HomeMy WebLinkAbout31996-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32042
Date: 12/01/06
THIS CERTIFIES that the building ADDITIONS/ALTERATIONS
Location of Property: 22655
(HOUSE NO.)
County Tax Map No. 473889 Section 135
SOUNDVIEW AVE
(STREET)
Block 1..-
SOUTHOLD
(HAMLET)
Lot 26
SUbdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
APRIL 7, 2006 pursuant to which
Building pennit No. 31996-Z
dated
MAY 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 ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR & AS PER CONDITIONS OF ZBA #5727 DATED 7/21/05.
The certificate is issued to NICK S POLOGEORGIS
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
06-6170
10/12/06
PLUMBERS CERTIFICATION DATED
N/A
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
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This application must be filled in by typewriter or ink and submitted to the Building Department ):Vith ~tollowing:
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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. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
/
Date.
NOU ;;LI
dOO&
Old or Pre-existing Building:
(check one)
Location of Property: d-d-fL?,C;:'::;-
House No.
Owner or Owners of Property: to ~ L K 3-> ~ \. 0 ~eo ~:~~S s
Suffolk County Tal' Map No 1000, Section l Block 0C0 \
S()UNDVlC..:>
Street
A",-
SDu+v..<:>l ()
Hamlet
Lot 2Cp
Subdivision
Filed Map.
Lot:
Permit No. :::s I q '1 <R ?.- Date ofpermit.
Health Dept. Approval:
Planning Board Approval: yes
Applicant: 'k'D g ~ k..J
Underwriters Approval: 'fe"
Final Certificate: /'
Request for:
Temporary Certificate
( check one)
Fee Submitted: $
;;2Sroo
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App !Cant Signature
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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.
31996 Z
Date MAY
11, 2006
Permission is hereby granted to:
NICK S POLOGEORGIS
143 WEST 29TH STREET
NEW YORK,NY 10001
for :
ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR PER ZBA AND DEC APPROVAL
at premises located at
22655 SOUNDVIEW AVE
SOUTHOLD
County Tax Map No. 473889 Section 135
Block 0001
Lot No. 026
pursuant to application dated APRIL
7, 2006 and approved by the
Building Inspector to expire on NOVEMBER
Fee $
150.00
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ORIGINAL
Rev. 5/8/02
APPEALS BOARD MEMBERS
Ruth D. Oliva, Chairwoman
Gerard P. Goehringer
Vincent Orlando
James Dinizio, Jr.
Michael A. Simon
Southold Town Hall
53095 Main Road. P.O. Box 1179
Southold, NY 11971-0959
Office Location:
Town Annex /First Floor, North Fork Bank
54375 Main Road (at Youngs Avenue)
Southold, NY 11971
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--i'~l ~ \\ \\\ BOARD OF APPEALS
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~\.I \ . ~1Flt'JD~S, DELIBERATIONS AND DETERMINATION
\---- t" , ,., ,'"', - MEETING OF JULY 21 2005
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ZB e. 5727 - Nicholas Pologeorgis
Property Location: 22655 Soundview Avenue, Southold
http://southoldtown.northfork.net
CTM 125-1-26
SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this
application and determines that this review falls under the Type II category of the State's List of Actions,
without an adverse effect on the environment if the project is implemented as planned.
PROPERTY FACTS/DESCRIPTION: The applicant's 24,682 sq. ft. parcel has 119.04 feet along
Soundview Avenue at North Road (C.R. 48), and is improved with a two-story, single-family
dwelling, shown on the May 10, 2005 map prepared by Angle of Attack Land Surveying.
BASIS OF APPLICATION: Building Department's April 11, 2005 Notice of Disapproval, citing
Section 100-242A and 100-244, in its denial of an application for a building penmit to construct a
proposed garage addition, after removal of the side porch area. The reason stated for disapproving
the application is the single side yard will be less than 15 feet and the total side yards will be less
than 35 feet following the new construction.
FINDINGS OF FACT
The Zoning Board of Appeals held a public hearing on this application on July 7, 2005 at which time
written and oral evidence were presented. Based upon all testimony, documentation, personal
inspection of the property, and other evidence, the Zoning Board finds the following facts to be true
and relevant:
AREA VARIANCE RELIEF REQUESTED: The applicants wish to construct a 15 ft. by 30 ft. garage,
approximately 15 ft. to the top of the ridge, along the east side of the dwelling. The existing porch on
the easterly side of the dwelling will be removed.
REASONS FOR BOARD ACTION: On the basis of testimony presented, materials submitted and
personal inspections, the Board makes the following findings:
1. Grant of the variance will not produce an undesirable change in the character of the
neighborhood or a detriment to nearby properties. The proposed single-story, single-car garage
measures 15 feet by 30 feet deep, and will be located on the southeast section of the existing
dwelling. The new side yard setback on the east property line will be 10 feet five inches, and the
total side yards will be 29.4 feet (18.9 and 10.5 feet), as shown on the May 10, 2005 site plan
Pag"'2 - July 21, 2005
ZB File Ref. 5727 - N. Pologeorgis
CTM 125-1-26
prepared by Angle of Attack Land Surveying. The property is short and narrow which leaves little
room for expansion without a variance.
2. The benefit sought by the applicant cannot be achieved by some method, feasible for the
applicant to pursue, other than an area variance. There is little room for a garage, and the westerly
side yard is unobstructed for a setback at 18.9 feet. Together the side yards will be 29.4 feet without
obstructions.
3. The variance granted is the maximum the Board would approve to reduce the easterly side yard
substantial.
4. The difficulty has been self-created based on knowledge of the existing building with its tight
tolerance for future side yard additions.
5. No evidence has been submitted to suggest that a variance in this residential community will
have an adverse impact on the physical or environmental conditions in the neighborhood.
6. Grant of the requested relief is the minimum action necessary and adequate to enable the
applicant to enjoy the benefit of an addition, while preserving and protecting the character of the
neighborhood and the health, safety and welfare of the community.
RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing
test under New York Town Law 267-B, motion was offered by Member Orlando, seconded by
Member Dinizio, and duly carried, to
GRANT the variance as applied for, as shown on the May 10, 2005 site plan prepared by
Angle of Attack Land Surveying and elevation diagrams date-stamped the ZBA May 17,
2005, subject to the following CONDITION: That the westerly side yard shall continue to
remain open and not be blocked, to allow for clear, open access.
This action does not authorize or condone any current or future use, setback or other feature of the
subject property that may violate the Zoning Code, other than such uses, setbacks and other
features as are expressly addressed in this action.
Vote of the Board: Ayes: Members Oliva (Chairwoman), Goehringer, Orlando, and Dinizio.
(Member Simon was absent.) This R~lution was duly adopted (4-0).
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Ruth D. Oliva, Chairwoman 7~f;>-I05
Approved for Filing
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
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
CERTIFICATE OF COMPLIANCE
# 0162C
Date October 25. 2006
THIS CERTIFIES that the
15'X 30' garage
At 22655 Soundview Ave.. Southo1d
Suffolk County Tax Map # 135-1-26
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 1/5/06 pursuant to which Trustees Permit # 6304&6304C Dated 2/15/06
Was issued, and conforms to all ofthe requirements and conditions of the applicable
provisions of law. The project for which this certificate is being issued
is for a 15'X 30' garage
The certificate is issued to NICHOLAS POLOGEORGIS
owner ofthe
aforesaid property.
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Authorized Signature
1. ELECTRICAL INSPECTORS, INC. is not resp\)]1siblc for thL' eXIsting conditions at the "lIbject pl'cmisc".
2. ELECTRICAL INSPECTORS, INC. is not responsible for corrcctlon.;, upgrading or replacement of Lxi"ting
elcctrkal violations at the subject premises. Any corrective work shall be solely the responsibility or lIlt.' property
owner. ELECTRICAL INSPECTORS, INC DOES NOT WARRANTY OR UNDERWRITE THE
ELECTRICAL CONDITIONS AT THE PREMISES.
3, ELECTRICAL INSPECTORS, INC, ollly [he ~,,,i(lllal Eledric Code. the IJuildiug C"dcs "f
Nc\v York State all volumes and Local ro.,-1unicipal Codes, as AUlhori/ed Thl' Dl'l1arllTlclJl of Stall'
Codes Division, via Village. To\\'n or City Board Resolution.
4. AN ELECTRICAL SLTRVEY consists of a vi:-;ual examin<-l1.iull of Ih\.' prl'miscs ()NLY: l~kctrica] Inslwctors
Inc. \vill comply \vith the requm:'mcnts of NFPA 73. lakst edition Chaph~r I, St~cti\ln ] - [, 1.2. If \. iolatlon" cxi'it. ;1
Notice of Violation (NOY) \\'i11 he issued requiring l'orrectioll hy a liccn"ed l~lcctrical contractor Aftcr till'
violation has been corrected, a rc-inspcctinn viill be condlh.::tcd and if ;Jpprovcd a ccrlificlh:: sh:111 be is~ucd,
5. A SURVEY CERTIFICATE docs nOLexaminc the dctu;JI wiring or devices lInk:-;s all w:-I11\ arc oJK'I1l'd and
wires and devices arc cxpo"cd prior to the slIne;.' being conducted.
6, A CERTIFICATE i, [l(ln-tronskrahle.
7. AN ELEC1'RICAL INSPECTION consists of an c:\ammaliol1 of wiring and installations during tile rough
stages of construction. After completion of the COll$trllclion a fillal implTlion will be conducted ~lt \vhich tinll' J
certifkate will bt' isslled provided no violation exi'iL In the event no inspection is requested durinf'. the rough stages
of construction ELECTRICAL INSPECTORS, INC, will perform" CLOSED W,\LL Sl:RVEY that
consists of a visual inspection of the \viring and installations unl)'. Sincl' acces::; is lirnitl'd, ELECTRICAL
INSPECTORS, INC. shall hear no responsibility rot any defe('l:-; or \"iolatirllls at the prcllli..,cs.
8. ELECTRICAL INSPECTORS. INC. shall 1101 hl:: rcsp\lllsih1c to rCIlIo\t:; any walls in order III conduct an
electrical inspection.
9. ELECTRICAL INSPECTORS, INC. will only release information, c~rtin(;atc:-i ~If]d report\.; to th~ applicant
after payment for services rendered h<lvc hecn paid in full.
10. ELECTRICAL INSPECTORS, INC. a,,~L1mcs no liahility for IlK' re:-iulrs of it" iJ1\pcctioJ1s,
II. The agreemenl may not be chang.ed orally.
3 1 9CZ'--tJ
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [
[ ] FOUNDATION 2ND [
[ ] FRAMING I STRAPPING [
[ ] FIREPLACE & CHI EY [
] ROUGH PLBG.
] INS ION
INAL
] FIRE SAFETY INSPECTION
REMARKS:
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48 Oriole Street
Pearl River, New York 10965
) 845-300-0707
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November 27, 2006
All wind load strapping meets Southhold Town code at Pologeorgis garage
improvements. Permit #81 ~~n 3 I C, cr 10
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NEW YORK STATE OEPARTMENT OF ENVIRONMENTAl CONSERVAllON
OEC PERMIT NUMBER
1-4138-01883I00004
FACIUTYIPROGRAM NUMBER{S)
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PERMIT
Under the Emll'Dll_ntal
Con"""",fIon Law
EFFECllVE DATE
December 22 2005
EXPIRAllON DATE(S)
~ber21,2010
TYPE OF PERMIT. New Cl Renewal 0 Modification 0 Penna 10 Construct 0 Permillo Operate
Cl Article 15. TJtfe 5: Protection of Walers
o Article 15. Tille 15: Waler Supply
o ArUcle 15. Tllte 15: Waler Transport
D. Article 15. Tille 15: Long Island Wens
D Article 15, Tille 27: Wild; Scenic and
Recreational Rivers
o Article 17,llfles 7,8: SPDES
o Article 19; Air Pollulion Control
o Article 27, Tifle 9: 6NYCRR 373:
Hazardous Waste Management
D Article 34: Co...tal Erosion
Management
D Article 23. Title 27: Mined land
Reclamation
o Article 24: Freshwater Weflands
o Article 36: Floodplain Managemenl
. Article 25: Tidal Wellands
D Articles 1,3,17.19, 27,37; 6NYCRR
380: Radianon Conlrol
o 6NYCRR 608: Water Quality Cerlifica-
o Article 27. Tille 7; 6NYCRR 360:
lion Solid Waste Man I
PERMIT ISSUED TO TELEPHONE NUMBER
Nicholas Poloaeorois (917) 860-4105
ADDRESS OF PERMITTEE
22655 Soundview Avenue Southotd NY 11971
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
Patricia C. Moore 51020 Main Road, Southold, NY 11971 (631) 765-4330
NAME AND ADDRESS OF PROJECTIFActLITY
Poloaeomis nro""'rN 22655 Soundview Avenue Southold
COUNTY TOWN WATERCOURSE NYTM COORDINATES
Suffolk Soulhold Lonn Island Sound E:716.7 ,: ..f 52.2
DESCRIPTION OF AUTHORIZED ACTIVITY:
Remove existing porch and construct a 15' x 30' single story attached garage to an existing single family dwelling. Alter
present layout of pervious driveway. All work must be done In accordance With the attached plan prepared by Wdliam
D. Milchen, last revised on 10f22/05 and stamped NYSD!::C approved on 12/19/05.
By acceptance of this permit, the permittee a9rees that 11>1'. pe.mh I.' contingent upon strict compliance wilt, !~e ECL, all
applicable regulations, the General Conditions specified (\Ilee ".9111 & 3) and any Specl.1 Conditions i"cll.(jfJd as part of
this permit.
PERMIT ADMINISTRATOR:
ADDRESS
Brook NY 11790-2356
=
December 19, 2005
Page 1 of4
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [
[ ] FOUNDATION 2ND [
[ ] FRAMING I STRAPPING [
[ ] FIREPLACE & CHI EY [
REMARKS:
] ROUGH PLBG.
] INS ION
INAL
] FIRE SAFETY INSPECTION
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DATE
() r; INSPECTOR
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] I~LA~
[ ] FRAMING I STRAPPING [vfFINAL~
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
1WV{~
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REMARKS:
r;
DATE
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [
[ ] FOUNDATION 2ND [
[ ] FRAMING I STRAPPING [
[ ] FIR~ & HIMNEY [
REMARKS:
] ROUG LBG.
] I LATION
FINAL
] FIRE SAFETY INSPECTION
~
DATE 9(110 (,
INSPECTOR
3 I '(9 " 't:
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [ '11N$ULATION
[ ] FRAMING I STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS: ~4~ ~. fJ;;".r~ ~f
Lkr :Z;;.r~~~ ~J '1..6;/.0 ~
10 ~r GW~. I
DATE ~~;(;6
INSPECTOR ~~;4
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [
[ ] F~DATION 2ND [
[ v("FRAMING I STRAPPING [
...
[ ] FIREPLACE & CHIMNEY [
([) -
REMARKS:
DATE )./,}(J I cD?
I
] ROUGH PLBG.
] INSULATION
] FINAL
] FIRE SAFETY INSPECTION
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INSPECTOR
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
SPECTION
[ [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
I
DATE o/;1jOt.
INSPECTOR
TOWN OF SOUTHOLD '
BUILDING DEPARtMENT
TOWN~
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
PERMIT NO. 2> \93 b P
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Plarming Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Examined
Approved
Disapproved alc
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\~~,.* ~<:L~)./ INSTRUCTIONS
. Thi ~ication MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of pi , accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot 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 ifthe 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.
4f-.~
(Signature of applicant or name, if a corporation)
Mail to:
Expiration
~
,
,20~
/15 S~Q V 11+, SINI' )J.'/. 117ft
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
1~^.~~1 cp~l~~+b~
Name of owner of premises /V/ck f!:,/Ott'~jlt...i..">
( s on the tax roll or latest deed)
If applicant is a corpora ion, signature of duly authorized officer
/. -;1,,, :aJ.
(Name and ti e of corporate officer)
Builders License No. 1,3QrS - If
Plumbers License No.
Electricians License No.
Other Trade's License No.
~ Location ofland on which proposed work will be done:
.22.6.$'5" SOv/lh"...w AVL,
House Number Street
s".tl./J
Hamlet
}'; ,-:'/ ',. .},j ~ ""\
County Tax Map No.1 000 Section
Subdivision
135'
Block 01 "
Filed Map No. -..,', ,.
Lot 26
Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed cOllstnrction:
a. Existing use and occupancy ~<<\I tk,~IA\ ,
b. Intended use and occupancy ?"""re- /s..l-o"""'iP
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated CostM'gS. 00 f)
.
Addition
Other Work
/
Alteration
(Description)
Fee
5. If dwelling, number of dwelling units :J.
If garage, number of cars /
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use.
, "
7. Dimensions of existing structures, if any: Front 60.'6
Height 2. ~ I -l- - Number of Stories 2...
I ..
Rear ,0 6
, .
Depth 32 {.
I U '~II I ({
Dimensions of same structure with alterations or additions: Front 6 S 'i Rear. ~ 5Q tr
I II I k:" ,
Depth ~() 6 Height ;z.<; of- - Number of Stories .h"<<<' ,.'.'
. !
-' OCpth. 3tl/~
Rear I ~
8. Dimensions of entire new construction: Front /5
Height /~ I Number of Stories I
9. Size oflot: Front /0/. b 2. . Rear /17 { . (, Z. I
Depth ;.'/i.(. (0
I
@DateofPurchase 1/1
0'/
Name of Former Owner
fj) Zone or use district in which premises are situated
@Does proposed construction violate any zoning law, ordinance or regulation? YES / NO_
13. Will lot be re-graded? YES_ NoL Will excess fill be removed from premises? YES_ NO I
~A-<\o. C.i
@NamesofOwnerofpremises#.."k f.bje4;S AddressJti('f ~~""",Ae- Phone NO.~ 76> -2.J(o
Name of Architect Address Phone No
Name of Contractor 6Ie",~ 611v>>A (,/l(.J.. 1r<:. Address/r''' st.,.e. ~ 111: 5,;'p: Phone No.(6~ t) }J I-'Ilf~]
d3 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 MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES_NO_
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SSe
COUNTY OF S" H~I")
c; I ~,..,.. E' d I '-IN J being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
CON fC\.Ac.. ~ ->(\.
(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 to before me this
'l~'" dayof~<\...,\ 20 or
~Pu~~
John M. Judge
NOTARY PUBLIC6State of New York
No. 01 JU605940
Qualified In Suffolk County "....
Commission Expires May 29, 20......
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Signature of Applicant
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I t1:GI STnNl or VlTN, STM1SllCS
M M1rltAG r=: OFFICErt
nECOfl/J5 MANAGEMENT OITICEI1
rflEEDOM OF INrOfUMTION OrrlCEfl
T"wn lIalL 5 .lilY:,> 1.10111
r.o, nr,. 1171)
$llUlhohl. New. Yurt.; ,
F;)x LS I (ll 7h.~-l R ~
T dcphnnc t.f) I (q 7(1~.
, . 'J't/P'lTH T. TERRY
, tOWN CLERK
OFFICI;; OF THE TOWN CLERK
TOWN OF SOUTH OLD
THIS IS TO CERTIFY THAT THE FOllOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOlD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 199]:
RESOLVED that the Town Board of the Town of Southold hereby adopts
two (2) new forms to be used under HIe Flood Damage Prevent regulations J
OJ the Code of the Town of, Southold:
/;\ppli~ation" [FDP(9J)], and /Certificate
Special Flood Hazard Area (c/C(9JJ],
"Floodplain Development Pe rmi l
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0'( Compliance ?/r Develu'pmen l in
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TOW:I OF SOlJllJOLD
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Southold Town Clerk
August 15, 1993
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APPLICATION (I
PNJE I of 4
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TOWN OF SOUTHOLO
FLOODPLAIN DEVELOPMENT PERMIT APPLICATION
This form is to be filled out in duplicate,
~
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SECTION I: GEI'IERAL PROVISIONS (APPLICANT to read and ,im):
1. No work may start until a ponnit is issued.
2. The penn it may be revoked if any fwe statements are made be rein.
3. If revoked, all work must cease untU permit is re-issued.
4. Developmeut sball not be lLSed or occupied until a CerliIic>te of Compliance is issued.
5. The permit will expire if DO work is commenced within six months of issuance.
6. Applicant is bereby informed tbat otber permits may be required to fulfilllocaJ, state wd Cederal regulBlory
requirement$.
7. Applicant hereby gives consent to tbe 1AcaI Administrator or his/ber representative to make reasonable
. inspections required to verily oompli=ce. .
8. r. THE APPLICANT. CERTIFY THAT ALL STATEMENTS HEREIN AND IN A TTACHME]ITS TO
_ THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUEANQ ACCURATE, ..
'. (APPLICANT'S SIGNATURE) DATE
,;' / /
/(SECTION l: PROPOSED DEVELOUhENT rro-~e comoleted bv APPLlCANl1
NAME
ADDRESS
TELEPHONE
APPLICANT
BUILDER
ENGINEER
PROJECT LOCATION:
To "\'(lid delay in p~ing tbe applicauon, please provide eDough information to easily identify tbe J:lroJeet
location. Provldo tho SUoet address, lot nurober or Ie~ description (attach) and, outside urban areas, tbe
distance to the nearest intersecting road or wcU.known liOdmark. A sketch attached to this application sbowing
the project l0C3uoo wouJd be helpful,
FDP(93 )
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APPLlCA nON #.
PAGE10Fd
DESCRIPTION OF WORK (Chock >1/ ,pr~G'lblc boxes):
A STRUCTURAL DEVELOPMENT
ACTIVITY
STRUCTURE TYPE
o New Structure
o AdditioD
o AJtorat;oo
o Roloc.atioo
o DomolitioD'
o Ropl.cemeDt
o ResideDtiaJ (1-4 Famuy)
o Residential (Moro than 4 Family)
o Noo-rosidootiaJ (Floodproofwg? 0 Yos)
o Combined Use (ResideDtial & CommercUJ)
p 0 Manu[.ctured (Mobue) Home (10 Manu.
[.ctured Horne Park? 0 Yes)
ESTIMATED COST OF PROJECT 5
B. OTHER DEVELOPMENT AcnVlTIES:
']
;
,
j
o Fill 0 Mining 0 Drilling 0 Grading
o Excavation (Except [or Struetural Development Cbeckod Abovo)
o Watoreourse AJtoralioD (IncludiDg Drwging aDd Channel t,{odiIications)
o Drainage Improvements (lncluding Culvert Work)
o Roa,l" StroOI or Bridge OmstnletioD
o Su~vi.sioD (New or ExpansiOD)
o !J!ilividual Water or Sewer System
o Other (Please SpociIy)
}
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AIter completing SEcnON 2, APPLICANT should submit form to Local Adrni.oislra[or [or review.
SECTION}; FLOODPLAIN DETERMIN....TlON 1T0 be com Dieted bv LOCAL ADMINlSTRATOR)
Tbc proposed development ls located ou FIRM Panel No.
. Dated
Tne Proposed Deve/opmeDt:
o Is HQI located in l Special Flood Hazard Area (Notify tho applicant th.t the apPUQtion
review is oomplete and NO FLOODPlAIN DEVELOPMENT PERMlT IS REQUIRED).
o Is 10000lcd iD a Speci.1 flood Haurd Area.
FIRM ronc de..~igoalion is
100. Yeu nood elevatioD .t the sile is:' Fe NGVD (MSL)
o UDavaiJablc
. 0 The proposed development is located 10 a fJoodway.
FBFM Panel No. D.led
OSee Sution ~ (or .1drli(jonal ioslr1JCtioos
SIGNED
DATE
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APPLICATION >'I
PAOE)OF~
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SECTION 4: ADDITIONAL INFOrwATION REOUIRED (To he comnlcled by LOCAL ADMINISTRATOI\)
The appUcant must submit the documents checked below belore tbe appUuuon can be processed:
o A site plan sbnwing tbe location of all existing strucluues. water bodies. adj~cent roads. 101
dimeDsions and proposed developmeD!.
o Development plans. drawn tosulc. and speciocat4;Jns, iDcluding wbere applicable: details for
ancboring structures. proposed elevation of lowest Ooor (including basement), lypeS of water
re.istiUll material. used below the ru'l Ooor, details of Ooodproofwg of utilities located below
the orst Ooor aDd detail. of coclosuues below the flfsl Ooor.
Also.
o Subdivision or other development plans (If tbe subdivision or other development exceeds 50
lots or 5 acres, wbiehever is the le.ser, the applicant !!!Jill provide lOO-yeu Oood elevations
if they are nOI otherwise available).
o PI3\IS showing the extenl of watercourse relocation and/or IMdform alterations.
o Top of DeW nn elevation
F!. NOVD (MSL).
o Aoodproofmg protection level (non-resideotial only) 1'1.' NOVO (MSL). For
Ooodproofed S(I1Jctures, )jppUcanl must attach certification (rom r~gislcred engineer or
hi / j
_ arc ted. / ,'-
o Certific.atioa [rom a~~gis(ered engineer lha{ the proposed acti~~ in a regulatory fioodway
will [lot rc:.sult i..a .MtY increase in the heigh! of Lhe lOO-year flood. A copy of all data and
ca1oUations supporti..ng this rlDdirlg musl also be submitted.
o Other.
SECTION 5: PERMIT DETERMINATION (To be comDlcted by LO<':AL ADMItllSTRATORI
I have delermined Ibat the proposed .ctivity: A. 0 Is
B.O Is Dot
In conformance with provisions of Local Law , , 19 The porooit is issued subjecllo tbe conditions
a((ached (0 iUld made part o( tbis ponni!. --
SIGNED
. DATE
Jr BOX A is checked, tbe Lou] Administrator may "sue a Development Permit UpOD paymanl of d'csignalcd
fee..
If ~OX B is checked. tbe Local AdmiruSlralor will provide ~ ......,.-illeo summary of dclicicncic.s. Applica.nl may
reVIse and resubmit an application 10 lhc Local Administrator or may rcquc51 a bearing from tbe Board or
AppcnJs.
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APPLICATION #
PAGE40F4
APPEALS: Appealed to Board of Appeals' 0 Yes 0 No
HeaIin~ date:
Appeah Bu.:lld Dl,......~;vlJ --- ^......'vlt.....d? 0 y(.~ 0 ~Ie
Cood..itions
SECTION 6: A.S.DUILT ELEVATIONS (To be submilled bv APPLICANT before Certificale of ComDlianee
is issued)
The foUowing information mllSt be provided for project slructWc.s.. This section must be completed qy a
registered profession.a! eogineer or a Uceosed land surveyor (or attach a certification to tlUs appUcation).
Complete 1 or 2 below.
1. Actual (As-Built) Elevation of the top of ihe lowest Door, iocluding basement (in Coastal Hl2h HWlrd
~ bottom of lowcst structural member of tbe lowest Door, excluding piliog and columns) is:
FT. NOVO (MSL).
2. . " Actua! (As-Built) Elevation of Ooodproofwg protection is FT. NOVO (MSL).
/ . .'
1'17: Any work performed prior to SUbminj/~f the above information is at Ibe ri.s(hf the AP!i:~ L
-' . '" /
SECTION 7: COMPLlANCE ACTION (To be comDleled bv LOCAL ADMINISTRATOR)
The LOCAL ADMINISTRATOR will complete this section as appUcable based 00 inspeaioo of the project to
ensure compliance with lhc community's loca.Ilaw for Oood damage prevention.
INSPECTIONS: DATE
DATE
DATE
DEFlCfENaES? 0 YES 0 NO
DEFlCIENClES? 0 YES 0 NO
DEFlClENaES? 0 YES 0 NO
BY
BY
BY
SECTION 8: CERTIFICATE OF COMPLIANCE(To be comnleled bv LOCAL ADMINISTRATOR)
Certificate of Compliance is.sucd: DATE:
BY:
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!\.ttaduuent B
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CERTIr~CATE fF COMPLIANCE
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for Developm~nt in a special Flood Hazard Area
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TOWN OF SOUTHOLD
., .,
CERTIFICATE OF COMPLIANCE
FOR DEVELOPMENT [1'1 A SPECW- FLOOD HAZARD AREA
(OWNER MOST RRT4 TN THIS r.ERTIFICATE)
PREMISES LOCATED AT:
OWNERS NAME AND ADDRESS:
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PERMIT NO,
PERMIT DATE
CHECK ONE:
o NEW BUILDING
o EXISTING' BUILDING
o VACANT LAND
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THE LOCAL ADM[NISTRATOR [S TO COMPLETE A, OR B. BELOW:
A. COMPLIANCE IS HEREllY CERTIfIED WITH TIlE REQUIREMENTS OF
LOCAL LAW # ,19
SIGNED: - DATED:
B, COMPLIANCE IS HEREBY CERTIFIED WITH TIiE REQUIREMENTS OF
LOCAL LAW # ,19_, AS MODIFIED BY VAR.!.A.NCE #
DATED
SIGNED: DATED:
C I C (93)
Tes! 80rlng
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SCDHS Ref. # RIO - 98- 0078
NYS DEe Ref. # /-47J8-0188JI0()()01
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SURVEY OF
PROPERTY
AT ARSHAMONOQUE
TOWN OF SOUTHOLD
SUFFOLK COUNT~ N Y
1000 - 135 - 01 - 26
Scal. 1" := 30'
May. 5, 1989
Feb. 19 , 799B (C6Itour 6Ms)
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Of.: T. 17, /998 ( r~""~/on addIIIons )
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COMMUNtTY PANeL MJ. 360813 0076 E. 'AUG. 16,199.
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DONNA J. 6E1bdlHTY
EXETER Hf)l..DING, I.. ro.
CO/NDNWEAL TH LAND nTLE
INSIJRANCE COMPANY
nTLE NO. 7099//76
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ANY A(;TE/fA TKJN OR ADO/1'tON TO TIG stA'l'VE'Y IS A IItOLA TION
OF' SEC'TION 72()901' THE HEr( . YCR/( $TA tt EDUCA T10N LAW.'n
'EJ<<:EPT AS PEIIPEII~SEC 72OS'-$tItJDMSION Z. ALL ~T'#I(.A rJNS
Ht/f6() Nff VALl' , . ms MAl" Cf1PIIrS THElfCOF ON!. YIF
SAD~ OR RAR THE .A'$SEO SCAL OF' THE: Sl.ffVE'YOR
WHOSE SNlIiA TI.JRe APPEA/fS HI!IIEON.
.DOI7'lDNALLY TO COMF'LyWlTH SAD LAW THE TERM 'ALTE7fm 8r
JlJSTIIE UffED BY ANY AN/) ALL $U'lVE'YO!'fS Un/.JlM A COPY
OF ANOTHER $U'lV!'Y0I'f'S MAI". rews SJ..JCH AS "IW'ECTE/J' AND
'8ROUGHT- TO-OA TF:' ItJIC NOT IN COMPLIANCt WITH THE LAW.
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STREET
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ELEVA TlONS ARE REFERENCED TO N.G. V.D.
AREA = 24;628 sq. ft. to tie line
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Tesl Boring
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2'
Mixed Sand &
Loam"
Paie Br. Fin.
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NYS DEC Ref. # 1-4738-01883/00001
ISLAND SOUND
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SURVEY OF
PROPERTY
A T ARSHAMONQaUE
TOWN OF SOUTHOLD
SUFFOLK COUNT~ N Y
1000 - 135 - 01 - 26
Scale 1" = 30'
May 5, 1989
Feb. 19, 1998 (contour lines)
+tAl{. 19"99'<1 ( zone Jille 1
MAR. 31' 1998 ( /lfall t'lI/! )
JUL Y 2, 1998 ( r."lslon )
AUG. 24, 1998 ( high /lfof., Un.. )
OC T, 11, f 998 ( r~ ,'iFie>ry addillons 1
APRIL 26, 1998' .cerlfi-:alion 1
TWel '.' JUNE 9, 113'99 (piles 1
/-NIO/F J(.I/y 2. WJ9L6/ot'l. e/]velope)
;"D." May ;:;5, 2000 (final)
JOHN PHILLIPIDES JUNE 14, 2000 ( updt/I. )
. -"nt: n, U>Oo (o.a.~t'. )
f'~PI, G MAR. 27,2001 (Lol Coverage)
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SHED AND NON-PERVIWS
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PERVIOUS DRIVEWA ~ WALK
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CONTOUR LINES ARE REFERENCED TO N.G. '
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FL-oO() ZONES TAKEN rROM FIRM
CCMMUN!TY PANEL NO. 360813 0/58 ~. / 5/4/98
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CETlFIED TO'
DONNA J. GERAGHTY
EXETER HOLDING, L TO,
COMMONWEAL TH LAND TITLE
INSURANCE COMPANY
TITLE NO. 7099/176
ELEVA TlONS ARE REFERENCED TO N,G, V.D,
ANY AL TERA nON OR ADDrFlON TO THIS SURVEY IS A VIOLA TlON
OF SECTION 7209 OF THE NEW YORK STATE EDUCA nON LAW.
EXCEPT AS PER SEcnoN 720S'SUBOIV/SION 2. ALL CERTFICA'T/ONS
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONL Y iF
SAID iJAp OR COPIES BEAR THE IMPRESSEO SEAL OF THE SURVEYOR
WHOSE SIGNA TURE APPEARS HEREON.
ADOITIONALL Y TO CONPL Y WITH SAID LAW THE TERM "AL TERED BY"
WST BE USEO BY ANY AND ALL SURVEYORS UTILIZING A COPY
OF ANOTHER SL/RVEYOR'SIIAP. TERMS SUCH AS "INSPECTEO" AND
"BROUGHT-TO-DATE" ARE NOT ~ COMPLIANCE WITH THE LAW.
AREA = 24,628 sq. ft. to tie lins
618
PECONlC S
(531) 765 - 50
P. O. BOX 909
1230 TRAVELER
SOUTHOLD, N. Y. 1/971.
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