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HomeMy WebLinkAbout29335-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30768 Date: 02/14/06 THIS CERTIFIES that the building ACCESSORY Location of Property: 10946 NORTH BAYVIEW RD SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 79 Block 5 Lot 20.8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 21, 2003 pursuant to which Building Permit No. 29335-Z dated APRIL 25, 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-HABITABLE POOL HOUSE IN THE REQUIRED REAR YARD AS APPLIED FOR. The certificate is issued to CLIFFORD C CORNELL (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 6139 11/23/04 PLUMBERS CERTIFICATION DATED N/A ;;)/(hiz/eX Sig ature Rev. 1/81 71.1c _h E-JUVA4R411- Form No.6 �7�1N" TOWN OF SOUTHOLD &0_4�M" 3� 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$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 Dated 1 q I Q New Construction: ✓ Old or Pre-existing Building: (check one) Location of Property: `0 I\tv(VAN ' Puy U ICS House No. (� pp Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section -72 Block 5 Lot Subdivision Filed Map. Lot: Permit No. 3 3 Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ App ant Signature L 0 3a�� Tuwn Hill 53005 M»111 food i t, ) I �� (5I6) 7��•1 57 P. 0. [lox 1178 ` l' 1,1 ri-Isap ionq (1;15) 7r�•1002 Soulliuld, Nqw York 11971 OFFICF- OF TIME BUILDING INSPBCTon TOWN Or' SUUT'I IOLD _C 1✓ R T I F I C. n T 1 0 rr _ DnT R�ja os 01 �z 1d ► ermlt No . X1. 10 " 03— �u i ny OU P ._.._ Owner : ( please pr.lrlt) . planes prim:) � -� I certify khat the solder meed 111 the writer supply sy!; tQrn conte iris loss than 2/ 10 of 1 % lend . Pew _ 111111)) u (Jn(a i.l.l.l_r?j sworn to before me Lhia dd� Of Notnry Public, SYFr-bC Coll 11t• y U ��Mob of Nm Yak No.1W12 :, mmmWm F>Om Oct.1a V-D S 11/23/2004 11:04 FAX 8317655133 Catiaon Multipass C530 I2002 11/23/2004 10:09 6318783764 N/S EHEC INSPECTIONS PAGE 01 N"Sau SufroJk Electrical InspecUans, Inc. JA Cotall Sa%vt• CAmW Marj&m,Now York 11934 Tel:631-67$-350010 Fam; 031-378-3764 Appficialdo4: 6139 Date:11/23/04 Issued to: Connell Address: 110%6 N.B*Yv*W.Rd Village: Southold By: ERCO Electric Licensc#:2781-E was exax>�jvwed and approved up to the atim&a AW was W- 'C0MPlLvw with the NEC 1st Floor PWfttw(E FW thmew Rwvn�t 21rdfkar canylama HITUb A*Jkn ing switches ReceplaClos Fixbjres G.F.I. Attafe Head Wit panel 4 rang Dishwasher Washor/Arrips Dryer/Amps Ova" Carbon Range/Amps vonoxwo F4 Place Oil Got moalzonew 81011the sell Delecliors Transformers Motor Amps Phase Mabry This cartificdc MUM not be alftred in.vAY mavow 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. 29335 Z Date APRIL 25, 2003 Permission is hereby granted to: CLIFFORD C CORNELL 22 WRIGHT ROAD ROCKVILLE CENTRE,NY 11570 for CONSTRUCTION OF AN ACCESSOROY POOL HOUSE IN THE REQUIRED REAR YARD AS APPLIED FOR at premises located at 10946 NORTH BAYVIEW RD SOUTHOLD County Tax Map No. 473889 Section 079 Block 0005 Lot No. 020 . 008 pursuant to application dated APRIL 21, 2003 and approved by the Building Inspector to expire on OCTOBER 25, 2004 . Fee $ 75 . 00 Authorized Signature ORIGINAL Rev. 5/8/02 ;jd j"II T. TARRY I„wn Hell. 53095 t,lan► P 0. 11ox 1174 'TOWN CLERK (fl� . I2EcIsTnAft OF STN.STATIS11Cs �" �- Fix (S I(,1 7fi5.1 R�� MARRIAGF: OrrICI'R TcicRlinnc 0 16► M5.1 RECORDS MANAGEMENT 0I7FICEII 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) ) . i �•{lyj I __ . BEG. DEPT. TOWN OF SOW(HOLD ►TOLD h T . Tern udi Y Southold Town Clerk August 25, 1993 . f l I ' APPLICATION w f PAGE l of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1• GENERAL PROVISIONS (APPLICANT to read and siPm: 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 oo 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 STATEMENTS HEREIN AND IN ATTACHMENTS TO _ THIS APPLICATION ARE,T THE BFST OF MY KNOWLEDGE,TRUE AND ACCURATE. .� (APPLICANTS SIGNATURE DATE 711%5 /Q3_ V SECTION 2• PROPOSED DEVELOPMENT (To be completed by APPLICA.NM NAME AD D R ESS TELEPHONE APPLICANT BUILDER �vasse T 2�t (�l� :�-f A4 3a 5 oP�i ENGINEER #-&111qq1 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 (he project location would be helpful, l d �,6 �l�r�- •ew Avg �'u�c;F FDP(93) APPLICATION PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT 16,MVTTY STRUCTURE TYPE New Structure 'Residential (1-4 Family) Addition O Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofing? ❑ Yes) ❑ Relocation O Combined Use (Residential & Commeraal) ❑ Demolition' R ❑ Manufactured (Mobile) Home (In Ma-nu- 0 Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT S `�, (AA B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill O Mining O Drilling O Grading ❑ Excavation (Except for Structural Development Checked Above) O Watercourse Alteration (Including Dredging and Channel Modifications) .' ❑ Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction O Subdivision (New or Expansion) O Individual Water or Sewer System ❑ Other (Please Specify) —Al—m—rcompl.eting 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- C3 Is MOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMEM 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 loca(ed to a floodway. FBFM Panel No. Dated ❑ Scc Scction 4 for additional iostruc(ioas. SIGNED DATE t I APPLICATION # PAGE 3 OF 4 SECTION 4 ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATORI The applicant must submit the documents checked below before the application can be processed: O A site plan showing the location of all existing structufcs, water bodies, adiaceot roads, lot dimensions and proposed development. O Development plans,drawn to scale, and specificatiprs,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 floodprooF 9 of uWities located below the fast floor and details of enclosures below the first floor. Also O 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). O Plans showing the extent of watercourse relocation and/or landform alterations. O Top of new fill elevation Ft. NGVD (MSL). .1 O Floodproofmg protection level (poo-reVt. NGVDMSL . Forsidential only) (MSL). 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. O Other- SECTION therSECTION 5 PERMIT DETERMINATION (To be comQlcted by LOCAL ADMINISTRATOR I have determined that the proposed activity. A_O Is B.O Is not in conformance with provisions of Local Law if , 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 Pcrmit upon payment of designated fee. if BOX B is checked, the Local Administrator will provide a written summary of deCicicncics. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from the Board of Appeals. ` APPLICATION # PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? O Yes O No Hearing dale: Appeals Board Decision --- Approved? O Yes O No Conditions SECTION 6• 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 mtLst be completed by a registered profession surveyor al engineer or a Licensed land sveyor (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 On Coastal High Hazard eas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). a L 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 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 preven(ion. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? OYES ONO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8• CERTIFICATE OF COMPLIANCECEo be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE BY: .l Attachment B ' SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area •^ r 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: O NEW BUILDING O E7(ISTING BUILDING O VACANT LAND .f 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 # , I9_, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) suu.uiNo DEPT. NSPECTION OUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE fl CHIMNEY �ARKS: a," qua, ��e��� 7.�-r.✓ 67 DATE D� INSP �� 33s suaoINc DE". 'SPECTION /OUNDATIO N iST [ ] ROUGH PLBG. NDATION 2ND [ ] INSULATION [ j FRAMING [ ] FINAL [ ] FIRE ACE & CH NEY REMARKS: DATE �5-��E X65-,802 BUILDING DEPT. INSPECTION LOUNDAT1ST [ OUGH PLBG. ODATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS:��tG� DATE � INSPECTOR 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: L` 4 DATE INSPECT 765-1802 BUILDING DEPT. INSPECTI N [ ] FOUNDATION 1ST OUGN PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY [ ) FIRE SAFETY INSPECTION REMARKS: 100, DATE �� -INSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION iST [ j:SULATION U PLBG. [ ] FOUNDATION 2ND [ [ ] FRAMING [ ] FINAL [ ] FlREPLAC CHIMNEY [ ] FIRE SAFETY INSPECTION REMARK ,- DATE � � -INSPECT a � 33s� ass-,ao2 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACE 8 CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: /'rs-.moi DATE 10/0 - INSPECTOR21�4 X933 s�� 7ss•,so2 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 CATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE ° INSPECTOR IM W7.Ii:Al ` FAFFA III i 1AflONPEA � �i._,/ �i �ai5��✓_� /� ''��j�s•-� �/- /� i _i%//�-� / moi/ � T. ilill Of VDIAM PLUMBING � 1 t 1 � /.���_� .., iii -tip _�� •- :f.Vii/ /fit �I .� �%�` � �� � / .♦ / /� �i �/��' /ice �� - ---------- � 1 INSULAUON PER N.Y. STATE ENERGYOD01, ►.7/�%�r-- - ------ ----- 1111111 JI'm a i �rM IFA Namfta L / TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DVPARTMENT Do you have or need the following,before applying? TOWN HALLTT 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. c;2 3 Check Septic Form N.Y.S.D.E.C. Trustees Examined ,-,20 03 Contact: R Approved W4 57 ,20 623 Mail 1to: Vassexkf �V�1derS�fin. Disapproved a/c o�110'UL",-,An �GaSApor k 19 owl Phonel3_ ) 3 ZS'0 R 1?1 Expiration J ,200 Building Inspector �n APPLICATION FOR BUILDING PERMIT Date 203 _ 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 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. Le,-4 LL-,( (Signature of applicant or name,if a corporation) �a � .5�.�.�-F l�� Ilg4�- (Mai,gg addre s of applicant) Iv17 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Cl--e n.f—,( oaf c-,��(ac-�u ir Name of owner of premises 1; �Lf A .� 1 n s t D-c r\ie Co< ,n e (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: _ er�--V\ -> RA 0 1-1 k-�no\ A House Number Street Hamlet County Tax Map No. 1000 Section Block 5 Lot o10 Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy `)06\ V\o U S 2 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal . Demolition Other Work (Description) 4. Estimated Cost boo Fee (To be paid on filing this application) 1. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 04 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 S. Dimensions of entire new construction: Front �' Rear Depth Height Number of Stories / 9. Size of lot: Front Rear Depth 7 Ac res 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_JC 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO i-� r lo`1y6N,xcti,Bc�yv«wP�► GitWALq f f 0.;ren 14. Names of Owner of premises �O�ne 11 Addr--ss'�:u,.� 1cl MV Phone 41"3)7?05- &s4.3- Name s61Name of ArchitectMl;l�irjnn1�j - PAe � e k Address°S to3 t /V rgyi Phone N (o r Name of Contractor, eS- o ar Mei B►,�p� 1�.� Address , '� ;�� Phone N (03► O-E 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 NOEL * 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 L4,� ME-. e a c-S e�� being duly sworn, deposes and says that(s)he is the applicant (Na6e of individual signing contract)above named, (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 to me this r day of 2 tU[��_20 0,3 Nota Public Signature of Applicant LINDA J.COOPER Notary Public,State of New York No.4e26s 63 Suffolk e1=V0,& Terri Making dreams come true... Leva5seurbullder5Inc. One house at a time 271 Old Country}load (65 1)525-0889 Tei/�ax Eastport,NY 1 1941 (65 1)727-5295 Tel/rax October 6, 2004 Town of Southold Building Department .......... _ Town Hall Southold,New York 11971 To Whom It May Concern: I would like an extension for building permit number 29335Z located at 10946 North Bayview Rd., Southold. I have enclosed a copy of the building permit for your reference. If you need any additional information,please do not hesitate to call me at 325-0889. Thank you for your assistance in this matter. Sincerely, Mary E.Levasseur Encs. Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 04/21/03 Receipt#: 3196 Transaction(s): Subtotal 1 Septic Permit-Construct- Resid. $10.00 Check#: 3196 Total Paid: $10.00 U Name: Levsseur, Mary E. 271 Old Country Rd Eastport, NY 11941-1427 Clerk ID: LINDAC Internal ID:73590 B�JILD IPd�— ' T—� L SII L --044- (– —L = Applicant/ Date. Owners Naive: i 1 �rCI a2ae-(( Reviewed: Architect/ Date Engineer: l.J,( �i F_ t „"t Submitted: lq.k 110-.3 SCTM #: District: 1,000 Section —7� Block: s Lo(: - Project . 11 Subdivision Location: 109 AL 1 _.U/ IA) T-� _— Name: Single& separate Required cpificat io�}: {Yes/NoI7n—e T)isttict of size: _ Actual:. (Lot coverage 1'rop<scd l Req. Req. I - Req. t (front Yard Proposed: J (Side Yar'6^ rop s ) (Rear Yard D\) Proposed I Project Description: /w unta-� AGENCWERMITS Permit REQUIRED FOR REVIEW N.A. ISO YES Number Suffolk County Health Dept. New York State D. E. C. / Town Trustees Town Zoning Board approval: Town Planning Board approval: S- Flood Plane Elevation??? Flood Zone: > f6 7 e y12-y'5 rW2,24 NEW YORK STATE CODE COMPLIANCE CHECKLIST USE/OCCUPANCY CLASSIFICATION: HEIGHT/FIRE AREA: TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEEREI(/��SCRIPTIV�E __ FULL FRAMING DESIGN ELAMENTS: HEADERS: Y/N WALL STUDS: Y/N GIRDERS: Y/N CEILING JOISTS: Y/N,-"'. FLOOR JOISTS: Y/N ROOF RAFTERS: Y/N LUMBER SPECIES AND GRADE: Y/N� DESIGN LOAD CALCULATIONS: Y/N CA/ SHOULD INCLUDE LIVE,DEAD,SNOW,SEISMIC AND WIND(INCLUDING UPLIFT AND EXPOSURE) WINDOW AND DOOR SCHEDULE: MISSLE TEST REQUIREMENTS: Y/N EGRESS, LIGHT, VENT: Y/N LOAD PATHS: Y/N ROOF TO FOUNDATION NAILING/CONSTRUCTION SCHEDULE: Y/N MEANS OF EGRESS: Y/N / PLUMBING RISER DIAGRAM: Y/N✓ LOCATION OF FIRE PROTECTION EQUIPMENT: Y/N r /A TRUSS DESIGN: Y/N CERTIFICATION: Y/N ENERGY CALCS: Y/N TOTAL COMPLIENCE? Y/N(RETURN TO PAGE ONE) BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: _/ /03 APPLICANT: DATE SUBMITTED: —/—/03 SCTM# • DISTRICT: 1,000, SECTION: , BLOCK: , LOT: SUBDIVISION: ADDRESS: CITY: ZONING DISTRICT: CONFORMING? BUILDING PERMITS OPEN/EXPIRED: BP -Z/C/0 Z- , INFO /BP -Z/C/0 Z- , INFO BP -Z/C/0 Z- , INFO /BP -Z/C/0 Z- , INFO PRE CO: Y OR N BP -Z/ C/0 Z- , SINGLE & SEPARATE CERTIFICATION-REQUIRED NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/l/8.- REQ. /1/8:REQ. LOT SIZE: ACT. LOT SIZE: REQ. LOT COV. ACT. LOT COV. REQ. FRONT PROP. FRONT REQ SIDE ACT. SIDE REQ. REAR PROP. REAR REQ. HEIGHT PROP. HEIGHT PROJECT DESCRIPTION: ESTIMATED PROJECT COST: ARCHITECT/ENGINEER: FAST TRACK WATER FRONT? DESCRIPTION: PANEL #: FLOOD ZONE: , COMPLIANCE: APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED #): DTE: / / PERMIT#: TOWN SEPTIC RECEIPT: Y or N NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or NO SOUTHOLD TOWN TRUSTEES: YES or NO TOWN ZONING BOARD APPROVAL: YES or NO TOWN PLAN. BOARD APPROVAL: YES or NO TOWN HISTORICAL PRE (SPLIA): YES or NO NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2): YES or NO NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE 1. ( SF)- ( SF)= SFX $ =$ +$ +$ = $ 2. ( SF)- ( SF)= SFX $ =$ +$ +$ = $ 3. ( SF)- ( SF)= SFX $ =$ +$ +$ = $ FINAL TOTAL: $ SURVEY OF LOT #1 N MAS' OF "PLOOK 5HELLr-I5wR �5ER1 "' r- � 'a C '��; '.W +/X � E FILED 6-14-85 A5 # T100 I� 51TUATE: BAYVIEN 2003 FEB 2 ! PH 12: 4d TOWN: 5OUTHOLD "E � OLK COUNTY W OFFICE 0W ts' TEE .ka MGM � �EFICE ASTEl�'A ER MGMT SURVEYED 10-12-qq AMENDED 10-30-qq, Lpt#2 03-28-00, OS-Oq-00, Lot# 1 10-25-00, 10-30-00, L 3 ° 12-13-00,5EPTIC 08-20-01, «INS 9a FINAL II-15-01, UPDATED 02-20-03 �-0 ox SUFFOLK COUNTY TAX # 1000 - -7g - 5 - 20.8 E�=B S81-26'1 pE SUFFOLK COUNTY DEPT. HEALTH 5ERVIGE5 REF. # RIO-qq-021 251.94' 1 I R100 Q h •,I, EL_12 �rl'� 1 - CT ID�]F©]k81®(�®I�`T1E1LL1,,111 , • RIEKLT Y'H I &17ERS A1307RACT CO,,CL;L -C S "EWAA� 1� 7Lc1NSlIANCE 03�A�Y � I _. ,) I PROPOSED SEPTIC 1000 GAL.5EPTIC TAN 1 4' DEEP 8' DIA. LEECHING POOL I h I Ls A o of# 1 h Record Test 001,�„ < Hole Data Lot#4 1 m � (not to Scale) Dwelling Flood Zone AE (8) dark brown sandy0 5 \ \ Flood Zone loan \ X. v v tp 2 o� sand .A v ry.' ASS, \ m m2,5 O 1 - �'O C 1 \\ \ b TEST r�.L '• S Z brown 1 \ '• 1 � �'� Q�" J 1 HOLE J i I I Ground 9.7' CJy ��, - - - — Flood Zone Flood Zone / AE(8) brawn ill 1 W ; 1 Icoarse II � 1 sand 1 4 \ I existing 1 a \ well 17' o \ 1 9 \ \ 1 \ \ exi5ting wells EXCAVATION ISPEC 10 ' } 00 i - ^ �r+n 1 VI S7 2z 'r s III 11.,R' , v ,'�E,, ,a ✓,1 IY.} ,� $,I-''~ "h\lp\ a•oni{1 trO \ �y 3,. I \, 4 o a3 b OF NEW NOTES: ■ MONUMENT tir..a.k ,ra,P Ed��n�,a„yaw p PIPE "On IY r_oP yes - i '�9o vey ark Coal w�f��a of al i� n `antllt s AREA 2.1-7 AGRES POOL LOGATED AFTER HEAVY 5NON by , ..- S A - t l'nl al ANY PATIO NOT OBSERVED OR LOCATED „ 1 -9,r I tl ii FLOOD ZONE ANNOTATED FROM FEMA „! MAP # 36103GO16-7 G MAY 4, Igg8 PROP05ED ACTIVITY OVER 100' TO ANY 5URFAGE WATER JOHN C. EHLERS LAND SURVEYOR NO. 50202 I 6 EAST MAIN STREET N.Y.S.LIC. GRAPHIC, SGALE I"= 60' RIVERHEAD,N.Y. 11901 --- - 369-8288 Fax 369-8287 REF.-TIGER\PROS\99-260C _ ►335 5URVEY OF LOT #1 MAS' OF TLOO�G 5HELLFI5HER PRESERVE' %, j, `= f ____ — s - W - E FILED 6-14-45 A5 # 4700 `` ; 'r 51TUATE: 13AYVIEV4 a ' j #2 TOM50UTHOLD Lot � j : SEP 152003 Lot#3 SUFFOLKGOUhlTY, 1�lY � SURVEYED 10-12-ciG S81 0 rr i?n AMENDED 10 30 ciq , 26,11 E 25 -- r) 03-28-00, 05-OCI-00, W 1110-25-00, 10-30-00, 1.94 12-13-00, SEPTIC, 08-20-01 q. 11-15-01, 02-20-03, 09-08-03 01 SUFFOLK COUNTY TAX # Q 1000 - 19 - 5 - 20.8 SUFFOLK COUNTY DEPT. , HEALTH SERVICES REF. # RIO-qG-021'1 r p C1E1R7C1 Hr(IEID'Iro: CLIDP P©XD CO RN1E1LL,TK R@AL7"1Y TRANSFERS ABSTRACT(CO.,1LIL(C STSWAIR1 [ TILEIINSbTRAN4;E COMPANY ��d; J P MORGAN CHASE BANK(addIcIIl 04-26 CO-) II II L r O t# 1 Vn cn 23'- �IW A I 01/ Flood Zone Flood Zone I do q r'sb @ Q �p \ J 8'. V`\ - - Flood Zone X. rw II i Flood Zone AE (8) 'i I r0 'I Q � < 1 1 � 1 N Q 2 \ s \ vJ \ s • II \ \ 01 I \ 00 O \ J` \ O \ 4$ t:3 ;s NEW , �t kc� a 711 tl �� au a. ;,o tl o NOTE5: � �� n-a ,� N Y St te Etl t 101, a. ■ MONUMENT V> tl�mpetl meal s ill ae tl t b Ia �'ii O PIPE Y P -,�:u�;.���tl .r°tinq Cotle o 1 Lana 5 veY=_a ev N.Y n nai Ion. ver ors ;I e"I, my AREA = 2.17 ACRES n � � �� r I na v � •� c sinN nr ane ie.a��� e,euro F.,�r��-d FLOOD ZONE ANNOTATED FROM FEMA MAP # 36103G0167 G MAY 4, IggB JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIC, SGALE 1"= 50' RIVERHEAD,N.Y.11901 369-8288 Fax 369-8287 REF.-TIGER\PROS\99-2600 sC0bVA 0 - 03 - coo30 MAP OF "" O� LOT #I N i'Lo6i< SHEL LF15I-ER F ERNE" WE FILED 6-14--x5 A5 # 8700 _ 51TUATEi f3AWIEK q * TOM: 5OUTHOLh Lot#2 %r-FOLK OOMTY, NY Lot#3 4 SURVEYED 10-12-qq -_- S'81026,11 FIE AMENDED 10-30-qq, 03-28-00, OS-Oq-00, _W 10-25-00, 10-50-00, 251,94, 12-13-00, 5EPTIC 08-20-01 11-P � . 11-15-01, 02-20-03, Oq-08-03 QoNt y - II-03-03, 12-30-04 000 h' 5UFFOLK COUNTY TAX # h 1000 - -7q - 5 - 20.8 , SUFFOLK COUNTY DEPT. HEALTH SERVICES REF. # RIO-qq-0211 I r I I I I CE@TIFIDED TO: I I I CLIFFORD CORNELL,DIES. � to REALTY TRANSFERS n�ABSTRACT C�iiO�.,L1LC STEWART TITLE INSURANCE COMPANY D MORGAN CHASE BANK( 04-26-02) ,..., Lot# 0 `6O + A 'o, 6 9' Flood Zone \\ +/ AE (8) I \ \ + e Flood Zone U � 0 0` Q Q 0 �y � •y - Q U Flood Zone 4 i 0 W. I I i Flood Zone AE W I � I i I , I , 0 , - # I g I n� ERVI"E �C�g3c�V.r A Pc?c'r16— S�@ >r-: Ks FOR o *M- Coon fWii d to •moi,\.Yn '• \\ \ ` 00 ` O \ \A5 ooJ , 006,13„ NEW - S 2 4" �a Y'uneut n or i zea alteration o atltlit 1pn to a vey NOTES: �, map daring a licensed 09. suNrveyor s,2, of a tmetion or season ]209. su'-division 1 pt the New York State Etlucation Law." ■ MONUMENT ®� c� only pdpiea from the a.igi'a] gf ""a Yey may, marketl wit'an orlg incl pf the lantl surveyor's jC\l'7y stampetl see] shell be conslle-2 to be-1,1d true ob'_ PIPE -te.0 ncationa indicated Hereon signify that tn,b Yer w s orepared i ardente with th.e .sting Cade of Practices faro Land Surveys adopted AREA 'y the New Yark State 455oc iation of Professional = 2.I1 AGRE5 Land Su...yors. Seib ce.tifi—tlonb bnel]r on:v to the person for venom the-1.1 er is prepared. end on nib benIf to the title copany. governmen- talagency and lending institution listed hereon and a aa FLOOD ZONE ANNOTATED FROM FEMA a ign.ee of the lending —titut— C.rtifica- tions are not trans I...11, to atltlit ion.. tns t,Iul,.n, MAP # 56103CO16-1 6 MAY 4, IggB JOHN C. EHLERS LAND SURVEYOR GRAPH I G 5GALE I i= 50' 6 EAST MAIN STREET N.Y.S.LIC.NO.502Q2 RIVERHEAD,N.Y.11901 369-8288 Fax 369-8287 REF.—TIGERTROM99-260C —+n._..rM...>wirsww_srwar+wr.+a.r+ +r.u.+xarm.,w,r..an.-,..«rrx_n_w..,nur.a...v..-ne.u,,,+n•n..w,,.-. ,int«.--,.w..w.fna.a.n++..rt+^=.nu.....mn w,va.,,•-nn...-.v_- ..w-w-.u.._..._..:_v....aw:w+-w.e_.e.0:+o+n a_+.-v...w,_..w'a..xn. .a- .u.rn r _.rwar.. -m..wnxnme_, . ar.u.w,.r.+ar_rn .n+,nnnne..w+.n•_.w,....r.nwn.-ewy,..�.+,,,.«. .. -v x++.'+w._r.-.a_a+n r.+_«.....at...,-.T.na .,,a-.,. •' - x•nw+.,a._.w.r".^^^'•'.n'+.+ ....— - - - ALL CONSTM ICTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. APPROVED AS NOTED _ DATE: A a-3 B. P.# 02 �� FEE• BY: -NOTO BUILDING DEPARTMENT AT � '1'�II ( CUPANCY 4R 704802 SAM To 4 PM FOR THE �?ir �► - __.__--. _----____._ FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIREDry II t I II I it I 11'` it IN ► it t FOR POURED CONCRETE jo , ' OUT i. RouGAWNGa PluWIT z� 3. INSULATION 4. FINAL - CONSTRUCTION MUST ; 9 i ! BE COMPLETE FOR C.O. PX ' I ; ALL CONSTRUCTION SHALL MEET THE I I REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR xI DESIGN OR CONSTRUCTION ERRORS. UNDERWRITERS CERTfIGATEREOMD6 I % { z tI ,� ,�, �- ; ;_�_ _ . _ , i_... - -'- OOD ZONE ' _ Eti i F viA ' j 4 ICOMPLY WITH CHAPTER "46" I " F, "* i �' ' � i I b E I� s (FLOOD DAMAGE PREVENTION I r __ _ I N , (SOUTHOLD TOWN CODE. � 4 � � � � I I CERTIFICATION OF II - . 41 d� ,I�� � I f I � NAILING & CONNECTIONS REQUIRED.COMPLY WITH ALL CODES OFqr NEW YORK STATE & TOWN CODES { AS REQUIRED AND CONDITIONS OF I . 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