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HomeMy WebLinkAbout17144-z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No 217577 Date DECEMBER 8, 1988 THIS CERTIFIES that the building ADDITION Location of Property 520 PVT. RD. #12 R.O.W. OFF MAIN BAYVIEW, SOUTHOLD House No. Street Hamlet County Tax Map No. 1000 Section 078 Block 06 Lot 06 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 16 1988 pursuant to which Building Permit No. 171442 dated JUNE 21, 1988 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 PORCH ADDITION TO AN EXISTING ONE FAMILY DWELLING. The certificate is issued to CLAIRE L. & CHARLES H. WOOLLEY (owner, XXXXX]~Of:{XXXXXX7DC) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL NfA UNDERWRITERS CERTIFICATE NO. N045273 NOV. 11, 1988 PLUMBERS CERTIFICATION DATED N/A Building Inspector Rev. 1/81 Fosas xa a TOWN OF SOU7HOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Nfl 017144 Z Date ......~.~.....~:1 19..0 Permission is hereby granted to: ..~4:,-~.~.....~....Q-~:... . ~ ~.:~.:....L ~.q.~.l............. C;u.~-~~.~.c~1- a...~c.A...4-~.~r~..~..M...~:~....~...~?.y!rr4-#.-.4%r:->~..~,. r~ n,~..~.k:w.~'^':~ p p,~ of premises located at ..~`~ra: V.....P~?.~...~.....~']...~.~1,..!!1.G!':'"'t.. ~~.~'u!'`~••••••~d.~""•`•'•"•`• . County Tox Map No. 1000 Section ....,~7.$.....,. /Block Lot No.....Q..~.......... pursuant to application dated ......~...6~...•~..1~!•.••••••....••....., 19.Ag., and approved by the Bui ldi neg~-I~nspector. Fee $.x.e . 9 uildin Inspector Rev. 6/30/80 - ~ 7/ ~f .Z ~y ~ ~ Li; ~ FORM NO. 6 TOWN pF SOUTHOLD Building Department ~ i1 ~ri " ~ ~ Town Hall Nd ~ t 7 Southold, N.Y. 11971 ~~LDU.Oc~pqq,, 765 - 1802 TOWN OOl4ipB1.t1CAT N FOR CERTIFICATE OF OCCUPANC Instructions t~F, f~i~1: A. This application must be filled in typewriter OR ink, and submitted ~ s~~~ to the Building Inspec- torwith the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal-(S-9 form or equal?. 3. Approval of electrical installation from Board of Fire Underwriters. - 4. Commercial buildings, industrial buildings, Mu{tiple Residences and similar buildings and installa- tions, acertificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing'° land uses: . 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. _ C. Fees: Additions $25.00 POOLS $25.00 ALTERATION $25.00 1. Certificate of occupancy New Dwelling , $25:00, Accessory 10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 year's $10.00 , / - 4. Vacant Land C.O. $ 20.00 ///~~jj S.Uodated C.O. $ 50.00 Da/te ~~~.~•:4......... NewConstruction,,,~OldorPre-existing Building(...... Vac/a~n~tLand Location of Property aL~T, C3:"S .s . E~;'1?-I ;J1r°`c) . ! }:5'...... ~c;'tYtc? F~:. . House No. Street } ~ Hamlet Owner or Owners of Property l ,~~b©~~E'. ~ . County Tax Map No. 1000 Section ~s~ Block ~ kJ...... Lot .....<<-?. R. ~ , . , , , Subdivision ...Filed Map No. ..........Lot No. . Permit No~1.7.f.~-~ , , , Date of Permit . ~G+.h.41~~~..Applicant ~ . f', ~C?~~.~/H, ~ , , , , , , , , , , . Health Dept. Approval .Labor Dept. Approval Underwriters Approval .ll/. o.~,r, a, 2';3, , , , , , , , , , , ,Planning Board Approval . Request for Temporary Certificate e ......p .............Final Certificate . Fee Submitted $ ...a °Ts? : ~..Y... ~ ~ 0 . Construction on above described building and per i gets all ap lic ble codes, nd re ulations. Applicant ..9 Rev. 10-10-78 ,QeL 3 6 ~ 75 x/~/~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICyyITYQ t~ Nf1V T~.PIHF:R ~ ~ $'~S~JOHN STREET. NEW YORK. N~rt~~Y,~4R i ]~U38 ~ 1~~~_ .y,f { Dote Application No. on file 4fR~ / THIS CERTIFIES THAT only the electrical equipment w described 6ebw and introduced 6y tAe app/icant nomad oEE the abose application number in the premisea of C. W017LN;Y. PY'C.Rt}AD, /Frt(,H; ~6 hl)-til, Si71t'CFII~Lq, N.X. inlhefollouinR taca;~,ffBryspmfg~y ~ lat Fl. ? Ynd Fl. .Sertian Block Lot woa examined on and found to 6e in compliance with the reyuiremenla of lhu Board. RXTBRE RXTURES RANDES COOKING DECXS OVENS DISH WASHERS EXHAUST TANS OUTIETS TAClES SWgCNES INGNDESCENT nuoMSCeNi y AMT. K. W. AMT. K. W. AMT. K.W. NAT. K. W. AMT. N. P. i F A Z 7, 6' DRYERS iURNACE MOTORS N1TUR! ANLANC! lilDEIIS SNCIAL R!C'si TIM! CLOCKS Eltl UNIT HEATERS MUlT1.OBTlRT DIMMERS AMT. K. W. pl N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. M. P. ~ ~T AMT. WATTS SERVICE DISCONNECT fq.OF 5 E R V 1 C E AMi. AMP. T11E ~R 1 ATn t / 3W ] L ]•M 7 R AW ~Eq I OND. Of CC COiaD. NO. Oi N41EG a~X4~~ NO. Of NEU111AL5 Of NWEII XAl OTHER ANARATUS: i'AIJT~ u. 91ikBS ~t?II'YKC?Lf?, NY. ,1 , 47'! ~ ~ OYEBAI Mi1RAfi~ 11 n'.Cr:NSM, td+!,. 'Jk?. A; Psr Thit nrtificate mmt not bs altered in any manner; return to the office of fhs Board if incorrect. Inspectors may be identified by their credeTHia s. COPY FOR 6UILDING DEPARTMENT. THIS COPY OF CERTIFIGTE (WlST NOT 8E ALTERED IN ANY MAIWER. r'1cLD""1.;51"i,-lUIJ ~~UniF. ~ i;OMMENT° ^1 Wro ra ~ 1. H FOU2JDATIO (1st) +~G a FOUNDATIOtJ (2nd) _ - 2 . o JJJ o u ROUGH FRAME ~ r` ~b 4 PLUMBING V 3. ra ~ IIJSULATIOCI PER N. Y. y p STATE ENERGY ~ CODE T r 4 . .3 L FI;JAL _ '~-.-t ADDITIOPIAL COMM S: x ro ' x .b H ~7 y r H ~ O ~ 2 ..,A x a ~ ~ r ya d ro H l 7~~~' T65-1802 BUILDING DEPT. INSPECTION- [ ]FOUNDATION 1ST ( ] ROUGH PLBG. [ ]FOUNDATION ZND [ ] IN ULATION ' [ ]FRAMING [ FINAL r ~ REMARKS:_~ ~ f t i ~ t ,~f f DATE / ~ INSPECTOR ~~1~~ 's5-iso2 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBC. [ ] FOUNDATION 2ND [ ]INSULATION [~MING [ ]FINAL REMARKS: ~i~•ce' DATE ~ ~ ~ V ~ INSPECTOR c ~ ~ c ~ o (d c1S ® ~ ~ E ~ ccS ~ ~ _ ~ ~ Q W N O ~ O ~ O. U cCfc~0i~0 ~ E ~ a~+ ~ ~ LL O U ~ ~ a N O N~~ N F ~ O C'~ O ~ ~ C ~ cn O O z C UoN.~~~ ~ c U Q C ~ ~ ~ O N m W i .r C ~ ~ ~ itl Z y_ O ~ N ~ ~ p W -r C 7 ~ N Z ~ O N ~ ~ O % C / +r ~ ~ U. O i ~ ~Q ~~~L Q O i C C ~ of i ~O N~Q cn z o I N i m i .Q /N X N Li. W m FORM NO. ~ T01VN OI' 50UTHOLD BUILDING DEPARTMCNT 'COIVN CLERICS orrice SOU1'IIOLD, N.Y. NUTIC)r OF DISAPI'ROVA File No . D:tte ~ ...2.J~...... . 19 . v I PLf:ASE "FAKE NOTICE that your application dated . , l~X~-~+,~.. ~.5........., 19 :2~ .d' . 1orl,cmtittoconstruct ............................................................at Location of Property a.°.....%?.o.W.•. s~~..~h?.~...9?~.>'.~-w.~ GSw-~-eeu~.~+'~ fLnrso No. Strenf • • •Horrrlnf County 'fax Map No. 1000 Section .4.? 8 131ock .....Q. .....Lot . ~`'.~P........ . Subdivision Piled 11ap Nu. Lot No. . is returned herewith and disapproval on the following grounds . SM~t~-.-1U-...Ol?c~:4o+~>.l.?~?- ~~9.1- ~ . µ .~,@A!~„-,..,g?-s.':~ . ~.~P-a~.~.,~.:. Q,t~ ~<?R: T. 0~ ~ 7 -n!.3 Building Inspector RV 1/IIO x . ~ ~P- - _r~ _ , ~ s~ Nb ~ - 3~ W , ~ ~ 1~ ~ ~ . ~o .9ogo 4040 9040 ' - ,'.-`"t ~ .3 _ ~ r ~ ~ ~ ~ ~ r~ ~ ~ ~ ~ ~ n _V : ~ ~ xx rain - v0 . .t I 'O Y _ b ~ - ~ ~ - iii u ~ w ~roru rr- n ~ ~ S I ~ p Ij R r+^ ~A Oy S A C 1 2 3 11 t6 u.. ~ R _ ~ n J y~y i.~.. ID~ ~y ~ t < ~ YP ~yl ~r "b ~ ~ x'PRi 0 4 a t e~ 4 t 5- ?S 1 7 .~4- ~ M d I L 'f, t F v" " xi ~ s E 1 as g r. y ~ r~ e 1: Y ` t 4 T~ r ~ l 1 Yxl6 Ylft'i+>~ ti -x'#: jxs S'~-. Y t4 _ ..,'r2 ~ ~k & tZ` N" fk rtt~a ? :r ( Ls ~ fi 4 4F ~ i m 1 I ~ 1 i'~~ ~ 4Y 44ST~ s dt'as { a L. ~ f ~ ~ k t' ~ NS y14YR6 P1 s r~ P - ry . ~ ~-~wi«+. ~ r pt 5 5 +4 -,iy~ ~ £„s .5 u„y.~ ti A ~ * ,e.: ~ a " 1 y~ i ~ r t i,i fi f s} y r W 7 E nN~ IA p ~ , nt i x-.1 n ' p rs it `s $ knyN a r +Yn'A t V A' ~ ~ ~ ilyt ~ 1 1 ~r e i ' ~ - -sF 1 ~ i. 1 ` * r a ,r ~f ~"r~ 1 5 P 1 1a• 1 ~q Y.. ~ P r F ? ~S~±~''/~~.~ V 1- r [ t a 'id y 5,~ i• ~ as s ~ 4° eylr `1. '~stiula -i.~4'4 f'/~~~s ~Ijt 'nk< d rx,n j, ~ ~Il s ~ ~ ~ . r ~L+r f S ~ u,~y ~jr{.j ai}}.Y..,~ ~ ;5 f 1 1 ll 1 a5 v. +N € t j x ~ ` a x-r f ~ . ~ ~Y s{ ~~a~~;fiaj~'`ii 'his' i k ~ h $`h r ~`yeas.. # t ii~?y` L M,a f N€FS y ai a~ tsm4 ~.-f S~ i.. M s c ~ nl x ~~r ~ Gift ,a. ~x ~t 4-ti } . r r r{ $ ~ r s~ k 5 'p a ~~..d 9 " 5a bait a r2 r x+&a P w s r x .r ~ a«. ysY r'; t ask y'^ ~rt_uf x ~ z~kK.~.3~r`~fi ~~"~rtdLa ~~~,rrtP t5r~""'+ny `~~?~n,~Yx ~eee '~aa~'ryi~t x ~1 i ~ 1 .~r ~ x~P nr `3r-~~ y~P~,J~y``~'sy'° ~~'Sf ~ '"J' ~ e } 5 n fjSM.sry`w Cw tixr. ~F ~PSx ~R ~ +Fy}%"1' 14. ixy yF. xk --~a,q..*ev,r.r~.,. -J'."iai,A,9+'^^'.~-" -4 ~x. - t 1 1 } ia-I` xT~ x'i ~ ~ ~ X25` ~ ~ .a ,.....~r.._ n....r.,,,t ..tt...,_.~~ _...~_a ....i.... ~a i. ,exdMOS.i~~as:.ces 'c f ORM fVO.3 TOWN OT SOUT}IOLD Bll1LDINO DEPAI2TMCNT TOWN CLCRIC'S O['f'ICG SOU1'110LD, N.Y. NOTICTi Or DISAPI'I20VA Pile No . Date ~....2.5......., 19 . 1 ..........~?-~..N..y...~r.97.~..... n 1'LF:ASE'I'AKE NOTICE that your application dated `~Y.~-a-t~...~.5........., 19 l.~.d'. . for permit to construct .............................................................at Loc;ilionofPropertYNou~~A~ ']~•o,.W,,, ~~~..~4.~..,,y,?~.~ye~.J....... iiiuu ~)a~er Swot County'1'ax Map No. 1000 Section ..~..47.~? 8 Block .....Q, , . i,ot . C't?. , . Subdivitiion Piled Map No. ~ plot No. .Q.....p... . is rcturncd hcrcwith and disapproved on Chc tbllotving grounds . 4~S~-.>~k-...N?it~'~A+'>.l.°•z?' ~~9'L Sc~ .lea:a-?-an r. w+, .I.+~?-.A.~. ~'~4~1~'~.^.: 9F.c~,~:Pd~,.~>~.... Building Inspector NV 1/CO D O MAY - 3 IQRp s~oc, eEar. ~zom tie ~es~Z o ` CLAIRE L. WOCILLEY ru..e. ~ ~ ~ ~ y ~y ~t~c,c~-+c! ~-~L ~cuX-1la.~a~ r1J y' i!`~`7i s,.x c~~ i-t-~ cv ca-a-r4.zs ~,w~: d-- L cE c~cl.;~~~ /YJC.~ /3S.Z-'Y~.L~ '.yjL41 /+~-x.a~ut C`~-i^~ .L.tl CL CC c'u.~i.z',z. ~ ~rrla.( -r?~v.t~~` y. c,f.,l1;,v' ,f/'-~'" /`aa''iJ ,(~-{,~J !c'!-~c~~-,t.~ ,c.c`-c.L~° i~t~~ .G~-.icy ~i* ~c.~r ~ p~ ~ y~~ C4 Z. P4-cs~L,~.r 7 ,ter°rtti ./Z+, a,c~, Cz ri,(: ~ ~ ~ ~ Cl~ iiji ~-1`.yL i. A: i.~ !C r~~CLi7.:: F- /~t/SY 6 L l'..F-LZ.YI.J.C{.I 1L~ ~`~°a'..F~,IV c~ /~~1> ~'Y'r"V, L~- ,4.(..12 ~/YC'F/?L~ l d //JIJIy ~ ~ T- ~ TELEPHONE (516) 765.1892 BO.1RD OF TOWN TRLSTEES TOIVN OF SOUTHOLO Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 1197] APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES OF THE TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK'FOR THE ISSUANCE OF A PERMIT PURSUANT TO THE LAWS, ORDINANCES AND REGULATIONS GOVERNING THE COASTAL AND 1NTERlOR WETLANDS, F400D PLAINS AND DRAINAGE AREAS OF THE TOWN OF SOUTHOLD, AND THE ISSUANCE OF PERMITS PURSUANT TO CHAPTER 32 OF THE GODES OF THE TOWN OF SOUTHOLD. APPLICATION NO.-----------------DATE OF APPLICATION---"P~"L1f~~ lE 5 /~3 ~ ~r I DENT 1 TY OF APPLICANT--L ti.31~--- t_Lt ~ ------------PHONE NO ADDRESS OF APPL 1 CANT_-~p_( ---/~~~„~-G:~F -/779//G~-[~Q,~4"-~L_Gy~ il`~ -='~~=~--------=SDS.~f1~'~-.~ --~(L~~---LL`X11---------------------------- TAX MAP NO. C._Z~Y ~Cj_aC. K [7 ~ a.a i C ----------------f`-'--------------- AGENT -----------PHONE NO. PERMIT REQUESTED TO---~/~,~---//`-~-Z/ fCG.9aE[ C7/- Gk~Si /~'%-.~yC6~.yV -----------'-------------------------------~----------"-----7------------- LOCATION OF PROPERTY FOR WHICH PERMIT WANTED-_9'~Tc-/~{Q~' a~'}'-/J~I~iIL' HOME ADDRESS OF PERMIT APPLICANT IF DIFFERENT FROM AFORESAID LOCATION CREEK, BAY OR HARBOR FRONTING PROPERTYLJQG~C'Et/~ __--j~_,;-~t3~~ L---- / / SIZE OF PROPOSED WORK /'~--X-17 LENGTH--- i WIDTH---L C'~ i HEIGHT ABOVE HIGH WATER , I DEPTH BELOW LOW WATER - VARDS TO BE E CgVATED__ i,~,• VARDS TO BE F 1'~,L IED__,__~',n sts 4 WIDTH OF CANAL, CREEK OR Hqy FRONTING PROPERTY bEPTH AT LOW T~1 DE ~ AVERAGE RISE IiN TIDE DISTANCE TO THE NEAREST CHANNEL__J.~'Z'7 ___FT. DISTANCE PROJ E~CT EXTENDS BEYOND SIMILAR PROJECTS IN THE AREA F' ~C2.[~ IS THIS FOR pR~~i VATE OR BUSINESS USE?____~~J~__________` AREA ZONING c%T /~t]U S tr MANNER I N WH 1 C~H MATERIAL W 1 LL BE REMOVED OR DEPOS 1 TED_ ~p(°i7~1>.l f ~L.4?~L~ i 1 NTENDED USE O~iF PROPERTY ~i('(L ~ y ~~i --1--= DESCRIHE ANY K~IOWry PRIOR OPERATIONS CONDUCTED ON THE PREMISE AND WHETHER ANY PRIOR LICENSE OR PERMITS HAVE BEEN ISSUED TO ERRECT STRUCTURES OR TO DREDGE OR DEPOSIT FILL ON SAID PREMISES AND WHETHER ANY PERMITS OR LICENSE S`~WERE EVER SC USPENDED OR RE~/V OKED BY q GOVERNMENT: AGENCY,__ If/'1R ~IL'C7 C____S S'~~~_ ~___LL~J~____L'~~~-_1=~~~~m~~?~=_~~ _ _ - ~ I _ , __._____._-_-___r_______.__ - DESCRIBE FULLY'ii THE REHABILITATION AND PROPOSED CONDITION OF THE PREMISES AFTER',, THE WORK IS COMPLETED INCLUDE AN ADDITIONAL SURVEY OF THE PROJECT SITE IF NECESSARY WRITTEN CONSENT OF THE OWNER OF THE PROPERTY, IF NOT THE SAME qS THE APPLICANT. ~I ARE TfIERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED TfiAT MOULD PROIIIBIT TIIIS PROJECT? 1i-16412/87)-Text 1; PROJECT I.D. NUMBER 677.21 SE( Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1, APPLICANT /SPONSOq / 2. PROJECT NAME 3. PROJECT LOCATION: Municipality t , t CountY - -t 4. PRECISE LOCATION (Street adtlress and roatl intersections, prominent landmarks, etc., or provide map? a`,~'lpnzc" /~'cd - ~c'~I,„oL~ ~i tiflti'~~ 5. IS OPO~ SED ACTION: ? New ®Expansion ? Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: ~{D4''J Lr.4-' i7 L=.9R Ui- ~!'J <s 7. AMOUNT OF LANG AFFECTED. / Initially ~"S / ~/lXJy~~yoyy Ultimately acres 8. WI~LIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS yr Yes ? No If No, describe Dnefly 0. WHAT IS PRESENT LAf:D USc IN VICINITY OF PROJECT? Residential ? ~ndustnal ? Commercial ? A nculture Descnbe: g ? ParklFOrest/Open space ? Other 10. DOES gCTION INVOLVE A PERFd IT APPROVAL, OR FUtJ DIfJG, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL STATE GR LOCAL)?~i~II ? Yes uy No It yes, list agency(s) and permit/approvals ~.C~~C' 7 Z. ~ ~ 11. DOES ANY ArrS~~PECT OF THE ACilOlJ HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ? Yes ¢y No II yes, list agency name and permit/approval 12. AS A RESULT OrF( PROPOSED ACTION WILL EXISTING PERMI7/APPROVAL REQUIRE MODIFICATION? ?YCS ,L1.No I CERTIFY THAI THE INFORMATION PROVIDED AROVB IS TRUE TO THE DEST OF h1Y KNOWLEDGE Applicantsponsor name: ~ ~ GL~~ rl~~}" Dale: .13"/~ Signature: /CoL'L ~i(7~L If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II-ENVIRONMENTAL ASSESSA9ENT (To be completed by Agency) ° ' A. DOES ACTION ESCEED qNY TYPE I THRESHOLD IN 6 NYCRR, PART 817.12? if yes, coortlmate iho review process and use the FULL DA F. ? Yps ? No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.fi? If No, a negative daelara: may be supersetled by another mvelved agency. ? Yes ? No C. COULD ACTION RESULT IN ANY gDVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING (Answers may be hantlwntten, If IeglDle) C7. Existing air quality, surface or grountlwater quality or quantity, noise levels, existing Irafhc patterns, solid waste production or dlspo potential far erosion, drainage or flooding problems? Explain briefly: - C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resouces; or community or neighborhood character? Explain br C3. Vegetation or fauna, fish, shellfish or wildlife species, sigmhcant habitats, or threatened or endangered species? Explain briefly: C4. A community's exlsting plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain b: C5, Growth, subsequent development, or related activities likely to he induced by the proposed action? Explain briefly. ' C6. Long term, short term, cumulative, or other effects not Identified In C7-C5? Explain briefly. C7. Other impacts Onclutlmg changes m use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL L17PACT5? ? Yes ? No if Yes, explain bnefty PAR7lII-DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether n is substantial, large, important or otherwise signifier Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; irreversiblllty; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure t explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ? Check this box if you have identified one or more potentially large or significant adverse impacts which I'.1AY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ? Check this box if you have determined, based on the information and analysis above and any supporting docurnentahon, that the proposed action l'VILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Naii„• Ui lead ni;,•n~y 1 i i w I vV~ n,inu of kr+Vun+~Ulc Uuuur m LceJ Agenav I tlic of ka+punvUk' Un¢rr >ixne Wye ul krNiOntibir Ulhccr in LceJ Agency Signelure of 1'n'Parry III Jill ereni Irom resVUnaelr oil i[rrl f1.uc 2 COUNTY OF SUFFOLK ) STATE/~O~7F N/E1W YORK ) SS: ff ~~Y / ~f~,yl'}('1~~~"~ BEING DULY SWORN DEPOSES AND SAYS THAT HE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS, AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS KNOWLEDGE AND BELIEF, THAT THE WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS pppLICATION AND AS MAY HE APPROVED BY THE TOWN BOARD OF THE TOWN OF SOUTHOLD. THE APPLICANT AGREES 70 HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT, IF GRANTED. Zn comUleting this application I hereby authorize the Trustees, agent or representative to enter onto my property to inspect the premises in conjunction olith rev}',,ec~/ot this application. - SIGNATURE OF APP(L///(/~/q'p NT / V SWORN TO BEFORE ME THIS / of DAY OF i ~ - ~~Y ~ ~.e-. y ~~c J o NOTA R13/ PUBLIC 0' LINDA J. CpOPER Notary Public, State of New Yo EXAMINED Termo~~~ea Dei~mbeir 3~jntY . APPROVED "WETLAND~° PERMIT (CHAPTER 97) APPROVED "BOAT,DOCKS, WHARVES' PERMIT (CHAPTER 32) DISAPPROVED "WETLANDS PERMIT"(CHAPTER 97) DISAPPROVED "BOATS,DOCKS, WHARVES" PERMIT (CHAPTER 32) CONDITIONS, IF ANY EXAMINING BODY SIGNATURE OF CHAIRMAN COMPUTATION OF FEES Approved 2/27/85 ' ~~~vF~®C~`? A FRANK A. KUJAWSKI, JR., President o re"'a . TELEPHONE ALBERT J. KRUPSKI, JR., Vice-President ~ ~ (516) 765.1892 JOHN M. BREDEMEYER, III ~~4~ " ~ JOHN L. BEDNOSKI, JR. ~°a~ ~ ~ ~ ~r~ HENRY P. SMITH e TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 P May 27, 1988 n„ ~ ~ Pvt. RD #12 Main Bayview Road Southold, New York 11971 Dear Ms. Woolley: The following action was taken by the Board of Town Trustees during their regular meeting held on May 25, 1988 regarding the above matter. RESOLVED that the Town Trustees approve the request made by Claire L. Woolley for a waiver of the Wetland Ordinance to add 11' on to the rear of an existing residence on property located on a r.o.w. off Main Bayview Road, Southold. Please remit the required $25.00 fee for this waiver at this time. Kindly return to the Building Dept. for a determination on the need of any other town permits that may be required for this project. Very truly yours, Frank A. K~awskr, Jr. President Board of Town Trustees FAK : ip cc: Bldg. Dept. Board of Appeals file , New York State Department of nvironmental Conservation Regulatory Affairs Unit C.C~(~~C1~1l~ Bldg. 40, SUNY, Rm. 219 ..~~-°1 Stony Brook, NY 11794 .~)N 16 1988 IhCommissio~~er 9 (516) 75]-7900 6LDG. EFT. TOWN OF SOUTHOl0 June 13, 1988 Claire L. Wooley P.0. Box 23 Southold, NY ]1971. Re: ]0-88-0824 Dear Ms. Wooley: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Very trulyy yours, RoberC N. Thurber Senior Environmental Analyst enclosure 95206 (918b}-25t NEN' YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERn11T NUh18ER ~ EFFECTIVE DATE 10-88-0824 ~ - ~ 6/13 88 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(9 Under the Environmental Conservation Law N/A 6/31/91 Article 15, Title 3; 6NYCRR 327, 6NYCRR 608: Article 25: 328, 329: Aquatic Pesticides ~ Water Quality Certification ~ Tida! Wetlands P oltelction ofltWat ~r ~ SPDES 17' Titles 7, 8: a Solid Waste IManageme tRR 360: r~ Article 15, Title 15: ~ Article 19: ~ Article 27, Title 9: 6NYCRR 373: L_J Water Supply Air Pollution Control` Hazardous Waste Management Article 15, Title 15: ~ Article 23, Title 27: ~ Article 34: Water Transport Mined Land Reclamation Coastal Erosion Management Article 15, Title 15: ~ Article 24: ~ Article 36: Long Island Wells Freshwater Wetlands Floodplain Management Article 15, Title 27: N-New, R-Renewal, M-Modification, Articles 1, 3, 17, 19, 27, 37; Wild, Scenic and Recreational C-Construct ('only), 0-Operate (`only) ~ 6NYCRR 360: Radiation Control Rivers PERMIT ISSUED TO Claire L. Wooley ADDRESS OF PERMITTEE - P.O. Box 23, Southold, NY 11971 AGENT FOR PERnIITIEE/CONTACT PERSON TELEPHONE NUMBER NAME AND ADDRESS OF PROTECT/FACILITY (If different from Permttee) Corey Creek Windy Pt. Lane LOCATION OF PROTECT/FACILITY COUNTY TOWN/CITYNILLAGE UTM COORDINATES Bayview Suffolk Southold DESCRIPTION Of AUTHORIZED ACTIVITY Construct addition onto existing porch. Work to be in accordance with attached plans stamped approved by NYSllEC (2 sheets). GENERAL CONDITIONS By acceptance of this Dermit, the permittee agrees that the permit is contingent upon strict compli- ance with the ECL, all applicable regulations and the tonditions specified herein or attached hereto. t The permittee shall f,le in the office of [he appropriate regional permit administrator, or other office designated in the special tonditions, a notice of intention to commence work at least 48 hours in advance of the time of commencement and shall also notify him/her promptly in wrsting of the completion of the work. 2 The permitted work shall be subject to inscection by an authorized representative of the Department of Environmental Conservation which may order the work suspended if the public interest so regwres pursuant to ECL §7t-030t and SAPA §40t(3). The permittee has accepted expressly, by the execution o! the application, the full legal responsibility for alt damages, direct or indirect. of whatever nature, and by whomever suffered, arising out of the protect described herein and haz agreed to indemnify and save harmless the State 4rom suits, actsom, damages and roses of every name and descrip Lion resulting from the said protect. 4 The Department reserves the right to modify, suspend or revoke this permit at any time after due notice, and, if requested, hold a hearing when: a) the scope of the protect is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations are foutsd; or b) the permit was obtained by misrepresentatmn or failure to disclose releven[ facts; or c) newly discovered information or significant physical changes are discovered since the Dermit was issued. 5 The permittee is responsible for keeping the permit active by submitting a renewal application, including any forms, fees or supplemental information which maybe required by the DepartmenC no later than 30 days (180 days for SPDES or Solid or Hazarduous Waste Management permits) prior to the ezpration date. 6 This permit shall not be construed as conveyin8 to the applicant any right to trespass upon the lands or interfere with [he riparian rights of others in order to perform the permitted work or as authonzmg the impairment of any rights, title or interest m real or personal property held or vested in a person not a party to the cermil i The permittee is responsible for obtaining any other permits. approvals, lands, easements and rights-of-way which may be required for thu project. R Issuance o! this permit by the Department does not, unless expressly provided tor, modify, supersede or rescind an order on consent or determination by the Commissioner issued heretofore by the Department or any of the terms, conditions, or requirements contained in such order or determination. 9 Any modification of this permit granted by the Dep rtmemt mus be in wrstsng and attached hereto. PERMIT ISSUANCE DATE PERMI ADMINIST ATOR ADDRESS 6/]3/88 Alfred T. Kellar 1dg. 40 SUATY Rm. 219 Stony Brook, PTY 1179 AUTHORIZED SIGNATURE Page T of 3 cc: BMHP 95-20fia (1/g61-25c ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34, 36 and 6 NYCRR Part 608 ( ) 10 That if future operations by the State of New York regv~lro art al- other environmentally deleterious materials assouated with the teration in the positron of the structure or work herein authorized, or project. if, in the opinion of the Department of Environmental Conservation 14 ~ Any material dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly, without leaving large refuse piles, ridges across waters or flood flows or endanger the hea{tfi, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State, the owner may be ordered by the Department to a waterway remove or alter the structural work, obstructions, or hazards caused 15 there shalt be no unreasonable Interference with navigation by the work thereby without expense to the State, and if, upon the expiration or herein authorized. revocation of this permit, the structure, fill, excavation, or other 16. If upon the expiration or revocation of this permit, the project hereby modification of the watercourse hereby authorized shall not be com- authorized has not been completed, the applicant shall, without expense pleted, the owners, shall, without expense to the State, and to such to [he State, and to such extent and in such time and manner as the extent and in such time and manner as the Department of Environmental Department of Environmental Conservation may requue, remove all or Conservation may require, remove all or any portion of the uncompleted any portion of the uncompleted structure or fill and restore [he site structure or fill and restore to its former condition the navigable to its former condition. No claim shall be made against the State of and flood capacity of the watercourse. No claim shall be made against New York on account of any such removal or alteration. the State of New York on account of any such removal or alteration. 17. If granted under Article 36, this permit does not signify in any way T1 That the State of New York shall in no case be liable for any damage that the project will be free from flooding. or injury to the structure or work herein authorized which may be caused 18. If granted under 6 NYCRR Part 608, the NYS Department of Environ- by or result from future operations undertaken by the State for the mental Conservation hereby certifies that the subject protect will not conservation or improvement of navigation, or for other purposes, and contravene effluent limitations or other limitations or standards under no claim or right to compensation shall accrue from any such damage. Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 12. Granting of this permit does not relieve the applicant of the responsi- (PL 95-217) provided that all of the conditions listed herein are met. bility of obtaining any other permission, consent or approval from 19 All activities authorized by this permit must be in strict conformance the U.S. Army Corps of Engineers, U.S. Coast Guard, N2w York State with the approved plans submitted by the applicant dr his agent as part Office of General Services or local government which may be required. of the permit application. 13. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, Such approved plans were prepared by Wnoley solvents, lubricants, epoxy coatings, paints, concrete, leachate or any on 4 / 29 / 88 SPECIAL CONDITIONS 1. There is to be no disturbance Co the tidal wetlands vegetation. 2. No construction materials or debris are to enter the waterway. 3. No placement of any excavated material is to be made closer than ]0' to the wetlands. Supplementary Special Conditions (ttl thru (J) attached. ' DEC PERMIT NUMBER ]0-88-0824 PROGRAMtFACILITY NUMBER N/A ' ~ Page of "etea 'i:' E N11~05 eB9~ ' 9T I .`"a I v ff H gtldH J C N+~ C Q ~ u~ qW v M31AAb8 ~P C d-fig oos oi° _ _i' B ipc~ ~ O~OHLWOy - ~ _ ' I , * OSStlOdR d%~e' SMFPAROp _ a% oa 'J~ a x i + y a. J e _ . ~ I F~ l?' SdN1dMtlM i` e i' O s,5 lM1V NSda~ ..P PNA _ ~}69d _ Z_e _ ji lln o $ ~f o ~ t 1111116 yokoa,.~~ ~t; ~~e.r ~ V I I I ~ r jiffy ~tl0', „1~ \ ~ ~ ~li AyQea 3f L ~ ~ N'iiHO' ~ 5 ,+~1 C/ U0.\SSON. P A j31 v _ ~ m P F ~ c 1 ~ '-l r 1 Ye " r is a y .4Yk - ~5_ ° qtr. ° ~ tlSa - e{~ :5~u .fie - t tom. - 1 _ ~ I - Ez ~ -r _ ~ c.,^ ~ - ~ - V i b ~ ~ m/io WATERNEW ON d u uLR ei •i : ~ ~ ~ ~ A!(„. NfiIR `6.O bho' oae, ie :x d+ a £ w FFYa~ ~ ~ I~Pap4 W' ~ i Eefef 4 a _ a K I ~~r" a'y SUMMER Pv ey z - a N • A v f ~ P 150) i b O I4 o ^EO ~ v on ~4~ _ ~ ~ ~ m 8 _ v o T v NIGN WOOD , c u~ ~ RO 1!0)y~ ~ Y ~ ~ ~ ~ Z zVICTORIA z OR R ~ D t ~ k _v _ I O. T 5 H•~~ r,l ~ OO v vgy0 COLUMBIA RU z Nml f8~ Y,. § £ ` ~ t x _ _ •d J ' W i 0 0 . pe~ er~5,1 ~ ae ~ mm. n ~ ~y 1 _a ~ f I" l~i ra BOARD OF HEALTH ~~~.~a"~~c,'~\•-I,n~ 3 SETS OF PLANS FORM N0.1 SURVEY • • - (6 ~9$$ TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM ..M•u--•°°°~--~•-° TOWN HALL BLDG. Of:~'T. NOTI / Tov+iiv OF SOUThf~l_[7 SOUTHOLD, N.Y. 11971 CALL • •71D~~ lc,~L• ` - - TEL.: 765.1802 M T0: Examined ,~!?tA. ~-a.., 19g$ Approved ,~'4~S-. fir') 19 g~ Permit No.. ~ ~ .2~. Aptte~ Disapproved a/c ~tr1t 2 5 (Building Inspector) APPLICATION FOR BUILDING PERPAIT Date . 19 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of glans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION I5 HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..FAY.LL>.':1~-2h-1 Name of owner of premises . ~!.-,1-(JFi'L,--; , . ~t A,RG.~, s:...~~:..~Q~.L.C.,G'~ . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No . . . Plumber's License No . . Electrician's License No . . Other Trade's License No . 1. Location of land on which proposed work will be done. .~VT v.~:~... ~.AiR/ . /5~,~!V/Gw House Number Street Hamlet County Tax Map No. 1000 Section Cj . Block .......l'........... Lot . Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~Uf ffi~.~,5.4 . . b. Intended use and occupancy ...~or~h. , . P7~!?~o.n/ , . ,~7p , ,T~R~~~tE, , ~fovsc . , , , , , , , , • , . 3. "Nature of work (check which applicable): New Building Addition Alteration . Repair Removal Demolition ..............Other tVork . (De'sc`ri9ion) 4. Estimated Cost t~ v.19, c? A.~ Fee . ` {to be paid on filing this application) 5. If dwelling, number of dwelling u . If ~,arage, number of cars' !tits /~1'7..!`/PS'S ~ . Number of dwelling units on each floor . 6. If bu • upancy, specify nature and extent of each type of use . 7. Dime any: Front....... .....Rear Depth............... Heig .:.........Nu of Stories........." Dime • s of3 e'=s5(u~t~te ~ ]terations or additions: Front Rear . p «TM De t:..s " eight . Number o Stories . r 11....... r rr r rr $ Heinh@sto • uct n: Front . Rear Depth /./...S? . g f Stories . • . 9. Sire of 1 , Rear . j Depth ~ .l . 10. _Date of Purchase 10,/. ~?d'... caner . , < .9,Y.~'.~'.~?.......... . • . .Name of Former O 11. Zone or use district in which prerfitises are situated . . 12. Does proposed construction violate any zoning law, ordinance or regulation : . 73. Will lot be regraded ..../Yp Will excess fill be removed from premises: Yes No•? 14, Name of Owner of premises L'.',,Cc?e~r~•~%; • , ,Address f~~ . r6~Y 3 ....Phone No.'~ ~ Name of Architect . , Address ~d ....Phone No........ . Name of Contractor .Address ....:..............Phone No............... . IS. Is this property located within 300 feet of a tidal wetland? *Yes .1~.. No *If yes, Southold Town Trustees Permit ma be reqgu~ired. PLO DIAGKAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ S COtiNTY OF . • • • • • • • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant {Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly', authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner!,set forth in the application filed therewith. 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