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HomeMy WebLinkAbout32008-Z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32554 Date: 08/23/07 THIS CERTIFIES that the building ADDITION Location of Property: 4170 (HOUSE NO.) County Tax Map No. 473889 Section 123 CAMP MINEOLA RD (STREET) Block 5 MATTI TUCK (HAMLET) Lot 21.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 27, 2006 pursuant to which Building Permit No. 32008-Z dated MAY 16, 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 ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RAYMOND & MARIE VILLANUEVA (OWNER) of the aforesaid building. N/A SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO_ 07-0898 08/06/07 07/17/07 BURTS RELIABLE, INC. PLUMBERS CERTIFICATION DATED ~ff~~"'"<' Rev. 1/81 . Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 r~ !~J --.,-.,> -- ' al~~W~ --. I; .1 .J1l197 '" ~ APPLICATION FOR CERTIFICATE OF OCCUPANCY tn.O .. DEP'~. L~T('IYVN OF ~,..., 'THO' This application must be filled in by typewriter or 1I1k and submitted to the Building Department with the following: A. For new building or new use: I, Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features, 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3, Approval of electrical installation from Board of Fire Underwriters, 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/1 0 of I % lead, 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements, B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features, 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied; the Building Inspector shall state the reasons therefor in writing to the applicant. C. 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 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Conunercial $15,00 New Construction: Date. Old or Pre-existing Building: l/ f!..A10 P 1-1/ NEO L-jC) ~-G-j, /1 /}.{9f)/} {/ / ( check one) 120 f..1A 7 n rUCk Hamlet 41'7D House No, Owner or Owners of Property: 1=:>1'2. Location of Property: Street . t:.> 011 e I ~ Bl~c~ , ') Filed Map, V I U...J::-.j N V6vA Z/. z. Suffolk County Tax Map No 1000, Section (2.t:!jYNo"-Jf.) /23 Lot Subdivision Lot: Pel111it No, ----- -... Date of Permit. Applicant: Health Dept. Approval: __ Underwriters Approval: Plmming Board Approval: _________ Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted' $ 2f3. /)0 dtLtk)H;o/&/?U Applicant Signature (AM.... 7d. JI.f3 c.Oc3J..55Y 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) 16, 2006 PERMIT NO. 32008 Z Date MAY Permission is hereby granted to: RAYMOND VILLANUEVA 86-51 PALERMO STREET HOLLISWOOD,NY 11423 for : ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR; FLOOD PERMIT INCLUDED at premises located at 4170 CAMP MINEOLA RD MATTI TUCK County Tax Map No. 473889 Section 123 Block 0005 Lot No. 021.002 pursuant to application dated APRIL 27, 2006 and approved by the Building Inspector to expire on NOVEMBER 16, 2007. Fee $ 279.10 ~~ ~~jl~ I Authorized Signature ORIGINAL Rev. 5/8/02 r~\'I/'l ,.,all. 53095 MOln q,y)j PO. 80> 1179 SC'~lr,oJd, New Yorx 1 HJ71 Fa, (5: C 70S.,: TE-!ep~C)n0 I:"~C -',-; ~--- ~ n W ~ T::~' i~ JL ~ 9;;lb i j \ , b~D.. DEPT L_T('W~ QF sr""~THO'cL-' OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I FIe A T ION Date:~ Building Permit No. ::s d 00 8 Owner Q "'.1.&4-~ t /"f1L.crl 'C V; I \ OJ Ir\U e vlA.. : \ '(,. '\Please Print) Plumber _0ur-n ~e);4.bk l(\( (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ;n/J /5~" (plumbers signature) Sworn to before me this , lJl-.. day of JJ\ 1 Notary Public. <;?~ Jfv IL 20Q2 County ~ i;L~ fialwy r'vtl,c- i P/'(PJ BERNADETTE L TAPliN NOTARY PUBlIC 114844893 State of Mew York ~esiding in Suffolk County c..' S.... "" u.\ ~,.,'".. u,PlIes );"" .J-7,oC; 32002-2:- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I~L [ ] FRAMING I STRAPPING [v(FINAL A [ ] FIREPLACE & CHIMNEY [] FIRE SAFE [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION Cu REMARKS: DATE 7/3110 I INSPECTOR I 3 J-o 0 y Z TOWN OF SOUTH OLD BUILDING DEPT. 765.1802 INSPECTION ] FOUNDATION 1 ST ] FOUNDATION 2ND ] FRAMING I STRAPPING ] FIREPLACE & CHIMNEY ] FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. ~INSULATION A...', [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS:~~ ~-' DATE ~~9~()1 INSPECTOR ~ ~ 3 J-o 0 '6 7-- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. P<J INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS: --. 49- 1) V- ~~~ DATE ;f--'(-D7 INSPECTOR ~ ~ - .......... - ~""..,. .- ~- 52,-OOP& TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING [] FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRucnON [ ] FIRE RESISTANT PENETRAnON REMARKS: -M~/~OJ-1~. ~ I DATE INSPECTOR 3 'J-oo '1 7- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ [ [ [ [ 5'~ ~. J JKl FOUNDATION 1ST [ ] FOUNDATION 2ND M FRAMING I STRAPPING , .......... [ ] FIREPLACE & CHIMNEY [ ] RRE RESISTANT CONSTRUCTION REMARKS: ~ ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION -6k -" rJid,~ ~/~ceJf~ DATE I?- r~- tJ , INSPECTOR ~ ~ 3 :t--o 0 'g' z.. TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION P<f FOUNDATION 1 ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] INSULATION [ ] FRAMING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: /~~4-~ - .. DATE 11-tJ-1 ~ a? INSPECTOR ~, ~ );;-00 ~ 2- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION .~, ~ E~ ~ ~~7 ~~cL, <<ROUGH PLBG. ~ [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION C~ [ ] FIRE RESISTANT PENETRA~ , - ~~ ~ ~ [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUC'nON REMARKS: tI-- , , ~ L.sL C) rc-, b ~ 1?-'[' - 07 DATE INSPECTOR ~r~ J~ ~~?PC: $cCl8 PROFESSIONAL ENGINEER 1725 HOBART ROAD I PO Box 616 SOUTHOLD, NEW YORK 11971 TEL: 631.765.2954 . FAX: 631.614.3516 . e-mail:joseph@fischelli.com Date: Reference: July 17, 2007 BP # 32008 Southold Building Dept PO Box 1179 Southold, NY 11971 ~ ~ ~I)'!J~ ." - - li" Jll , 9 ? i eJ ..-J I I bd) " OtP~ ,-__~T('\I'JN OF ~,...' 'THor ~~ Dear Sir, I have inspected the damproofing at 4170 Camp Mineola Road in Mattituck and certify that it is in compliance with NY State Codes. JosepH Fischetti, P.E. VillmlllL'Va d;'n~~'lillg=t.mc H"-';/.RL.' FhJ(~Ii'Jt_,-;_H - I ~ . FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) 0' " " ~;g \I/')q-l)", A:t' V~ j),~..o- 0:)(-, /--;" JI't;/;; \\ g, ~ ( ::-.-- ~()_ n >I- h: ,J).. ~ '::" ;:: 1\0 ~ t- .t V 1. _"A =l (7 r-tN.. I;)-')Jl- t>'C r- II /I 11 "'~ .iv2Jl-a-!<./ 'db{\> 17-,I't-d/ /'l.,f2I7--A "oAJ-, k Jj'-. /l). A I-J - . -/ ~ "'2 j, , () R' I /~a _t'l FOUNDATION (2ND) ROUGH FRAMING & PLUMBING 19~ l-r ~. L /-> ~ -- ~ m...17 ==tiJf ~ I' ().(/)V 1"17 . l.nA f)n' ." J ( ~ '7>tJd . I( ~ L;;'J.~ /' IL - d. ~ C) ~ ~ ' -V [I v -= ~ /hlhl?-/.# ~9-~~~ ('.Iv.~'~ .Po ~.~~~ I / 'L/JI!- .A l2. / d,,, ~.J/~- ~ '\ A, _r\ ~ / J.-W /~ .AI.::/. -/ r6 / // / /// / . '3 .~ ~. ;).-<J.-fJ~ t .()~H; 'V. , n< J1H~."""'l'\ .NI-o,A,t.J.--.t, li~^1l ~ 0 IJ... "VIr......... I Y ~,jlf/, _I;:i f' ~ ~-q ~ F, t"f.u -r ,~) " ~ .;'..6, .)';:J;; .tJk 'l.AJ- r~:: ./.7 ~ ~.., INSULATION PER N. Y. STATE ENERGY CODE Ir7//,. /" I / fb-'rt:- Df /? - -r:--, ~. L." J. "u:;;. P /.L ~hjJ ~:I-5"P /~/jjiV...J. ',.,._-'-'......r ff'. / +1-., A A .-1- t;... , A -: 1-. dL . N ,.....1...1" VLPJ b .h..Jo flJo.-!'VA ' FINAL1' "'" /"'A v{J" -117,,' L". L /) U .. ~c _ _ ~ ~ "i; It". p": I - O. ffJ'< - r~.J. -J-. (\' Al l.\I ~'L?/ v, ~ '7./... I 7 ~/'/./ Pa... __.-/. ~ L..7: r 11~J;t'6 nr~ LA bXrP !..~' .:- //. JyL '-- nk NALCOMMENTQ lP '11n.,/ f // // . ~ -'A v V r', .. '-01/ tu/J fI1" ~ ,VA >' ... , ') a '1(<~: vi1 0 '" <: ::E C\ z m. " t \- 13, ~ 4 t'l ......~ ~... I _ ;::::~ .., c - -J~ ". ~g; f~ I:;j t'l ... ~ . PERMIT NO. 3~of[v BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: . r /In lJ-r.JefI- Mail to: ft (t3efJ ::::Jit'V1 (J [@V/W{;ICX/t2J-.1i3 Phone: fa::?! 7~ 1- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.netlSouthoId/ Examined 1/ ~t , ,20 Ok> ,20~ Approved Disapproved ale Expiration 1(110 / 2007 '- /~~ Building Inspector APPLICATION FOR BUILDING PERMIT i27 Date tft2ul ~1 ,20~ INSTRUCTIONS . l~ i a. This applicati6fi1\ttfST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, 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 if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South old, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. 1::Rl<A y H 01\1 D e k4DEVi L1..J..k/c.M (Signature of applicant or name, if a corporation) t(;(y - 6/ 'Tp u;e J-10 ST (Mailing address of ~p~licant) flDLL ISuJOO D N ,Yo / /423 State whether applicant iG;n~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~ N EI2. Name of owner of premises uk'.. f2..A Y M D I-J r,:) S H0"'J H iAfl~ V I LL,t\N Vf'JA I (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. I. Location of land on which proposed work will be done: ;....1 El ..,- T I ru r k... 4/ ~() C/:1/-lp ,fG-11;()f:-(iL;4 (<0 I ,-, I V' House Number Street ' Hamlet County Tax Map No. 1000 Section I Z 5 Subdivision Block 5 Filed Map No. Lot Lot 2/. Z. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ifGf"'5/ f::>E3f..t I b. Intended use and occupancy 1<. f'"'S I b6101 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost r$- ,,~ OZ7. CO Addition Other Work / 'Z5TOfO( 51D{3 /iPVI/7CJt/. Ie DECc-:;;. A teration (Description) Fee 5. If dwelling, number of dwelling units I If garage, number of cars Aj/ yf 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. (To be paid on filing this applic,ation) Number of dwelling units on each floor (/J ,I hi /d' 1 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of SJlr;ne structure wi~h alterations or additions: Front -3 r; J Depth "5 ":> Height 70 1 Number of Stories I 8. Dimensions of entip:, new construction: Front / 8 Height (.5 ' Number of Stories 0,/7 / Rear ./' / 2-.. ?, f7 I Depth '.J fL. Rear '2. lei 9. Size oflot: Front 1"2'5.03 Rear ~Y'G Depth /-71/ 15 '7, ? I 10. Date of Purchase (P' e& Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO X 13. Will lot be re-graded? YES_ NO x' Will excess fill be removed from premises? YES_ NO X l:J2. ~M l-( D 1\4 D" ILL A. N l) t V J.i P€U3.erft'L -=r /-I()(.M7I,;/ (-0;> 1.../ Y 14. Names of Owner of premises . Address 1J:7lj1.ljl - -Phone No.-7/p> cP:?9 . 44'_4P. Name of Architect ;:: <;M'.0~1 c/PJlH'6iTIff"Address t;C?ql/JtYY5IiY(1flJ Phone No 77 t/ "Z'?9<j Name of Contractor .111'1!J t?0~ /Yl/V,e Address //,l/7777UCZ- Phone No. 15 a. Is this property within 100 feet ofa tidal wetland or a freshwater wetland? *YES_NO X * 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) ss: COUNTY OF ) 1?1c.J.fJ4/f'f) fl. /M1";<IIF being du1y sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (~He is the /luf3/Jr (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 ~ ;:;((.1 day of 20 0 ~ b)./uyw, ,<YY)lY<91A./ Notary Public ~{)J)d a !W~r~ Signature of Applicant EILEEN S. SANTORA. ~TAR.Y PUILIC, St.t. of tWw Yodr; No. 30-4916018 QUlllified in NasIlIU Coullt! Commission Expires I , I ~ I () , I r .0 " 1-;' ., :1: Permit # plAY I 5 c " J Permit Date ! L___,'j' I _-.-J REScheck Software Version 3.7.3 Compliance Certificate Project Title: New 2 story Addition with Crawl Report Date: 05/08/06 Data filename: C:\Program Files\Check\REScheckWillanueva.rck Energy Code: New York State Energy Conservation Construction Code Suffolk County, New York Detached 1 or 2 Family Non-Elec1ric 18% 5750 Location: Construction Type: Heating Type: Glazing Area Percentage: Heating Degree Days: Construction Site: 4170 Camp Mineola Road Mattituck, NY Owner! Agent: Joseph Fischetti, PE 1725 Hobart Road Southold, NY 11971 631.765.2954 Designer/Contractor: Assembly ..... . .: ..... .. . - .. . . . ~", Ceiling 1: Flat Ceiling or Scissor Truss: Wall 1: Wood Frame, 16" D.C.: Window 1: Wood Frame:Double Pane: Floor 1: All-Wood JoistlTruss;Qver Unconditioned Space: 600 896 163 600 30.0 19.0 0.0 0.0 0.350 21 44 57 20 30.0 0.0 proposed building represented in this document is consistent with the building plans, specifications, and other calculations s bitted with this permit application. The proposed systems have been designed to meet the New York State Energy Conservation C ruction Code re uirements. When a Registered Design Professional has stamped and signed this page, they are attesting that to t bes f his/he and professional judgment, such plans or specifications are in compliance wi this de. ~l<. Builde Date Proje Eile . New 2 story Addition with Crawl Page 1 of 1 " ,,...... :..~ ,I -t ..I~. .' . 'ftIP'ITH T. TERRY to Wl'I CLERK , IlEGISTnAJ1 or VlTN. STAllSl1CS MArH1I^GF. orTICI.:n RECOf1IJS MNi^GfMENT OITICEIl fl1EEDOM Of INfOfUMTlON OfflCW ,3;;).ODf] [""",,, 1\"11. .\ )II~~ Mu," P.O. nn. 1171} Sltl1l11old. New. Yurl.: 1 Fox (.') 1(" 7<'>~'IR" T ckflhonc t 51 (q 1(.5-: OFFICE OF THE TOWN CLERIC TOWN OF SOUTHOLD 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 "Floodplain two (2) new forms to be used under We Flood Damage Prevent regulations ..I 0; the Code of the Town of: Southold: f\pplication" (FDP(93) I. and /Certificate Special Flood Hazard Area [e/C(93)]. of Compliance Development Permit ! ) (/1 Develeprnen t in . I O '0:,"(0; I:;::' LSJ, . ,_ , --1 ~ ~T.;~- Southold Town Cle,k August 25, 1993 ~ - , I!I J -' BUD. Or:?! TOW;4 OF S0Ul110LD Y" " '1 1'.. . . . APPLICATION # rMjE I or ~ - .' TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. ~ , SECTION I: GENERAL PROVlSIONS (APPLICANT to read and sirn); 1. No work may start unW . permit is wued. 2 Tbe permit may be revoked if any false sl.temenl.l ue made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall nol be used or occupied until a CertifiC<lte of Compliance is issued. 5. The permit will expire if 00 work is commenced within six months of issuance. 6. Applicant is hereby infnrmed th.t other permil.l may be required to fulfill local, st.te aJld federal regulatory requirement&. 7. Applicant hereby gives coosenlto the Local Administrator or his/her represent.tive (0 make reasonable . inspections required to verily compliance. . 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND lJ'i A TTACHMEJ'ITS TO _ THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND ACCURATE. (APPLICANT'SSIGNATURE)~ IWPY/)JwJMA, DATE U' /qO(o' . ) I I I I //SECTION 2: PROPOSED DFYELOethENT ITC'Se comDlcled bv APPLlCANl1 NAME ADDRESS APPLICANT ElL E E IV -3i li!hDaq (p Fj() V AAJ 570 N BUILDER -...J ("---'\ 'Brzo:=.t: l-"::1~ N I-C ENGINEER. 1.--+ I /' ~ 1 . "-/;'\:lSe-Pl-J 't""X-I'-t-ell\ TELEPHONE tz.IJ ~~~)'4 '2 TCJ -4 fRomCf LOCATION: To .void del.y io prooo.s.sing tbe .ppOWlUO'" plc..,e provide eoough information to easily ideotify the project location. Provide the street addrus, lot oumber or Icg<ll description (attach) and. outside urba.o areas, tbe dislllDCC to the nearest intersecting road or wcU-KnO\lfll Giidmarl A skelch attached to Lhi.5 application sbowing (he project location wouJd be belpfuJ 4/'7D 'PI)(. N () QA~1 P WIN cO/Ai 11:':0 40'3fJ'7Y'''I ~d 1'2") 'F6Ik. 00:111 ~ 'g ih,{J~ FDP( 93) " \'1' ;\ t'. ~ APPL/CA TION ;'! PAGE20F' DESCRIPTION OF WORK (Check all appuGlblc boxes) A ,TRlJCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE o New Structure 2t:ResidentiaJ (I i ,.Jly) 'l>(' Addition 0 Residential (More than 4 F:undy) o Alteratioo 0 Noo,residential (FloodprooClng? 0 Yes) o Relocatioo 0 Combined Use (Resideotial & Commercial) o DemoUlioo I' 0 Manu(actured (Mobile) Home ([0 Manu, o Replacemeot (aeluredJ1ome P~k7 0 Yes) ESTIMATED COST OF PROJECT S /}t); f1{lO. ()c) ( B. OTHER DEVELOPMENT ACI1VlTIES: o Fill 0 Mining 0 Drilling 0 Gnding o ExC3vation (Except (or Structural Development Cbecked Above) o Watercourse Alteralioo (lDcludiog Dredging aod Channel Modificalions) o Drainage Improvements (Including Culvert Work) o Roa:rit., Street or Bridge ConstructioD o :Su~jvisioQ (New or Expansioo) o ~ilividua1 Water or Sewer SYSlem o Otber (PI=se Specify) / ! After completing SECTION 2, APPLlCA.l'fT shouJd submit form to L..oc.a.J Adminislraror for revicw. SECTION); FLOODPLA.lN DETERMINATION eTo be comulcted bv LOCAL ADl>ffNlSTRATORl Tbe proposed devctopmen( lS loca{cd 00 F1RM Panel No. Dated The Proposed DevelopmeDt: o Is t;!QI 10CHed in . Special FlOO<i Hwud Area (Notify the .ppUant that the applkntion review is complete ODd NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). o ls located io . Special AOO<i H lIMd Area. J..IRM ronc dc....:;ignation i.s lOO,YeaJ nood ekvation althe site ls: Ft. NOVO (MSL) o Unavail.ble o The propo5cd development is lou(ed in a lloodway. FBFM Panel No. Dated OSee SUllon <1 (or ~drliljona in:;lrI!(lioo.1 SICNED fA /L/pt A/ DATE &, /9,tI/J . ------- --~--._----- ,~ - . '" ",k., '.' , ;, . APPLICATION >'I PAGE] OF4 - SECTION 4: ADDITIONAL INFOf\MnION REOUIRED (To he comnleted by LOCAL ADMINISTnATORj The appuClJ)t must submit the documeniS checked below before tbe appucation ClJ) be processed: o A site plan sbowing the location of all cmtlng structurcsf wate.r bodies, adi.aceDt roads, lot dimcnsioU5 aJld proposed development. o DeYelopmeol plans, drawn lo,calc, and speciocat4;Jns, iocludio~ wbere applicable: <lelails (or ancboring slructures, proposed elevation of lowest Ooor (including basemeot), Iypes o( waler resistant materials used below lhe rlIst Ooor, dctaili of noodprooflDg of uiilities located below the orsl Ooor aDd details of eoclosures below the Or" Ooor. Also. o Subdivisioo or otber developmcol plans (I( tbe subdivisioo or olher developmenl exceeds 50 10ls or 5 acres, wbicbever is tbe lesser, the applicanl !!!Jill provide lOO-year Oood elevations if they are oot olberwise available). o PI31lS showing the extenl of watercourse relocation 3lld/or l311dform a1teratioDS. o Top of new mJ elevatioo Ft. NGVO (MSL). o AoodprooCUlg protection level (non.residential only) Fl.' NOVO (MSL), For Ooodproofed slructure.s, -:!lppl.ic.aol must aUacb certification rroro r~gislered eDgineer or architeCl. / ,t/- o Certification [rom a-r;~s{ercd engineer tha( {he proposed activit in a regulalory Uoodway will not r~ul{ in .!UlY increase in tbe height oC the tOO-year naod. A copy of all data and ca1cu1ations supporting this rt.nding must also be submitted. o Gtbe" SECTION 5: PERMIT DETERMINATION ITo be comDleled bv LO<':AL ADMINISTRATOR) [ have delermined tbat tbe proposed activity: A. 0 ls B.O Is Dot in conformance with provisions of Local uw r1 , 19 The permit is issued subject to tbe cooditlons attached to and made part nf t~nnil. SIGNED tIL(/{ 0h/t'f:tJ/l . DATE j;,/c}-tf; If BOX A is chec~ed, tbe Local AdminLllrator may lIsue a DevelopmeDt Permit upoo payment o( designated ree. If ~OX B is checked, tbe Local Admirustrator wlJI provide a YvTitlCO summary o( dcncicncics. Applica.nl may rc'llSC and resubmil a.I1 application 10 the Local Administrator or may request a bearing (rom tbe Board of Appeals .r-., .. ;'" " APPLICATION # PAGE 4 OF 4 APPEALS. Appealed 10 Board of Appeals' 0 Yes 0 No Hea.ring dale: Appeab BUii,d Di;....~;lJU --- AfJP,v~!..,j? 0 Yo 0 ~10 Coowtio0.5 SE:CTION6: A's.OUILT ELE:VATlONS ITo be submitted bv APPLICANT before Certificate of ComDliance is issued) The foUowiog information must be provided for project structures.. This sectioD must be completed qy a registered professioDal eDgineer or a ticcDSed land surveyor (or attach a certification to llUs apptication). Complete I or 2 below. L Aelual (As.Built) Elevation of the lop of ihe lowesl noor, includiog basemenl (in Coastal Hi2h Haza'rd Areas, bollom oC lowest structural member of tbe lowesl Ooor, excluding piling and columns) is: FT, NGVD (MSL). L . " Actual (As,Buill) Elevation oC OoodprooHng protectio. is FT, NOVD (MSL). I -. " I I .' I 1'1U'J~: Any work performed prior to submittal/of the above information is a( lhe risk ;6[ !.he Appl;:ca.nL / j // / SECTION 7,: COMPllANCE ACTlON ITo be [omDlcted bv LOCAL ADMINISTRATOR) The LOCAL ADflHNISTRATOR will complete lbis section as applicable based 00 in..speuioo of the projcc( (0 ensure compliance 'lrilb the community's locaJ law for Oood damage preventioo. INSPECTIONS: DATE DATE DATE DEFICIENOES? 0 YES 0 NO DEFICIENOES? 0 YES 0 NO DEFICIENOES? 0 YES 0 NO BY BY BY SECTION 8: CERTIFICATE OF COMPLlANCEITo be [omnleled by LOCAL AD~llNlSTRATOR) CcrtlIicale of CompUance issued: DATE: BY: , . , t't._ , JJ ~~ " '. .' l>.ttacllIDent B / / / 8Al{~.LE CERT~JICATEj)F COKPLIANCE for Development in a special Flood !iazard Are~ < '-', I.. " I, ( ~. J ~ t ( Ir.,' " '. , TOWN OF SOUTHOLD .. " .. CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD A.REA (OWNER MT'ST REH TN THIS r:ERTlFICATE) PREMISES LOC~TED AT: ~ J N 41'7D L/7~P V'VI/ 50LA Hf)Til jOCr en '-=SLoan PERMIT NO. PERMIT DATE "-'10-_',-\ \ '" ,'2tDCp CHECK ONE: o NEW BUILDING -m::X:ISTING' BUILDING o VACANT LAND OWNERS NAME AND ADDRESS: KAY H t:ll',h) \1 \ L-U" N I )eJ A ) / I / j THE LOCAL ADMINIS'DtATOR IS TO COMPLETE A, OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIfIED WITH TIlE REQUIREMENTS OF LOCAL LAW # ,19 SIGNED: - DATED: B. CmilPLIANCE IS HEREBY CERTIFIED WITH TIiE REQUIREMENTS OF LOCAL LAW # I 19_, AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: C I c: 191) .--------_._-------~----~---~-- ----~------~----.---~-_._--~ ~ j.ri<w lQ , . :l \'0.... Z '1'- t~~ ! ......~ -. _i{Z -~ -t .'; '. lLi I ~ ~ '..:.....} - ,~-'-'~ - ."10- Q ';;;1 ;/~ 1!'$ f j1j i~ Wv if?~ l1J i E ~ci;~' ~v\ "f)"'f ~ l' g /~ t' i .' 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(', j L . ,,' , . .. \" -",.l. t..o-t,-' r"'-;t\.,l t I OF' .':j)UfH , r'.~ f. I 1/ I II // I I I. ! I / , I ! I .f J II! ! I , i ..... t 1 I I , I i ! I , _______~_______T---- , , I ' f.:: c , i r jr ,# I / " ., ;1 .' } ~...::: k~ :"l,,' ,1<_,.,""'\' .... , j ....., t " i I I '{ ."-'- -""", c e'l' ':~'4~"~_ ._'- :: ~:I,f&:&na,~s.F. H;~HMENT . ~~-:,:;,,~; : ,.--: -~''" -~ .', :.~, --- " r:-.t. [~ PI eE ~-"";~",:"",..;;."""'-_"":,,r4~~.~,. . I '. ~J~~-~ ',','''' ..,", ',. . '.. .~''<%...... t,'~,,!, ..' 'I~ .. . - -" . l1.6Il.~D ~v:t.i tl\Alltl<:. - . ~ -~--.;~ , .. SUF FOLr~ CO HEALTH OEPT APPROVAL'''' H 5 NO c;': ,c~_ : ,-'.3 I I l I i I I I i I I' STATEMENT OF INTENT THE WATER SUPf'L Y AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE I SUFFOLK CO DEPT OF HEALTH SERVICES, (51 APPLICANT PEI'T. OF HEAL TH APPROVAL OF SUFFOLK COUNTY SERV ICES - FOR eONSTRIJCT1ON ONL Y 'Oil"&:: ,e I' I ;H':S.RE'F,Nli: ~-w~!aa A~~G: ., ~- ." -.$UfI"FOf,.ti:CO, TAX MAP~tGHATION: '01.; SECT eUX:K 'Pct., ,i:rtQ2. ',l~ . 5 / -2t~- OWN!ltS A .. RESS: ,,'" QEm: 1..44$5 '.!" .",,;,""(';'0:'17. ~y . LOAM' ":C-,";'CC \,f rh'!; S'j?"':;w-_mar not bearing- ',' 'f:1-l'J <;~1--.<;'-"'f:)~'5 ,,,'tad SESa~ ()l; ~~'-~~'~"~:~!i~O;~iu~'1:;:p~~nle ronsiderfld ,.:;;",,.r8""1~'?1; in-j;~3;"C hereon shall fun \""":1' '~'~'c1 :,1flrSQn tor whom the,~tJrvtlY 'f" ~,:',;Ct'fe.l <,:nd on his bt;half to'the_ ,,~:~, [:_cn1:'-~-v{. gm:ernmsntal ~ger.~ and' Iy, :;;;y, <!~:"~util)n listed hi),t\oo and to t;-,;~ ~-ss,()I1?es; m the lilnd;rog insti. :)'.''-,<1. GU8f!'l;ctBaS "re not transferehl9 ~:,"j::.~:"Oi"';81 ir\&ti!;,tions (l(' subso9quent .SAWD.. WA.Te:~ . , ~ '-..,: ., -~ ~ ,l '//<"'\1. r r- . . r'../1 !\ t ~ . ..1-'1.1 CI~-=- !..~r2 \::.1 ;:: r,~ ~ <-' . '. j I / , I J' . I S!..) r~.~\.! r:~'y' E L> -- -----..~ "" ----.- / -- ---------.; r') ,\ " I " l' -, 1 'P', lu-\ T J"k)I'JLJ , , .' .'. [' )1' I'\~ J I \ , f: I iH ( .~ '.' . . ~~ ,.. , ," :~5QJ_ - - ...... P('2IVA,:'E. r<!.OAD e.+-' ___ WI'" '0',. ~Lt:E"N (VAC,...kLT) 'J! . Hl-" T'! ,r (/ 1"0\ ,IIV~l<._ F\:'Q.. , ~~~ r....-. L__ . Ii' , l' f < ..--.. :/' \1 i L_LJ\i".lU L_ \!,~, 1 rr.)w.~J OF ::DUTHCUJ 1'-1."( -_.~---.--_._-_.. ._--'.~_. . "--! .-....: ------ -------... '; 1 i 1 ~,' ~ $:',-~. ~- ;"';":t:;'._'" ~- ,,;.. '., '::./:,L. " 'v <- '- ' , , .~: ~-:;:> '1'- 'I" ,: j' ':t;'~' , ,-;' --. .~- .:" ..~, ,,~ -; .. ~ "---' "v:::. . ^ ( , , , , ; , '" ..-~ : " N. . 'I.~'~ ;..;'.. ,. ~. j:,"!' q i ~'~;~(j~~;:~ ~ . .,' 'j >, " r " <<J > I1J !# T /;-t j " I ,,! J i ! ~'. ':' , i ! ! J J 'I 1 '-, [' .~., .., " ,':l .;"_1 ., ~, " :ft. h f ~i ~t~ /~ --.... '''~.'~' ~. .. A' i " 'J' . :;~~:,< / . - ~. "'-.. ,.- :., ~ ',',. ~i~Y' , "~ {~~~,;J\ ~. ..to}. .' .' ~ .~~, ,-~1~tli~~ ....\. -t; , ..~ :- l .- " .~. 'C.....-li-F.C,., "l'0'< I" 2-~~~ ~" :~IZItf5:.'~,:t~?i~;:f S.F, , 'T;'\""'~'11'\"\."Adj,:'J"1~"""';', ., .\.:J ,.:~1tV..iS~.J~_',"')~1..,L_._. ...;.i.,.. . ,'rn~rn:~".I:~i~grr:1~- :':t..:;:,~ .~- ~.~:-i..'. "~'. KI.;IN. .u;;:.......-- ;'~d" . .;t~.::~~;J..;.~~ .~>>.~j. ~ i~'~, .... . c;~~,t~oro15ECi)' ~~~,,~,,~;:~~,)~;:~;gi~':; ~l$D JCl!..~?.;.!~;~..;.,,;.._ , ' .' ".er,: .'- . ~"~~::<;:~,i 12EYlSEct.:JAN:zl' .-19~.; -'-' ......._-"-~'.......~-~~_......,..-,~ .,.-- ':, "", JUOO:';'I;3 "1986'. t"~' ..::~:~._:.J.-:-:,~_ , _~;:llCJ.\f.m.IOO7~~ :J~,:,=4;..Jq~'; " ", !SUFFOLK co I i HEAL TH DEPT APPROVAL H. S NO 3S<..:~(.;; IRS i STATEMENT OF INTENT THE WATER SUPPL Y AND SEWAC;E DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO, DEPT, OF HEAL TH,SERVICES, (51 ,SUFFOLK COUNTY OEPT, :SE:RVICES '- ,F'OR,- 'CONSTRuCTiON ONL Y ~p~~j.~,~-.{. ~,~~.~~ .,,', iiH::S;REF, NO.:" 85.~;la8 ,,- :IA:PP~6"EO: ; ,i~~'. /. ~ -.', ' ~l< ~~! :;; :;'. APPLICANT ," '.. ,~~~ 0 'y,-. ...~: -, 1.:' ;, ' ~$ ~~ i4,... /..:. oWNERS AOO~ESS:; /",. :: . -r':): ~~:' ~.~ ~;:~ ~~...~,' <, i~:tI~~ OF HEALTH "-,"-.- APPROVAL or! .. ,. "'< "~..~..-< :t'?:: .'.. " ':'<F-{'-.' -.-....}- [;>" ); i/,SOF'FQl;KCO::T AX' MA":'Oj1;SIGilATlON:'>~ ~..;i._./.,,>.<, '0 .,',!,'- ,. . '. ~-...-, "" .', ,.,,-,,~ "'>~'-..1',,:; ,',:~,'Olst,' 'SECT, ',". BeoeK," . "pclL'~~: ~~t!'j{tjj./.~~ ~..y~~' -'-~'~'~~.'~~5~ .'~n""'~';~'~:'~2J~Z~j ., <. <:r~~-;' ," ..~;. "0..' ~: " ., ";;'. ..r.;-;-'_ ~ ~ . ~;; . . {', OEED::L::M:?P. .. - - ". . ",. . .HOL ~\" .-: ~'~E" , , ., ...-.,~ _,;.r ", '~y.'; - LOAM.''''; <\:' \'" ci,'A"'D" .;......~...... f~.. of.. '..' .:,,;~ ,. 'nA..--a:..... .~yy~,l,_~ .; :, ,,;r ~",. ~~ . :':-,~ ...., .,.l. . i,~:t:. ~, .' , rlr lS';~~~:,:' '.1 Hi-i.' 'i:.V;' :~ ~,;;i~ ~ - ;'~~~i' j"t>f...~i -;.,....'~~: r~f, ';toiw:' .,../. ^~~"'" ):-T .I-{'>Jl. ~4' J"M'\.~~I.~, ~"'fl ~t~iJ~f"i~;;~.;!,. . ::'\~ l!:.tH~{~..:>~..,__~f ~ .1;';;' r,.;;.,,< .-p.-, ,-'~ - " ~- .-~ "~. ':. .....', t-r>-:/'" ;. . ,,~...;., ,.; ~>\ ".' j ..: i7il ..- ."1 ,.., '",':j '-' ~;d~{~ , ..r-; \ ~ " ". " ..;:~ " _~f~~~'t:~f~~{;~ . , IV: , .. 1(," of~' ~~;}~.--r-;; ..\.. ~..~,. ; ~". O. t e aw ktc" . ~,;'...-;.,~~on!..1lw, "-; ~::f'-"~,~~~J '~{}:li-:; of th's SI;N~, mar not beari~ :_'-- . ~ ,.,,, 16.1'J "'.I'''veyor't. in"ooo is,,..J 0('." >.'/ .-'>- ","I'Y.)""'",C S~:l; fU13t: not:be cooslderfld ~~";.f; Il)kt.1....~lid"'u..f:..'>P'I/' (.: .~,:~..,..~...,l; . Gu~rant~el>' i,,1;C3t~<5 h~feon. shail run ." ~1Ol't t~ thO') Pl'lrs?" ~or whom" ~he ~urv.,(, o~ '$ ~rer.at'Sl'j. ano on hill b6haif to'ths " tl::r, l;.?m.:-~,\'{. 9'o\'ornman~ol agency Ii;;" I' I-;:>,,:I;:"l~l .n,,",tut!on I,st~j l'1areoo and to ,t.:, a9$,qf!i3as Of the landing in~i. W:ir,n. Guarli...te~$ are n"o1 lraI1SSrll"'e ~ ""'. .iFft;l'tio~al.~'?f,titatioo, (II" sub8>9quenf _"''''''''1'10 :-_.0. ,; . 5/; ....,.-. ."- , :..::,-. '-",' " .";'- ~:-~~.~. ''":~~.~ .' ~r:-~ ,,'~ ;.:' ~ .':~ ,.' };~! ~~ ~~i9,A