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Home My WebLink About50174-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 50174 Date: 1/3/2024 Permission is hereby granted to: Wickham Farmland LLC 28770 Route 25 PO BOX 928 Cutchoque, NY 11935 _m _ ITITIT To: Construct additions and alterations to an existing congregate living facility (farm worker housing) to include HVAC system as applied for per SCHD approvals. Requires Fire Protection System Permit. At premises located at: Route 25, Cutcho ue SCTM # 473889 ............ Sec/Block/Lot# 102.-6-20.2 Pursuant to application dated 11/4/2022 and approved by the Building Inspector. To expire on 7/4/2025. Fees: FARM BUILDING ALTERATIONS $799.00 DEMOLITION $92.80 CERTIFICATE OF OCCUPANCY $100.00 Total: $991.80 Building Inspector �,''t Yl' "I,,N ' ��ttz TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 Ilt!RS',/`/WWW,SOLItholdtownU.gov m� 16, Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO._ Building Inspector: C Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date. OWNER(S)OF PROPERTY: Name:Whickham Farm Land LLc ]�scTM#Zo00-102-6-20,1 Project Address:28700 Main Rd, Cutchogue, NY 11935 Phone#:631-734-5454 ]Ell.:tomwickham39@gmaiI.com Mailing Address:PO Box 928, Cutchogue, NY 11935 CONTACT PERSON: Name:Thomas Wickham Mailing Address:PO Box 928, Cutchogue, NY 11935 Phone#:631-734-5454 Email:tomwickham39@gmail.com DESIGN PROFESSIONAL INFORMATION: Name:Studio A/B Mailing Address:PO Box 444, Orient, NY 11957 Phone#:631-323-1426 TEmall:glynis@studioabarchitects.com CONTRACTOR INFORMATION: Name: Mailing Address: Phone#: Email:. DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ddition ❑Alteration Repair emolition Estimated Cost of Project: $300,000 ❑Other Will the lot be re-graded? ❑Yes O No Will excess fill be removed from premises? ❑Yes No 1 PROPERTY INFORMATION Existing use of property:Farm Worker Housing Intended use of property:Farm Worker Housing Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to AC this property? ❑Yes 5i No IF YES, PROVIDE A COPY. R Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,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(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print n ):Th ickham ❑Authorized Agent Owner Signature of Applicant: x Date: STATE OF NEW YORK) SS: COUNTY OF Sufolk Thomas Wickham being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the LLc Manager, and Partner (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/her knowledge and belief; and that the work will be performed in the manner set forth in the application file ther,T with. Sworn before me this " day of �, , ZD Q, Notary Public DONNA MCGAFIAN Notary Public CW:e of New York No. 01 MCs�,`51459 PROPERTY OWNER R AUTHORIZATION Qualified in SLIffolk County (Where the applicant is not the owner) Commission Expires Aug„ 16, 20"- I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 COUNTY OF SUFFOLK STEVEN BELLONE SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES GREGSON H. PIGOTT,MD, MPH Commissioner J"r-JEJUNUT CONDITIONS Project Name:Wickham Farm South Cottage Health Services Reference#: C-23-0128 SCTM#: 1000102000600020002 Revision#: I The attached plan,when duly signed by a representative of the department,in conjunction with these conditions, constitutes a permit to construct a water supply,sewage disposal,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 approved plans as,well as all applicable standards including Standards for Approval of Plans and Construction for Sewage Disposal Systems for Other than Single Family Residences,.omissions, inconsistencies or lack of detail on the plan do not release the applicant from the responsibility of having the construction done in conformance with applicable standards. Issuance of this permit shall in no:way relieve the design professional of responsibility for the adequacy of the complete design. The permit(plan)expires three (3)years after the approval date.Any modification to the approved design requires the submission of a revised plan and additional fees (if applicable)for approval prior to construction. No inspections will be performed by the department if a copy of the approved site plan/survey is not on site during construction or if the permit,has expired. Permits may be renewed,transferred, or revised in accordance with the procedures described in Instructions to Renew, Extend, or Transfer an Existing Permit for Other than Single Family Residences (Form WWM-081). Itis the applicant's responsibility to schedule an inspection of the sewage disposal and/or water supply facilities prior to backfilling. This includes inspections of the sewage collection and disposal systems,water supply system components and piping, and final grading as,shown on the approved plans.This can be done by calling the department at(631)852- 5754,or through the ACA Portal at bgp_sWao-pr2q, -Q— m/S FF JI-E-M In certain cases,inspections of the soil Qd,_a Cgla. - excavation may be required to determine the acceptability of the soils for sewage disposal systems.Excavation inspections must be confirmed by calling('631)852-5700 between 8:30a.m. and 9:,30 a.m.,the morning of the inspection.Article V11 of the Code, "Septic Industry Businesses," requires that all installers of Septic systems within shall possess a valid license from the Office of Consumer Affairs, This office will not perform inspections for or grant final approval for construction,of projects that are installed by an unlicensed individual. it is, therefore, in your best interest to utilize a cesspool contractor with a valid license to avoid substantial delays in your project. Final approval issued by the Department is necessary prior to the occupancy of new buildings, additions to existing buildings,or for the use of sewage disposal or water supply systems. WWM-016 Page 1 of 2 S Project Name: Wickham Farm South Cottage Health Services Reference#: C-26-0128 SCTM#: 1000102000600020002 Revision#: 1 CONDITIONS FOR OBTAINING FINAL APP'ROV'AL OF CONSTRUCTED PROJECT As a condition of this permit to construct„the following items must be completed as a minimum„ prior to bullding occupancy and use of the sewage disposal system or water supply facilities. For further information concerning this, refer to Instructions For Obtaining Final Health Department Approval Of Constructed Projects For Other Than Single Family Residences (Form WWM-019). -Satisfactory inspection by Office of Wastewater Management of the sewage disposal system /sewage treatment system. (Call 852-5754 to schedule an inspection.) - Four(4) prints of an As-Built plan -"Tap letter"from water district - Certifications from the licensed sewage disposal system installer - Certification of Sewage Disposal System Abandonment(form WWM-080) - Design Professional's Certification of Constructed Works(form WWM-078)for: Sub-surface sewage disposal system WWM-016 Page 2 of 2 t °9.p �90EWxD� °AEE N g �,� ,� '§. � y�a3ro c.ExFEa 4a � � DESuxcD life eP.e•wn HEst'ccrnED.vm d>xs.ai=x�Eaiwu Flt I s#.g € �� xnr, 0. i'� xnv DnaeTx sorrAnEs�„c�5w.Farexxo FARM , re i AjZM' ....ma.A,F°N.A 4 , <'\ ,,iF Dw 3D,A5 Dan, :: lTIDE= £30 NAF GARm EcauC+ar4^M1SPxm"de°Br MEM�.w,l3 Aenlam swt w f 0�x mss'. 4s a*_ ra-r %"zeJ#E.A ®.519 F,PiF S-¢sPsr 4M x P iii I u ... •�:� `"`_ F ass € I �r for i _. )- a � g to ho.� C-23.0128 Design Flow 1030 GPD r X)STtNG RESIDENCEIADDITION(PER.PLAN) These plans have.bzen reviewed for general conformance with Suffolk ] ; J/ � t County Depanrrent of Health Services standards, relating to water (f-' supply nt-sdj*age disposal. Reguardless of any emissions, 7 t rtrracata e.. orf lack of detail. construction is required to be in ed permit condifiam and . w resb€e € �• ,” - "�a't`C'ihess prcint It i.ived by he Dcp mens s sprvaf - n expires 3 years f�m the pp i dat unless to €i:renewed. S - 05/01/2023 •--•-R Approval Date " Water lines must be insaected by the �`= a�D�,rtDxNraa cuffolk County DORL of Health Services. istudio aro architects j PAtEaa�,E,E.a°�aSE� D Call(631)852-5754,48 hours in advance,to schedule inspadion(s). € 5 ABBREVIATIONS- APPROVAL ISSUED ONLY FOR .\ a EXISTING RESIDENCE/ADDITION P&0P a @ xEx [[ ITE P LVIassllm Farmland LLC t S ` D� D� Da xED3 maw E D �. L (PER PLAN) xow„ra En E vaxST "YANK AN I a xw„EmEvE °ao,�awA,E,a —ErFar,. Y.s i3-M r<. rtara �A�ovaDo D�90 P v E w ��w i u .G) rowA,E w -Pa 3� F� � avA,� . . . . ; Rusit sell � e � STO]EZI��I WA'7C'lE][� MANAGEMIE SOUTHOLD TO"HALL-P.O.Box 1179 T J NW 5MI95�'IW `4623.d-SOUTHOLD,NEW YORK 11971 + l �W n �f So u th o l d CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER) i APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) NAME: Hideaki Ariizumi (behalf of Thomas Wickham) Date: 6/2/2023 hideaki@studioabarchitects.com 631 323 i is�,ar.re Contact Information: 1426 Property_Address / Location of Construction Site, 28700 Main Road, Cutchogue, NY 11935 S.C.T.M. #: 1000 ...._ Distrjct 102. 6 20.2 �.�.._.... ._..._.. .� � _.. ��. _... .._.�.._��..._,��.�....._...�_ Section Block Lot Lot _.... TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT - Area of Disturbance Is less than l Acre. No S.P.D.E.S. Permit is Required I n', - Project does Not Discharge to Waters of the State. No S.P.D.E.S Permit is Required ! _ Area of Disturbance is Greater than I Acre & Storm-water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S P.D E.S Permit DIRECTLY From N.Y S. D.E.C. Prior to Issuance of a Buildin Permit. [j - A:-ea of Disturbance is Greater than I Acre & Stornr��ater Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of' Ne\,v York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit through the Southold Town EnameercnQ Department P:-ior to Issuance of a Bui".dm Permit. P�evie> ed By: / - Date: �6 e. F r t O 41, ElevatH Datum NAVD 1988 Topographic ri f i a x e � s r p i x �z Surveyoon of € _ -Property 'd -� e t ho p f _ gUUL K f � nr g -I a u,