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HomeMy WebLinkAbout29053-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30636 Date: 12/14/04 THIS CERTIFIES that the building ACCESSORY Location of Property: 2335 MINNEHAHA BLVD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 87 Block 3 Lot 55 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 26, 2002 pursuant to which Building Permit No. 29053-Z dated JANUARY 2, 2003 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 NON-HEATED, NON-HABITABLE ACCESSORY GARAGE IN THE REQUIRED REAR YARD AS APPLIED FOR & AS PER CONDITIONS OF ZBA #5200. The certificate is issued to PATRICK W. LOHN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1181497 06/25/04 PLUMBERS CERTIFICATION DATED N/A th rize Sign4ture 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 PREMIZESUNTIL FULL COMPLETION OF THE WORK AU O Date JANUARY 2 , 2003 PERMIT NO- _ 29053 Z Permission is hereby granted to: PATRICK LOHN 2335 MINNEHAHA BLVD SOUTHOLD,NY 11971 for N-HEATED, NON-HABITABLE ACCESSORY GARAGE I CONSTRUCTION OF A NO THE REQUIRED REAR YARD AS APPLIED FOR WITH FLOOD PERMIT 2335 MINNEHAHA BLVD SOUTHOLD at premises located at 0003 Lot No. 055_ Block County Tax Map No. 47 9 Section 08_ 7 _— by the pursuant to application dated DECEMBER 26 , 2002 and approved Building Inspector to expire on JULY 2 , 2004 . Fee $ 197 . 80 4 Aut o zed Signature ORIGINAL Rev. 5/8/02 Form No.6 , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY i ; This application must be filled in by typewriter or ink and submitted to the Building Department with the foll 2 iing: 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 I%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$25.00,Additions to dwelling$25.00,Alterations to dwelling$25.00, Swimming pool$25.00,Accessory building$25.00,Additions to accessory building$25.00,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 Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: IM,GR ry &A , 'T ��� House No Street Hamlet 1 Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: Permit No. j `' Date of Permit. 03 Applicant: AT(t1 U Health Dept. Approval: JR, 10 " Q ( Underwriters Approval: r Planning Board Approval: Request for: Temporary Certificate Final Certificate: V/ (check one) Fee Submitted: $ Applicant Signature P-19-c- C a -27 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE: June 14. 2002----- TO 4 2 _--- TO Elizabeth Thompson A/C Lohn 250 Mercer Street New York, NY 10012 Canew Please take notice that your application dated May 13, 2001 For permit to demolish an existin sin le famil dwellin andcoe farnilv d lin at Location of property: 2335 Minnehaha Blvd., Southold County Tax Map No. 1000 - Section 87 Block 3 Lot 55 Is returned herewith and disapproved on the following grounds: The proposed construction, on this non-conforming 11,596 square foot lot, with two front yards, in the Residential R-40 District, is not permitted pursuant to Article XXIV Section 100-244B which states that, on parcels measuring less than 20,000 square feet in total size a minimum front yard setback of thirty-five(35) feet and a maximum lot coverage_of 20 percent. Plans note aproposed front yard setback of ten feet and a total lot coverage of+/- 22 percent This disapproval is based on a proposed amendment to an existing permit issued by the Southold Town Building Department on October 19, 2001. Construction has not commenced on the property and the applicants have requested a chane in location of the proposed new dwelling,as well as a change in the scope of the project. -- ---------- -------- Authorized Signature Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. \ Cc: ZBA, File ar��r�r���r����� I rlclrJrJ� a.N. pa t:lrylr rrJ�r�cJ@lrJ� v S ° r Pl r. 5 5 BY THIS CERTIFICATE OF -t,COMPLIANCI THE rj 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 SSBUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 c S c5 CSS CERTIFIES THAT c S 5 5 Upon the application of upon premises owned by 5 5 SSJAMES MURRAY PATRICK LOHN c5 P.O. BOX 305 2335 MINNEHAHA BLVD. 5 SLAUREL, NY 11948, SOUTHOLD, NY 11971 S 5 SLocated at 2335 MINNE!-HAHA.BLVD. SOUTHOLD, NY 11971 cS SSApplication Number: 1181497 Certificate Number: 1181497 S 5 Section: Block: Lot: Building Permit: 28899 BDC: nsl1 5 5 S SDescribed as a Residential occupancy, wherein the premises electrical system consisting of Selectrical devices and wiring, described below, located in/on the premises at: S 55 5 Basement,First Floor,Second Floor,Detached Garage,Outside,Attic, eS SA visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed Bj Sherein, was conducted in accordance with the requirements of the applicable code and/or standard S5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 25th Day of June,2004. Name QTY Rate Rating Circuit Twe Cj Alarm and Emergency Equipment Sensor 2 0 Carbon Monoxide 5 SSensor 5 0 Smoke S Appliances and Accessories SFurnace 1 0 Oil S Exhaust Fan a 4 0 F.H.P. C Oven 1 0 3.5 KW 5 5 Dish Washer 1 0 1.2 KW S Hydro Massage Tub,Residential 1 0 5 Cooking Deck 1 0 .40 amp Amps L5 Air Conditioner 2 0 42.000 BTU Panels 51 40 4 5 Wiring and Devices Outlet 65 0 Fixture C Fixture 63 0 Incandescent 5 Fixture 2 0 Fluorescent seal Outlet 118 0 General Purpose �5 5 Continued on Next Page 1 of 2 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. —ff 11911131 IN 5 BY THIS CERTIFICATE OF COMPLIANCE THE S 5 NEW YORK BOARD OF FIRE UNDERWRITERS S S S 5 BUREAU OF ELECTRICITY 5 5 40 FULTON STREET — NEW YORK, NY 10038 SCERTIFIES THAT 5 S S 5 Upon the application of upon premises owned by 5 5 SJAMESMURRAY 5� 5 SO BOX 305 2335 RMINNEHAHA BLVD. 5 LAUREL, NY 11948, SOUTHOLD, NY 11971 S S 5 SLocated at 2335 MINNEHAHA BLVD, SOUTHOLD, NY-11971 5 5 Application Number: 1181497 Certificate Number: 1181497 S 5 5 Section: Block: Lot: Building Permit: 28899 BDC: ns11 5 SDescribed as a Residential occupancy, wherein the premises electrical system consisting of 5 5 electrical devices and wiring, described below, located in/on the premises at: SBasement,First Floor, Second Floor,Detached Garage,Outside,Attic, c5 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 herein, was conducted in accordance with the requirements of the applicable code and/or standard Spromulgated by the State of New York, Department of State Code Enforcement and Administration, or other S authority having jurisdiction, and found to be in compliance therewith on the S ,Day of 5 25th June,2004. Name QTY Rate Rating Circuit Twe SReceptacle 75 0 General Purpose 5 Switch 49 0 General Purpose 5 5 Receptacle 2 0 20 amp Laundry 5 Receptacle 2 0 30 amp Dryer 5 S5 Dimmers 4 0 Paddle Fan 1 0 5 Receptacle 13 0 GFCi Disconnect 2 0 60 amp Air Conditioner 5 5 Service S5 1 Phase 3W Service Rating 200 Amperes 5 Service Disconnect: 1 200 cb S SMeters: I 5 5 5 5 S S seal S S 5 2 of 2 5 5 SThis certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. S _ FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE lmpwtmt Read the instuctlons on paW I-T. SECTION A-PROPERTY OWNER INFORMATION For IrtsuanmCa quy Use: BUILDING OWNER'S NAME Policy Number PATRICK W. LOHN BUILDING STREET ADDRESS(Imx#txltng APL,Unti,Suis,andlor Bldg.No.)OR P.O.ROUTE AND BOX NO. Comparny NAIC Number 2335 MINNEHAHA BLVD. CITY STATE ZIP CODE SOUTHOLD, NY 11971 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,dc.) 1000.87-03.65 BUILDING USE(e g.,Resl i s Ual,Non-residential,Addition,Acoessory,etc. Use a Comments area,if neoessary.) RESIDENTIAL LATITUDE&ONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: El GPS(Type): #9-#W or ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 81.WIP COMMUNITY NAME&COMMUNITY NUMBER 82.COUNTY NAME B3.STATE TOWN OF SOUTHOID SUFFOLK _T NY B4.MAP AND PANEL B5.SUF X 67.FIRM PANEL B9.BASE FLOOD ELEVATIONS) NUMBER B6.Fllilul INDEX DATE EFFECTIVE/REVISED0ATEB8.FLOOD ZONE(S) (Zara AO,tree dept o(Iloodirmg) 3610300186 G 05" AE EL 8 B10.hxflcate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. ❑FIS Piolk ®FIRM ❑Co mKinily Determined ❑Other(Describe): B11.1,jr, the elevation datum used for the BFE In W.®NGVD 19M ❑NAVD 1988 ❑Oft(Describe): 612 is the bung located in a Coastal Barmier Resources System(CBRS)area or OfiwAse Protected Area(OPA)?[]Yes ®No Designation►Date SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1.Budding elevations are based on:❑Canshuction Drawings' ®BulOng Under ConsbuctW ❑Finished Consbuction 'A new Elevation Certificate will be required when construction of the building is czatnplate. CZ Bm"V Diagram Nunber$(Select the building diagram most similar to the buffing for wft this certificate is being completed-see pages 6 and 7. If no diagram aoaxately represents the buddmng,p mft a sleet h or photogr*.) C3.Elevations—Zones A1,A30,AE,AH,A(with BFE),VE,V1 V30,V(with BFE),AR,AWA,AWAE,ARIA1-A30,ARIAH,ARIAO Complete Items C3.-a4 below according to the bAlding diagram specified in Item C2.State the datum used.If the datum is different from the datum used for the BFE in Section B,convert the datum to Mused forte BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G,as PVF rLip rIds lo document the datum conversion. Datum ConversionlCom menu Elevation reference mak used Does the elevation reference marls used appear on the FIRM? ❑Yes ®No o a)Top of bottom floor ,(indudng basement or enclosure) $. QR(m) a QE N E jv y o b)Top of next hk,)frer floor o c)Bottom of kmwest horiaontal structural mmember(V zona+only) !ice(toP �ti' xs o Attached ofstab) �_ft(m) E o e)Lowest elevation of madminery amdlor equipment servicing the building(Describe in a Comments area) _it(m) td `ti'"� ►?� 0 f) k sly MG) 7-.5-ft(m) Z �-�� / o 0 9)Hood&Went PnW grade(HAG) 8. 0 ft(m) `/�• , NO. 4 9 6\, o h)No.of permanent openings(flood vents)wft 1 fL above adjacent grade 4 U. o Q Total area of all permanent openings(flood vents)in C3.h sq.In.(sq.cm) SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation Information. I ce*that the information in Sections A,B,and C on this ced ficate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. CERTIFIERS NAME JOHN T.METZGER LICENSE NUMBER 49618 TITLEPRESIDENT COMPANY NAME PECONIC SURVEYORS,PC ADDRESS CITY STATE ZIP CODE P.O.BOX 909 SOUTHOLD NY 11971 SIGMA DATE TELEPHONE 05121/03 (631)7856020 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL DATE: June 14,, 2002_ TO Elizabeth Thompson A/C Lohn C, 250 Mercer Street �� I New York, NY 10012 Please take notice that your application dated May 13, 2001 For permit to demolish an existing single family dwelling and const t a new single famil d llin at --- - -- —_—' Location of property: 2335 Minnehaha Blvd., Southold County Tax Map No. 1000 - Section 87 Blocs: 3 Lot 55 Is returned herewith and disapproved on the following grounds: The proposed construe ion, on this non-conforming 11,596 square foot lot with two front yards in the Residential R-40 District,is not permitted pursuant to Article XXIV, Section 100-244B which states that, on parcels measuring less than 20,000 square feet in total size a minimum front yard setback of thirty-five (35) feet and a maximum lot coverage_of 20 percent. — Plans note a proposed 1rnt yard setback often feet and a total lot coverage of+/- 22 percent. This disapproval is based on a proposed amendment to an existing permit issued by the Southold Town Building Department on October 19, 2001. Construction has not commenced on the property and the applicants have requested a_chanin location of the proposed new dwelling, as well as a change in the scope of the project. V pf ��- --- - -------- 12- -- tu [7 *2PAuthorized Signature Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. Cc: ZBA, File T. TERRY r; G+,. Irr��n Hall. 53(195 t,la.r. IZoa(l - �IZ�Ii 1 P.O. 110\ 117() TOwN CLERK N r ch s Suulhold. New r York- I 1171 t(ECISrR/U2 OF V1TAJ.STATlS1ICS Faz (S 10) 71 5 -) I�_l MARRInOF: OFFICCR - J Tc lcPlrunc (S 16) 765. 1}(()1 RECORDS MANAGEMENT OFFICER 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 (C/C(93) ) . SL::G. DGF7. TOWN OF SOEJ-PlOLD /-e Judith T. Terry Southold Town Clerk August 25, 1993 4).ap APPLICATION # f PAGE 1 0( 4 TOWN OF SOUTHOLD FLOODPLAIN DENT LOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1• GENERAL PROVISIONS (APPLICANT to read and si�n): 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. 1,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO _ THIS APPLICATION ARE,TO THE B T O Y KNOWLEDGE,TRUE AND ACCURATE. (APPLICANTS SIGNATURE) DATE Z 0 SECTION 2• PROPOSED DEVELOPMENT (To be completed by APPLICAftTI NAME ADDRESS TELEPHONE APPLICANT C-L47 a63eSM -0j4owPSOM tO PY Iootz z12-b14-7�kb BUILDER -pAo FIN#7C Ito 660MV ST rggwN-bpq 1j`1 0 ENGINEER ST1521 SIA(tgSt,4 ISU-01 W IAftAW-r4W11 4A14M0M% N`f �3I-7L8-948b 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. 2335 MwA)6t4A1+A 'gt U 0 SooT!-loLN loft - &8^2 -00bt - bs S Sum. 'LLC" sktw ole-% FDP(93) APPLICATION PAGE 2OF4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE New Structure Residential (1-4 Family) Addition Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Flood proofing? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition R ❑ Manufactured (Mobile) Home (In Manu- ❑ Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT S iS,trot� B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill 0 Mining O 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 DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. . Dated The, Proposed Development: ❑ Is M 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 Spedal 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 ❑ See Section 4 (or additional instructions. SIGNED DATE r APPLICATION W PAGE 3OF4 SECTION 4 ADDITIONAL. INFORMATION REQUIRED (To he completed by LOCAL ADMINISTRATOR] The applicant must submit the documents checked below before the application can be processed: O A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. O Development plans,drawn to scale, and specifications, including where appbcablc:details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the fust floor, details of floodproofing of utilities located below the first floor and details of enclosures below the first 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 lib-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). ❑ Floodproofmg protection level (non-residen(ial only) PC 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 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 (To be completed by LOCAL ADMINISTRATORI I have determined that the proposed activity. A. ❑ Is B. ❑ Is not in conformance with provisions of Local Law dt , 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 appbcation to the Local Administrator or may request a hearing from the Board of Appeals. .• APPLICATION W PAGE 4OF4 APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved? O Yes ❑ No Conditions SECTION G: AS-BUILT ELEVATIONS (To be submitted 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 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 floodproofing 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 ADN1INISTRATOR 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. INSPTEMONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ONO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) 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_, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: / /02 APPLICANT: hoHN DATE SUBMITTED��06 /02 SCTM#DISTRICT: 1,000, SECTION: , BLOCK: LOT: STREET ADDRESS: 0?33 �irine�,�ti c CITY: ` �a�r,,�� SUBDNISION: PROJECT DESCRIPTION: P2<16 /ooc .2 a�• v ESTIMATED PROJECT COST: A HI E�ENGINEER 7L,4 D V FAST TRACK?y�� SINGLE& SEPARATE CERTIFICATION-REQUIRED? *p NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30, 1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at anytime after 7/1/8: ZONING DISTRICT: CONFORMING? 416 REQ. LOT SIZE: _ACT. LOT SIZE: // REQ. LOT COV. ACT. _ LOT COV. REQ. FRONT 3 ' PROP. FRONT ✓ REQ SIDE 313/ ACT. SIDE ,i REQ. REAR 3' PROP. REAR ✓ REQ. HEIGHT PROP. HEIGHT WATER FRONT? /Vo DE CRIPTION: PANEL FLOOD ZONE:, APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or ZO (BED#): DTE:_/_/_ PERMIT#:RIO- TOWN SEPTIC RECEIPT: Y or( NEW YORK STATE DEC: PRE-DEC 9/1/75 YES o SOUTHOLD TOWN TRUSTEES: YES or TOWN ZONING BOARD APPROVAL: YES or TOWN PLAN. BOARD APPROVAL: YES or TOWN HISTORICAL PRE (SPLI/A): YES or d NYS ENERGY: YES OR NO : /1/ EGRESS (18 H min.? 4 sq total) r- VENT(SQ. FT. x 4%) LIGHT (SQ. FT. x 8%) BUILDING PERMITS OPEN/EXP D: BPS -Z/C/0 Z- HAVE PRE CO'S : Y OR N BP -Z/C/o Z- , NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: ,7� SF FEE EEE 'PEE 1. SF)- SF)= 76 SF X$ 3v =$ C22 80 +$ 7�5_ +$ 100 =$ I c+_:�.BU 2. ( SF)- _SF)__ SF X$ _$ +$ +$ _$ BUILDING DEPT. SPECTION [ 0' �OUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY RE RKS• -+ QGC-� 000, of-V-j e�La- e Ile DATE INSPEC M-lW2 BUILDING DEPT. 1/ NSPECTION 0UNDATION IST ROUGH PLBG. FOUNDATION 2ND INSULATION FRAMING FINAL RE A <DATEi ` , `���� 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN CATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE - INSPECTOR ^ / ' imm FOUNDATION(isl) Aim'' FAVA 0 0, 12 ,511- e�.%�.:_, - .�_�,�-- �yGl�Air ..: L T�/� mn UNI PLUMBING 04 r INSULATION ENERGYSTATE EVA MID WM1 Ima At 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructiofi:.. a. Existing use and occupancy S„N WEE&M u.Y b a3MAA lvz b. Intended use and occupancy 3. Nature of work(check which applicable):New Building _Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost Zv voo 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 I 6. If business, commercial 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 of Stories 8. Dimensions of entire new construction: Front 1(0 Rear ( to ` Depth Zo Height IQ ' Number of Stories I /z Sr&Rcc?'S 9. Size of lot: Front 8-S Rear 10-0 Depth 11 lo.5' o 2 1397 R S 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO V A-kt~C6 ow., Bet:N Rera uo 13. Will lot be re-graded? YES NO—)LWill excess fill be removed from premises? YES NO Y ; M"U0j00*tp N Bwa ' 14. Names of Owner of premises P4TR4eA, L,0 Address 2 So3ul 5 42,6 N't Phone No. b31 -71.5(.(o(64, Name of Architect 1%N,Ti &en+ -r+mmo to Address ,� NY c ewe Meawfz ° Phone No 2 cL -big -71 go Name of Contractor UAcu f iOOG Address I20 "'re2 s- Phone No. &%i-477 -1710 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. STATE OF NEW YORK) SS: COUNTY OF ac �&AM being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contra t)above name1d, (S)He is the (Contractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief, and that the work will be performed in the manner set forth in the application filed therewith. Sworn tp before me this day of C 0 Notary Publ' Signature of fijplicant A. CU1*1NING6-x,4Mrd 04 i�ew York; ",X'4212 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TO"HALL Board of Health SOUTHOLD,NY 11971 3 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO j 9 v` Check Septic Form N.Y.S.D.E.C. Trustees Examined ,20 3 Contact: Approved i Z ,20 3 Mail to: Disapproved a/c Phone: Expiration y .2 ,20 '; � Buil Zctor -! APPLICATION FOR BUILDING PERMIT L Date l 2�1� , 20 J oZ TQNd/P�C<� .fit_=---._.: 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 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 t 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 other regulations affecting the property have been enacted in the interim,the Building 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. l (Signature of applicant or name,if corporation) Zti o IM 9"fit.. ST. ,' B gob N trio t?.- (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder A U+i I Te CT Name of owner of premises ("�/. TgAC,lr_ (-o l+Aj (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 2 3 3 H I fjy1+i4 61+A 13 t.u D �u T1tyt.i� House Number Street Hamlet County Tax Map No. 1000 Section 43 '7 Block Zj Lot 51-2 Subdivision Filed Map No. Lot (Name) SCDHS Raf: RIO-01-0148 {toSURVEY OF P1�4�f'�'ARTY I am lonr/Ilar with the STANDARDS FOR APPROVAL '�' AND CONSTRUCTIOW OF SI49SURFACE SEWAGE DISPOSAL SYMMS FOR SINGLE FAMILY RESADENCES �a NG WA TER and wlll ab/de by /he condllions set forth therein and on the T ` /"� �r� pry? {y permit to const el. 7 0 le a► #e x i Tr r0�/ V Q- ]F'� SOV ! OLD ?'n..,t=rKt7' SUFFOLK COUNTY, NEW YORK iMI CHM rav SEPT SYSTM R 1000-87-'03-55 SCALE: ,J � SCALE: 1 "�20� _ = JULY 5, 20M WABUtit ASA Y If, 200 t prop. 1te. d garage 1 y p NA Y e3. 2W ( Twat tk* J Ate' 20, 2003 I AWSJ Zg.93 �I t FE ` el 9.0 01' FE _ 1 O 4.0$ W I a FE 9'E �{ap 3Gh�f"' G.o'N 211.0' 35.3 • O Z S( TEST HOLE AO 'S�,;.A Brown loamy 3.00v' ei r8.o 2b sand Z06 own SM rk 'di 5.7' 2.. r0 lS.o' Qe}? loe � I Water In / b•6:M $e.o 9reykh brown � }g eA'ly rand SM 6. � 7' y water In . sand SP O . FC 9. t 112' 3.a AREA 11,596 S �"or°f o"" �R.TGf"�'L7 TO, � � Q4 S renie _ \ "0 FE gto�knde , I PATRICK W. 1. AFI co'w g,a' S 79'26' NlI3/T 8 /,� wafer} CONW ABSTRACT JVC. a vof+ /$LAND EAST SERMON CORP., ISAOA � � FLOOD ZONE AE gel, 8� 1 �„PN7n9 t r FLOOD ZONE FROM FIRM The /OCONOnf 0I u41b a 36103C(1,166 r6 MAY a, 1998 shown hereon a1•a AI+I'tm VBAb/ i/y�) N.Y.S �J' 61% 'J and or from dela ad/+�el , , .�ia#++A►t . //, ANY ALTERATiDN OR ADDITION TO• THIS SURVEY IS A VIOLATION AxAaf, � a , n� I7Er�., / ECONIC` VEYORS: P.C. OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. EXCEPT AS FER SECTION 7209-SUBDIVISION 2 ALL CERTIFICATIONS 7tA bt r"t' -ttvv row. t (631) 765 - 5020 FAX (631) 765-1797 HEREON ARE VALID FOR THIS MAP ANT, COPIES THEREOF ONLY IF' ELt VATIDNS REI• EREI4CEP Tp N,G, V,D, F' O• BOX 909 SAID MAF OR COPIES YEAR THE IMPRESSED SEAL OF THE SURVEYOR - 1230 TRAVELER STREET D D — © , WHOSE S16NATURE APPEARS HEREON 0 =MONUMENT 3RLyOg /ea+'>A�wallsn / SOU THOLD, N,Y 11971 �I-nll - - - - - — — - - - - - -- - - - -I- �.9, r - - - - - — - - - - - — — — - -I- f- I p w I p I h SII 7 I ceN�a , SUP -N I AT I N I Q II To r - - - - - - - - - - - - - - - .n I 0 I I fo X��0: T- �oUUDb'flb�l PI.�-I - G��46uE z G2ouu� pl.rxa2, PI�4la - Gr•i4.� � I,oGr PI,�1 -GdYtk�E I UI GI OFFICE I C- 43" 2 K I O I'•o 117/ 141 h bPE1� o 5 IL P- FLOOD &1w COMPLY WITH CHAPTER"4e f1A00 DAMAGE PREVENTIOR t{ Por �VAHIMGr Fi,4w - GI.4Z - Cj poor F71A" - C4az (v Orf raHIU/ Pl,Am - 4AX-41,6 SOUTHOLD TOWN CODE. 4I OCCU1;"9T� . � I U UNDERviRl IERS CERTIFICATE USE IS ���' 1! REQUIRED WITHOUT Cs ATE C) veonsNOTED OF OCCUi - Y �p 0 7-11 NOTIFY BUILDING DEPART----- 165-7602 6 AM TO 4 PM FOR THE e _ IYLuJ�, fl FOLLOWING INSPECTION& L FOUNDATION • TWO REQUIRED FORPOUREDCONCRETE -" L ROUGH • FRAMING i PLUMBING - i INSULATION lr ♦ FINAL • CONSTRUCTION MUST BE COMPLETE FOR C.O. Job THE REQUIREMENTS OF THE Iffute TATE,��1STA�y_���pN_i ENE OY _ Elizabeth Thompson . Architect SIFN(dAfRtl4lIONSIBLE ON 41;q /Oz, BESION OR CONSTRUCTION EM 98 250 Mercer St. Suite B 606 Title scale New York; NY 212-614-7180 Gllt12AG�E _PANS I/�I II'I I�U 10012 ETArchitect@nye.rr.com 2xq STuD \VAR, q" Gn I-IG�t.6-fZ s1,48 �V/Gxlo to/xlo /��iPN-M.T r71aIUfnL� � \VL'WED \V121r H� Tv MdTLH' i�aUSE 00 /-aMP.tUfGO �fly2A�uCUyl�d(2 Io -- s , ,, e •,� AlV2Ky i{N25A - /,4\V 77� _ /Z51 \ O _r Go�iTl �IUDUS fooT11�G pETM L CTYP� CO No2tN EI.GvdTID�I - ln,4RA.G,L � ioU?I� ��GVfltlol.-I - G�,e,P�,G� p�Dl�r. 12, Glx¢D I, 11 Id �12 2A, \ I I I I ` ; l A�IF�I� QJ�fP.421-I`�IN1,M�I 'I �l ',IIII! TAS PPaWL'? rc�aC Tn� M _I L- �� ["1 M4fwF Hauls , „a fTv, PR,gY7 GeD4R /�� (0 .8 xZ '6 eut5\YIt.1CrlUl�t �I I_ A I_�' '' ll v tl EurRaucE Pe, RoGuE V 4u ZY ylal�ll,�x� 911.1 I ' I , I; �t9o31 (14)02 �, SfP+�P 41PAM I Q 5AST EI. YA-rloW • CdII Wre'( 514\14 100 - -11A'O4611 GZ �Z Job Date I Elizabeth Thompson . 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Architect l ORW E1561P NCE IIr2Z/oz 250 Mercer St. Suite B 806 Title scale New York, NY 212-614-7180 IITI5 PILAN I�8' 4I Lot l 10012 ETArchitect@AOL.com