5 5 2 of 2 5 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 D rJ�rJ�rJ�rJ�rJ�rTrJrJ�rJ�r!@PrJ�rJ�rJ�rJrJ�rJ�r�rJ�rJ�rJrl_fflLrJr�r.rL3pLpLLpLpLLjEUPPIEUEEUMEEgrJ'rJ��PrJ��PrJ�cPcPrJcPrJ�rJ�rJ�rJ?JrJ�r�cPrJ�rJ��PrJ�iPcf�P O TOWN OF SOUTHOLD PROPERTY,.WORD ��� AOR D CARD OWNER STREET VILLAGE V SUB. LOT Ua-r. ., a r ? ' / �C3 Y- d Deli- DIST T • FORMER OWNER N E ,I1_� S W / TYPE OF BUILDING 1,72 RES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS�f 2 ?�J' A� D f 7Lp o a zed 3700 / /O L z k 3Lv. pe r%, °r `%72� ' a i � / aao CIO � 3 ©r7 3®O � 3/ tk 1 toS 3 I a cx rc C_ K ob o� fillabie FRONTAGE ON WATER r7 f c 71 Noodland FRONTAGE ON ROAD ']e ' b Meadowland DEPTH -louse Plot BULKHEAD fotol BUILDING PERMIT EXAM NER CHECK LIST DATE REVIEWED: _!j_/j_3 /01 .DATE SUBMITTED: /g_/O1 APPLICANT NAME:CJ, � 1�. �e1.��„ SCTM# DISTRICT: 1.000 SECTION: -251 BLOCK: IZ LOT: �•1 STREET: 10 10 f b mmo s Tek CITY: a, SSUUBDIV. NAME: NJ& PROJECT DESCRIPTION: D rn o is '(a a �—c .� �( f�Jl.u� o►.� �,— ARCHITECT/ENGINEE : Iu —„LL FAST TRACK? SINGLE&SEPARATE CERTIFICATION-REQUIRED? /4o NOTES: GOTS 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: jq- �Zo CONFORMING? x'98 REQ.LOT SIZE:q010.00ACT. LOT SIZE: 191REQ. LOT CO o 0 o ACT. LOT COV._ /3 0lo REQ.FRONT 3f PROP.FRONT�oZg REQ SIDE /o/zs ACT. SIDE :,gyz.4' REQ.REAR Z5� PROP. REAR `/ d o c F,�r tv ,vo C"444-95, WATERFRONT? 1 DESCRIPTION: M,1-A(0,0 L*445; PANEL #: FLOOD ZONE: , AGENCY PERMITS REQUIRED FOR REVIEW APPROVALS REOUIRED: SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED#): pTE:_/ / PERMIT#:R10- NEW YORK STATE DEC: PR EC 9/1 YE or NO 1•`730.OZ l 10/0/ SOUTHOLD TOWN TRUSTEES: r NO Le TTP 2 TOWN ZONING BOARD APPROVAL: S or TOWN PLAN. BOARD APPROVAL: YES o TOWN HISTORICAL PRE (SPLIA): YES o NYS ENERGY: YES OR NO : T- ff EGRESS (18 H min.?4 sq total) . FT. x 4°o) �LIGHT(SQ. FT.x 8%) BUILDING PERMITS OPEN/EXPIRED: BP yg21, -Z/C/0 Z- uew cr.�2e.-Q HAVE PRE CO'S : Y OR N BP /6 -?-3 -Z/C/o Z- NOTES: 16y6,0 FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR : T6 o SF SECOND FLR : SF INTT OTHER TOTAL TOTAL: 76 SF FEE FEE FEE 0 DT( A-o SF)- SF)= // SFX$ - _$_ +$ /j +$ _$_ STATE FARM CERTIFICATE OF INSURANCE affill T isf=t t ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois in res 1��'f� wing policyholder for the coverages indicated below: Name of policyholder J A Rose Construction Inc. Address of policyholder 2591 Island Channel Rd Seaford, NY 11783-3320 Location of operations same Description of operations The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subject to all the terms exclusions, and conditions of those policies. The limits of liability sho n.may have been reduced by any paid claims. POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date Ex imflon Date at beginning of policy perlod Comprehensive BODILY INJURY AND 92—CG 0813 2 Business Liability 06-01-01 06-01-02 PROPERTY DAMAGE This insurance includes: ® Products-Completed Operations ❑ Contractual Liability ❑ Underground Hazard Coverage Each Occurrence $ 300000 ❑ Personal Injury ❑Advertising Injury General Aggregate $ 600000 ❑ Explosion Hazard Coverage Products-Completed ❑ Collapse Hazard Coverage Operations Aggregate $ 600000 ❑ General Aggregate Limit applies to each project EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE Effective Date Ex iration Date (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑ Other Aggregate $ Part 1 STATUTORY Part 2 BODILY INJURY Workers'Compensation and Employers Liability Each Accident $ Disease Each Employee $ Disease- Policy Limit $ POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date Expiradon Date (at beginning of policy period) If any of the described policies are canceled before Its expiration date, State Farm will try to mail a written notice to the certificate holder 15 days before cancellation. If, however, we fail to mail such notice, no obligation or liability will be imposed on State Farm or its agents or representatives. Name and Address u Certificate Holder I J V"))fa,-J Town of Southold L/ �`�.,� Signatureo Authorized epresentative Building Dept Town Hall Title Southhold, NY 11973 Date NEW YORK STATE INSURANCE FUND 8 CORPORATE CENTER DR, 2ND FLR, MELVILLE, NEW YORK 11747-3166 (631) 756-4000 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE J A ROSE CONSTRUCTION INC POLICY NUMBER 2591 ISLAND CHANNEL ROAD H 1222 955-5 SEAFORD NY 11783 DATE 12/26/2001 CERTIFICATE NUMBER 165-343 PERIOD COVERED BY THIS CERTIFICATE 12/19/2001 TO 12/19/2002 POLICYHOLDER CERTIFICATE HOLDER J A ROSE CONSTRUCTION INC TOWN OF SOUTHOLD 2591 ISLAND CHANNEL ROAD BUILDING DEPARTMENT SEAFORD NY 11783 TOWN HALL SOUTHOLD NY 11973 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY NO. 1222 955-5 UNTIL 12/19/2002 , COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 12/19/2002 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THE STA E INSURANCE FUND U-26.3 DIRECTOR, INSURANCE FUND UNDERWRITING / r 1 n w^sy rfP u.,y rr�x� r �. Y +.. 0k r .+ h irll tl, r�` tir. r1 Yk a✓ a� f Y r i r r y d Y" Y r,. .k �.\ S,. 't t ✓r , i.� o. f h1�i,4� +'f� -71 t° 4�" 1k',.�'I<'h ��. '4"� �i ti. '�"t' �•`a.i''I '�'�'f� ,� `fG;� .ei, '���."�"I���,� � �.I �<.. � .t �` a+��' �+�}..j' Y'�j,�R�.'ll-;i Suffolk County t Executive's 1\t r a rl h4 t 30 VETERANS t • • ' • • ' fi 11788 h DATE ISSUED: No. 29t949 § r IYt f SUFFOLK COUNTY Home Improvement 1 A JAMES A ' • doing businessROSE CONSTRUCTION INC 1 '4 having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws, rules and regulations the County ofSuffolk, StateofNewYork islicensed toconductbusiness f \ HONE 13"ROVEMENT CONTRACTOR, in the County of Suffolk. 1-� r . . Lu THIS LICENSE EXPIRES: 12/01/2003 .. i KOT VALID WITHOUT DtPARTMFNTAL tPAL ;, 4 ,. y r N Kti � i �t ieaor s I a y+ v-r: y h �r, �.:r"� �. >r,:n �" 3 . ;, d rq� nw`, r � �x� •, ��i � � W`r�r ,,. Yr.L.� �� .J. ��(,„ �, N r f�P 1t ;.'-J 1M"�I Sr1�'. {r+ LAWRENCE M. TUTHILL PROFESSIONAL ENGINEER P.O. BOX 162 �^ GREENPORT, N.Y. 11944 i (631) 477-1652 �aR 6 7 1 L 20,2 April 26, 2002 j fi To Whom It May Concerns Res Brennan Residence 1050 Trumans Path East Marion, NY 11939 Insulation and Ceiling support With reference to the above mentioned residence please note the followings 1. I inspected the insulation in the area of the renovation and note that it meets the New York State Energy Conservation Code as to existing buildings. 2. That the beam that is diagonally supporting the living room ceiling consist of three laminated veneer lumber one and three quarter inches thick by fourteen inched wide. Sincerely, Lawrence M. Tuthill, P.E. of NEW yo INCE h y� us W (^ W v a 032254-1 i' �Q'�E�5t4NA New Yo' k State Department of Environmental Conservation Division of Environmental Permits Building 40 - SUNY, Stony Brook, New York 11790-2356 ` Telephone (631) 444-0365 AM Facsimile (631) 444-0360 NOW Erin M. Crotty Commissioner November 1, 2001 Mr. William H. Brennen P.O. Box 221 East Marion, NY 11939 RE: 1-4738-02931/00001 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 proj ect site and protected from the weather. Sincerely, L�,��to✓t� Sherri L. Aicher Environmental Analyst SLA/Is Enclosure NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738102931/00001 November 1 2001 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental Conservation Law November 1, 2011 TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Permit to Operate ❑ Article 15, Title 5: Protection ❑ 6NYCRR 608: Water Quality ❑ Article 27, Title 7; 6NYCRR of Waters Certification 360: Solid Waste Management ❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR Supply 11 Article 19: Air Pollution 373: Hazardous Waste Management ❑ Article 15, Title 15: Water Control ❑ Article 34: Coastal Erosion Transport 11 Article Article 23, Title 27: Mined ❑ Article 15, Title 15: Long Land Reclamation ❑ Article 36: Floodplain Island Wells Management ■ Article 24: Freshwater Wetlands ❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ❑ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER William H. Brennen (631) 477-2395 ADDRESS OF PERMITTEE P.O. Box 221, East Marion NY 11939 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Brennen property, 1050 Trumans Path LOCATION OF PROJECT/FACILITY East Marion COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Lake Marion DESCRIPTION OF AUTHORIZED ACTIVITY: Construct a 24'x 40'addition to a single family dwelling. All work must be done in accordance with the attached plans prepared by Joseph A. Ingegno last revised 10/19/01 and stamped approved by NYSDEC on 11/1/01. 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 8 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Ro er Evans SLA Bldg. #40, SUNY, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE 117DATE Page 1 of 4 November 1, 2001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives,employees,agents, and assigns for all claims, suits, actions, damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits,approvals, lands,easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility,including relevant records,is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL.Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal,modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities(HWMF), major Air Pollution Control(APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg#40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modifications,Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. DEC PERMIT NUMBER PAGE 2 OF 4 1-4738-02931/00001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15(TITLE 5), 24,25, 34 AND 6NYCRR PART 608 ( FRESHWATER WETLANDS ) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work,obstructions,or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall,without expense to the State,and to such extent and in such time and manner as the Departmentof Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation,or for other purposes,and no claim or right to compensation shall accrue from any such damage. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S.Army Corps of Engineers, U.S.Coast Guard, New York State Office of General Services or local government which may be required. 4. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly,without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall,without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 8. If granted under 6NYCRR Part 608,the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977(PL 95-217)provided that all of the conditions listed herein are met. 9. At least 48 hours prior to commencement of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and retumed, along with photographs of the completed work and, if required, a survey. 10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by — DEC PERMIT NUMBER PAGE 3 OF 4 1-4738-02931/00001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. Any work,disturbance,and storage of construction materials shall be confined to within the"Limit of Clearing and Ground Disturbance"as shown on the approved plan. 2. Prior to commencement of any Construction activities, a continuous row of straw bales shall be staked end to end on the downslope edge of any areas of filling, grading or excavation. The bales shall be maintained, repaired and replaced as often as necessary to ensure proper function, until all disturbed areas are permanently vegetated. The average useful life of a bale is approximately 3-4 months. Sediments trapped by the bales shall be removed to an approved upland location before the bales themselves are removed. 3. Straw bales shall be recessed two to four inches into the ground. 4. All fill shall consist of clean soil, sand and/or gravel that is free of the following substances: asphalt, slag, flyash, broken concrete, demolition debris, garbage, household refuse, tires, woody materials including tree or landscape debris, and metal objects. The introduction of materials toxic to aquatic life is expressly prohibited. 5. All equipment and machinery shall be stored and safely contained greater than 100 feet landward of the regulated wetland or water body at the end of each work day. This will serve to avoid the inadvertent leakage of deleterious substances into the regulated area. Fuel or other chemical storage tanks shall be contained and located at all times in an area greater than 100 feet landward of the regulated wetland or water body. If the above requirement cannot be met by the permittee,then the storage areas must be designed to completely contain any and all potential leakage. Such a containment system must be approved by NYSDEC staff prior to equipment,machinery or tank storage within 100 feet of the regulated wetland or water body. 6. All areas of soil disturbance resulting from this project shall be seeded with an appropriate perennial grass, and mulched with straw immediately upon completion of the project,within two(2)days of final grading,or by the expiration of the permit,whichever is first. Mulch shall be maintained until a suitable vegetative cover is established. If seeding is impracticable due to the time of year, a temporary mulch shall be applied and final seeding shall be performed as soon as weather conditions favor germination and growth. 7. Suitable vegetative cover is defined as a minimum of 85% area vegetative cover with contiguous unvegetated areas no larger than 1 square foot in size. 8. The permittee shall incorporate the following language as a notice covenant to the deed: "Regulated freshwater wetlands associated with GP-1 are located on/near the properties of William Brennen and his heirs, assigns or successors. This property is subject to the provisions of Environmental Conservation Law (ECL) Article 24, and the conduct of regulated activities may occur only pursuant to ECL Article 24 if prior approval is given by the New York State Department of Environmental Conservation(NYSDEC)or its successor(s). Regulated activities include, but are not limited to clearing of vegetation; application of chemicals; excavation; grading and filling; and erection of any structure(s)." This deed covenant shall be recorded with the Clerk of Suffolk County within 90 days of the issuance of this permit. A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be sent within one calendar year of the issuance of this permit to: NYSDEC, Regional Manager Bureau of Habitat, SUNY Building 40, Stony Brook, New York 11790-2356. DEC PERMIT NUMBER PAGE 4 OF 4 1-4738-02931/00001 NYSDEC Commencement Notice AM Bt reau of Habitat _r SUNY, Bldg. 40 'Row Stony Brook, NY 11790-2356 Permit No: Issued To: d Contractor's Name: Contractor's Address: Contractor's Phone No.: To whom it may concern: Pursuant to Supplementary Special Condition D of the above referenced permit you are hereby notified that the authorized activity shall commence on The permit sign will be posted at the site and copy of permit will be available at site for inspection. Submitted by: This notice is to be sent at least 2 days in advance of commencement of the project. Failure to notify or post will leave owner and/or contractor subject to applicable penalties for non-compliance with permit conditions. Cut along this line NYSDEC Completion Notice AM Bureau of Habitat `e SUNY, Bldg. 40 14111W Stony Brook, NY 11790-2356 Permit No: Issued To: Contractor's Name: Contractor's Address: Contractor's Phone No.: To whom it may concern: Pursuant to Supplementary Special Condition D of the above referenced permit you are hereby notified that the authorized activity was completed on Submitted by: This notice, with photos of completed work and/or completed survey, is to be sent to above address promptly upon completion of project. Failure to notify will leave owner and/or contractor subject to applicable penalties for non-compliance with permit conditions. 9&20-1 (Wn-90- New York State Department of Environmental Conservation Iowa'ah NOTIC v The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. T Regional Permit Administrator Permit Number I-yq3g--bz 00 / JOH W. PAVACIC Expiration Date NOTE: This notice is NOT a permit Albert J. Krupski, President _ = ''c> James King, Vire•Presidert ®SUffa,��= Town Hall He pry Smith .Z� 53095 Route 25 'yam"•. P.O. Box 1179 Artie Foster p r Southold, New York 11971-0959 Ken Poliwoda ri H '' pn C Tele ' one (631) 765-1892 ��►Ol �a0�; Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 16, 2001 Mr. & Mrs. William Brennen 48 Spring Lane Levittown, V`r' 11756 RE: 1050 'I'rumans Path, East Marion SCTM#31-12-5.1 Dear Mr. &Mrs. Brennen: The Southold Town Board of Trustees reviewed the survey dated April 24, 2001 and determined the construction of an addition to the existing single-family dwelling, to be out of the Wetland jurisdiction under Chapter 97 of the Town Wetland Code. However, any activity within 100' of the Wetland line would require perm is from this office. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, am-'� (7 / , � Albert J. krupski, Jr. President, Board of Trustees AJK:Ims —] 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 User BUILDING OWNER'S NAME Policy Number BUILDING STREET ADDRESS(Including Apt.,Unit Suite,and/or Bldg. No.)OR P.O. ROUTE AND BOX NO. Company MAIC Number /✓SU T2[4.efgti 'S PA7h CITY STATE ZIP CODE PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) /pci�- 3/ - /Z' S• / BUILDING USE(e.g.,Residential,Non-reaidential,Addition,Accessory,etc. Use Comments section if necessary.) ReS/acNr1+ LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS(Type): ##.W or 0. 11 LJ NAD 1927 LI NAD 1983 IJ USGS Quad Map j_J Other. SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION lBt.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82.COUNTY NAME B3.STATE �!fl Town/ nr- Sc rrkcLD 3608/3 O u r 4/r- �' i { B4,MAP AND PANEL I B5.SUFFIX I BB.FIRM INDEX 87.FIRM PANEL 88.FLOOD B9.BASE FLOOD ELEVATIONS) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) G# G MA 01 I /5 SP I X --- B10. Indicate the source of the Base Flood Elevation(SFE)data or bass flood depth entered in B9. IJ FIS Profile VJ FIRM I_I Community Determined LJ Other(Describe):_ _ B11. Indicate the elevation datum used for the BFE in B9:t,I NGVD 1929 IJ NAVD 1988 IJ Other(Describe): B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OP.A)? L-I Yes "No Designation Date: SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1.Building elevations are based on: LlConstruction Drawings' JlBuilding Under Construction" ejFinished Construction •A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number_L(Select the building diagram most similar to the building for which this certificate is being completed-see pages 8 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 Items C3a-i below according to the buiidmg diagram specified in Item CZ.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 marls used appear on the FIRM? {J Yes LXNo a)Top of bottom floor(including basement or enclosure) 21 .8 R.(0) O b)Top of next higher floor — ft(a) O 0 Bottom of lowest horizontal structural member(V zones only) O d)Attached garage(top of slab) ❑ e)Lowest elevation of machinery and/or equipment W ' servicing the building _ ftdtlN ; 0 0 Lowest adjacent grade(LAG) /9 7 R.(at) z. 0 g) Highest adjacent grade(HAG) a/ 0 h)No.of permanent openings(flood vents)within 1 R.above adjacent grade `i NVON 0 1)Total area of all permanent openings(flood vents)in C3h — sq.in.(sq.rm) 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 fine or imprisonment under 18 U.S. Code, Section 1001. CE TIFIER'S NAME LICENSE NUMBER TITS COMPANY ADDRESS v,4le Ct1TM� AT Z SIGNATURE DATE S_y-O/ TELEPHONE G:3/ i'L 7-evfo FEMA Form 81-31,AUG 997 14 5EE 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 CITY STATE ZIP CODE Company MAIC Number GEST A SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company,and(3)building owner. COMMENTS 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 a=rately represents the building,provide a sketch or photograph.) E2.The top of the bottom floor(including basement or enclosure)of the building is IJ-1 ft.(m)LL–Jim(cm) LI above or LI below (check one)the highest adjacent grade. E3. For Building Diagrams 8-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is LL-1 ft.(m) I LIin.(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?LI Yes LI No Li 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 R OWNER'S AUTHORIZED REPRE TI 'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS �J Check here N 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. IJ 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 da�r the Comments area below.) G2. LI A community ofti mpleted Section E for a building located in Zone A(without a FEMA-Issued or community-issued BFE)or Zone AO. 1 G3. LI The following.inform n(items G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER 5. DATE PERMIT ISSUED 8. DATE CERTIFICATE OFC PLIANC U A Y • ISSUED G7.This permit has been issu6d for: IJ New Construction LI Substantial Improvement G8.Elevation of as-buift lowest floor(including basement)of the building is: _ft.(m)Datum: G9. BFE or(in Zone AO)depth of flooding at the building site is: _ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE ATE COMMENTS I I Check here if attachments FEMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS STATE OF NEW YORK } } ss: COUNTY OF SUFFOLK ) u M �/>, l f , being duly sworn, deposes and says: That 0epone is over the age of 18 years and resides at That on the day of /YO-Le be- , 2001 deponent architectlengineer, licensed by the State of New York, hereby states thathe accepts foil responsibility for the accompanying plans compliance with the New York State Fire Prevention and Building Code (9 NYCRR); said plans pertain to property located at SCTM# 1000- I�Lc7t K 1 L `t r ( t l street address S!7 Ti4U ry t +F'P TH 9- jnA'RtV1,) NY 1 l r'I 3`t" G 271 .�-- t Engineer Sworn to before me this °F NEW Yo9 day offer 2001 . P ce r y �• ��'t EILEkN S. SANTORA �� �!� (✓a NOTARY PUBLIC, State of Now Yolk No, 30.4916018 Qualified /C�em/minion Expires / Notary Public Z`jF 032254-t opgOFESS, M Applicant �7 X53 0� 765-1802 BUILDING DEPT. INSPECTION [ FOUNDATION IST [ UGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: -T v DATE �-2- 0 INSPECTOR �'/ff3 .f 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: ALI DATE INSPE ` L-7 ?. F 3 M-1802 BUILDING DEPT. IN PECTION [ ] F ATION 1 ST [ ] ROUGH PLBG. [ F UNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: �! s;� DATE l 2,--msPECTOR �? 3 M-102 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST I ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [�] FRAMING FINAL [ ] FIREPLACE & CHIMNEY REMARKS: !'o LlLv,{ c// ry%^�G TO.S '� 'tsn.+G e�S SG` /O%�6 /CK •vG� 117fi3 J {�dVlaF e c'!l erc.Jlc �fJ / mac DATE a�3��z INSPECTOR= �acj 765-1802 �( BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [� ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY / �� l= REMARKS: A c' P A,r ci e /74 L 6 1JC ffl�jeCS eS'77 4//O ' i,cs l4 7�c v DATE a3 �S/`�� INSPECTORooe LSrG�v 765-1802 BUILDING DEPT. INSPECTIO [ ] FOUNDATION IST [ ROUGH PLBG. [ j FOUNDATION 2ND [ ] INSULATION [ ) FRAMING [ ) FINAL [ ] FIREPLACE a HIMNEY REMARKS: O D Q INSPECTO M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING / [ FINAL [ ] FIREPLACE A CHIMN Y REMARKS: Z7--- - DATE :51 ��w. INSPECTO / AWA IMM10AW'.IMP KIM . r �� ►9iT� TOWN OF SOUTHOLD BUILDING PER=APPLIWION CHEG'&L BUILDING DEPARTMENT Do you B c et �appb A SOUTHOLD,NY 11971Q 3 setsofBuMbgPlaas r/ TEL: 765-1802 a 7P 1' � PERMIT NO. C�ectc� 353 Septic Fam N.Y.S.D.Ma Examined ( 20�� coatAets Approved l 20 Mail to: Disapproved a/c Phone:(o 31 -�/77-023 9 S . NOV 8 �i01 �' 1 /T PKC APPLICATION FOR BUILDING PERIVD.T. a9r' BlDf. F T. INSTRUCTIONS Date.,20 a.This application MUST be oompletaly ffiled in by typewriter or in ink and submitted to the Buildinglnspectm with sets ofplans,accurate plot plan to scale.Fee accordiog.to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoiniagprecuses or public streets areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building rnapector will issue a Buili ft Permit to the applicank Such a perm shafl be kept on the premises available for inspection tbrogghout the work. e.No building sban be occupied or used in whole or is part for any purpose wlat-so-ever until a Certificate of Occupy is issued by the Blinding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuaaoe of aBuildingPermit purso=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 describe&The applicant agrees to comply with all applicable lands,ordinances,building code,housing code,and mgt,and to admit suthorned inspectors on promises and in building for necessary inspections. _ Vitt;WIf . (sigoatr„ofappliasat ocname,ifa ) Pd• BOX 12( E. /1MiQ10N• llC(3g-o2z� Waftg address of applicant) State whether applicant is owner,lessee, agent,architect,engineer,general contractor,electrician,plumber or builder a w NEK- Name of ownerofpremises W ItUA/k t4 AND JOA-7 91 cJA 1/gLCA/NFN (as on the tax roll or latest deed) If applicant is a corporation,signature of duly antho&&d officer (Name and title of corporate officer) Builders License No. T l3�» Phmibers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done. 10150 -t VMANs PA-V BAST /M t2(oN N y l I q 3-i House Number Street Hamlet County Tax Map No. 1000 Section /000 Block 12- Lot Subdivision Filed Map No. Lot (Name) tense and p yo£premises and intended use and ocmano3►bf"8edWnst &Ci: a.* Existing use and occupancy F46m c b Intended use snd occupancy F)U M `� mon Nature of work(chedcwhich applicable):New RmfldinQAddition Other Work gam_ Demolition R,eP (Description) Bs Fee . (to be paid on fling Eris application) If dwelling,number of dwelling units / Number of dwelling units on each floor ,If garage, number of cars If business, c6mmerscialor mixed occupancy,specify nature and extent of each type of use. � Dimensions of existing structures,if any:any:Front O Rear Z/0 Depth Height ' Number of Stories Dimensions of same structure with alterations or additions: Front Rear Defy Height Number of Stogies {+ � Dimensions of entire new constriction:Front Rear Depth Height Number of Stories • , , Size of lot Front 7 Rear 5 Depth 0.Date of 0 7) a 11-7 In ? Name of Fortner Owner A 1.6E I Vo&rr - 1.Zone or use district in which premises are situated 2.Does proposed construction violate any zoning law,ordinance or regulation: 3.Will lot be re-gradedW>71 access fill be removed from premises: YES NO - excess iRox yZ 4.Names of Owner of pra=ises n NSni. Addr�s �P14�1N St.Y_-'_ C:No.�3 f 4?? 2,34J` Name of Architect L•A v7' I!/Address r�lZ �8: 2?4 Phone No Name of Contractor Address Phone No. 5. Is this property witbin 100 feet of a tidal wetland? *YES NO • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUHUM 6. Provide survey,to scale,with accurate foundation plan and distances to property lines. 7. If elevation at airy point on property is at 10 feet or below,must provide topographical data on survey. TATE OF NEW YORK) SS: 'OT NTY O _� being duly sworn;deposes and says that(s)ho is the applicant ane of individual signing contract)above named, We is the l��lJitlf=/> (Contactor,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 application; rat all.status contained in this application are true to the best of his knowledge and belies;and that the work will be erfonned in the manner set filth in the application'filed therewith. wom to before me this /3 Y-4 ;;day of 20 0E D / �T�PubHe LLT tIN a. aANTOBA Signature of Applicant j� NOTAPUBLIC,Slals of Nw.•York ' No.301916018 ConuQuIdi &diron MAIN READ rSR 25� SURVEY OF PROPERTY SITUATED AT EAST MARION TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-31 - 12-5. 1 SCALE 1 "=20' APRIL 24, 2001 AREA = 18,798.09 sq. ft. 0.432 Go. a NOTES: J s a 1 . ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN THUS;50 LA6• S 2. FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. 36103CO064 G r COS ZONE AE: BASE FLOOD ELEVATIONS DETERMINED ,•g 17. y ZONE X: AREAS DETERMINED TO BE OUTSIDE 500—YEAR FLOODPLAIN. oI ERSgERSgN / ,� ]00 OTT y�O - � •,: � s; CIA o CID / .,DPF" M�SCIW,SID BJ 1 a• CK.N"'Nj S. .. ��� � S�rn• \ o' Off' • CERTIFIED TO: • i a WILLIAM BRENNEN ♦�1 \ / •� PATRICIA BRENNEN a. 3 NO 16a 6p �5 r ,W W '0 v. v '`1 nl \ 13 D 9 7 TO THIS SURVEYV20 1 UNAUTHORIZEDOF I-TERATION OR MOTION \'51.q ak EDUSECCATION 7209 OFISTNEWNEW TIYNN STALE 4 EDUGnON UW. \ \ / gy/{ ° 1 . COPIES PIES OF THIS SURREY MMP NOT RFMING THE �D Y �(, SHL( fS� OR EMBOSSED SELL SO INKED BE CONSIDERED \jE y� j1L' TO BE A VAUD TRUE COPY. 0IF CK� P� CERTIFICATIONS INDICTED HEREON SHALL RUN Z ( 41•/ I(E�-I��C`• ONLY TO YAE FOR WONE SU S PREPARED ANDSON ON HIS BHALFTTO THE O LQ DING IINSItPANYNnON USTED HEREON, AND D \ STI- p,O 0ts o Ey TOTHE CORT IGnON9� NET TTUENDINRANSFFEERABLE. ti 'ZA \ THE EXISTENCE NT OF R ROF DAT' I �• AND/OR EASEMENTS OF RECORD, IF A��� \ ♦ , ♦N ANY. NOT SHOWN ARE NOT GUARANTEED. \ 6PREPARED IN A[3mRDkN THE MINIMUM BY LI LS iR AS ESTABLISHED B THE LIALS AND O EO AND ADOPTED Joseph A. Ingegno POR SU EW YORK SPATE VND ni "" Land Surveyor A a Title Surveys — Subdivisions — Site Plane — Construction Layout A �� n, --n .•� PHONE (831)727-2090 Fax (831)727-1727 OFFICES LOCATED AT U41LING ADDRESS N.Y.S. Lic. No. 49668 1380 ROANOKE AVENUE P.O. Boa 1931 RIVERHEAD, New York 11901 RwrNeod, New York 11901-0965 21-230 1 �---� A rr I , I I I "I f I 911?VI /5�� rl �'loa a4 I�djlTi - -- ---- --- - - - - - - (; DO NOT PROCEED WITH OCCUPANCY I R UNDERWRITERS CERTIFICATE � Y FRAMING UNTIL SURVEY USE IS UNLAW UL REQUIRED ` OF FOUNDATION LOCATION WITHOUT CERTIF CATE — — PROVIDE OPENINGS FOR HAS BEEN APPROVED. OF OCCUPAN Y APPROVED AS NOTED 1NCY ESCAPE AS BA+a // /3 °/■n ', BY PAR]. FIS I1 23 TH NOTIFY BUILDINQ DEPARTMENT AT N.Y. STAT BUILD 1766-1902 s AN TO 4 PM FOR E - { FOLLOWING INSPECTIONS: , L FOUNDATION - TWO REQUIRED 4 uC7af aj FORPOUNEDCONCRETE f i u i — f °jTJGl,fll I - -_ 1 I j I ROUGH - FRAMING i FLUMBIN13 ' I INSULATION ' -- — —--- ` I 1 4 FINAL - CONSTRUCTION MUST _ a BE COMPLETE FOR CA ` I ALL CONSTRUCTION SHALL MEET EA ` THE REQUIREMENTS OF THE NX i $TATE CONSTRUCTION S ENERGY I I i�I - DUCODES. NOTRESPONSIBLEg FOR ne,Lnr e■ I I II I f -- - - - - — '--- - - - - - - -- -- - a .- .- -.f. FLL.�• ; PROIUDE ANTI-SCRLD AND/OR 'CARE THERMAL SHOCK P EVENTING Eof NEW y : n CER, 4luCY DEVICES AS TO PAq.902.6(K) ER N.Y. ST+BUIWMG CODE. 10T S;:,I, - - EJCC4i_W, „D. 2 M2 -I �U ��AI hlf7fi_ 1•'�- '✓_sem C7 t-� •p�OFES$ 0Nr�4. PLILINIBING ALL PLUMBING WASTE If copper is used �cht /q I d &WATER LINES NEED system;pipfor water ing steel b / q TES*I oBE COVERING system:Plpilg shell be E of types K or L only UNDERWRITERS CERTIFICATE Id t, ALARM DEVICES REQUtRREQUIREDPROVIDE SMOKE-DETECTING AS TO PART.721.1 N.Y.S BUILDING CODE. y uoV CpQL `✓ W/TF1 U I ! E ' o ll I . IE 9 , II t�raH�ra� �.�✓.onG'� '1-��6J " �r�l�to�..J F N W " uo y 2 I 12 " �Iw" GLfJC?I�aO� a i i I t, I 4 ' I f l 1 i i I I I 1 P 1 I I OF NEW yo ' � Y �✓yr�I 1�r'� �,n . 11 �~P��CE T`ti� IOMI 1 J A 2 "��W" A�i�lj�o�1 FO 03]]51-1 ��V p9pfESS10HP a N a 77 r 114 { ' f ,. `� f fief �"1sF l�y�. j I lx -- - - �; - - 9, 4'f Uh �SFIF.a Cs l ; f 0 f f o 1 � ra IJ G1'G�F�. �+ { IT i t y t i OF NEW CE 17 0322541 OEESSIONP� LU .s^ wrf atz a: e i 4 r . t N. EI L !amu ANN 44 4 � III L rGa•jM'�{= yelu�`f ' � D � � ' 064° 414 1 f 2I�4X&Mac 140"a QLmAt 5 TIM 1 �, f- / 4;�7t¢a - GI2 2urD F1aeDE G r?. Q - .� r 'y yam. ,!� �, �, •/(� pq 'Y U. (_ L1 43Gv MAI- � 1 G u P-"Li ,�. A > OF NEW17 °.j E'AA"4LfZQ G '7{f GF5,3�+ G "U4(v4i�i o eazss�.l ?v - l+h�,k" i pR�FESSIONP�� I a a ° l w Aw, N4Nrxn l� res �i 4 i .. A"T'�i✓}�a � •'j � k ...r v_ .e-w.-.�..-.nw.r a� � <� 'G�IQ II f`1� ��L`r/Fr ^`fM' „ , L x I .r • N Y N .. n `/ 'J Y IT G O C F. 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