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Home My WebLink About28063-Z 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. 28063 Z Date FEBRUARY 4, 2002 Permission is hereby granted to: MARILYN BURKHARDT 321 W 24 ST NEW YORK,NY 10011 for ADDITION AND ALTERATION TO A 3 BEDROOM SINGLE FAMILY DWELLING AS APPLIED FOR W/ TOWN TRUSTEE ' S #5300 AND NYSDEC CONDITIONS . INCLUDES $100 . FLD. PMT at premises located at 1425 ISLAND VIEW LA GREENPORT County Tax Map No. 473889 Section 057 Block 0002 Lot No. 013 pursuant to application dated AUGUST 8 , 2001 and approved by the Building Inspector. Fee $ 667 . 60 i Authorized Signature ORIGINAL Rev. 2/19/98 O��S�f FO�,�coG o� y� COD Z Town Hall,53095 Main Road 5 Fax(631)765-9502 P.O.Box 1179 y/jJol �aO� Telephone(631)765-1802 Southold,New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD December 13, 2004 Ms. Marilyn Burkhardt 321 West 24t11 Street New York, N.Y. 10011 Re: Premises @1425 Island View Lane, Greenport, N.Y. Suff. Co. Tax Map #57.-2-13 Building Permit #28063-Z Dear Ms. Burkhardt: During a review of our files, it was noted that the above building permit has expired. According to the Code of the Town of Southold, a building permit expires in 18 months from date of issue, but work must begin within a 12 month period or the building permit becomes void. We have voided out this permit. If you have any questions regarding this matter, please do not hesitate to contact this office. Respectfully Southold Town Building Dept. z 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: ' ' " IV DATE �-��b INSPECTOR'S FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(1ST) y ------------------------------------ C FOUNDATION(2ND) � z O y ROUGH FRAMING& PLUMBING r INSULATION PER N.Y. STATE ENERGY CODE FINAL Q `( ADDITIONAL COMMENTS k Z m a UJ� y O t x y x G C o � C' FORM NO. 1 �. i. TOWN OF SOUTHOLD J_AAA4� BUILDING DEPARTMENT TOWN HALL $ ,,Q,t,,l �-��• SOUTHOLD, N.Y. 11971 Examined /b 16 ,2001 TEL.: 765-1802 cam- 537- IGD Approved 2 200J,Permit No..2 8'063 Disapproved a/c I r) r� (` (Building nspector) APPLICATION FOR BUILDING PERMIT i_- -- -- Date July 27,2001 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,with 3 sets of plans,accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or,public streets or areas,and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such permit shal),be kept on tjie premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sh4ll have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Qrdinance 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 inspecti s. (Signature of applicant, or name,if a corporation) Suffolk Environmental Consulting,Inc. P.O.Boz 2003,•Brideehamyton,NY 11932 (Mailing address of applicant) State whether applicant is owner,lessee,agent, architect,engineer,general contractor,electrician,plumber or builder AGENT Name of owner of premises Marilyn Burkhardt (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. N/A (Name and title of corporate officer) Builder's License No. Plumber's License No. Electrician's License No. Other Trade's License No. 1. Location of land on which proposed work will be done 1425 9aI^iIi d View Lane Southold House Number Street Hamlet County Tax Map No. 1000 Section 057 Block 02 Lot 013 Subdivision N/A Filed Map No. N/A Lot N/A (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a.Existing uqe and occupancy Single familX residential dwelling with related appurtenances b. Intended use and occupancy Sin family residential dwelling with �ie■![i�Mist alhnces >f,wsA to MMA istow Qpwoa2o ro.00 ao i Ioltue Ri hsitit6uo Ot _ M.- 3. Nature of worjc(checkwhich applicable): New Building Addition X Alteration Repair Removal Demolition Other Work O� 4- (Description) 4. Estimated Cost 3S Fee (to be paid on filing this application) 5. If dwelling,number of dwelling units 1 Number of dwelling units on each floor N/A If garage,number of cars 2 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use N/A 7. Dimensions of existing structures, if any: Front 22' +/-(max.) Rear 22' +/-(max.) Depth Height 32' (max.) Number of Stories 1 %2 Dimensions of same structure with alterations or additions: Front 22' +/-(max.) Rear 22' +/-(max) Depth 56' +/-(max.) Height 32' max. Number of Stories 2 8. Dimensions of.entire new construction: Front 22' +/-(max.) Rear 22' +/-(max.) Depth Height 32' (max.) Number of Stories 2 9. Size of lot: Front 60' Rear 60' Depth 224.5' 0. Date of Purchase February 4. 1992 Name of Former Owner N/A 1.Zone or use d*hct in which premises are situated R-40 2. Does proposed construction violate any zoning law,ordinance or regulation: No. 3.Will lot be regraded No Will excess fill be removed from premises: Yes No 4. Name of Owner of premises Marilyn Burkhardt Address 1425 Sound View Ln; Southold.NYPhone#212)469-3885 Name of Architect L. Tuthill Address Main Rd:QEMort.NY 11944 Phone No. 477-0400 Name of Coi}tractor N/A Address Phone No. 5. Is this property within 300 feet of a tidal wetland? *Yes X No *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings,whether existing or proposed, and indicate all set-back dimensions from -roperty lines. Give street and block number or description according to deed,and show street names and indicate whether iterior or corner lot. S` Please refer to attached Plans. ;TATE OF NEW YORK, �OUNTY OF S.S Matt D Ivans-Agent being duly sworn,deposes and says that he is the applicant (Name of individual signing contract) bove named. ie is the Agent-Suffolk Environmental Consulting, Inc (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication;that 0 statements contained in this application are true to the best of this knowledge and belief;and iat the work will be performed in the manner set forth in the application filed therewith. worn to before me this o�77h' day off/ 20 4otary Public soft I*n N*rY PONof Now Signature o Applicant) Ybdi No.010SM449 01108d In Suffolk CmnMv - fMir Jl�, Town Hall Albert J.'Ki-apsL,Preeid.nt OQ Mir.., Jame,3-{ing,Wise:-President 13095 Rou-te 25 P,O.Box 1170 Henry Smith Sou;hold,Naw York 11971-0959 Artie Fodter ii0 �r Ken Poliwoda F Telephone 765-1892 Fax(6811!)76785-1368 BOARD OF TOWN TRUSTEES TOWN OF SOX rTHOLD March 22,2100 1 Mr.Bruce Anderson Suffolk Environmental Consulting,Inc. PO Box 2003 Bridgehampton,NY 11932 RE: Marilyn Burkhardt 1425 Island View lane Southold,NY SCTM#57-02-13 Dear Mr, Anderson: True following action was taken by the Board of Town.Trustees during a Regular Meeting,held on March 21,?,001,regarding the above hatter WBEREAS.Suffolk Environmental Consulting,.Inc.on behalf of MARILYN BUREHARDT applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Totii�l of Southold,applicant a dated February 9,2001 and WHEREAS,said application was referred to the Soui.hold Town Conservation Advisory Council for their findings and recommendations,and Wf1EREAS,a.Public Hearing was held by the Town Trustees with respect to said application on r.larch 21,2001 at which time all interested persons NN-.re given an opportruuty to be heard,and, WHEREAS,fixe Board members have personally viewed and are familiar with the premises in question and the surrounding area,and, WHEREAS,the Board has considered all the testimony and documentation submitted concerning this application,and, WHEREAS,the structure complies with the stand�u'd set forth in Chapter 97-18 of the Soutboid Town Code, V&'PMRJSAS,the Board hay deter lined chat the project as pr.oposed will not affect the health. safety and general welfar::of the people of the town., NOW THEP.EFORE BE TT. RESOLVED,that the Board of Trustees approved the application of NLARILYN BURYMARDT ior a Wetland Pemu:to c,?nstruct 55 sq. ft. addition to Jie northeast comer of the existing dvc alling a 55 so. ft. addition to the northwestern corner of the existing dwelling, a $50 sq. ft. sec-,ond story balcony to the northern race of the existing dwelling with 42 sq.R.of steps leadip g down to the ground. Row of hay bales lie placed during construction and old septic system pumped and filled with sand. BE IT FURTHER RESOLVED that this daermination shuuJd not be considered a.deterimn.ation made for any caber Dcpartment or Agency which may also have an application pending for the same or similar project. Permit Io construct project will expire two years from the date it is signett. Fees must be paid,if applicable,and permit issued within six months of the:date of this notification. Pees must be paid, if applicable,and permit issued within six months of the date of this notification. Two inspections are required and the Trustaes are to he notified when project is started and on completion of said project. FELLS:NONE Very truly yours, � } i Albert J. krupski,Jr. President,Board of Trustees A.JK/cjc cc:DEC Building Department Health Depaz-tment , a Southold 'Town Trustees Bard Of _ _ SOUTHOLD, NEW YORK PERMIT NCS. ... .,...... PATE:March `L1, 2001 .p MARILYN BUR KHARDT .._....,..-- ISSUIrD TO .._ .._............ .. Aul'qort7.a#tuxt Pursuant to the provisions of Chapter 616 of the Laws of. the Sta+a of New York, 1893; and Chapter 4 Of t @ Lawsofrics he State of Near York 1952, and the Southo titled "RMULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS dnd f6 AL SAND, GRAVEL R OTHER th LANDS UNDER OWN-WA TOWN-WATERS.-!t � arordancawihe Resolution of The 66ard adopted at a meeiing held on March.-21,. ZO01-.:., and io consideration oK t6 sum of i...24.Q.F G.....,. paid by Suffolknviraamenta? �;. �4f.'Altli,` I� B[Y1KHARL�T N. Y. and, subject to flit of .Bridg-chsa� t�--.---......._............... .. .. Terms and G�anditions listed on the reverse side hereof, t c...,+t,,,w T.,wii 'r us+QQs authorizes and permits +hd WOW": Wadond T emii i to construct 55 sq,ft,addition to the northeast r*mer of the existing dwelling a 55'sq,A.,Oilitiun to the northwestern conner of tho cxl6ting dwelling,a BSO seq. ft second story balcony.to the northern:face of the cxiat ng divelling•kith 42 sq.it.orsteps icading down to tho .ground. I<ow of hay bales be placed during construction lad old septic system pumped and 61Wwl sand. a8�n aaeordanee with the datatt6a apacarctSTtans as �xeeier>Tt3o � .the 0dol"ating application. Y IN- WITNESS WHEREOF, The said Board of Trustees here- by causo: its Corporate Seal to b* affixd, and of the sdaBoard eshof thk da},s,fo be subscribed by a majarlty r } ,� �•� Trustees a �V' s 1 . ` New York State Department of Environmental Conservation Division of Environmental Permits, Region One Building 40-SUNY, Stony Brook, New York 11790-2356 Phone: (631)444-0365 FAX: (631)444-0360 Website: www.dec.state.ny.us John P.Cahill Commissioner February 26, 2001 Ms. Marilyn Burkhardt C/O Jim Pelton 420 West 23rd St., 6D New York, NY 10011 RE: 1-4738-02822/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also encloded is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, Marilyn;E. Peterson Environmental Analyst MEP/Is Enclosure NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-02822/00001 0 February 26, 2001 FACILITY/PROGRAM NUMBER(S) P E RM I T EXPIRATION DATE(S) Under the Environmental Conservation Law February 28, 2004 TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Permit to Operate ❑ Article 15, Title 5: Protection ❑ 6NYCRR 608: Water Duality ❑ Article 27, Title 7; 6NYCRR of Waters Certification 360: Solid Waste Management ❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR Supply 373: Hazardous Waste Management ❑ Article 19: Air Pollution ❑ Article 15, Title 15: Water Control ❑ Article 34: Coastal Erosion Transport Management ❑ Article 23, Title 27: Mined ❑ Article 15, Title 15: Long Land Reclamation ❑ Article 36: Floodplain Island Wells Management ❑ Article 24: Freshwater Wetlands ❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER MarilynBurkhardt (212) 469-3885 ADDRESS OF PERMITTEE C/O Jim Pelton 420 West 23rd St., 6D New York, NY 10011 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Matt lvans, Suffolk Environmental Consulting, P.O. Box 2003, Bridgehampton, NY 11932 (631) 537-5160 NAME AND ADDRESS OF PROJECT/FACILITY Burkhardt property, 1425 Sound View Lane LOCATION OF PROJECT/FACILITY Southold COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold DESCRIPTION OF AUTHORIZED ACTIVITY: Construct two first story additions,each 55 sq.ft.,a 48 sq.ft.second story balcony,an 858 sq.ft.second story addition and a 190 sq.ft. story deck with steps to the ground. Install a new septic system. All work is to be done in accordance with the attached plans stamped NYSDEC approved. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS George W. Hammarth (MEP) Bldg. #40, SUNY, Stony Brook NY 11790-2356 AUTHORIZED SIGNATURE DATE ' ss+�lt►ly2�S '` Page 1 of 4 February 27, 2001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives,employees, agents,and assigns for all claims, suits,actions,damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. 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. GENERAL CONDITIONS General Condition 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 SAPA401(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. General Condition 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. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for 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. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control(APC)and Solid Waste Management Facilities(SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg#40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. DEC PERMIT NUMBER PAGE 2 OF 4 1-4738-02822/00001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION • • •ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15(TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 (TIDAL WETLANDS) 1. 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 oralterthe 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. 2. 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. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S.Army Corps of Engineers,U.S.Coast Guard, New York State Office of General Services or local government which may be required. 4. 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. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly,without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. If upon the expiration br 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 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. 8. If granted under 6NYCRR Part 608,the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977(PL 95-217)provided that all of the conditions listed herein are met. 9. 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 fully 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 and, if required, a survey. 10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved survey was prepared by: Joseph InQegno dated 9/11/02. DEC PERMIT NUMBER PAGE 3 OF 4 1-4738-02822/00001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas. 2. 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 tidal wetlands and or protected buffer areas. 3. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activity. 4. All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion or prior to permit expiration, whichever comes first. The approved methodologies are as follows: a. Stabilization of the entire disturbed area with appropriate vegetation (grasses, etc.). 5. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than 75 linear feet from the tidal wetland boundary. 6. A row of staked hay bales or approvable erosion control devices shall be placed at the landward edge of the buffer area or 30 linear feet from the tidal wetland boundary, or as per NYSDEC approved plan, at commencement of regulated activities and remain in place until project is completed and all disturbed areas stabilized with vegetation. 7. Roof runoff shall be directed to drywells landward of the side of the house. DEC PERMIT NUMBER PAGE 4 OF 4 1-4738-02822/00001 s 15 0� �ryo0o / (TEST HOLE DUG (c0• , x-Z& t HOLE X ti 16 I x7.4 4 sem ! ' G 7.4 `s9/ O7.4 r IV, 7,5 .-+ EA .n 9 vj-_ p a 5 G0 GGAC,-��'"�' It 47 AL O 9 V1� / �4�f ^� / / I 2. /`L 1 COASTAL BARRIER IDENTIFIED 11-16-90 J ILL 4cFP 19 JAL 0.1 4) AL l � 6°o 2-4x 0 V 17 �► o. Z APPLICATION •. PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION 'Phis form is to be filled out in duplicate. SECTION I GENERAL PROVISIONS (APPLICANT to read and sign)- 1. 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 cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. 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 local, 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. 8. I,THE APPLICANT, CERTIFY THAT ALL ATEMEPITS HEREIN AND IN ATTACHMENTS TO _ THIS APPLICATION ARE, TO THE B OF Y MVI-EDGE, TRUE AND ACCU E. (APPLICANT'S SfbINATURE) DATE SECTION 2 PROPOSED DE LOPMENT (To be completed by APPLICANTI NAME ADDRESS TELE H NE / 0,K 7q3*5. S t _�l�d APP I� rVAv -�QGIL 4/�'�f�tl�• o+-� U(.V� J J N �L BUILDER EN INFER / 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. . �✓. 0 t� LA'/9 V 1' P ic— AZ AMO O Q,/'% w o o Jho FDP(93) APPLICATION PAGE 2OF4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DE LOPMENT A IVITY UCTUp TYPE ❑ ow Structure Residential (1-4 Family) Addition ❑ Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofing? O Yes) ❑ Relocation O Combined Use (Residential & Commercial) ❑ Demolition R ❑ Manufactured (Mobile) Home (In Manu- 0 Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT sL5,00� B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill ❑ Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) O Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage Improvements_(Including Culvert Work) ❑ Road, Street or BAage Construction ❑ Subdivision (New or Expansion) O Individual Water or'Scr System O Other (Please Specify)" After completing SECTION 2, APPLICANT should submit form to Local Administrator for rcvicw. SECTION3: FLOODPLAIN DETERMINATION (To be comnlctcd by LOCAL ADMINIS�'RATOR) The proposed development is located on FIRM Panel No. Dated The Proposed Development: O IsijLQ'1=located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). O Is located in a Special flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable O The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE APPLICATION �H PAGE 3OF4 SECTION 4 ADDITIONAL INFORMATION REQUIRED fTo be completed by LOCAL ADMINISTRATOR) The applicant 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, lot 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 first floor, details of floodproofmg of utilities located below the first floor and details of enclosures below the fust 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) Ft.'NGVD (MSL). For flood4�toofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification`from a registered engineer that the proposed activity in a regulatory floodway will 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 DETERMINATION fTo be completed by LOCAL ADMINISTRATORI I have determined that the proposed activity. A. ❑ Is B. O Is not in conformance with provisions of Local Law # , 19 . The permit is issued subject to this 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. APPLICATION PAGE a OF a APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved" ❑ Yes ❑ No Conditions SECTION 6: AS BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of COMPhance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a Gccased land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. 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 completed by LOCAL ADMINISTRAT R Certificate of Compliance issued: DATE: BY: Attachment B 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_1 AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) �+`eais.y 1 Zs-o63Z BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: 9 /2 /01 DATE SUBMPTTED4 /8/O1 APPLICANT NAME:�� —— SCTM# DISTRICT: 1,000 SECTION: BLOCK: a LOT: k-5- STREET: 3STREET: I A5 Spur& U CITY:&L m.t,r.%z SUBDIV.NAME: N/l, 3b PROJECT DESCRIPTION: IT ICA ?c R- 1E 17E C �'f + 14Zvs7EE 1 FLS �u f vo ">A,41-74- . ARCHITECT 1 ENGINEER: ( ;t. FAST TRACK? N� SINGLE& SEPARATE CERTIFICATION-REQUIRED? NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LATS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83) ZONING DISTRICT: -Q-Lk c.> CONFORMING? �O 1'S r'Z 53 REQ.LOT SIZE:^yo,000 ACT. LOT SIZE: REQ. LOT COV. 20°3 ACT. LOT COV. REQ.FRONT 3S PROP. FRONT !-L REQ SIDE 0�2 S ACT. SIDE REQ.REAR 3 S PROP. REAR = /oS */7. WATER FRONT? ES DESCRIPTION: PANEL #: l FLOOD ZONE: e , AGENCY PERMITS REQUIRED FOR REVIEW ,olMROVALS REQUIRED: _ SUFFOLK COUNTY HEALTH DEPT: S NO, (BED#):_DTE: 5 / *r l o� PERMIT#:R10-O( - Oo66 NEW YORK STATE DEC: PRE-DEC 9/1/75or NO ( stc-60-I. 7152.0asQ? 0000 1 SOUTHOLD TOWN TRUSTEES: S rN0 TOWN ZONING BOARD APPROVAL: YES ori TOWN PLAN. BOARD APPROVAL: YES or 10 TOWN HISTORICAL PRE (SPLIA): YES ora) NYS ENERGY: YES OR'C EGRESS (18 H min.?4 sq total)= VENT(SQ.FT. x 4%) / LIGHT(SQ.FT.x 8%) . ./ BUILDING PERMITS OPEN/EXPIRED: BPJyfa -Z/C/0 Z- 1.9 AIA HAVE P CO'S : Y OR N BP -Z/C/0 Z- , NOTES: k, / ,% lie el u Sc.v "•r+ l lit C FEE STRUC : FOUNDATIO SF 4fS� - — FIRST FLOO SECOND FLR : /// SF Z2 INI'T OTHER TOTAL TOTAL: _ SF -G6 FEE FEE FEE 'OT �zl 3� SF)-