HomeMy WebLinkAbout31050-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: 2-31784 Date: 08/28/06
THIS CERTIFIES that the building ACCESSORY
Location of Property: 220
(HOUSE NO.)
County Tax Map No. 473889 Section 104
BROADWATERS RD
(STREET)
Block 10
CUTCHOGUE
(HAMLET)
Lot 7
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
APRIL 11, 2005 pursuant to which
Building Permit No. 31050-2
dated
APRIL 12, 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 WITH FENCE
TO CODE AS APPLIED FOR.
The certificate is issued to BRUNO CIPPITELLI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
3001475
07/31/06
PLUMBERS CERTIFICATION DATED
N/A
~or~
Rev. 1/81
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Form No.6
TOWN OF SOUTHOLD
BUll.DING DEPARTMENT
TOWN HALL
I 765-1802
_;1P.~ APJLICATION FOR CERTIFICATE OF OCCUPANCY
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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 2/1 0 of I % 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:
I. 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. F~es
I. 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.
$-/7- 6~
"New Construction:
Location of Property:
Old or Pre-existing Buildin :
,'JOc-);.//c.2 'CR ,-
Street
{Jjpp; h.(li
{ I
/ tJ 5"
House No.
131' U 1)0
Owner or Owners of Property: v
Suffolk County Tax Map No 1000, Section
Block
/0
Lot
7
Subdivision
, .Filed Map.
DateofPermit./O/~~j .' Applicant:
/
Underwriters Approval:
Lot:
Permit No. .> ::;s )0"::;0 .~
Health Dept. Approval:
Planning Board Approval:
Request for:
Temporary Certificate
Final Certificate:
/
(check one)
Fee Submitted: $
~..~-':
8w<-. 70 ~r,~
Co .z: ?J f7 'tf Y
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~ BY THIS CERTIFICATE OF COMPLIANCE THE...Jof' .? ~
I NEW YORK BOARD OF FIRE UNDERWRITERS I
~ BUREAU OF ELECTRICITY ~
~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~
~ CERTIFIES THAT ~
~ ~
~ Upon the application of upon premises owned by ~
~ ~
~ MR. CIPPITELLI MR. CIPPITELLI ~
~ 17 KINGS LANE 220 BROADWATERS RD. ~
~ MAN HASSETT, NY 11040 CUTCHOGUE, NY 11935 ~
~ Located at 220 BROADWATERS RD. CUTCHOGUE, NY 11935 ~
~ ~
~ Application Number: 3001475 Certificate Number: 3001475 ~
I Section: Block: Lot: Building Permit: BDC: ns11 I
~ Described as a occupancy, wherein the premises electrical system consisting of ~
~ electrical devices and wiring, described below, located inion the premises at: ~
~ ~-~~ ~
~ 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 andlor 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 31st Day of July, 2006. ~
~ Name OTY Rate Rating Circuit ~ ~
~ Appliances and Accessories ~
~ Time Clock/Switch 1 0 ~
~ Furnace 11 00 Gas ~
F.!l PooV Spa Bonding F.!l
~~~~ ~
ffi! Receptacle 1 0 20 amp Pooll Spa ffi!
~ Switch 2 0 General Purpose ~
~ Receptacle 1 0 GFCI ~
rnJ (Swimming Pool): This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have rnJ
~ frequent test and/or repairs made by a qualified person. ~
~ ~
~ ~
~ ~
~ ~
I seal I
~ ~
~ 1 of 1 ~
I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I
l!l.l!l
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.
31050 Z
Date APRIL
12, 2005
Permission is hereby granted to:
BRUNO CIPPITELLI
NEW HYDE PARK,NY 11040
for :
INSTALLATION OF AN ABOVE GROUND SWIMMING POOL IN THE REQUIRED REAR
YARD, FENCED TO CODE
at premises located at
220 BROADWATERS RD
CUTCHOGUE
County Tax Map No. 473889 Section 104
Block 0010
Lot No. 007
pursuant to application dated APRIL 11, 2005 and approved by the
Building Inspector to expire on OCTOBER 12, 2006.
Fee $
150.00
t~ Wk-
Authorized Signature
ORIGINAL
Rev. 5/8/02
31050 ~
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING [)<] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
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DATE
INSPECTOR ~ ~
3/oS-o z..
TOWN OF SOUTHOlD BUilDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PlBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING t;<1 FINAL ~ :
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
.~~~, ~ olr,
10 "-rS --0 >'
DATE
INSPECTOR ~,~
'-
FIElD INSPECTION REPORT DATE COMMENTS ,-
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FOUNDATION (1ST) .-,-- ~ \1\_
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FOUNDATION (2ND) g~
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PLUMBING .--...- _d._ &>
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INSULATION PER N. Y. 10'"'
STATE ENERGY CODE {7
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ADDITIONAL COMMENTS .-
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TOWN OF SOUTliOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/SoutholdJ PERMIT NO.
3/0 5"&_ e::-
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of.n ,iW ~ ~'no ~COL 5.(l~,,;>
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
~~/.~~ V;;-
Examined
Approved
Disapproved ale
Mail to:
Expiration
I,)ft 2..,20 Oh
. -
Cd:(
Phone: 51 t
~ '7 - :l to c./J..
(i'R"~il~~
W. lli &i LS -"_.~ II
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"\Iii APR I ,- .
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Building Inspector
PPLICATlON FOR BUILDING PERMIT
Date
,20_
INSTRUCTIONS
Name of owner of premises
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location oflot 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 new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of South old, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections. ....C":;,,""'~.~:.O /
OCCUPANCY OR :':';:'-': 'B---/ ..
"IMMEDIATELY" USE IS UNLAWFUL /' (Slgilatureofapplie t ,
ENCLOSE POOL TO CODE WI'THOUT CERTIFIC ) v-. CJ d)()OC.(i
UPON COMPLETION . . . . , .
BEFORE "WATER" OF OCCUPANCY (Mallmg address ofappheant)
Stat/w1fethe~~~~t rs owner, lessee, agent, architect, engineer, general contractor, et\9ABQW,ijIlI.S,NQTilllder
DATE: ~c;' B.P.I '3~
FEE: _ BY: ;1~-
'~ I NOTIFY BUILDING DEPARTMENT AT
IlllLm: liltes dee8~-18
litRTI~ICATE FoLLOWING INSPECTIONS:
REQUIRED 1. FOUNDATION. TWO REQUIRED
FOR POURED CONCRETE
..L CONSTRUCTION SHALL 2. ROUGH. FRAMING & PLUMBING
ME!!:THE REQUIREMENTS OF THE 3. INSULATION
CAneS OF : ,;2N YORK STATE. .4. FINAL. CONnR'.'CT"'N MUST
"Q" . . BE COMPLt:l ~ cuR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
~ . ~SlqN q,R CONSTRUCTION ER~ORS.
II I t "--\)i('.-\ / ~
Hamlet.
Sec.'hoV\: ro4-
Block \ 63M J'f'JIWl Lot
Fil~~~~rh~~~
yl'lIIoJ~","u2 ni bel~11
_ OS .OS nil !81lCll3 flQll.""'no:l
{kl..}/1 R. r
(
If applicant is a corporation, signature of duly authori
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1.
County Tax Map No. 1000 'I
Subdivision
: ,-H-7 ~s< ~ QI
7
Lot
(Name)
2. State existing use and o.ccupancy o.f premises and intended use and o.ccupancy o.f pro.po.sed construJtio.n:
a. Existing use and o.ccupancy
b. Intended use and o.ccupancy
3. Nature o.fwo.rk (check which applicable): New BuildinK
Repair Remo.val Demo.litio.n
Additio.n Alteratio.ny t
Other Wo.rk (lhnu--e ~()/J11 ~ !U-'n
escnptlOn)
+- DO
4. Estimated Co.st b D 0 ~
Fee
5. If dwelling, number o.f dwelling units
If garage, number of cars
(To. be paid o.n filing this applicatio.n)
Number o.f dwelling units o.n each flo.o.r
6. Ifbusiness, co.mmercial o.r mixed o.ccupancy, specify nature and extent o.f each type o.fuse.
7. Dimensio.ns o.f existing structures, if any: Front
Height Number of Stories
Dimensions of same structure with alterations or additions: Front :In,'
Depth Height Number of Starnes
Rear
Depth
Rear
8. Dimensio.ns o.f entire new co.nstructio.n: Front
Height Number of Stories
Rear
Depth
9. Size o.flo.t: Front
Rear
Depth
10. Date o.fPurchase
Name o.fFo.rmer Owner
11. Zo.ne o.r use district in which premises are situated
12. Do.es propo.sed co.nstructio.n vio.late any zo.ning law, o.rdinance o.r regulatio.n? YES_NO_
13. Willlo.t be re-graded? YES_ NO_Will excess fill beremo.ved fro.m premises? YES_ NO_
Pho.ne No..
Pho.ne No.
Pho.ne No..
14. Names o.fOwner o.fpremises
Name o.f Architect
Name o.fCo.ntracto.r___
- ,Address
Ad,iress
____Address
15 a. Is this pro.pertywithin 100 feet o.fa tidal wetland o.r a freshwater wetland? *YES_NO_
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet o.f a tidal wetland? * YES NO! - .\ ';, .
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.~. ~~ ;.~~;-~
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16. Provide survey, to. scale, with accurate fo.undatio.? ~Ian anddj~.t~~~~ilfITWY lines. ~">.. ;, _ '::~ >:), c'
17. If elevatio.n at any po.int o.n pro.perty is at 10 feet o.r belo.w, m~t pro.~ia~y>~phical dat~'bliiilf\,ey.' - '"
STATE OF NEW YORK)
. SS:
COUNTY OF ~\JF{:.oLII ) -
6f!uttJn CJ. jpprT6{L I being duly sworn, deposes and says that (s)he is the applicant
(Name of individual sigiting contract) above named, .: - ':~a\-i'J
(S)He is the
(Contractor, Agent, Qilrporate Officer, efp")
'. \#
of said owner or owners, and is duly authorized t? perr~rW or have perrormed the said work and to make and file this application;
that all statements contained in this application are hue to the best ofliis knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
20 O-!J--
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Mien. FUSCO
-~"CIfMIII1lrk
-, 0 45
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18' a..nll
$749,
,..sg9~ .f!
POOLYZ!
12'118'..........51799...
12'x24' ............2199..........1199
15'x2-4' ............2799......._1299
1\' , 3Q' ..,....... 279'1......"..1599
18',3r ............2999..........1799
21'x41' ............4999..........2199
f, "'199 ,POOL
rl' ,<; ~ . ,_.. - 0 t,
THE ATLAS 100% EXTRUDED
ALUMINUM POOL
18 .___..........._.............~""'........,,_._.....-_.....T- _~__...........".""""".................._........~.....""'_""'IonI................
IXlnLYlI's...,.~&--... l'lIlililW"............ ......efI.r5..............,...Gfhrs.N_I.kenYMo. H1825970000Suffulk No.4018HI.
!!!lli!!! !!l! WI
If ...L...... S2421 _. $1'"
IS' ............._ 2811....._. ,'''
18' ..........._...3239.......... 21"
21' ................. $61.....=-. 2699
2~ .................4212.......... 29M
21' loP! ...186L' S4"
12' a"H
$1699
Sftg POOL
T., INSTALLATION'
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12'118' ..........$3437......$2599
12'124' ............3887..........31"
15' x 24' ............4321.......;..32"
lS'x3O'...........S40L.
1h 33' __...... 1......_... 3",
4/21
" All Extruded Aluminum Panel Paul
" The SIrongesl Pool we have ever sold
" 60 Year Warranly on all aluminum Parts (see slore for
wanE GLOVE
.RsrALLAftO.'
LOOIt WIIAT WE DO POR TOU FROM START TO fINIS8!
INCLUDES
~ SITII SURVEY
~ 4" LEVELING
ts.-YOUUPW$12O)
~ DELIVERY
Of youts-l a.. " Block.
~ _ HANDLING
Is.- u 1111120)
~ _POOLINSTAlUTIOII
s.-yauupto$1100
~ __IQUIPIIE/lTIIISTAUAnOM
s.-youupto$75
~ WRR GLOVE $IRVICI C1.ASS
W.lIIdI'fOUIlcrwIO..JOlI'....,IIcrwkl_\'OIlI'pcd.
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LAYOUT FOR
RESIDENCE
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PROPOSED POol_
THE CiPPITELU
SDU1HCLD, NY
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FORMER OWNE '
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
STREET 2:2 D
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VILLAGE
SUB. V
LOT ~I
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DIST
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ACR.
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TYPE 01' BUILDING'
F.
~nc{r-eiJ
RE~/cJ SEAS.
LAND IMP.
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Is-o 0
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/500
Tillable 1
Tillable, 2
nllable 3
o 0 0::>
Hoodlond
5wampland
3rushland
;ouse Plot
.....- ~ .... ~
--
rota 1- -
.=:;
S
W
VL.
FARM
COMM. CB. MISe. Mkt. Value
TOTAL DATE
.,
..:" '--_ ':J!
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
70
--
DOCK
..... -
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104-18-7 02192
~'.-'_..1"'",._,~...,
xtensi~'; (1
/.5 X ..70 .
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xtenslon
#".~~' -
5.50
'}).2.
i Ext. Wolls
Fire Place
Yoz.-
IS "" 110 "" :z.4c
",tension
lOR
I
I
iation
"
Basement
Type Roof
900 Recreation Room
Ib7-+&/ Dormer
300
3.00
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tlv4' ,...y LI ~
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~ 'IS'i?
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Patio
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:7/,0
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Total
'in L ~ 110..../6+... DalCj &..d! /!<NI<! kv<>~IIV/<) AAAi:r~
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Driveway
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Bath Yoz- :3 Dinette
Floors ;j? I ,IV'c.. K.
Interior Finish J..-/'t.;/ E L -p LR.
{A/;}!.-L Fb .
Heat ~f/H DR.
Rooms 1 st Floor BR.
Rooms 2nd Floor FIN. B.
5'
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
O.M.B. No. 3067-0077
Expires July 31. 2002
ImDOrtant: Read the Instruction. on paa.. 1 .7.
SECTION A.. PROPERTY OWNER INFORMATION For Irwurance Company Use;
BUILDING OWNER'S NAME ,PoIIqN~
Bruno Cinitelli
B:f~INg STREg ADDRESS (Includi2P Apt., Unit, Suite, and/or Bklg, No.) OR P.O. ROUTE AND BOX NO. ComPfiny NAIC Numbef
roa waters Roa
CITYCU tchogue , STATE NY
PROPERTY DESCRIPTION (Lot and Blade. Numbers, Tax Parcel Number, Legal Desaiption, etc.)
1000-104-10-07
BUILDING USE (e.g., Residential, Non-reaidentllll, AckIItIon, AocMsory. ate. Uu Commenb sedion if necessary.)
Residential
LATITUDElLONGITUDE (OPTIONAl) HORIZONTAL DATUM: SOURCE: U GPS (Type):
( fIf'...-..... or ..........) LI HAD 1927 U HAD 1983 U USGS Quacl Map
ZIP CODE
11935
L1Other:
SECTION B _ FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP COMMUNITY NAME & COMMUNITY NUMBER
New York
84. MAP AND PANEL 87. FIRM PANEL 88. FLOOD B9. BASE FLOOD ElEVATION(S)
Nut.eER EFFECT1VEIREVISED DATE ZONE(S) (Zona AO, UN depth of ftoodlng)
X
810. Indleate Ihe source of the Base F'ood Elevation (BFE) data or base ftood depth entered In 89.
U FIS Profile L!J FIRM U Commoolty Determined U Other (Describe):
B11. Indicate the elevation datum used for the BFE In 89: ~ NGVD 1929 U NAVO 1988 U OIher(Oescribe):
B12. Is the building located In a Coastal Banier Resources System (CBRS) area or Otherwise Protected Area (CPA)? U Ves IKJ No
Designation Date:
SECTION C . BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: UConstruction Drawings. UBuildlng Under Conltruction. RLIFinished Construction
.A new Elevatioo Certificate will be required when construction of the building is complete.
C2. Building Diagram Number ....2....- (Select the building diagram most limilar to the building for which this c:ertificate is being completed. lee
pages 6 and 7. If no diagram accurately represents the buIlding, provide a sketch or photograph.)
C3. Elevations - Zones A1-AJO. AE. AH, A (with SFE). VE. V1-V30. V (with BFE), AR. ARIA. ARlAE. ARlA1.A30. ARlAH. ARlAO
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum i8 different from
the datum used for the SFE in Section 8. convert the datum to that used for the SFE. Show field measurements and datum oonveraIon
calculation. Use the apace provided or the Comments area of Section 0 or Section G. as appropriate. to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used 0081 the elevation reference mark used appear on the FIRM? U Ve. 1..x.J No
o a) Top of bottom ftoor (indudlng baaement or enclO$ure) 1 Q .Lft.(m) 1
Q b) Top of next higherlloor '7 .Lft.(m) I
o c) Bottom of Ioweat horizontal structural member r.J zones only) . _ ft.(m)
Q d) Attached garage (top of slab) . _ ft.(m)
Q e) Lowest elevation of machinery and/or equipment j
serviclng Ihe building 10 .6-ft.(m) !
Q 1) Lowest adjacent grade (LAG) ? i:; ..L ft.(m) z
Q g) Highest adjacent grade (HAG) ?&;: 'O-ft.(m) ~
Q h) No. of permanent openings (1Iood vents) within 1 ft. above adjacent grade _ ~
o i) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. an)
SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification 18 to be signed and sealed by a land surveyor, engineer. or architect authorized by law to certify elevation information.
J certify that the mf0tm81ion in Sections A. 8, and C on this ceffilicate I8pf8S&nts my best efforts to intetp18t the data available.
I understand that any false statement may be ounlshab1e by fine orimprisonment under 18 U.S. CodfI. SlIc60n 1001.
CERTIFIER'S NAME UCENSE NUMBER
John T. Metzaer
TITlE Pres~dent
COMPANY NAME
119~19
Peconic Surveyors, P.C.
STATE ZIP COOE
ADDRESS
SIGNATURE
FEMA Form 81
CflY
Southold
""TE
01 29
SEE REVERSE SIDE FOR CONTINUATION
TELEPHONE
P.O. Box 909
REPLACES All PREVIOUS EDITIONS