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Home My WebLink About25750-Z FORM NO. 4 TOWN OF SOUTH-OLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N-Y. CERTIFICATE OF OCCUPANCY No: Z-30412 Date: 09/09/04 THIS CERTIFIES that the building ACCESSORY INGROUND POOL Location of Property: 95 KIMBERLY LA SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 70 Block 13 Lot 20.1 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 12, 1999 pursuant to which Building Permit No_ 25750-Z dated MAY 25, 1999 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 ACCESSORY TNGROUND SWIMMING POOL WITH PATIO AS APPLIED FOR. The certificate is issued to DOUGLAS F- ROSE SR. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-500635 09/14/99 PLUMBERS CERTIFICATION DATED N/A a Authorized Signature Rev- 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 25750 Z Date MAY 25, 1999 Permission is hereby granted to: LORRAINE T ROSE 95 KIMBERLY LANE SOUTHOLD,NY 11971 for : CONSTRUCTION OF INGROUND POOL AND DECK ADDITION AS APPLIED FOR TO ZBA SPECIFICATIONS (APPEAL #4399 ) . at premises located at 95 KIMBERLY LA SOUTHOLD County Tax Map No. 473889 Section 070 Block 0013 Lot No. 020 . 001 pursuant to application dated APRIL 12 1999 and approved by the Building Inspector. Fee $ 225 . 00 i 0 Authoried Signature i ORIGINAL Rev. 2/19/98 Form No.6 lL` TOWN OF SOUTHOLD 0 BUILDING DEPARTI% ENT TOWN HALL 765-1802 -- " '� APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form)- 3_ Approval of electrical installation from Board of Fire Undenvriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 190 lead. 5. Commercial building, industrial building,multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning BoardApproval of completed site plan requirements- B. For existing buildings (prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is deaied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$25.00, Additions to dwelling$25.00,Alterations to dwelling$25.00, Swirruning pool$25.00,Accessory building$25.00,Additions to accessory building$25.00, Businesses$50-00. 2. Certificate of Occupancy on Pre-existing Building- $10000 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5- Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 +� Date. 3 ,3 — New Construction: (y Old or Pre-existing Building: (check one) Location of Property: _ 9S FR 14 H use No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Sectf Block Lot cG�CB �O1 Q7o Subdivision Filed Map. Lot: Permit No-_ 57 s ® to ofPermit. LApplicant: 40& /( c 7 f�CDS Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ rant Signat C,0 3 � f THE NEW YORK BOARD OF FURE NDE - RIT R P i 13009E3 BUREAU OF ELECTRICITY 40 FULTON STREET, NEW YORKI NY 90038' - fiF�ir' # eQrI9S9 `�'c3$5'?;59%59• x SOG635 Date Application .No. on file THIS CERTIFIES THAT - 4 Quip the electrical equipment as described below and irstrodaeed by the appltcaart nesse Yoz*he-abTlTe application ansn+ber is to the premises of ' F F. �.li�� r�. e �� €.� � t SQ�di�i+�s t .. -. , • '. is in the following loc'afio Basem rsf ❑ 1st FP. ❑ 2nd Fl. Section $lock Lot f g �pWQ� u .1399 ` Hws examined on and found to be in cotnplimace with the 1 ational Electrical Code.. iIIII FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES -,COOKING-aECKS'. ! OVENS DISH WAS EXHAUST FANS 9 OUTLET$ INCANDESCFNT FLUORESCENT OTHER MT- K W AMT' X W. AMT K.W. LMT K W AMT. H.P. I` li �I Z L p.Ng7T EPiiPrL`. .;L FEEi'i 'n.L•;.UTiETFum.ERe P1Rf .CF hfGTORS p I ... ur• e.r. I h r.. t :,LH: 'd f _ �' - � i �-- - M1 �— ��r,• !_ .cell SERVICE;DISCONNECT NO.OF S E R t, gV -,T ,C E f METER NO Jf CC WHu P W - P • R ANTI AMP TT'FE EQUIP 0 dW 0 iW i J $ a 0 7W .R u G wrLi 1 h� OF d ,�-LEG NO OF fBJheu JF r¢NNA, OTHER APPARATUS: - IT M-�;�0F S c 1-6 Cip.. 1W G.F.t.z:-1 -� ' RM'GE, JP.:MS- T. 132 MOSCM3 AVE-. f84vr�Li ,z 1,7 11'•-82-25-0o - GENERAL MANAGER ee Per This certificate must not be altered In any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPYFOR BUILDING DEFARTDAENT. THIS COPY OF CERTIFICATE MLLST NOT BE .ALTERED IN Ard'i MANNER. TOWN OF SOUTHOW PROPERTY RzL aj' _ D„ .-� ►RQ OWNER /j7 STREET �� VILLAGE D ST, SUB, LOT I�IS��PS�P Sf: g Lorra �� jr-, WeAd, FORS ER OWNE - — zk4! + -• N E AR, c� r” C/o MC�hn l r-nieverifles -..�vl S W" " TYPE OF BUILDING j RES, Z _.. SEAS. VL, FARM COMM,. CB. MICS. Mkt, Value , T LAND IMP. TOTAL DATE REMARKS JO/ OLT�1Z0 P. /s/ .7iyc1+4 al. 11/M SW l/I✓iJ l" - I F%�- w h f//d 3A�'u Fre z. ✓/T . - / T x7 la ,uanare j _ 5 I'DoryEv !� OOra 17 1 00 3 i6 vt- I z.- l�� L ;Y� 1,62 h16 r&. -o �vl lrrf�r r� 1)r,)0L0 �7 �J /, / fir—♦ i �j ITC? — --- �6 /F !' 0r)rro f ` — -- ------=— 32 5120 3/91 i Tillable FRONTAGE ON WATER s yea R f Woodland FRONTAGE ON ROAD W Meadowland DEPTH '� House PIoT - BULKHEAD ^� A Total { .$2 1 fy+4�a tv+ vw vor 1 �� 1 iy�.y +C � + •r+ `+� a � h ` m.. (vAJ 1W.mr ( I COLOR � fi � TRIM V`4 l r��,�+n.�ynv 1�,{'i�! ! I E '4ti+f (• I `, ^ + ,r f �+�,I — +.rY�• r1� 1 i i +7J +•' 1 'Jw li Iis 1 __ — _ e F hs" r, ,. . �..ay� - - - - — ' h "14. Ut •al_. fi ice.. - + '1 J ' `gid:.,, �. `�.` ..•��"�� i C.�M-r. Bldg. 3 � z,u '�,•�'�< ��3 _ e '!50 S58 Zbz 732- Extensign - - _ - ----- - - -- - - - -_ - •'7'a 7,700 - -- - - - - Extension - a a11_ P-1 ---- SL) r/pQ F !t° Z. iCa Both FoundDinette (7Uf"�VG I k"�,••IJ "4.•ta r' ---__ I.) t_. — .— utIon 1�Fr•'•Is.._(.a&,r...W BasementK• _ 11 — — Il,,l Floors (� t".'.. Porch _ _,_ - LR rt—mssl _ Ext. Walls k ctel! �l� '•1.y` Interior Finish Hear G.�, \t..-k'J, ;:, DR. Bi'eezeW9y �' �a l 2 0 Fire Place tir — _--- �(k6 -- BR. C.y ar v le3o. Type Roof GaP Ixl 1'mm Rooms lst Floor a �• rage Z- f ^sl l 5 ICJ - Patio Recreation Room Rooms 2nd Floor FIN. B — O, B. Dormer _ Dri.vewa--- Y _ � 7 IaAUt. �raUaf�..• 1 Total AA ` f .: I APPEALS BOARD MEMBERS %�$UFFO(fe0� � } �O Gy o � Sourhold Town Hall Gerard P. Goehringer. Chairman ;c < zw c n� 53095 Main Road Serge Doyen y v� _ • oo PO. Box 1179 James Dinizio. Jr. O � v, S urhold New YorL: 119'1 Robert A. Villa �'.�� app fr jr Le E Fax (516) 765-18-3 LvdiaA_Tortora 1 �� cc 1Nlephone (516) 765-1309 0 f BOARD OF APPEALS T" TOWNI OF SOliTHOLD` Appeal 14399 ACTION OF THE BOARD OF APPEALS Jule 24, 1996 APPLICANTS: DOUGLAS AND LORRAINE ROSE. PROPERTY: 95 Kimberly Lane, Southold, NY_ Parcel ID 41000-70-13-20-1 - BASIS OF APPEAL: June 20, 1996 Building Inspector's Notice of Disapproval- CODE isapproval_CODE PROVISION APPEALED: Article IIIA, Section 100-30A RELIEF REQUESTED_ 25 ft. setback from property line along easterly side of Pine Neck Road, for a portion of proposed deck around inground pool at northwesterly corner of existing two-story frame dwelling, and side deck area, all as shown on the April 30, 1996 Map_ MOTION BY: R. Villa SECONDED BY: L. Tortora RESOLUTION ADOPTED: Granted variable setbacks as shown on the April 30, 1996 map with 25 ft_ at the closest point between deck and westerly front property Line, and greater as shown thereon, provided the setback from the bulkhead at its closest points shall be at 75 feet (or more) to meet code requirements" Note: The grant of this variance is based oiilv on the Building Inspector's Notice of Disapproval as written and noted above, and does not apply to any other sections of the zoning code or other provisions of law. REASONS/FINDINGS: The subject lot is a corner lot fronting on two streets, and contains a lot size of 47,916+- sf_ The single-family dwelling was built in 1988 under Permit $16867. The setback requested for reduction to 25 feet is along the northerly street (Pine Neck Road) which is a "dead-end" area, used for vehicle turning. A chainlink fence separates Pine Neck Road and the proposed pool-deck area. The relief requested does not create an undesirable change or detriment to adjoining properties or surrounding residential areas. OTE OF THE BOARD: Ayes: Members Serge J. Doyen, Robert A. Villa, L-vdia A_ Tortora, Gerard P_ Goehringer_ This resolution was unanimously adopted 4-0. Member J_ Dinizio was absent (out-of-state) . New York State Department of Environmental Conservation Building 40 - SUNY, Stony Brook, New York 11790-2356 AM Telephone (516) 444-0365 Facsimile (516) 444-0373 John P. Cahill Commissioner LETTER OF NONJDRISDICTION TIDAL WETLANDS ACT April 7, 1999 Re: 1-4738-02205/00001 Rose Property Construct a pool and Deck Douglas F. Rose, Sr. PO Box 967 95 Kimberly Lane Southold, NY 11971 Dear Mr. Rose: Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that: The property landward of the bulkhead which was constructed prior to September 20 , 1977 as shown on the survey prepared by John T. Metzger dated September 6, 1988 is beyond Article 25 jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act . Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, 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 Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15 ' to 20 ' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. DORM NO. 7 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N_Y_ NOTICE OF DISAPPROVAL DATE: . _ NNE 20,_ .1996_ _ _ _ - - DOUGLAS & LORRAINE ROSE To . " - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - P.O. BOR 967 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SOUTHOLD, NY 1.1971 - - - - - -- - - - - - - - - - - - - - - - -- - - - - - - - - - -- - - - - - PLEASE TARE NOTICE that your application dated - _ . . . . . . . . . . . 19. 96. . . for permit to CONSTRUCT AN INGROUND POOL WITH RAISED TERRACE IN THE FRONT YARD - - - - - - - • - • - - - - - - • -- - - - - - - - - - - at Location of Property - -95 KIMBERLY LANE SOUTHOLD NY House No_ Street Uamlet County Tax Map No. 1000 — Section - - -70. . . . . . BLOCK - - - -13 . .. . . LOT . . . . 20 '1_ - _ _ _ Subdivision _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Filed Map No. . . . . . . . . .Lot No_ - - - - - - - is returned herewith and disapproved on the following grounds - - -INSUFFICIENT FRONT YARD - -. . • _ -. . _ _ - FFR SETBACK IN THE FRONT YARD IN AN R-40 ZONE, ARTICLE III A CHAPTER 100-30 A.3. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - • - - • - - - • - - - - - - • - -- - • - - - - - - - - . .. . - . . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ACTION REQUIRED BY THE ZONING BOARD OF APPEALS. - - - - - - - - - - - - - • - • - - • - - . . . . . . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - - - . . - - - - • - - - - - ' • - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - ' - - - - - - - - - - - - - - • - - - - - - - - - - - - - - - - - - - - ' - - - - - - - - - - ' . . . . . . ' - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - • . . . . . . . . . . . . . . . . . - - - - - - - - - - - - - - - - - - - - _- - - - - - - - - - - - - - - - - - - - - - - - - ""` - - - - - ' - ' RV 1/B0 Ru _nr Inspector _ Fish �° r � y �� truer,• , + ' SURVEY OF s LOTS MAP OF PARADISE BY THE. DAY AT SOUTHOLD TOWN OF SOUTHOLD s FII.EDNOV.411976 NO. 6463 T 04 ?`S1_ SUFFOLK COUNTY, N.Y. 1000-70- 13-20,1 � Scale I " = 40' , July 14, 1987 r Sept. s. lose (find) A / :,� .Wfo Q � ass• Z � /mat' / •s. ,►yam / Q w \ acJ.�?�sp• - '•o�a a arp, s 1 �p J• �3 ro a CID LOT o t !l �' yrs z s jo fl hQ ,an a f l Q Cb Mm SUFFOLK EOIJIM DEP R1T flf"WIN SON= s SINGLE FAMILY DWELLING ONLY ! let s DAIEI gig N.S. REF. NO. s, � 4*� 5'O7%p. sewage disFosai and nater .-ninly Faciiitiss} s Ft - 9.2 loc-';an hw.,P. o_rn i cc_..ef: cr iy.: `!:JartmenF�r or _ y L oilier zRoppcies•avid icu:,d io ire ,3fisi QCuy. IK I LL TO SE LOCA ON r• iLL EASEAIEN NOFD 1, ':�•`•.•. `'. . FILED ANAP F SUeDlV/SirESlV. rr Chre( of Bureau of WastewaliManage r� 3a I / rC er° 53/O // Cb /� �c / ti a.O.K 07-so-wo ,` 14f n \'eve r rnr /33.26 �r 'T r 4 4 New York State' Department of Environriental Conservation Building 40 -SUNY, Stony Brook, New York 11790.2356 Telephone (516) 444-0365 Facsimile (516) 444-0373 NEW John P.Cahill i Commissioner LETTER OF 14ONJURISDICTION TIDAL WETLANDS ACT d� April 7 , 1999 i j Re: 1-4738-02205/00001 Rose Property Construct a pool and 1 Deck ! Douglas F. Rose, Sr. PO Box 967 95 Kimberly Lane Southold, NY 11971 Dear Mr. Rose: Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that: The property landward of ,the bulkhead which was constructed prior to September 20, 1977 as shown on the survey prepared by John T. Metzger dated September 6, 1988 is beyond Article 25 jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act . Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, 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 Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the• tidal wetland jurisdictional boundary and your project (i. e. a 15 ' to 20 , wide construction area) or erecting a temporary fence, barrier, or hay bale berm. J -BUILDING PERMIT REVIEW CHECK LIST Application Name: ILU S Architect/Engineer: SCTM#: District 1.000 Section: o Block: [ Lot: 20 Subdivision Name: Req. Req, Zoning DistricC [W Sim. Proposed: [ [Lot coverage Proposed' J Req_ Req. Req. [Front Yard Proposed [ [Side Yard Proposed. ] [Rear Yard _ Proposed. _f JJ�� Project Description: 'CO D 1-- 4— 1 mac.L-- AGENCY PERMITS Permit REQUIRED FOR REVIEW I.A. ISO YES Number Suffolk County Health Dept_ New York State D. E_ C. j�� > t Town Trustees Town Zoning Board approval: ✓ rq3 q ef Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: Notes / �O ertLj s --ki --1c) b-e P C(5 l O`5 0./E LI�Cy _� �1 4 4 7 r cj () JU7JITH T. TERRY +�i Fu` '� -Town Hali. 511195 Main Road ( 1� ' — P.O. Rox (17c) TowN CLERK Suudlold. Nc,,, ) (irk 1 11171 " IiE:CISCTLIR OF VITAL STATI517CS � .+' � fCa = ti Fax (516) 76s-1911 MARRIAGE OFFICER _ % c- � yb Tcicphanc (516) 765-I9(11 RECORDS MANAGEMENT OFFICER " Ol ?iI I FREEDOM OF INFORMATION OFFICER ' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" (FDP(93) ] , and "Certificate of Compliance for Development in Special Flood Hazard Area (CIC(93) ] . a TOWN OF SOJT+OLO Ajetel t Southold Town Clerk August 25, 1993 APPLICATION #_ PAGE 1 of 4 TOWN OFSOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION1: GENERAL PROVISIONS (APPLICANT to read and si )- L No work may start until a permit is issued_ 2. The permit may be revoked if any false statements are made herein 3- If revoked, all work must erase until permit is re-issued- 4 Development shall not be used or occupied until a Certificate of Compliance is issued. SF The permit will expire if no work is commenced within six months of issuance. 6_ Applicant is hereby informed that other permits may be required to fulfill low state and federal regulatory requirements. 7- Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. S. I;THE'APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO TEES.APPLICATION ARE,TO THE BEST OF MY KNONLEDGE,TRUE AND ACCURATE. (APPLICANTS SIGNATURE) DATE SECTION 2: PROPOSED DEVELOPMENT(To be comuleted by APPLICANT) NAME ADDRESS TELEPHONE APPLICANT BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location- Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION r _ PAGE ? OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure ❑ Residential (1-4 Family) ❑Addition d Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofmg? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition 0 Manufactured (Mobile) Home (In Manu- 0 Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PRO-TECT s B. OTHER DEVELOPMENT ACTIVITIES_ ❑ Fill ❑ Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) ❑ Individual 'Water or Sewer System ❑Other (Please Specify) After completing SECTION 2,APPLICANT should submit form to Local Administrator for review. SECTION 3: FLOODPLAIN DETE INATIONff o be coin leted by LOCAL ADMINISTRATOR • The proposed development is located on FIRM Panel No. Dated The Proposed Development: ❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED)_ ❑ Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated i ! ❑ See Section 4 for additional uustructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REOUiRED (To be completed by LOCAL ADMINISTRATOR) The apphcant must submit the documents checked below before the application can be processed: ❑A site plan showing the location of all existing structures, water bodies, adjacent roads, lo[ dimensions and proposed development. ❑Development plans, drawn to scale,and specifications, including where applicable:details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the furs[floor,details of floodproofmg of utilities located below the fust floor and details of enclosures below the firs[ floor_ Also. ❑.Subdivision or other development plans(If the subdivision or other development exceeds 50 lots,or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available)_ ❑ Plans showing the extent of watercourse relocation and/or landform alterations- ❑ Top of new fill elevation Ft. NGVD (MSL)- ❑ Floodproofing protection level (non-residential only) F[- NGVD (MSL)- For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway w[11 not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: SECTION 5: PERMIT DE7ERMINAT16N (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity. A ❑ Is B.❑ Is not m conformance with provisions of Local law #_, 19_- The permit is issued subject to the conditions attached to and made part of this permit. SIGNED , DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. if BOX B is checked, the Local Administrator will provide a written summary of deficiencies- Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals- O APPLICATION # PAGE 4 OF 4 AFPEAIS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved? ❑ Yes ❑ No Conditions SECTION 6: AS-BUILT ELEVATIONS (To be submit[ed by APPLICANT before Certificate of Compliance is issued) The following information must be provided for project structures_ This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete I or 2 below. L Actual (As-Built)Elevation of the top of the lowest floor, including basement (im Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding-piling and columns) is: FL NGVD (MSL). 2. - .Actual (As-Built) Elevation of Boodproofmg protection is FT. NGVD (MSL)_ NOTE: Any work performed prior to submittal of the above information is at the risk of the AppGcauL SECTION 7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be comnle[ed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE BY: Attachment E SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑ EXISTING BUILDING ❑ VACANT. LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: CIC(93) �g11FFO(, c Albert J. Kmpsld,President Off' GG Town Hall John Holzapfel, Vice President y1 53095 Maio.Road ez P.O. Box 1179 -Jim King da _ " Southold,New York 1197I Martin IL Garrell O .F Peter Wenzel y� O! Telephone (5-16)765-1892 Rm(516)`765-1823 BOARD OF TOWN TRUSTEES TOWN OF S'OUTHOL D. r raq a �� r 3.. IP 20? i. y I 1. 1a� 09 September 5 , 1997 Douglas F. Rose, Sr. 5 ane 95 Kimberly L :. ,.y ',s *,::';;. r, • .,..:' Southold NY 11971 RE: SCTM. #70-13-20.1 Dear Mr. Rose, The following action was taken at the Southold Town Board of Trustees Regular Meeting on May 28, 1997: RESOLVED, that the Southold Town Board of Trustees approved the request for a Waiver to construct an. addition, deck and pool as per revised plans dated and received 915.197 If you have any questions, please feel. free to contact our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh _ cc. Bldg. Dept. i - . . ---�-.- i a '�' � �.-• �. �,..y^�^,� ,-,� _ � -mss, 5-rs - i• 765-1802 ' BUILDING DEPT. 1 � NSPECTION p [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION ` �jREMARKS: , c � ' r-3 CIJGiv DATE INSPECTOR 3. qkj IBLD MNSPECTION REPORT DATE COMMENTS � OUNDATiON ( IST) _ y r -OUNDATION (2ND) q N C+1 ' ry �N — 1 q q q O � OUCH FRAME 6 I — 7 PLUMBING x u � p Ju q q tl q N INSULATION PER N. Y. STATE ENERGY p .. t , CODE p qq A 2 q q q q H H q N n FINAL q M ,r _ ADDITIONAL COMMENTS: 4-PIL.y•� -:.»"�. � N tL a. — � C ifawmau -a,r '••-=iu.iu . . . . .. . .. . .. . . . J" ` � '• f� � FORM NO. I 3 SETS OF PLANS . ... . . .. . . . . . . TOWN OF SOUTBOLD SURVEY „ APR ' [ BUILDING DEPARTMENT CHECK . ... .. . .. .. . . . . . . . . . . . . .. TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 I311IG.0 T'OWH£SR'SOl[T 'D ! TEL: 765-1602 NOTIFY: JJ CALL 51.6•-208; 900 , • - lkamined...�l?. ....... 19�_.I//�� _ MAIL. TO: . . . . . . . . .. .. . . .. . . .. S/2`5. �iC - � .. PO `Box 967 Approved-...1......_•-._., 19._.. Permit No. _..-.•.-•••.-... ..._...-•-•.-.•.•....•...•-...-:... Di a/c ......................... Southold, NY 11971 ..........___.......... / (liunlding ) APPLICAATION FOR WELDING PERMIT .Date. m4mh _4,• 19.99- INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sutyffitted to the Building Inspector wi 3 sets of plans, gccukate plot plan to scale- Fee according to schedule. b. Plot 31anS sbbwiug location of lot and of buildings on premises, relationship to adjoining premises or public. streets or areas,(aod}giving a detailed description of layout of property must be drawn on the diagram which is part of -this applicatidn. c. The work covered by this application nay not be commenced before issuance of Building Permit. d. Upon .pprova3 of this application, the Building Inspector will issue a Building Permit to the applicant. Such - peAmit shall be.kept mj,the premises available for. inspection througl out the work. - e. No building shall be occupied or used in,whole or in part for any purpose whatever until a Certificate of Occupancy shad have been granted by the Building Innspector. APPLICATION Is umm MAnE to the Building Department for the issuance of a Building Permit pursuant to the Building Zooe 'Ordinana of the Tbwn of-Southold, Suffolk Canty, New York, and other applicable Lars, Ordinances or Regulations, for the construction of buildings, additions or alterations for rural or demolition, as herein described. The applicant agrees to comply with all applicable Laws rdina ce , building code, housing code, and regulations, and to admit authorized iospectors,on premises and - buil ing for Cessary inspections. (Signa a applicant, or nom, if a corporation) PO Box 967, Southold, NY 19971 ................................................... (Mailing address of applicant) State wlnetber applicant is aver, lessee, agent, architect, engineer, general contractor, electrician, plumber or builders .................Ow-nes........................................................-....................................... Name of owner of premises ..........Douglas and Lorraine Rose ............................................................................... (as an the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. n/a (Nate and title of corporate officer) Builders License No- 25.,372,••- .R1.—..Casraige Hill Associates Plumbers Linc No. THD Electricians License No. ...T_BD............. Other Trade's.License No. .....TBD............ 95 I. KimLocation of loon m which work will be dane..............berl...y W.Lane............Southold...... , NY 1 ..........197.............. ....................................................................................................................... Haase Nmber Street Hamlet Canty Tax Map No. 1000 Section .. 7 0 .......... Block ..�3........... lot 3R-.1......... Paradiby the 64.Nap No. ldt ............... (Name) 2. State existing use and occupancy of premises and intended use and occupwx-7 of proposed construction: a. Existing use and ocanpa cy ......Si.ng.le family dwelling b. Intended use and occupancy .... Single family dwelling ............ P?s.)a 1 3. Nature of work (check which applicable): New Ruildkrng .._....:_. Addition ....._.__ Geratron ..._._... Repair ............ Removal Demolition Other rk - Pool- •wild Patip,-•R__.. _........_.. ............ (DescrhLp4aoh� 50,000 ^ = 4. Estimated Cost .....I. ................ fee (to be paid on filing this application) 5_ TE dwelling, number of dwelling units ............ limber of dwelling units on each floor ...n4?......... If garage, number of cars - n/a 6_ If lousiness, commercial or mixed occuparw-7, specify nature and extent of each type of use.......$f a .......... 7. Dimensions of existing structures, if say* Front...Z9.,$........ Rear ...7.6.7.6-5........ Depth _.54..7..___..._.. kleigbt 3.0................... Nmber of Stories ...-.2................ Dimensions of same structure with alterationsor additions: Front ..7-q_a. ....... Rear .......a3.1 Depth ..._5.9............. Heigbt ..27 ............... Naber of Stories '6. Druenskons of entire new construction: Front ._-n./a........ Rear --2.4-.-751-_._ Depth —11:-...--- 24' Height Huber of Stories ...2................. 9. Size of lot: Front ...... Rear -15-9.39 . ........ Depth _ 88.82 '...:..... 10. Date of Purchase .....6J5-9.......... Name of Former Owner ....Rohrimg.Enter.prises....... II. Zone or use district in which premises are situated Resident Lal.............................................. 12. Does gtoposed construction violate any ming lass, ordinance or regulation: no-variance •4Dproved copy 13. Will lot be regraded .......LIR.......... Will excess fill be revved from premises: YES XAU encl. 14. Names of Owner of premises .... Address .�5.)4 1417��aY..Id>a4..... Phone No.2.08.:290.0._. Wave of Architect Thomas Piekutowski Address 1541 • .4th•-St;Seaclif ,� No. 676- 7•g2.- Name of Contractor -Carriaqre . Hill Associate�ress344 .Duffy„Aye,,•$�4okSvPhone No. 93.fi--:7.17._ ... ... 15_ Is,this pioperty within 300 feet of a tidal wetland? * YFS xx ...... NO .......... I *IIF YPS, sO1 nUD 117441•Tt smES pmuT MAY BE REWmm. Enclosed PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property, lines. Give street and block umber or description according to deed, and show street Thames and indicate whetber interior or corner lot. Enclosed separately SCA1T; OC N3W YORK, ss OUM[yor .....Suffolk....... Douglas F. Rose Sr, being duly sworn, deposes and says that he is the applicatmt (Nave of individual signing contract) above named, Owner Heis the -•-----•...................................................•---........................----•--•---- (Contractor, agent, corporate officer, etc.) of said owner or owners, and is.duly authorized to perform or have performed ahe 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 belie F; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...............4...day of -March---------19..4 9.-._ e Notary Publi .. .......... .... Notary Public. state of New hart ..• ....• I No. CIVA50 (Signature o ppli.cant) Ousltfled In :0 only Commission Expires August 0, o SURVEY OF `v LOT 1 non a n tc BY TGIF_, FIA X �._AT SOJ'fHOLDa _° -TOWN Oc- S'DUTHOLD cr, r, FILE-DNO'.V.4, 4976 NO. 6463 SUFFO-LK CObWY, N.Y. k 3 1000.-i0- 13-20.k i 4#T ,., , gA o S c'a l I " = 4 0' � � / July J�4, l967 / w °+r m / 'G+ 6 . CO Cl LOT 2 CV o ^ / y •! Qom`_ _ ,J W C. / h JD LO CO !a• / 2 / 500, ' gas L 39. ( � WELL TO BE LOCATED ON - kk WEL'_ EASEMENT AS NOTED ON .7X ED MAP OF SUBDIVISION. No3o5 , , m r`BTo 3/0 1Y 11 N l B.O.H 97-SO-IYP MAr L q Ner`;•J Srr_2 oc F a`. �. } i CD xv UoapL ;ODmoa 2 m i WAw/ l`y Fuox� W/ �P Giai1hyU-;5ir-- F 91FFA5f ,.tJe t — — 3s. t:%In �Htinx.-GA f 24,5 (Lh'uV$N� -DOh5 IN51 �. 'acid", clx 2staaY f1Q1 4Ct1A oew 4' ldi'k*twA 4. 1 SE7.F L F13'I M51�7d) I m Zo `*Air 2'= &LX ftwp oVEa esurt. Pl..U6c '? EerrwY s1sP'S 9 I � 0 0 , f w _ 3 -- - — i _— - - - — - -- - - - ---- - Q_2r i o 5 �• 39 2'1 __ _ 41 1 _ KIM�EIZL`{ LANE P�.oT PLP� —I I Dow ON q�j% f-wA A'UZVLS'( of Ldr I MAP C`r- PA9ADh56 la;( 7+ r— U\? AT t7UTaoL.177 Tomo of j5oi ATtjpLD - 5uprowe Gow.rr, N`(' TSL MAI° NQ I000--70 - POOL, GARDEN WALLS & PATIO ADDITIONS to the ROSE RESIDENCE tE 1n, , SSP ps°• �>or°� LORRAINE & DOUGLAS ROSE, SR . I f 95 KIMBERLY LANE - SOUTHOLD, SUFFOLK CO., NEW YORK x THOMAS C. PIEKUTOWSKI DRAWING NO aa r ��j• o, 0154 �,v 159 fourleenlh avenue sea cliff, n.y. 11579 676-5742 _ — FRED ADATE: 2I�-Ig9 �uLk+�u LINA - v9/ T4� __ _ I I'-g3/`�" 241_ �u 1 I � \ ro s OT 12 \ P Ai DATE; AP S 0. E B�P. PUaT 7TED SD� U� 0 \� A FEE. -2�-S BY: .) I } co ^10 I NOTIFY BUILDING DEPARTMENT AT e• '�2 9r \ FOLLOWING INSPECTIONS: 765-7802 9 AM TO 4 PM FOR THE 1 FOR POURED NCON RETE REQUIRED � 2. ROUGH - FRAMING & PLUMBING 3. INSULATION w 4. FINAL - CONSTRUCTION MUST E COMPLETE FOR.3 ALL CONSTRUCTIONSHALLMEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION ENERGY 0 / i CODES. NOT RESPONSIBLE FOR i r \ DESIGN OR CONSTRUCTION ERRORS 1 -_ _ -_ Alt toe 0/ "IMMEDIATELY" OMMMMMCGICIE UPON COMKETION 5EFORfi'NNM' ' v i I!' .' R� �� / \�. -_ - - -- -- -_ - _ _ UNDERWRITERS CERTIFICATE REQUIRED NII fa0 A -I � wT� - -vOCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE o OF OCCUPANCY i _/ Y 4 x4 �4 REINP ��r �G` SLAn ON C �vE F / A% LATIN ivv 48 / QW(- G PI � 'm/ �Galp O P51N1P LTe; _ .,� /"�� 1,..,` /l - v D✓401NS <_ -I-`I`" e 'X ° ON SAtJO Y-j �' / M X- � ;�X v ` � A•, i �, r � A i� -II-h � AN12 Q Wi� LdTF Qj i - r / fix F,QMIL`r M (O-O9 � W�� AIfL To "Is�2• � ;' I Rm ��/ \ 1 / -0 �� - - - II ze� - - �1DfJITIQ.�- - 11V/4' NIGN ,Ic fA o f - � plN n. � . ' oEU. LP/11.1!t pOM ! wAU•1A4$ F;o-w/ _._ _ __ FJL� UIJI YZ SE'PA✓LAi'E .OPVLq LQ'710h1 1 f I,AT s A!r -p? A or o•Ik' - 2 cMU wI Pad s Coli, rc.�o j <oJ�R- 5K F9ti11SH oti 69xl,- .W I4/vJ l 4 �NWM � -- -- I i I l� p WATt LI JE — - d39m .SC: is"o,a � I '�I a/'8(I• C01.YT11.11AOU% - i I / - 1 - PATeI 9e: �Q ��. , I ��GT I oto -- - - - - - - Q' = 1 -O �'• 224IY9 - - i",i;dILDiNG �cYJA✓%[M�uJY I`1i'�� N°' 9q-f� y'��IpT-loti POOL, GARDEN WALLS & PATIO ADDITIONS LO the ROSE RESIDENCE 0 f tP 0�P plc p o0 RRAINE & DOUGLAS ROSE, SR.s0. KUP IMBERLY LANE - SOUTHOLD, SUFFOLK CO., NEW YORK /THOMAS C. PIEKUTOWSKI DRAWING NO N4 1 159 °� 0154'I2 159 fourteenth ovenue sea ch![ n y. 71579 676-5742 1 1 eRfD ARC DATE SCALE- SCALE AS NOTED I OF 1