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
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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
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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.
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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
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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
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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)