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Home My WebLink About31900-Z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 10/18/06 No: Z-31921 THIS CERTIFIES that the building ADDITION Location of Property: 1657 MEADOW (HOUSE NO.) County Tax Map No. 473889 Section 116 BEACH LA (STREET) Block 4 MATTITUCK (HAMLET) Lot 15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 5, 2006 pursuant to which Building Permit NO. 31900-Z dated APRIL 11, 2006 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 2ND FLOOR ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ANTHONY COLLETTA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 109052C 09/13/06 PLUMBERS CERTIFICATION DATED 08/31/06 ANTHONY TRISTANO ~~ Authorized Signature Rev. 1/81 . Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 r . APPLICATION FOR CERTIFICATE OF OCCUPANCY 1 I 0 2 -16 . . I , . . 'f6iIO(ali~~~!'TL~ This application must be filled in by typewriter or ink and submitted to the Building Department A. For new building or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 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. Fees "..------- ~ I. Certificate of Occupancy - New dwelling $25.00,V\dditions 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 - $] 00.00 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 cr -(\ ~- 0' Date. Location of Property: 165, House No. Old or Pre-existing Building: V /v1e.o..da.u ~ L.c./lL MGlliJ-....vl Street I 0. t.. 0 f1~ffi Lt (check one) New Construction: Hamlet AI/', tt..OJ\. Y Suffolk County Tax Map No 1000, Section I ~ b Owner or Owners of Property: Lot I)" Block Subdivision Permit No. l{ i D Z> Date of Permit. Health Dept. Approval: J./ I t+ Planning Board Approval: ,tt / A Filed Map. Lot: Ltt ,t! <>6 Applicant: ~*.lJ'\ \. J: G,11f'th Underwriters Approval: I Request for: Temporary Certificate Final Certificate: ,/ (check one) Fee Submitted: $ JS.;,? SliC-:(.i~~~ ~./J/(Pt( Co C ~I q :< ( Electrical Inspection Certificate Issue Date 9/18/2006 Electrical Inspection Service, Inc. 375 Dunton Avenue East Patchogue, New York 11772 (631) 286-6642 Application 109052C Issued To: Street: Village: Section: Mr. Anthony Colletta 1657 Meadow Beach Lane Mattituck Zip: 11952 Town: SouthoJd Block: Lot: Contractor: Citera Electric Corp. ILl Lie. # 5108-E Was examined and found to be in compliance with the National Electrical Code. [J Commercial D NV Defects D Pool D 1st Floor [J Indoor D Basement D Hot Tub IX] Residential [J Det. Garage D Attic [l<J 2nd Floor D Outdoor [XI Addition [l Survey 1- Switch~~ _.,------" Receptac/es Fixtures GFI Heaters AlC Fans I 10 8 18 3 3 , Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves Furnace Oil Gas Circulators Smoke Detector Bell Transformer 1 Meter Amps Phase UG/OH Jacuzzi Television CO Detector / 1 Bldg. Permit: Other Equipment 11- 20 Amp Jacuzzi Disconnec:t---- i , I{ If./ I{/' () l I / / ..../ / ~ Hugo S. Surdi President Rough Inspection: 05/31/2006 Inspector: Dennis Brandi Final Inspection: 09/13/2006 Inspector: John Me Mahon III This certificate must not be altered in any manner. Inspectors may be identified by their credentials. 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. 31900 Z Date APRIL 11, 2006 permission is hereby granted to: ANTHONY COLLETTA 24 SOUTH LEWIS PLACE ROCKVILLE CENTRE,NY 11570 for 2ND FLOOR ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR; FLOOD PERMIT INCLUDED at premises located at 1657 MEADOW BEACH LA MATTITUCK County Tax Map No. 473889 Section 116 Block 0004 Lot No. 015 pursuant to application dated APRIL 5, 2006 and approved by the Building Inspector to expire on OCTOBER 11, 2007. Fee $ 250.00 ~C~ , Authorized Signature ORIGINAL Rev. 5/8/02 l-LJl..:> =lJ . t::lb t::l,;:::;. .1.H'I'! ;.\AJ i Ht.A..l..J tlULl..JJlI't\::l O,:iJ, rbO ':O~c;. "1ownliaL, .53095 MaIn Ro~d P,Q.lio, 1179 S"uthOl...N.", York 1 ,971-0959 BUILDINO DEPARTMBN1 TOWN OF 8QUTHOLD CEl<TIFICATION Date: Buiiditlg pennit No, _;If} Q_Q_1r:. Own.r; ..LbuTtiCM.Jt_('() I (~tfa.. __ (Pl"Dse print) l':umber -'ifl/T /fo,vY_1&s.TI1/!.tQ (pI~"-se print) ~ (31/00 I ".. --J Fax (631) 765.9502 Telephone (631) 76~.1802 lead. I certify that the sold~l' u~~d in the water supply Syst~Dl contains less dllll12/1 0 of 1 % &~,,~ (PI Q1'j S'ignature) -r '___;3_1''.___ :Swom to before m~ 'his _ __ ,layOfA:v~vst . ;!O_.E...L ...... ~..n NotiU")' Pilblic, 2Y..f {;; _Ll. County JuAN JABLONSKY Notary Public, Slale of New York No. 7049200 Qualified in Suffolk County Commission Expires June 30 20 10 3/,bO Z- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] INSULATION [ ] FRAMING I STRAPPING P<lFINAL A..,' ~~ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: ~.4-~l4- 6F, ~~ rf- jJ~ eM. Jvr~ J t~ Jo'-O~ DATE INSPECTOR ~~ 31100 L TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION ] FOUNDATION 1 ST ~OUGH PLBG. [ ] FOUNDATION 2ND [] INSULATION [X FRAMING} STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION ~ / ~ ~() - ~~-f:F Jlr ~ ~ ~Mr}-~~~ DATE b-6'-o~ INSPECTOR ~ ~ 31100:2- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] INSULATION [ ] FRAMING I STRAPPING J.><f FINAL ~ /~ ~ , [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: ~~ ~~!- ~ ~~, ~~~ ~~~~~ --tAt-~ ~~~ ~I DATE 7 ~;-o - (J G INSPECTOR ~~ I r' r 9 :Ci f\ 1-:\ l, ,i'. - I 1 i "i 'I I JAMES 1. DEERKOSKI, PE 260 Deer Drive Mattituck, NY 11952 (631) 298-7116 To: Town of Southold Building Dept Date: June 12,2006 Re: Insulation Inspection Calletta 1627 Meadow Beach Rd. Mattituck, NY 11952 Permit# 31900 To Whom It May Concern: After an Insulation inspection was preformed on the above property, it is deemed that all Insulation was installed correctly, and meets all building codes. Any other questions please call. r '. \ \ \ J~'k"'k; . , . , FIELD INSPECTION REPORT DATE COMMENTS ~ -'" -4)l"l C>~ O::l rv"" FOUNDATION (1ST) FOUNDATION (2ND) ~ ~ ~~ , 11D-1..'--o p^ ... "" 1\p.......A_".,/I,. U.' N.-- . .... ...~"f. /ffJ. LJ ... "to;:1' r.... n tIi10 J F ) '":^ OJJ <J--;;.) .P , . o/JA' -- . 1'--tr_L L .. ~ I. tJ- 0 ~,v /o"rJ ~~ JJ, U II -z ~p '-l . t~ r ~ ~~ m .., ROUGH FRAMING & PLUMBING . INSULATION PER N. Y. STATE ENERGY CODE / \ ( /.l..R-L. ./ - J ~ ./ ... 1';}o-61 A+;'.'~ C(J4JL 1\ ~,V [A.., J^ _~ tJ 12 ~ o!...Ju . A"- ,. J ~ " .........(~...fiA , / JC.r, "- , ...,1_ r>A~. ~~U./g r . /. ..., y- hi _;I- LUL. . /J .At.. v ' FINAL ,,~ . 't- JO'?)? -r-~ .1 .x. _/) ~ f)-fc. ~ - 1U ~ .J- ?.--F V C:v\;( ~'d'___....-<A '" V' v ADDITIONAL COMMENTS I':> ~ ~ o , ::E ,...Z ~? ~ ......, ffrllt-- /1-.. i),1_P.. I I " 1+:.../ kvfbl--o /0 K.a<..\~. f6. ~. ~: L - (J ~~' hI< ~ I/ "', -l"l ~~ ~- 0-5: -....J::l . 0 Z ::= \ l"l ~ ;! I:l l"l '" ~ --------. -- PERMIT NO. :3 /frJtJ t:? BUILDING PERMIT APPLICA nON CHECKLIST Do you have or need the following, before applying? Board of Health ~4 sets of Building Plans Planning Board approval ~ Survey Check \So .00 Septic Form N.Y.S.D.E.C. Trustees Contact: GIer-\".6 -;J~ Mail to:-::r(,(\oConSuL+,'1~ ~Cl, fut--4<f:J.- "dO P'J11 Qu I::>.JVe I ^ \---{, If.." LVC'I Phone: (0S !.~OfcP+ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL , SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.net/SouthoId/ Examined I , 20 oj; ( , 20f2~ Approved Disapproved alc Expiration I / ~{,200? I t::-II. I Building Inspector V:::-. '\ . -,--;:-."!, ----.--- \~ "'" r .( I (' ,: .':._,- \'.\ APPLICATION FOR BUILDING PERMIT (" ",~ WR-5L}) Date---Eeb('\ 1Ant II l , 20 QJ:2... INSTRUCTIONS ,. This _~Rpljq~tiQlli "completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets ofp~\lrate pot 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. ~~4't-:th O. ~lle .10-1 Ilqs<i-~ (Mal ing ad of applicant) State whether applicant is owner, lesse~~chitect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises-A4~hor"t ::T, ~ Jo~V"'r" (;ol\.R+\<L (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. I. Locjltion of land on which proposed work will be done: 1 \,os, Me...A..'t."~PAIA... (....0.\,,\1" ( lIJ\a.th.tt...cl- House Number Street Hamlet County Tax Map No. 1000 Section Subdivision t\ ~ Block 0 '-{ Filed Map No. t . Lot I r Lot (Name) -,,'.. 2. State existing use and occupancy of premises and i tended use and occupancy of proposed construction: a. Existing use and occupancy S- b. Intended use and occupancy < 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition <i- Other Work Alteration 4. Estimated Cost (Description) Fee 5. If dwelling, number of dwelling units I If garage, number of cars nf c; , (To be paid on filing this application) Number of dwelling units on each floor Ilia 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. 117/( 7. Dimensions of existing structures, if any: Front f?Jcf ( Height Number of Stories Rear ('8 '( r ./ Depth f.-{ / Dimensions of same structure with alterations or additions: Front Rear Depth L-{ I ' Height '::J.-;j.-' Number of Stories Q i1r~ Depth R ~- 8. Dimensions of entire new construction: Front IS,S~ Rear Height ::J'&'( Number of Stories I 9. Size oflot: Front I !'!?c/ Rear r -:Is. I Depth ./ 8-f)::? 10. Date of Purchase ;}C{)'--( Name of Former Owner ~/ti'" II. Zone or use district in which premises are situated ---K / 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO ~ 13. Will lot be re-graded? YES_NO ~ll excess fill be removed from premises? YES_NO ~ A....~......,.r..c{ ..jJCl<\i\,e.. ~:r S.L,e...liS.':vtG.-cR 14. Names of Ow~er of premises C'.r-.I{~ 1-f0..- Addres~_:&~CelL~ntPhone No..;;;J.J:>~-I..('I1D9. _ Name of Archltecfa",~ A \/Cl.l'.r\"V.\..oA Address.:M;:tJ7(b:,IIl."I'.~~p Phone No '::l;:t-:t-a.~d-~ Name ofContractorlc.;II,.rt,^ ('~'^S:. -:t:'V'lr. Address ~ 1? r\~..(.o/\ ' Phone No. 'Y/:).#~qr;;;; -bR<Co I ~C'\~~I"'-{ 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES .-/No * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MA- Y BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES ~O_ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. Ifelevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) C; SS: COUNTYOF )f(--oUC) (,~bV" 'E~ -:\uS-t- being duly sworn, deposes and says thai (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ~,^1:- (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn./e before me t~ - day of (hTII~ . -' 'Ole 1 Public 20~ MELANIE DOROSKI NOTARY PUBLIC, State of New ""' No. 01004634870 Qualified in Suffolk County 'J. ,-'i,L Commission Expires September 30. _!;..~"A) (-')~ 1::\01:'1 ble,,,--,, 3\Qoo , James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Jobo Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 11 , 2006 f -- . -;-, nl ' ._ I ~ : : "I i ;1 (flAY ,/ J aov!o ,. i Mr. Glenn E. Just J.M.O. Environmental Consulting Services 121 Jessup Ave., 2nd FIr. P.O. Box 447 Quogue, NY 11959-0447 RE: ANTHONY COLLETTA 1657 MEADOW BEACH LANE, MATTITUCK SCTM#116-4-15 ,.' t-, j ie'I.':; :;:....') Dear Mr. Just: The Southold Town Board of Trustees reviewed the plans prepared by J.M.O. Environmental Consulting Services last revised May 3, 2006 and determined the proposed construction of a 5'X 8.5' roof deck to be out of the Wetland jurisdiction under Chapter 97 of the Town Wetland Code and Chapter 37 of the Town Code. Therefore, in accordance with the current Tidal Wetlands Code (Chapter 97) and the Coastal Erosion Hazard Area (Chapter 37) no permit is required. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, or within 100' landward from the top of the bluff, without further authorization from the Southold Town Board of Trustees pursuant to Chapter 97 and/or Chapter 37 of the Town Code. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. 2 This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, Jam};;;g, :s~ Board of Trustees JFK:lms . . .. New York State Department of Environmental Conservation Division of Environmental Permits Building 40 - SUNY, Stony Brook. NY 11790-2356 Telephone (631) 444-0404 Facsimile (631) 444-0360 ~ ~ ~ Denise M. Sheehan Commissioner March 27,2006 Mr. Anthony Colletta 25 South Lewis Place Rockville Centre, NY 11570 RE: 1-4738-02233/00009 Dear Permittee: In conformance with the requirements ofthe 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, ~~~"~ Darleen M. Gerbino Environmental Analyst DMG/ls Enclosure NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION . DEC PEttMIT NUMBER 1-4738-02233/00009 FACILITY/PROGRAM NUMBER(S) PERMIT EFFECTIVE DATE March 27, 2006 EXPIRATION DATE(S) . Under the Environmental Conservation law March 26, 2011 TYPE OF PERMIT. New 0 Renewal 0 Modification 0 Permit to Construct 0 Penn it to Operate o Article 15, Title 5: Protection of Waters o Article 17, Titles 7,8: SPDES o Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management o Article 15, Title 15: Water Supply o Article 19: Air Pollution Control o Article 15, Title 15: Water Transport o Article 23, Title 27: Mined land Reclamation o Article 34: Coastal Erosion Management o Article 15, Title 15: Long Island Weils o Article 36: Floodplain Management o Article 24: Freshwater Wetlands o Article 15, Title 27: Wild, Scenic and Recreational Rivers . Article 25: Tidai Wetlands o Articles 1, 3, 17, 19, 27,37; 6NYCRR 380: Radiation Control o 6NYCRR 608: Water Quality Certifica- o Article 27, Title 7; 6NYCRR 360: tion Soiid Waste Manaoement PERMIT ISSUED TO TELEPHONE NUMBER Anthonv Colletta (516) 241-4809 ADDRESS OF PERMITTEE 25 South Lewis Place, Rockville Centre, NY 11570 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER JMO Environmental Consulting, P.O. Box 447, Quooue, NY 11959-0447 (631) 653-0607 NAME AND ADDRESS OF PROJECT/FACILITY Colletta orooertv, 1657 Meadow Beach Lane, Mattituck, NY 11952 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Halls Creek DESCRIPTION OF AUTHORIZED ACTIVITY: Construct an 8.5' x 15.5' second floor addition to the existing single family dwelling. All work must be done in accordance with the attached survey prepared by John T. Metzger last revised on 3/23/04 and stamped NYSDEC approved on 3/27106. 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 RIZED SI.G~~]1RE . ,/~~~ Brook, NY 11790-2356 March 27, 2006 Page 1 of 4 NEW YORK STATE OEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area fordisposal. No debris is permitted in tidal wetlands and or protected buffer areas. 2. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activity. DEe PERMIT NUMBER PAGE 2 of 4 1-4738-02233/00009 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 'ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5),24,25,34 AND 6NYCRR PART 608 ( TIDAL WETLANDS) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein 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 loss or destruction of the natural resources of the State, the owner 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 ofthe watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 2. 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. 3. All necessary precautions shall be taken to preclude contamination of anywelland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 4. 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. 5. There shall be no unreasonable interference with navigation by the work herein authorized. 6. If upon the expiration or revocation 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. 7. 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. 8. 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. 9. 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 1. Metzger last revised 3/23/04 and stamped NYSDEC approved on 3/27/06. OEC PERMIT NUMBER PAGE 3 of4 1-4738-02233/00009 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION - NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee, excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in 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 DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. 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. ttem 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, including 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 EeL 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: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, 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 submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the 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 (HWMF), 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 ri9ht to modify, suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification, suspension or revocation include: a) materially false or inaccurate 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 ofthe commissioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. DEC PERMIT NUMBER PAGE 4 OF 4 1-4738-02233/00009 ~."h.', , , " r(l\\,Jl 11;111. ') )UY,\ .1..1., . - ~ ,'\ II P.O. nn., 117<1 Slluthold. Nc\....york , F" () 1(" 7j),<'IR~ TdcfllHlnc (51('.7(..<.-: i ..;~, .' . "J'UP'l1'H T . TERRY , tOWl'l CLEnK IU::CISTf1!\.11 or VlTN. ST^llSl1CS MAnr1IAGF: ornCl.:n nLCOl1lJS /Yt.J\N^CEMENT OITtCEll rf1EEDOM OF INrOnJM1l0N orrlCEn OFFICE OF THE TOWN CLERIC TOWN OF SOUTH OLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOlD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST lQ, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (1) new forms to be used under tHe Flood Damage Prevent regulations oJ , 0; the Code of the Town of Sou thold: f'pplication" [FDP(93)), and lCertificale Special Flood Hazard A,'ea (CIC(9J)]. "Floodplain Development Pe rmit / i 7/r Oevek1pmen t in . / of Compliance fQI:L5: 1,0 ! ;:~- ~i; '-1 , ; i', ,. ~. BL.:;,J.OC:PY TOW;{ OF SO!JTlJOLD ~~ ~T.T~ Southold Town Clerk August 15, 1993 J- .... " 'l "~" . ., APPUCA TION (/ rM;E I of 4 - TOWN OF SOUTHOLO fLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be lilled out in duplicate. \ SECTION 1: GENERAL PROVISIONS (APPLICANT 10 read and ,i",,), L No work may ,tart unW a permit is issued. 2. The permit may be revoked if any faile ,tatement< arc made berein. 3. If revoked, all work must cease unt~ permit is re-issued. 4. Development ,hall not be used or occupied unt~ a Certificate or Compliance is issued. 5. The permit will expire if DO work is commenced within ,ix months of issuance. 6. AppliC3lJt is hereby informed tbat other permit< may be required to fIlUUJ loctl, ,tale and federal regulatory requirements. 7. AppliC2llt hereby gives coosentto tbe Loo! Administrator or his/her representative to make reasonable . inspectiOlLS required to verily complimce. . 8. r, TIlE APPLICANT, CERTIFYTIlAT AL IN AND IN ATTACHME)'ITS TO _ TIllS APPLICATION ARE, TO THE B T E, TRUE AND ACCURA~. (APPLICANT'S SIGNATURE)~ ATE t..f!r=f-tJJ.k;2. j , / / //SECTrON 2: PROPOSED DEYELOeliENT fT",le comolel , NAME ADDRESS TELEPHONE APPLICANT BUILDER ENGINEER PROJECT LOCATION: To avoid delay in pr<><:essing tbe .pplication., please provide enoug.b information to e.as~y identify the project location. Provide the street address, lot numlxr or legal description (attach) and, outside urban areas, tbe distance to the nearest intersecting road or wcU-known Lllidmark.. A sketch attached to Lhi.s application sbowing the project location wouJd be helpfuL FDP(93 ) ~. . ....... '.' . '.' , \ I' ~ .' " APPLlCA TJOI' ;'; PAGE10F' DESCRIPTION OF WORK (Check ,jJ appGc.oblc boxcs): A STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE o New Structure o Addition o Alleratioo o Relocatioo o Demolilioo' o Replacement o Residential (1-4 FamUy) o Residential (More than 4 Fam~y) o Noo.residential (FloodprnofLDg' 0 Yes) o Cowbined Use (Residential &. CommcrciaJ) r 0 Manu(actured (MobUe) Home (10 Manu. [actured Howe Park? 0 Yes) ESTIMATED COST OF PROJECT S B. OTHER DEVELOPMENT ACllVlTIES: o Fill 0 Mining 0 Drilling 0 Grading o Excavation (Except (or Structural Development Checked Above) o Watercourse Alteration (Including Drodging and Channel ModlJic.olions) o Drainage ImprovemenlS (Including Culvert Work) ) 0 Roa;!.. Street or Bridge Coll5truction / 0 Su~vision (New or Expansion) I 0 !J!1imdual Wate.r or Scwe.r Systcm o Olber (Please Specify) . After completLog SECTION 2, APPLlCA.l'IT should submit form to L.oc..al Adminlstra[Or for rcvievt. SECTION); I'LOODPLAfN DETERMINA.TION (To be com Dieted bv LOCAL ADMINISTRATOR) Tbe proposed devclopmco{ ls located 00 FIRM Pand No. . Dated The Proposed Development: o 15 MQI located in . Spedal Flood Hazard Area (Notify the appliC=J that the appUcation review is complete aod NO FLOODPUJN DEVELOPMENT PERMIT IS REQUIRED). o l.s 1000lcd in a Special Flood Haurd Area. FIRM LOne de.signation is 100- Year Oood elevalion althe sile is; Fl. NOVD (MSL) o Uoavailable o The proposed developmcnt i~ located 10 a noodway FBFM Panel No. Daled o See Section ~ (or .)(Jrli{jonal iOSlrlJclioCL\ SIGNED DATE ,. '.' ~'. . "," . ;t . APPLICATION >'I PAGE] OF 4 - SECTION ~: ADDITIONAL INFORMATION REOUIRED ITa he comnlcted bv LOCAL ADMINISTnATOR} The .pplicant must submit the documents checked below before tbe .pplicauon can be processed: o A Silt. plan sbowing tbe location of all existing struclurcs, water bodies, adj~ccDt roads, lot dimensions a.nd proposed development. o Developm ent pl.ns, dr.wn to scalc, and speciCtcatif,ns, including wbere appUC<lble: details (or ,,!Cboring structures. proposed elevation or lowest Ooor (including basement), types of Water resistant m.teri:us used below tbe f"st floor, details of floodproofwg of utilities localed below the flfst floor and details of eoclOSUlC' below the flfSl OOOL Also. o Subdivision or other development plans (Iltbe subdivision or otber development exceeds 50 lot' or 5 acres, wbichever is the lesser, the .pplicant !!!Jill provide l()(}..year nood elevations if !bey are Dot otberwise .vailahle). o PI1l.\IS showing the extent of watercourse relocatioD aDd/or landform alterations. o Top o( new CtIJ elevation FL NGVD (MSL). o Aoodproofmg protectioD level (DoD-resideDtial only) Ft: NOVO (MSL). For Ooodproofed structures, ';ppUcaDt must .ttacb certification from r~gistered engineer or hi /' _ arc teet. I /. o Certification [rom a~(;gis(ercd engineer lhar the proposed acth:it( in a regulatory floodway will nol result in .~ increase in the height of the loo-year fiood. A copy of alJ data and ca1oDa(jons suppord..ng this rwding must also be. sllbmiUcd. o Otber. SECTION S: PERMIT DE'ffiRMINATlON ITo be comDlcled bv LO~AL ADMINISTRATOR) I bave de(ennined lbat tbe proposed .ctivity. A. 0 Is B.O Is Dot in conformance with provisions of Local Law II , 19 attached 10 and Wilde part or this. sx:rmit. ~ The permit is issued subjeetlo the conditions SIGNED , DATE !L!lQX A is cheCKed, tbe LocaJ Administrator may issue a Devtlopmeot Permit upon p.yment nf design.ted kl"... If ~OX B is checked, (be Local Admirtislralor will provide a wrillcD summary of dcClcicncics. Applicanl may reVlse and resubmil iU1 appuc.alion 10 {he Local Administr:llor or may requesl a bearing (rom tbe Board of Appe:Js "-', ". ;- '. " '" APrLlCA TION ~ PAGE40F4 APPEALS Appealed to Boud of Appeals' 0 YO\ 0 No Healing dale: Appeah BUil,d D(;"~;lJU --- App'lJYl...d? 0 y(.~ 0 pIa Coawtions SECTION 6: ,IS.QUILT ELEVATIONS ITo be submilled bv APPLICANT before CertiliGlle of ComDliancc is issued) The foUowiog information mUSl be provided for projecl structures.. This sectioD mllSl be compleled ~y a regislered prolessional engineer or a licensed raod surveyor (or attach a certification to tlili application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of ihe lowcst Door, including basement (in c"asl.1 Hi"h Haulrd Are.s, hollom of lowest structural member of tbe lowest Ooor, excluding piling and columns) is: FT. NGVD (MSL). L . " Actual (As.Bu~t) Elev.tioo of Ooodprooflllg protectioD is FL NOVO (MSL). I ' "' / i / ../ N7: Any work performed prior to sUbmill~iof the above information is .1 tbc ris~,bf the AP~':cant. /J . ,) ,--,' SECTION 7: COMPLlAJiCE ACTION ITo be comDleled bv LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete tbis section as .pplicable based on inspection of the project to ensure corn pliancc with the commun.ity's locaJ law for Oood damage prevention. INSPECTIONS: DATE DATE DATE BY BY BY DEFICfENOES? 0 YES 0 NO DEFICIENCrES? 0 YES 0 NO DEFICIENOES? 0 YES 0 NO SECTION 8: CERTIFICATE OF COMPLlANCEfTo bc comnlcled by LOCAL ADMINISTRATOR) Certific.atc 01 c"mptiaoce mued: DATE: BY: .. . . " . . I.:, " '. " l>.ttactunent B / j } 8AMP;GE CERTlr~CATEj5F COMPLIANCE for Development in a special Flood Hazard Area <, " I... <I I '. I ~." . . , ,I " ., , TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZ.AJU) AREA (OWNER MTlST Rl!:TA IN THIS C:ERTlFICATE) PREMISES LOCATED AT: OWNERS NAME AND ADDRESS: / / I ) / /) PERMIT NO, PERMIT DATE CHECK ONE: o NEW BUILDING o EXISTING. BDrLDING o VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A, OR B, BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQU1REMENTS OF LOCAL LAW # .19 SIGNED: - DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH TIlE REQU1REMENTS OF LOCAL LAW # ,19_, AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: C I C (93) H.5. Ref. # 89-50'::96 'i\.. 'l- well . -l 'J ." CP. ~~).,.:: - CP ;-;+- TEST HOLE Dark br."'n 'ODmY sand Pal. brown coors. sand Water In pol. broWlt coarse sond 97' - _H'- 8" 4:7' I/' u' .. ~ ... ... .. " Q :r o '" .... i :t: '" q ~ o :t: .... .... "- o "- :z well . II P'o C.P (r'- ( DWELLING) G. MORITT N/O/F FRED - .~ .. .. a ROSEMARY SKYE MORITT S. 89030'30" E. ..)' I ~I ~I , I o o o ,!l:! i ~ I ~ l::'~ ~~ " /S4,.'jO' rCL.i1 .7.2 , ,o,oIe . t./i.. &o!lv 10' -,OJ > ' .35';; - <fI.O' r. ' ~ //: gar, . 2"5,.' ----1 I , 2 STY. ADDIT10N R.O.W :t: o '" .... ~ !:'s'~ -- Jj II 8RIot ! tWNEw... t '" ,. '" ~ ::> q HOT TI.8 ON II'llcl!I&lv -~ > ~ A. 40.c1. I ~ planl,,, 3d t! 35,:; ~:i -____ 13.9' lei "t t 8'p J~~. ~ ," ,. I Qlble , c-~\I\\ ~ II n 0#. '~/ \1.1 ~ \ ' C' J ~ <' o '-1 ~,,$r ~ . N r'\1I~ ~'--. --: ~ f.~~ I . CoBBLESTONE c;t.IlB l}\~.t! ~\rf'v . I'ot i I1r.' 'l.l "C ~ 1; (\.) ''; .;..... ~~ .j ',,- =lU 0(/ ~F: I <\I ~ ~~ z: """'" OECJr ., - (, o t o ~ . ~ 16 :j ~ ~ ~ -~ "g ~ o o o z: '1 .,7 16985' FCNCCl I '0' 70'~ F'C. I POST, 5It ya705s' OO"W. I N/O/F DOROTHY R, SMITH 60' (DWELLIN G) CP. 6 . LAna: ,(~"c~ ~. \ rJ' 19,;',1/' " . :~ ".i216.8Ij -....4.8...' I I I I , I I I I I I , I I 1 I I / I I -. , I ~ J 'i . . ..-.1 1I~ ~f~-b'-__ I d .... , " d I~~ I ,"l ' t U ~ I ~ t I ~ '- I d IJ :;:: '" :... C) l-l l~:..;. I ' I' ~ .I .. I~"l I~' 52.'/' NYSD'i:iC ,it. ! r~:R~l~ ( I . SURVEY OF PROPERTY AT MA TTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 7000 - 776 - 04 - 75 SCALE: 1" = 30' MAR. 76, 1987 MARCH 23, 2004 ~l ~I Ilk ~ 0 c"11 Ql !.O I Q: E) ~ CeRTIFIED TO' ANTHONY J. COLLETTA d: JOANNE COLLeTTA COMMONWEAL TH LAND TITLe INSURANCE UNITED STA TES TRUST COMPANY of NY lIs successors and/or assigns LAND AMeRICA ,.. . .~~ 010 .'" 1)1' ~'li d'( .~! CI) r . ""'" AREA = 37,079 sq. ft. to tie lines I ~, ( ~ ANY AL 1E7fA TION OR ADOIT1ON TO TIIS SlRIiEY IS A mA TION ..J:: OF SECTION 7201 OF TIE fEr YORK STATe EDUCATION LA~ DlrDT AS I'fR SECTION 7209-SUIDMSION 2. ALL CERTFICA T10NS /EllEON AIlE VALD FOR TIIS lIAI' All) COI'/E$ T/ERErJF 0IlI.), F SAm lIAI' OR CCI'IES 1IEAIt TIE _ .!Esse SEAL OF TIE SUMYOR W/tOSC ~ TIJf/E AI'f'lARS 1DIEON. ADotTTON.lLLY TO COI#l.Y "',." SA_ LAW TIE TERM ~mD BY" WST BE USED BY ANY All) ALL .suM'YlII9$ II1IJZM A t:cn OF MDTHE1I ~ IIAI'. TEI/IiII tutJlU 'fI!iI'ttTEll' All) '8RtX.IttHT.TO-/loI rr AM NOT " ~ fIlTH TIE LAW. The kHMtiDn. of ..... end ce.8IIOOIe .""..,,__ In from field ~ end or from .,. 06t-..d from othere. gi -- ELEVATIONS ARE REFERENCED TO N,G.V. DATUM ,~/2M 'ZO'1~ t,ir,e ~~')(T7 F/~ -" .. " 3 ,,, ",.J <: fF"lo.P rvO, cP/f;";)':'. 04~'" " "'7 1; I?~a --- I.,; ~ . ~ CiJ' ! I , , I I ) I C. NO. 49618 765" /797 87 - 155C