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HomeMy WebLinkAbout25164-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31783 THIS CERTIFIES that the building ADDITION Date: 08/28/06 Location of Property: 85 LAKE CT SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473689 Section 59 Block 5 Lot 8.3 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 22, 1998 pursuant to which Building Permit No. 25164-Z dated SEPTEMBER 8, 1998 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 SECOND STORY ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED The certificate is issued to GEORGE J BAMBRICK (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N489800 05/27/99 PLUMBERS CERTIFICATION DATED Rev. 1/81 07/21/99 GARY BUFKINS zed Aignature OFForm SOp( .6 e 5 V I TOWN OF SOUTHOLD / ( BUILDING DEPARTMENT - s TOWN HALL 765-1802 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: 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 Inspector 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, Swimming 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 Date. �� 6 New Construction: Location of Property: p s Old or Pre-existing Building: X (check one) 4 1% Co c� 7` S V u 7%o �a/ House No. Owner or Owners of Property: 6:- CO /'9 Suffolk County Tax Map No 1000, Section �.S Street 3L? 14"',1 c�( N Hamlet Block I_s— Lot (f , S)4— Subdivision 4— Subdivision Filed Map. Lot: Permit No. c>,2k� Date of Permit. Oe 96F' Applicant: CT Poo e 9M Z^, C7 Health Dept. Approval: Underwriters Approval: o? % Planning Board Approval: Request for: Temporary Certificate CC me Fee Submitted: $ c2,6 Final Certificate: it (check one) 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. 25164 Z Date SEPTEMBER 8, 1998 Permission is hereby granted to: GEORGE J BAMBRICK P O BOX 360 SOUTHOLD,NY 11971 for : CONSTRUCT A TWO STORY ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.EXP.PERMIT LTR 8/06 at premises located at 85 LAKE CT SOUTHOLD County Tax Map No. 473889 Section 059 Block 0005 Lot No. 008.003 pursuant to application dated JULY 22, 1998 and approved by the Building Inspector to expire on MARCH 8, 2 Fee $ 221.40 Authorized Signature ORIGINAL Rev. 5/8/02 THE NEW YORK BOARD OF FIRE UNDERWRITERS RzcE 1 BUREAU OF ELECTRICITY 40 FULTON STREET, NEW YORK, NY 10038 Date I-g;Y 27, 1" Q= Application No. on file 1749439$/98 11 489800 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of CEC??' E SAI MR --_:I;, LP,v,E COURT, SOUTHOLD, NY _05 in the following location; ❑ Basement ❑x 1st Fl. © 2nd Fl. OUT Section Block Lot was examined on 1LAY C4 T 1999 and found to be in compliance with the National Electrical Code. FIXTURE RECEPTACLES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS SWITCHES INCANDESCENT1 FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. I K.W. jAMT. K.W. AMT. H.P. OUTLETS YERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL TRANS. UNIT HEATERS MULTI.OUTLET DIMMERS MS NO. OF FEET AMT. WATTS N.W. OIL M.P. GAS H.P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. AMT. H.P. f SERVICE DISCONNECT NO. OF METER EQUIP. S E R V I C E AMT. AMP. TYPE 1 0 YW 1 B 3W 3 0 3W NO. OF CC COND. J R dW PER 0 A. W. G. OF CC. GOND. NO. OF HI -LEG A. W. G. OF HI-LFG NO. OF NEULRALS A. W. G. OF NEUTRAL 1 0 CE 1 Y. _ 4/0 OTHER APPARATUS: E 1DDLE AV'c;- 5 _..U L.:Lt HEP.TERv. .� q 1, ..f9.,1-. 7 5 I.Y1.,1-.7_ K. W. _F If IE DETECT"'.:: "C" L �rn TH?EE ELECTRIC LIC. #332 ri RT. kl BOX 4514 SOUND AVE RIVER.TIEAL, NY, 11901 GENERAL MANAGER Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. a� I ,� 2 21999 Town Fh P 11971 Fax(516)765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: / ' a? / ?F Building Permit No. ow—'�5-16 owner: ,cc Me, 5rnbR e K (please print) Plumber: &.4 Rte/ 13 y l'/(/)✓ C (pleade print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ' (plumjWees S nature) Sworn to before me`` this a1 5'1� day of 19C#c�9 1 Notary Public, CX county BETSY A. PERKINS Note rryy Public, Stats Of Ns�1M- No OIPE6005733 Ouslitied in Suffolk C"My 1D xpi Commission Expires AP TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]IN ATION [ ] FRAMING / STRAPPING[ 1, FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION DATE INSPECTOR C+ M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU ION [ ] FRAMING [ NAL DATE a% INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO H PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE C IMNEY REMARKS: DATE 1 1' % INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO GH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE/&%CHIMMNEY R ARKS: DATE !�S INSPECTOR M-1802 BUILDING DEPT. I NSPECTIO [ ] FOUNDATION IST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ROUGH PLBG. [ ] INSULATION [ ] FINAL AW A LV �� , / % O i /- / , 9 l -ATE 4z 1 14&9 INSPECTOR ��' (� 5 -/ /�/ 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] F UNDATION 2ND [ FRAMING ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL DATE /��/� � INSPECTOR ,PPEALS BOARD MEMBERS Gerard P. Goehringer, Chairman Serge Doyen, Jr. James Dinizio, Jr. Robert A. Villa Lydia A. Tortora o�ogUFFDI�-coGy � 1 0 y 2 oy • !� BOARD OF APPEALS TOWN OF SOUTHOLD ACTION OF THE BOARD OF APPEALS Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax(516)765-1823 Telephone (516) 765-1809 August 21, 1996 APPLICANTS: GEORGE AND CAROLE BAMBRICK. Appl. #4405 LOCATION OF PROPERTIES: Parcel 1000-59-5-7 referred to as 85 Lake Court owned by George and Carole Bambrick, and Parcel 1000-59-5-8 owned by Brian and Brendan Bambrick referred to as 155 Lake Court, Southold. BASIS OF ACTION: Request of George and Carol Bambrick to change lot line and increase size of nonconforming lot as referred to in the July 17, 1996 Notice of Disapproval from the Building Inspector. Section 100-30A.3, Bulk Area and Parking Schedule in the Zoning Code - one nonconforming lot will be reduced while the other lot will be increased in size. The Zoning Code does not permit reduction in nonconforming lot sizes without variances. MOTION MADE BY: k'` ° SECONDED BY: RESOLUTION ADOPTED: APPROVED exchange of land area to increase nonconforming lot from 7000 sf. to 14096 sf, while reducing nonconforming lot to a size of 16,604+- sf: as shown on survey map amended July 10, 1996 prepared by Roderick VanTuyl, P.C. REASONS/FINDINGS: Nonconforming setbacks will be increased on smaller lotlocated on a corner, by enlarging rear/side yard area. Each parcel will be more in character with nearby configurations. VOTE OF THE BOARD: Ayes: Serge J. Robert A. Villa, and Gerard P. Goehringer. This resolution was unanimously adopted. GERARD P. GOEHRINGER, CHAIRMAN Approved for Filing ZBA:ik Doyen, James Dinizio, Jr., (Member for )2:Yr( .. n abCONT.) Albert J. Krupski, President John Holzapfel, Vice President Jim King Martin H. Garrell Peter Wenczel August 1, 1996 George Bambrick P.O. Box 360 Southold, NY 11971 RE: George Bambrick SCTM # 59-5-7 o�o�OgUFFO(,�c y� G C* x BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 Dear Mr. Bambrick: The following action was taken by the Southold Town Board of Trustees July 31, 1996: RESOLVED that the Southold Town Board of Trustees approve a waiver to construct a 12' X 321, two story addition (enclosing existing deck) on west side of house and a 8' X 20' - one story addition (enclosing existing deck) on north side of house. This approval does not constitute any other approvals from any other agencies. If you have any questions, please do not hesitate to contact this office. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:jmd cc: Bldg. Dept. PLANNING BOARD MEMBERS RICHARD G. WARD Chairman GEORGE RITCHIE LATHAM, JR. BENNETT ORLOWSKI, JR. WILLIAM J. CREMERS KENNETH L. EDWARDS August 27, 1996 George Bambrick 85 Lake Court Southold, NY 11971 PLANNING BOARD OFFICE TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax(516)765-3136 Telephone(516)765-1938 Re: Proposed lot line change for George J. and Carol J. Bambrick and Brian and Brendan Bambrick SCTM# 1000-59-5-7 & 8 do Dear Mr. Bambrick: The following resolution was adopted by the Southold Town Planning Board at a meeting held on Monday, August 26, 1996: BE IT RESOLVED that the Southold Town Planning Board, acting under the State Environmental Quality Review Act, do an uncoordinated review of this unlisted action. The Planning Board establishes itself as lead agency, and as lead agency makes a determination of non -significance and grants a Negative Declaration. Enclosed please find a copy of the Negative Declaration for your records. Sincerely ichard G. and Chairman enc. New York State Department of Environmental Conservation Building 40 - SUNY, Stony Brook, New York 11790-2356 Telephone (516) 4440365 Facsimile (516) 444-0373 August 22, 1996 George J. Bambrick PO Box 360 Southold, NY 11971 RE: 1-4738-01383/00001 Dear Permittee: Commissioner 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 posted at the project Jr CTH:jmr enclosure File a permit sign which is to be conspicuously site and protected from the weather. Very truly yours, I44a-w - C7� ChaAbst T. Hamilton Permit Administrator X NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-01383/00001 8/20/96 FACILITY/PROGRAM NUMBER(S) PETTIT 8/31/99ION DATE(S) Under the Environmental Conservation Law TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification 0 Permit to Construct 0 Permit to Operate 0 Article 15, Title 5: Protection 0 6NYCRR 608: Water Quality ❑ Article 27, Title 7; 6NYCRR 360: of Waters Certification Solid Waste Management 0 Article 15, Title 15: Water 0 Article 17, Titles 7, 8: SPDES 0 Article27, Titlste e 9; 6NYCRR 373: Supply 0 Article 19: Air Pollution Hazardous 0 Article 15, Title 15: Water Control 0 Article 34: Coastal Erosion TransportManagement 0 Article 23, Title 27: Mined Land 0 Article 15, Title 15: Long Reclamation 0 Article 36: Floodplain Island Wells Management ■ Article 24: Freshwater Wetlands 0 Article 15, Title 27: Wild, 0 Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers 0 Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control 0 Other: TELEPHONE NUMBER PERMIT ISSUED TO 516-765-1473 George J. Sambrick ADDRESS OF PERMITTEE PO Box 360 Southold, NY 11971 TELEPHONE NUMBER CONTACT PERSON FOR PERMITTED WORK George J. Sambrick PO Box 360, Southold, NY 11971 NAME AND ADDRESS OF PROJECT/FACILITY Bambrick Property 85 Lake Ct. LOCATION OF PROJECT/FACILITY Southold TOWN WATERCOURSE NYTM COORDINATES COUNTY Suffolk Southold Great Pond DESCRIPTION OF AUTHORIZED ACTIVITY Enclose existing deck around house with a 2 story frame structure measuring 12'x32' on west side ofjhouse and a 8' x 32' on the north side of house. ALL work shall be in accordance with the NYC approved plans by George one story addition Bambreck dated 7/15/96. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL,. alt applicable regulations, the General Conditions specified (see page 2) and any Special Conditions included as part this permit. PERMIT ADMINISTRATOR: AUTHORIZED SIGNATURE ADDRESS plldg. 40, SUNY, Room 219, Stony Brook, NY 11790-2356 DATE 8/21/96 5 NNING BOARD MEMBERS RICHARD G. WARD Chairman GEORGE RITCHIE LATHAM, JR. BENNETT ORLOWSKI, JR. WILLIAM J. CREMERS KENNETH L. EDWARDS o�OgUFFO(,�-c� 0 CODIvy 2 PLANNING BOARD OFFICE TOWN OF SOUTHOLD State Environmental Quality Review NEGATIVE DECLARATION Notice of Determination Non -Significant August 26, 1996 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax(516)765-3136 Telephone (516) 765-1938 This notice is issued pursuant to Part 617 of the implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental Law. The Southold Town Planning Board, as lead agency, has determined that the proposed action described below will not have a significant effect on the environment and a Draft Environmental Impact Statement will not be prepared. Name of Action: Proposed lot line change for George J. and Carole J. Bambrick and Brian and Brendan Bambrick SCTM#: 1000- 59-5-7 & 8 Location: 155 Lake Court, Southold SEQR Status: Type I ( ) Unlisted (X) Conditioned Negative Declaration: Yes ( ) No (X) Description of Action: This lot line change is to subtract 7,096 square feet from a 23,700 square foot parcel and add it to a 7,000 square foot parcel Page 2 SEQR Negative Declaration - Proposed lot line change for Bambrick August 26, 1996 Reasons Supporting This Determination: This project involves a lot line change that will result in the transfer of 7,096 square feet from a 23,700 square foot parcel; to a 7,000 square foot parcel. Both parcels are non -conforming parcels. Thus the smaller non -conforming parcel will become more conforming. The change requires a Zoning Board of Appeals decision. The change will not result in a more intensive use of the land. An Environmental Assessment Form has been submitted and reviewed, and it was determined that no significant adverse effects to the environment were likely to occur should the project be implemented as planned. For Further Information: Contact Person: Robert G. Kassner Address: Planning Board Telephone Number: (516) 765-1938 cc: Michael D. Zagata, DEC Albany Suffolk County Water Authority Judith Terry, Town Clerk Southold Town Zoning Board of Appeals Southold Town Building Dept. Applicant ER LA.V �.�lyG ✓va✓EY✓�rvE�/� IJ N 6,z 4:::A�v4r e.a r Jr/geOO�.�.,�.A�orE r -�vr FcSvc IN M/0 . �4e-wx ae I', DEPARTMENT OF THE ARMY NEW YORK DISTRICT, CORPS OF ENGINEERS D:TT JACOB K. FEDERAL BUILDING NEW YORKRK.. N N.Y. 10278-0090 August 12, 1996 NTION O Eastern Permits Section SUBJECT: Joint Application with New York State Department of Environmental Conservation George J. Bambrick P.O. Box 360 Southold, NY 11971 Mr. George J. Bambrick: We have recently received a copy of the Joint Application for permit you filed with the New York State Department of Environmental Conservation (NYSDEC). Please be advised we have reviewed the copy of the Joint Application sent to this office by NYSDEC. Based solely upon the information provided, it appears that a Department of the Army permit is not required for your proposal. The Department of the Army regulates construction activities in navigable waterways and discharges of dredged or fill material into waters of the United States, including inland and coastal wetlands. If your proposal would involve such work, and has not been portrayed as such in your Joint Application, you should contact this office immediately so that a project -specific determination can be made as to whether a Department of the Army permit will be required. Any inquiries can be directed to this office at (212) 264- 3912, 3913, 6730, or.6731. 'ely, 'liv.,S /-1-/ -11 �kGii W. Haggerty Eastern Permits Section ELEVATION CERTIFICATE O.M.S.prMay 37 1993 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment ar Revision (LOMA or LOMR). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE POLICY NUMBER BUILDING OWNER'S NAME STREET ADDRESS (Including ApL. Unit. Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIL NUMBER OTHER DESCRIPTION (Lot and Block Numbers. etc.) _ SCTM#1000-59-05-07 STATE ZIP CODE Cm 11971 Southold,N Y SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION _..:�., rti� r..u....,1.... #I N.c pruner FIRM ISee Instructions): CV,. ..... .............. ..y . _... ..._ 1. COMMUNITY NUMBER _�_ , 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE AE Pe _ 8. (inAD FLOOD nual depth) N 1 1 r _ _ 7Andicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): '—I NLavu ZV :__J utner tueau,-- "I 8. For Zones A or V, where no SFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: i I ( I 1 .J feet NGVD (or other FIRM datum—see Section B, Item 7), SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, Indic Ia the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level _ . 2(a). FIRM Zones At -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of I I I I ,4I feet NGVD (or other FIRM datum—see Section B, Item 7). (b). FIRM Zones V1430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation oil I I I I .I.J feet NGVD (or other FIRM datum—see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is W .J feet above ❑ or below ❑ (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram isI �J.LJ feet above ❑ or below ❑ (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: T NGVD '29 ❑ Other (describe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on the FIRM (see Section B, Item 77, then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: ❑ Yes n' No (See Instructions on Page 4) 5. The reference level elevation is based on: ni actual construction ❑ construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent t0 the building is: l 1 1 1 112 LI feet NGVD (or other FIRM datum -see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: I ) 1 1 1 •J feet NGVD (or other FIRM datum—see Section B. Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81 -3 11 MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who Is authorized by state or local law to certify elevation information when the elevation information for Zones Ai—A30, AE, AH, A (with BFE),V1—V30,VE, and V (with SFE) is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 - Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. I certify that the information in Sections B and C an this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Lewandowski 33696 GERTIFIER'S NAME - LICENSE NUMBER (or Affix Seal) Licensed Land Surveyor------------ Tn1E COMPANY NAME P.O.BOX 44R Srmthnla N V 11 A71 ADDRESS CITY �) X n X7 STATE LP er DATE PHONE J171y 1-) inns Copies shounbede of this Certificate for: 1) community official, 2) insurance agenUcompany, and 3) building owner. COMMENTS: ON aue A v ZONES ZONES WITH 9ASeNPM A tr ZONES MSE RLW ON PILES, PIaRS, OR COLUMNS The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2 t JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORI)S MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall. 53095 twain Road P.O. Rox 1170 Southold, New Turk 11971 Fax (516) 765-1821 Telephone (516) 765-1901 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 for Development in Special Flood Hazard Area [C/C(93)]. A `udi t Southold Town Clerk August 25, 1993 APPLICATION # PAGE I of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be tilled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and si¢n): 1. 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 no 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 reasonable inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE, TOT EST OF I Y KNOWLEDCAE, T UE AND ACCURATE. (APPLICANT'S SIGNATURE) DATE SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICANT) NAME ADDRESS TELEPHONE APPLICANT BUILDER ENGINEER PROJECT LOCATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION # PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE J7 New Structure 0 Residential (1-4 Family) ❑ Addition ❑ Residential (More than 4 Family) ❑ Alteration ❑ Non-residential (Floodproofmg? 0 Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) • Demolition ❑ Manufactured (Mobile) Home (In Manu- • Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT S B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill ❑ Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) • Drainage Improvements (Including Culvert Work) • Road, Street or Bridge Construction • Subdivision (New or Expansion) ❑ Individual Water or Sewer System ❑ Other (Please Specify) After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. SECTION 3• FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. The Proposed Development: ❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). 0 Is located in a Special Flood Hazard Area. FIRM zone designation is 100 -Year flood elevation at the site is: Ft. NGVD (MSL) 0 Unavailable O The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED APPLICATION # PAGE 3 OF 4 SECTION 4• ADDITIONAL INFORMATION REOUIRED (To be comnleted by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: 13 A site plan showing the location of all existing structures, water bodies, adjacent 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 fust floor, details of floodproofmg of utilities located below the fust floor and details of enclosures below the fust floor. • 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 are not otherwise available). • Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofing protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. 0 Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100 -year flood. A copy of all data and calculations supporting this finding must also be submitted. [] SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity: A. O Is B. O Is not in conformance with provisions of Local Law #_, 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 fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPLICATION # PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision -- Approved? ❑ Yes ❑ No 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 section must be completed by a registered professional engineer 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 Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. - Actual (As -Built) Elevation of floodproofng protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be completed 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 prevention. INSPECTIONS: DATE BY DEFICIENCIES? O YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? OYES ❑ NO SECTION S: CERTIFICATE OF COMPLIAN E(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: OWNERS NAME AND ADDRESS: PERMIT NO. PERMIT DATE CHECK ONE: ❑ NEW BUILDING ❑ EXISTING BUILDING ❑ VACANT LAND TIME LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW #_, 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # 19_, AS MODIFIED BY VARIANCE # DATED ' SIGNED: DATED: C/C(93) r C- i'.. , ..a Examined .... ,,(./K ....... 19. Approved .... 6.�.Q......... FORM NO. I 'TOWN OF SOUTUOLD PenniI Disapproved hf/c................................... r.Cq.� .. (Blah di Inspector) APPLICATION FOR BUTLDINC PERMIT INSTRUCTIONS BOARD OF UEAI:I11 ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORM ................... NOTIFY: CALL .................. MAIL TO: .................... Date........,19/. a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wit' 3 sets of plans, accurate plot plan to scale. Fee according to schedule. h. Plot plan slowing location of lot and of buildings on premises, relationship to adjoining promises or public streets or areas, and giving a detailed description of layout of property must be dram on the diagram which is part of this application. c. 'Ne work covered by this application may rot 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 permit shall be kept on the premises available for inspection throhug)hout the work. e. No building shall be occupied or used in wlole or in part for any purpose wlhatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICNI'l(N IS IIEREKY MALE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Oidinance of the Town of Southold, Suffolk County, New York, and other applicable Lars, Ordinances or Regdlations, for the construction of buildings, additions or alterations, or for removal or demolition, as lherein described. The applicant agrees to comply with all applicable laws, ordinances, building code, lousing code, and regulations, and to admit authorized inspectors on premises and in building for noes ry ins tion (Signatureof applicant', or nave, if a corporation) �o '&'X d G o Y //Q 1 ................................................... (Mailing address of applicant) State wlhetler applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,Ge17t-�1- Nam of owner of premises ....... ��,t e ......:.......9 %'/ G .. ............................................................. (as on tle tax roll or latest decd) 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 . .................... p �j- 1. Location of land on which O �4i1 .. Cay r proposedwork will be oldxe..........................................q................... .............................................................. a Y / i7.o/V....!f >/ // < 7 / .................... House Nhnber Street\ ,Ilanlet C xnty Tax Map No. 1000 Section ...� ...... Block ... ........ Tot . ........... Subdivision ...................................... Filed Map No. ............... Int ............... (Name) 2. State existing use and occupancy of promises intended use and occup c of proposed construction: a. Existing use and occupancy ........l................CJ ......................... b. intended use and occupancy ...... �nnoo''DD 3. Kilure of work (dieLk wdnidt applicable): NeW Ikrildiat. ...._..... Addition .. ^...... Alteration .......... Repair ............ Renhoval ............. beard ition'.....y ',:.;::`:r .;OUher Work /�S (Description) 4. Estinrhted Cost .73-, d D f% fee....... .................................. (Co la►d on filing this application) 1 • 44 5. If c►elling, txniier of dwelling units; ...l..... Nrdler_of c rt ll ng units oeach floor .......... If garage, umber of cars ...........?.• .r .:�.: -::,•alt... G. if Ihusiness, mnercial or mixed occupancy, specify nature and extent of east type of use ...................... 7. Dinensioos of existing structures, if any: Front: .... dl?�...... Rear .. `. ....... Depth .: 3a ......... i Ikight ..... 0 .. ............... Naber of Stories .. �................. oZ Dimensions of sale. structure with alterations or additions: Front .....�?2 .... Rear ............... i Depth .... ........... l@ih4nt ........... Nnber of Stories ... a... .. 8. Dinensioos of entire new construction: Front ....�!. ...... Rear ..' ........ I)eptlh . `3 a ....... IleiglhC ...J.< .................. Naber of Stories ... a.............. 9. Size of lot: Front.,. ... Rear ...... Depth ....�.7nn ��--// ............ 10. Ihhte of Puurdnse .G..a .-(.... Name of Fortner Owner ................................. If. 7nne or use district in wltidt premises are situated............................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ... /.':.�............... 13. Will lot be regraded .. IVre?............ Will excess fill be removed frau premises: YES NO G y /� Pa B 3a c 9 3 14. Nares of Owner of premises .. �F •E 4�/ �!%I Acklress IJ • %l None No. J ..... ��7 Wane of Ardritect .................................... Address .............................. FEhone No. .............. Nrre of Contractor ................................... Acklress ...............................phone No. .............. 15. is this property within 300 feet of a tidal wetland? * YIS .......... ND .......... *IF YES, SOUIIK71D 1101411 1141SW1S FEMI'r My HE tuplitiI. PLOT DIAGRAM A locate clearly and distinctly all buildings, wltedier existing or proposed, six] indicate all set -back dimensions` Fran property lines. Give street and block nnber or description according to deed, and allow street names and indicate wiletlter interior or corner lot. r //•v SI'A'IIS OF "t#4"4K • SS (IUINIY (A? N,� vl'c l YC ..`.......... P USCI Y�VU.1-.' ..........................being duly sworn (Nam Of I ividual. signing couLract) alxove nmed, deposes anxl says that Ire is lbe applicanL Ileis the................................................................................................... (Gxttractor, ageut,'corporale officer, eLc.) of said owner or overs, and is duly out to pt>rfonn or have Ierlinrned Ilne sai(I work anal to nuke and file this application; that: all slatepents captained in this appl.icaliah are troe to the Ipest of his knowledge and belief; and lhaL Ole work will Ile perfonred in the (mnner set fort -h in We application filed therewitli. 'M)rn to FFb��efore ne this ..... a..1........day of6.........19.09..... Notary lldhli� Y. DOLO S STFiICCHIOLA NOTARY PUBLIC OF NEW JERSEY MY COMMISSION EXPIRES MARCH 28.1998 (Sigipture o�an ENERGY CODE CALCULATIONS (ror Non-ElecL•ric heat) FOR: F(2h, ! rL C� SUBSYSTEM I AREA 1•:xtcrior. Walls (Opaque) Io V $ 3p % Glazing Z�• Doors Ceiling/Roof (opaque) Skyliyllts $ r loor . y P ) roundation Walls Slab Insula Lion Design Criteria (j,000 Ueyree'.DayS O.A. IU -F I.A. 7U"F PER Penny .�� 6e. 1634 — un'rrD: Rev 20- F, F7 ES1GN 1(tLti4EL REMARKS ,lull RJNTING 12.V 2. k- 05' 1 o o S 1 0 9- 3 Z- ., N I Buildl.uy Envelope Systems to meet requirements of: 7U15.2 „N 'g� HVAC rquipement to meet requirements of 7015.11 uu HVAC Systems to meeL• requirements of 70U.T2 gLD nFrPT. UucL Systems to meet requirements of 70ts of S ��uNOFSOUTHC VenLilaLions Systems to meet requiremeuLs of 701 .14 Insulation of Piping Systems to meeL requir.emenLs of: 7015.15 Service Water Ileatiny Systems 6 Equipment to meeL- requiremeuLs of '1015.21 Electrical 6 Lighting Systems 6 rquipmenL to me�requiremeuLs of 7015.31 To the best of my knowledge, belief, 6 Professional judyement, these plans are 1.11 compliance with the code. r� � .r49zs S3 30 E Fd / r;__ _ kms/ � • .. ' y fie, tin I -� r ' i I � i v + � .r49zs S3 30 E Fd / r;__ _ kms/ � • .. ' y S.'.$•c�Z DV. - 1//.S/ , . Wild fie, tin I -� Fin 77 v + IL� ����W. \�lr .$•� RrJ. ;'STC i 6 � � • N� � L` �� • � u S.'.$•c�Z DV. - 1//.S/ , . Wild b ,b' h.8 -Z A r�0. Box 360 e • �. ... f, :Q .Sly, r - a -. � .. LG�:'�7-Ir1ti• � KE'F�!* �.� ..��7•�9u ss.a LC-�'_L., ,ti16!/O. ,ime.ydeo 4./u/y /o, 191, J,. 6 9- 6 b ,b' h.8 -Z A r�0. Box 360 e • �. ... f, :Q .Sly, r - a -. � .. LG�:'�7-Ir1ti• � KE'F�!* �.� ..��7•�9u ss.a LC-�'_L., ,ti16!/O. ,ime.ydeo 4./u/y /o, 191, J,. r Y PROVIDE OPENINGS FOR N copper tubing Is used EMERGENCY ESCAPE AS forweerdistributing REQUIRED BY PART. 714 OF system; piping shell be N.Y. STATE BUILDING COOL of tvp"jffj0-nhL PROVIDE SMOKE -DEFECTING PROVIDE ANTI -SCALD AND/OR ALARM DEVICES THERMAL SHOCK PREVENTING AS TO PART. 721.1 DEVICES AS TO PART. 902.6(K) N.Y.S BUILDING CODE. 111.1 VATE BUILDING CODE rwmom All rr..rui.....w ✓/ST�cOM v� 4J y OCCUPANCY OR W USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY AItINOYm A! 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