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Home My WebLink About30816-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32012 Date: 11/17/06 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property: PVT RD (HOUSE NO.) County Tax Map No. 473889 Section 12 OFF E END RD (STREET) Block 2 FISHERS ISLAND (HAMLET) Lot 6.15 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 22, 2004 pursuant to which Building Permit No. 30816-Z dated DECEMBER 2, 2004 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 ADDITION & ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAMES BAILEY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2090902 07/27/06 PLUMBERS CERTIFICATION DATED 03/24/06 THOMAS RAVIDO Rev. 1/81 . Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 Sr:o I I 7S '-' APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Departme~twilh4he following: A. For new bnilding or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natoral 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 existiag buildings (prior to April 9, 1957) non-eonfonning uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, building and unusual natora! or topographic featores. 2. A properly completed application and a consent to inspect signed by the applicant. Ifa 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, 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 - $25.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. { /s .I DC New Construction: Old or Pre-existing Building: X Location of Property: PRIVATE ROAD OFF EAST END RD, House No. Street Owner or Owners of Property: JAMES AND ROANNE BAILEY (check one) FISHERS ISLAND Hamlet Suffolk County Tax Map No 1000, Section 012 Block 0002 Lot 6.15 Subdivision Permit No. 308162 Date of Permit. 12/2/04 Filed Map. Applicant: Lot: JAMES BAILEY ATTACHED Health Dept. Approval: Planning Board Approval: NA NA Underwriters Approval: Request for: Temporary Certificate Fee Submitted: $ 25.00 Final Certificate: X (check one) ~ 7!?)5~ eO~);10 1:2.. H.P. BROOM - HOUSEWRIGHT, INC. P.O. BOX 70 - 162 FERRY RD. HADL YME, CT 06439 (860) 526 - 9836 FAX (860) 526 - 2647 LETTER OF TRANSMITTAL Date: 9/5/06 To: TOWN OF SOUTHOLD BUILDING DEPARTMENT P. O. BOX 1179 SOUTHOLD, NY 11971 ATT: To Whom It May Concern Re: BAILEY RESIDENCE WILDERNESS POINT FISHERS ISLAND, NY WE ARE SENDING YOU X Attached Under seperate cover via the following items: ShOp Drawings Prints Plans Samples _Specifications Copy of Letter Change Order Other Copies Date No. 1 9/5/06 1 2090902 1 3/24/06 1 6/22/06 1 9/5/06 Description Application for Certificate of Occupancy New York State Board of Fire Underwriters Certificate of Compliance Lead Free Solder Certificate Copy of request for six (6) month extension of Building Permit faxed 6/22/06 H.P. Broom-Housewright check #13624 in the amount of $25.00 THESE ARE SUBMITTED as checked he1ow: ~ For approval !.... For your use As requested Approved as submitted Resubmit__ copies for Approval __ Approved as noted __ Submit __ copies for Distrib. Returned for corrections __ Return__ corrected prints RIl:Ml\RKS : Enclosed you will find the above referenced material which, I hope, are all the documents needed for the issuance of a Town of Southold Certificate of Occupancy. In a conversation with Damman Rallis (9/1/06) I was told no additional as- built is needed. The one submitted for footings is sufficient. Please feel free to give a call should you have any questions or should additional material be required. Thank~ou, 4:ny Br ~ P its 30~11" l!I.l!I I BY THIS CERTIFICATE OF COMPLIANCE THE I ~ NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~ BUREAU OF ELECTRICITY ~ ~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~ ~ CERTIFIES THAT ~ ~ ~ ~ Upon the application of upon premises owned by ~ ~ ~ ~ ZELEK ELECTRIC CO. MR BAILEY ~ ~ 187A BOSTON POST ROAD WILDERNESS PT ~ I OLD LYME, CT 06371-1384, FISHERS ISLAND, NY 06390 I ~ Located at WILDERNESS PT FISHERS ISLAND, NY 06390 ~ ~ ~ ~ Application Number: 2090902 Certificate Number: 2090902 ~ ~ Section: Block: Lot: Building Permit: BDC: n511 ~ ~ ~ ~ Described as a Residential600-t 199 square ft. occupancy, wherein the premises electrical system consisting of ~ ~ electrical devices and wiring, described below, located in/on the premises at: ~ ~ First Floor, Second Floor, Outside, ~ ~ A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ~ ~ herein, was conducted in accordance with the requirements of the applicable code and/or standard ~ ~ promulgated by the State of New York, Department of State Code Enforcement and Administration, or other ~ i authority having jurisdiction, and found to be in compliance therewith on the 27th Day of July,2006. i ~ Name OTY Rate Rating Circuit ~ ~ ~ Miscellaneous ~ ~ bedroomlkitchen ~ ~~~~~ i F.!l Oven I 0 40 Amps ~ ~ Exhaust Fan I 0 F.H.P. ~ ~ Dish Washer I 0 1.2 KW ~ ~ Disposal I 0 I H.P. ~ ~~~~ ~ ~ Receptacle 23 0 General Purpose ~ ~ Switch 16 0 General Purpose ~ ~ Fixture 18 0 Incandescent ~ I Receptacle 4 0 GFCI I ~ ~ ~ ~ ~ seal ~ ~ ~ ~ I of I ~ ~ ~ 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!I.l!I Towa II.U, 53095 Mala 1lMd P.O. Sol( 1119 SoIxboId. New York 11l17l.lI9S9 ~-~~ ..11; ~"f({ . ~ FIX (631) 76M8%! 1'cItphoe (631) 766-1~ BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: frlo-.oc ir1\ . ;),'/ !ex; ( Building Permit No. ? 0 g [ c; owner:-;CvY1(:"S ~-'-~ 1 €-j ~ease print) Plumbe;\OM \(0.,) ~cJCr (please print) I certifY tbat the solder used in the water supply system contains less tban 2/10 of I % lead. ~(;U (Plumbers Signature) Sworn to before me this ~ day of fYIlirr~ . 20~ Q16M~#4"lcLo Notary Public, J1 ~ County ROXANNE SPAULDING NOTARY PUBLIC, STATE OF NEW YORK Nn 01SPfilD942 UII^IIIIIIIIN Sill I 01 K COUNIY MY t:O~IMISSION I XI'IIIIS ^UG. ~1, 70PK , New York State Department of Environmental Conservation Division of Environmental Permits, Region One Building 40 - SUNY, Stony Brook, New York 11790-2356 Phone: (631) 444-0365 . FAX: (631) 444-0360 Website: www.dec.state.ny.us September 10, 2004 ~ ..... .... Erin M. Crotty Commissioner James Bailey 12 Reservoir Street Cambridge, MA 02138 Re: Permit #1-4738-00524/00003 Dear Mr. Bailey: 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 carefully read all permit conditions and special permit conditions contained in the permit to insure compliance during the term of the permit. 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, tP~ Mark Carrara Deputy Permit Administrator cc: Jacob Albert, Architect BOH MHP file NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER 1-4738-00524/00003 FACILITY/PROGRAM NUMBER(S) . PERMIT EFFECTIVE DATE September 10, 2004 EXPIRATION DATE(S) Under the Environmental Conservation Law September 10, 2007 TYPE OF PERMIT . New 0 Renewal 0 Modification 0 Permit to Construct 0 Permit 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 15, Title 15: Water Transport o Article 15, Title 15: long Island Wells o Article 15, Title 27: Wild, Scenic and Recreational Rivers o Article 19: Air Pollution Controi o Article 23, Title 27: Mined land Reclamation o Article 34: Coastal Erosion Management . Article 24: Freshwater Wetlands o Article 36: Floodplain Management . Article 25: Tidal Wetlands o Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control oilNYCRR 608: Water Quality Certification , o Article 27, Title 7; 6NYCRR 360: Solid Waste Management PERMIT ISSUED TO TELEPHONE NUMBER James Bailev (617) 457-5740 ADDRESS OF PERMITTEE -12 Reservior Street, Canbridae, MA 02138 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Jacob Albert, Albert Righter & Tittman Architects, 58 Winter Street, Boston, MA (617) 457-7500 02108 NAME AND ADDRESS OF PROJECTIFACILlTY Bailev Propertv, Wilderness Point, Fishers Island, SCTM #1000-012-2-6.2 COUNTY TOWN I WETLAND # NYTM COORDINATES Suffolk Southold NL-1 DESCRIPTION OF AUTHORIZED ACTIVITY: CONSTRUCT AN ADDITION TO AN EXISTING DWELLING. ALL WORK SHALL BE DONE IN ACCORDANCE WITH THE ATTACHED PLANS STAMPED NYSDEC APPROVED ON 9/10/2004. ,: By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECl, all i!pplicable regulations, the General Conditions specified (see page 3 & 4) and any Special Conditions (see page 2) included as part ~f this penmil. PEPUTY PERMIT ADMINISTRATOR: Mark Carrara AUTHORIZED SIGNATURE ADDRESS Region 1 Headquarters Bid . #40 SUNY, Ston Brook, NY 11790-2356 DATE September 10, 2004 Pa e 1 of 4 ~i< , !; f... :''f '. " , NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1, During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks. mixers, or other devices enter tidal wetlands and or protected buffer areas. ,:2. 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 for disposal. No debris is permitted in freshwater wetlands or tidal , . wetlands and or protected buffer areas. 3. There shall be no disturbance to vegetated wetlands or protected buffer areas as a result of the permitted activity. 4. All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion or prior to permit expiration, whichever comes first. The approved methodologies are as follows: Stabilization of the disturbed area with appropriate vegetation (grasses, etc.). 5. If seeding is impracticable due to the time of year, a temporary mulch must be applied and final seeding performed at the earliest opportunity when weather conditions favor germination and growth, but not more than six months after project completion. 6. The storage of construction equipment and materials shall be confined to within the project work site and or upland 'areas greater than 100 linear feet from the wetland boundary. 7. All disturbed areas where soil will be temporarily exposed or stockpiled for longer than one (1) week shall be contained by a continuous line of staked hay bales/silt curtain (or other NYSDEC approved method) placed on the seaward side between the fill and wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 8. Necessary erosion control measures i.e., haybales, silt fencing, etc. are to be placed on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good condition until thick vegetative cover is established. 9. Disturbance to the natural vegetation or topography greater than 25 feet seaward of the approved structure is prohibited. , DEC PERMIT NUMBER 1-4738.00524/00003 PAGE 2 OF 4 . .. NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee 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 undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent acts. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect . to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights Iilf 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 ECl 71-0301 and SAPA 401 (3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility.' Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: 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, !l1odification or transfer granted by the Department must be in writing. . The permitteemust 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 right to modify, suspend or revoke this permit in accordance with 6 NYCRR Part 621. rhe 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 of the commissioner, any provisions of the Environmental Conservation law or regulations of the Department related to the permitted activity. OEC PERMIT NUMBER I I PAGE 3 OF 4 1.4738-00524/00003 . . NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ~'- I ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 (FRESHWATER 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 Departmentto 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 10 the State, and to such extent and in such time and manner as tihe Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 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. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S. Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local govemment which may be required. 4. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 5. 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. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. 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. 8. 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. 9. 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. to. 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 Richard Strouse last revised on 02/12/04. DEC PERMIT NUMBER 1-4738~524/00003 PAGE 40F4 11103/2004 it: S~ FAX 617 451 2309 " Albert.R1ghter&I1ttmann ~002 ,\1berl J, Krupoki. Preoidont James Kinc, Vlc:e-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P,Q. Box 1179 Southold. Now York 11971-0959 Telophone (631) 76~.1S92 P',"" (831) 765-1366 . '. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 29, 2003 Mr, Jacob Albert Albert, Righter & Tittman Architects. Inc. 58 Winter 51. Boston, MA 02106 RE: ,JAMES No, BAILEY. WILDERNESS POINT. FISHERS ISLAND SCTNI#1000.12-~ d(,,_ IS- Dear Mr, ,Albert: The Southold Town Board of Trustees reviewed the survey prepared by Chandier. Palmer & King dated January 17, 1990 and plot plan prepared by Albert, Righter & \Tittmann Architects, Inc. dated November 7,2003 and determined the proposed . additions to the existing dwelling to be out of the Wetland jurisdiction under Chapter 97 of the Town Wetland. Code and Chapter 37 01 the Town Code. TAer-efore.~n.-al;:Cordanc;e with Ihe'CWfrent Tidal Wetlands Gode (Ghapter-97) and the Coastal Erosion Hazard Area (Chapter 37) no permit i$ required, Please be advised, however, that no construction, sedimentation, or disturtlance of any kind may take pi ace seaward of the tidal wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above. without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or otlier 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 m~intaining adequate work area between the tidal weUand jurisdictional boundary and the coastal erosion hazard area and your project or erecting 8 temporary fence, ~,artier, or hay bait) berm. . ... However, a'ny activity Vlithin 100' of a Wetland line or seaward of the Coastal Erosion Hazard Area would require permits from this office, Albert,Rlghter&Tlttmann ~003 1l/03/2('()4 H: S6 FAX 61 i 4S1 23r)9 ~ ,. c- -) . This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, p~..~ 9- ~.(}. Albert J. Krupski, Jr. President, Board of Trustees - _.. - .-.-- - AJK:lms 10/30/2008 1.3: 08 FAX 831 '/.,8 7798 ..t:.. . FISouERS :;:!~LANJ) UTILITY I4J002 . FOUNDATION (1ST) COI\IIMJ\:NTS R;'J.4II:~~ tD- J;.- , \.)J..., ~~ ~~ FIELD ll'!SPECTION .REPORT '" oeII?'4i1N fb .GAY 2 o ~. ~'" ---.. ..-..-.-.. ~ -....... ~~ ... FOUNDATI01' ,2ND) ROVGH FR<'tJ'fi"lG" PLUMBING , ~ ~ ~~ ~5 INSULATION ,....;, N. Y. STATE ENEF.':' . CODE 'I .... :-n ~ IilN}L ADDITIONAL COI\III\IIENTS (J:> ~ - r; ~ L..\~ ":J> 'J- ~ , 1 ~~ ~- ~~ ~ '-~.,~.~."_. '0~-- . ~-~~ -....-.-...-- \- '--'-'i'7~?-' \.) ["- --*-- '-~ \ \\ .--~ -z;..iil ~ :Y", ~ Qo--()' -r ~~Q 39~llp \JGts1 u: f--U I d-.- ~-L .J) 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. 30816 Z Date DECEMBER 2, 2004 Permission is hereby granted to: JAMES BAILEY 100 SUMMER STREET BOSTON,MA 02110 for : ALTERATION & ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at PVT RD OFF E END RD FISHERS ISLAND County Tax Map No. 473889 Section 012 Block 0002 Lot No. 006.015 pursuant to application dated NOVEMBER 22, 2004 and approved by the Building Inspector to expire on JUNE 2, 2006. Fee $ 201.60 ,~G~ Authorized Signature ORIGINAL Rev. 5/8/02 ..,,1-..1...... ;~~ -u ,TOWN OF SOUTHOLD PROPERTY RECORD CARD . I ' . . 15,4 STREET VILLAGE DIST. SUB. LOT I y ACR. ~.59 ~. S B. . ("") v, 001 1;:r -. ,..yo e oS MISe. Mkt. Value TYPE OF BUILDING VL. FARM LAND IMP. TOTAL DATE COMM. CB. REMARKS Woodland Swampland Brushland 1-. 0 7 :j,."J~o.. . - z-~"?'i' If: ~c!ldtMd..T;;- R-rz: F UJcdlJ'<!'. . z-,.4"'2..3".fJ, c: . - ...... 7.. I=!J,J. f~. -P.Je!.- ~l 15"''', e - s;P. '" 1... , . 1 - ( () U\o'l<'e II & V'" .."we TIt,,,,,,,,,,( (- If,';' ;;"~...e"+ TkIJU"!/ -b S;~5'O~J <1'" T...""....\ee.ff.1;Hf - 'Eo. O. 14 r= ...h--. N"':!is _~ tiOC> ... -I~ 7'~~'~ki~ ~y~~- t;, :ib# 7i.fe. :'0 ~~ AjJA..t!;'~/O" v1~r. " "11,..,.. ",b pn"'L ~f cI""'"~ .lIfpo, O()f') COilS 14~\ bw~/itoJQ.. Uj) iQ.ul House Plot f c. FRONTAGE ON ROAD DEPTH BULKHEAD ~ b 11 ~3 ').- J-C;-71", ? ~+-Sufe. if 'j-Il.'.s O-CS -h--M.,J -- Total - Y' DOCK ..." .... - .... --= ~~ --~"'- I . "", .1-- A I'?: I';;'. -"/t ,~'J : ",~rl.~, ,., r?.I, .,~~'iJj ..~.a" ; ':,'1,' ,11 '1'fI"'''':.'~' 3.' I I' . 'I'~~~ ftt ~ J~ ~ -I s-1> '(iJ~. H" f - , v..it., ;:. .s- (.~ 'lJ tt 1'tN - I' '~l\if~q.. ~<<=t ,T / / ~,.. .-- .'":'\ ''ll' , <,,-' v COLOR (1)1" t -( TRIM ,," " "D 111.':1.-' Foundation Basement ;:~1':) '.",' i"~ " II> 'In. Ext, Walls Fire Place , ~ (1jr t ~'. I t$"OO Type Roof o\q (Recreation Room ~-r .\OOf> Dormer Driveway 3lCJ;tl.~ '1S9 '~lt'lb"'~' ,\-9~' r- IH~~': -'a. ' ,., \ ~'\. <5':.0 J~ ,," \.. l/~ - , , ) 370Cfs 1175 ~ ('., ,-'1 ,.,L'- ... " ! I I.. 1 )\ I~~' ;- , <: 1" ( :,J; ') II 3~ 't / I/. ~ L Ir:7 ,) .. - l'l r.,.. .s' ., ,), ~~.J.-r: <j7Mi(: , ~~ t1 ~ .<. .1 ;-0;\ ",r, () J.,. :' .. \ ';:) . . ~ . - \- '. I. rr- I - - ,"-""".. I.' i' (' ) I'" .... ... - - Bath ~ Dinette Floors ~(J.tI K. n Interior Finish Pi, .-r:. LR. Heat S-tct\.'W\ . DR. Rooms 1 st Floor BR. Rooms 2nd Floor FIN. B. 11000-'\-2 -<2-6.'4 OVJNER dd k1 pC" ~r:; Ip tI ..) y,.-L..",,++ LAND IMP. <' t') <5 r1v->Y; L_ _ TOWN OF SOUTHOLD PROPERTY RECORD CARD n_ . STREET R O.VI ACR. .--.. -2, ('T TYPE OF BLD. PROP. CLASS 313 TOTAL ::::>~~ DATE 2?b,hr " " VILLAGE .. -. DIST. - LOT -- SUB. ~:~, f.t '"'v<: {S l<:'Jllid 4 REMARKS -' . -/ . ~ , I .:.Lw6zr43'l -.sfl d -tl'". 'P,de*-r;Q.~ - L _ { ,h;HG. WI HI I 2 '.2-~ .10 ( Co.59 .<'\C -to-kl {~ / FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH 3TI4----- TILLABLE WOODLAND MEADOWLAND BULKHEAD HOUSE/LOT TOTAL - -- "~ ..... .crt - COLOR I. TRIM M. Bldg. Foundation pc. Bath Dinette c. FULL Extension Basement CRAWl Floors Kit. SLA. Extension Ex!. Walls Interior Finish L.R. Extension Fire Place Heat D.R. Patio Woodstove BR. Porch Dormer Fin. B. Deck Attic Breezeway Rooms 1st Floor . Garage Driveway Rooms 2nd Floor . O.B. Pool . pvomh>"'<l I/'/n I 2/"2- . . 20 eX! .20" ,J BUlll>ING PERMIT APPUCATION CHBCKllS" Do you haw or aced tho foUowiDg, before applying Board ofHcalth , sots ofBuildiDg Plans ".. SllIVey, , ,/ PERMIT NO. gD!(~ 'C' Check' V SepticFODIl N.Y.SD.E.C. CO"y KNC.~ . Trustees V' Contact: Mall to: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTBOLD, ~ 11971 TEL: 765-1802 Approved Disapproved ale "'. &p r~ /p. /01- v I I Phono: Ic~ I Buildini Inspector r,' 1 , \ I' I \ "~ INSTRUcnONS J'l'b:lS-ipplicati.on MUST be COI1Wletdy filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accume plot plan to scale. Fee according to schedule. ' b. Plot plan showing location oflot and of buildings on premises, relationship to adjoiDing premises or public streets or areas, and waterways. c. The worle covered by this application may not be Commenced before issuance of Building Pccnit. d. Upon approval of this application, the Bui1diIig Jnspector will issue a Building Pccnit to the applicant. Such a permit shall be kept on the premises available for inspection thrctlghout the work. e. No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupanc is issued by the B'uilding Inspector. ' ' \'.vi 2. 2. ?:J04 i t'U'PLICATION FOR BUILDING PERMIT. Date, NOVEMBER 17 .20~ APPUCATION IS HEREBY MADE to the Building DepartmentJor the issuimce of a Building'Pccnit pursuant to the Building Zone Ordinance of the Town ofSouthold, Suffolk County, New York, and other applicable Laws, ()rtHnRn~ or Regulations, for the construction of buildings, additions, or alterations or for removal or ~lition as herein described. The applicant agrees to comply with all applicable laws, OT,HnRnces, building code, housing code, and regulations, and to admit authorized inspectors -on pIcmises and in building for necessary'inspections. H,P BROOM HOUSEWRIGHT, INC (Signaluro of appJicant orDllDle, If a corporation) POBOX 70 HADLYME, CT 06439 (MailiDg address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder GENERAL CONTRACTOR ' , Name of owner of premises JAMES AND ROANNE BAILEY (as on the tax roll or latest deed) If applicant is '/ (Name and title 9 COIporate officer) Builders License No. Plumbers License No. 13061 HI Electricians License No. Other Trade's License No. 1. Location ofland on which proposed work will be done: HA. TT.RV RRSTn'RN~R, .wTT.nRRNESS POINT. House Number Street FISHERS ISLAND. SOUTHOLD Hm:nlet County Tax Map No. 1000 Section Subdivision 012 Block 2 ) Filed MlIifNo. Lot . ~. ~.. ~. 1:;- Lot (Name) State existing use and occupancy of'premises and intended use and occupancy {)fproposed mnstmetion: a. Existinguseando<Napaney SINGLE FAMILY. DWELLING .. b. Intended use and occupancy Nature ofwark (check which applicable): New Builtllng Repair Removal Demolition SINGLE FAMILY DWELLING Addition Other Wark x Alteration. x (Description) Estitnated Cost 114 , 500 If dwelling, number of dwelling units If garage, number of cars Fee (to be paid on filing this application) Number of dwelling units on each floor Ifbusiness, cdmmercial or mixed occnpancy, specify nature and extent of each type of use. Rear 135' Depth 43' Dimensions of ~ structures, if any: Front 135 ' Height . 27 Number of Stories 2 Dimensions of Same structure WIth alterations or additions: Front 138~ Depth 45' Height ., ~~:l< wWJSl< ". u .t'Ium~~~ Qf Stories. 2 :. Dimensions of entire new construction: Front BAY 4' Rear. 10.' Height S'l2\IR 'f<MR ;15' Number of Stories . S'l2\IR 'f<MR 2 . ......: II I. Size oflot: Front 370+ 135' Rear /-bn BAY 1 3 ' Depth Rear 367! Depth 306+ .0. Date of Purchase Name of Former Owner .1. Zone or use district in which premises are sitUated R-3 .2. Does proposed construction violate any zoning law, ordinance or regulation: m .3. W1l1lot be re-graded. Will excess :fill be removed from premises: ~ NO 12 RESERVIUR ST .4. Names of Owner of premises JAMES BAILEY Address CAMmIOOE, Ml\ 02~one No. NameofArcbi~ AImRT,RIGHl'ER & TITlMl\N Address58 WINl'ER ST JJUj"l~eNo bll-4~1-~/4U NameofContractorHP ~ IDJSEH,UGffi' Address PO OOX 70 PboneNo. 860-526-9836 . HAIJLYMti, (;1' Ut)4.:s~ 15. Is tbispropertywitbin 100 feet ofa tidal wetland? *YES x NO . IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED m l6. Provide survey, to scale, with accurate foundation plan and distances to property lines. l7. If elevation at any point on property is at 10 feet or below, must provide topograpbical data on survey. ;TATE OF1'lJ:\~) CXHID:TIClJf SS: ::OUNTY OF NEW l1Hpl HARRY P ~, JR . being duly swom, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, . :S)He is the PRESIDENI' (Contractor, Agent, Corporate Officer, etc.) )f said owner or own~ and.is d~y autJ;1~ed to perform or have p~ormed the said work and to make and file this application; hat all statements contained m this application are true to the best ofbis knowledge and belief; and that the work will be )erformed in the manner set forth in the application filed therewith. . ;wom to before me ~ ~t,,~ ,":of~ ";""- ~ . Notaty Publi