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HomeMy WebLinkAbout42874-Z xxof 30�Tyo� Town of Southold * * P.O. Box 1179 �04 53095 Main Rd UNI" Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 46243 Date: 06/17/2025 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 75 Wells Rd Peconic, NY 11958 Sec/Block/Lot: 75.-6-3.1 Conforms substantially-to the Application for Building Permit heretofore,filed in this office dated: 07/03/2018 Pursuant to which Building Permit No. 42874 and dated: 07/18/2018 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 in-ground swimming pool fenced to code as applied for. The certificate -is issued to: Morton Dubin Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 42874 9/10/2018 PLUMBERS CERTIFICATION: uth riz d Si ature OfsoulyolQ TOWN OF SOUTHOLD BUILDING DEPARTMENT `�,��• �¢ TOWN CLERK'S OFFICE �oinal. SOUTHOLD, NY BUILDING PERMIT RENEWED (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 42874 Date: 07/18/2018 Permission is hereby granted to: Renewal Date: 02/11/2025 Morton D Dubin II 355 Pacific St Brooklyn, NY 11217 To: construct accessory in-ground swimming pool as applied for per Trustees Non-Jurisdiction letter and DEC approval. Premises Located at: 75 Wells Rd, Peconic, NY 11958 SCTM#75.-6-3.1 Pursuant to application dated 07/03/2018 and approved by the Building Inspector. To expire on 02/11/2027. Contractors: Fees: Renewal Fee $200.00 Total 200 ui ding Inspector � Y o�guFFQ��co TOWN OF SOUTHOLD BUILDING DEPARTMENT y TOWN CLERK'S OFFICE oy . 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#: 42874 Date: 7/18/2018 Permission is hereby granted to: Dubin II, Morton 355 Pacific St Brooklyn, NY 11217 To: construct accessory in-ground swimming pool as applied for per Trustees Non-Jurisdiction letter and DEC approval. At premises located at: 75 Wells Rd, Peconic SCTM # 473889 Sec/Block/Lot# 75.-6-3.1 Pursuant to application dated 7/3/2018 and approved by the Building Inspector. To expire on 1/17/2020. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building nspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT 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 Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%.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 Board Approval 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 denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 p Date. 3/��� 0 'New Construction: Old or Pre-existing �/ (check one) At Location of Property: "� & �5 �� CaA 1•C__ House No. ( Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000,Section S Block 6 Lot 3• I Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ l g pu0 mac. Appli cWSigVatur6 o��OF SO�r�o! � o Town Hall Annex Telephone(631)765-1802 54375 Main Road H Fax(631)765-9502 P.O.Box 1179 G Q Southold,NY 11971-0959 �p • �� roger.richert(cD-town.southold.ny.us UNV BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Dubin Address: 75 Wells Rd City: Peconic St: New York Zip: 11958 Building Permit#: 42874 Section: 75 Block: 6 Lot: 3.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: LC Electric License No: 38043-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph . Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 2 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches Twist Lock Exit Fixtures TVSS J Other Equipment: In ground swimming pool to include, bonding, control panel, 1-spa blower, 2-pool pumps,5-GFCI circuit breakers,gas pool heater,pool lights Notes: Inspector Signature: Date: Setember 10 2018 81-Cert Electrical Compliance Form.xls sa ryO6 # # TOWN OF SOUTHOLD BUILDING DEPT. `ycouMv,Ne`' 765-1802 INSPECTION [ /FOUNDATION 1STxjo [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: l DATE 30 INSPECTOR 5f SOUTyo� # # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm, 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. 4, [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ELECTRICAL (ROUGH) ( ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: `� �Jr DATE INSPECTOR L OF SOGIyo� * # TOWN OF SOUTHOLD BUILDING DEPT. cou 765-1802 INSPECTION �, [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ )] CAULKING REMARKS: r DATE �`� ,! �`` INSPECTOR `S--may oF souryO� - - — # # TOWN OF SOUTHOLD BUILDING DEPT. cou 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION_2ND [ INSULATION/CAULKING [ ]B FRAMING/STRAPPING ] FINAL ] . FIREPLACE-& CHIMNEY [ ] FIRE SAFETY INSPECTION. [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE`RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ :] RENTAL k- �i REMARKQ(M S- l l 1 DATE INSPECTOR FIELD INSPECTION REPORT DATE A 9OXMENTS 'FOUNDATION (1ST) ------------------------------------ 'FOUNDATION (2ND) �y z 0 ROUGH FRAMING& PLUMBING • INSULATION PER N.Y. STATE ENERGY CODE z Ir01/1 1 l ft)64 1/l Pig, FINAL o ADDITIONAL COMMENTS �— IZ 8 - Z�o C G Z •— � o�L��v�.�s cc(�. m - -ate 3�D d b H �I TOWN OF SOUTHOLD - BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,.before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval 'FAX: (631) 765-9502 Survey ,. Southoldtownny.gov `PERMIT NO. Check f Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 20 Single`&Separate Truss Identification Form Storm-Water Assessment Form r Contact: Approved ,201 (\ Mail to: Wfkt _ 41na"", Disapproved a/c Phone: 631 563665 Expiration ,2 D BuildNg4R<pector DD PLICATION FOR BUILDING PERMIT JUL - 3 2018 Date 3 ,20 16 INSTRUCTIONS B�•DING DEFT. MOO ,e y ' A ]5be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot p an to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.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 issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector issues a Certificate.of Occupancy. f.'Every-building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18_months.from'such date.If no zoning amendments or:otlier regulations affecting the property have been enacted in the interim,the'Buildih 'Inspector may authorize;in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. 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,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)Milo, (Mailing address of applicant) State whether appli nt is wner lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises A n 9 0 Vb I n Mock n D. Do k a (As on the tax roll or latest deed) If applicant' a c "atigna re of ly authorized officer 101 (Name and tit . o .. orporate officer) 11 Builders License No: S 919 — �-1- Plumbers License No. ISO -IA3 Electricians License No. _ Other Trade's License No. 1. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section S Block 6 Lot 3. Subdivision Filed Map No. ' Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy _Ao�� " b. Intended use and occupanc Pad 3. Nature of work(check which applicable):New Building Addition Alterat' n Repair Removal Demolition- Other Work p (Description) 4. Estimated Cost p l © � Fee' (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business;zommercial or mixed occupancy, specify nature and extent of each type of use. 7.' Dimensions of existing structures, if any: Front Rear Depth Height ' Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number ofSterep_nn Ej 8. Dimensions of entire new construction: Front Rear i Depth h ri t Height Number of Stories ` ,+ s jw'.. PFy 9. Size of lot: Front Rear Depth ;H 10.Date of Purchase Name of Former Owner n;r, 11.Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO 13. Will lot be re-graded?YES NO�Will excess fill be'removed from premises?YES INTO J 14.Names of Owner of premises tul*\ Address wells rcl f reoweLn Phone No. P16 3A0 Q-Iqq Name of Architect Address el, f' one No 6.3 1m 3 �i— Name of Contractor Pt, S D 89 S Z^e Address S PS P Phone No. . 6 3/ (f'-B 3 15 a.Is this property within 100 fEet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. +b. Is this property within 300 feet•of a tidal wetland? * YES NO * IF YES,D.E.C. PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate,foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COL4Y OF ) U'� f C, being duly sworn,deposes and says that s)he is the applicant (Name of indivi 1 signing contract above named, CONNI D. BUNCH Notary Public,State of New York s _ " No.01811618 Fe ( Co l S)He is the l.�' V '' Suffolk ' (Contractor,%ent,Corporate Officer,etc.) Commission Expires April 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. Sw rn to before me thi 1 " day of � wt/t Ci 20 Notary Public i ture of Applicant Michael J.Domino,President Town Hall Annex ��► 54375 Route 25 John M.Bredemeyer III,Vice-President P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 O� rj�L� CQ 'N �ti`'`.. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 29, 2018 Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 RE: MORTON D. DUBIN 11 75 WELLS ROAD, PECONIC SCTM# 1000-75-6-3.1 Dear Mr. Patanjo: The.Southold Town Board of 7rustees.reviewed the site plan. prepared by Jeffrey Patanjo.,: iast.:dated 'May 115, 201,:8; and,.deterrnined that.the proposed construction of a proposed 20'x40' :in-ground,.swirhrning,pool-with a,surroundirig brick paver pool patio (25'x67' of pool &-,patio,) is.out:of;the:l V land jurisdiction under C hapter 275 .of'the Town Wetland'•Code and ;Chapter-111 :of'th'e Town Code: Please be advised that-pool endlosur:.e fencing'was not'applied for nor was it shown on ahe site,;plan ast dated May 15,,.20'i 8:. If the appJicant proposes to install.fencing in the area within.l Q:0' from:the'landward edge of vegetated wetlands; a„p�ermit:will be requiretl from this office. Please be advised, however,.that no construction, sedimentation, or disturbance of any kind may take place seaward°of the tidal and/or freshwater.wetlands jurisdictional b.oundary,.or*ithin,104' landward from the edge.-of vegetated wetlands„without further authorization from the Southvld`Town'Board of Trustees pursuant to Chapter 275 andlor Chapter 111-1 of'th:e'Town Code It s°your re.sponsibifiity:to ensurelhat.alt. necessary precautions are taken to preven �any�Sedirnentation or_other''a.lterati;on or" disturbaneeao the ground;surface or vegetation within Tidal VVetiti idt'jurisdiction,and, Coastai Erosion Hazard Area,, which may result from your project. 'Such,precautions may include maintaining adequate work area between the tidal wetland;jurisdictional 2 boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, a ?i7chae J. Dornrn.o, President Board of Trustees MJD:eac • r I, J ARM KNEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04375 PERMIT _ Under the Environmental Conservation Law {JCL) Permittee and Facility Information _ Permit Issued To: Facility: MORTON DONALD DUBIN DUBIN PROPERTY 355 PACIFIC ST 75 WELLS RDISCTM 1000-75-6-3.1 BROOKLYN,NY 11217 PECONIC,NY 11958 Facility Application Contact: JEFFREY PATANJO PO BOX 582 BOHEMIA,NY 11716-3007 (631)484-9332 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility Principal Reference Point: NYTM-E: 714.21 NYTM-N: 4546.668 Latitude: 41'02'35.1" Longitude: 72°27'05.1" Authorized Activity: Install an in-ground swimming pool with surrounding pavers. The pool and pavers will encompass a 25' x 67' area. Swimming pool equipment will also be installed. Approved plans prepared by Jeffrey Patanjo are dated 03-27-17 and stamped "NYSDEC Approved" on 07-06-2018. F_ Permit Authorizations Tidal Wetlands -Under Article 25 Permit ID 1-4738-04375/00002 New Permit Effective Date: 7/6/2018 Expiration Date: 7/5/2023 NYSDEC Approval 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. �.n Permit Administrator:JOHN A W I7AND, Depu y".egion,il Permit Aciminish�itor Address: NYSDE .. .[.e�,>_,ion 1 He4 gwarters IN: .artitci»y Z3rot�yl. 50 Circle Rd Str� l3roo1 , NX 1 790-3409 Authorized Signature Page 1 of 6 l� Aft NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATIOIti law Facility DEC 1D 1-4735-04375 Distribution List JEFFREY PATANJO Marine Habitat Protection JOHN A WIELAND -- � Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS, APPLY TO ALL AU.I'HORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following Permits: TIDAL WETLANDS 1. Regulated Activities Authorized By This Permit This permit authorizes only those regulated activities /structures identified under the section Description of Authorized Activity.NYSDEC does not issue after-the-fact or as-built permits. This permit does not authorize activities, or legitimize the existence of structures, which would have required a permit but for which no permit or other authorization has been granted NYSDEC. 2. 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 Jeffrey Patanjo dated 03-27-17, stamped NYSDEC approved on 07-06-201 8 . 3. Notice of Commencement At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are filly aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work. Q. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. 5. Failure to Meet Permit Conditions Failure of the permittee to meet all the conditions of this permit is a violation of this permit and grounds for an order to immediately cease the permitted activity at the project site. 6. Accessory Structures Must Be At Least 75 :Feet Landward Of The Wetland Boundary This permit authorizes the construction of new accessory structures located in the adjacent area at the prescribed minimum setback only. Structures located in tidal wetlands, or structures in the adjacent area but located less than 75 feet from the wetland boundary, are not authorized. Page 2 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC 11) 1-4738-04375 7. Development Restrictions New accessory structure construction projects authorized by this permit must meet all of the applicable development restrictions of 6 NYCRR Part 661.6(a)(1), (4) and (7): -The 75 foot minimum wetland setback requirement for all principal structures and all non-water- dependent structures exceeding 100 square feet in area. - The 20% maximum adjacent area coverage limitation for impervious structures and surfaces. - The 75 foot minimum wetland setback requirement for all hard surface driveways, roads, parking areas and similar impervious surfaces exceeding 500 square feet in area. s. No Changes to Septic System This permit does not authorize any alteration, expansion or replacement of existing septic systems. 9. Area of Disturbance for Structures Disturbance to the natural vegetation or topography greater than 25 feet seaward of the approved structure is prohibited. to. Straw Bales or Other at Tidal Wetland A row of staked straw bales or approvable erosion control devices shall be placed at the landward edge of the buffer area or 75 linear feet from the tidal wetland boundary, or as per the NYSDEC-approved plan, prior to commencement of any regulated activities and remain in place and in good, functional condition until the project is completed and all disturbed areas are stabilized with vegetation. 11. Contain Exposed, Stockpiled Soils All disturbed areas where soil will be temporarily exposed or stockpiled for longer than 48 hours shall be contained by a continuous line of staked haybales/silt curtains (or other NYSDEC approved devices)placed on the seaward side between the fill and the wetland or protected buffer area. Tarps are authorized to supplement these approved methods. tz. Vegetate All Disturbed Areas The permittee shall revegetate all exposed faces and disturbed areas to prevent soil erosion prior to the project completion or expiration date of this permit, whichever comes first. 13. Roof Runoff Directed to Drywells Roof runoff shall be directed to drywells with the capacity to store/recharge the runoff from a 2 inch/24 hours precipitation event. All drywells shall be located a minimum of 75 feet landward of the tidal wetland boundary. 14. Clean Fill Only All fill shall consist of'clean sand, gravel, or soil (not asphalt, slag, flyash, broken concrete or dernolition debris). 15. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activities. 16. No Construction Debris in Wetland or Adjacent Area Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in wetlands and/or protected buffer areas. 17. Storage of Equipment, Materials The storage of construction equipment and materials shall be confined within the project work area and/or upland areas greater than 50 linear feet from the tidal wetland boundary. Page 3 of 6 Ask NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DK ID 1-4738-04375 18. Concrete Leachate During construction, no vet or'fresh concrete or leachate shall be allowed to escape into any wetlands or waters of New York State, nor shall washings from ready-mixed concrete trucks, mixers, or other devices be allowed to enter any wetland or waters. Only watertight or waterproof forms shall be used. Wet concrete shall not be poured to displace water within the forms. 19. Precautions Against Contamination of Waters All necessary precautions shall 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. 20. No Interference With Navigation There shall be no unreasonable interference with navigation by the work herein authorized. 21. 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. 22. State May Order Removal or Alteration of Work If fixture 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 pennit,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. 23. 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. _.........._.._._......._........._......_.........._...._.._...........__ ......_._....._.......__........._..__........_........w......................___...._......,........._.......... GENERAL CONDITIONS - Apply to ALL Authorized Permits: 1. 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). Page 4 of 6 NI?W YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC Iv 1-4738-04375 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,NY11790 -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. s. 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. 0. 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. Page 5 of 6 r , Ask NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DIPC 11) 1-4738-04375 NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS 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 Environmental Conservation Law as those prescribed for the permittee. 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 BUILDING DEPARTMENT- Electric sriect o��TOWN OF SOUTHOLD D1 Town Hall Annex - 54375 Main Road - Box 1179 Southold, New York 11971- 9 AUG 1 6 2018 Telephone (631) 765-1802 - FAX (631) 765-9502 roger.richertCcD-town.southold.n Lu-- XJEI]DING DEPT. roikw oTisoumnLD APPLICATION FOR ELECTRICAL INSPECTION Date, REQUESTED'BY:- "---­-' ....... Company Name: L Z /,3 Cr AU- Name: email: .1�d- License No.: 0 Z-1-3 M 1p_ Address: Glob) (�j4,,e L A kStMeria,t Phone No.: JOB SITE INFORMATION: (All Information Required) Address: Cross Street: Phone No.: BIdg.P6rrnit email: Fax Map District: 1000 Section.. Block: Lot:--Z; BRIEF DESCRIPTION OF WORK (Please Print Clearly) Circle All That Apply: Is job ready for inspection?: NO Rough In Final ' Do you need a Temp Certificate?: YES NO Issued On Temp Information: (All information required). Service Size I Ph 3 Ph Size: A # Meters Old Mete.rff New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: 02QO t fl PAYMENT DUE WITH APPLICATION Pee Request for Inspection FormAs r' Scott A. Russell ;��°SU '��� STOWMMIWAT]ER, SUPERVISOR l�MIA.NAG]EMIEN T" SOUTHOLD TOWN HALL-P.0.Box 1179 v' 53095 Main Road-SOUTHOLD,,NEW PORK 11971 Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: Yes No (CHECK ALL THAT APPLY) 00"A. Clearing, grubbing, grading or Stripping of land which affects more than 5,000 square feet-of ground surface. ❑ B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑ C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of. horizontal.distance. ❑ D. Site preparation within 100 feet Of wetlands, beach, bluff or coastal erosion hazard area. ❑ E Site preparation within the one-hundred-year f loodplain as depicted on.FIRM Map of any watercourse. _ ❑ F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. #: 1000 Date: District �'1 �/�. I V II1�,1h � {I NAME: ` v �F"• 1-l�C moils �� 'L�• mu Section Block Lot "!vr�p 2 [/�(/�� ****FOR BUILDING DEPARTMENT USE ONLY**** Contact information• 6 t/1 —lV , �" `� ' - .RelepMnr Yumlrt! Reviewed By: — — — — — — — — — — — — — — — — Date- - - - - Property Address/Location of Construction Work: — — — — — — — — — — — ' �� ��1 i . Approved for processing Building Permit. C Stormwater Management Control Plan Not Required. r �R Cnnt C` T Stormwater Management Control Plan'is Required (Forward to Engineering Department for Review.) FORM SMCP-TOS MAY 2014 '.. py`` / 2b, \\�\ LAND N/F OF ZONIA M. MVA ONO JUANf �\ a i / g, ``,• �`�2F /i Y♦♦ LANDD N/F j/' / f.' :� 0♦�;: ; \` ; JEFFERY ANDRADE - IN SUBACK \\\ \♦\\ \,\ \���',`.� .•,\ ♦\-♦\�� MGG®bYCOIEEhWi0PL5dMC656I0/15 " \i.\ L�=1 N •\,\ 90 \ \ mawussou`�. covE�n e �.-�xvoo N lC � \ \ \ ♦Fve•asa�oeuv. p N d fn Ms \\\ N� Y 9 �OF S.C.T.M, NO. DISTRICT: 1.000 SECTION: 75 8LOCK: 6 LOT(S):J.I 103 s LAND N/F OF JUAN A. MONZON ZONIA M. ALVARADO tS> 0 y1 Ira. \ O 'rf sl� ,oj� i LAND N/F OF ���� Gj�+��� ► �� JEFFERY ANDRADE J 41Ot� \ �' \\�e I TIDAL WETLANDS AS SHOWN ON FILED MA .sJ hp O ,ii 75 NON—TURF 1 BUFFER Q / FRW SHED oOJ �L 1AL AL XXXX 4' YM &SYTTEM `.`'r' .ti o WOOD �� '. (3�8bG1r4'DEEi°LP.O 4.pxR g• '''i5�`: :axz, .STEPS �•. O.YN � 1 ,5 SEPTIC LOCATION \ \ POINT A' POPINT'S' S.T. 18.5' 41' \ L.P.#1 19, 52' L.P#2 31, 58, L.P.#3 31' 47' THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL UPDATE SURVEY 10-16-17 LOCA77ONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS AREA: 80,050 SQ.Ff. or 1.84 ACRES ELEVATION DATUM: UNAUTHORIZED ALTERATION OR ADDI7ION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN ONLY TO 77-IE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS7777J77ON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS77TV770N, GUARANTEES ARE NOT TRANSFERABLE. 7HE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND 07HER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUC-TURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT 7HE 77ME OF SURVEY SURVEY OF: LOT 1 CERTIFIED TO: MORTON D. DUBIN II; MAP OF: JOHN SCOTT FIRST AMERICAN TITLE INSURANCE COMPANY; FILED:APRIL 27, 2009 No.1 i 1699 CITIBANK N.A., ISAOA; SITUATED AT: PECONIC TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design J � P.O. Box 153 Aquebogue, New York 11931 FILE # 14-192 SCALE: 1"-50' HATE: APRIL 12, 2015 PHONE (831)298-1588 FAX (631) 298-1588 N.Y.S. LISC NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk D� AP RFVED AS NOTED DATE: ' B.P. FEE:- BY: RETAIN STORM WATER RUNOFF NOTIFY._ BUILDING DEPAR T AT . PURSUANT TO CHAPTER 236 765-1802 8 AM TO 4 PM FOR THE - OF THE TOWN CODE.FOLLOWING INSPECTIONS: 1. FOUNDATION TWO REQUIRED FOR'-Pni�Ot CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ELECTRICAL ALL CONSTRUCTION SHALL MEET THE INSPECTION REQUIRED REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF "? qj terr NEW YORK STATE & TOWN CODES �EN,CL-OSE.POOL TO CODE ` AS REQUIRED AND CONDITIONS OF i'1PON.COr.n�LETION BEFORE"WATER" G BOARD SOUTHOLD TOWN TRUSTEES N.Y.S.DEC OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE Or 0' rUPANCY co 1 ..+..rr+.ae:..wury.{..a:1vm s >mwc'.nui'F=+a+i�csNs-':?"�M•Y»•r,�rx-.m. e�.:*+c S�>aw.c._�y.L....-._ ........:.a.. '._�...ci...�...a.,.::.�._.«.t..�....n...-"_..:.�......._..-.•,. as-nwe-..w+.. - r -±m+-r--^.Ar.+cca++w•.. r00, 10 pA e�t, ` 1� 4 �t}� !f, T��� ���� -+' '1 L�"+""£ti.��fl '3• ,���j C..�Y`�� -� � I ter: _ ,�,..�..w...=-.•.•.-e.e-,e,...-.,e.. �...a..,_ .�.�....__...._.,.._. 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