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Home My WebLink About31654-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: OS/28/07 No: Z-32370 THIS CERTIFIES that the building ACCESSORY Location of Property: 1160 GOOSE (HOUSE NO.) County Tax Map No. 473889 Section 78 CREEK LA (STREET) Block 8 SOUTHOLD (HAMLET) Lot 5.1 SUbdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 2, 2005 pursuant to which Building Permit No. 31654-Z dated DECEMBER 6, 2005 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to GRAHAM & BARBARA HEAD (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 114577C 02/07/07 PLUMBERS CERTIFICATION DATED N/A ~L6cu" Rev. 1/81 . Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY FF9 2 ?' This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval tram 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: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. ~ C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 2-/2.-/87 Date. New Construction: /PE>OL Location of Property: II feD House No. Old or Pre-existing Building: t9C>O~ C~ Street ( check one) L-~ 5~~ Hamlet Owner or Owners of Property: G lG4i.{.f/I....~ Suffolk County Tax Map No 1000, Section ~D Block Lot Subdivision Filed Map. Lot: tt.l P. c90tR.. WlA-AJ Permit No. "3 I ti '-1- Date of Permit. Health Dept. Approval: JJ /1} ~/It- Applicant: Underwriters Approval: Planning Board Approval: Request for: Temporary Ce,iificate Final Certificate: v (check one) Fee Submitted: $ UD 2-,:?'Y?/O I!.e c '1 J.bO )" Electrical Inspection Certificate Isaue Date 21712007 Ek!ctrical inspection Service, Inc. 375 Dunton Avenue East Patchogue, New York 11772 (631) 288-6642 Application Number 114577C Issued To: Street: Village: Section: Gram Head 1160 Goose Creek Lane Southold Block: Zip: 11971 Lot: Town: Southold Contractor: North Eastern Electric (L) Lie. # 4658-E Was examined and found to be in compliance with the National Electrical Code. o Commercial D NV Defects I!J Pool D 1st Floor D Indoor D Basement D Hot Tub IKJ Residential D Del Garage D Attic D 2nd Floor D Outdoor D Addition D Survey Switches Receptacles Fixtures GFI Heaters AlC Fans 2 1 Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves Furnace 011 Gas Circulators Smoke Detector Sell Transformer Meter Amps Phase UG/OH Jacuzzi Television CO Detector / Bldg. Permit: Other Equipment 1 rain tight sub panel 1 2 time clocksT 2-20amp pecialty outlets 11 pool light H~/;f!j~ President Rough Inspection: 01131/2007 Inspector: John Me Mahon III nn__ I Final Inspection: Inspector: 0210712007 John Me Mahon III This certificate must not be altered in any manner. Inspectors may be identified by their credentials. 71/ 9/6 )~ James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. 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 .-:- r. ~ CERTIFICATEOFCOMPLIANCE'::J~ ' , \f~-~? ~ 292f 1 ll\ # 0204C i 1 d :.J ,VL' I Date Mav 2!Wf'M7w. THIS CERTIFIES that the in-ground swimming pool, patio, fence, pool drvwell and non-turf buffer At 1160 Goose Creek Lane, Southold, Suffolk Couuty Tax Map # 78-8-5.1 Couforms to the applicatiou for a Trustees Permit heretofore filed in this office Dated 4/27/05 pursuant to which Trustees Permit # 6133Dated 5/18/05 Was issued, and couforms to all ofthe requiremeuts aud conditions of the applicable provisions of law. The project for which this certificate is being issued is for an in-ground swimming pooL patio, fence, pool drvwell and non-turf buffer. The certificate is issued to GRAHAM HEAD owner of the aforesaid property. rO<7 Authorized Siguature ...: .) if i ~ fl t :'{ ':' \ , , ... / l. I t I ~ t II I ~ld r (/'. ~ . ; ~ ~ '... 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. 31654 Z Date DECEMBER 6, 2005 permission is hereby granted to: GRAHAM & BARBARA HEAD 55 WALKER ST APT 5A NEW YORK,NY 10013 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL AS APPLIED FOR PER DEC AND TRUSTEES AS APPLIED FOR WITH FLOOD PERMIT. at premises located at 1160 GOOSE CREEK LA SOUTHOLD County Tax Map No. 473889 Section 078 Block 0008 Lot No. 005.001 pursuant to application dated DECEMBER 2, 2005 and approved by the Building Inspector to expire on JUNE 6, 2007. Fee $ 250.00 ORIGINAL Rev. 5/8/02 610ry~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [] ROUGH P- G. [ ] FOUNDATION 2ND [] IN ATION [ ] FRAMING I STRAPPING [ INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS:[U,4f( ~"Z/k..) oN ~S b ~dv0 .;:;v.L4~ <Yf- 6JJ.oS<d-L AJ;vl) J'1es,4 7V bL do tJt f7r,W (6.;{ ~./ j;6L 4Nb ff If w() (!)~ " (ff) ~'vJ. k DATE INSPECTOR ~ 31G S""~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [; I~AT [ ] FRAMING I STRAPPING [~INALj ~. [ ] FIREPLACE & CHIMNEY [ ] FIRE SA INSPECTION REMARKS:---Ar( ~~Yo k. a,.o .f/JS1:SL ~ ~J.e~ ~'t-.. Ml ~5 'fa &It,:) ~r_ .~/1-- ;rJ;r-~.eo-,_-::J ~S-.. 6j7/v(., DATE /);I(IO~ INSPECTOR -< 3/fcS"y.t- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS ATION [ ] FRAMING I STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRAnON REMARKS: lJ <:::::>~ cL/ ( I- (_'---ZV--.: . " , ~ / .....A- (,/ .") .' V" DATE INSPECTOR " FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) "I -r' ." _t'J (""~ \f\_ -L'"' 'It FOUNDATION (2ND) "t:JH ~ o G\", I 1't'J 2: -p ~ -a CJ ~, '" ri (' p ~~ ~ij ROUGH FRAMING & PLUMBING f--. INSULATION PER N, y, STATE ENERGY CODE FINAL Pl?/ot (j All /.A..--...~ C &N (. S /D b N V- I f -r::)l.a,.c r}4:. ~ ,. /,0 <, ., A... ,.\ ~ I'd m ~ 'i d" M.a.',.- TIM..) %. fr ,,.} .,k~L AlA If''' A,,, i- lL. ,...... (" fD PO A. I I, I. ,.__ /J~,-,rr;I '7' 3")t4ntJr ~ ";';p .P.d','.. { ~ I.r-, AL ---r ~ ':.J.t.<:r n, ~l Yl,L \--:'AIr f> / 1 . 'k ~.. / - to ~ rJ~f...c-.....J(.JAS"'/c. ,/--( )4.0./'- ,- PX~ "- /M/rhA~/Z., ~ ~ ~/i~ '--t.1'-r;:,. L~~";/~. /~. 1~1 .A.lt f.:.Ll'LC 1'1l~8/ ~J.;;~ X,.. ,,,\ .I. /,0(," ~ ADDITIONAL COMMENTS (\\ :t> D t.:...D 0 i L_ -Bi 1'\.0..1 ;t v' V. L1:::.o...Q n /'\ i.JivIN (.J hr ( n ,3 :U/t. P'o",...,f/ {)cl/b 'i41 I Mol/P ~"" .....'r, C:;U4..r/cefll- CA.-L! ,,/ /J?LU& d <'IJA J. @&1J / (', ); II[ .-I-.&-I/L/ . {/ If I //;9/f17 #L~ r~ / f ' // fio~ ro. r _ (7 // . / /) // / / v l/' , /. -f .l/.~ ( <// / ? (j\o ~ ::E t~ s C'-t'J , >< I ." f~ CJ ::l '0 ~2: = l'!l 6~ ~6! t:l l'!l ~ Examined I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 , 2 2005 ) Approved ,2005 ------- 2005 permitNO.(~/b6Zl:C:: ,~_J Disapproved ale (Building Inspector) APPLICATION FOR BUILDING PERMIT Date December I. 2005 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location oflot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. 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 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICA nON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the BUilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remova or demolition, as herein described. The llpplicant agrees to comply with all applicable laws, ordinances, buildin ousing code, and regulations, and to admit authorized inspectors on premises and in building for necessary' pee (Signature 0 . ant, or name, if a corporation) Suffolk Environmental Consulting, Inc. P.O. Box 2003: Bridl!ehampton. NY 11932 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder AGENT Name of owner of premises GRAHAM HEAD (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. N/A (Name and title of corporate officer) Builder's License No. Plumber's License No. Electrician's License No. Otber Trade's License No. I. Location of land on which proposed work will be done 1160 Goose Creek Lane House Number Street Southold Hamlet County Tax Map No. 1000 Section 078 Block 08 Lot 005.1 Subdivision N/A Filed Map No. N/A Lot N/A (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Residential lot w/existing single family dwelling & related appurtenances b. Intended use and occupancy Same as above w/proposed swimming pool. Pt~ill'W.tlefVlous cNiv~rav 3. Nature of work (check which applicable): New Buildinl1. Additione1 .\" X Alteration' Repair Removal Demolition "".OtberWork' , (Description) 4. Estimated Cost $ 50. 000 Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units One (1) Number of dwelling units on each floor One (1) If garage, number of cars Two (2) (existing) 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use N/A 7. Dimensions of existing structures, if any: Front 85' or (max.) Rear 85' or (max.) Depth 30' or (max.) Height < 32.0' Number of Stories Two (2) Dimensions of same structure with alterations or additions: Front 85' or (max.) Rear 85' or (max.) Depth 30' or (max.) Height < 32.0' Number of Stories Two (2) 8. Dimensions of entire new eo truetion: Front 45' or (max.) Rear 45' or (max.) Depth 20' or (max.) Height at- ade Number of Stories N/ A 9. Size oflot: Front 160.0' Rear 410.0' or Depth 270.0' or 10. Date of Purchase N/A Name of Former Owner N/A II. Zone or use district in whi p mises are situated 12. Does proposed constructio VI ate any zoning law, ordinance or regulation: No. 13. Will lot be re-graded No. Will excess fill be removed from premises: Yes No 14.NameofOwnerofpremi es GahamHead Phone (917)330-2947 Name of Architect Penn umbe Address Main Road: Greenoort. NY 11944 Phone No. (631) 477 - 0400 Name of Contractor N/ Address N/A Phone No. N/A 15. Is this property within 0 feet 0 a tidal wetland? *Yes X No *If es, Southold own Tru tees Permit may be required. PLOT DIAGRAM Locate clear y an Istmct y al U1ldings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. Please refer to attached Plans. , STATE OF NEW YORK, COUNTY OF SUFFOLK S.S WILL LOHN being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He/she is the Agent - Suffolk Environmental Consultin!!. Inc. (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 this 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 29 ~ of No_"" 2005 ~-~ / ' (Signature of Applicant) Notary Public Mallhew D. lvans Notary Public of New Yolk No. 011V6053859 Qualified In Suffolk CountY Commission Expires January 22, 20 il7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION , DEC PERMIT NUMBER 1-4738-03290100002 FACILITY/PROGRAM NUMBER(S) e - PERMIT EFFECTIVE DATE November 18, 2005 EXPIRATION DATE(S) Under the Environmental Conservation Law November 18, 2010 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, Tille 9; 6NYCRR 373: Hazardous Waste Management o Article 15, Tille 15: Water Supply o Article 19: Air Pollution Control o Article 15, Title 15: Water Transport o Article 23, Tille 27: Mined Land Reclamation o Article 34: Coastal Erosion Management o Article 15, Title 15: Long Island Wells o Article 36: Floodplain Management o Article 24: Freshwater Wetlands o Article 15, Title 27: Wild, Scenic and Recreational Rivers . Article 25: Tidal Wetlands o Articles 1, 3,17,19, 27,37; 6NYCRR 380: Radiation Control o 6NYCRR 608: Water Quality Certi!ica- o Article 27, Title 7; 6NYCRR 360: tion Solid Waste Manaqement PERMIT ISSUED TO TELEPHONE NUMBER Graham Head 917-330-2947 ADDRESS OF PERMITTEE 55 Walker Street, Apt. 5A, New York, NY 10013 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Suffolk Environmental Consultinq, P.O. Box 2003, Bridqehampton, NY 11932 631-537-5160 NAME AND ADDRESS OF PROJECT/FACILITY Head property,1160 Goose Creek Lane, Southold, NY 11971 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Goose Creek DESCRIPTION OF AUTHORIZED ACTIVITY: Construct 20' x 45' swimming pool, patio, and pervious driveway. Install new sanitary system. All work must be done in accordance with the site plan prepared by Suffolk Environmental Consulting last revised October 26,2005 and stamped approved by NYSDEC on November 18, 2005. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the EeL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS George W. Hammarth Region 1 Headquarters ~/l SUNY Bldq. #40, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE ..5}- __ I/~ October 18, 2005 Page 1 of 4 TEST HOLE DATA "Ic:OQ<(AlD GEOSCENCE WAR. 1,2005 EL_1.11 "' DARK BROWN ,~ BROWN SILTY ,~, BRO'/INflHE TOWECllU/ll ..., WATER IN BRO....fIHE TO MEDIUM ,~, WATER IN BRDIINFINE ..., '" ,., ,., "" EL-2-4 .. '" e. 0>\ol~~~ OC..... r"" (Q)<@& y~ .-OLtlW.ll- ~~ 0 __ ~___:______ --- .~ ~ '" (QJ 'JQl c m 1 (QJ i @I>> , i m , (QJ i i , 0 , i % i ~ i ~ i ~ ! m ./1' il 1" '~__._,6 ./" ,,) """...-" ....~ ~/.J > 'Q ~~~G.V 1.lr'r .'%~,,:;;.o' a~ . ~"" / R; ... . / ~.,. /~'~f',:,,. e:~. ~ -- /~. ~-- ~ ~a.~ -- pLl..&..!J... 1.~~'j. ~Q."p~ :: .,. VIEU(TOIlt AlI~l ......::...:.....1til:lIAI<l lRAloUU;D"O.Dw.o.v RIGHT Of WAY (GOOSE CREEK LANE) AREA of HIGH MARSH (approximate) as per NYSDEC ....~~~ o~~r",~ ~~~ "t", 00 ,,-<, ;r~ ;:::0- 0, 03 " .. .. ::l. '<,< 1126.65' z o ;0 i! to l> ~ ", :IE ;0 o l> o NYSOEC APPROVED AS PE.R TERMS AND (;ONnlTJnN~ nl: 6~~~~;i1~?';~~t~oo"z- Su'/ )-48(DIIOCUS ""'" IT_IO.S av....5P-'CE GRDUNC....TER --, . EL_2.4 a_, ....""., SEP1lC r_ ,=~ CESSPOa. ht.,<>'1t~= 41 3,"1 S<..t'+. ADJACENT LOT COVERAGE: I U EXISTING: HOUSE & GARAGE = 1,866 5.F. OR 4,5" ..-c: Pr'I>f'o':><!'al " HOUSE & GARAGE = 1,866 S.F. OR 4.3:11: POOL _ 900 S.F. PAllO .. 493 S.F. TOTAL .. 3,259 S.F. OR 7.9" SITE PLAN: HEAD Property Situate: 1160 Goose Creek lane; Southold, NY SCTM t, 1000 - 078 - 08.005 Suffolk Environmental Consulting, Inc. Phone: (831) 1537 - 5160 Fax: (831) 537 - 5291 P.O. Box 2003' Bridgehamptoo . NY' 11932 Dote, Scole, Prepared by, Comments: (')ctobe- 26 2005 10. ..4.0rY 'i: m,.lj Arl7lptt"d ftom flu.. <;lJ~ of o;ubll!'.r't ptqpertr' dO; p~tM ~ FOX I AND lilJRVFYING rn OF [)] .1 ,3 Ilpl5 Lf ~ ,... .'. I , '.t._, . , . llECISTnNl or VlTt\.L STADSllCS M^nnIAGF.: OfTICI.:n f1ECOfUJS MNMGEMENT Ol'TICEll rr\EEDOM Of INFOruMTION OFFICEn Tllwn Hall. _~.lOl}:\ M;UI' r.o. nil., 1171) SlllJthnltl. Nc\.....yorl; , FJ); (.') 1(11 1fl5.IR-" T dcpllClnc t 51 (I) 7(1,"-: . . 'J'UP'lTH T. TERRY , toWN CLERK OFFICE 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, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under We Flood Damage Prevent regulations oJ OJ the Code of the Town of Southold: j'pplication" [FDP(93) J. and /Certificate of Special Flood Hazard Area [CiC(93)]. "Floodplain De'lelopment Pe rmit i I Compliance y/r Develc/pmen t in . j '0 1":,'(0; ,:;'~:. LS1, - ._ , --1 _ J 1]1 8wCi. oc:rr TOW:I OF SOUTHOLD .~. ~~ ~T.T~ Southold Town Clerk August 25, 1993 I- ..... .' . . " ., " APPLICATION II P^GE I of 4 TOWN OF SOUTHOLD fLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. ~ , SECTION I: GENERAL PROVISIONS (APPLICANT to read and sil!T1): L No work may start unW a permit is issued. 2. The permit may be revoked if any false statements are made berein. 3. If revoked, all work must cease untU permit is re-issued. 4, Development shall nol be used or occupied UDtU . CertiIi",,'e 01 Compliaoce is issued, 5, The permit will expire if Ill) work is commenced within six months of issuance, 6. Applie>nt is hereby informed that other permits may be required to fulfill local, state wd federal regulatory requirements. 7, Applie>nl hereby gives consentll) tbe lAcal Administrator or his/ber representative to make reasonable . inspections required to verify oomplianee. ' 8. 1, THE APPLICANT, CERTIFY THAT AIi TATEMENTS HEREIN AND IN ATTACHME)'lTS TO _ THIS APPLICATION ARE, TO KNOWLEDGE. TRUE AND ACC'fkTE. (APPLICANT'S SIGNATURE) DATE Izl1Jf , I , / / //SECfION l: PROPOSED DEYELOeJEI'IT rr0~e comolcred bv APPLlCA1TI1 NAME A1'PLlCANTG~ ~ ~..k..,...- kl&J. BUILDER ADDRESS ff-(;}~~~ )A TELEPHONE (f/7) 3;0- d54 7 ENGINEER PROJECT LOCATION: To avoid delay io processing tbe application. plca.se provide eDough informalioD to e.asUy ideDtify tbe projecl location. Provide the $!reel address, 101 Dumber or legal description (attach) and, outside urbw are.as, tbe distance to lbe nearest intersecting road or W'CU-k.oO\VU tindmarl A sketch attached to lhU application sbowing the project location wouJd be be/pM g~ca~,?~? FDP( 93) .' . I'\, ;\. ;,.. '.' . . . APPLlCA TIOl'< I;' PAGE20Fd DESCRIPTION OF WORK (Check all appuG1blc boxes): A <;TRUCTURAL DEVELOPMENT ACTiVITY STRUCTURE TYPE ~ \ o Residential (1-4 FiUIlUy) ~ o Residential (More than 4 Fa.mUy) o Noo.residential (Floodproonng? 0 Yes) o Combined Use (Rcsideotial & CODlIDercUJ) p 0 Manufactured (MobUe) Home (10 Manu. factured Horne Park? 0 Yes) ~ew Struclure o Addilioo o AJleratioo o Reloc.atioo o DemdUtioo o Replacemeot ESTIMATED COST OF PROJECT S '!:6,(J(;D B. OTHER DEVELOPMENT ACOVITIES: o FiJI 0 Mining 0 Drilling ~;ading o Exc.avalioo (Except for Structural Developmeot Checked Above) o W.tercourse Alleratioo (Iocludiog Dredging aod Channel ModiJicalions) o Drainage ImprovenlenlS (locluding Culvert Work) 'J 0 Ro.;), Street or Bridge Construction / 0 Su~mion (New or Expansioo) /1 0 ~ilividua1 Water or Sewer System o Other (Please Specify) . " f / / / Ntcr completiog SECf10N 1, APPLlCAl'IT should submit form to Local Administrator for rc\-iew. SECTiON): FLOODPLAlN DETEMIlN....TION (To be com Dieted by LOCAL ADMINlSTRATOR) Tbe proposed development ls located 00 FIRM Pancl No. Dated The Proposed Developmeol: o Is liQI located in . Special FlOO<i Hazard Area (Notify the .pplicant that the appUcation review is complete and NO FLOODPUIlN DEVELOPMENT PERMIT IS REQUffiED). o ls located io . Special F100<i H anrd Area. FIRM lOne de...:;ignation i.s IOJ.YeOJ' Rood elevalioo .lthe sile is: FL NOVD (MSL) o UoavaiJablc o The proposed dcvcloprncrJl is lou(ed in a Ooodway. FB FM Pacel No. Daled OSee Sc.Clion ,1 (or .)rlditiOf1JI in<;ir!Jctio(n SIGNED DATE ',' ;' ~ ',. , " , APPLICATION >JI PAGE) OF ~ - SECTION 4: ADDITIONAL INFORMATION REQUIRED ITo he comnkted bv LOCAL ADMINISTf(ATORj The appUcant must submit Ihe documents checkcd below belorc tbe appUcatian can be processed: o A sile plan showing the location of aJl oisting structures, wa(cr bodies, 3dj~CCDt roads, 101 dimensions and proposed develapmeDL o Development plans, drawn 10 sClk, and speciocati<Jns, ineluding where appUcable: details for ancboring struclures, proposed elevation or lowest Ooor (including basement), types of waler resistant materials used below Ibe first Ooor, details of Ooodprooflllg of utilities located below lhe first Ooor and details of enclosures below tbe orst Ooor. Also, o Subdivision or other development plans (II the subdivision or other development exceeds 50 lots or 5 acres, whichever is tbe lesser, the applicant must provide lOO-year Oood elevations if they are not otherwise available). o PI91lS sbowing the extent of watercourse relocation and/or landform alterations.. o Top of DeW ftJJ elevation FL NGVD (MSL). o Floodproofmg protection level (ooD.residential only) Ft.' NOVO (MSL). For Ooodprooled structures, ';,ppUcant must attach certification lrom r~gistered engineer or L' / ' ~ arcwlecL. I I/- o Certificatioll [rom a,r;gistcrcd engineer tbat the proposed adh:i(~ in a regulatQr)' fioodway will 001 result in.~ increase in (he heigh! of Lhc loo-year Oood. A copy of aU data and caJaUalions supporting this fwding must also be submiHcd. o Other. SECTION 5: PERMIT DETERMINATION fro be comDlcted bv LO<-':AL ADMINISTRATOR) [ bave determined tbat the proposed activity: A. 0 Is B. 0 Is not in C!lnlormance with provisions of Local Law I , 19 The permit is issued subject to tbe conditions attached (0 and made part or tbll ~rmil. ~- SIGNED ,DATE Ie BOX A is chcc\:cd, lhc Lou! Admillislralor may issue a Developmeol Permit upoo payment of designated r~c. If BOX B is checked, (be Local AdrniruSlralor will provide. a writteD summary or deficiencies. ApplicanlOlay revise ~nd resubmit an application 10 the Local Administr"Jlor or may request a bearing from lbe. Board or Appd\ '. ". t.. " " '" APrLlCA TION # PAGE 4 OF 4 APPEALS Appealed 10 Board of Appeals' 0 Yo, 0 No Hearing dale: Appeals 8Uilld D(..,-~;uu --- AppnJvt...d? 0 '/....'> 0 ~Ie Coodilions SECTION 6: AS-DUILT ELEVATIONS fTo be submiued bv APPLICANT before Certificate of ComDliance is issued) The foUowing information must be provided (or project structures. This sectioD must be completed b:y a registered professional engineer or . tieeused land surveyor (or attach a certification In tlUs application). Complete 1 or 2 below, 1. Aetual (As-Built) Elevation of the lop of ihe lowest Door. induding basement (in Coast.1 Hi2h Haulrd Are.s. bottom of lowest structural member of tbe lowest Ooor. exduding piling and columns) is: FT. NGVD (MSL)- L . " Actual (As-Built) Elevalioo of Ooodproofwg protection is FT. NOVO (MSL). / . ." / i ;: I N7: Any work performed prior 10 sUbmitljiOf the above information is at tbe ris('6f the A~!I"caol. SECTION 7: COMPLlANCE ACTION (fa be comoleled bv LOCAL ADMINISTRATOR) The LOCAL ADMIN1STRATOR will complete this section iL'i applicable based on in5pec!ion of the project to ensure compliance with the community's locaJ law for Oood darn3.&c prevention. INSPECTIONS: DATE DATE DATE DEF1CfENClES? 0 YES 0 NO DEF1CIENCfES? 0 YES 0 NO DEF1ClENClES? 0 YES 0 NO BY BY BY SECTION 8: CERTIFICATE OF COMPLIANCE(fo be comoleled bv LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: I., '. " , '" . " .' / / A.ttactunent B / 8JlJ{~.LE CERTI.fICATEjJF COMPLIANCE for Developm~nt in a special Flood Hazard Area -. '. I. ~ . I, ( ,I' ~ ~ ,{ 'r.". .' '. , TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT [N A SPECIAL FLOOD HALARD AREA (OWNER MTlST U.ETA TN THIS CERTIFICATE) ". PREMISES LOCATED AT: OWNERS NAME AND ADDRESS: ! I J j / PERMIT NO, PERMIT DATE CHECK ONE: o NEW BUILDING o EXISTING BUILDING o VACANT LAND " , / j THE LOCAL ADMINISTRATOR [S 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 VAIUANCE # DATED SIGNED: DATED: C/C (9J) TEST HOLE DATA McDONALD GEOSCIENCE MAR. " 2005 EL=7.B DARK BROWN LOAM BROWN $IL TV SAND BROWN FINE TO MEDIUM SAND GW EL=2A WATER IN BRO'ttN FINE TO MEDIUM SAND WATER IN BROWN FINE SAND 0.0 ~(-v-. \APPROX LW" .'f[;>'f[;> N88'09'54-E (j~ ~~ / _3.o.13~_ 0>'" .~9. / ~ 0~t "'~~~. t..OO~CJ." , O.t:,.'f[;> "~..O' ~ro:rollj;l./ ./ ~ "" -""'" '2.. GO ..",t;./". / / :v;: - - / - -,". \_~ = ..~- '" AVO / /' _ BOUNDA.RY AS DILlNEATEO BY ~ . '...:!-'_'),--- .._ " / yh\ Ul SUFFOLK ENV10RNMENTAL "'" / :v :;;.... CONSlLl1NG, INC ON FEB. 27, 2002. "~i. ./ A", (to-+ ,., ~. I /', >pg,...J... "\; "\; ~ ~ 0 I . ,/.-'/ " v,,"~~lJ~Y 9-~ ~ O. ~....~ I '( "-.. -rQ~~;O,b<O ~~ o. t"\ ~Z~+ I I '-0 <O~~":lli:l'() / ~l-~ 1,,~ l"rF I ../t ?,1. {<r~~ \~c. <o&~~ ~...~ "_r~..;;J / .,. """.. ~... ~~ JU:' 1\ "": . ~a~!!;~~~~ 0 g)NiJ I i;" ", /:j' ~.. / ~~~~E b~~ ' ,. ~~ ;g~1 \.uL 0 ;. z ~ \ ~ 1\ \ / \ \ \ COVERED ENTRY \ \ ~ \\ \ 'Ii \ 1-, \\1 ./-/, ARBOR OVER '0. \ !\'.. __~?.o \ BRICK PA"O U.. ~~ \~/ \ _/\ ~.~~ ~V \\_---' ~ }.. \ V' \ n,'l.~ \ ///~' \ \ //-... \ \ \ \ ~\:Q: \ '1-:\ \ ~j _ ~'~:r"'-- ~a'?b~ \ I' bJ . ~I . ELl0.0 3-4 BEDROOt.tS HOUSE FF-10.5 CRAM. SPACE -o? DO c.~ -- :s:.9. --- poOl- ":'r6uIP. :tJ~~ '",0- ~.i - ~9. 9-3 o (1) ? -. (1) -- ~~ kt~Sf6RY ~;:I~~,-~~ ~-::(F.F....l0.5) .":<(c.s."'J:?) :n;3', rt.\'l..~ 0.' -.d!? 'IIi-\}. 'i ~ I' ff..I'l uW~'+Ip..c\l~e. . o:t~ S\~~ e\..~\JtU) ep...G\ E. ~:E.\I. l"iO e ~ ~ ~ a "" ~s 1.0 q. ~ ~ ~ ~fl-~ ~ of \..~~~' ~\GI(\ 5~ c~~~'f. I..c,oo 3.0 5.4 7.0 / -- 13.0 Col. COVER TO GRADE FINISHED GRADE El.-tQ,2 IE_8,S r I~ 1 2.0'MIN J.O.I.IIN'I J.g....n, GROUND WATER SEPTIC TANK 1000 GAL CESSPOOl ~ ~ A -:s:. OJ ~ ~ ~ ~ ADJACENT LOT COVERAGE: EXISTING: HOUSE & GARAGE Survey for: GRAHAM HEAD At Bayview Town of Southold Suffolk County, New York s.c. T.M.: , DOD-D78.DO-08.0D-005.DD1 EL=2.4 40 I 40 I o I SCALE: 1"=40' NOTES: 1. AREA = 43,870 S.F. (TO TIE LINE) ADJACENT AREA = 41,374 S.F. 2. . = MDNUMENT FOUND, :Q: = LIGHT PDLE 3. REFERENCE DEED L. 4624 CP. 216 4. THIS PARCEL IS WITHIN FIRM ZONES SHOWN HEREON AS INDICA TED ON FIRM BOUNDARY MAP NO. 36103CD166 G LAST DATED MAY 04, 1998. 5. PROPOSED FEMA BOUNDARY AS PER SKETCH PROVIDED BY SUFFDLK ENVlORNlIENTAL CONSULTANTS, INC. ON MAR. 27, 2002. 6. CESSPOOL LOCATIONS AS PER OWNER. 7. PROPERTY ADDRESS: "6D GOOSE CREEK LANE, SOUTHOLD, N.Y. APR. 19, 2005 At,I[NDED PROP. IN'vtRTS MAR. 22, 2005 PROP. POOL &: SANITARY FEB. 17, 2DD5 UPD'TE SUR'IEY FEB. 9, 2004 IND. LOW WATER I.lARK APR. 23, 2002 IND. PROP. BEARINGS .It: OIST. MAR. 27. 2002 IND. PROP. FEI.1A LINE DATE: MAR. 14, 20D2 JOB NO:20D2-103 CERTIFIED TO: GRAHAM HEAD DAVID H. FOX N.Y.S.L.S. #5D234 FOX LAND SURVEYING 64 SUNSET AVENUE WESTHAMPTON BEACH, N.Y. '1978 (631) 288-0D22 = 1,866 S.F. OR 4.5" EXISTING: HOUSE & GARAGE POOL PATIO TOTAL = '.866 S.F. 900 S.F. 493 S.F. 3,259 S.F. OR 4.3% UNAUTHORIZED ALTERATION OR ADDlllON TO THIS SURVEY IS ... VlOLAllON OFSECllON 7209 OF THE NEW YORK STATE EDUCATlON LAW. COPIES OF THIS SURVEY MAP NOT BEI'IRING niE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE ... VALID TRUE COPY. OR 7.9% CERTlFICATlON INDICATED HEREON SH"'LL RUN ONLY TO THE PERSON FOR v.'HOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TlTLE COMPANY. GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON. AND TO THE "'SSIGNEES OF niE LENDING INSllTUTlON. CERllFICATIONS ARE NOT TRANSFERABLE TO ADDITlONAL INSnTUTlONS OR SUBSEQUENT OwNERS OWG: 2002-103 "IMMEDIA TEL V" ENCLOSE POOL TO CODE UPON COMPLETION BEFORE "WATER" [. 45.0' - I I 'ROPOSED FENCING I 1 P I ! - : ~ I ~ cO~P;~ ~~~;~\OWN COD I I I NEW. " . ~ ^,." t"',OND'TiONS I I S REG) .kD .-. . c. . A . .. ~""~ _;~ -.--- I- - .- tsJ, ~~ ~~" ~~:_; ;~~N~~NN\NG FLOODZONE~ - ~ Da~ -- 1 'f) S00 iliOlD 10WN lRUS1EES COMPL Y WITHG~H::~~:NT'ON "- N.lS. DEe I f -./ ~~~~~gt~~OWN CODE, r- PROPOSED POOL EQUIPMENT L- a fPJJtl.OJfPJOJ~!EJl)) ~ WlIIMMIIlNlG fPJOJOJJL r- APPj/fED AS NOTED . ) 0 DATE: 17 i :i'B.P~i....:b C'\I "- OCCUPANCY OR ~~(Jt/' . FEE:. BY: USE IS UNLAWFUL - NOTI BUllD!'c'; v -lRTMENT AT 765,1802 8/.),,1 , :'J FOR THE ,WiTHOUT CERTIFICATE - FOllOWING INSPECTiONS: 1. FOUNDATION, TWO REQUIRED OF OCCUPANCY FOR POURED CONCRETE - 2. ROUGH, FRAMING & PLUMBING 3. INSULATION n r n '-- 4, FINAL, CONSTRUCTION MUST -~-- _. .- BE COMPLETE FOR C.O. I I I I I I ALL CONSTRUCTION SHAll MEET THE REQUIREMENTS OF THE CODES OF NEW ~. YORK STATE, NOT RESPONSIBLE FOR L ~ DESIGN OR CONSTRUCTION ERRORS, ~ ~....r. Y4fG, · PROPOSj V PATIO J. 7t \ .J <1) ~OJJ I PLAN fot: ..-- HEAD Ptopetty I I I I P/Opo5e</ Swimming "'""" 1160CooseC ES o SOAR Pool reck; Town of500thold. NY 5CTM #: 1000 - 079 - 08 - 005.1 EXISTING DWELLING UNDERWRITERS CERTIFICATE REQUIRED 6' . Suffolk Environmental Consulting, loCo Phone: (131)537-5180 Fax: (631)537-5291 SITE PLAN VIEW P.Q.Box2003-B" ehamptonoNY-11932 DA~ Dp<",.ml.J.~ "O!)'; SCALE: A~ r;-lIi- DIl.AWN &Y: mtll COMMENTS: P......-i ~T........ nf......Jt1.nltl R"dtll"Q "",,"It '" ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. []]o,[I] \,,~\I.i' . ~ SOUTH ELEVATION . 45.0' ~ I . I I I . jpJl&@jpJ@~ED ~WIMMllN({l} jpJ@@JL, " ..~~ b o ..... PI AN fot: HEAD Ptoperty Propose:l5wimming Pool SItu~: 1160 Come Creek; Town otSouthold. NY SCTM #. 1000 - 078 - 08 - 005.1 Suffolk Environmental Consulting, IDe. P.O. Boll:2003' B Phone: (631) 537 - 5160 Fax: (831)537-5291 on'NY"1,932 DATE: SCA'" DRAWN (SY: COMMENTh lhor-Pmlvo.<;1on<i A~""..vj_ rn<Il p_...!~rt'Mm"f......";""I""",.j"j"(/P_/t [I] [I] OF