HomeMy WebLinkAbout31119-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30908 Date: 05/10/05
THIS CERTIFIES that the building NEW DWELLING
Location of Property: OFF EAST END RD FISHERS ISLAND
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 11 Block 1 Lot 4
subdivision FiledMap No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 10, 2005 pursuant to wtmich
Building Peri,it No. 31119-Z dated MAY 10, 2005
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 ONE FAMILY DWELLING WITH COVERED PORCHES~ FIRST AND SECOND FLOOR
TERRACES A~D SCREENED PORCH AS APPLIED FOR.
The certificate is issued to RICHARD A MILLER
(OWNER)
of the aforesaid building.
SUFFOLK COUIFI~ DEPARTMENT OF H~ALTtI APPROVAL R10-00-0134
ELECTRICAL C~RTIFICATENO.
PLUMBERS CERTIFICATION D~'~u3
Rev. 1/81
2042186
11/02/04 GLENN GELLO
o3/ol/o5
02/04/05
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-30909 Date: 05/10/05
THIS CERTIFIES that the building ACCESSORY
Location of Property: OFF EAST END RD FISHERS ISLAND
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 11 Block 1 Lot 4
Subdivision Filed Map No. __ Lot NO. --
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 10, 2005 pursuant to which
Building Peru%it NO. 31119-Z dated MAY 10, 2005
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 TWO CAR GAP~AGE AS APPLIED FOR.
The certificate is issued to RICHARD A MILLER
(OWNER)
of the aforesaid building.
SUFFOLK COUN~ DEPARTMENT OF I{EALTH APPRO%rAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DA'r~
N/A
2042186
N/A
02L0¢/05
Rev. 1/81
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT ./ .~.~.,.
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY ~--.-' ~
This application must be filled in by typewriter OR ink and submi~~ding
inspector with the following: 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 lZ lead.
5. Commernial 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.
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 a nonsent to inspect signed by the applicant.
Ifa Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees ~A
i. Certificate of Occupancy - New dwellin dditions 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 Buildine - $I00.00
3.Copy of Certificate of Occupancy - $20.00
4.Updated Certificate of Occupancy - $50.00
5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . .~ ...................
New'Construction ........... Old Or Pre-existing Building..
Locatmon of Property ..... C ...... ~-~..-~. ................. ''''
House No. Street Hamlet
O f P perry ...........
Onwer · '' · ...............
County Tax Map No 1000, Section...-~..~l ...... Block .... ~.~-~.~ ..... Lot ..... -~',~ ...........
Subdivision~~. lt~ ~ Filed Map Lot ·
Permit No...--~T%~.....'..~...Date. -~Of Permit./;¥A'.' ...... /...appx~canc..~ ..... ..~ ............
~ - · · b'" . . Underwriters Approval V .....
Health Dept. Approvaz ........................ ' ................
Planning Board Approval .................. i .....
Request for: Temporary Certificate. Final Certicate ...........
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. 31119 Z Date MAY 10, 2005
Permission is hereby granted to:
RICHARD A MILLER
425 LEXINGTON AVE
NEW YORK,NY 10017
for :
CONSTRUCT ONE FAMILY DWELLING AND ACCESSORY GARAGE AS APPLIED FOR.
THIS PERMIT REPLACES BP26788.
at premises located at OFF EAST END RD FISHERS ISLAND
County Tax Map No. 473889 Section 011 Block 0001 Lot No. 004
pursuant to application dated MAY 10, 2005 and approved by the
Building Inspector to expire on NOVEMBER 10, 2006.
Fee S 2,148.00 ~, .,~~.~re~./
ORIGINAL
Rev. 5/8/02
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUII~)ING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 26788 g Date SEPTEMBER 22~ 2000
Permission is hereby granted to:
for :
RICHARD A MILLER
425 LEXINGTON AVE
NEW YORK~NY 10017
DEMO EXISTING HOUSE & GARAGE & CONSTRUCT 1 FAM. DWELLING WITH FIVE
BEDROOMS~ TERRACES~ PORCHES AND ACCY GARAGE AS APPLIED FOR AND PER DEC.
Swiping pool not included.
at premises located at
County Tax Map No. 473889 Section 011
pursuant to application dated MAY
Building Inspector.
OFF EAST END RD FISHERS ISLAND
Block 0001 Lot No. 004
18~ 2000 and approved by the
Fee $ 2~148.00
COPY
Rev. 2/19/98
TOWN OF $OUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX'?28 ',.
TOWN HALL
SOUTttOLD, N.Y, 11971
C E RTI F I CA'T I ON
TEL. 765-i 802
Date.
Building
Owner
Plumber
Permit NO. ~7~--'Z
· (please print)
(please print)
I .certify that the solder used in the water supply system
contains less than 2/10 of 1% .lead.
.(plumber's signature)
Sworn to before me this
~ur~ day of ~q~
.Notary'Public,~County
Public
Public St~ ~ New Yo~
NEW
BY THIS CERTIFICATE OF COMPLIANCE THE
YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET .~ NEW YORK, NY 10038
CERTIFIES THAT
Upon the application of
upon premises owned by
Z & S CONTR. INC.
P.O. BOX 202
FISHERS ISLAND, NY 06390,
RICHARD MILLER
ISABELLA BEACH ROAD
FISHERS ISLAND, NY 06390
Located at
ISABELLA BEACH ROAD FISHERS ISLAND, NY 06390
Application Number: 2042186
Certificate Number: 2042186
Section: Block: Lot: Building Permit: BDC: ns11
Described as a Residential 3000-3600 square t't. occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
Basement, First Floor, Second Floor, Detached Garage, Outside, Attic,
A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed
herein, was conducted in accordance with the requirements of the applicable code and/or standard
promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
authority having jurisdiction, and found to be in compliance therewith on the 4th Day of Febma~'.2005.
Name QTS' Rate Rating Circmt Type
Alarm and Emergency Equipment
Sensor
Sensor
Appliances and Accessories
Exhaust Fan
Dish Washer
Pump Motor
Fmxtace
Air Conditioner
Air Conditioner
Air Conditioner
Panels
2 0 Carbon Monoxide
9 0 Smoke
4 0 F.H.P.
2 0 1.2 KW
I 0 I H.P.
1 0 Oil
1 0 40 Amps
1 0 30 Amps
I 0 20 Amps
1 100 14
Wiring and Devices
Outlet 120 0 Fixture
Fixture 105 0 Incandescent
Fixture 15 0 Flourescent
Outlet 256 0 General Purpose
Contmued on Next Page I of 2
seal
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU Of ELECTRICITY
40 FULTON STREET ~ NEW YORK, NY 10038
CERTIFIES THAT
Upon the application of
upon premises owned by
Z & S CONTR. INC.
P.O. BOX 202
FISHERS ISLAND, NY 06390,
RICHARD MILLER
ISABELLA BEACH ROAD
FISHERS ISLAND, NY 06390
Located at
ISABELLA BEACH ROAD FISHERS ISLAND, NY 06390
Application Number: 2042186
Certificate Number: 2042186
Section: Block: Lot: Building Permit: BDC: ns1 t
Described as a Residential 3000-3600 square ft. occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located m/on the premises at:
Basement, First Floor, Second Floor, Detached Garage, Outside, Attic,
A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed
herein, was conducted in accordance with the requirements of the applicable code and/or standard
promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
authority having jurisdiction, and found to be in compliance therewith on the 4th Day of February,, 2005.
Name QTY Rate Ratim~ Circuit
Receptacle 115 0
Switch 152 0
Receptacle 1l 0 20 amp
Receptacle 4 0 20 amp
Disconnect 3 0 60 amp
Receptacle 24 0
Service
I Phase 3W Service Rating 400 Amperes
Sen'ice Discomnect: 2 200 cb
Meters: 1
Type
General Purpose
General Purpose
Appliance
Laundo'
Air Conditioner
GFCI
seal
2 of 2
This ceAificatemay not be altered in any way and is validated only bythe presence of a raised seal atthe location ~ndicated.
04/20/2005 16:07 FAX 631 788 7798
FITELEPHONE
7GS-18OZ
BUILDING DEPT.
INSPECTION
~]002
[ ] FOUNDATION tST [ ] ROUGHPLBG.
[ ] FOUNDATION2ND [ ]INSULATION
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
DATE
INSPECTOB~~~~
STATE OF NEW YORK )
) SS:
COUNTY OF SUFFOLK )
Oliver Cope i being duly sworn, deposes and says:
That deponent is over the age of 18 years and resides at
151 W 26th St., 8th Fl., NY,. NY 10001-6810
That on the/~ day of /~¢¢ ~ , 2000 deponent architect/engineer,
v
licensed by the State of New York, hereby states that s/he accepts full
responsibility for the accompanying plans compliance with the New York State
Fire Prevention and Building Code (9 NYCRR); said plans pertain to property
located at SCTM# 1000o 011-1-4
street address s. side of Isabell~=~a~h R~d'~private road),
1300 ft. S. of East ~,~/,q/r ~a~
End Road, Fi rs Island NY.
Arch~e"ctJEr~ neer
.~.rn to befo~ roe.this
day of /~/..~ ,2000.
Notary Public
cc: Applicant
Adam Graehler
Notary Public, State of New York
No. 41-5001894
Qualified in Queens County
Commission Expires September 27~, ~000
New York State Department of Environmental Conservation
~;vf~_i,~r~ of E.-.viro?...~e,~tal ~3ermit~, ~egfn_n O.n.e
Building 40 * SUNY, Stony Brook, New York 11790-2356
Phone: (631) 444-0365 · FAX: (631) 444-0360
Website: www.dec.state.ny.us
John P. Cahdl
Commissioner
July 28, 2000
Mr. Richard A. Miller
1095 Park Avenue
New York, NY 10128
RE:1-4738-02665/00001
Dear Permiztee:
In conformance with the requirements of the State Uniform Procedures
Ace (Article 70, ECL) and its implementing regulations (6N-YCRR, Part
521) we are enclosing your permit. Please read all conditions care-
fully. If you are unable to comply with any conditions, please
contact us at nhe above address.
Also enclosed is a permit sign which is ~o be conspicuously posted
az the project site and protected from ~he weather.
Very? truly yours,
,,/ 'v ~-' ,., ,' ~'~'"'/
~.Laura J. Scov~zo
Environmental ~alys~
LJS:cg
enclosure
NEW YORK STATE OEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER
1-4738-02665/00001
Under th~ En¥ir~nmentaL
EFFECTIVE DATE
July 28r 2000
July 31, 2005
TYPE OF PERMIT · New [] Renewal [] Modification [] Permit to Construct [] Permit to Operate
Article 15, Title 5: Protection
of Waters
Article t5, Title 15: Water
Supply
Art(tlc 15, Title 15: Water
Transport
Article 15, Title 15: Long
Islancl Wells
Article 15, Title 27: Wild,
Scenic and Recreational Rivers
PERMIT ISSUED TO
Richard k. Miller
[] 6NYCRR 608: Water Quality
Certification
Article 17. Titles 7, 8: SPOES
[] Article 19: Air Pollution
Control
Article 23, Title 27: Mined
Land Reclamation
[] Article 2&: Freshwater Wetla~s
· Article 25: Tidal Wetlands
Article 27, T(tle 7; 6NYCRR
360: Solid Waste Manage~nt
[] Article 27, Title 9; 6NYCNN
[] Article 34: Coastal Erosion
[] Article ~6: Floodplain
Articles I, 3, 17, 19, 27, 3?;
6NYCRR 3~0: Radiation Control
TELEPHONE NUMBER
C212) 727-1225
ADDRESS OF PERMITTEE
1095 Park Avenue
New Yorkt NY 10128
CONTACT PERSON FOR PERMITTED ~RK TELEPHONE NUMBER
JMO Environmental Consulting Services
PO Box 447,Quogue NY 11959-0447 (631) 653-0607
NAME AND ADDRESS OF PROJECT/FACILITY
Miller Property
No # Private Roadr Fishers Island
LOCATION OF PROJECT/FACILITY
COUNTY TOWN WATERCOURSE NYTM COORDINATES
Suffolk Southold BLock Island Sound
DESCRIPTION OF AUTHORIZED ACTIVITY
Demolish existing single family dwelling. Construct new single family dwelling, garage, driveway, pool, deckinR, fence
ar~ septic system. Negrade area adjacent to new dwelling. All work shall be in accordance with NYSDEC stan~oed approv~
By acceptance of this permit, the permittee agrees that the permit is contingent uF~n strict co~liance with the
ECL. all applicable regulations, the General Conditions specified (see page 2 & 3) a~ any Special Conditions included as
part of this permit.
John,S,id / LJS
AUTHOR~
m
,SUNY, Stony/ 'ook, gY 117 D- BS6
Page 1 of 4
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 ~nQemmty an~t 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 avadable for
inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon
request ~)y 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 BJdg #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 I PAGE 2 Of 4
1-4738-02665/00001
I
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 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.
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.
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.
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 Richard Strouse, dated 4124/00, revised 5/8/00.
DEC PERMIT NUMBER [ ( PAGE 3 OF4
1-4738-02665/00001 --
NEW YORK STATE DE~PARTMENT OF ENVIRONMENTAL CONSERVATION
SPECIAL CONDITIONS
1. The permittee shall cause all exposed faces or disturbed areas to be vegetated to prevent soil erosion prior to the
project completion or expiration date of this permit, whichever comes first.
2. There shall be no discharge of runoff or other effluent on, in or down the bluff face or onto the beach.
3, Necessary erosion control measures i.e., haybales, silt fencing, etc. are to be placed on the downslope edge of any
disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to
be maintained in good condition until thick vegetative cover is established.
4. There shall be no draining of swimming pool water directly or indirectly into tidal wetlands or protected buffer areas.
5. Sanitary system (bottom of tank and leaching pools) shall be located a minimum of 2' above seasonal high
groundwater.
I DEC PERMITNUMBER I I PAGE 4 of 4
1-4738-02665/00001
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AREA = 112,970f S.F. (2.591 ACRES).
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