The URL can be used to link to this page

Home My WebLink About28805-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29375 Date: 04/22/03 THIS CERTIFIES that the building ACCESSORY Location of Property: 420 LAKEVIEW TERRACE EAST MARION (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 31 Block 9 Lot 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 3, 2002 pursuant to which Building Permit No. 28805-Z dated OCTOBER 3, 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 INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to ARIF & HINA A HUSSAIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1118670 03/14/03 PLUMBERS CERTIFICATION DATED N/A Authorized Si ature 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. 28805 Z Date OCTOBER 3 , 2002 Permission is hereby granted to : ARIF & HINA A HUSSAIN PO BOX 24 EAST MARION,NY 11939 for CONSTRUCTION OF AN INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. THIS PERMIT REPLACES BP#25996 . at premises located at 420 LAKEVIEW TERRACE EAST MARION County Tax Map No. 473889 Section 031 Block 0009 Lot No. 011 pursuant to application dated OCTOBER 3 , 2002 and approved by the Building Inspector to expire on APRIL 2 , 2004 . Fee $ 150 . 00 J Author' ze Signature COPY Rev. 5/8/02 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. 25996 Z Date SEPTEMBER 20, 1999 Permission is hereby granted to: ARIF & HINA A HUSSAIN PO BOX 24 EAST MARION,NY 11939 for DEMOLISH EXISTING DECK & A/G POOL & CONSTRUCT AN ACCESSORY I/G POOL & FENCE TO CODE AS APPLIED FOR & AS PER CONDITIONS OF DEC & TRUSTEES at premises located at 420 LAKEVIEW TERRACE EAST MARION County Tax Map No. 473889 Section 031 Block 0009 Lot No. 011 pursuant to application dated AUGUST 27 99 and approved by the Building Inspector. Fee $ 165 . 00 Authoriz S gnature COPY Rev. 2/19/98 Or3rL3rC3j-L3r FL3Fd3'rJ�rJ�rJ1i:1 2 �rJ�t:PcPrJ2 2 2112 2"iiIN 2 2 I V lilllcn�frJ��l gl aicn�l�l�lcn�l�nrJ�cncPcI I II 111@nrJ'dJ�LPLrL3PLj3rL3r3rJL �o 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 BUREAU OF ELECTRICITY c5 5 40 FULTON STREET — NEW YORK, NY 10038 5 CERTIFIES THAT Upon the application of upon premises owned by 5 +4-L4 e5st~x. 4, 5 5 REP ELECTRIC M ARIS 75 5 P.O. BOX 635 420 LAKEVIEW AVENUE 5 MATTITUCK, NY 11952, EAST MARION, NY 11939 5 Located at 420 LAKEVIEW AVENUE EAST MARION, NY 11939 fS Application Number: 1118670 Certificate Number: 1118670 Cmc Section: Block: Lot: Building Permit:28805Z Ell NS11 1S Described as a Residential occupancy,wherein the premises electrical system consisting of 5 electrical devices and 5 wiring, described below, located in/on the premises at: 5 5 Outside, PooUSpa, 5 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5 5 found to be in compliance therewith on the 14th Day of March, 2003. 5 5 5 Name OTY Rate Rating Circuit Type 5 Appliances and Accessories 5 Time Clock/Switch l 0 5 5 PooUSpa Bonding 1 0 5 5 Wiring and Devices 5 Receptacle 1 0 GFCI 5 Receptacle 1 0 20 amp PooUSpa 5 Fixture 1 0 Pool/Spa 5 Switch 1 0 General Purpose 5 GFCI Circuit Breaker 1 0 20 amp PooUSpa 5 (Swimming Pool): This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have frequent test and'or repairs made by a qualified person. 5 5 5 5 5 seal 5 1 of l This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 D LpLrL3'LpLLpLLpLLpLLILLI�LI@I nC.nC.nE.I@1111 IAC �LI�LI�C fCJ�CPC PLIC fC fC @l�C @I@PC fC1@PLfC1@I�LI@l@J�C C fC fL1�C fIJ�i fi f� 05 A 4 � t X Lig• _- - °ly. ��'. Board Of Southold Town Trustees SOUTHOLD, NEW YORK k PERMIT NO. SO4'4 DATE: ..Aug. 26, 1999 ARIF HUSSAIN " ISSUED TO ........ ........... A011nrizatinn Pursuant to the provisions of Chapter 615 of the Laws of I g the State of New York, 1893; and Chapter 404 of the Laws of the Y ° State of New York 1952; and the Southold Town Ordinance an-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;'.'. and in accordance with the Resolution of The Board adopted at a meeting held on ...Aug. 25 1 " 19 99 150.00 ! , and in consideration of the sum of $.. paid by ." AKIF HUSSAIN ........ ...... s, East Marion of .......... ........._...-�.......... ....... .. N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: t x Wetland Permit to remove a deck and above-ground pool and �rt install a new in-ground pool and dry wells as per approved J � plans dated June 29, 1999. all in accordance with the detailed specifications as presented in the originating application. ` IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. 'A .� QOg�FFOG�C o Trustees NEN YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ER EFFECTIVE DATE 0001 August 26 1999 OGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the EnvironmentaL r Conservation Law August 25, 2002 TYPE OF PERMIT ■ New ElRenewal ❑ Modification 11Permit to Construct ❑ Permit to Operate Article 15, Title 5: Protection ❑ 6NYCRR 608: Nater Quality ❑ Article 27, Title 7; 6NYCRR of Waters Certification 360: Solid Waste Management ❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR Supply 373: Hazardous Waste Management 11 Article 19: Air Pollution ❑ Article 15, Title 15: Water Control ❑ Article 34: Coastal Erosion Transport Management ❑ Article 23, Title 27: Mined ❑ Article 15, Title 15: Long Land Reclamation ❑ Article 36: floodplain Island Wells Management ■ Article 24: Freshwater Wetlands ❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ❑ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Arif Hussain (516) 477-3558 ADDRESS OF PERMITTEE P.O. Box 24 East Marion NY 11939 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Hussain property, 420 Lakeview Terrace East Marion LOCATION OF PROJECT/FACILITY SCTM #1000-31-9-11 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold (GP-1) Marion Lake DESCRIPTION OF AUTHORIZED ACTIVITY: Replace existing timber retaining wall. Construct stairway and dock, swimming pool and deck. All work is to be done in accordance with plans stamped NYSDEC approved on 8/26/99. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Roger Evans (SVA) Building 40 SUNY Room 121 Stony Brook NY 11790-2356 AUTHORIZED SIGNATURE DATE Page 1 Of 4 August 27 1999 BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: / /0 APPLICANT: DATE SUBMITTED:_/_/0 SCTM#DISTRICT: 1,000, SECTION: -531 , BLOCK: LOT: STREET ADDRESS: CITY: SUBDIVISION: PROJECT DESCRIPTION: ESTIMATED PROJECT COST: ARCHITECT./ENGINEER: FAST TRACK? SINGLE & SEPARATE CERTIFICATION-REQUIRED? NOTES: LOTS 40,000SF-100-24.Lot meognition.(CREATED before June 30, 1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger(A nonconforming at anytime after 7,1 ZONING DISTRICT: CONFORMING? 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 WATER FRONT? DESCRIPTION: PANEL #: 7 FLOOD ZONE: ,�701' APPROVALS REQUIRED —~ SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED #):_DTE:—/ / PERMIT#:R10- TOWN SEPTIC RECEIPT: Y or N NEW YORK STATE DEC: EaF-DEC 9w75 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 NYS ENERGY: YES OR NO : EGRESS (18 H min.? 4 sq total) VENT(SQ. FT. x 4%) LIGHT(SQ. FT. x 8%) BUILDING PERMITS OPEN/EXPIRED: BP -Z/C/0 Z- HAVE PRE CO'S • Y OR N BP -Z/C/o Z- NOTES: � lael� FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE 1. ( SF)- ( SF)= SF X $-=$-+$-+$-= $ 2. (-SF)-( SF)= SF X$ =$ +$ +$ = $ Albert J. Krupski, President '"O$UFF�(I{'C Town Hall James King,Vice-President �� V�j T 53095 Main Road Henry Smith � y� P.O. Box 1179 Artie Foster y Z Southold, New York 11971 Ken Poliwoda p • `� Telephone(516) 765-1892 y�J01 O� Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 26, 1999 Mr. Arif Hussain P.O. Box 24 420 Lakeview Terrace East Marion, NY 11939 Re: SCTM#31-9-11 Dear Mr. Hussain: The following action was taken by the Board of Town Trustees during its regular meeting held on August 25, 1999 regarding the above matter: WHEREAS, ARIF HUSSAIN applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated July 26 , and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 25, 1999, 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 standard 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, RESOLVED, that the Board of Trustees approve the application of ARIF HUSSAIN to remove a deck and above-ground pool and install a new in-ground pool and dry wells as per approved plans dated June 29 , 1999 . 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. Two 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 AJK/lms cc : DEC Bldg. Dept. .K '<> tr'{'' �<�T_�"A 'fiii' Y:P..4t •¢4 "/r:�... Board Of Southold Town Trustees t, SOUTHOLD, NEW YORK PERMIT NO. So 4 DATE: . Aug. 26, 1999 v e ARIF HUSSAIN ISSUED TO .. . . .............. . ..... ,�u#l�nri�atinn Pursuant to the provisions of Chapter 615 of the Laws of i the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- q` , titled "REGULATING AND THE PLACING OF OBSTRUCTIONS „ i� IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;". and in accordance with the ` Resolution of The Board adopted at a meeting held on ...Aug, 25 y 19 99 , and in consideration of the sum of $ 150.00 . .. paid by 'i t ARIF HUSSAIN t. .... .. ..................... .a of ... East Marion N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: t' Wetland Permit to remove a deck and above-ground pool and b n install a new in-ground pool and dry wells as per approved -, plans dated June 29, 1999. all in accordance with the detailed specifications as presented in the originating application. a IN WITNESS WHEREOF, The said Board of Trustees here- u' by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. Trustees �h New York State Department of Environmental Conservation Division of Environmental Permits Building 40 - SUNY, Stony Brook, New York 11790-2356 Telep6ne444-0365 AM Facsimile (516)516) 444-0360 taboo John P. Cahill Commissioner August 27, 1999 Mr. Arif Hussain P.O. Box 24 East Marion, NY 11939 RE: Permit No: 1-4738-02367/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address . Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Very truly yours, Asan AV. Ackerman Environmental Analyst SVA/ls Enclosure NEN YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-02367/00001 ■ August 26 1999 FACILITY/PROGRAM NUMBER(S) P E RM I T EXPIRATION DATE(S) Under the Environmental Conservation Law August 25, 2002 TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Permit to Operate ❑ Article 15, Title 5: Protection ❑ 6NYCRR 608: Nater Quality ❑ Article 27, Title 7; 6NYCRR of Waters Certification 360: Solid Waste Management ❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR Supply 373: Hazardous Waste Management ❑ Article 19: Air Pollution ❑ Article 15, TitLe 15: Water Control ❑ Article 34: Coastal Erosion Transport Management ❑ Article 23, Title 27: Mined ❑ Article 15, Title 15: Long Land Reclamation ❑ Article 36: FloodpLain Island WeLLs Management ■ Article 24: Freshwater Wetlands ❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ❑ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Arif Hussain (516) 477-3558 ADDRESS OF PERMITTEE P.O. Box 24 East Marion NY 11939 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Hussain property, 420 Lakeview Terrace, East Marion LOCATION OF PROJECT/FACILITY SCTM #1000-31-9-11 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold (GP-1) Marion Lake DESCRIPTION OF AUTHORIZED ACTIVITY: Replace existing timber retaining wall. Construct stairway and dock, swimming pool and deck. All work is to be done in accordance with plans stamped NYSDEC approved on 8/26/99. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Roger Evans (SVA) Building 40 SUNY Room 121, Stony Brook NY 11790-2356 AUTHORIZED SIGNATURE DATE Page 1 Of 4 August 27, 1999 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, agents, and assigns for all claims, suits, actions, damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and 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 Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities(SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg#40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. DEC PERMIT NUMBER PAGE 2 OF 4 1-4738-02367/00001 -T NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15(TITLE 5), 24,25, 34 AND 6NYCRR PART 608 ( FRESHWATER WETLANDS ) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove 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. 2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local government which may be required. 4. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. If upon the expiration 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 require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 8. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. 9. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by Robert O'Brien P E dated 7117/99 . DEC PERMIT NUMBER PAGE OF 4 1-4738-02367/00001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. A 7 foot buffer of undisturbed natural vegetation shall be maintained landward of the water body at all times. 2. Heavy equipment, including bulldozers, backhoes, payloaders, etc., shall not be operated in the water body. 3. Prior to commencement of any construction activities, a continuous row of straw bales shall be staked end to end along the upland edge of the buffer zone. The bales shall be maintained, repaired and replaced as oftern as necessary to ensure proper function, until all disturbed areas are permanently vegetated. The average useful life of a bale is approximately 3-4 months. Sediments trapped by the bales shall be removed to an approved upland location before the bales themselves are removed. 4. Any demolition debris, excess construction materials, and/or excess excavated materials shall be immediately and completely disposed of on an approved upland site more than 100 feet from any regulated freshwater wetland. These materials shall be suitably stabilized so as not to re-enter any water body, wetland, or wetland adjacent area. 5. All fill shall consist of clean soil, sand and/or gravel that is free of the following substances: asphalt, slag, flyash, broken concrete, demolition debris, garbage, household refuse, tires, woody materials including tree or landscape debris, and metal objects. The introduction of materials toxic to aquatic life is expressly prohibited. 6. All roof runoff and/or pool discharges shall be directed to drywells located landward of the retaining wall. 7. Use of wood treated with pentachlorophenol or creosote is prohibited. Standard pressure treated lumber is treated with CCA and its use is permitted. 8. Pressure treated lumber(CCA) used in this project shall: a. Be completely clean and free of surface deposits, b. Be washed for at least 5 minutes under running water to remove unfixed metals. The washing shall occur greater than 100 feet from the regulated wetland and/or water body. 9. All equipment and machinery shall be stored and safely contained greater than 100 feet landward of the regulated wetland or water body at the end of each work day. This will serve to avoid the inadvertent leakage of deleterious substances into the regulated area. Fuel or other chemical storage tanks shall be contained and located at all times in an area greater than 100 feet landward of the regulated wetland or water body. If the above requirement cannot be met by the permittee, then the storage areas must be designed to completely contain any and all potential leakage. Such a containment system must be approved by NYSDEC staff prior to equipment, machinery or tank storage within 100 feet of the regulated wetland or water body. 10.AI1 areas of soil disturbance resulting from this project shall be seeded with Switch Grass (Panicum virga to um) and mulched with straw immediately upon completion of the project,within two(2)days of final grading, or by the expiration of the permit,whichever is first. Mulch shall be maintained until a suitable vegetative cover is established. If seeding is impracticable due to the time of year, a temporary net shall be applied and final seeding shall be performed as soon as weather conditions favor germination and growth. 11. Suitable vegetative cover is defined as a minimum of 85%area vegetative cover with contiguous unvegetated areas no larger than 1 square foot in size. 12. The permittee shall incorporate the following language as a notice covenant to the deed: "Regulated freshwater wetlands associated with NYSDEC Wetland GP-1 are located on or near the properties of Arif Hussain and his heirs, assigns or successors. This property is subject to the provisions of Environmental Conservation Law(ECL)Article 24, and the conduct of regulated activities may occur only pursuant to ECL Article 24 if prior approval is given by the New York State Department of Environmental Conservation (NYSDEC)or its successor(s). Regulated activities include, but are not limited to clearing of vegetation; application of chemicals; excavation; grading and filling; and erection of any structure(s)." This deed covenant shall be recorded with the Clerk of Suffolk County within 90 days of the issuance of this permit. A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be sent within one calendar year of the issuance of this permit to: NYSDEC, Regional Manager Bureau of Habitat, SUNY Building 40, Stony Brook, New York 11790-2356. D1-4738-02367/000EC PERMIT NUMBER PAGE 4 OF 4 01 NYSDEC Commencement Notice Am Bureati of Habitat dbk/ SUNY, Bldg. 40 Stony Brook, NY 11790-2356 0 Permit No: 38-�a3 6 Issued To: HussaINLI Contractor's Name: Contractor's Address: Contractor's Phone No.: To whom it may concern: Pursuant to Supplementary Special Condition D of the above referenced permit you are hereby notified that the authorized activity shall commence on The permit sign will be posted at the site and copy of permit will be available at site for inspection. Submitted by: This notice is to be sent at least 2 days in advance of commencement of the project. Failure to notify or post will leave owner and/or contractor subject to applicable penalties for non-compliance with permit conditions. Cut along this line NYSDEC Completion Notice AM Bureau of Habitat IMAM SUNY, Bldg. 40 Now Stony Brook, NY 11790-2356 Permit No: I " 38'W36 Issued To: 5GL Contractor's Name: Contractor's Address: Contractor's Phone No.: To whom it may concern: Pursuant to Supplementary Special Condition D of the above referenced permit you are hereby notified that the authorized activity was completed on Submitted by: This notice, with photos of completed work and/or completed survey, is to be sent to above address promptly upon completion of project. Failure to notify will leave owner and/or contractor subject to applicable penalties for non-compliance with permit conditions. 95201 (Mn-9d New York State Department of Environmental Conservation vNOTICE v The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Regional Permit Administrator Permit Number 38"Da36 JOHN W. PAVACIC Expiration Date 9/003- /Roo NOTE: This notice is NOT a permit ll[l�l%1Nie:I:JiiNlltilt/\lllllillq/iilllllllllliiii/ilr'1lllirill//\\///ii/ilillliiin/lllliiiiiiiliiiiiiii ' riii\\i■Nim^.nrJl:iL�i >,9•.IiL3al:E7I_rR7I■■■■riiiiii//N:9r�la:II1■rr/\lr■/irrrrr■■■riiiiY■!■iiiiii\l■r/liiiiii iiir.%!s\r■tAiiiilir►Iiia\lliriHlri■l/!iiiiiiiiiiiii■riiiiiiiiiiii\iiiiiiii■iiiiiiiNi■iiiii■■■i■■iiiiii ■/ell■■�i■/iii■■■i\iii\l�Irtl!��Iiiil■■l■■■■iiiiiiiiiii\■iiiiiiii\■■iiiiiiii■■■■iii■Ir�277I:a12712�Ri7E7FJ■ iNii■\!%7►�liiiisml/l►liiiLlrlirl!_7►,IJl�lrrliiiiiiiiii\lllllliiiliiliiiiiiii/■■/iiiiiiilll\ii■i!%\iiiiii iii/■rGi;1i\iiiililii\1i/illi!.riiiilillilliii■\i\i//iiiiiii/ii\iliiiiiiiiiliiiiiiiii•L�7!J/7�Ii7Y[J72i■■e " iiiiii:dii\lillil��i7llli/.iR■■■!S//IJii rii//lillillliiiiiilllliiiiiiil iiiii//illliiliiiiiiiiliiiii liiNllrlllllri�C��r�:\illi.■�r�lll'rJ�ll.��allllllllliillllllilli/llllliliC/illllllliiiillllliiii/iilil /il�■7iilllll/.11.,91.Z1lS�IL►CnIi►..��..�......iilllllllllllliiiillllliliiiiiliiliiillllliiiiiiillllliiiiii ir,llkllti■■■■■■rl/./.i L[iiNiNl\10 iiS,.w Illllliil■■Iliiiiillliillilliiiiilliiiiiiiii■iiiiiiiiiiiiiiiiiNii■riiiiii lllR`lNiiii/l!■■Lii4iil■�tli\i:�L1711■■■■■i■■■a■■■■■■■i!lCiCilN/illllliiii/iillllOii/iiiiiiiiiiiii■iiiiiii lliLSlNiii\li■ii►�\iNil►�■■1'\IrN,'/SP■uu■�■■Iliiilllliiiiiiirii■iiiiiiii/iiiiiiiiiiillliiiii/iii!■iiiiiiii liif►/liiilliliill/iiiii/.■C:7\�ltr911■■■■��11■iiiiiii!%G/LJ'L.\irlliiiiiiiiliiiiiiiilliiiiii/iiiii\iiiiiiii iiNPii�\illillil\llWliNr4?►0Ii!911iilllllllll�\\ii/iii llnl+alb%t:JrA7i■1t■■■■■■■■m►;=r.611■■■■■■■■■Illi\\lllii�ll/i/lllllllilillllCllii/lllllliiililllllliiiiiii� /i►sur/imilLr�llclllllllirlai�diu■■■■■■■■■nli\llllllllllliii/\llllllliiiilllllllllllllllii/iiilililliii lrlC9iillllllli:C\liltill.\Ii iNllllllllllilllll\\lliliiliiilllllliiNNOir7r�r7/ii/.li■�l�.l/illiiliiiiiiiii lrir�riillliiiiil!iiNlll►./ilrii r7[1:=========a iiiiii/iii/illlliiiiii/ille�LG["7liG:iii!•.ri.vliiiiiiiiiioii !MPlN■Nilliiii117.'i!\Nlli!\I■/rl Il��liiiii/Il,lliiii\\\iiiii/�leiiiiiiPr000�r��___'ii/iiiiiiiiiii irll!aiiiilllli►YrC!!!i\lwE1►iGIQi�-----��\iiiiii\\iiil7CR7f47iiiiC�`�"_..��.a...i ..■■rdiiiii/iii lL ll4�rNiilliiiiiPl'loll!■ii►lN®i�11Ct2i�lEL1�117\liiiiii►:�ii1Ci1!9■ Li7iiiii��iiiii/iiiii\iCiiiiiiiiiiOi/■i� NiiiriN\iilliiiniiClG7■lIlii\IN I9r■IIJr:tY1i■■II�Irii\iiiiii:\illliri■i/i/iliiiiiiiiiiiiiiiiiiiiiiiii\i/■iii/i\ iii\\Niilii\lily[1//r/i�A.:.1�lrgrlllli\iiiill��\�I\7iiii�i►`Oi\iiiiiiii/iiiiiiii\/i\iiiiii\ii\iiiiii\■■iiiiii rN■ii.�iR79'�Illill!:C7li■►.7li�IClillli/iilllll�l\iiri\ii/ill\`iiiii/iiiiii ilii/llliiiiiiillliiiii/elliiiiiii\ iNlYi■r■liiiillilin■!�� .Li-1l/�liuiilllliullii.[■aliiii►��■_il_ill iN.■V7■R>1I[7ilfllr!�Gi■Niel[\i\le►A71/1[i lllliillllii6lLl0iiiiii►lir..""`__=-__--=`�-_'=rca■�rli■Uiiiiilliiiiii■■■ iN'!C�IiiR227I2.Ill■ii[�JNr■C�h`IiIS!!/IIT liiiiil■lilll►ll■oiiiiir lllii��iiii�i iliiili■■■��■r■i]iiii/iiiiiiiiiiiNNN ir'i eYiiiiiiilliiii/tillillii\I■G:2 i11M\iiiiillll/ilei\`\ll►iiiii LI■iiiiiiiiir■Iliiiiiiii■N e.rlhliii■iii\!ilii■■■■■ ■riiill!■ii■iiiii■■■MrJti'/.Gd 111■6.J i1�8 iii■i■I■iiiiiii\LI■►`\■ii rii/i■■■■■■iiipir■i■■■■//iii rllW■lSwneC�\■■i■■i■■ ■■Nil■i■■ii\■ii[!iG{A�%iii illYa ill!\\iiiillllliiiiii\\rl►\■N■liii■iiilliN�:7iiiiii■■ri■■1!DI,�NISiY:IiICf:\■■■ilii iilNiiifii/■J■rrrG. FdC`!�S�lGIll111�iiiiiiilliiiiiNii\/'■\\r■iiiiiiiliO Rlliiiiiii/\!■r1►4![AiM!.:��r::'1\N■■■1■ iiiiiii■iiiliiiiiilrVGi►lINGN\I!S!�lliiilllliiilllliii\\[\\■iiZa!11G9/\Ar,lr/■iiiii■■!■.wXyRo tri1GDC\Gi\■■■■■ \itiilliiilliiiiilai\sir.►.r�./JlNlarailllZiil/Iiii1L:1■liii1�..!—=_---=5 'yl_••••.■■ur1�'.li►:/�;G/\■rY►Z:\1i►7■■■■ iiiiiNilllllii/ll7iiiil.■N'iAd■11►�\1'Ilillllll\ll:■iiiiii\\■Il ri!c7l��tl■r■1;;lru �.�=_=■%Mlt�:r\A�!\iC'^.►li\\i■iO iiiiiiilli/■■illIii/lNillll■DA`i11I OLS\lllllil�311rmi/illlil�olc�tilu_I��iiNlriiiii■liilfA l:�►irfiC._^;.'f.�iGii.111iiii ■iiiiiliiiiliii�ii/llriiiliiNAIICGIiI\\rill■r11!biiliiiiii\�iiii.GG��_��■4■Mfill\ii'P43�*.n.7iil�illi■ii iriiiiiUilllUYiiil!%iiii�l[17\ani'•[9=\\Ilriil!1�'Iiilliiiiii/Ili�liiiiiiiiii!/i■iiiiilli Irlliiifc'ir2�.77YiiillAlliiii ■�ilNiiiiiilJ'ihx773'iiiii)'i1lSlilliiiiii\:flliili!■iii\iiiiNill■7iiiiiiiiiii■■■iiiiilli!'JII■■ilfN,';:9rie■�h,;Itiiii ■iiri■riiiillNiiG°1�L►•17�1ir►`°.■w!�Iliiii■G:�IIIN:�:\iiiiiiii■liillil■iiiii■■■■i\iiiii■■■l I/IIY.11ii[�>`�:�::1ii/L91►1■■■■ ■\iii■rlliiGiii■i/iiiii^.ill■rJ NlliiiiiYi11L161i\\iiiiiiili\■IIIINiiiiii/i■■■■iiiiii/1I■IJL'7l\iNir■\e\t/IICi'I■■■■ ■iNllliiiiil�i\l V/iiiiiNl■l:■\,\aiiiiiD■11/ilii'\.�\iiiiiliilYlllLiliii//lllilJiiiiiiiit ill.ry\\'L'7i�1L47L1I�►iiii■i iiiliiNiiinirli/17iE7lLil.CiNriiliillliillllLliit,!'°�!illlliN�tlllLillilli►IE'/.�iiiillill it \'11:]\\rL' 3r.f3:/Ii/ill iiiiiiC■ll\liirEi%Llli■iil./rA1711liiiiiillllLliPIGtA V`l►9iiiNAllirill�iiii\%%illliiii011l�i►`I1:91�-�:/R7@%■■N■NN iiNiill'111/lvill/97.1�'L1iliR■III1�11liiiilillllLIF11►cilli\►Ni��\II['AS'f.��/��//�illllll►%l101itll\l�'�IL•L73TR�li�i6iiii�ii■ N■NNEN\ irrll\iiilllllllLl[\iiiO3.1►.)wnr'illi■rooGr�..��'!rr:<.%'�■■llillC Zr►��•��5ircf�7!/.•Ipi iiiiiil'iiii/iiiiii/•I■illi\flla■IliiiiillllllNlliErIIIc\!rii■l�dliiiiiiiiE'/.. :�iiiiiii\■llill■■■■■fi=�_�■■■■■■i■i ii■ii�rAiiiiriliiilli■Illi\iilll■alli\\illlllllriBl��1\iiiii/iii\Iliiiiiiiiifk iliiiiiiiiillillliii.i/_%.+.- r,FI.:4/.�1ei i/■NiiNr■■■■1■rii..iia■■SIiiIClilliiiiilllllilMiiiiiiiiiililliiiiiiil/7diiiiiiiiiil illiii7liiiiiiiiiii■■■■ iiilil��lillliiii/iiililiiiil�llllllliliiillNitil%iiirir■■riinrR'l�llliiNiiiii\iiiiil/IINCYiis!/iiN■■eiiJiii liNNll►iilliiiiLlllliN/i/illlulilliiiiiillNli[�lillliiiiiir/unllll■■iiliiiiii/iililll'al!ilifiii■iUU■■N■■Ni i�iillrriiiilllilhfr�7/illlV`■Illiiii/ilirli■illlliiiiiiR7iliilll■liiiiiiiiillii0'T•Iiiiiiiiii/i■NNlR■lir iiiiiii,iiN■llllllil� :�llllllYlilliiiiillllrllllNllil/iiia./illllllii/i/iiiiiilliiAi4uiiiiiiiiilliiiiiiN\r iiiliil;ii■ llllliirLXta7lN�eilyCeiuiililllll■\■Aliiii ^ - •' -� iiiNiil/iilllliiiiiiilliliilY.7:■iiillllllilliiiii, iiiNiil■iNilliriiiii/l/iliilE%Niiiliiililliiiri/r NNNNNNL iiiiiiiiiiiiiiNii■■il I.'°'-�7l::7.7_Zi�lliiiiiir � ■!NN■■liNii/iiiiiiilii/lNiilel�i■irraarn.%eiiiiiiii ■ieNiif r■iiia■■■■■iiiii■■■■!r■iii■ii■iii■i■iiiii - i�lrii\iiiiiiiiiilliiiiiiii■iiiiiiiiiiiii/i/ilii i!J7_Ti�YNNii■iillliiiiiiiilllliiiiiiiiii/illllliii \c...r^;rrNr�zyyrws:�rr�rl�:eszeisa:_a�l�rrr..+s[riiN ROBERT O' _ - iiNNiri//■Yil`YiiiiiliiliiiiiNiiN/liilliiiiiiiillMOM iiiiiiNiir�lOLC6C7iC51i�ft�JiilSliPif{=acro iiiiiii NNii\■i■i<6iiiiiii/rYiiiiiiiiNNNgrii/iiriiiil■r ' ii■■■lNiiiliiiilllNi■iiiiiiii■/i/iiiiiiii\■NNW CONSULTING ENGINEERING SERVICES ill■N■Nii!.!r�fi'J�7ilE7i��CL•R22f17a9./iiiiiiiii■Nii , �' ii\■Niii■iiiiiiY\li/iiiiiiiiiiiiiiiiiiiiii/■■iii �� lir■Niiiiiii/ieiilli�JliiiiiNiieiiiiiiiiiiiiriNtit Main - -Road, Laurel, 11S48 11NNii■\iiiii�iiB\■■'I�iiiiiiiiii■liiiiiiiiiiilii - ii■■i■N■UEL37F'iiC:�af::3SLD7Nn77!/J7�!77E�'JGLC7PlJ/R7 �DRAWING NO. ■■■iiiiiieliiiiiiiiiiiiil�i/ii■riiiiiiiii■i■■■'rQ , ' ■■iliiiiiNlii�■■iiiiiiili■■■!■■■iiiiiiii■i■■■■ih7 p� NNiiiR�e'�'�r8!9:.,.J■■rw7we�:llf■■■■■iiiiiiiiiii■■iYNe/6' ` ' • ■■■iliNliiiiii■■■iiiiiiili■■■■■iiiiiiili\■■■■■i■1 ■■■iiiiiiiiiiii■■■iiiiiiiir■■■iiiiiiiiiii■■■N■■N� ■lriiiiiiNiiiiiii■iiiiiiii■ii■iiiiiiiiiiiii■■■■NI , - _ ■■N■iiiiNiii■■ii■■■iiiiii■■■i■■■iiiiiiiiNi■■■■■■ M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ] IN LATlON [ j FRAMING [ FINAL [ ] FIREPLACES CHIMNEY REMARKS: & (X-- 1 - DATE INSPECTOR 4" ' �� 7GS-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: zt DATE D v INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS ION [ ] FRAMING INAL [ ] FIREPLACE & CHIMNEY REM KS: DATEC9 INSPECTO FIELD INSPECTION REPORT DATE COMMENTS �� R FOUNDATION ( IST) r-- n n u IIS---- FOUNDATION (2ND) � - II Ii it JI O C ROUGH FRAME S ° n o II JI --- -- PLUMBING ii ii J n it - I IIIt - II II II _ _ ___________________________ . ------ -------_ --_________________- _____ _____ _______ Iy j�j INSULATION PER N. Y. it n - > STATE ENERGY CODE u u II It u ___ __ --------------------------- �TI H = II ✓ (J — II µ —t l�cT it a FINALit 11 R ADDITIONAL COMMENTS: , H f, r m b A -1 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAIL 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: L 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: L 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, Swinuning 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. 04i—14 — O ES New Construction: " ��Old or Pre-existing Building: (check one) Location of Property: 4 O ZA1*-_ 6W ;R_�ACF ZA7 8 �f�lO ti, d�y If 4 g House No. Street /I Hamlet Owner or Owners of Property: Ak i g rl 11jaA J'fG4Z AItj Suffolk County Tax Map No 1000, Section to f Block ()(0C) I Lot—_ 01/ Subdivision�t {gyp Filed Map. Lot: / Permit No. p apQS Date of Permit. Applicant: kir zyz\! Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: ._ (check one) Fee Submitted: $��O J a2�3�� C �20q / pp t A lic t tature BOARD OF HEALTH �._. FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . BLDG.DEs• TOTOWN OF SOUTHOLD SURVEY . WN D SD . BUILDING DEPARTMENT CHECK . . . TOWN HALL SEPTIC SOUTHOLD, N.Y. 11971 'f7 1, ��•�_ TEL: 765-1802 NOTIFY: f / pp Examined....91;2q........ 1911. �0 CALL MAIL I�:O CaQx, . . . . . . . Approved....rl.[ZR....... 19 Q� Permit No. Disapproved a/c .................................. .!e/ta�T 1:� •r�lyj.W',1.�.� ........................................ .... ........ / (Building t ) APPLICATION FOR BUILDING PERMIT 77 Date. .O,l.�. .of 1. . . . . , 19.lqq .� INSTRUCTIONS a. This application mist be completely filled in by typewriter or in ink and submitted to the Building inspector wi 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan stowing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property mist be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in rtnole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS 13EREW MALE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ............................ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) xIfsrMA-RrolJ/ N�/-//q 39 State whether applicant is ower, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .....................................................'.I..........I..•.'.a.....A...............+..................................... Name of owner of premises ..Ai>a F..Au ZSAX kl...� ..11�N Ir.r..f1.:�Ic�J��1•�............................. (as on the tax roll or latest deed) If applicant is a corporati/on,,� signature of duly authorized officer. ......................!.: 17....................... (Nae 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.............................................................. .:de. fll� �liE.kl . RR�c, ---..�mr ......................... Haase Number Street Hamlet Canty Tax Map No. 1000 Section .. �......... Block ... .......... lot ... Subdivision ...................................... Filed Map No. ............... lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: W lorl .M AVIAW a. Existing use and occupancy ....::�.�............................rNeYrraH•una><r•^v�7'•'.;•.:'i WiATON......• OR b. Intended use and occupancy ... /%...T. .L/.................... tm!}:�.�..,.il ......... 3. VoLure of work (check idridh applicable): Pie, Building .......... Addition Alteration .•...... Repair Removal ..f De ml it ion p ............ Other Work .....I. (Description) 4. Estira[ed Cost .... :'� ........._.. fee ......... (to be paid on filing this application) 5. If dwelling, number of dwelling runts ............ Number of duelling units on each floor //��y 'T� /L.[��W✓i'< If garage, ember of cars .............lu O.N,r.,................ ,-1 6. If business, coonercial or mired occupancy, specify nature and extent of each type of use..... .jq ......... 7. Dirmnsions of existing structures, if any: Front................ Rear ............... Deptlh .. . .............. I@ight .........:.......... ..... Number of Stories ...................... Dimensions of same structure With alterations or additions: Front _• Rear ......... ...... Depth .................... Height Number of Stories 8. Diuensions of entire new construction: Front ................ Rear ............... Depth .......... .... Height ......................... Number of Stories ..................... 9. Size of lot: (tont Rear Depth.................... .................... 10. hate of Purchase ..................... Nae of Former Owner II. Zone or use district in which promises are situated ............................................... ............... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..............• 13. Will lot be regraded .................... Will excess fill be removed from premises: YES NO 14. Names of Owner of premises ...... Address7AwsFlrTf�I'l�1% r.I � Phxxre No J/. 477.-Aa Name of Architect ��•5'J'/`� ,�I�, 031 Rare No.7i�f-I.q .................................... Address ....... Name of Contractor ................................... Address ...............................bane No. ............ 15. Is tris property Within 300 feet of a tidal wetland? * YES . *117 YES, SOUND TOIdi TRIMIMS PIMMIT MAY BE W!gnRED. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block ember or description according to deed, and show street names and indicate whether interior or corner lot. DATE: gI2oI4r( y�� r r �I FEE: —1PVT. _ - 1. /�'� — 2 GC Y P."I' -ii;. -. c:': .T AT (l U NOTIFY 1/ i6,) ,802 9 L.P.° 'r) 4 F'rv1 r "' TIrE FOLLOWING INSPECTIONS 1 FOUNDATION - TFVO ELC.JIr,EL. "IMMEDIATELY" FOR POURED CONCRETE ENCLOSE POOL TO CODE 2 ROUGH FRAMING & PLUMBING UPON COMPLETION 3. INSULATION BEFORE"MATER" 4. FINAL - CONSTRUCTION MUSTI ( � fCun BE COMPLETE FOR C.O. 4-U , .l a, f 1 ALL CONSTRUCTION SHALL MEET REQUIREMENTS IS UNLAWFUL THE REGUIREEN7S OF THE N.Y. STATE CONSTRUCTION & ENERGY. �, �=ROUT CERTIFEC,?; CODES. NOT RESPONSISI E rr1F' o f' DESIGN OR CONSTRUCTION ERRC)f' OF OCCUPANCY SPATE OF NTd WW ("USTE L ti i C Ll Ll SS OJIINIY OF ...... ................. UNDERWRITERS CERTIFICATE REQUIRED """' :. .J`... �71d S / .� :/��•�� ............... s being duly sworn, deposeand says that he is the applicant (Na , e of individual signing, contract) above ivni ed, lie is the ...................................��tiv :7f. ..-................ (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 statonents 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 before me this ..... J. .....day of ..J l )h�L.y.�.7. 19 . ./r, !.•1 Notary Publi .( y.....(.....!-:!.f.[. Y. .. / (Signature of Applicant) NOTARYPUBLIC Stats of New York N0.01& 0201132 0ua11Bed In Suffolk County SURVEY OF PROPERLY , i 51TuJ,TE: E^5T MARION TOWN: 50UTHOLD w Land noor erly of: N Jeffrey fformorm �'SUFFOLK COUNTY, NY E - 98.20'sr 5UR/EYED 06-24-q9 N55047120 f y s �Q gate _ ofe SUFFOLK COUNTY TAX u —` 1000 - 31 - 9 - 11 fe_ 5tol:kade E I 0.4' S. fence \ &rPROVEll A.. ��f1 ,SLL // >oPhUIL L.• /S•B ..• ♦,o tii7,111.?t[?;:5 CERTIFIED TO: ANP �IDOOC{ 3 ,O ARIF HU55AIN O �b5, .// � ♦ i \ L S , 9 �.l A- . 4k 44, G Brr • i G�c � , p.b ♦. + r+ r k' iw � r+ - 110 Ott �_i ! ,�' ,�WAIG_ _; 9•J \♦ • M YYC le. Y � / V• \ ,��Q\ °�.� •> t, •. a e'er, / � moi' V JEitf� e • Id- \ M 36 6• r �I y,/ ��• EL /7•� 1`t {• � 1/nn O _ r S55°47'20„w 159.26 PSE Of NEW YO o .,” ® „ . • ® / 5� QRS F. O. R r >: Hyl• O O 00 ii„ REVISIONS If SSA 1,A1 N os2111` V. N07E5: �FESSIONP�'� � ROBERT O'BRIEtV P.E. MONUMENT O24f R•O.�I• CONSULTINC3 ENGINEERING SERVICES PIPE -el G AREA = 12,813 SF OR 030 ACRE-5 210.0' Main Road, Laurel, N.Y. 11948 - 3 O KEY/EW T.f�• E.aS7 /�?AiC io�t/ DWN /q _ GRAPHIC SCALE 1'= 20' SCALE DRAWING NO. SHEET DATE 7 9 f-/ / ! / ., OF SURVEY OF PROPERTY SITUATE: EAST MARION TOWN: SOUTHOLD Land no,, orWi I I amSy of: � ,\ � COUNTY NY Jeff y \ �xl�/r: SUFFOLK SURVEYED 06-24-44 N 5 5 047'20►'E 98.20o SUFFOLK COUNTY TAX # gates �Cv�1D fe \ �/ 'v lobo - 31 - 4 - II fe. Stockade I ; o.415. fence i of % \, CERTIFIED TO: OIL,- -1yIQTRKEScif ARI F HUSSA I N � O � 245 � \+ <� 6o Io IDe moot` G WA4- 4- FO-OL- M 36.61 , r „W 159.26 y S55 47 20 Lanj now or formerly of : N Walter E. 60ip13 OF NFA, O Linel I C�aipa �Q'�o N C Ey�F9`O '11nauMorliee altneedion o aedit ion to a surrey S wap Pear inq• ]icenaed bnersurvaror'a seal i N (/� A iPlat{Pn or,action 7209, fuP-eiviaion 2, oratne r - hek York state Education Law.- y 'On1Y ccP{ef Stow the or i9inal of this Survey 7� 1 maW d with an original of the land s ,.yor'f st,.rkd seal,hall be c .W.ree to Pe-liE tru! NOTES: 1� IJ CPP iee' `r r • 'I /.. 'Ceti{/{cations indicated hereon Signify Loaf this MONUMENT ^ furry was Prepared in acc-.once kith the as- ' �aO aW• ��-Y �� 04�V O Land athe ee oYork Stat a iAsaoc iatir L.dn ofd SUrProfesaionai o PIPE 24 1� , YPrf. Said certification,,hall run only S t0 tht Perfen fOr whew the furrey i,prepared. and on hie behalf to the title c wpany, g-rnwen- �A ND SJ tel s9encr aha lending institution Tutee hereon. ane to the•sitinees of the ]end inq institution. Certifica- AREA = 12,873 5F OR 0.30 AGF tionssare not transferable to additional in 210.0' JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPH I G SCALE I"= 20' RNERREAD,N.Y. 11901 369-8288 Fax 369-8287 REF.-TIGER\PROS\99-202