HomeMy WebLinkAbout51689-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#: 51689 Date: 02/26/2025
Permission is hereby granted to:
Dignans Realty LLC
445 Glen Ct
Cutchogue, NY 11935
To:
Construct a new modular single-family dwelling as applied for to include outdoor shower and HVAC
system per Planning, DEC and SCHD approvals.
Premises Located at:
2100 Dignans Rd, Cutchogue, NY 11935
SCTM#83.-2-7.4
Pursuant to application dated 01/15/2025 and approved by the Building Inspector.
To expire on 02/26/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling-NEW MODULAR $5,274.50
CO Single Family Dwelling-New $100.00
Total $5,374.50
Building Inspector
a
Y.gJ?
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
,r
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
Telephone 631 765-1802 Fax 631 765-9502 htt ://www.soLitholdtownn c�rr
, P ( ) ( )
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
Q e'
PERMIT NO. tp Building lnspectorJR�-
JAN 1 5 2025
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:11/01/2024
OWNER(S)OF PROPERTY:
Name: Dignans Realty, LLC SCTM# 1000-83-2-7.4 & 7.5
Project Address:2100 & 2240 Dignans Road, Cutchogue, NY 11935
Phone#: 917.355.3972 1Email:dasack@mac.com
Mailing Address:445 Glen CT, Cutchogue, NY 11935
CONTACT PERSON:
Name: Robert E. Herrmann, En-Consultants
Mailing Address: 1319 North Sea Road, Southampton, NY 11968
Phone#:631 .283.6360 Email:rherrmann@enconsultants.com
DESIGN PROFESSIONAL INFORMATION:
Name: Resolution: 4 Architecture
Mailing Address: 150 W28th Street, Suite 1902, New York, NY 10001
Phone#:212.675.9266 Email:rluntz@re4a.com
CONTRACTOR INFORMATION:
Name:Cruz Brothers Construction
Mailing Address: 163 W Montauk Hwy, Hampton Bays, NY 11946
Phone#:(631 ) 594-5740 1Email:leocruz@cruzbrothersconstruction.com
DESCRIPTION OF PROPOSED CONSTRUCTION
BNewStructure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $2,000,000
Will the lot be re-graded? ®Yes El No Will excess fill be removed from premises? ❑Yes iiNo
1
PROPERTY INFORMATION
Existing use of property:2100/2240 Dignans Rd Intended use of property: Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-80 this property? DYes❑No IF YES, PROVIDE A COPY.
❑ Check Box After Reading: The owner/contractorldesign 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,Suffok County,New York and other applicable Laws,Ordinances or Regulations,for the corom aeon 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 mind In budding(s)for necessary Inspections.False statements made herein are
punishable as a Gass A misdemeanor pursuant to Section ZIOAS of the New York State Penal Law.
Application Submitted By( t name):Robert E. Herrmann, En-Consultants ®Authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK
SS:
COUNTY OF Suffolk
Robert E. Herrmann, En-Consultants being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Agent
(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 therewith.
Sworn before me this
L—day of < k ��'� 5 �,� ZO-.�
Notary P li
7NotaryPublic
TEPHENS
tate of New YorkPROPERTY OWNER AUTHORIZATIONufffolk ouffolk County20
(Wherethe applicant is not the owner) esAugust02„
Dignans Realty, LLC
I,/We David & Stel2hanie Sack Members residing at 445 Glen Court, Cutchogue, NY 11935
do hereby authorize Robert E. Herrmann, En-Consultants to apply on our/
my behalf to the Town of Southold Building Department for approval as described herein.
X 12/19/2024
Owner's Signature Date
David Sack, Member, Dignans Realty, LLC
Print Owner's Name X tephanie ack Member Digrta y 12/19/2024
Pr
' ns-Realty, LLC Date
2
119
suFFQ Albert J. Krupski, Jr. STORlMMA\TIER
SUPERVISOR 1w1[A\NA\G1EM LENT
SOUTHOLD TOWN HALL-P.O.Box 1179
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold
Cif ER 236 - STORM WATER MANAGEMENT REFERRAL FORM
( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT
ONLY FOR PROPERTIES ONE ACRE 1N AREA OR LARGER. )
APPLICANT: (Property � � Profess
p y Design Profession , Age1 ntractor, Other)
NAME: Raab E. Herrmann Date:
January 17, 2025
Contact Information: rerrmann@enconsultants.com
(E-Mall.8 Telephone Number)
631-283-6360
Pro2erty Address / Location of Construction Site:
2100 &2240 Dignans Road, Cutchogue S.C.T.M. #: 1000
District
83 2 7.4 & 7.5
Section Block Lot
TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT
Area of Disturbance is less than 1 Acre. No S.P.D.E.S.Permit is Rec aired i
❑ - Project does Not Discharge to Waters of the State. No S.P.D.L,S, Perntiii is lic,c aired p
❑ - 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. Building Permit.
❑ - Area of Disturbance is Greater than I Acre&Storm-water Runoff Flows Through Southold
Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN
a S.P..D.E.S. Permit throe It the Southold. Town En2ineering Department
Prior to Issuance of.a.Building Permit.
Reviewed By: Date:
FORM * SMCP-TOS December 2024 '
I
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i
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I
Suffolk County Department of Labor, Licensing &
Consumer Affairs
VETERANS MEMORIAL HIGHWAY * HAUPPAUGE NEW YO RK 11788 8
DATE ISSUED: 4/11/2018 No. 60021-H
SUFFOLK COUNTY
Home Improvement Contractor License
This is to certify that JORGE A CRUZ
doing business as CRUZ BROTHERS COiwTRUCTON UC
having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws,rules
and regulations of the County of Suffolk,State of New York is hereby licensed to conduct business as a HOME
IMPROVEMENT CONTRACTOR,in the County of Suffolk.
License Category
NOTVAL[DWITIIOUT 44dditaorsalSu` GC
DEPARTMENTALSEAL
AND A CURRENT
CONSUMER 6_RFA[RS
ID CA.RI'
Suffolk County Dept of Commissioner
Labor,Licensing 6 Consumer Affairs
HOME IMPROVEMENT LICENSE
Name
JORGE A CRUZ
Business Name
,
This aeNaes
CRUZ BROTHERS CONSTRUCTION i
the -'
bearer is duly lice licensed LLC
by the County of suffoac License Number H-60021
W"rv.T."ws Issued: 04111=16
Commissioner Expires: 04101I2026 �
r� "
40 4ti
Town Hall Annex „ Telephone(631)765-1802
54375 Main Road i", Fax(631)765-9502
P.O.Box 1179
Southold, NY 11971-0959 ��
BUILDING DEPARTMENT
NOTICE OF UTILIZATION OF TRUSS"TYPE CONSTRUCTION PRE-ENGINEERED
WOOD CONSTRUCTION ANDfOR TIMBER CONSTRUCTION
Date: ,January 14, 2025
Owner: Dignans Realty LLC
Location of Property: Dignans Road, Cutchogue
Please take notice that the (check applicable line):
✓ New commercial or residential structure
Addition to existing commercial or residential structure
Rehabilitation to an existing commercial or residential structure
to be constructed or performed at the subject property reference above will utilize
(check applicable line):
V Truss type construction (TT)
Pre-engineered wood construction (PW)
Timber construction (TC)
in the following location(s) (check applicable line):
Floor framing, including girders and beams (F)
Roof framing (R)
✓ Floor and roof framing (FR)
Signature:
Name (person submitting this form): David Sack, Member„Dignans Realty, LLC
Capacity(check applicable line):
V Owner
Owner representative
TrussRegl5.docx Effective 1/1/2015
.f
NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION,
PRE-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER
CONSTRUCTION IN RESIDENTIAL STRUCTURES
(In accordance with Title 19 NYCRR PART 1265)
Local Authority having jurisdiction logo:
TO:Name of Authority having jurisdiction.•
OWNER OF PROPERTY: Sack
SUBJECT PROPERTY(ADDRESS AND TAX MAP NUMBER):
2100-2240 Dignans Rd
Cutchogue, NY 11935
Suffolk County
PLEASE TAKE NOTICE THAT THE(CHECK ALL THAT APPLY):
x� New Residential Structure
Addition to Existing Residential Structure
Rehabilitation to Existing Residential Structure
TO BE CONSTRUCTED OR PERFORMED AT THE SUBJECT PROPERTY REFERENCE ABOVE WILL UTILIZE
(check each applicable line):
❑ Truss Type Construction (TT)
❑ Pre-Engineered Wood Construction (PW)
❑ Timber Construction (TC)
IN THE FOLLOWING LOCATION(S) (CHECK APPLICABLE LINE): APPROVED—
❑ Floor Framing, Including Girders and Beams (F) DATE 10/4/24
S, CORPORATION
❑ Roof Framing (R) Icaor� tsarr' , PA
X Floor Framing and Roof Framing (FR)
SIGNATURE: DATE:
PRINT NAME:
CAPACITY(Check One): ❑ Owner ❑ Owner's Representative
NEW YORK STATE DEF:1A11R 11WEN r 0111:::o ENV11111RO III'QWE114 TAIL CONSEIRVATION
Division of Environmental Permits,Region 1
SUNY ed Stony Brook,50 Circle Road,Stony Brook,NY 11790
P:(631)444-03651 F:(631)444-0360
www.dec.ny.gov
September 6, 2024
Dignans Realty, LLC
c/o David and Stephanie Sack
445 Glen Court
Cutchogue, NY 11935
Re: Permit ID 1-4738-05020/00001
Dignans Realty LLC
2100 & 2240 Dignans Road
Cutchogue
Expiration Date: 9/5/2029
Dear Permittee.-
In conformance with the requirements of the State Uniform Procedures Act (Article 70,
ECL) and its implementing regulations (6 NYCRR, Part 621), we are enclosing your
permit. Please carefully read all permit conditions contained in the permit to ensure
compliance during the term of the permit. If you are unable to comply with any conditions,
please contact us at the above address.
Please be advised that this permit does not relieve you of the responsibility of obtaining
any necessary permits or approvals from local municipalities or other agencies.
Sincerely,
*ffle WW e*ni
Environmental Analyst
Distribution List:
En-Consultants
BMHP
File
NF;rp„Y.YORK Departmentof
Environmental
Conservation
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Raw
Facility DEC ID 1-4738-05020
PERMIT
Conservation Law !,' `
Under the Environmental C„onse...—. .��.. .......m._.._ m... .. w _... - .
Permittee and Facility Information
�. �.. __ - ... . _._.._..,..__ �......_ _..._. . _...mm_ .�..�. .... ......._. .
Permit Issued To: Facility:
DIGNANS REALTY, LLC DIGNANS.REALTY LLC PROPERTY
C/O DAVID & STEPHANIE SACK 2100 & 2240 Dignans Rd
445 GLEN CT CUTCHOGUE, NY 11935
CUTCHOGUE,NY 11935
Facility Application Contact:
EN-CONSULTANTS
1319N SEA RD
SOUTHAMPTON,NY 11968
(631) 283-6360
Facility Location: in SOUTHOLD in SUFFOLK COUNTY
Facility Principal Reference Point: NYTM-E: 708.9848637415071 NYTM-N:
4546.071435635689
Latitude: 41°02'20.6" Longitude: 72°30'49.4"
Project Location: LI Sound
Authorized Activity: Change the lot line by merging the two parcels as shown on the plan by Maresca &
pp �.....Associates last revised 05.20.24 and stamped NYSDEC Approved on 9/6/2024. ARNO-DEP.....�._.
The portion of the property landward of the "TOP OF BLUFF" more than 10 feet in elevation, as shown on the
survey of the subject property by Kenneth M Woychuk Land Surveying, PLLC dated May 18, 2022, is beyond
the jurisdiction of Article 25 Tidal Wetlands. Therefore, in accordance with the current Tidal Wetlands Land Use
Regulations (6 NYCRR Part 661), no permit is required for work occurring at the property landward of the
jurisdictional boundary described above. Please be advised however, that no construction, sedimentation,
discharge, or disturbance of any kind may take place seaward of the jurisdictional boundary without a permit. It
is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other
alteration or disturbance to the ground surface or vegetation within DEC's jurisdiction which may result from
your project. Such precautions may include, maintaining an adequate work area .(i.e., a 15' to 20' wide
construction area) or erecting a temporary fence, barrier, or hay bale berm.
Authorizations
_wee ...-._—_.... .. ... ....... �. ...... .......�.._ ._ . ....�.Permit . .. . .....— ._.. .. _..-� ._.. ... ��. �. ...... _ .�_
Tidal Wetlands - Under Article 25
Permit ID 1-4738-05020/00001
New Permit Effective Date: 9/6/2024 Expiration Date: 9/5/'2029
Page 1 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-05020
NYSDEC A
.... ......_ ��_ . � ........._ ..... __ .--........
pproval
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict
compliance with the ECL, all applicable regulations, and all conditions included as part of this
permit.
Permit Administrator: SHERRI L AICHER, Regional Permit Administrator
Address: NYSDEC Region 1 Headquarters
SUNY @ Stony BrookJ50 Circle Rd
Stony 13 ,00k,NY 1 1 790 -3409
Authorized Signature: Date m� _ ._.
:..... ._._. . ....... .... d /
_......
.... ......
.�
..I
.�� �........._...._.__ �.. ... ...�...�__—......._.... . . �._Distr.ibution Llst....mm�.._ � .....�._ �._..... .._,.�._ � � .._..
EN-CONSULTANTS
Marine Habitat Protection
Wildlife
Environmental Permits
... _Permit Com onen......_.A,_
p is
NATURAL RESOURCE PERMIT CONDITIONS
GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS
NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS
NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following
lowing
Permits: TIDAL WETLANDS
I. Conformance With Plans All activities authorized by this permit must be in strict conformance
with the approved plans submitted by the applicant or applicant's agent as part of the permit application..
Such approved plans were prepared by Maresca & Associates last revised 05.20.24 and stamped
NYSDEC Approved on 9/6/2024.
Page 2 of 6
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Iffibmw
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ill 1-4738-05020
2. Tidal Wetland Covenant The permittee shall incorporate the attached Covenant (or similar
Department-approved language) to the deed for the property where the project will be conducted and file
it with the Clerk of SUFFOLK County within 30 days of the effective date of this permit. This deed
covenant shall run with the land into perpetuity. A copy of the covenanted deed or other acceptable
proof of record, along with the number assigned to this permit, shall be submitted within 90 days of the
effective date of this permit to
Marine Habitat Protection
NYSDEC Region 1 Headquarters
SUNY @ Stony BrookJ50 Circle Rd
Stony Brook, NY11790 -3409
Attn: Compliance
3. No Easement for Structures 1 his permit does not authorize the granting of easements for the
construction of water access structures, mooring facilities, or other structures.
4. Tree Clearing Prohibition for Long-eared Bats Due to the proximity of a known northern long-
eared bat summer occurrence, tree clearing is prohibited between March 1 and November 30, inclusive, of
any calendar year.
5. No Runoff down Bluff or onto Beach There shall be no discharge of runoff or other effluent on, in
or down the bluff face or onto the beach.
6. No Pool Discharges to Wetland There shall be no draining of swimming pool water directly or
indirectly into wetlands or protected buffer areas.
7. State Not Liable for Damage The State of New York shall in no case be liable for any damage or
injury to the structure or work herein authorized which may be caused by or result from future operations
undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no
claim or right to compensation shall accrue from any such damage.
8. State May Order Removal or Alteration of Work If future operations by the State of New York
require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the
Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation
of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause
loss or destruction of the natural resources of the State, the owner may be ordered by the Department to
remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State,
and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other
modification of the watercourse hereby authorized shall not be completed, the owners, shall, without
expense to the State, and to such extent and in such time and manner as the Department of
Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill
and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall
be made against the State of New York on account of any such removal or alteration.
Page 3 of 6
Aft
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION lqww
Facility DEC ID 1-4738-05020
9. State May Require Site Restoration If upon the expiration or revocation of this permit, the project
hereby authorized has not been completed, the applicant shall, without expense to the State, and to such
extent and in such time and manner as the Department of Environmental Conservation may lawfully
require, remove all or any portion of the uncompleted structure or fill and restore the site to its former
condition. No claim shall be made against the State of New York on account of any such removal or
alteration.
10. Precautions Against Contamination of Waters All necessary.precautions stiall be taken to
preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents,
lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials
associated with the project.
GENERAL CONDITIONS _
. LLAp. plymm to ALL Authorized
thoi-ized Pmm.
ermits
1-111111-1 _ ... ---_ __._ ...
._.. _ ..n ._..
I. Facility Inspection by The Department The permitted site or facility, including relevant records, is
subject to inspection at reasonable hours and intervals by an authorized representative of the Department
of Environmental Conservation (the Department) to determine whether the permittee is complying with
this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71- 0301
and SAPA 401(3).
The permittee shall provide a person to accompany the Department's representative during an inspection
to the permit area when requested by the Department.
A copy of this permit, including all referenced maps, drawings and special conditions, must be available
for inspection by the Department at all times at the project site or facility. Failure to produce a copy of
the permit upon request by a Department representative is a violation of this permit.
2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly
provided for by the Department, issuance of this permit does not modify, supersede or rescind any order
or determination previously issued by the Department or any of the terms, conditions or requirements
contained in such order or determination.
3. Applications For Permit Renewals, Modifications or Transfers The permittee must submit a
separate written application to the Department for permit renewal, modification or transfer of this
permit. Such application must include any forms or supplemental information the Department requires.
Any renewal, modification or transfer granted by the Department must be in writing. Submission of
applications for permit renewal, modification or transfer are to be submitted to:
Regional Permit Administrator
NYSDEC Region 1 Headquarters
SUNY @ Stony BrookJ50 Circle Rd
Stony Brook, NYl 1790 -3409
4. Submission of Renewal Application The permittee must submit a renewal application at least 30
days before permit expiration for the following permit authorizations: Tidal Wetlands.
Page 4 of 6
Am
oftwo
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-05020
5. Permit Modifications, Suspensions and Revocations by the Department The Department
reserves the right to exercise all available authority to modify, suspend or revoke this permit. The
grounds for modification, suspension or revocation include:
a. materially false or inaccurate statements in the permit application or supporting papers;
b. failure by the permittee to comply with any terms or conditions of the permit;
c. exceeding the scope of the project as described in the permit application;
d. newly discovered material information or a material change in environmental conditions, relevant
technology or applicable law or regulations since the issuance of the existing permit;
e. noncompliance with previously issued permit conditions, orders of the commissioner, any
provisions of the Environmental Conservation Law or regulations of the Department related to
the permitted activity.
6. Permit Transfer Permits are transferrable unless specifically prohibited by statute, regulation or
another permit condition. Applications for permit transfer should be submitted prior to actual transfer of
ownership.
`NOTIFICATION OF OTHER PERMI � � .m_m___
OBLIGATIONS E.-1-11----..-.-.-.-............... ... .._ ......-.-.______.._ _ ...�.._- -- w TTEE OBL m_ ...........
Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification
The permittee, excepting state or federal agencies, expressly agrees to indemnify and hold harmless the
Department of Environmental Conservation of the State of New York, its representatives, employees,
and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the
permittee's acts or omissions in connection with the permittee's undertaking of activities in connection
with, or operation and maintenance of, the facility or facilities authorized by the permit whether in
compliance or not in compliance with the terms and conditions of the permit. This indemnification does
not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or
intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under
Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision
under federal or state laws.
Item B: Permittee's Contractors to Comply with Permit
The permittee is responsible for informing its independent contractors, employees, agents and assigns of
their responsibility to comply with this permit, including all special conditions while acting as the
permittee's agent with respect to the permitted activities, and such persons shall be subject to the same
sanctions for violations of the Enviromnental Conservation Law as those prescribed for the permittee.
Page 5 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-05020
Item C: Permittee Responsible for Obtaining Other Required Permits
The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-
way that may be required to carry out the activities that are authorized by this permit.
Item D: No Right to Trespass or Interfere with Riparian Rights
This permit does not convey to the permittee any right to trespass upon the lands or interfere with the
riparian rights of others in order to perform the permitted work nor does it authorize the impairment of
any rights, title, or interest in real or personal property held or vested in a person not a party to the
permit.
Page 6 of 6
NOTICE COVEN ANT TO '['HE DEED
DECLARATION
THIS DECLARATION, dated day of.................................
20—Js made by
(hereinafter the "Declarant"), whose address is
WITNESSETH
WHEREAS, the Declarant is the owner of certain real property located in-the Town of
County of State of New York, Tax Map # District—, Section , Block
Lot(s) „._..............a,,..... which real property is more particularly described in Exhibit A annexed hereto
(hereinafter referred to as the "Property"); and
WHEREAS, the Property is situated in or adjacent to regulated tidal wetlands which have been
inventoried and mapped by the New York State Department of Environmental Conservation (hereinafter
"Department"), pursuant to Environmental Conservation Law (hereinafter"ECL") Article 25 (also known
as the "Tidal Wetlands Act") and Part 661 of Title 6 of the New York Code of Rules and Regulations
(hereinafter"6 NYCRR"); and
WHEREAS, various activities conducted both in and adjacent to tidal wetlands are regulated by the
Department pursuant to ECL Article 25 and Part 661 of 6 NYCRR and require written authorization from
the Department prior to being conducted;
NOW, THEREFORE, in recognition of the Department's jurisdiction as set forth above, it is the
responsibility of a party having any right, title, or interest in the Property, to obtain from the Department or
any successor organization, a current description of all activities which are regulated pursuant to ECL
Article 25 and Part 661 of 6 NYCRR, and to obtain written authorization from the Department prior to such
regulated activities being conducted on the Property. Regulated activities include, but are not limited to
clearing of vegetation; application of chemicals; excavation; grading and filling; dredging; erection of
structures; construction or reconstruction of shoreline erosion structures; and construction and
reconstruction of docks and bulkheads.
By:
STATE OF NEW YORK
) ss.
COUNTY OF )
On the—day of in the year 20_, before me, the undersigned, a Notary Public
in and for said state, personally appeared wwwwµITmmmmmmmmpersonally known to me or proved to
me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument
and acknowledged to me that he executed the same in his capacity, and that by his signature on the
instrument, the person or entity upon behalf of which the person acted, executed the instrument.
NOTARY PUBLIC
IEW
Department o
YORK
STATE Environmental
Conservation
iNOTICE
i The Department of Environmental Conservation (DEC) has issued permit(s) pursuant
to the Environmental Conservation Law for work being conducted at this site. For further
information regarding the nature and extent of work approved and any Departmental
conditions on it, contact the Regional Permit Administrator listed below. Please j
refer to the permit number shown when contacting the DEC.
i
s Regional Permit Administrator
SHERRIACHER
_ 3
Permit Number: 1-4738-05020/00001
NYSDEC Region 1 Environmental Permits
50 Circle Road
Stony Brook, NY 11790-3409
Expiration Date: 9/5/2029 Email: dep.r1@dec.ny.gov
E
i
I r
Note: This notice is NOT a permit
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ALL SITE DATA SUPPLIED BY KENNETH WOYCHUK SURVEYORING, co x
AQUESOGUE NY 01.20-23 REVISED 02.01.24 N N SCTM#1000-83-2-7.4 & 7.5/92,322 SF /2..21 ACRES +115,177 SF/2.64 ACRES c o
H
ELEVATIONS NAVD 1985 DATUM o 0 0
PROPOSED SITE PLAN SUPPLIED BY
RESOLUTION 4 ARCHITECT
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
SINGLE FAMILY RESIDENCE ONLY
ftow" LA
U (D
DATE 10/11/24 S. *"� _C =
- • R•24-0945
APPROVED
C
FOR MAXIMUM OF 5 SEDROOMS W o (j
EXPIRES THREE YEARS FROM DATE OFAPPROVAL M
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co
Design Professional's Certification Required. O 00 Ct!
Submit P.E. or R.A. Certification For LLJ
I The Installation and Construction of the Sewage Disposal System
Use Form WWM-073
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NEIGHBORING WELLS ASSUMED
U D SHALLOW
HEALTH DEPARTMENT AND NYSDEC FOILS
PRODUCED NO RESULTS F154331-332
YO)y�
AR
50.0
CRUSHED `
STONE 1 �
0.5o
PALE BROWN � 0 RRO
_ SILTY SAND
[UST BE SM
6.0
;VEY
BROWN
FINE TO COARSE
SAND
NO GROUNDWATER SW
17.0' .
EI COUNTEL-,�L
-
20
30
40
arD AR
i 52 0F SRC}AREAS 68UND
.. E
0 '" l
all
00
LL
f
r -- co LJL ' es) +r " - ~—"" PROPOSED LIMIT OF CLEARING, GRADING AND GF
O DISTURBANCE 42,537.5 FTz; AREA S og EAWARD
OF 100' BLUFF SETBACK TO REMAIN UNDISTURBEI
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�WAY ��, '
S -- .. - - I
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r
1>0
68 6 ro
/cl,
4 1.8�� - 68
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PROPOSED (1) 8' x
' DRYWELLS FOR SM
SEE S-2 FOR DRAINA
60
/ P
Ir
PO.. � RO SED 141 x 241 t