HomeMy WebLinkAbout30645-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31202 Date: 10/11/05
THIS CERTIFIES that the building ADDITIONS/ALTERATIONS
Location of Property: 1160 GOOSE CREEK LA SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 78 Block 8 Lot 5.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 10, 2004 pursuant to which
Building Permit No. 30645-Z dated SEPTEMBER 20, 2004
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 ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY,DWELLING AS
APPLIED FOR & AS PER CONDITIONS OF ZBA #5541 DATED 8/24/04 .
The certificate is issued to GRAHAM & BARBARA HEAD
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ 1044034 11/04/02
PLUMBERS CERTIFICATION DATED 09/27/05 GARY STAHL
A thorized Signature
Rev. 1/81
O rJ�i PcPrJ�rJ��PrJ�rJ�r�rJ: INC: ii: :I E: r�rJ�0 J'PLPr PLLrL3PLLPrrJPLrl�fi PrJi PrJ�r farlrJ arJ@PrJ�r�rPrJ�cP�PrJ�i P�PrJ�rJ@PrJ�P�rJ�rJr��PrJ�rSrJ� o
SBY THIS CERTIFICATE OF COMPLIANCE THE 5
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
SBUREAU OF ELECTRICITY e5
5 40 FULTON STREET - NEW YORK, NY 10038 C�5
CERT117IES THAT 7�
5 Upon the application of upon premises owned by �
5 TOP GUN ELECTRIC GRAHAM & BARBARA HEAD C5
f5� P.O. BOX 1464 GOOSE CREEK LANE
SOUTHOLD, NY 11971, SOUTHOLD, NY 11971 5
C7 Located at GOOSE CREEK LANE LAST HOUSE ON RIGHT SOUTHOLD, NY 11971
Application Number: 1044034 Certificate Number: 1044034
c5 Section: Block: Lot: Building Permit: BDC: NS11 5
Described as a Residential occupancy, wherein the premises electrical system consisting of 5
5 electrical devices and wiring, described below, located inion the premises at: 5
5 Basement, First Floor, Second Floor, Detached Garage,Outside,Attic, 5
5 5
r5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5
found to be in compliance therewith on the 4th Day of November, 2002. 5
5 Name OTY Rate Racine Circuit Tspe 5
5 additional Charges 5
5 rough done on paper app,
5 when originally submited 5
5 Alarm and Emergency Equipment 5
5 Sensor 1 0 Carbon Monoxide 5
5 Sensor 9 0 Smoke 5
5 Appliances and Accessories 5
55 Exhaust Fan 1 0 F.H.P. 5
Furnace l 0 Gil
5 PumpMotor 1 0 F.H.P. 5
5 Water Heater 1 0 4.5 KW 5
5 Dish Washer 1 0 1.2 KW 5
5 Panels 5
1 60 4 5
5 Wiring and Devices 5
5 Receptacle 41 0 General Purpose 5
l
Switch 41 0 General Purpose seal 5
Fixture 39 0 Incandescent NContinued on Next Page 1 of 2
`�] This certificate may not be altered in anyway and is validated only by the presence of a raised seal at the location indicated. 5
5 5
D rJ arJ�rJ@Pr�rJ acPrPrJ�rJ�[PcP�f a rJ�rJ�rJ�rJ�rJ�rPr��PrJ�rJ�rJ�tPrJ�r�rJ2l-L3rJffl@Pr Qflr3rJ�rJPLrJ�rJ�rJ�rPrJorJ�[PrJ�rJ�rPrJ�rJ�rJ�rJ�rJ�rPrJtJrJrTI[P
l7 �ncPrJ@n clrJ�r�rSrJ�rJ�rJ�rJrJ�rJ�rJ@PrJ�rJ�r�rJ�c rrJ�rJ�rJ�cnr�rJ�rJ�rJ�r��PrJZnrJ�rJ�rJ@nrJ�rJ�rJ�rnrJ�rJ�rJ�rJ�cPrJ�u�rJ@nrlu�rJ��rIJ�rJ�rJ�rJ@nrJ� o
5 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5
NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 BUREAU OF ELECTRICITY 5
5 40 FULTON STREET — NEW YORK, NY 10038
5 CERTIFIES THAT 5
SUpon the application of upon premises owned by
5 TOP GUN ELECTRIC GRAHAM & BARBARA HEAD 5
5 P.O. BOX 1464 GOOSE CREEK LANE C5
CCC7775 SOUTHOLD, NY 11971, SOUTHOLD, NY 11971 5
Located at GOOSE CREEK LANE LAST HOUSE ON RIGHT SOUTHOLD, NY 11971 CC
Application Number: 1044034 Certificate Number: 1044034 S
5 Section: Block: Lot: Building Permit: BDC: NS11 5
Described as a Residential occupancy, wherein the premises electrical system consisting of 5
5 electrical devices and wiring, described below, located inion the premises at: 5
5 Basement, First Floor, Second Floor, Detached Garage,Outside, Attic, 5
5 5
r5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5
found to be in compliance therewith on the 4th Day of November,2002. 5
5 Name QTY Rate Rating Circuit Tvoe 5
5 Dimmers 3 0 5
5 Receptacle 1 0 20 amp Laundry 5
5 Receptacle 1 0 30 amp Dryer 5
5 Receptacle 5 0 GFCI 5
5 Service 5
5 l Phase 3W Service Rating 200 Amperes 5
C5� Service Disconnect: 1 200 cb 5
Meters: I
5 5
NEI 5
5 5
seal 5
5 5 5
2 of 2 5
55 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
5
D rJ-Qj'L3 L3rL3 PLL PrJ�r3pr1iJ�[PrJ�rJ@f�fcPrJ�rJ�r�rJ�rJ�rJ@P�PrP rJ�rJ�rJ�rJ�tPrJ�rJ�rJ@P�Pr�cJ�[PrJ�rJ�rJ��rJ�r�rJ�rJ�rJ�rJ�rJ�rJ�rJ�r1rJ�tPrJ�rJ�rJ�[P o
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Toren Hall.51095 Main RoadFaz 631 O l I
766-9501-
P.O.
66-9502P.O. Box 1179 y�Ol �aO� - Telephone (631) 765-1802
Sou hold. Neje fork 119'1-0969
i
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date: ( Z7
Buildinu Permit No. �3 c>(e 4kA ✓ D 6 ` �
Owner: 6'[ vv'\'- kk
>
(Please print)
Plumber: G �
(Please print)
I certify that the solder used in the water supply system contains less than 2,10 of 14 o
lead.
( lumbers Signature)
Sworn to before me this
to
day of - 206S
v� zztilQj-
(
Notary Public, LCounty
JANET V.STE'R:U%T
NOTARY PUBLIC,Sale cf Ncw Y,rh
No.5243%33?`;5
Ouott--t IF 5-'4"A C L-Itv
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. 30645 Z Date SEPTEMBER 20 , 2004
Permission is hereby granted to :
GRAHAM & BARBARA HEAD
55 WALKER ST APT 5A
NEW YORK,NY 10013
for
ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR PER ZEA, DEC W/ FLOOD PERMIT AS REQUIRED
at premises located at 1160 GOOSE CREEK LA SOUTHOLD
County Tax Map No. 473889 Section 078 Block 0008 Lot No. 005 . 001
pursuant to application dated SEPTEMBER 10 , 2004 and approved by the
Building Inspector to expire on MARCH 20, 2006_
Fee $ 457 . 60
orized Signature
ORIGINAL
Rev. 5/8/02
' �gpFFO(,�c .
APPEALS BOARD MEMBERS pv OG Southold Town Hall
Ruth D. Oliva, Chairwoman hp y` 53095 Main Road
Gerard P. Goehringer Cy z P.O. Box 1179
Lydia A. Tortora • Southold, NY 11971-0959
Vincent Orlando T' p! Tel. (631) 765-1809
James Dinizio, Jr. �Ol �p Fax (631) 765-9064
-�
http:,/southoldtown.northfork.net
` I
BOARD OF APPEALS
TOWN OF SOUTHOLD
bio — a R DINGS, DELIBERATIONS AND DETERMINATION
I MEETING OF AUGUST 2, 2004
Application No.554f'__G�ham Head
Property Location: 1160 Goose Creek Lane, Southold
CTM Parcel Id: 78-8-5.1
SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under
consideration in this application and determines that this review falls under the Type II category of
the State's List of Actions, without an adverse effect on the environment if the project is implemented
as planned.
PROPERTY FACTS/DESCRIPTION: The applicant's 43,870 sq. ft. parcel has 160 ft. along the
north side of Goose Creek Lane (a private right-of-way), 256.11 ft. along land of Paul Maloney, and
two sides bordering a dredged channel and Goose Creek waterway, in Southold. The property is
improved with a single-family, two-story frame house, an accessory garage, and detached arbor
structure, all as shown on the March 14, 2002 survey prepared by Fox Land Surveying, updated
February 9, 2004.
BASIS OF APPLICATION: Building Department's May 3, 2004, Notice of Disapproval, citing Code
Section 100-30A(3) in its denial of a building permit application concerning proposed new
construction, as follows: (a) an enclosed addition to the dwelling, attaching the accessory building,
which accessory building is presently in a nonconforming side yard location, at 3.2 ft. from the
easterly side line, and (b) a new addition over the existing garage area, after attaching the existing
garage and made an integral part of the principal dwelling structure, all as shown on the map
updated February 9, 2004 by Fox Land Surveying, and rough diagrams prepared by Regi Weile,
Architect, with a ZBA date-stamp of May 14, 2004.
FINDINGS OF FACT
The Zoning Board of Appeals held a public hearing on this application on July 15, 2004, at which
time written and oral evidence were presented. Based upon all testimony, documentation, personal
inspection of the property, and other evidence, the Zoning Board finds the following facts to be true
and relevant:
AREA VARIANCE RELIEF REQUESTED: The applicant wishes to increase the living area of the
existing dwelling from 924 sq. ft. to 1859 sq. ft. with the proposed additions. The use of the enlarged
principal building will continue as a single-family dwelling, and the garage will remain in its present
location at 3.2 ft. from the side property line.
REASONS FOR BOARD ACTION: On the basis of testimony presented, materials submitted and
personal inspections, the Board makes the following findings:
•Page 2—August 2,2004
ZBA No.5541 —Graham Head
CTM 78.8-5.1
wn
1. Grant of the relief requested will not produce an undesirable change in the character of the
neighborhood or a detriment to nearby properties. The proposed new construction will not it p se
the existing setbacks. CuCA f
2. The benefit sought by the applicant cannot be achieved by some method, feasible for the
applicant to pursue, other than an area variance. The applicant would have to build an entirely new
foundation and building instead of this proposal to simply building an addition (enclosed breezeway)
and adding it to an already existing building.
3. The variance granted herein is substantial. The current setback of 3.2 feet will not change.
4. The difficulty was not self-created. The house and the garage were built before the imposition of
the zoning requirement.
5. No evidence has been submitted to suggest that a variance in this community of single-family
residences will have an adverse impact on the physical or environmental conditions in the
neighborhood.
6. Grant of this relief is the minimum action necessary and adequate to enable the applicant to
enjoy the benefit of additions, while preserving and protecting the character of the neighborhood and
the health, safety and welfare of the community.
RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing
test under New York Town Law 267-B, motion was offered by Member Dinizio, seconded by
Member Goehringer, and duly carried, to
GRANT the variance as applied for, as shown on the plan updated February 9, 2004 by Fox
Land Surveying, and rough diagrams prepared by Regi Weile, Architect, with a ZBA date-
stamp of May 14, 2004.
This action does not authorize or condone any current or future use, setback or other feature of the
subject property that may violate the Zoning Code, other than such uses, setbacks and other
features as are expressly addressed in this action.
Vote of the Board: Ayes: Members Oil
(Chairwoman), Orlando, Goehringer, Tortora, and Dinizio.
This Resolution was duly adopted (5- . )
. hl)
Ruth D. Oliva, C airwoman 8/4/04
Approved for Filing
FIELD INSPECTION REPORT DATE COMMENTS
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P.O. Box 1447, Mattituck, NY 11952 • (631) 445-1461
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULA
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FRAMING / STRAPPING FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAF I PECTION
REMARKS:
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DATE 3-30 INSPECTOR
Dominick Salvati & Son Architects
Fre I ,
October 24, 2004
Building Department
Town of Southold
Town Hall Annex
P.O. Box 1170
Southold, NY 11971
Re: Graham and Barbara Head
1160 Goose Creek Lane
Southold, NY
Permit# 30644 Z
Dear Sirs.
Site observation this date reveals that the footing and foundation waterproofing conform
to standard practices and the New York State Building Code.
Sincerely,
Anthony M. Salvati
pFICHIT
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c- rr tirnrl. �uur. 1ti()4. BiOOkl`, n, Pvl' 11 _li1 1 „v. ,
Dominick Salvati & Son Architects
December 4, 2004
Building Department _g 17
Town of Southold
Town Hall Annex
P.O. Box 1170
Southold, NY 11971
Re: Graham and Barbara Head
1160 Goose Creek Lane
Southold,NY
Permit# 30644 Z
Dear Sirs,
Site observation this date reveals that the framing, structural elements and strapping of
the new garage and breezeway additions conform to standard practices and the New York
State Building Code.
In addition, the rough plumbing inspection conforms to standard practices, and the waste
line water test was successfully performed in accordance with New York State Building
Code requirements.
Sincerely,
Anthony M. Salvati
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OF
, l „urrtii � � t. �uu� t�U+. Lir�� r4<I� ri. U\ 11 'i � l I i41x , Er,x�;
Survey for:
GRAHAM HEAD
gpPROz �w.M. APPRO K Y 9 D P C
VED AS PER TER11.($ At
CI N -30-IX 4E AND CONDITIONS of y
•fLPERMIT NO, I-� Bayview
COG •y9 ,. - ---- s Z°/o oazo/ Town of
O� oho.N"N6q Q ,� Southold
GO . . 2 Suffolk County, New York
AODS
SOLNEMYEOCE OFEMA BY
♦� ' 9JITOIA ENNORNMENTAL
consmnnc.INC ON FEB. 2z 2002. S.C.T.M.: 1000-076.00-08.00-005.001
1 i / 40
�Ajti e`•' I 0 I iD
/ 6 �� SCALE:1"=40'
NOTES:
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o
0. Ib O 'O 1. AREA = 43,870 S.F. (TO TIE LINE)
ADJACENT AREA = 41,374 S.F.
z 2. ■ = MONUMENT FOUND, = LIGHT POLE
3. REFERENCE DEED L. 4624 CP. 216
aY O
4. ELEVATIONS SHOWN HEREON ARE REFERENCED
o5ti 2 TO N.G.V. DATUM (MSL 1929).
W I I \ d-I& q0 2, O 0 5. THIS PARCEL IS WITHIN FIRM ZONES SHOWN
S- 3 13 HEREON AS INDICATED ON FIRM BOUNDARY MAP
O10
.I� 7 co NO. 36103CO166 G LAST DATED MAY 04, 1998.
T"� \ O N ,1 6. PROPOSED FEMA BOUNDARY AS PER SKETCH
Z i ,� \\ WELL Mb �B G 01
/n9 PROVIDED BY SUFFOLK ENVIORNMENTAL CONSULTANTS,
Z PROPOSED IST INC. ON MAR. 27, 2002.
STORY ADDITION
COVERED 7. CESSPOOL LOCATIONS AS PER OWNER.
f.. \ S
ENTRY ..3.2PROPOSED 2ND (� FEB. 9, 2004 NO. LOW WATER MARK
„o STORY ADDITION APR. 23, 2002 W.PROP. BEARxIcs:DIST.\ :m:. MAR. 27, 2002 IND. PROP. FEMA UNE
\ D)w �
STORY
GA
FliAME ..: ".. RAGE
DATE: MAR. 14, 2002
\ 20.6 0 JOB NO: 2002-103
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NO '/5.1,0 \ ARBOR OVER m 3 ,n
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Q �� �• \ \ \ z CERTIFIED T0: .
GRAHAM HEAD
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ADJACENT LOT COVERAGE:
.y \ ' / \ , T{LP�'� EXISTING
9jJ � \% / 15� ,6000 HOUSE = 942 S.F. OR 2.3%
!/ OZ� • \ GARAGE = 618 S.F. OR 1.5% DAVID H. FOX N.Y.S.L.S. #50234 X00 " Y/ 35p0 WPB TOTAL = 1,560 S.F. OR 3.8% FOX LAND PO
O BOX224
2
�I 1 500 /•�O"� \G1� O� PN�1 PHOUSEROPOSED 942 S.F. OR 2.37. S(6311) 325-2902 2
i
/ ��•�� \ �0QQQ GARAGE — 618 S.F. OR 1.5% UNAUTHORIZED ALTERATION OR ADDFnON TO THIS SURVEY
IS S OP THE W YORK STATE
ADDITION - 299 S.F. OR 0.7% EDUCATION LAW.AOLAflONOCOPESOOFYTIIE SIRVEY M P NOT BEARING
THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL
SHALL NOT BE CONSIDERED TO BE A VALID 1RVE COPY.
TOTAL = 1,859 S.F. OR 4.5%
CERTFICATON INDICATED HEREON SN RUN ONLY TO THE
PERSON FOR WHOM THE SURVEY 15 PREPARED AND ON HIS
BEHALF i0 1}IE nRE GOAIPANY, GOVERNMENTAL AGENCY
AND LENDING Irv5➢IDnON LISTED HEREON AND TO THE
ASSIGNEES OF THE LENDING N"TUTION. CiRTFIGAn ONS
ARE NOT TRANSFERABLE TO ADDITIONAL INSn NnONS
OR SI,RSEOUENT OWNERS
DWG: 2002-103
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P.O. Box 1447, Mattituck, NY 11952 • (631) 445-1461
New York State Department of Environmental Conservation AM
of Environmental Permits, Region One
Building 40 -SUNY, Stony Brook, New York 11790-2356
Phone: (631) 444-0365 • FAX: (631) 444-0360 _
Website: www.dec.state.ny.us
Erin M.Crotty
Commissioner
April 12, 2004
Barbara Head
55 Walker Street
New York, New York 10013
Re: Permit #1-4738-03290/00001
Head Property, 1160 Goose Creek Lane, SCTM # 1000-78-8-5
Dear Ms. Head:
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 carefully read all permit conditions and special permit conditions contained in the
permit to insure compliance during the term of the permit. 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.
Sincerely,
Naomi Brown
Environmental Analyst
cc: Regi Weile
MHP
file
95-20-1 (11/09)-0d
New York State
Department of Environmental Conservation
vNOTICE Am
� r
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 the approved
work and any Department conditions applied to the approval,
contact the Regional Permit Administrator listed below. Please
refer to the permit number shown when contacting the DEC.
Permit Number W-
I Regional Permit Administrator
�
f -
Expiration Date
NOTE: This notice is NOT a permit
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER EFFECTIVE DATE
1-4738-03290/00001 April 12,2004
FACILITY/PROGRAMNUMBER(S) PERMIT 2,
EXPIRATION
April 1 2009
Under the Environmental
Conservation Law
TYPE OF PERMIT■New ❑ Renewal ❑Modification❑ Permit to Construct ❑ Permit to Operate
❑ Article 15, Title 5: Protection of Waters ❑ Article 17,Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR 373:
Hazardous Waste Management
❑ Article 15, Title 15: Water Supply ❑ Article 19: Air Pollution Control
❑ Article 34:Coastal Erosion
❑ Article 15, Title 15: Water Transport ❑ Article 23,Title 27: Mined Land Management
Reclamation
❑ Article 15,Title 15: Long Island Wells ❑ Article 36: Floodplain Management
❑ Article 24: Freshwater Wetlands
❑ Article 15, Title 27: Wild, Scenic and ❑ Articles 1,3, 17. 19, 27,37; 6NYCRR
Recreational Rivers ■ Article 25: Tidal Wetlands 380: Radiation Control
❑ 6NYCRR 608:Water Quality Certification ❑ Article 27, Title 7; 6NYCRR 360:
Solid Waste Management
PERMIT ISSUED TO TELEPHONE NUMBER
Barbara Head 631 765-0053
ADDRESS OF PERMITTEE
55 Walker Street, New York, New York 10013
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
Regi Weile, PO Box 223, East Marion, New York 11939 (631) 477-9735
NAME AND ADDRESS OF PROJECT/FACILITY
Head, 1160 Goose Creek Lane, Southold, New York 11971, SCTM If 1000-78-8-5.1
COUNTY TOWN WATERCOURSE NYTM COORDINATES
Suffolk Southold Goose Creek
DESCRIPTION OF AUTHORIZED ACTIVITY: CONSTRUCT A FIRST STORY ADDITION TO CONNECT
EXISTING SINGLE FAMILY DWELLING AND GARAGE, CONSTRUCT SECOND STORY ADDITION OVER GARAGE.
ALL WORK SHALL BE DONE IN ACCORDANCE WITH THE PLAN PREPARED BY FOX LAND SURVEYING, LAST
REVISED FEBRUARY 9, 2004.
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 3 &4) and any Special Conditions (see page 2)
included as part of this permit.
PERMIT ADMINISTRATOR: ADDRESS
Mark C. Carrara Region 1 Headquarters
Bldg. #40, SUNY, t ny Brook, NY 11790-2356
AUTHORIZED SIGNATURE DATE
Page 1 of 4
4
Ali i3 l oa
NOTICE OF COMMENCEMENT OF CONSTRUCTION _
RETURN THIS FORM TO: COMPLIANCE OR FAX TO: 631-444-0297
Marine Habitat Protection gamma
NYSDEC -
Building 40- SUNY
-y 73g-o3,2 o Y ,�Cx 90 r 1 Q R� 8 f�R6�b
PERMIT NUMBER: ISSUED TO:
PROJECT LOCATION/ADDRESS:
CONTRACTOR NAME:
ADDRESS:
TELEPHONE:
Dear Sir:
Pursuant to General Condition#9 of the referenced permit,you are hereby notified that the authorized activity shall commence on
We certify that we have read the referenced permit and approved plans and fully understand the authorized project and all
permit conditions.We have inspected the project site and can complete the project as described in the permit and as depicted on the
approved plans. We can do so in full compliance with all plan notes and permit conditions.The permit sign, permit and approved plans will
be available at the site for inspection in accordance with general Condition No. 1.
(Both signatures required)
PERMITEE DATE
CONTRACTOR DATE
THIS NOTICE MUST BE SENT TO THE ABOVE ADDRESS AT LEAST TWO DAYS PRIOR TO COMMENCEMENT OF THE PROJECT AND
/OR ANYASSOCIATED REGULATED ACTIVITIES. FAILURE TO RETURN THIS NOTICE, POST THE PERMIT SIGN, OR HAVE THE
PERMIT AND APPROVED PLANS AVAILABLE AT THE WORK SITE FOR THE DURATION OF THE PROJECT MAY SUBJECT THE
PERMITTEE AND/OR CONTRACTOR TO APPLICABLE SANCTIONS AND PENALTIES FOR NON-COMPLIANCE WITH PERMIT
CONDITIONS.
Cutalong this linex............................`...............................`............................$`......I........................`............................�`
...............................`
NOTICE OF COMPLETION OF CONSTRUCTION Aim
THIS FORM TO: COMPLIANCE OR FAX TO: 631-444-0297
Marine Habitat Protection Iowa
NYSDEC -
Building 40-SUNY
Stony Brook, NY 11790-2356
PERMIT NUMBER: ISSUED TO:
PROJECT LOCATION/ADDRESS:
CONTRACTOR NAME:
ADDRESS:
TELEPHONE:
Dear Sir:
Pursuant to General Condition #9 of the referenced permit,you are hereby notified that the authorized activity was completed on
. We have fully complied with the terms and conditions of the permit and approved plans. (Both signatures required)
PERMITEE DATE
CONTRACTOR DATE
THIS NOTICE, WITH PHOTO MPLETED SURVEY, AS APPROPRIATE, MUST BE
SENT TO THE ABOVE ADDRESS WITHIN 30 DAYS OF COMPLETION OF THE PROJECT.
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
SPECIAL CONDITIONS
1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix
trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas.
2. 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.
3. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted
activity.
4. The storage of construction equipment and materials shall be confined to within the project work site and or upland
areas greater than 75 linear feet from the tidal wetland boundary.
5. All disturbed areas where soil will be temporarily exposed or stockpiled for longer than one (1) week shall be
contained by a continuous line of staked hay bales/silt curtain (or other NYSDEC approved method) placed on the
seaward side between the fill and wetland or protected buffer area. Tarps are authorized to supplement these
approved methods.
6. 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.
7. Disturbance to the natural vegetation or topography greater than 25 feet seaward of the approved structure is
prohibited.
8. Roof runoff shall be directed to drywells a minimum of 100 feet landward of the tidal wetland boundary for
immediate on-site recharge.
9. This permit does not authorize any alteration, expansion or replacement of existing septic systems.
DEC PERMIT NUMBER PAGE 2 OF 4
1-4738-03290/00001
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
SPECIAL CONDITIONS
1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix
trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas.
2. 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.
3. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted
activity.
4. The storage of construction equipment and materials shall be confined to within the project work site and or upland
areas greater than 75 linear feet from the tidal wetland boundary.
5. All disturbed areas where soil will be temporarily exposed or stockpiled for longer than one (1) week shall be
contained by a continuous line of staked hay bales/silt curtain (or other NYSDEC approved method) placed on the
seaward side between the fill and wetland or protected buffer area. Tarps are authorized to supplement these
approved methods.
6. 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.
7. Disturbance to the natural vegetation or topography greater than 25 feet seaward of the approved structure is
prohibited.
8. Roof runoff shall be directed to drywells a minimum of 100 feet landward of the tidal wetland boundary for
immediate on-site recharge.
9. This permit does not authorize any alteration, expansion or replacement of existing septic systems.
DEC PERMIT NUMBER PAGE 2 OF 4
1-4738-03290/00001
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,and agents("DEC")for all claims,suits, actions,and damages,to the
extent attributable to 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. This
indemnification does not extend to any claims,suits,actions,or damages to the extent attributable to DEC's own negligent
acts.
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 accompanythe 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 in accordance with 6 NYCRR Part 621.
The grounds for modification, suspension or revocation include:
a) materially false or inaccurate statements in the permit application or supporting papers;
b) failure by the permittee to comply with any terms or conditions of the permit;
c) exceeding the scope of the project as described in the permit application;
d) newly discovered material information or a material change in environmental conditions, relevant technology
or applicable law or regulations since the issuance of the existing permit;
e) noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the
Environmental Conservation Law or regulations of the Department related to the permitted activity.
DEC PERMIT NUMBER PAGE 3 OF 4
1-4738-03290/00001
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608
( TIDAL 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 maybe 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 Fox Land Surveying.
DEC PERMIT NUMBER PAGE 4 OF 4
1-4738-03290/00001
Survey for:
K.�
APPRD% LWN NYSDEC GRAHAM HEAD
N$$'Q954"E AND APPROVED AS PER TERMS At
G CONDITIONS OF Bayview
_39.13'
ss, cNva OG39 - - - PERIU1 NO. I"� Town of
0 p 0.G,.N \,ro ag nATe� �{ I IBJ o Southold
GD 6 2 ' _+- Suffolk County, New York
VLNDWARG EDGE OF WETLANOS
BWNDARY AS D.LINEATEO BY
•� SUVTOLR ENNORNMENTAL
AA
A CONSULPNO. 'ec ON Fee v. zooz S.C.T.M.: 1000-078.00-08.00-005.001
^ , 60 V MD
Y �
? �y/
b !
SCALE:1"=40'
UII
P�' +
p NOTES:
o Oi �0� 1. AREA = 43,870 S.F. (TO TIE LINE)
/ y�a�aou. P4L4'+ o ADJACENT AREA = 41,374 S.F.
o� y �`��� O 2. ■ = MONUMENT FOUND, 0 = LIGHT POLE
3. REFERENCE DEED L. 4624 CP. 216
O^ 4. ELEVATIONS SHOWN HEREON ARE REFERENCED
/ o�dr°�i��yl. �.. Z TO N.G.V. DATUM (MSL 1929).
W I i \� / �o P59E• �e� ee' O O 5. THIS PARCEL IS WITHIN FIRM ZONES SHOWN
N
�. HEREON AS INDICATED ON FIRM BOUNDARY MAP
7 (DA NO. 36103CO166 G LAST DATED MAY 04, 1998.
N 6. PROPOSED FEMA BOUNDARY AS PER SKETCH
Q \ WELL
ry9/ PROVIDED BY SUFFOLK ENVIORNMENTAL CONSULTANTS,
Z \ IS� PROPOSED IST N INC. ON MAR. 27, 2002.
II \ V STORY ADDITION �. 7. CESSPOOL LOCATIONS AS PER OWNER.
I I \ CENTRED
\ ENTRY 3.2 PROPOSED 2ND (n FEB. 9, 2004 IND.LOW WATER NMN
STORY ADDITION APR. 23, 2002 IND.PROP. BEARINGS k 01ST.
\\ O
2 STORY p „ FRAME
MAR. 27,
2002
IND. PROP. FEMA UNE
FRAME GARAGE DATE: MAR. 14, 2002
uHOUSE Q JOB N0: 2002-10320.
(F.F.-10.5' BRIG, 27.9N (C.S.-3.0
PATO
ARBOR OVER I m o R i -
BRICK PATIO C
CERTIFIED T0:
/r COVERED \ m GRAHAM HEAD
•�: \ f Y \\ a STONE
ENTR
\O DRIVEWAY s 6�
0% 112
\yt9B ,2�E V
"p / 66.p, SD7 \
`', \ \ � � h \\ RDNoWAN ADJACENT LOT COVERAGE:
2\ \ a• P�\Y'�,A / p EXISTING
ro"MI5� Q00 HOUSE = 942 S.F. OR 2.3%
ZA a I ' \ / �6 GARAGE = 618 S.F. OR 1.5% DAVID H. FOX N.Y.S.L.S. #50234
pOs\ \' 3`'' FOX LAND SURVEYING
PO�( < `,' TOTAL = 1,560 S.F. OR 3.8%
(00
,I 5024
00 �'�O•� \GN` TtV- PROPOSED
= 942 S.F. OR 2.3% S(631) 325-2902
N. 2
56�•y3 R l�OOsE GARAGE = 618 S.F. OR 1.5% UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY
IS A VIOLATION OFiECFONI 7209 OF TME NEW YORK ]STATE
ADDITION = 299 S.F. OR 0.7% EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEAKING
ME LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL
TOTAL = 1,859 S.F. OR 4.5% SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.
CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE
PERSON FOR WHOM ME SURVEY IS PREPARED AND ON HIS
BEHALF TO THE PTLE COMPANY, GOVERNMENTAL AGENCY
AND LENDING IN STITEI LISTED HEREON AND TO THE
ASSIGNEES OF ME LENDING IN'iTNTION. CERTFIGATIONS
ARE NOT TRANSFERABLE TO ADDITIONAL INSO FETTONS
OR i1B5EOVENT OWNERS
DWG: 2002-103
-ftAMA. . - i ,R r Survey for:
APPROX. L.W.M. E,Y ' ':-t I �T•
�� ._ HEAD
N88"09'S4"E At
�� 39,13 __ � 3-4 BEDROOMS C.I. COVER
l _ _ Na,� O GRADE Bayview
�,..�' FF�t0.5
t\ p� ��al // _ FINISHED GRADE Town Of
091#*
V t_•�. / ELno.a u-ro.z Et-roz Southold
// _ 7 ' _ — - _ CRAWL SPACE n T .1.
GD — Suffolk County, New York
"O � ' / / A GA YD y L, ev _ io S.C.T.M.: 1000-078.00-08.00-005.001
1" 1 40 0 40
' ro.o� x ao'MK.
JK, � LANDWARD EDGE OF WETLANDS I �y.ACT
BOUNDARY AS OILINEATED BY GROUND WATER 1 T EL=2.4
SUFFOLK ENMORNMENTAL SCALE:1"=40'
? A 4MCONSULTING. INC ON FEB. 27, 2002 NOTES:
tT SEPTIC TANK CESSPOOL
1. AREA = 43,870 S.F. TO TIE LINE)
J� r ADJACENT AREA = 41,374 S.F.
CAL
2. ■ = MONUMENT FOUND, L} = LIGHT POLE
�}�+ 'O $UFFCLK COUNTY DEPARTMENT OF HEALTH SFOR A � 3. REFERENCE DEED L. 4624 CP. 216
° o CONSTRUCTION FOR A
/M1 a G_ik PERMIT Fon Aper OVAL OF 4. THIS PARCEL IS WITHIN FIRM ZONES SHOWN
r I /O',, Ed a° / Poa'`.'oAJ`a ti ti s y n SINGLE FACM1ILY RE=IDENCL- ONLY HEREON AS INDICATED ON FIRM BOUNDARY MAP
NO. 36103CO166 G LAST DATED MAY 04, 1998,
{,,,}//y�/-a' 5. PROPOSED FEMA BOUNDARY AS PER SKETCH
Ol` 1I `\ /epp PROP e p ^ �0-k- ! REF. N PROVIDED BY SUFFOLK ENVIRONMENTAL CONSULTANTS,
OPIN it `\ �' FENCE ' G DATEINC. ON MAR. 27, 2002.
M O \\ 1,-\B�. APPROVED 6. EXISTING SANITARY SYSTEM TO BE ABANDONED
.. rye ` \ r N Poa C3 U B OOMS PER S.C.D.H.S. REQUIREMENTS.
E p j 1 \ •' E P1LOP \P. FOR MAXIM 7. PROPERTY ADDRESS:
Ia O Z i 444 \ WELL TO 6E USED 1 A"' gPROPOSED ""TT E� FROM DAT F APPROVAL 1160 GOOSE CREEK LANE, SOUTHOLD, N.Y.
v) I FOR IRRIGATION Poa i v EXPIRES THREE Y
.. i I \ "": lI ow; DEC. 02, 2005 AMENDED LABELS
E' N 44I I \ _ D" WOOD 3'2 APR. 19, 2005 AMENDED PROP.INVERTS
E O I \ GOM RFD P OSEPATIO ARB0R TEST HOLE DATA MAR. 22, 2005 PROP.POOL A SANITARY
ENTRY n'Y. Att�D FEMW MCDONALD GEOSCIENCE FEB. 17, 2005 UPDATE SURVEY
y [ O 7 B1URY ', GARAGE MIH " wWR .A MAR. 1, 2005 FEB. 9, 2004 IND.LOW WATER MARK
CU i \ \ u�l E NOOSE r g 2W FLOOR WMO ORI p B O EL=7.B 0.0
APR. 23, 2002 IND.PROP.BEARINGS k OSI.
.� 11 \I \ u (C5�=30) ¢ o '2T 9?W 9 CE 00. .RC1 MAR. 27, 2002 IND. PROP. FEMA LINE
c y �'�-\ ( ro BE O DARK
DATE: MAR. 14, 2002
ARBOR OVER ri _
H " N \ `_.. 570' \ BRICK PATIO 5ra-- JOB N0:2002-103
00 C 1.0
.� N , N ���/ i \ I FEJ Ut u BROWN SILTY
CAN \ ��� i f-<iftvFE� °ro �____725A•______________��Im SAND
3.0 CERTIFIED T0:
-N .«L' •,� O Off \ \\ \k��// ��0h� \ \ ii / OSED`DP 1�•a_i` '^4. 65 BROWN FINE
i TO MEDIUM GRAHAM HEAD
C . -H TD• 176'
�pq+ NI •'k'pe` m ooe 1 SAND
U �•+ \\ ^' �q1 \ JWP \ I ^cP��4?.p' `t GW
�oWtV E'L 2.4 5.4
1% i \ J �pN WATER IN
O -\ \ \`0Q i U• ` \ 19.8 OWN FINE
`\ /r \ SAS/ J •IRO N77 ?eOPDSED m MEDIUM
.c �/ PLEASE NOTE SAND
� e.1j,P�'I.�ii3 pEANDUS 7.0
Q E $ `� y� $[L�� / �aP HaE D Ron Wp Sanitary System Tat to be instalEe ATER IN
9 ya�V
TP\% / *d?iLF \ TD pO RA EL c 1 under driveway. B WN SAND
FINE \/
?i . ? o \ ` a" 01\'� \ 13.0
y /
O /
35OO /\ / Wd\V`L+
o+j4014 \ ADJACENT LOT COVERAGE- DAVID H. FOX N.Y.S,L.S. ,#50234
1 w` FOX LAND SURVEYING
OD
SO' se01
ap\ /•W EXISTING: 64 SUNSET AVENUE
C � NES \ WESTHAMPTON BEACH, N.Y. 11978
1A,,A1AAnn P HOUSE & GARAGE = 1,866 S.F. OR 4.5%
1•II1R 2 2 561" R�GN� CREEK O\\gdl \ (631) 288-0022
rVI`.QO �\ °EYfW55 PROPOSED: UNAUTHORIZED ALTERATION OR ADDITION TO T1IS SURVEY
QG \ IS A VIOLATION OFSECTON 7209 OF THE NEW YORK STATE
\�
HOUSE & GARAGE = 1,866 S.F. OR 4.5% EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING
D\ 1 \uT4 THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL
— 900 S.F.
�DWa
POOL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.
I -
y-- _ -.._ -. -_ •Hd\\D \ PATIO = 493 S.F. CERTFICATON INDICATED HEREON SHALL RUN ONLY TO THF
PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS
loypl TOTAL = 3,259 S.F. OR 7.9Y" ANDALENDING INETTJTION COMPANY,
MDVI INAIEN A NG NC
ASSIGNEES OF THE LENDING INSTNPON. CER T FICATIONE
\ ARE NOT TRANSFERABLE TO ADDITONAL INSTNTONS
OR SUBSEQUENT OWNERS.
DWG: 2002-103
1'HOLD BUILDING PERMIT APPLICATION CHECKLIST
�u1NG DEPARTMENT Do you have or need the following,before applying?
fOWN HALL D 0 2004 Board of Health
SOUTHOLD, NY 11971 1 3 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
www. northfork.net/Southold/ PERMIT NO. S� Check
Septic Form
N.Y.S.D.E.C._
Trustees
Examined_ 120 Contact: —&U, R1
Approved ,20 Mail to:
Disapproved a/c 3 /
Expiration ,20_
CQ:]Z;?
_._-. - -- Building pe for
Z 6 APPLICATION FOR BUILDING PE
Date October
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit
sball be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
£ Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings,additions, or alterations or for removal or demolition as herein described.The
applicant agrees to comply with all applicable laws,ordinances,building code, housing code, and regulations,and to admit
authorized inspectors on premises and in building for neves ections.
< °VkEp Ch'A
S�
(Si ture of applicant or name,if a corporation)
u
'k P BOX 22 , EAST MARION, N.Y. 11939
(Mailing address of applicant)
ns2A
State whether applicant is owner, lessee, agent, arc general contractor, electrician,plumber or builder
Architect
Name of owner of premises Graham Head
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. _
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
1160 Goose Creel: Lane, Southold
House Number Street Hamlet
County Tax Map No. 1000 Section 07A Block Og Lot 005.001
Subdivision_ Filed Map No. Lot
(Name) —
2. State existing use and occupancy of premises and intended use and occupan4f proposed construction:
a. Existing use and occupancy one family Fesiidence
b. Intended use and occupancy no change
3. Nature of work(check which applicable): New Building Addition XX Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost $100,000 Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units One Number of dwelling units on each floor NA
If garage, number of cars Two
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
32.3' x 32.0' x 29.4'D
7. Dimensions of existing structures, if any: Front 27-0 ' x 27.0' Aear 23.0'D Depth
Height Z5' H Number of Stories two
Dimensions of same structure with alterations or additions: Front 3 3' Rear 73.3'
Depth 29.6' Height 25' Number of Stories two
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front 160' Rear 407.33' Depth 256'
10. Date of Purchase 3/02 Name of Former Owner Eps to i n
11. Zone or use district in which premises are situated Residential
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO X
13. Will lot be re-graded? YES_NO .K Will excess fill be removed from premises? YES NO K
14. Names of Owner of premises Graha+n Head Addressll60 Goose Creek L'Phone No. 765-0053
Name of Architect Ragi Weile Address PO 223 East MarionPhoneNo 477 9735
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES X NO
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetl - iS NO
* IF YES, D.E.C. PERMITS MAY BE REQ
16. Provide survey, to scale,with accurate found s a to property lines.
17. If elevation at any point on property is at 10 feet or below,mus r• de topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF )
Regi We i t e being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the Architect
(Contractor, Agent,Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
n
Sworn to before me thiys— �
day ofCom—20 0 q p
otary Public Signature of_Xppftt4nt
JOYCE M.WILKINS f
Notary Public,State of New York IJ
No.4952246,Suffolk County
Term Expires June 12, aOV2
BUILDING PERMIT EXAMINER CHECKLIST
DATE REVIEWED: 1//l/04
APPLICANT: .6mVa.k 4ew - DATE SUBMITTED: f /iV/04
SCTM#DISTRICT: 1,000, SECTION: �� , BLOCK: 8 , LOT: S. / SUBDIVISION: ti/A
ADDRESS: )/6/0 6,-sc Caeex Z4,CITY: ZONING DISTRICT:ft CONFORMING? fe-S
BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N BP o2&`/y/-Z/C/@Z=� , INFO "/,,
BP -Z/C/0 Z- , INFO BP -Z/C/0 Z- , INFO
SINGLE & SEPARATE CERTIFICATION-REQUIRED NOTES:
LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconfonning at any time after 7/1/83)
REQ. LOT SIZE: SACT. LOT SIZE: 93k-;b REQ. LOT COV. . ACT. L
REQ. FRONT Sb PROP. FRONT__�-�tEQ SIDE I � ACT. SID ,2 •►c zss
REQ. REAR PROP. REAR 'T REQ. HEIGHT PR . HT
PROJECT DESCRIPTION:-i�z A A&&i k 0t
ESTIMATED PROJECT COST. loomsCHIT /ENGINEER:
WATERFRONT? Ae5 DESCRIPTION: oorss C2et PANEL # FLOOD ZONE: hc(r
BULKHEAD? DISTANCE? C of'S'M#cra-�V 0,07-S,OW-,i
APPROVALS RL06UIRED
00
SUFFOLK COUNTY HEALTH DEPT: YES or 0 ED#): TE: _/_/_ PE T#:
4FOWN SEPTIC RECEIPT: Y or N SEPTIC CER IFICATIO or N � /
NEW YORK STATE DEC: 1 or NO DTE: &1 /'2- l PERMIT#:14-V31'03;*)
SOUTHOLD TOWN TkigiEES: YES o DTE / /_ PERMIT#:
TOWN ZONING BOARD APPROVALMDor N _ .ATE: /B^ / PERMIT#: �S`f
TOWN PLAN. BOARD APPROVAL: YES or
DTR. _/_/_ PERMIT#:
TOWN HISTORICAL PRE (SPLIA): YES
NEW YORK STATE CODE OMPLI CE (SEE PAGE 2) NO
NOTES: r Qrw,Aa v ow S
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: ��/ SF
SECOND FLOOR:
OTHER: -� SF INIT OTHER TOTAL
TOTAL: z ? SF FEE FEE FEE
DUSF — Q
ASF)- �_5.� )—_�9v� SFX$'J =$ow � +$ /J� +$ =$
2. ( SF)- _SF)= SFX$ =$ +$ +$ =$
3. ( SF)- SF)= SFX$ =$ +$ +$ =$
60
FINAL TOTAL: $ ���
NEW YORK STATE,CODE COMPLIANCE CHECKLIST
CLIMATIC/GEOGRAPHIC SIGN CRITERIA:
Ground Snow Load: 45 Wind Speed: 120MPH smic Design Category:B
Weathering: Severe Frost Depth:36" er te:M-H Decay: S-M
Design Temp: 11 Ice Shield Underlay: S Flood H ards:
USE/OCCUPANCY CLASSIFIC ON:
HEIGHT/FIRE AREA:
TYPE OF CONSTRUCTION:
DESIGN CRITERIA: ENGINE /PRESCRIPTIVE
FULL FRAMING DESIGN ELEMENTS: Y/N
HEADERS: Y/N WALL STUDS:Y/N GIRDERS: Y/N
CEILING JOISTS:Y/N FLOOR JOISTS:Y/N ROOF RAFTERS:Y/N
LUMBER SPECIES AND GRADE:Y/N
DESIGN LOAD CALCULATI S: Y/N
LIVE:Y/N DEAD:Y/N SNOW:Y/N SEISMIC:Y/N WIND:Y/N
WINDOW AND R SCHEDULE:
MISSLE TEST REQUIREMENTS:�/N
EGRESS 5.7 S.F.: Y/N
LIGHT 8%: Y/N
VENT 4%: Y/N
NAILING/CONSTRUCTION SC DULE: Y/N
MEANS OF EGRESS: Y/N
PLUMBING RISER D : Y
LOCATION OF ROT ION EQUIPMENT: Y/N
TRUSS DESIGN: Y/N
CERTIFICATION:
ENERGY C : Y/N
TOTAL C PLIENCE? Y/N(RETURN TO PAGE ONE)
pp ROVED AS NOTED
C'G"roA'R 5914 4E'S Y'f"1 DATE: B.P.N
FEEc`,`ZL
NOTIFY BUILDING DEPATrOENT AT
"'-'_' ^v-"'+`-TM^ *_"*"' -^'•'^,..-w"•^^^" "`^w- +Y`^- 765.1802 8A TO 4PM FOR THE
I FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE „/'" 4
2. ROUGH - FRAMING & PLUMBING
MLM""�- -+� 3. INSULATION
__'I........ . '� __-'_ i.. �,?'" -" •T_='*a _"' x. `w-�ci" a::�"., �", w ".�",x? w"'Ly'Pra�.--:.zrs-_ .,,"'n ?'FINAL - CONSTRUCTION MUST ..... '� -'--
r
ALL CONSTRUCTION SHALL MEET THE
ORE ME TS OF THE CODES OF NEW
OR
DESGNORCON TRUCTION(ERRORS.
�� � fAhAr'nGt' ��f"P'f.7•rt,F"' — �.,�.. __.���- -� 11 _� ..�..� . �,. /JdtFntlS "7S+ M,A."F�;�I& � STATE. LE FOR
F N157laXr
� , ,r -r-r� � 7-,-,, r* � r I -� -r r-n r � ••-� - •--�� +"" If
COMPLY WITH ALL CODES OF
i, ; ii1n 111 fit i ',J i ' Il� li IIS '��
NEW YORK STATE & TOWN CODES -/
I AS REQUIRED AND CONDITIONS OFAl
SOUTHOLD TOWN ZBA
==-" NIA SOUTHOLD TOWN PLANNING BOAR)
1A SOUTHOL
DTOWNTAUSTEES
NY.S.DEC
41
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT
a ,« 2 r OF OCCUPANCY CERTIFICATE
I,
- I -- �i�T'�a�"'• �%RC1• � �� �.,
PLUMBER CERTIFICATION I
ON LEAD CONTENT BEFORE CERTIFICATION OF
------- CERTIFICATE OF OCCUPANCY NAILING & CONNECTIONS
REQUIRE:.
^
SOLDER USED IN WATER i'
'M2 SUPPLY SYSTEM CANNOT
EXCEED 2/100F1%LEAD.
..r..r",T--r-r..,_1
r.
.Y
FLOO
jq
:..u"'`.`_--" -n-+ '.�"ur__ _� ..i=",i__.._e..,�.w> ._.• xr.".:?:•.erg= ?E.=',i fra�:=., car_..,.•^- x�-..amu riz ,yr _,;c'.=v;r _.�:;�:x .s• _ ?3s.,..�P�,'w'r:-c mtr m r "--_ —__ __,`T " i"I_� � _I.l_�. I '_�..w__I _ _I__ _...�. ,_.__T__. � ,_ r _,.._�.__ , _ . p �qIT�
COMPLY CIA
,.G_ ✓ _ %
{FLO46"
ODA _ . „EREVEN_.... . 90U7HOLtlTo CODE. TION rr
—
I I I
ALL CONSTRUCTION SHALL I
- I — — - MEET THE,REQUIREMENTS OF THE
`- k' r..7e35 CODES OF NEW YORK STATE,
�fxtl �1
RETAIN STORM WATER RUNOFF
_ PURSUANT TO SECTION 45.10C
- — - 7—i- OF THE TOWN CODE.
- II -� - -1
- E
�I
!
j
I I
PLUMBING
_._.
ALL PLUMBING WASTE
&WATER LINES NEED
1'- TESTING BEFORE COVERING
,_, ...,._
_,-._ _.. .. _ . ,___ .__.. . . ........., _. .,, , ._..,. ..-.. ..... ... _-____ ..._.,_ __.._.,. .. .-.___ _. _._.___. ._ .. ...,.-.._,._. DO NOT PROCEED WITH
FRAMING UNTIL SURVEY
OF FOUNDATION LOCATION
HAS BEEN APPROVED. Gc>f7
UNDERWRITERS CERTIFICATE
REQUIRED
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'Kor' 0. Box 1447
i? -c'we e 31 Midtituck, NY 11052
'A VII 631-445-1461
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Mattitack, NY 11852
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