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HomeMy WebLinkAbout27431-ZFORM NO. 4 TOWN OF SO,HOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29555 Date: 07/02/03 THIS CERTIFIES t~at the building NEW DWELLING Location of Property: PVT RD OFF E END RD FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 7 Block 2 Lot 9 subdivision Filed Map NO. -- Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 10, 2001 pursuant to which Building Permit NO. 27431-Z dated JUNE 25, 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 SINGLE FAMILY DWELLING WITH COVERED ENTRY AS APPLIED FOR & AS PER ZBA #4218 & 4220. The certificate is issued to ARTHUR J & BERNADETTE WALSH (OWNER) of the aforesaid building. SUFFOLK COUNT~ DEPARTMENT OF ~RALTH APPROVAL R10-00-0172 EL~t-r~IC_A_L CERTIFICATE NO. PENDING PLUMBERS CERTIFICATION DA-r~U 06/19/03 THOMAS RAVINO 06/25/03 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 COMPLETION OF THE WORK AUTHORIZED) FULL PERMIT NO. 27431 Z Date JUNE 25, 2001 Permission is hereby granted to: ARTHUR J & A/qO WALSH MONTAUK AVE FISHERS ISLAND,NY 06390 for : CONSTRUCTION OF A NEW SINGLE FAMILY DWELLING WITH COVERED ENTRY AS APPLIED FOR AND TO THE CONDITIONS OF THE DEC,TRUSTEES & ZBA at premises located at County Tax Map No. 473889 Section 007 pursuant to application dated MAY Building Inspector. PVT RD OFF E END RD FISHERS ISLAND Block 0002 Lot No. 009 10, 2001 and approved by the Fee $ 1,056.00 ORIGINAL Rev. 2/19/98 APPLICATION FOR CERTIFICATE OF OCCUPAN(Y This application must be filled in by typewriter OR ink and ~ubm]~t~o ~O th~ ~ul/dirtg~ 2. Fin~ Approval from Health Dept, of water supply and sewera~e-disg, osai(S-9 fo~m), 3. Approval of eleccrical installation from Board of Fire lnderwriters. " Swor~l statement from plumber certifying that the solder used %~ ~ystem contains less than 2/10 of 1% lmad. 5. Co~erclai b0ilding, industrial building, m.~lrlpl~ rasideDces ~nd similar buildin~ ~esponsible for the building. For existing buildings (prior to April 9, 1957) not~conformlng uses, or buildings an{ 1. Accurate aurvey of propar~y showin8 all property lines, streets) building cna unusual natural or topographic featuras, 2. A properly completed application and a consent ~o lnspect signed by the applicant If a C~rglficate of Occupancy is denied, the Bui]dlng Inspector shall state the C, Fees I, Certificate of Occupancy - New dwelling $25.00, Additions to dwel]lng $25.00, Alterations to dwelling $25.00, Sw~_m~..i~g pool $25.00, Accessory building Additions to accessory building $25.00. Businesa~ $50.00. 2. C~rtiftcate of Qccupancy' on Pre-existing Buildin~ - $100.00 3, Copy of Certificate of Occupancy - . 4. Updated Certificate of Occupancy - $50.00 5. T~mporary Cergificate of Occupancy - ~esidential $15.00, Commercial $15.00 ..... ....................... New Construction... ~' Old Or Pre-eXisting Building ........... Location of Property ............... .7.~. .............. ~ .................................... House No. Street Hamlet Onwer or Owners of Pro~ert~ ~ A~..I~O~I(~ Co~=ty ~ ~p ~o moo, S~o:ion .... q.O. 7. ..... Block .... ? ......... ~o~. ? ....... Subdivision .................................... Filed Map ............ Lot ................... ................. ii3'A Health Dept. Approval .......................... Underwr~Cer~ Approval .................... Planning Board Approval ........................ Keque~ for: Temporary Certificate ........... Final Certfcate... APPLICANT APPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Richard C. Wilton BOARD OFAPPEALS TOWN OF SOUTHOLD ACTION OF THE BOARD OF APPEALS Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1809 Appeal Nos. 4218 and 4220. az amended to include.Swimmingpool: Application of JOHN E. S~RIPP and JUDITH D. STRIPP, A Variance is requested from Article III. Sect~ion 100-32 for permission to locate a new principal dwelling structure with a reduced front yard setback. Also requested under Appl. No. 4200., as, amended, is a Variance based upon the Building Inspector's- February 24. 1994 Notice of Disapproval concerning a building per, mit appHcation for a swimmingpool with enclosure in a front yard, location; ref. Article III. Section 100-32 (100-33) of the Zoning Code. Location of Property: Private Road off East .End Road, Fishers Island; NY; County Parcel ID 1000-7-2-9. WHEREAS. a public hearing, was held on March 2, 199~, April 6. 1994' and May 4. 1994' concerning the above application (at the last two hearings* jointly with Appeal No, 4220 as an amendment to include a swimmingpool structure in the front yard. and, at said hearings all,,who desired to be heard~were heard and their testimony recorded; and WHEREAS, the Board has carefully considered all.. testimony and documentation submitted concerning, this application; and WHEREAS. the Board Members have personally, viewed and are familiar, with the.premises in question, the current R-120 Zoning. and the surrounding areas; and WHEREAS. the Board made the following,findings of fact: 1. OWNERSHIP. The applicant 'is Stephen L. Ham III. Esq. as atterney and agent for the,property owners. John E. and Judith Stripp~ who acquired the subject premises from the County of Suffolk, for $11.000 on,April 30. 1979 (Liber 8615 cp 515). 2. PROPERTY DATA. The property which is the subject of this variance application is vacant, unlmprove{J (natural) land consisting of a lot area of 1.10+- acres, or 47.916 sq. ft. (including, wetland grass areas). This parcel is nonconforming as to lot size in this R-120 Zone. which provides for 120.000 sq. ft. of 'land area'to be conforming. This parcel: is als(~ a corner lot with frontage~ along: two private rights-of-way I~age ;~ - Appt. Nos. 4218 *id 4220 M~i'~er of JOHN E. 8 JUDI-I n STRIPP Decision Rendered June.13, 1994 (roadways) off East End Road, Fishers Island, and is identified on the Suffolk County Tax Maps as District 1000, Section 7, Block 2, Lot 9. 3. BASIS OF APPEAL: On or about February 4, 1994, the applicants applied to the Building Inspector:for a building permit -to construct a single=family dwelling, and on Febru- ary 9, 1994 a Notice of Disapproval was-issued on the following g rou n ds: ...Under Article III, Section 100-32 Bulk; Area'and Parking Regulation proposed construction will have insufficient front yard setback. Action required by Zoning Board of Appeals. Action also required by Board of Town Trustees and, New York State Dept. of Environmental Conservation,... 4. AMENDED BASIS OF APPEAL: On or about Febru- ary 22, 1994. the applicants and their agent returned to the Building Inspector and filed a new~ building permit--application to construct a single-family dwelling and, accessory sw[mmin~J pool, and on February 24, 1994, a new Notice of Disapproval was issued on the ~followlng grounds: ...Under Article III, Section 100-32 Bulk; Area~and Parking Regulation,proposed construction~ will have insufficient front yard setback. Under-Article III, Section 100-33, Accessory Uses and Structur. es (swimmingpool) shall be located in the ,required rear yard. Action required by Zoning Board of Appeals. Action also required by Board of Town Trustees and New York State Dept. of Environmental-Conservation,... 5. VARIANCE REQUEST: By this application; as filed February 10. 1994 and amended on March 4. 199tl-. variance relief is requested for permission, to extend~ to Iocate~a new single-famil,y dwelling: with a 20 ft. setback from the. wester~ly front property line, at. its closest point. The face of the house, is angled towards the east/northeast, with variable setbacks between 20 feet and. 53 feet from the, westerly front property line. and at 98+- feet from the southe~ly front property line. Included in this later application is a request for relief to. locate an, accessory swimming pool str. ucture in the front-yarcl area to the south of the, proposed dweH~ncj,: with a setback not closer than 60 feet to the southerly (front) property line, 6. CODE REQUIREMENTS. In the Zoning Code Bull~ and Parking. Schedule~ the setback requi,rements provided for principal, structures in the- R-120 Zone. District are:~ {a) front yard setbacks at 60 ft. from the front property line; (b} 30 I~a, ge J ~ Appl. Nos. 4218 ' Id 4220 Matter of JOHN E. & JUDllrt STRIPP Decision Rendered June 13, 1994 ft. side yard; lc) 85 ft. rear yard setback for lots situated in the R-120 Zone District. Also, Section 11~0-33 Of the Zoning Code requires all accessory uses, buildings and structures be located in the rear yard area. 7. AMOUNT OF RELIEF REQUESTED. The.relie~ requested by this variance application for the- location of the dwelling at 20 feet. from the westerly front ~ property line at. its closest point is substantial at 66% when compared to the 60 ft. front yard setback code requirement. The relief requested to locate an accessory swimming pool structure in the front yard is not substantial since the property does contain a significant amount of wetland and unbuildable areas, and if the premises were "waterfront," Section 100-33C of the zoning code would allow an accessory structure in a front yard at 60 feet (or more)-from both front property lines - without the need for a variance. 8. CHARACTER OF NEIGHBORHOOD. The character of the neighborhood consists generally of vacant lots, with the exception that to the west, across "Private Road", there is an accessory building situated 20 feet, more or less, from the front property line and another storage building in the same front yard. 9. ALTERNATIVES. The Board' Members agree that the dwellin9, and all activities must be located landward of the flagged wetland, lines established by' the. N,YoS. Department of .Environmental Conservation. However', it is the opinion of the Board Members that the. design of the dwelling-can be modified to accommodate a setback at 25 feet from the weste~'ty front property' line rather than the requested, 20 ft., while maintainin9 all other yard setback requirements and the 10% maximum lot coverage limitation. The dimensions of, the dwelling together with deck area az shown on the plan submitted for consideration are 86, ft. in length and variable,depths-of up to 40 feet. The footprint is shown to be 1720 sq. ft. (which excludes the 6 x 8 step area at the northerly end to, the deck). When built at two stories, the, liveable,-,floor area could maximize to 3440 so~, ft. The actual, areas of. the,proposed dwelling affected by this. reduction are at~ the northeast corners of the dwelling. (approximately 6 x 7 ft. triangles-). In fact the building area. for an.accessory swimming pool is shown at 40 ft. by 22 ft. which can also be reduced to allow adjustments for the affected corners of the proposed dwelling; 10. OTHER CONSIDERATIONS. Under this application, the property owners were *informed of archeological concerns-raised by the Fishers Island. Consenvancy and the fact that Charles Ferguson. President of the H.L. Ferguson Museum on Fishers Island. that this land contains an archaeolocdical site. of American Indian origin which has not yet been explo~ed. Prior J~age ~ - Appl. Nos. 4218 ~d 4220 Mat~cer of JOHN E. S JUDI-~H STRIPP Decision Rendered June 13, 199~ to construction activities commencing at this site, the owners have agreed to cooperate with the Museum in explc~'.ing, these concerns and in order to determine the precise extent and dimensions of ancient American Indian remains, artifacts, etc. at this site. 11. CONCLUSION. In considering all the above, the Board also finds: (a) that the essential character of the neighborhood will be altered with a setback at 20 feet from the front property line; (b) that the relief as requested for the front yard setback of-the dwelling is not the minimum necessary to afford relief to the applicants; (c) the difficulties claimed in meeting the 60 ft. front yard setback are uniquefy related to the land; ~d) that there is an alternative-available -which is feasible for appellants to pursue for an adjustment in the size and/or design of the dwelling, as noted above, and which will preserve and protect the character of the neighborhood; (e] in considering all, of the above ~factors,~ the interests of justice will be served by granting alternative relief~ as conditionally noted below. Accordingly. on motion by. Member Wilton. seconded by Chairman Coehringer, it was RESOLVED, to DENY the variance requested for a setback at 20 feet from the westerly front property line; and~ BE IT FURTHER RESOLVED, to GRANT alternative relief for the location of a principal dwelling at no closer than 25 feet from the westerly proper~y line, SUBJECT to the following conditions: a) Compliance with the lot coverage: limitation at 10% of the code and alt other code regulations; b} No further reductions in the westerly front yard setback to less than' 2.5 feet: c) Conditions set forth in the N.Y.S.D.E.C. permit shall be complied with, and additionally, hay bales shall be stockpiled on the north and east sides of the dwelling area, and the east side of the swimming pool afearD prevent erosion and disturbance to nearby sensitive lands; · : ' I~a~e ~ .~ Appl. Nos. ~.218 ~d 4220 .: M~t~er of JOHN E. & JUDI',,, STRIPP Decision Rendered June.'13. 1994 d) No alteration in the elevation or contours on the remaining areas of the parcel {except where the 'dwelling and pool construction is shown on the map}, and no disturbance to land areas on this parcel or near this parcel which are of archeological or environmental significance; e) Pool water shall be removed from site and properly disposed of. or properly placed in a pool backwash dryweU or cistern; f) Pool structure shall not be located any closer than that shown on- the map with setbacks of 50+- feet from the westerly front property line and a minimum, of 60. feet from the southerly front property llne. VOTE OF THE BOARD: Ayes: Messrs. Goehringer. Dinizio and Wilton. ~Mernbers Villa and' Doyen were absent,) This resolution was duty adopted. Ik BOARD OF APPEALS DEPARTMENT Of HEALTH SERVICES FICEOf WASTEWATER M~NAGEMENT COUNTY Of SUFFOLK ROBErt U. GAFFNEY SUFFOLK COUNTY EXECUllVE CLARE B. BRADLEY, H.D., M.P.H. COMMISSIONER{ The attached plan, when duly signed by a represetttative of the Department, constitutes a permit to construct a water supply and/or collection system for the property as depicted. The applicant should take note of any conditions of approval, which may be indicated on the plan or enclosed herein. Construction must conform with applicable standards including "Standards for Approval of Plans and Construction for Sewage Disposal Systems for Single Family Residences" and "Standards and Procedures for Private Water Systema." Omissions, errors or lack of details on the plan does not release the applicant from the responsibility of having the construction done in conformance with applicable standards. The permit (plan) expires three (3) years after the approval date. Any modifications which may affect the proposed sewage disposal or water supply ~ystems requires submission of a revised plan and additional f~s ut applicable) for reapproval p'ior to conslxuction. No inspections will be perfo,'a,ed by the Department on ex~vired permi!s. Permits may be renewed, extended, transferred or revised in accordance with the procedures described in "Submission Requirements for Approval of Sewage Disposal and Water Supply Facilities for Single Family Dwellings" (Form WWM-041). It is the applicant's responsibility to call the department at 852-2097, in advance, to arrange inspections of the sewage disposal and/or water supply facilities prior to backfilling. These include inspections of the sewage collection and disposal systems, water supply system components and piping, a~d final grading as shown on the approved plans. In certain cases, inspections of the soil excayation may be required to determine the acceptability of the soils for sewage disposal systems. The Department must be notified at least 24 hours in advance to schedule an inspection and excavation inspections must be confirmed by calling 852-2100 prior to 9:30 AJ~I., the morning of the inspection. ., FINAL APPROVAL ISSUED BY THE DEPARTMENT IS NECESSAr~Y PRIOR To THE OCCUPANCY OF NEW BUILDINGS, ADDITIONS TO EXISTING BUILDINGS, OR FOR THE USE OF SEWAGE DISPOSAL OR WATER SUPPLY SYSTEMS, WWM-05$ (Rev. 9/99) PAGE1OF2 COUNTY OF SUFFOLK DEPARTMENT OF HEALTH SERVICES CARBON MONOXIDE ALARM FACT SHEET On Imle 16, 1999, the Board of Health adopted new standards to the Suffolk County Sanitary Code for Carbon Monoxide (CO} Alarms. Beginning October 1, 1999, CO alarms must be installed in all new one family, l~svo family and maltip!e dwellings. By October 1, 2000, CO alarms must be .installed in all existing hotels and motels. Carbon Monoxide Alarms are acceptable if they are certified by a nationally recogniz~ testing laboratory and conform to Under~vriters Laboratories Standard UL 2034. Units must bo equipped with a digital readout of CO concentration and a button to indicate the maximum CO concentration since it was last reset. Alii new construction must have CO alarms directly connected to the lighting circuit with no intervening wall ssyitch. Line c~ direct plug-in and battery-powered alarms are not acceptable. Carbon Monoxide alarm's are required on each level of one family, two family and multiple dwellings on which sleeping quarters are located. All existing multiple dwellings must have a CO Alarm 'installed by October 1, 2000. These alarms may be directly coun~cted to"li lighting circuit, be line cord counacted or bo direct plug-in models. The alarms must be placed on each level in all dwelling units or sleeping rooms containing a fuel.fired appliance or served by a centralized system supplying air for cooling, heating, or ventilation. Additionally, a CO Alarm shall be located ia dwelling units an.d sleeping areas sharing a common wail with, or located directly above or below, a room containing a centralized'fuel-fired~appl!ance. They also must bo placed in corridors which serve both a room containing a centralized fuel-fired appliance and dwelling unit or sleeping rooms. Each alarm must be mounted in .aqecordance with the manufacturer's instructions. CO alarms am not manc]ated for existing one and two ~'amily homes, but they are reeommcodad if the home has an attached garage br any type 0f fuel burning appliances. For more information on the req~i~linunts or installation of CO Alarms, call the Office of P0llution Control at 854-2540, or check the intcrnet at http_ ://www.co.suffolk.nv.us/health/environ/cofacts.hlql, For a fact sheet on CO poisoning, call the D~partmant of Health Services CO Hotline at 853-2911 ww -o7 l of ). p~;~i41% [~ AP~i~oVAL~DF COH~STRUCTIO# Fold A SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES WASTEWATER MANAGEMENT COUNTY CENTER RIVERHEAD, N.Y. 11901-3397 (631) 852-2100 J.M.O. CONSULTING P. O. BOX 447 QUOGUE NY 11959 CASH RECEIPT Date Processed: 07/14/00 Hdref No: E10-00-0172 Received From: ARTHUR J. WALSH,~ JR. Project Name: Location: Receipt ~: 71475-P-44246-11884 RESIDENTIAL PUB WTR & LP'S Fee: $220.00 Amount Paid: Check Nut,her: RESIDENCE @ N/E/C PRIVATE RD. & PRIVATE RD. N/E/C PRIVATE RD. & PRIVATE RD. $220.00 2358 GE0155 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. ~ 7f/3! 2_ owner /~' ~/~j~/Y (please p ' t) Plumber 1 [~.F/b~% 0 %~'~ ~ ~(p-lease p I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this /~ day of ~/~ , Notary Public, ,~/~ County [/ - Nota~~ ' VERONICA HAMILTON NOTARY PUBLIC STATE OF NEW YORK NO. 01HA606778~ QUALIFIED IN SUFFOLK OOUNTY /W, zl os' APR April 2, 2002 Michael Verity Office of Building Inspector Southold Building Department P.O. Box 1179 Southold. NY 11971-1179 Ph (63 i) 765-1802 Fax (631) 765-1823 8 02 RE: Walsh Residence Fishers Island, NY Building Permit #27431Z Dear Michael, Enclosed is the revised MECcheck Compliance Report for the Walsh residence being constructed on Fishers Island-Acorn job #2811. Mr. Walsh has requested the insulation value of the ceilings be increased to R-38, the wall insulation to be decreased to R-13, and that the minimum HVAC efficiency be 79.0 AFUE. The residence as specified, will still be in compliance w/the 1995 CABO Model Energy Code and the NY State Building Code. If you have any questions, please call me at 1-617-783-0674. 28 Penniman Rd Allston, Ma. 02134 eltonar¢@gis, net ph. 617.783.o674 fx. 617.782.9525 hampton@ultranet, com Bldg. Dept. Use [] [] £ ] £] [7 [] [7 [] ~ILIN~S: Comments/Locatio~ WALLS: 1, Wood Frame, 16. O.C., R-13 Comments/Location BASeMeNT WAL~S: 1. C~C. 8.0' hr/9.0' ~/8.o, inaul, R-13 in=erior cavity Co~ts/~cation Z. U-val~e: 0.39 For windows without l~ele4 U-~lues, desc~i~ featu~e~: ~ Panes Fr~ ~ ~e~l Bre~9 [ ] Ye~ [ ] No Co~ents/~oati~ Pot windows wltho~= l~led U~vatues, de~cri~ Co~t~/Loeation ~ P~e~ Fram~ ~e_ ~e~l Break? [ ] Yes [ ] No C~ts/~cation Pot skylights withou= I~el=d U-values, describe f~atures: ~ Panms Frame ~e_ T~r~l Break~ [ ] Yes [ ] NO C~s/~cation Co~ents/~cati~ Z. U-valve: 0.4 C~ts/Location 8~-ON-~E C~ent~/~ca~ion slab insulation to ~te~d do~ fr~ the ~ of ~he sl~ ~o at leas~ 24" OR do~ ~0 at leas~ the ~ttom of the slab then ~rizont~lly for a total dis=anc~ of 24,. ~AC 1. ~aoe, 79.0 ~ or higher ~e ~d ~del N~r AIR LEJXK~E: Jointo, peneLrutions, and all other such ~a~ings in the building MECcheck COMPLIANC~ REPORT 199S C~BO ~odel ~ner~y Co~e MECcheek Software Version 2.07 Release 4 TITLe: W&lsh Residence Per.it ~ Checked b~/Pate CITY: DObbs Ferry STATE: New York DAT~ OF pl~%l~; 3/20/01 PASSES Required UA = 663 Hor0e = 642 Better Than Code Area or cavity C~D. ~lazin~/Door Perimeter R-Value R-value U-value UA ~-~ILIN~ 1359 W~*LL~: Wood Frame, 16" O.C. 2720 ~SMT: Conc. 8.0' hr/7.0' b9/8.0' insul 180 GhAZING: Windows or Doors 479 ~LA~IN~ Windows or Doorm 17 GLAZING: Windows or Doors 18 GLAZINg: Skylights 14 DOOR~ 40 ~OORS 22 38.0 0.0 13.0 0.0 41 223 0.390 187 0.400 7 0,350 5 0.410 0.340 14 0.400 9 138 COMPLIANCE STAT~4ENT: The proposed buildin~ dmsi~n described here is consistent wi~h ~he ~ildin~ plans, epeci~ica~i*na, and o~her calculations e~i~=ed with ~he pe~it a~l~ation. ~ pr~sed ~ildi~g ~s been APB. 02 '09 (SUN) 12:39 THE DECK MOUSE 508 263 4159 PACE. 3/4 [] [] [] [) [) from co~Dustibl~ meterie/a and 3" clearance from inaulatlon. VAPOR R~TA~DER= Required on the warm-in*winter aide of al/ noN-vented framed ceilin~3s, walls, a~d floora. MATERIALS IDENTIFICATION: Materiala and equipment must be identified so that co-~1iance can be determined. Manufacturer manuala for all installed heatin~ a~d cooling equipment and aervice water heatin~ equip~nt ~n~t be ~rovi~ed. Insulation R-values, glasinN U-values, and heating equipment efficlenc-f must bu clearly marked o~ the building ~lans or specificatio~a. DUCT INSULATION: Ducta in unuonditioned apaces ~st be insulated to R-$. Ducts outaide the buildin~must be insulated to DUCT C~S~UC~ION: 2%11 duets must be sealed w~th~s~ic a~d fibrous backing tape. is not permitted. ~h~ }~VAC system ~/a~ provide a rflea~ls for T~PERAI'Ua~ CONTROLS: Thermostata are required for each separate HVAC system. A manual or automatic means to Dartially restrict or shut off the heating and/or cool~n~ input to each zone or floor shall be provided. SWIN~4ZN~ i~OL~: · -11 heated swimmi~ ~ools ;ust have an on/off heater awitch and require a cover unl=ss over 20% of the heating ener~ i; from non-depletable so~rces. Pool pum~a require a time HVAC PZPIN~ INSULATION: HVAC piping conveyin~ £1uids above 120 F or chilled fluid~ below 55 F muat be ~nsulated to the following levels (in.): HEATING By~Ms: ~ (F) COOLING S¥$T~: PIPE SIZES (in.) 0.5 1.0 1.0 0.5 0.5 0.75 1.0 CIEC~TING H~ WATER SYSTEMS: Inaulate circulating hot water pipes to the following levels (in.): WATER PIPH SIZES (in.) NON-CIEC~TING CZRC~TIN~ MAINS & R~O~5 RL~OUTS 0-1" 0-1.25" 1.5-2.0" 2.0*" O,5 1.0 1.5 2.0 0.5 0.5 1.0 0.~ 0.5 0.~ 1.0 .... NOTES TO FIELD (Buildin~ Department Use Only) ......................... 95 19.5 (1r/95)--10c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPLICATION FOR PERMIT TRANSFER (In Accordance with Uniform Procedures, Part 621.13) Please read ALL instructions on back before completing this appgcation. Please TYPE or PRINT c~eady in ink. PART 1--TRANSFEREE (NEW OWNER/OPERATOR/LESSEE) COMPLETES: 1 L~ST PERMIT NUMBER(S) AND THEIR EFFECTIVE AND EXPIRATION DATES. 1-4738-0010;~/00001-0 : ~:~-31-2003 2 NAME OF TRANSFEREE II other than an individual, provide Taxpayer ID ARTHUR WALBH and BERNADETTE WALSH Number STREET TELEPHONE NUMBER P.O. Box 476 (63'[, 788-7605 C,TY STATE I z, PCODE Fishers Island ~) NY 06390 3. TRANSFEREE IS A/AN: ~Owne/ [] Operator [] Lessee 4. NAME OF FACILITY/PROJECT STREET Private Road adjacent 1:o Barlow Pond (SCTM# 1000-7-2-9) CITY Fishers Island STATE I ZiP CODE NY 06390 COUNTY TOWN SuFfolk Southold 5. HAS WORK BEGUN ON THE PROJECT? [] Yes )~[No If no, proposed starting date; Approximate completion date: If lhere will be any modifications to the current operation, the transferee must attach a statement specifying the details. 6 CERTIFICATION: This certifies that the transferee is the current owner/operator/lessee of the named facility, has a copy of the permit, understands and will comply with all conditions in the referenced permit. Facility operatlons~project scope/discharges/emissions will remain Iris same. Further, I hereby affirm that under penalty of perjury tltat information provided on this form and all attachments submitted herewith is true to lhe best of my False nts made herein ar pu ishable as Class A misdemeanor pursuant to Section 210.45 of the Pe I La . Signature and Title __ Date PART 2--TRANSFEROR (FORMER OWNERIOPERATORILESSEE) COMPLETES: 1. NAME OF TRANSFEROR ' ~ STEPHEN R. LeFEBVRE STREET 27 Stoney Corner If other than an individual, provide Taxpayer ID Number TELEPHONE NUMBER ( 20~ 264-7064 CITY STATE I ZIP CODE Bouthbury BT J 06488 2 NAME OF FACILITY/PROJECT, IF DIFFERENT FROM NAME IN PART 1: 3. CERTIFICATION: This certifies that the facility referenced in Part Iol this form will be/was translerred to t.he party identified as the new transferee (ownerloperatorllessee) on August PA.T 3--PEBM, T.A.B.E. VAL %O. CO.S .VA¥,O. COMR ETE ~Transfer of permit approved. Transferee subject to conditions,of permit, without exception. [] Transfer of permit approved, with the following modifications: [] See attached revised permit page(s) [] New application required. Ple~ compl~,~the enclosed permit application and return it to the undersigned Regional Permit Administrator, Division of Regulatory Services, at tltll~ a..a=~Pppp~ropr(~l~f.fice of the Department (see map on reverse). APPLICATION'FOR PERMIT TRANSFER ,,,.,:~ :'.,', ' ' ' : ~"' v,~ ~?~., 1*'''~ ~ ~'~'" S ~A~ won~ ~OUN o~ T~E ~OJECTt DEC PERMIT NUflBER I-&738-00102/00001-0 FACILiTY/PHOGI~H NtMBER(S) NEV ~ STATE DEPARTMENT OF ENVIRON#EM?AL CONSER~~ PEI rVIIT Urxler the Envira~em~ll EFFECTI~ DATE Decend~r 29, EXPIRATION DATE(S) December 31, 1996 J TYPE OF PERHIT I Neff D Refuel D #udlficetion a Permit to Construct D permit to Operate ArticLe iS, TitLe 5: Protection D 6NYC~R 608: ViLer QUnLIty ArticLe IS, TitLe 15: VeLar SimpLy Article 15, TiTLe 15: VeLar TrIMpert ArticLe 15, TitLe 15: LM~ JcJendVeJJe . . , Article 1S, TitLe 2ti ~lLd, Scenic end Recreational Rlvere Other: PERMIT ISSUED TO John & Judith Stripp Certificltiofl ArticLe 17, TitLes ?, 8: SI)DES ArtlcLe'19: Air PoLLution Control iArtlcte ~, TitLe 2T~ #ired Lind HKJlleetJm Article 24: Freah~eter VetL~nda Article ~: TIlL Vet~ ADDRESS OF PENMITTEE % Scetacook Trelt, Vestofl, CT 0688~ CONTACT PERSON FOR PERMITTED UONK John & Judith Stripp NAHE AND ADDRESS OF PROJECT/FACiLITY Etrlpp Property - hrLow Pond [] ArticLe 27, TitLe 7; 6NYCER ~60: SoLId Veate 0 ArticLe 27, TitLe 9; MYCRR 373: hzlrd~Veetl Nlnlg~t 0 ArticLe'S: c~sta( Eroslm O ArticLe ~: Ft~a~n N~g~t ~Y~R~OI R~lltf~C~tro~ TELEPHONE NUMBER JTELEPHONE MEMBER LOCATION OF PROJECT/FACILITY hrteff perm - SCTH #1000-7-2-9 TONN J ~ATER(~URSE Southoid BerLow po~cl MYTH COORDINATES (N Construct single famlLy MtLIng, pooL, septic system and regrade parcel adjacent to Barto~ Pond. ALL work shaLL be In accordance with the attached NYSOEC approved pfaff dated 12129193. By acceptance of thee permit, the pamittee agrees that the permit le contingent upon itrict compliance #lth the ECL, eli applicable regulations, the General Co(~ltlons specified (mpa g e Z) end any Special Conditions Incl.u~edu part of this permit. REGIONAL PERMIT ROMINISTRATON: J RI)DRESS I BL~. &O, ~NY, Rom 219, Stay Brook, NY 11~0-~56 ~T~tZED SIGNATURE DATE Page I of 6 Impect i~s 1. '[he permitted site or facility, including relevant records, is subject to in- Inspection at reasonable hours and intervals by an authorized representative of the Depar~,¥ent of Envirof.untal C~nservation (the Deper~,fent) to determine v~ether the permittee is cu~plying with this permit and the ECL. Such represen- ter ive rmy order the work sus..pended pursuant to ECL 71-0301 and S~A 401(3}. ,~ copy of this permit, including all referenced rmps, dra~vings and special conditions, rrust be available for inspection by the Depar~unt at all tirms at the project site. Failure to produce a copy of the permit upon request by a Deparb,ent representativ.e is a violation of this permit, Permit Oranges and Fime~ls i .- . i - . 2. The Oepartrmnt reserves the right to rrodlfy, suspend or revoke this Permit when: a) the scope of the;permitted activity is exceeded or a violation of condition'of the permit or provisions of tee ECL and pertinent t ions I s found; · b) the permit v~s ol~tained by misrepresentation or failure to disci0s~ relevant facts; c) newrmterlal info.~ution Is discovered; or d) enviro, rental conditions, relevant technology, or applicable laN.O~ regulation have rmterial ly changed since tee permit wes issued. 3. The permittee rrust sub~it a separate written application to the Deparlnunt for rene~l, rrodificatlon or transfer of this permit. Such application rrust .include any fon,~, fees or supplemental Info,~utlon the' Deparb~unt requlres.~ ;N~/ rene~l, rrodification or transfer granted by the Deparb~ent trust be in writing. Other 6. '[he permittee mJst submit a renewal application at least: - .. a) 180 days before expirati°n of permits for State Pollutant Discha~'ge Elimination Syste"n (St=E:ES), Hazardous V~bste tlV'enageTent Facilities (I-I/WF), rmjor Air Pollution Control (,N=C) and*Solid V~ste'lV'enage-mnt Facilities (S/M=); and b) 30 days before expiration of all other permit types. Unless expressly provided for by the Deparl~,unt, IsSUance of this not rroclif¥, supersede or rescind any order or determination previously Issued the Deparbfunt or any of the terms, conditions or requirements contained in order or determination. .. ' Legal Chi igations of Pem'Jttee The permittee has accepted expressly, by the execution of the appl I.cation, tee full legal responsibility for all. deluges, direct or Indirect,'of wt~atever nature and by w%u~ver suffered, arising out of tee project described i.n this permit and has agreed to indeTnlfy and save harmless the State frcm SUits., actions, day'ages and costs of every n~,u and descrlpt.lon resulting :from this project. This permit does not. convey to the permittee.any right to trespass upon the lands or interfere w~th the riparian rights of others in.orde.r to per.form the permitted work nor does it authorize tee Irrpalrrmnt of any r'~ghts; t~tle, or Interest in real or personal property held or vested in a person not a party to tee permit. The permittee is responsible for obtaining any other permits, approvals, lands, easu~ents and rights-of-way that may be required for this project. Page 2 of 6 ADOITIONAL GENERAL CONDITIOIN$ FOR ARTICLES 1S (Tille 51, 24, 25, 34 .and 6 NYCRR Par! 608 ( I"c.cl ~, If 8Tanted under 6 NYCRR Part ~l,~, Ihe NYE I)ul)artment of Environ: PaLmer and King " ,)~, ~. e SPECIAL CONDITIONS . Any work,disturbance, and storage of construction materials shall be confined to: within the "Limit<~of Clearing and Disturbance" as shown on the approved plan. Heavy equipment, including bulldozers, backhoes, payloaders~ etc., shall not be operated beyond the limits of clearing on the approved plan. .. A snow fence or other temporary, project-limiting fence shall he erected prior to the commencement of any construction activities: along the "limits of clearing' on the approved plan. Prior to commencement of any conetruction activities, a continuo~ row of straw bales shall be Etake~ end to end: along the base of the snow fence ( or other temporary,' project l~m~ting fence) on the upslope or project side of the'fence. ~h~-bale~ shall be maintained, repaired and reDlaced as'often as necessary to ensure proper function, until all dist~rbed areas are permanently vegetated. The average useful life'of a bale ~s approximately 3-4 months. Se~iments trapped by the bales shall be removed to an approve~ uplan~ locatio~ before the bales themselves are removed. 1-4738-00102/00002-0 Page ~ of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Se SPECIAL CONDITIONS For Article 24 ( Fresh. al:er gel:lands ) All disturbed areas where soil is temporarily exposed/stockpiled for longer than one (1) day shall be covered with a tarp or contained by a continuous line of staked straw bale~ placed on the downslope or wetland side. Any demolition debris/excess construction materials/excess excavated materials shall be Immediately and completely ~isposed of on an approved upland site more ~han 100 feet from any regulated freshwater wetland. · These materials shall ~be suitably stabilized so as not to re-enter any water body, wetland, or wetalnd alaacent area. Excavated materials/fill materials shall be stockpiled more than 100 feet landward of the wetland or water body and shall be contained by straw bales or silt fenging to prevent. erosion. 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. During the grading or sloping operation s0~l shall not be placed in or graded toward the wetland. The work area shall be graded to conform with the elevation and contours of the undisturbed land ~mmediately adjacent to the work area. All roof runoff and pool discharge shall be directed to drywells located according to the approved plan. 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 serve to avoid the inadvertent leakage, of deleterious substances into the regulated area. Fuel. 'or other .chemical . storage ta~ks shall be contained and located at all .tim~e~',~ih ..... an area greater than 100 feet landward Of the regulated '' wetland or water body. If the above requirement cannot be' by the permittee, then the storage areas must be designed i...to · completely contain any and all potential leakage. Such a contaminant system must be approved by NYSDEC staff Prior to equipment, machinery or tank storage within 100 feet of the regulated wetland or water body. .. DEC PERMIT NUMB[R 1-4738-00 ] 02/0000 I-0 FACILITY ID NUh4DER Page NEW YORX STATE DEPART,%dENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS For Article. 24 ( Fresh~ater ~el:lands } 13. 14. All areas of soil disturbance resulting from this project shall be -- seeded with an appropriate perennial grass; end: mulehed 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 ~ntil a suitable vegetative cover is established. If seeding is ~mpraot~oabls due to the time of ~aar, .a temporary hat/mulch shall be applied and final seeding shall be 'pmrformed as sonn as weather conditions favor germination end growth. The permittee shall incorporate the following langugage as a notice covenant to the deed: "Regulated freshwater wetlands associated with MY-9 are located on or near the properties of John & Judith Stripp and his/her/their heirs, assigns or successors. This property is subject to the provisions of 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). 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 BEP, SUNY Bldg. 40, Stony Broo~, New York 11790-2356. Supplementary Special Conditions (A) through (F) attached. DEC PERMIT 1-4738-00102/0000 FACII I'Ty ID NUMBER I J PROGRAM NUMBER J Pace _ 5 of R - SUPpL]~M~IqTARY SPECIAL CONDITIONS The following condit£ons apply to A. A copy of this permit, including all conditions and approved plans, shall be available at the project site whenever authorized work is in progress. The permit sign enclosed with the permit shall be protected from the weather and ~osted in · conspicuous: location at the work site.until all authorized work has been completed. The permittee shall ~equire that any contractor, project engineer, or other person responsible for the overall supervision of this project reads, understands, and complies with this permit and all its general, special, and supplementary special conditions. Any failure to comply precisely with all of the terms and conditions of this permit, unless authorized in writing, shall be treated as a violation of the Environmental Conservation Law. If any of the' permit conditions are unclear, the permittee must contact the Division of Regulatory Affairs at the address on page one or telephone (516} 444-0365. De If project design modifications become necessary after permit issuance, the permittee shall submit the appropriate plan changes for approval by the Regional Permit Ad~ninistrator prior to undertaking any such modifications. The permittee is advised that substantial modification may require submission of a new application for permit. At least two days prior to commencement of the pro~t, 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 the authorized work, the bottom portion of that form shall also be signed and returned, along with photographs ~f the completed work and, if required, a survey. For projects involving activities to be undertaken in phases over & period of more than one year, the permittee shall notify the . Regional Permit Administrator in writing at least 48 hours prior to recommencing work in subsequent years. The granting of this permit does not relieve the permittee of the responsibility of obtaining e grant, easement, or other necessary approval from the Division of Land Utilization, Office of General Services, Tower Building, Empire State Plaza, Albany, NY 12242 (518) 474-2195, which may be required for any encroaohment upon State-owned lands underwater. DEC Permit No. 1-4738-00102/00001-0 Page6 of 6 ;YSDEC ~ureau of'Environmental Protection ;ldg. 40, SUNY ;tony 8rook, New York 11790-23S6 Contract0r'e Phone No. ?ursuant to General Condition Number i of the above referenced permit you are hereby notified :hat the authorized activity shall c~mmence on ~hie notice is to he sent at least two days in advance of commencement of the pro)eot. ~he permit sign will be ~osted at the site and copy of permit will be available at site for ;nspectlon. Submitted by: :ailure to notify or post sign will leave owner and/or contractor subject.to applicable ~enalties for non-compliance with permit conditions. ]YSDEC lureau of Environmental Protection {ldg. 40, SUNY ;tony Brook, New York 11790-2356 ?o whom It ~&~'ccncern~ Contractor's Name Contractor's Address Contractor's Phone No. 'ursua~t to General Condition Number i of the above referenced permit you are hereby notified :hat the authorized activity was completed on Submitted by: ~ .. · his notice, with photos of completed work and/or completed ~urvey, is to be sent t~ above .ddress promptly upon complettion of pro,eot. Failure to notify will leave owner and/or tcntractor subject to applicable penalities for non-compliance ~ith permit conditions. New York State Department of Environmental Conservatio. Bu~dln~ 40 - SUNY, Stony Brook. New York 11790-2356 Phone (516) 444-0365 Fax # (516) ~ 0373 John & Judith Stripp 4 S~atacook Trail Weston, CT 06883 Date: March 20, 1996 Re: Permit No. & Location: 1-4738-00102/00001-0 Dear 5:r & MrS Stripp, Private Road odjacent to Earl©w Pond Wishers ' Island SL']~ ~ 1000-7-2-9 ~ Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR, Part 621. The expiration date is extended to December 31~_1997 ×_~_X Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR, Part 621. It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or %_he existing permit conditions. Therefore, l~he permit in amended to authorize: H~dification~ to proF~s~ dwelling and pool in accorrl~nce with plans by Richard H ~trmuse - last revisioa 9-22-95, and N"fSDEC apDr~,ed ~rch 20, ~996. ~ffer has been accepted biz this Depa,r. tment and NL'S Office o£ I Thi~ letter is an amendment to the original permit and, as such, ~hall be available at the job site whenever authorized work is in progress. All other terms en~ conditions remain as written ia the original permit. Very truly yours, et-mit Administrator cc: Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 26, 2001 Mr. & Mrs. Arthur Walsh P.O. Box 476 Fishers Island, NY 06390 RE: Private Rd., Fishers Island SCTM#7-2-9 Dear Mr. & Mrs. Walsh: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 25, 2001 regarding the above matter: WHEREAS, ARTHUR & BERNADETTE WALSH applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated April 3, 2001 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 ~co said application on April 25, 2001 at which time all interested persons we~;e 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 standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, -2 safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of ARTHUR & BERNADETTE WALSH to construct a single-family dwelling, garage, driveway, and septic system, with the condition of a 50' non-disturbance from the edge of the wetlands. 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, President, Board of Trustees AJK/lms cc: DEC Bldg. Dept. Health Dept. Board Of $outhold Town Trustees .SOUTHOLD, NEW YORK PERMIT NO..~.~O ~ DATE: ...A...gr!~. Z.~'.,....;~.001 ARTHUR & BERNADETTE WALSH ISSUED TO Au h rizalio. Pursuant to the provisions of Chapter 61El of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 197i2; and the Southeld ToWn Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUC~TIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROId LANDS UNDER TOWN WATERS;!:~ and in accordance with the Resolution of The Board adopted at a meeting held on 2001 and in consideration of the sum of $.~.q.(~.:..(~.0 ...... paid by ....... ~.~.r....~....B~rn~d~t e ~alsh .................................................... ~ ......... of Fishers Island .......... N. Y. and subject fo the Ter~'"'"~i"""~'~'i~i~'~'"li~'~CJ on the reverse side hereof, of Southold Town Trustees authorizes and permits fha following: Wetland Permit to donstruct ~ sin:g]e-£amily dwelling, garage, driveway and septic system, with the condition of a 50' non-disturbance buffer from the edge o£ the wetlands. all in accordance with the detailed specifications as presented in fha originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Senl to be affixed, and these j~.re~ents to be subscribed by a 'majority of the said Board as of th,s date. · He,nry, Smith - Absent - · ~usteet TERMS -,nd CONDITIONS TI~ P~ Arthur & Bernadette Walsh ~a~g~ P.O. Box 476, Fishers Island N. for ~ 4. That d~e wock ~.-.~,Ived will be subject to d~e impection and apptowl its sgen~ and noa-e0mpllance with. die ptm4slons e~ the ~--~-g ~evo~fioa of ~ Pen~t by molution of d~e said 5. 'l'l~t there will be no unteaso~b!e interference rate atvigst~ ss · ~ o~ d~e world. the beada between hi.~', ,ad low water marks. ~ d~e notice, to mnove or alter this wodc d Soud~old. That ~e sald Board wiU be aog~ed by the Permittee ot the cempleeleaof tine ~ot4~ and~ 8. otized. 9- That the petmittee will ebtaln aH other permlt~ and comenu d~at me/be zequlted ~ plemen~ to d~ prank ~ may be subject to tevote ulX~ f-",.~ to ~e-~"~ san~ SOUTHOLD TRUSTEES No. ~ Issued Date~t THIS NOTICE MUST BE DISPLAYED DURING 'CONSTRUCTION · TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLp, N.Y.?1971 BUILDING PERSIlT RE\qEW CHE(. l, LLST Owners Nmne: Architect/~ Engineer: SCTM fl: District J,000 Section: 7 Block ~ Lot: Reviewed: Date Submiued NUbdivision Single & separate Required cemficalion: (Yes / No) Project Description: AGENCI~j'ERMITS REQUIRED FOR REVIEW Proposed N.A. NO Suffolk County Health Dept. Town Trust es Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: Req. .} [Rear Yard ~I~ Proposed Permit YES Number Notes: ~o ~o, BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING FIREPLACE & CHIMNEY ROUGH PLBG. INSULATION ~]'I~INAL REMARKS: DATE ~~z__INSPECTOR~ BUILDING DEPARTMENT TOWN HALL SO T.OL , l lp l TEL: 765-1802 i ~' -' Disapprol~a~c U~U F/~ledvll I At't~bit2A I'IUN~CHISCK. LIb Do yon have or need the following, before applyin Board of Health 3 sets of Building Plans Survey. Check Septic Form N,Y.S.D.E.C Trustees Contact: Mail to: Phone: Building In~ Ctor APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ,20 tg/ a. This application MUST be completely filled in by tYPewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on'premises, relationship to adjoining premises or public streets or areas, and waterways. c. Thc work covered by this application may not be commenced before issuance of Building Permit. d. Upon app,,oval of this application, the Building Ins~pector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection through0.ut'the work. e No building shall be occupied o~; tlsed in whole or in part for any purpose what-so-ever until a Certificate of Occupar is issued by the Build!rig Inspector. A~PLICATION IS HEREBY MADE to the Buildi~ag. Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, SuffolklCounty, New York, and other applicable Laws, Ordinances or Regulations, for the cbnstmction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to coinply with all applicable laws, ordinanc'~es, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for neees. Sary inspections. (Signature o~pplicant or name, ifa co,potation) (Mailing address ofapplicanf) t State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~c~£~q . Name o f owner o f pi'cruises (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. Location ofland on which proposed work will be done:.. . /~/S/e~5 ~-~/,q/oO/ t~c/ oagclo House Number Street County Tax Map No. 1000 Section Subdivision 007. (Name) Hamlet · ' Block Filed Map No. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy V'/:I' ¢/t,oT /-.,4,5JD b. intendeduseandoccupancy ~/~o'i1¢ ~'~r~,'l~7 Nature of work (check which applicable): New Building )~ Addition Alteration Repair Removal Demolition Other Work o * (Description) Estimated Cost ;~00. 0o0. ~ Fee ' (to be paid on filing this application) lt'd~ellmg, number of dwelling units / Number of dwelling units on each floor If 9arage, number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front Rear .Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height. Dimensions of entire new construction: Front ~ r Rear Height .~ ' Number of Stories Siz~ of lot: Front o~/°O / Rear 36,5"'* Depth Number of Stories ~ O" .Depth 0. Date of Purchase oo°//za/oO..NameorFormerOwner ,5"F~/°//'~/J A, L</c'.E~cl.q~ l. Zone or use district in which premises Ire situated ~ ~/2- o 2. Does proposed construction violate any zoning law, ordinance or regulation: A) ~ 3. Will lot be re-graded c/C::~ Will excess fill be removed from premises: YES (~ ,~o 8ox 4. Names of Owner of premises - ' ~'~lldress ~.g,4e,~$ 2"s/,4,0~0 ,~,~ Phone No. (::,--?[ Addressta a~oo&l,H~a.l~a Phone No Name of Architect t~rUcg ,.q,#,~rt>,~ ' ' ' Name of ContractorthO'lar~, g~r.,,,~t~t~e I.D,~t~I, Address~PhoneNo. ~t f. k this property within 100 feet of a tidal wetland? *YES ,~ NO · lF YES, SOUTHOLD TOWN TRUSTEES PEKMITS MAY BE REQUIKED 6. Pro',ide survey, to scale, with accurate foundation plhn and distances to property lines. 7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. TATE OF NEW YORK) SS: OUNTY OF /~,1'~7'7tc4~ ~-', ~'~,~ /-'- -~ ~ being duly swom, deposes and says that (s)he is the applicant (,Name of individual agning contract) above named, (Contractor, Agent, Corporate Officer, etc.) said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; t all statements contained in this application are true to the best of his knowledge and belief; and that the work will be 'formed in the manner, set forth in the application filed therewith. om to before me this /0 dayof /~,,'? £/ Notary fubiic Signatla'~ of Applicant ELIZABETH A STATHI~ NOTARY PUBUC, S~ate of New N~. 01ST6008t 73, Suffolk ~