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Home My WebLink About31154-Z~ORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31500 Date: 03/27/06 THIS CERTIFIES that the building INGROUND SWIMMING POOL Location of Property: 2280 OLE JULE LA MATTITUCK (HOUSE NO.) (STREET} (HAMLET) County Tax Map No. 473889 Section 122 Block 4 Lot 10 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 6, 2005 pursuant to which Building Permit No. 31154-Z dated MAY 20, 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 "AS BUILT" INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR & AS PER COA~DITIONS OF ZBA #4732 DATED 8/18/99. The certificate is issued to RICHARD L & KATHLEEN 0'TOOLE (OWNER) of the aforesaid building. SUFFOLK COUNTYDEPARTMENT OF ~IEALT~APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2091886 03/18/06 PLUMBERS CERTIFICATION DATED N/A Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPEICATION 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: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building h~spector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, SwinUmng pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy- $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: J Old or Pre-existing Building: Location of Property: 222l) ~L~- ~-{/'Z.~ X/~/~/2 House No. Street Owner or Owners of Property: /~C/-~/qt6~ 4g ,~/4t/-~/g..~C~/L/ Suffolk County Tax Map No 1000, Section/.~ - Block (check one) /0 Subdivision eermitNo. ~3 ] ] ~ t'tt' ~' DaleofPermit. Health Dept. Approval: Planning Board Approval: _ Request for: Temporary Certificate Fee Submitted: $ o~, .,~ ~ Filed Map. Lot: Applicant:f/~ff~/~ ~/tff 4 /--~// ~'~'--/C fl Underwriters Approval: _ Final Certificate: j (check one) BY TI-IlS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by KATHLEEN OTOOI. E 55 LOCUST ST FLORAL PARK, NY 11001 KATHLEEN OTOOLE 55 LOCUST ST FLORAL PARK, NY 11001 Located at 2280 OLE JULE LN MATTITUCK, NY 11952 Application Number: 2091886 Certificate Number: 2091886 Section: Block: Lot: Building Permit: BDC: ns11 Described as a Residential 0-599 square fl. occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, pool, Outside, Pool/Spa, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 17th Day of March, 2006. Name QTY Rate Rating Circuit Type Miscellaneous as built-2004 Appliances and Accessories Pool/Spa Bonding I 0 Time Clock/Switch I 0 Furnace I 0 Gas Wiring and Devices Receptacle I 0 GFCI Switch 1 0 General Purpose Receptacle 1 0 20 amp Pool/Spa Fixture 1 0 Pool/Spa (Swimming Pool): This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. An as built inspection, of the delineated electrical installatiom determined that an obvious hazard is not present and the installation is believed to be in comformance with the applicable reference standard for the estimated period of construction of the premises wiring system. seal I of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 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. 31154 Z Date MAY 20, 2005 Permission is hereby granted to: RICHARD L O'TOOLE FLORAL PARK,NY 11001 for : "AS BUILT" INGROUND SWIMMING POOL PER ZBA DECISION #4732, TO CODE FENCED at premises located at County Tax Map No. 473889 Section 122 pursuant to application dated APRIL Building Inspector to expire on NOVEMBER 2280 OLE JULE LA MATTITUCK Block 0004 Lot No. 010 6, 2005 and approved by the 20, 2006. Fee $ 300.00 Authorized Signature ORIGINAL Rev. 5/8/02 re°PEALS BOARD MEMBERS Gerard E Goehringer, Chairman James Dinizio, Jr. Lydia A. Tortora Lora S. Collins George Horning BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND D~- I ~-RMINATION MEETING OF SEPTEMBER 1, 1999 Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 ZBA Fax (516) 765-9064 Telephone (516) 765-1809 Appl. No. 4732 - RICHARD O'TOOLE 1000-122-4-10 STREET & LOCATION: 228;00le .lule Lane, Mattituck DATE OF PUBLIC HEARING: August 18, 1999 FINDINGS OF FACT PROPERTY FACTS/DESCRIPTION: The applicant's property consists of 17,500+- sq. ft. in area with 125 ft. frontage along the westerly side of Olejule Lane and a depth of 210 feet along the northerly side property line and 200 feet along the southerly side property line, in Mattituck. The lot is improved with a single-family dwelling situated 44.4 feet from the front line along Olejule Lane, 12.8 feet from the southerly property line and 78+- feet from the bulkhead at its closest point. BASIS OF APPLICATION: Building Inspector's 3uly 1, 1999 Notice of Disapproval citing Article XXlII, Section :1.00-239.4B of the Zoning Code for an application to build a 20 ft. by 40 ft. in- ground swimming pool within 75 feet of the bulkhead. AREA VARIANCE RELIEF REQUESTED: Applicant requests a Variance for a 20' x 40' in-ground swimming pool in a location shown on the Ehlers survey of August 17, 1999, as follows: East side parallel to easterly property line at a distance of 21 feet. South side parallel to the rear wall of the house at a distance of 34 feet; closest point to the bulkhead at southwest corner of the pool at a distance of 22 feet measured on a line perpendicular to the bulkhead. (No other areas are noted in the Notice of Disapproval, which is the basis of applicants' request.) REASONS FOR BOARD ACTION, DESCRIBED BELOW: Based on the testimony and record before the Board and personal inspection, the Board makes the following findings: The shape of applicant's yard and location of the house result in there being no room for a pool that satisfies the requirement for a 75-ft. setback from the bulkhead. Thus, applicant needs a variance in order to construct a pool of any sort. 2. The requested variance, for a setback of only 22 feet at the closest point to the bulkhead, is substantial. However, at the hearing of August 18, 1999, applicant indicated a willingness to consider alternative locations. 3. Grant of the relief set forth below will not produce an undesirable change in the Page 2 - September ~., ~.999 ZBA Appl. No. 4732 - R. OToole Parcel 1000-122-4-10 at Nattituck character of the neighborhood or detriment to nearby properties because any pool constructed will have to be in a location that is fairly close to the house, not prominently visible to the neighbors and not visible from the street. 4. There is no evidence that grant of the relief set forth below will have an adverse effect or impact on physical or environmental considerations. The grant of the relief set forth below is the minimum action necessary and adequate to enable applicant to have the benefit of a pool while preserving and protecting the character of the n,eighborhood and the health, safety and welfare of the community. RESOLUTION/ACTION: On motion by Member Collins, seconded by Chairman Goehringer, it was RESOLVED, to DENY the variance applied for and to GRANT ALTERNATIVELY a variance authorizing construction of an in-ground pool located no less than 40 feet from the bulkhead at the closest point, such measurement to be taken on a line perpendicular to the bulkhead and running to the edge of the pool, or, if there is any raised border around the pool, to the edge of such raised border. Vote of the Board: AYE,S: Goehringer, Dinizio, Tortora, Collins. This Resolution was duty ADOPTED (4~0). (Member Horning of Fishers ]~sland was absent.) GERARD P GOEHRIN~'ER, CHA]E AN TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION l ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN_SULATION [ ] FRAMING / STRAPPING [~INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE ~/16/0~ INSPECTOR FOUNDATION (1ST) FOUNDATION (2ND) DATE ROUGH FRAMING & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE COMMENTS FIN~,AL ADDITIONAL COMMENTS New York State Department of Environmenta[Conservatio~ Division of Environmental Permits Building 40 - SUNY, Stony Bm,ok, NY 11790-2356 Telephone (631) 444-0365 Facsimile (631) 444-0360 June 7, 2002 Erin M. Crotty Commissioner Richard & Kathleen O'Toole 55 Locust Street Floral Park, NY 11001 RE:1-4738-02329/00001 Dear Permittee: In conformance, with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit. Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is. a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, Carol A. Farkas Environmental Analyst CAF/Is Enclosure ALL :4OORINGS AND STAKES 2'lUST DISPLAY VISIBLE NOORING ~NUNBERS ALL DOCKS AND BULKHEADS MUST DISPLAY VISIBLE PEP~iIT NUNBERS Board Of $outhoid Town Trustees SOUTHOLD, NEW YORK Mooring # PERMIT NO. ]:~.!9 DATE: .9~.t.~ ..2~..~ .]-983 ISSUED TO Robert White Aull~ori~uliun Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893~ and Chapter 404 of the Laws of the State of New York 1952~ and the Southold Town Ordinance en- titled "RF~ULATIN~ AND THE PLACING OF: OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, ~RAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accgrdance with the Resolution of The Board adopted at a' meeting heid on O¢.C.,... 11.~. 19 q.~..., ,'md in consideration of the sum of $ ~'.9.1~.9 paid by .................................... .Rober. t ...~hi te ..................................................................... ofq~.;~.!~D.q}$ ......................................................... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Application approved under the Grandfather Clause to secure a permit for a dock, ramp and bulkhead in James Creek. all in accordance wffh the detailed speclflcaflons as presented in the originating applicaflon. INr WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. · ~..~:. ~...,..~p;.~.¢ .....,~ Grandfather Clause Please Bo~,rd Of MOOZ~:.~G NO. PERMIT NO. .~-~ TO tear off ~nd return t'o'~h~ T~rusteb% $outhold Town Trustees 17~9 DATE: Oct. 25, 1983 Robert White NEW YORK STATE DEPARTMENT OF ENVIRONMEN.TAL CONSERVATION DEC PERMIT NUMBER 1-4738~02329/00001 FACILITY/PROGRAM NUMBER(S) PERMIT Under the Environmental Conservation Law EEEECTIVE DATE June 7, 2002 EXPIRATION-DATE(S) Jdne 30,2005 TYPE OF PERMIT · New [] Renewal [] Modification [] Permit to Construct [] Permit to Operate [] Article 15, Title 5: Protection of Waters [] Article 15, Title 15: Water Supply [] Article 15, Title 15: Water Transport [] Article 15, Title 15: Long Island Wells [] Article 15, Title 27: Wild, Scenic and Recreational Rivers [] Ar[icle 17, Titles 7, 8: SPDES [] Article 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamation [] Article 24: Freshwater Wetlands · Article 25: Tidal Wetlands [] Article 27, Title 9; 6NYCRR 373:' Hazardous Waste Management [] Article 34: Coastal Erosion Management [] Article 36: Floodplain Management [] Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control [] 6NYCRR 608: Water Quality Certification PERMIT ISSUED TO Richard & Kathleen O'Toole ADDRESS OF PERMI'I-I'EE [] Article 27, Title 7; 6NYCRR 360: Solid Waste Management TELEPHONE NUMBER (516) 352-0685 55 Locust Street, Floral Park, NY 11001 CONTACT PERSON FOR PERMITTED WORK EnConsultants, Inc., 1329 North Sea Road, Southampton, NY NAME AND ADDRESS OF PROJECT/FACILITY 11968 TELEPHONE NUMBER (631)283-6360 O'Toole property, 2280 Ole Jule Lane, Mattituck COUNTY TQWN Suffolk Southold DESCRIPTION OF AUTHORIZED ACTIVITY: WATERCOURSE James Creek NYTM COORDINATES Install inground pool, All work must be done in accordance with the attached plans stamped NSYDEC approved. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Region 1 Headquarters -George W. Hammarth (CAF) Bldg. #40, SUNY, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE · June 7, 2002 Page 1 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMIT-FEE OBLIGATIONS .... : Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnity and hold harmless the Department of Environmental Conservation of the State of New York, its representatiw.=s, 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 D EC'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, inchJding relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationslhip of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modity, 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 su bruit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must inclL~de any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by Ihe 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 (H~,~VlF), 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 modity, suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification, suspension or revocation include: a) materially false or inaccu:rate 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 )ermitted activity. DEC PERMIT NUMBER 1--4738-02329/00001 PAGE 2 OF 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 ( TIDAL WETLANDS) If future operations by the State of New York require an alteration in the position of the stnJctu"re'or Work ~er-ein 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 !oss or destruction of the natural resources of the State, the 0wrier-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. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the IJ.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local government which may be required. 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. 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. There shall be no unreasonable interference with navigation by the work herein authorized. If upon the expiration or revooation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302, 303,306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. 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 John C. Ehlers 4~9~02. PAGE 3 OF 4 DEC PERMIT NUMBER 1-4738-02329/00001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. Any debris or excess matedal from construction of this project shall be completely removed from the adjacentarea (upland) and removed to an app~roved upland area for disposal. No debris,is permitted in tidal wetland~and or - protected buffer areas. 2. All areas of soil disturbance resulting from this project shall~(~stabilized irnrnediately following projectcompletioa. or prior to permit expiration, whichever comes first. The approved methodologies are as follows: a. Stabilization of the entire disturbed area with appropriate vegetation (grasses, etc.). 3. The storage of construction equipment and materials shall be confined to landward side of house. 4. A row of staked hay bales or approvable erosion control devices shall be placed at the landward edge of the buffer area or 40 linear feet from the tic[al wetland boundary, or as per NYSDEC approved plan, at commencement of regulated activities and remain in place until project is completed and all disturbed areas stabilized with vegetation. 5. Necessary erosion control measures i.e., haybales, silt fencing, etc. are to be placed on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good condition until thick vegetative cover is established. 6, Dry wells for pool filter backwash shall be located a minimum of 75 feet landward of the tidal wetland boundary. PAGE 4 of 4 DEC PERMIT NUMBER 1-4738-02329/00001 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ / Examined br~..O ,20 0% Approved H'}~0, 20;~] Disapproved a/c Expiration [~] ~0,20 O~ ]PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: -- Building Inspector APPLICATION FOR BUILDING PE~IT ''~OG C~ ~k~~ ~STRUCTIONS Dae ,20 ~e completely filled ~ by t~ewfiter or in ~ ~d submitted to ~e B~ld~g ~spector with 4 sets of plans, acc~ate plot pl~ to scale,. Fee accor~ng to schedule. b. Plot pl~ showing locmion of lot ~d of hullings on pre~ses, relations~p to adjoin~g premises or public stre~s or areas, and wate~ays. c. The work covered by this applicmion may not be co~enced before issu~ce of Building Pe~it. d. Upon approval of ~s application, the B~l~g hspector will issue a Bulldog Pe~t to ~e applic~t. Such a pemit shall be kept on the premises available for ~spection ~ou~out the work. e. No building shall be occupied or used in whole or ~ p~ for ~y p~ose w~t so ever ~til the B~l~g hspector issues a Ce~ificate of Occup~cy. f. Eveu bulling pe~it sh~l expire if the work authorized has not co~enced witch 12 months a~er ~e ~te of issu~ce or has not been completed within 18 months ~om such date. If no zoning mendments or other re~lations affecting property have been enacted in the ~tefim, the Building ~spector may authorize, addition six months. ThemaRer, a new pe~it shall be mquked. ~PLICATION IS ~BY M~E to the Building Depa~ment for the issu~ce of a Building Pemt pmu~t to ~e Building Zone Ordin~ce of the Town of Southold, Suffolk County, New York, and o~er applicable Laws, Ordin~ces or Re~lations, for the construction of bulldogs, ad~tio~, or alterations or for removal or demolition as here~ described. ~e applic~t agrees to comply with all applicable laws, ordinances, bulling code, housing code, ~d m~lations, ~d to a~t authorized inspectors on premises and in building for necessary inspections. ~LL CONSTRUCTION SHALL ,,~,. ............. ~ ~'" '~NCLOSE P~L TO CODE COBES OF NEW YORK STATE, UPON COMPLETION BEFORE "WATER" (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name ofownerofpremises ic!,~cao} ? ,' ~ ~. ~ (As on the tax roll or latest de{~[l~,~8 If applicant is 0 corporal, signature of duly authorized officer DATE:__,5/~?5 OCC . ~J(Name and title of corporate offiCE IS UN~WFUL FIE: r4o-o NOT~FY BUILDING DEF,-.RTMENT AT Build rs UcenseNo. -' I iTHOUT CERTIFICATE ,^M zO THE Plumbers License No. FOLLOWING INSPECTIONS: lect ians Uoense OV OCCUPANCY Other Trade's License No. ~DERWRITERS CERTIFICATE l. Location of land on which proposed work will be do~g~U. Ilt[O House Number Street County Tax Map No. 1000 Section Subdivision W/~ (Name) 12. -c Block Filed Map No. FOR POURED CcNCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CoNSTRUCTiON MUST BE COMPLETE FOR C.O. Haz~tCONSi HucTk."N SHALL MEET THE REQUIREMENTS OF 1 HE CODES OF NE-gN YORK STATE.,NOT R~.~,PONSIBLE FOR DESlG N ORLRS~QNST F~ I~A'ION ERRORS. 2. State existing use and occupancy of premises and intended use and occupancy of proposed constmcti'on: a. Existing use and occupancy --~-~,, 0e~.-~d.~ / b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration Other Work (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear q 7_ Depth Dimensions of same structure with alterations or additions: Front <~ ',~'-~ Rear Depth <~, ~_~ Height ~; ~---~ Number of Stories Ali,;~; ,} ",t~ Height 9. Size of lot: Front 10. Date of Purchase Dimensions of entire new construction: Front Number of Stories Rear Rear ?-~ Depth -&/O Name ofFormer Owner /~,,t...}o3cFL 11. Zone or use district in which premises are situated Depth 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO >( 13. Will lot be re-graded? YES /'. __ NO Will excess fill be removed from premises? YES ,'~ NO__ Address42)o~,) {vv/L~ II ac, I 14. Names of Owner of premises Name of Architect Name of Contractor Address Address ~o ~. 15 a. Is this property within 100 feet <)fa tidal wetland or a freshwater wetland? *YES )~ NO __ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES X NO__ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. YJ3TA C3MM; ':,: 16. Provide survey, to scale, with accurate foundation plah and d~stm~, cee to ~op&~ty hnes. 17. If elevation at any point on property is at 10 feet or below, must provide:t~pographical data on survey. Phone No. gig- 3~ Z - o/o ~.q Phone No Phone No. ~$/- 2 ! ~ - o e .5 g STATE OF NEW YORK) SS: COUNTY OF ~/~ ~ -t ~ C ~ ~ a I [ ~ ~ ~ being d~y sworn, deposes and says that (s)he is the applic~t ~me o~individu~ si~ng comract) above nmed, (S)He is the ~ ~i ~ ~o~ ~ (Con~acto, Agent, Cowomte Qffieer of s~d owner or owners, ~d is duly au~ofized to pg~o~ or ~e~ ~ ~d work and to m~e ~d file ~s application; · at all statemems conta~ ~ t~s applioatien.~e t~e to the 5~s~of his ~edge ~d belie~; and ~at the work will b~ pe~o~cd ~ the m~er set leah in the application filed the~., Sworn to b~fore me this (o Sq' ..day of ublic hn M Judge ~q°~ TAR~f pUB}_}~,t State o{ New York No. 01JU60594uu Qua tied in Suffolk County 0 Cormniss on Expires Mey29, 20 ~ "Signature of Applicant Id,AP OF PROPFR'r¥ 51TUATE, I'4ATTITUC, K. TOI~N.: .5OU'I"HOLD SUFFOLK COUNTY, NY PROPOSE~ POOL Ah'rENOF:D OI- 2-/- OO, 02-8'-00, 01-14-2002, 02-0~-02, 02-1~-02, 0:~-01-02, POOL LOC. ATION 11-18'-04, SEPTIC. 12-15-04 SUF:FOLK: C. OUNT¥ TAX # I000-122-4-10 C, EF~TIFIF:P TO: RIC,HARID O'TOOLF: KA THLF:F:N O'TOOLE C, OYiPIONI. NEALTH LANI~ TITLF: INSUIRANOF: OOhIPAN¥ N S Lanc~u°5~ or. Pot ~nne r~ ~er'h~ o A $72°3O,3o,~ 2~O.oo, NOTES: AREA = I-/,q20 S.P. OR 0.41 AC,. L.IIb-/2 Poge 2-/8, Sepf, lc ~ well [occltlon5 provided b~ others F:LF:VATIONS REFF:RENCF: N~VO'2Cl ®t~,APHIC, SC, ALE I"= :~0' · 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERI-IEAD, N.Y. 11901 369-8288 Fax 369-8287 REF. \~g-Ip server~pros\99-21 lb.pro JOHN C. EHLERS LAND SURVEYOR