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Home My WebLink About28012-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29850 Date: 11/18/03 I~{IS CERTIFIES that the building Location of Property: 2700 MILL RD (HOUSE NO.) County Tax Map No. 473889 Section 67 Subdivision Filed Map No. ACCESSORY PECONIC (STREET) (HAMLET) Block 5 Lot 2 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 25, 2001 pursuant to which Building Permit No. 28012-Z dated JANUARy 17, 2002 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 BOAT STORAGE BUILDING AS APPLIED FOR. The certificate is issued to 2700 MILL ROAD LLC (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF ~EALT~ APPROVAL EI~CTRICAL C~RTIFICAT~ NO. PLUMBEP~ CERTIFICATION Dlkl'~u N/A N/A N/A ~//d~ignature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28012 Z Date J~NUARY 17, 2002 Permission is hereby granted to: HUGH K SWITZER 4651 SENTINEL POST RD ATLANTA GA, 30327 for : DEMO COTTAGE AND CONSTRUCTION OF A 528 SQ. FT. ACCESSORY BOATHOUSE FOR WITH FLOOD PMT AS APPLIED FOR WITH DEC AND TRUSTEES CONDITIONS at premises located at 2700 County Tax Map No. 473889 Section 067 pursuant to application dated JUNE Building Inspector. Fee $ 294.90 MILL RD SOUTH/PEC Block 0005 Lot NO. 002 25, 2001 and approved by the Authorized Signature COPY Rev. 2/19/98 Form No. 6 TOXVN OF SOUTHOLD BUILDING DEP.~RTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by Dpewriter or ink and submitted to the Building Department with the following: A. For ne,,,,' building or new use: 1. Final survey of properly 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 Undem, riters. 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 Platmlng Board Approval o. fcompleted site plan requireme,'ts .... :, ~. B. For existing buil~ip~'(prior [~.44'rjl 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate sun ey &~ prope~rty stropping all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application aud consent to inspect signed by the applicant. Ifa Certificate of Occup?acy is. denied, the Building Inspector shall state the reasons therefor i,n writing to the applicant. ~.: C. Fees 1. Certificate of Occupancy - New dwelling $25.00, ,~,d'Ji~jons to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Adititions to accessoD' 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 New Construction: Location of Property: ~--'-[ C-) ~) House No. Owner or Owners of Property: 2_-'(~_~ ~ Suffolk County Tax Map No 1000, Section Date. Old or Pre-existing Building: ~ (check one) Street 0 (o ~ Block 0 ~ Lot Hamlet Subdivision Permit No. ~-76'0\ ~-- -- ~ Date of Pennit. Health Dept. Approval: Filed Map. ~/I "1/O ? Applicant: ~CI, (4 t-fi~ Undep. vriters Approval: Lot: Plamfing Board Approval: Request for: Temporary Certificate Fee Submitted: $ ,2--~-". C~ C~ Final Certificate: J (check one) · P~plicant Signature Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 October 1, 2003 Hugh Switzer PO Box 283 Peconic, NY 11958 RE: 2700 Mill Road, BUILDING DEPARTMENT TOWN OF SOUTHOLD Peconic, 1000-67-5-2 Fax(631)765-9502 Telephone (631) 765-1802 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is (not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 28012-z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. ,,BUILDING PERSHT EXAMINER CHECK LIST SCTM# DISTRICT: !,000 SECTION: STREET: 27'~o /14//. c DATE REVIEWED: .xe)/~/01 DATE SUBMITTED: (' BLOCK: J'~ LOT: 2-~ CITY: ta~r9.'~'/C SUBDIV. NAME: PROJECT DESCRIPTION: ARCHITECT / ENGINEER: SINGLE & SEPARATE CERTIFICATION LOT~ 40,000SF -100-24. Lot recognifion.(CREATED before Jm zoNE G D,STnCT: REQ. LOT SIZE: REQ. FRONT REQ. REAR WATER FRONT? rANEL #: AGENCY PERMITS REQUIRED FOJ ACT. LOT PROP. FR PROP. R FLOOD ZONE: ,~z~ FAST TRACK? ~O NOTES: ~' ~a N.1997 100-25. Merger.(A nonconfo~ing at any time a~r 7/I/83 ~~T. SUFFOLK COUNTY HEALTH DEPT: YES or O~, ED #): NEW YORK STATE DEC: v~-D£cgar~or NO SOUTHOLD TOWN TRUSTEES: ~(~o_S ,r. LNO ~ xowN BO am TOWN PLAN. BOARD APPROVAL: YE..Wort~ ~. TOWN mSTORICAt, PRE (SPLIt): Yt~,S:or~ff PERMIT #:RI0- NYS ENERGY: YES OR~ : __ EGRESS (18 H min.? 4 sq total) VENT (SQ. FT. x 4%) LIGHT (SQ. FT. x 8%) BUll.DING PERMITS OPEN/EXPIRED: BP -Z / CI0 Z- , HAVE PRE.CO'S: YORN FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: ~'.~ ~ SF SECOND FLR: SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE 'OT( ~' SF)- )(__2~SF)= -27, .- oWNER STREET ~ 7(.~~ N FORMER OWNER S VI LLAGE ~)~c o~7 E W DISTRICT SUB. ACREAGE TYPE OF BUILDING b'kND . _¢_¢70 AGE NEW SFAS. IMP. ~/t~-O NORMAL JVL TOTAL FARM DATE BUILDING CONDITION BELOW COMM. J IND. J CB. J MISC. REMARKS ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD Tillable 2 DOCK Tillable 3 Woodland Swampland Brushland Ho~se Plot Tctel JEst. Mkt. Value COLOR ,¢..., TRIM J M. Bldg. / Ir ~' 'L Y' Extension / '2,. \ ,-' ~ Extension Extension Porch ,c '~ ¢ ~', Breezeway Garage Patio O.B. TotaJ /.? £, ,//¢? Foundation Bosement [ Ext. Walls i ' ' F~e Place Type Roof /--' , ~' :~,.',,~ ' IRecreat~on Room D°rmer · Bath Floors Interior Finish Heat Rooms Ist Floor Rooms 2nd Floor Driveway /nette LR. DR. BR. FIN. B Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda June 26, 2001 . BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 Mr. Hugh K. Switzer 3180 Mill Lane Peconic, NY 11958 RE: 2700 Mill Rd., Peconic SCTM#67-5-2 Dear Mr. Switzer: The Board of Town Trustees took the following action during its regular meeting held on Thursday, June 21, 2001 regarding the above matter: WHEREAS, HUGH K. SWITZER applied to the Southold Toxvn Trustees for a permit under the provisions of the Wetland Ordinance of the Tox~m of Southold, application dated May 29, 2001, and, WHEREAS, said application was referred to the Southold Toxvn Conservation Advisor3' Council for their findings and recommendations, and, WHEREAS, a Public Heating was held by the Town Trustees with respect to said application on June 21,2001, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the 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 standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, 2 RESOLVED, that the Board of Trustees approve the application of HUGH K. SWITZER to demolish/remove the existing cottage that is within 6' of Goldsmith Inlet, and replace it with a boat house that would be set back 70' from the Inlet, with the condition that there is a 20' non- turf buffer left between the Inlet and the demolition zone, and that hay bales be placed along the wetland fringe during the demolition process. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Txvo inspections are required and the Trustees are to be notified upon completion of said project. Fees: None Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJKllms cc: DEC Bldg. Dept. Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO.. ~../.~3.~'/~. , , DATE: ~.~}e 26,....~0.01 HUGH K. SWlTZER ISSUED TO .......................................... · ..................................................................... Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893: and Chapter 404 of the ,1~. ws of the · State of New York 1952; and the Soufhold Town Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN'WATERS;?. end in accordance with fha Resolution of The B6ard adopted at a meeting held on ..~.u.~...;~.~.: .... ~00.]L...'.., and In consideration of the sum of $...~.~..Q.Q ....... paid by Hugh K. Switzer of ............ ~.o.~!~ ......................................................... N. Y. and subject to the Terms and Conditions lided on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to demolish/remove:the existing cottage that is within 6' of Goldsmi/tk Inlet and replace it with a boat house that would be set back ~ from the Inlet. with the condition that the~ is a 2~* non-turf buffer left between the Inlet and the de~n~litibn all in accordance with the detei~ed specifications as presenteam · the originating application. ~one, a~d that hay ha]es be placed along the wetland fx:inge during the de.molition process. -- IN WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate Seal to be affixed, and these p.resenfs to be subscribed by a 'majority of the said Board as of this date. H, enry Smith~- Absen~ Trusteet Phone: {g311 444-03~5 · FAX' ¢6"' ' !1 0360 Erin M. Crotty Commissioner July 27, 2001 Mr. Hugh Switzer P O. Box 283 Peco;fic, NY 11958 RE, '1-4738-02906/00001 [)ea~ Permittee: In conformance with U'I~. r~.qui.¢ements of the Stme l)niform Procedures Act (Article 70, ECL) and its implementing '" (6NYCRR, Part 621) w~ are.enclosing your permlt Please rr~ad all condmons carefully. If yo~g~'e ulaable to comply with any conditions, please contact us at the a~,.ove a~dress. Also enclosed is a permit siga which is to be conspicuously posted at the project site and protected from the weather. Sincerely, MRP/Is Enclosure Matthew R. Penski EnCon Program Aide NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION /DE~ PERMIT NUMBER 1-4T58-02906/00001 FACILITY/PROGRAM NUMBER(S) PERMIT under the Environmental Conservation Law EFFECTIVE DATE July 27, 2001 EXPIRATION DATE(S) duty 27, 2006 New ~ Renewal ~ Modification [] Permit to Construct [] Permit to Operate J [] Article 15, Title 5: Protectfon [] [] Article 15, Title 15: Water [] Supply [] ~ Article 15, Tttle 15: ~ater Transport [] D Article tS, Title 15: Long Island Wells [] ~ Article qS, Title 27: Wild, Scenic and Recreational Rivers · PERMIT ISSUED TO Hugh Switzer ADDRESS OF PERMITTEE P.O. Sox 283w Peconicr NY 11958 CONTACT PERSON FOR PERMITTED ~ORK 6NYCRR 608: ~ater Qualfty Certification Article 17, Titles 7, 8: SPDES Article 19: Air Pollution Control Article 23, TLtke 27: Mined Land Reclamation Article 24: Freshwater Wetlands Article 25: Tidal Wetlands [] Article 27, Title 7; 6NYCRR 360: Solid Waste Management [] Artic[e 27, Title 9; 6NYCRR 373: Hazardous Waste Management [] Article 34: Coastal Erosion [] Article 36: Floodplain Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control TELEPHONE NUMBER , (631) 765-3296 TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Switzer propertyr 2700 Mill Road, Peconicr NY LODATION OF PROJECT/FACILITY SCTM #1000-67-5-2 I DESCRIPTION OF AUTHORIZED ACTIVITY: ~* ~ atlached p~ans stamped NYSDEC approved on~5725/01. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Condition~cffied (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT AOMIN TR OR: DDREBS John A. (MAP) Brook, NY 11790-B~56 P~ge ~.. '-? ~ ~ ~ July 27, 2001 i NEW yORK STATE DEPARTMENT OF EN~/[RONMENTAL CONSERVATION · . NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to indemnification 'l'he 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, ~ncluding 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: Permtttee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvars, 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 perm[flee 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 rerevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). 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 p,e~,mit I~enewals or Mod flcat one The permittee must submit a separate~rit~en a[~plicat on to the Department for renewal, modification or transfer of this permit. Such applicafion must incl~'~e any fo~ms or supplemental information the Department requires. Any renewal, modification or transfer granted~ th~ Dep~rtment must be in writing. The permittee must submit a renew~ application at least: a) 180 days before expiration'of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities'iHWMF), 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 f~r permit renewal or modification are to be submrtted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg #40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modificatlons, Suspensions and Revocations by the Department The Department reserves the right to modifT, 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 prowsions of the ECL and pertinent regurations is found; b) the permit was obtained by misrepresentation or failure to discrose 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 1-4738-02906/00001 PAGE 2 OF 4 NEW YORK STATE DEPARTMENT OF EN¥~RONMENTAL CONSERVATION . ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE $)~ 24, 26, 34 AND 6NYCRR PART 608 ( TIDAL WETLANDS) 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 or alter the 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. 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. 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 Engineer's, 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 or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to'the State,:and to such extent and in such time and manner as the Department of Environmental Conservation may req.~lc"e, re,~ove all or any portion of the uncompleted structure or fill and restore the site to its former condition.,~.blairr~hall be made against the State of New York on account of any such removal or alteration. 8. If granted under 6NYCRR Part 608, tl~e NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effibent [~mitations or other limitations or standards under Sections 301,302, 303, 306 and 307 of the Clean Water Act of 1977 (pi' 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 podion of the enclosed notification form certifijing 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/he 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 Plans were prepared by: S_tanley_J. Isaksen Jr. last revised on 5/30/01. DEC PERMIT NUMBER 1-4738-02906/00001 PAGE 3 OF 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. Prior to the demolition and removal ol the cottage, a continuous line of staked haybales/silt curtain (or other NYSDEC approved method) shall be placed between the cottage and the tidal wetland boundary. This sediment barrier shall remain in place until project is completed and all disturbed areas stabilized with vegetation. 2. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas landward of the new boat house location· 3. 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. 4. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal weUands and or protected buffer areas. 5. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activity. 6. 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 ~getation (non-fertilizer/pesticide dependent grasses. etc.). 7. If seeding is impracticable due to the time of year, a temporary mulch must be applied and final seeding performed at the earliest opportunity when weather conditions favor germination and growth, but not more than six months after project completion. BUILDING PERMIT EXAMINER CHECK LIST SCTM# DISTRICT: 1,000 STREET: 27~o /14/t-c PROJECT DESCRIPTION: ARCHITECT / ENGINEER: SINGLE & SEPARATE CERTWICATION-REQUIRED? ///O NOTES: SECTION: oz~Z BLOCK: J'- LOT: ~o ~-r~ CITY: t~ E~,~ / DATE REVIEWED: /u/Zt/01 .DATE SUBMITTED: g' FAST TRACK? SUBDIV. NAME: 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 7/1/83. zo aNG DISmCT:conoco: REQ. LOT SIZE: ~ ~ aO ACT. LOT SIZE:__/7' O~'~.EQ. LOT COV. REQ. FRONT REQ. REAR WATER FRONT? PANEL #: PROP. FRONT REQ SIDE PROP. REAR )/~ 7 ' DESCRIPTION: FLOOD ZONE: v~-~'4/ , ACT. LOT COV. ACT. SIDE AGENCY PERMITS REQUIRED FOR REVIEW APPROclg-~LS REQUIRED: SUFFOLK COUNTY HEALTH DEPT: YES or~O,J~ED #):__ DTE: NEW YORK STATE DEC: ~-~Ec 9an~br NO SOUTHOLD TOWN TRUSTEES: (0'ES)or NO --~ TOWN ZONING BOARD APPROVAL:'¥L~ o~ TOWN PLAN. BOARD APPROVAL: YES or~ TOWN HISTORICAL PRE (SPLIA): YES or~l~ / / PERMIT #:R10- NYS ENERGY: YES OR~: __ EGRESS (18 H rain.? 4 sq total) ' VENT (SQ. FT. x 4%) ~,/'"/ LIGHT (SQ. FT. x 8%)~ BUll.DING PERIVlITS OPEN/EXPIRED: BP -Z / C/0 Z- ~,. HAVE PRE CO'S: Y OR N BP - -Z / C/0 Z- , NOTES.: ,~ ~. I~. FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: 3~',,~ ~ SF SECOND FLR: SF TOTAL: SF 'OT( o~OZ~' SF)- (___~-o~ SF)= .-~g SF X $. yo =$ INIT OTHER TOTAL FEE FEE FEE APPLICATIC~N # PAGI~ I of ,1 TOWN OF SOUTHOLD FLOODPI,AIN DE\rELOI'MENT PER~IIT APPLICATION This form is to be filled out in duplicate. ~_CTION 1: GENERAL PROVISIONS (APPLICAJ~T I9 read and si~.' 1. No work may start until a permit ks kssued. 2. Thc permit may be revoked if any fal~e statcment~ are made herein. 3. If revoked, all work mu~t cease until permit is re-issued. 4. Development shall not be treed or oca:upied until a Certificate of Compliance ks issued 5. The permit will expire il no work i~ commenced within six months of i~suance. 6. Applicant is hereby informed that other permit~ may be required to hdfill local, state and federal regulator3' requirements. 7. Applicant hereby giv~ consent to the Local Administrator or h/s/her represeuta6ve to make reasonable inspectiom required to verify compliance. 8. I, THE APPLICAI4T, CERTIFY TH.AT ALL STATEMENTS HEREIN AIqD IN ATTACHMENTS TO . THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE. SECTION 2: PROPOSED DEV'ELOPMEN~ ('Ti~ ICe completed bv APPLICAJ~0 APPLICANT BUILDER ENGINEER NAME, =, ADDRESS TELE~PHONE To avoid delay in proee~ing the applicadom please provide enough information to e.~ily identify the project location. Provide the street addre~ lot number or legal description (attach) and, out~ide urban a.rea~, the dista.nco to the neaxest intersecting road or well-known landmark. A sketch attached to ti~ application showing the project location would be helpful. FDP(g3) , . AJ~PL, ICAI ]()~, ~ P.ACJE 2 OF ~ DESCRIPTION OF WORK (Check all appbcablc boxcsl A STRUCTURAL DEVELOPMENT A(~TI\qTT [] Addition El Alteration [] Relocation [] Demolition [] Replacement [TRUCFURE_ TYPE [] Residential (14 Family) [] Residential (More than d Family) 12 Nou-residen6al (Floodproof'mg~ [] Yes) [] Combined Use CResidetmal & Commercial) [2 Manufactured (Mobile) Home (la Manu- factured }tome Pask? [] Ye-s) ESTIMATED COST OF PROJECT B. OTIfER DEVELOPMENT ACTIVITIES: [D Fill [] Mining [~ Drilling ~r'Grading [] Excavation (Except [or Structural Development Checked Above) [] Watercourse Alteration (lndudlng Dredging and Channel Modifications Ul Drainage Improvements (Including Culvert Work) [] Road, Street prestige Construction [] Subdivision (New or F__l'pansion) [] Individual Water or Segl~r System [] Other (Please Spec'fly)." After completing SECTION 2, APPLICANiF should submit form to Loc,al Administrator for review. SECTION 3: FLOODPLAIN DEItI~RMINATION (To be comuteted bv LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: [] Is N--Q.T located in a Special Flood Hazard Area (Notify the applicant that the appllcafioa review is COmplete and NO FIX)ODPLAIN DEVELOPMENT PER_MIT IS REQUIRED). [] Lq located in a Special Flood Ha?ard Azea. FIRM ZOne designation is 100-Year Ilood elevation at the site is: Ft. NGVD (MSL) UI Unavailable El The proposed development is located in a floodway. FBFM Panel No. Dated [] See Section 4 for additional instructions. SIGNED DATE APPLICATION PAGE 3 OF q SEC-FION 4: ADDITIONAL I~FOPoM^TION~UIRKD (To h~%completcd by L~OCAL ADMINISTRATOR~ The apphcam must submil thc documems ctmckcd below before the applica6on can be processed: Development plans, drawn to scale, a~nd specifications, including where applJcablc: details for anchoring structures, proposed elevation of lowest floor (Laduding basement), lypes of water resi~t~t materials used below thc first floor, details of floodproot-tng of utilities located below the first floor and details of enclosures below thc fuse floor. Also, Subdivision or other developmcm piaixs (If thc sub&ivision or other development exceeds 50 lots or 5 a~es. whichever is the lesser, the applicant must provide 100-year flood elevations if they are not other,vise available). [] Pla.as showing the ex'teat of watercourse relocation and/or landform alterations. [] Top of new FdJ elevation Ft. NGVD (MSL). [] Floodproo£mg protection level (non-residential only) Ft. NGVD (MSL). For flo~lproofed structures, applicant mU~t attach certtficauon from registered engineer or architect. [] Certification from a registered engineer that the proposed activity in a regulatory floodway will not result La ~ Lacrea.se in the height of the 1.00-year flood. A copy of all data ired calculations support/ag.4hi~ finding m~.tst also be submitted. El Other: SECTION 5: PERMIT DETER35. INATIQN (To,I~ comvleted bv LOCAL ADMINII~'T.RATOP,~ I have determined that the proposed activity;. A. [] Is B. [] Is not in conformance with provisions of Local Law ~ , 19 attached to and made part of this permit. · The permit ia issued subject to the conditions SIGNED , DATE f~OX A is ~:hecke~dd. the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B i~ gheck~d, the Local Admimstrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing [rom the Board of Appeals Appealed to Boa;d of Appeals? [] Yes O Ho Hearing date: Appeals Board Decision - Approved'~ [] Yes Conditior~s [] No AP PLIC/',TION # PAGE a OF ~ ~Eg"TION 0: A,$-BUILT ELEVATIONS (To be submitted by APPLICANT before Certuqc~te of Compliance is issued) The foUowing information must be provided for project structmes. Thi~ section mUst be completed by a regSstered professional engineer or a licensed land surveyor (or attach a certific~oon to th~ application). Complete 1 or 2 below. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal Hi~:h Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piLing and columns) is: FT. NGV'D (MSL). 2. Actual (/ks-Built) Elevation of floodproo£mg protection k I=T. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION f-Fo bc comolcted bv LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will comple't'~ th.is section as applicable based on inspection of the project to ensure comp'dance with the community's local law for flood damage, prevention. INSPIECTIONS: DATE BY DEFICIENCIES? 0 Y~ [] NO DATE BY DEFICIENCIES7 [] ~ [] NO DATE BY DEFICIENCIES? [] ~ [] NO SECTION g: CERTIFICATE OF ~:0MPLIANCECTo be comoleted bY LOCAL ADMINIS"TRATOR) Certificate of Comptiance issued: DATE: BY: Attachment B CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZ. a, RD AREA (O~X, rNER MUST RETAJN THIS CERTIFICATE) PP,~;MISES LOCATED AT: PERMIT NO. PERMIT DATE. OWNERS NAME AND ADDRESS: CHECK ONE: [] NEW BUILDING [3 EXISTING BUILDING ID VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIR.EMENTS OF LOCAL LAW # ,19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19__, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED:. C/C(931 76S-~.802 BUILDING DEPT. INSPECTION [ -] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ]INSULATION ] FRAMING [ ] FINAL ] FIREPLACE & CHIMNEY DATE ~~INSPE~ BUILDING DEPT. INSPECTION [/~J~OUNDATION 1ST [ ] ROUGH PLBG. ~_~i/~i~/ ] FOUNDATION 2ND [ ] INSU~TION [ ] F~MING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: /~ DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROU~PLBG. [[ ]]~ORAUNMiDtGTION 2ND [[~TION [ ] FIREPLAC~ ~ CHIMNEY DATE ~E~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION l ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] IN~J~LATION [ ] FRAMING [ ,~ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR FIELD INSPECTIO~N REPORT I ~I)ATE.~ I COM~'IENTS FOUNDATION (2ND) ~ ~ m ROUGH F~I~G & -~ ~ m PLL~IB~G ~ ~Sk~ATION PER N.Y. ~ " ~~~ STATE ENERGY CODE z~DITION.~ CO~ENTS TOWN OF SOUTItOLD ' BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 Examined / ~/,/~ ,200/ Approved ~//.~ ,20. dZ~ Disapproved ~'c PERMIT NO.~O/~'~--~~ ! BUILDING PERM1T APPLICI~ATIGN CHECKLIST Do you have or need the tblloWmg, before applying ? Board of Healih 3 sets of Buildlng Plans Survey t/ Check Septie Form N.Y.S.D.E.C. Trustees Contact: Mail ~o: Building Inspector APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcation 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 premiaes or pubhc streets or areas, aaa waterways. c. The work covered by this application may not be commenced before iss,~ance of Building Peamit. · d. Upon approval of this application, the Building Inspector will issue a Building Pea'mit 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 an>, purpose what-so-ever until a Certificate of Occupancy is issued by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance cfa 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. (Signa~ of appli~-ant ~r ,~ a corpomton) (Mailing ~ldress of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises '~.7[~ .VIAl( _t_ .~x~Ort% , 'k LC'L . (as on the tax roil'or latest deed) If apphcant is a corporation, signature of duly authorized officer (Nan~e and title of corporate oftleer) 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: House Number Street Hamlet County Tax Map No. 1000 Section O(o-'( Block O~"' Lot O2 Subdivision Filed Map No. Lot (Nme) State existing use and occupancy off. raises and intended use and occupancy of proposed constxuction: a. Existing use and occupancy ~ [oc-~ K_C_ ~3rwt ~. t__,q b. Intended use and occupancy ,'qx ~-~(~{-c° ~:w~¢_,-( .--I~t~-~_C.(,.. ~ 3. Nature of work (cheek which applicable): New Building. ~ Addition Alteration Repair Removal Demolition Other Work Estimated Cost Jg~ ~ ~ ~ CbC)Cb Fee If dwelling, number of dwelling units If 9arage, number of cars (Description) (to be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Rear Depth. Height. 8. Dimensions of entire new construction: Front 2~ 2. t Rear Height [ '~ ~ Number of Stories 9. Size of lot: Front ~10,~t Rear -~ ~_~.,c~ ~ t Depth 10. Date of Purchase \ ~. ] Z. OOO Name of Former Owner Number of Stories ?_. Z. ~ Depth l 1. Zone or use dish'ict in which premises are situated ~__~ ~ ~ e_~oTh ~c~ 1_. IZ Does proposed construction violate any zoning law, ordinance or regulation: ~ C2> 13. Will lot be re-graded ~ 0 Will excess fill be removed f~om premises: YES (~ 14. Names of Owner of premises~g~r~T~:~JAdclress ~ ~O gttC-~ LqluZPhone No.~ Name of Architect Address ~_c_~ ~ x C.. Phone No Name of Contractor ~W¢~' t~_t. "'~'t-~--,~,t/:~6~ Address ]fl/Lr.~W~Phone No. "-l'~:~'-.%"q ~ ~ 15. Is this property within 100 feet of a tidal wedand? *YES ~ NO 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 ) k-~ ('-~ x4- ~ t ~ \ w ~ being duly sworn, deposes and says that (s)he is the applicant (Name 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 malc_e 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. I'~EL~N~ O. HORNE Notary Public, State of New York No. 4951364 Qualified in Suffolk County Commission Expire~ May 22,'-~_~(~_.~ ~ Sismture of Ap~az~ SW! r££ lP REP. OWNER iV £~' 18' Jg' W -- ~ ~ 74.97' [__.~.z; APO.ox. ~'/]/7 . ~"~. 'POSED 4T JSE lO AR ?ti S 28' 00' E FMj; 860 FILED JUNE 6, 1,926 TAX ~fAP NO, 1000-067-0.5-02 FLOOD ZON~ DATA MAP IYO, 36zO~C O/GIG MAY 4~ 1'9.998 GUARAN?EED TO 2700 MILL ROAO LLC PECONIC ADS IRAC F CORP ,'F 641 - S - 01140 COUNIRY ¢,IDE LENDINO NOI£. I. 50 MAY, 2001 LOT 16 PlO LOf 15 APPROVED AS PI:.R TERMS AND CON{)I'£iONS OF I STORY WOOD FRAME RESIDENCE MI L fqOAD ~ SURVEY OF IN MAP OF PROPERTY OF BLANCHE 7~ DICKINSON SI TUA 1E PECONIC, TOWN OF SOU THOLD SUff-OLK COUN i' Y, N.Y. SURVEYED FQR .' 2.700 MILL ROAD LLC 14.2' _..12.6'- lO 110. 90' c. liE= 220' ADD BOA r ItOUSE & DEMOLII-ION NOTE, ELEVATIONS SURVEYED 24 OCL, 2000 SCALE 1"=20' AREA= 1Z090.145 SF OR ~Jg2 ACRES SURVEYED BY STANLEY U iSAKSEN, JR P.O BOA' 294 NEW, SUFFOLK, NY ~ 19~ NYS LI~i NO. 4927J OORg46 ~ r~ ii_t/z) ,! t ' .+_