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HomeMy WebLinkAbout31239-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31205 Date: 10/11/OS THIS CERTIFIES that the building ACCESSORY Location of Property: 235 RABBIT LA EAST MARION (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 31 Block 17 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 27, 2005 pursuant to which Building Permit No. 31239-Z dated JUNE 29, 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 ABOVE GROUND SWIMMING POOL IN THE REQUIRED REAR YARD AS APPLIED FOR. The certificate is issued to CLAUDIO & CAMILLE SCIARA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO_ 2069014 08/29/05 PLUMBERS CERTIFICATION DATED N/A A ori ed Si nature Rev. 1/81 - - - _-, Form No. 6 2 6 TOWN OF SOUTHOLD I fi „9 0 5 9� { BUILDING DEPARTMENT 1 l TORN HALL i 765-1802 NP 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: I. Final survey of property with accurate location of all buildings. property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2%10 of 1','a lead. 5. Cornmercial 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 i. For existing buildings (prior to April 9, 1957) tion-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate sun ey of fitoperty showing all property litres, 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 $25.0, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pont $25.00, Accessory building $25.00, Additions to accesscrc 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 - $511.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $l 5.00 Date. New Construction: _ -Old or Pre-existing Building: _(/ (check one) LocationofProperty: (::Q�>S ej L 1),j L am_ 6'YI r�N House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax biap No 1000, Section ) 3 __ Block a G I 1 Lot 00 Subdivision —Filed Ntali. t or Penuit No. 3 I-a-3 9___ Date of Pemti � t. � `0-5applicant � SC l�tZA �T Health Dept. Apptocal: _._ _ Undemriters Approval: - ib(09 U 14 Planning Board .-\pproval: Request for: Temporary Certificate Final Certificate: V (check one) Fee Subrmitted: r � Applicant Signature Co4-L3 Po5 a ����ss��rnrs���ssss�n���ss��������nrn�����r��n����n s�n���n�jMMMMn������ss o ru 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 BUREAUTY 40 FULTTON STREET F C NEW YORK, NY 10038 C� 5 CERTIFIES THAT 5 5 Upon the application of upon premises owned by 5 PO BOX 396 CLAUDIO SCICIARA 5 5 EAST MARION NY 11939 235 RABBIT LANE 5 EAST MARION, NY 11939 5 5 5 c5 Located at 235 RABBIT LANE EAST MARION, NY 11939 Application Number: 2069014 Certificate Number: 2069014 5 5 Section: Block: Lot: Building Permit: BDC: ns11 5 Described as a Residential 0-599 square ft. occupancy, wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 Attached Garage, Outside, Pool/Spa, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 5 herein, was conducted in accordance with the requirements of the applicable code and/or standard 5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other Sauthority having jurisdiction, and found to be in compliance therewith on the 29th Day of August,2005. 5 5 Name QTY Rate Ratine Circuit a 5 Miscellaneous 5 5 supply recepticle for power to 5 above ground pool 5 SAppliances and Accessories c C5 Pool., Spa Bonding l 0 5 5 Wiring and Devices c 5 Receptacle 1 0 GFCI 5 5 (Swimming Pool): This certificate covers compliance at the dare of inspection only. Because of unusual environments it is advisable to have 5 5 frequent test and,br repairs made bN a qualified person. 5 5 5 5 5 5 sea) 5 5 5 1 of I e 5 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 5 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. 31239 Z Date JUNE 29, 2005 Permission is hereby granted to : MR & MRS SCLARA 235 RABBIT LA. EAST MARION,NY for CONSTRUCTION OF AN ACCESSORY ABOVE GROUND SWIMMING POOL IN THE REQUIRED REAR YARD PER TRUSTEES AND DEC PMTS . , FLOOD PMT. INCLUDED at premises located at 235 RABBIT LA EAST MARION County Tax Map No. 473889 Section 031 Block 0017 Lot No. 009 pursuant to application dated JUNE 27, 2005 and approved by the Building Inspector to expire on DECEMBER 29, 2006 . Fee $ 250 . 00 Authorized Signature ORIGINAL Rev. 5/8/02 FIELD INSPECTION REPORT DATE COMMENTS W 'o FOUNDATION(1ST) — - ----------------------------------- FOUNDATION(2ND) 2 KJ O ROUGH MIMING& PLUMBING — �J � z INSULATION PER N. Y. — — -- — STATE ENERGY CODE - 3 FINAL L d ADDITIONAL COMMENTS O m b Q O -r -- G m �v 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ } FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE o INSPECTOR 573-3052 POOL ASSEMBLY AND F "the original portable pool" INSTALLATION .INSTRUCTIONS doUghbuevo y® 6 " , 6- 1 /2 " , 7" & & 1 /2 " OVAL POOLS '. THINK "SAFETY FIRST" Safe and correct use of your new Doughboy pool means swimming and wading only. DO NOT DIVE OR JUMP! The above-ground pool is not designed for these activities! INSTALLATION Installation of a Doughboy pool is not very hard, but it is a big job. The job will be easier if two of three friend's help with the installation. Follow all instructions exactly. Your pool warranty is void if pool assembly and instpllation instructions are not followed 1000%. Read all instructions provided with accessories such as filter, pump, skimmer, etc. prior to starting. Plan 3-5 days for pool assembly and installation. Avoid windy days. Before you start, check to see Pint you have the correct number of parts. Use your Parts List,which is broken down by carton. Do riot throw away any of th ` nspection slips or cartons until you are sure you have all the parts. Your dealer will promptly replace any missing parte., The warranty is void if the design of the pool is altered in any way. No changes may be made to any of the parts. The Pool must be assembled according to Doughboy's instructions. You must be completely satisfied with the completed pool Installation, whether self-installed or professionally installed, before proceeding with adcRional landscaping. CONTRACT INSTALLATION Doughboy Recreational is in no way affiliated with any professional pool installer. Therefore, 4oughjloy can assume no responsibility for errors in installalion by the homeowner or said professional installer. If you have the pool installed by others, please supervise to be sure they comply with proper installation techniques as shown. I LOCAL CODES Check to see if building permits or utility clearances are required. Obey all safety codes for fertcinc. and all electrical codes. SPECIAL CARE Doughboy pools are designed to exceed industry recommended safety factors. However, spers•it care must be taken with certain Installation procedures that the installer performs and controls. I 1) Frameworkmustbelevel-Referringto"Installation Cautions"shown at right,six pool installations illustratelmproer methods of installation or errors during the leveling of the ground(Step 2) or positioning of the patio blocks((Step 10). The entire pool framework must sit on flat(level)ground. An out-of-level condition will produce stresses in the p?ol structure and/ or deformities in the wall that could cause pool wall failure. 2) Wall joint and joint piece-This is where [tie wall joins together. Damage to the wall joint or joint piece reduces the safety factor and can result in a weak installation. Follow instructions using extreme care. 3) Cove-The cove keeps the liner from creeping out from under the pool wall. Follow instructions t('the letter. Don't short-cut or substitute materials. Do not use materials that will shift. Improperly installed pools:can ._iptu-e, allowing thousands of gallons of water to rush out and cause extensive property damage and per injury. 4) Set up pool on soil surface. Doughboy pools are not designed to be installed below-grade lburied) using these instructions. Outside ground forces can collapsethe poolwall. ForapprovedBelow-Grade lnstallationjlnstrUctions,seeyour Doughboy dealer, 5) External Support-The excavation and use of 8"x 8"x 16"concrete blocks(Steps 5-8)to reinforce file side Supports is a critical structural detail which cannot be varied from instruction. These blocks and the firm undisturbedsoil around them become the load bearing components for the forces on the pool sides. DO NOT substitute other building materials for the concrete blocks. =tt 28' X 12' 24" 448-" 48" 48" 24" POOL RADIUS X 1 U IIUS +— �- CLRADSCE I / 5'-93/4" ` / 5'-931", X\\� O -` - A - B LINE STRING 5'-VA" ' LINE / / SIDE-- - J STAKES_ f SUPPORTS SUPPORTCLEARANCE J Sc, ) 2A- QeL5iiDEQCE 235 P_Aa3ejl- LPJF— (J-) eAsT— rck?J lid 1.- 0 939 R 3INSTALL CONCRETE BLOCKS CONCRETE FILL WITH -fir—� TILTED TOWARDS r BACKFILL - CONCRETE / I� INSIDE OF POOL SIDE SUPPORT ASSEMBLY ALTERNATE BLOCK SETTING FILL WITH / I // LEVEL CONCRETE --, - I FIRM --sem II II" UNDISTURBED EARTH IF CONCRETE BLOCK Position a 24"carpenter's level on top of the ground supports. Ad;ust the side vertical assernblys until the ground supports are level. When ground Supports are level, the I, vertical will be TILTED-IPI at the top TO provide a 'pre-load' condition so that when tna pool*ata pressure,s against the wall,the sides will move outward and become j vertical VVIthcut this pre-load, the wall would tilt outward at the top and create a curve In the top rails Fill concrete blocks with concrete mix and level with top of blocks. If you have over-excavated, fill any space behind the blocks with concrete. See ALTERNATE BLOCK SETTING above. I Q i t M O cJ sciu-�� ;�csi�E�JG.� �.3 S �►rsg f; �€ t� /1939 ,¢n ogVFFO(�-c Albert J. Krupski, President V'�O�' �G ,y Town'Hall James King, Vice-President = y�p 53095 k.nute 25 Artie Poster h 'S P.O. Box 1179 Ken Poliwoda T Southold, New York 11971-0959 Peggy A. Dickerson ip if. Telephone (6�L) '755-1992. A�L ma y' Fax 1(;31):^,65-L366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 1 i Permit No.: 6087a Date of Receipt of Application: January 21, 2005 Applicant: Claudio and Camille Sciara SCTM#: 31-17-09 Project Location: 235 Rabbit Lane, East Marion Date of ResolutionlIssuance: March 23, 2005 Date of Expiration: March 23, 2007 Reviewed by: Board of Trustees Project Description: Install a 16' x 32' above-ground swimming pool; deck, and plant trees along the East and West property lines from the existing house, to the 10' buffer zone, with the condition that a dry well be installed for pool drainage and a 10' no mow buffer be maintained along Marion Lake, and all as per the plan drawn by Nigel Williamson last dated March s0, 2005. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code. -The issuance of the Administrative Permit allows for the operations as indicated in the project description. Special Conditions: Dry well to contain pool drainage. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code,:a Wetland Permit will be required. This is not a determination from any other agency. Albert J. Krupski, Jr., President Board of Trustees r NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBE? EFFECTIVE DATE 1-4738-03443/00001 ' May 25,2005 FACILITYIPROGRAMNUMBER(S) PERMIT EXPIRATIONDATE(S) Under the Environmental May 24, 2010 Conservation Law TYPE PF PERMIT ■ New ❑Renewal ❑Modification ❑Permit to Construct ❑Permit to Operate ❑ Article 15, Title 5: Protection of Waters ❑ 6NYCRR 608:Water Quality ❑ Article 27,Title 7;6NYCRR 360: Certification Solid Waste Management ❑ Article 15, Title 15: Water Supply ❑ Article 17,Titles 7, 8: SPDES ❑ Article 27, Title 9;6NYCRR 373: ❑ Article 15,Title 15:Water Transport Hazardous Waste Management ❑ Article 19:Air Pollution Control ❑ Article 15, Title 15Long Island Wells ❑ Article 34: Coastal Erosion ❑ Article 23, Title 27: Mined Land Management ❑ Article 15, Title 27:Wild, Scenic and Reclamation Recreational Rivers ❑ Article 36: Floodplain Management ■ Article 24: Freshwater Wetlands ❑ Articles 1, 3, 17, 19, 27, 37; ❑Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control I PERMIT ISSUED TO TELEPHONE NUMBER Mr. & Mrs. Claudio Sciara 631 477-2835 ADDRESS OF PERMITTEE P.O. Box 396 Ea4t Marion, NY 11939 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Nigel Robert Williamson, P.O. Box 1758, Southold, NY 11971 631 765-4156 NAME AND ADDRESS OF PROJECT/FACILITY Sciara property, 235 Rabbit Lane, East Marion SCTM # 1000-31-17-09 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold —7GP-1 Marion Lake DESCRIPTION OF ,UTHORIZED ACTIVITY: Installation of above ground pool and associated deck. The project also includes cedar plantings located along side property lines and the landward edge of the natural buffer area to remain undisturbed adjacent to Marion Lake. Fencing will be installed along the front of the existing dwelling. All work must be done in accordance with the attached plans by N.R. Williamson, dated May 5, 2005 and'stamped NYSDEC approved on May 25, 2005. 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 ADMINI, RATOR: ADDRESS Region 1 Headquarters Roger Evans VA Bldg. #40 SUNY Ston Brook NY 11790-2356 AUTHORIZE SIG ATURE DATE Page 1 of 4 Ma 26, 2005 TORN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you hate or need the following, before apphing° TORN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans_ TEL: (631) 765-1802 Plamung Board approval FAX: (631) 765-9502 Sunv\ Srl'2 NJ d' vvivwc. northfork.net/Southold, PERMIT NO. 3(� ��ti Check #A- Septic Form NXS.D.E.C. ay Trustees _ Examined ti �� ' _ Contact: .-,pproved_ („/y/. =O 0�- Mail tori u &g_ (._ , _toJ Disapproved ac Po- Batt I7Sg_So�naarao Uy h97 Phone: 6 3t. 165 415-4 —7— Expiration / w Buu ldiJnngg Inspector ELLF ` APPLICATION FOR BUILDING PERMIT �IJI� � YT am Lj j Date 2401- Zvi 2005- INSTRUCTIONS 005INSTRUCTIONS �7 t `i -- :n a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a neve pernut shall be required. APPLICATION IS HEREBY M.-\DE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold. Suffolk Count}, 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. PC f I tGEl BEQr 1J, ",art Soj (Signature of applicant or name, if a corporation) Pct J?., 175"8 Sov.-,f-La AJI //9171 (Mailing address of app cant) State whether applicant is owner, lessee, agent,4rchi ngineer, general contractor, electrician, plumber or builder Name of owner of premises M P-. MRS. C+-gt Lo S r,tgeA (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (N-m5" ar i titl- of rgmnrme -ff TO«N OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying^ TORN HALL Board of Health SOUTHOLD, NY 11971 d sets of Building Plans::�� TEL: (631) 7654802 Planning Board approval FAX: (631) 765-9502 Sune S,Ve d' rrltvc. northfork.net/Southold/ PERMIT NO. 3(0�3�ti Cheek___ Septic Form NN.S.D.E C'._ S' _ K Tntstzes___�� _ Examined '0 0 _ Contact: "•�' Approied 'U� Mail to: ry t � FoA", 011, w J Disapproved a c _ Pd_BaK 1758 107i _ Phone: 63% 765 415-4 Expiration U Building Inspector ' APPLICATION FOR BUILDING PERMIT r1- _ Date124_zu! 2005 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within IS 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 BLADE 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 fork, 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 latus, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ' 1 / N I(X - �BE2r 1J t_r,,.am Soj (Signature of applicant or name, if a corporation) pn 17V8 Sov.rpiow IJ.`j' 71 (mailing address of applicant) State whether applicant is owner, lessee, agent,6rchi ngineer, general contractor, electrician, plumber or builder Name of owner-of premises M 12. MES_ CLAVE)w SC-tAeA (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: 235 RABBIr LA>,I6� Egsr M,A+2w�J House Number Street Hamlet County Tax Map No. 1000 Section 31 Block / 7 Lot 0'q Subdi6sion Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Si a Gt C .�t�. c4-L ,J4 b. Intended use and occupancy 51,JGrLa � POEu Je . 3. Nature of work check which applicable : New Building /� Addition_ Alteration Repair Removal__�Demolition_,,,­' Other Work Sir lw W cr Poof_. (Description 4. Estimated Cost �S,o� � Feeo (To be paid on filing this application) 5. If dwelling, number of dwelling units _Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. _ 7. Dimensions of existing structures, if any: Front 2 6. 5 Rear 2 C• S Depth 30. 5-' Height 32 -0 ± Number of Stories 3 sr Dimensions of same structure with alterations or additions: Front 26. S Rear 2(7,S* Depth 3o. S Height 3 sn Number of Stories 8. Dimensions of entire new construction: Front 2,8`-o Rear 28'- 0" Depth l 2'- D' Height 52 1alcu4s Number of Stories 9. Size of lot: Front 8 3. 05 Rear 84, 16' Depth 234 avcrAyE �,qw. 10. Date of Purchase Name of Former Ovnier 11. Zone or use district in which premises are situated R- 40 12. Does proposed construction violate any zoning law, ordinance or regulation.) YES_NO-)�— 13. Will lot be re-graded? FES_NOWill excess fill be removed from premises? YES_NO -Z Po. 0.4 396 t4. Names of Owner of premises Mk. e A& C. Sc,4W Address Easr M*k�d u 11939 Phone No. 6-31-4-71-2935 Name of Architect N;ricu I?1kX1 1 L'44..As0 Address P.o 90 htB u"wtoPhone No 631. 765_ lit C6 Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YESe�fNO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF � _W • ( (- C-�- - _ 2 being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, 61He is the (Contractor, Agent, Corporate Officer, etc.) of said otcner or owners, and is duly authorized to perform or ha%e perfortned the said work and to make and file this application; that all statements contained in this application are true to the best of his knowl dge and belief; and that the work will be performed in the manner set forth in the application tiled therewith. Swto betiore me this a� nZr t 1 day ' 00< _ Lia Notary Public Si¢nature of Applicant BARBARA ANN RUDDER Notary Public,State of New York No.4855805 Qualified in Suffolk County commission Expires April tot g F ti os o 110 , 09 o.0 " y\per •o > pSSJ �'0�' oE� J d� F .�a 6 Q. E�L� 27� rQ,.� FLOOD ZOWC COMPLY WITH CHAPT R "46" ,Sao FLOOD DAMAGE PREVENTION ® 1 �/u L(7 SOUTHOLD TOWN CODE. O I . Ul O. O (-D • OCCUPANCY OR 5 e a� USE IS UNLAWFUL �5� �� c WITHOUT CERTIFICAT �� ` ��° ry� �' L _ i; OF OCCUPANCY �� � \°'(O9\1rjL�{qq-i ELY" NEW YORK 8 OWN TH ALL CODES COD u APPROVED AS NOTED 1 uuvi ENCLOSE POOL TO CODE AS REQUIRED AND CONDITIONS 4 p1 DATE: S B.P.i Z UPON COMPLETIONgp BEFORE"WATER" FEE:—= BY: SOUTHOLD TOWN ZBA p NOTIFY BUILDING DE ARTMENT AT SOUTHOLD TOWN PLANNING 765-1802 8 AM TO 4 PM FOR THE ONDER0,ffERS CERT OTE Z FOLLOWING INSPECTIONS: AEOUIRED --------- SOUTHOLD TOWN TRUSTEES 1. FOUNDATION - TWO REQUIRED N.Y.S.DEC c FOR POURED CONCRETE SITE P L f J SGALE = 30-0 O 2. ROUGH - FRAMING 8 PLUMBING U) 3. INSULATIONIN oTzu kE MA-rloTAu F-12-0H SURVEY PeEE EPA2D Bv{ -c 4. FINAL - CONSTRUCTION MUST PpE�u is 5UZVEyoras P.C. SourHOLD u.y. BE COMPLETE FOR C.O. ffTED M41 17 2004-. RETAIN STORM WATER RUNIMI p ALL CONSTRUCTION SHALL MEET THE PURSUANT TO SECTI N 4510 Ln REQUIREMENTS OF THE CODES OF NEW PURSUANT SU TOWN CODE. YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. ® IkIDICATES Dip ECT:o , or PHOTOG2APH. ` 00 lWDlr-bTE5 PROP05E.D FEUCF- (VIQ�L) 31, O x DEC x I-4738-03443/Oo0ol RSV A k2 MARCH 2005 - EUGE RL0w1G MARIOM LAVb RRf�..LOCATEb \ _ O 10=0 F20H EDGE O� WETLA+JD BOtAJDAJN m NOTES AnDeD. 2F-V B 30` MARCH 2005 _ {`&,,,Q,C6 AL.WrNoe*H, EAsr .y WEsr — C PRDPLPTy u�lEs e6MOVEA. TREE5 ADnEz TO P RApE2 Li J6S qD ci,1i.1G klelrl N$z RS MF. Mrs . C . S C I A R A RLV DS 5`M&y ?D - lkoposeo lis gED;C6A �J$xTG FODTFP 14T- 2FJ+ IJ07E -APS lb REMA, AIATWA4. � VI•hi i5riVU9D ADDED eD 10 235 RABBIT LANE Area= 19, 430 sq. ft. To Te LIME. a z EAST MARION N.Y. 11939 S.C .T.M. 1000 -31 - 17- 09 3 ,° b PVUILDI iG. PE*T�TA�- ApplicanUDatc. :. Owners Natiie:, ^ `'�-�`-'_ - Reviewed: _� Architect/ Qate Submitted: SCTM #: District: 1.aoo Scwott: 31 131ock: 1--7 _ Lor. Project 2 Subdivision l.ocatioti: ✓� r f- _--:— Name: $iqk � separate Required cclltrJefi ion: (Yo I No) T _ Req l Req. Zoning llislrict: (tAt slzc: Acta 1 (i.ot coveragC _I'ri)pnScd (()root Yard Proposed: i- (Side Yard Propos ✓ J (Rear Yard 3 ._ PtopoI Project Deseription: . �4GEIYC'N '�ItMTTSFermi Pm QVIRED e i)12>fiQVIRED FQRREWE N0 YES Number Suff-olk County Health Dept. New York State. D. R C. Town Twstees Town ZoulIng Board approval: Town Planning Board approval. Flood.Plane Elovation?2? Flood Zona; RRY '14 T TE P.o n wx 117() TOWN CLERK' LP ftEGjsTn/%-R OF VITAJ,STATIS-11CS Fax (.S I(,) 765—Ig; WARMF OFFICIMTulcphonc (51(1) 7(,C. ; RECORDS "AGEMENTOFFICE11 FREEDOM OF Jr4FORMA-nON OFFICER OFFICE OF THE TOWN CLERIC TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 : RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent. regulations of the Code of the Town of.. Southold: "Floodplain Development Permit Application" ( FDP(93) ] , and "Certificate of Compliance W r Develcpmen L in Special Flood Hazard Area ((:/C(93)] . D ' TOW;4 OF SOUTPICILD A d/t h T . Terr y Southold Town Clerk August 25, 1993 1 APPLICATION ab+_ r PAGE 1 of a TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION I GENERAL PROVISIONS (APPLICANT to read and siznl- L. No work may start until a permit is issued. 2 The permit may be revoked if any false statements are made herein- 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire. if iio work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator-or his/her representative to make eaasoaable inspections required to verify compliance. 8. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE,TO THE BEST OF MY KNOWLEDGE,TRUE AND ACCURATE. (APPLICANTS SIGNATURE) . J .05 0 S� JSECTTON 2: PROPOSED DEYELOF.f+/IENT (T,,-•�c completed by APPLICAhEn X31.76S"4 IS-6 NA-ME ADDRESS TELZ✓PHONE A • APPLICANT 4t,,1, 'one& Fall ,sod cN�a•�cr' �.�. QAC Ihs'� S,a � l tJV li4�i+ BUILDER ENGINEER PROJECT L CATION: To avoid delay in processing the application, please provide enough information to easily identify the project location_ Provide the street address, lot number or Iegal description (attach) and, outside, urban areas, the distance to the nearest inlersectiog road or well-know❑ Landmark A sketch attached to this application showing the project location wotdd be helpful. it 41J�' ,sr MA�roJ ��>J yore 1193-9 R-Vfx 2f $ tt 4yr-,iuc Csourt1) Tt) WC FDP(9J) APPLICATION PAGE2OF4 DESCRIPTION OF WORK (Check all applicable boxes): A STRUCTURAL DEVELOPMENT ,ACTIVITY STRUCTURE TYPE t ew Structure ❑ Residential (1-4 Family) L � � Addition ❑ Residential (Mort than 4 Family) O Alteration O Non-residential (FloodproofIng? ❑ yes) O Relocation ❑ Combined Use (Residential & Commeraal) Cl Demolition- O Manufactured (Mobilo) Home (In Ma-nu- El Replaccmcnt factured Home Park?. ❑ Ycs) ESTIMATED COST OF PROJECT S S,000 B. OTHER DEVELOPMENT ACTIVITIES: O Fill D Mining O Drilling O Grading O Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) , O Drainage Improvements (Including Culvcrt Work) j ❑ Road, Street or Bridge- Construction / ❑ Subdivision (New or Expansion) / O [dual Water or Scwcr Systcm O'Other (Please Specify) Aftcr completing SECTION 2, APPLICAI`(T should submit form to Local Administrator for rcvicw. SECTION I FLOODPLAIN DETERMINATION (To be completed by LOCAL ADM[MSTRATOk) The proposcd dcvclopmcnt is located on F[RM Pancl No. . Dated - The Proposed Development: ❑ Is NOT located in a Special Flood Hazard Arca (Notify the appUcant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). O Is located in a Special Flood Hazard Arca. FIRM zone designation is 100-Year flood elevation at the site is:" Ft. NGVD (MSL) Cl Uoavailablc O Tbc proposcd dcvclopmcnt is located in a floodway. FBFM Paocl No. Dalcd El SCC Stolon I (or additional instructiogs. SIGNED DATE T- ' , I I , 1 �T t APPLICATION # PAGE 3 OF 4 SECTION.4- ADDITIQNAL INFORMATION REQUIRED (To he completed by LO CALADMINISTRATORI The applicant must submit the documents checked below before the appbcadop can be- processed: O A site plan showing the location of all existing structures; water bodies, adjaeeol roads, lot dimensions and proposed development_ 0 Development plans,drawn to scale,and specifications,including where applicable: details for anchoring structures,proposed elevation of lowest floor(including basement), types of water resistant materials used below the First floor,,details of floodprooFwg of utilities located below the first floor and details of enclosures below the first poor. Also O Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations if they arc not otherwise available). O Plans showing the extent of watercourse relocation and/or landform alterations O Top of new fill elevation Ft. NGVD (MSL). MSL . For ❑ Floodproofing protection Ievd (non-residentialFt:NGVD only) ( ) floodproofed structures,/Applicant must attach certification from rtgislered anganeer or _ architect. / `; O Certification from a-re istercd engineer that the proposed activit}!r in a regulatory [loodway will not result inany increase in the height of the 100-year flood. A copy of all data and calculations supporting this Fording must also be submitted_ ❑ Other. E l 5: PERMITDETERMINATI -N fTQ be completed by_LQCA_LADMj.NISTRkTQRj I have determined that the proposed activity. A. D Is B. ❑ Is not in conformance with provisions of Local Law i , 19_. The permit is issued subject to the conditions attached to and made part of this permit. SIGNED DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fcc. If BOX B is checked, the Local Administrator will provide a written surnmary of deficiencies. Applicant may revise and resubmi( an application to the Local Administrator or may request a bearing from the Board of Appeals. APPLICATION ?+ PAGE I OF a APPEA S: Appealed to Board of Appeals? ❑ Ycs ❑ No Hearing date: Appeals ___ Approved! yes 9 No Conditions SECTION 6 AS BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This sccdoo must be completed by a registcrcd profession'u a] eogincer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement(in Coastal High F-Iazi . Areas• bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. HGVD (MSL). L Actual (As-Built) Elevation of floodproofing protection is FT. NG VD (MSL). NOT'/: Any work performed prior to submittal of the above information is at the risk if the Appl'cant_ SECTION 7 COMPLIANCE ACTION (To be complctcd by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prcvention- INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8 CERTIFICATE OF CQMPLIANCEfi'o be complctcd by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B BAMP'iiE �I CERTIFjICATE /DF COMPLIANCE For Development in a special Flood Hazard Area I r s "r TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (o rNglg MUSTTRETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO, PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: D NEW BUILDING El EXISTING BUILDING O VACANT LAND r THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQLgFEMENTS OF LOCAL LAW # , 19_. SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VAR-LANCE # DATED SIGNED: DATED: CIC ( 93)