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Home My WebLink About31773-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 10/10/07 No: Z-32663 THIS CERTIFIES that the bui1ding ADDITIONS & ALTERATIONS Location of Property: 720 (HOUSE NO.) County Tax Map No. 473889 Section 61 MECHANIC ST (STREET) B10ck 4 SOUTHOLD (HAMLET) Lot 11 Subdivision Fi1ed Map NO. Lot No. conforms substantially to the Application for Building Permit heretofore fHed in this office dated JANUARY 4, 2006 pursuant to which Bui1ding Permit No. 31773-Z dated FEBRUARY 6, 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. The certificate is issued to CURTIS & ANGELA DWYER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPAR'l'MEIIT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2098366 09/21/07 PLUMBERS CERTIFICATION DATED 09/10/07 CURTIS DWYER Signature Rev. 1/81 7G5-06.:?6 d('"' '~H1W ,L J I ",-D" DEP7. L-T02^,'tLQLS"!JTHQ1-.L.- . APPLICATION FOR CERTIFICATE OF OCCUPANCY Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 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: ,.' 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: Old or Pre-existing Building: M eo ...."'--.;.... ~{- Street ~........f-.'7 I A""<{e-l... Date.~.a7 /' ( check one) Location of Property: "1 ). 0 House No. '50... +(.....,.1.,1. Hamlet Owner or Owners of Property: O~YL(' Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: ~''''') Date of Penn it. ), - ", 0 I.. Applicant:____. Pennit No. Health Dept. Approval: Underwriters Approval: Planning Board Approval: _._. Request for: Temporary Certificate Final Certificate: /" (check one) Fee Submitted: $ , ,,'i-oo ~t~ ~31/8 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. 31773 Z Date FEBRUARY 6, 2006 permission is hereby granted to: CRISTINA HESSEL 720 MECHANIC ST SOUTHOLD,NY 11971 for : ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR WITH FLOOD PERMIT at premises located at 720 MECHANIC ST SOUTHOLD County Tax Map No. 473889 Section 061 Block 0004 Lot No. 011 pursuant to application dated JANUARY 4, 2006 and approved by the Building Inspector to expire on AUGUST 6, 2007. Fee $ 250.00 , e ORIGINAL Rev. 5/8/02 ~/, - 7 - II lID.lID I . BY THIS CERTIFICATE OF COMPLIANCE THE I ~ NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~ BUREAU OF ELECTRICITY ~ ~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~ ~ CERTIFIES THAT ~ ~ ~ ~ Upon the application of upon premises owned by ~ ~ ~ ~ CURTIS DWYER CURTIS DWYER ~ ~ 1014 CROWN CT 1014 CROWN CT ~ ~ MAHWAH, NJ 07430 MAHWAH, NJ 07430 ~ ~ ~ ~ Located at 720 MECHANIC ST SOUTHOLD, NY 11971 ~ ~ ~ ~ Application Number: 2098366 Certificate Number: 2098366 ~ I Section: Block: Lot: Building permit:3Ii/:3,BDC: n511 I ~ Described as a Residential 0-599 square ft. occupancy, wherein the premises electrical system consisting of ~ ~ electrical devices and wiring, described below, located in/on the premises at: ~ ~ First Floor, kitchen.2 baths, ~ ~ A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ~ ~ herein, was conducted in accordance with the requirements of the applicable code and/or standard ~ ~ promulgated by the State of New York, Department of State Code Enforcement and Administration, or other ~ ~ authority having jurisdiction, and found to be in compliance therewith on the 21st Day of September, 2007. ~ ~ Name OTY Rate Ratin. Circuit Im ~ ~ Miscellaneous ~ ~ install new main panel ~ ~ kitchen & bathroom renovation ~ f.!I Appliances and Accessories f.!I ~ Dish Washer I 0 1.2 KW ~ ~ Exhaust Fan I 0 F.H.P. ~ ~ Hydro Massage Tub (Therapeutic) I 0 ~ ii!I Wiring and Devices ii!I ~ Outlet 15 0 Fixture ~ ~ Fixture 15 0 Incandescent ~ ~ Outlet 14 0 General Purpose ~ ~ Receptacle 5 0 General Purpose ~ f.!I Switch 5 0 General Purpose f.!I ~ Dimmers I 0 ~ ~ Paddle Fan I 0 ~ ~ Receptacle 5 0 GFCI ~ ~ seal ~ I Continued on Next Page I of 2 I I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I lID.lID (!J.(!J I . BY THIS CERTIFICATE OF COMPLIANCE THE I ~ NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~ BUREAU OF ELECTRICITY ~ ~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~ ~ CERTIFIES THAT ~ ~ ~ ~ Upon the application of upon premises owned by ~ ~ ~ ~ CURTIS DWYER CURTIS DWYER ~ ~ 1014 CROWN CT 1014 CROWN CT ~ ~ MAHWAH, NJ 07430 MAHWAH, NJ 07430 ~ ~ ~ ~ Located at 720 MECHANIC ST SOUTHOLD, NY 11971 ~ ~ i ~ Application Number: 2098366 Certificate Number: 2098366 ~ ~ Section: Block: Lot: Building Permit: BDC: n511 ~ ~ ~ ~ Described as a Residential 0-599 square ft. occupancy, wherein the premises electrical system consisting of ~ ~ electrical devices and wiring, described below, located inion the premises at: ~ ~ First Floor, kitchen-2 baths, ~ ~ A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ~ ~ herein, was conducted in accordance with the requirements of the applicable code andlor standard ~ ~ promulgated by the State of New York, Department of State Code Enforcement and Administration, or other ~ ~ authority having jurisdiction, and found to be in compliance therewith on the 2tst Day of September, 2007. ~ ~ Name OTY Rate Ratin. Circuit ~ ~ ~ Defects previously reported, as items of non-compliance, have been corrected. A visual inspection made ofthe exposed electrical equipment in ~ ~ the premises indicated found no obvious unsatisfactory condition. ~ ~ ~ ~ ~ i i ~ ~ ~ ~ ~ ~ i ~ ~ ~ ~ ~ ~ ~ ~ s~ ~ ~ ~ ~ 2 of 2 ~ ~ ~ I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I (!J.(!J Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 Fax (631) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: '1. 10. 07' Building Permit No. ~(11~ Owner: e:::' v Po,o( I <; 0 wI" e.1l--- (Please print) Plumber: t:: ...a'n ':i r:;7y~e.fZ- (Please print) lead. I ceriify that the solder used in the water supply system contains less than 2/1 0 of 1% -~fu~ (Plu 'gnature) Sworn to before me this \1 day ofSe~~ 20 6\ ~~ CONSTANCE~ . Nolary PutIIIc s_ 0I*" YoI1l No. oiSZ8t-~ .. ~~AIlr'1"- Notary Public, ~,-m\L.... County 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 CERTIFICATE OF COMPLIANCE # 0261C Date October 3, 2007 THIS CERTIFIES that the conversion of a sun-porch into a kitchen At 720 Mechanic Sf.. Southold Suffolk County Tax Map # 61-4-11 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 10/25/05 pursuant to which Trustees Permit #6246 Dated 11116/05 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 the conversion of a sun-porch into a kitchen The certificate is issued to CURTIS & ANGELA DWYER owner of the aforesaid property. ~~hf Authorized Signature Board Of Southold .Town Trustees SOUTH OLD, NEW YORK PERMIT NO. ... ..~.~l+.~......... DATE: hN~:l.,.. ..!(j.,.....~g95 ISSUED TO h_h....<?'::!l:!!~...~~~~F;!:-A....~I.r.l..E.~............ ................................ ............. i\ut4nrtlutinu Pursuant to the provisions of Chapter 615 of the laws of the. State of New Y o~ 1893: and Chapter 404 of the laws of the . State of New Yorl: 1952: and the Southold Town OrdinanCe en- .tit!ed."REGULATINGAND .THE.PLAClNG. OF OBSTRUCOONS IN AND ON TOWN WATERS AND PUBUC lANDS and.the REMOVAL OF SAND, GRAVEL OR OTHER MATERIAl.S..FiDM LANDS UNDER TOWN W A TERS;t'. and in aCcorGan<:e witldhe Resolution of The Board adopted at a meeting held on tl",~.:_..~.?1.-'.... . 2..0.~S..~~ and in consideration of the sum of $...?:5.Q.,Q.Q....... paid by .. _........~.~t;.~.s.....~..A;>~!i'...P~.".r:. ............................................._..__...........c.......'.._h.' of ..............J~g"'.!J!gJ.<.L........................................... N' Y. and. subject to. the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the foHoWing: Wetland Permit to convert the existing sun-porch into a kitchen, with the condition drywells.& gutters are installed to contain t roof run-off. and a line of staked hay bales. is installed prior t. , construction a~d all as depicted on the survey prepared by aU in ac:cordance with the detailed specifications as presented in .the originating apptccation. Survey Solution". dated 9/17/05 a!1d amended by Michael Liegey on II/3D/OS. . IN WITNESS WHEREOf, The said Board of Trustees here- by causes its Coq>orat~ ~al to be a~xed, and these ~sents to be subscribed by a malority of the saId Board .as of this daf". . f~~ ~~ ~ ...~ Albert J. Kr~pski. Jr. 'IJ;~. ~ . Artie. Foster ~. .. ~ . Trusi<<s 3 ( 773-t:: TOWN OF SOUTH OLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONS'I1lUC'nON [ ] ROUGH PLBG. [ ] IN~TION [~NAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETMnoN REMARKS: M6~1 , DATE t;/3/o 7 / INSPECTOR )\//J,q: TOWN OF SOUTHOlD BUilDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PlBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/STRAPPING [~Al [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUC'nON [ ] FIRE RESISTANT PENETRAnON ~O ItlcasJ REMARKS: Il -R lA;J S P!.L{7 D DATE "' INSPECTOR ~ ;;(7/3 ~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION REMARKS: [ ] FOUNDATION 1 ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [ ~SULATION [ ] FRAMING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION ~~ 01::. DATE os-J~loh I I INSPECTOR ")1"t$~1{.p 3/77?~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [~UGH PLBG. [ ] FOUNDATION 2ND [] INSULATION [ ~RAMING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: !J.e, ~ ~.._~. 3" ///c ~A'll"-~ , ~ P,c. C/"~ 'i'-u ~ ~ t)~. /!.... vi? ;&.-G,~)..,.e.:. c-" U'&--c.-t?~ W-4.fi-A~ - - v " ~ ~ z/'t:? 6? ~ ,.0 ~ '<-.... DATE ~~ ,;LDOG INSPECTOR ~ ~?~? :5 J 7 7 3~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [~ F~ATION 1 ST [ [vrFOUNDATION 2ND [ [ ] FRAMING I STRAPPING [ [ ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION REMARKS: DATE yo I()~ I INSPECTO . . , FIELD INSPECTION REPORT DATE COMMENTS dn':,L. /. /_ + > ,,-If , / " FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRAMING & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL \') -. ... -...)t'l ..j~ lJJ::l "" JL. L./.. / - [~ ~~ \ / /1 ' ( ) t~ (;: ~.~~/ /~ t ~ /fJr-/~~ ~ . <<. t-V~ ~ . ~ .L I' , 4'_ .~.... L 7:?'./ L_ -.: ""- V S'...c.. ~ ~ L ;. '3"...~C~. .o(-H.. d~ 'l';;) L:! ~ /J U ~~MO ~ - t'l J?~ .- ~ '", . ~ . _' -- U/~ .., /. "'- - ./, ~ /.. 4 /? ~'r. ' I;; - ~ 7 } r ~~ 't"' t'l .., z .,P A Os7.t;a....kl~ ~ . /1_ ~'n 4l-a.- , . L..--d ~__.~ .~ ~---- ~, y J '7b.o. '(J7 ;vO /I~S,. 'l I / -fJ&..4S"I ()..// ~ ~\ ~. N. " ......... , ~/..7~? [/ I< ~JNSjh -' .I , .9 /') /' ./ A A ./ /" --' ~ /~a-.f. ~. 7 .9 }/~./ 7,/ ./ ". # -", ()/? //~ ~{L,./. // / V ADDITIONAL COMMENTS t;/ r , J~ ~ z ~~ :::t-- Lr' DQ~ , ... (j'--;i , :> O::l '0 ...JZ := Gt'l ~~ T := I:l t'l ." :-l ~ IIl1111D11115.... ....lIIII1..lUlI.111!11 11I_ 11: 5IIllT1-' t 11"_11I11( 11ft[ _. -.IIIIEI t __ USUI.... l;l ~ 1~ I I i II! SCALE 1 "=30' '" I III j III I GPS.NAV, '1./ 8M=6.64 MECHANIC STREET SOUTH 8 . . . .:.:. WATER ; ~ METCR , .;~ ... ,~ 8.7.'/Ji x 't' 2.5' .:J1.0......... ~.:29.J...... x9.1 ;:~'; siOii~:;,..1~:-:.:.::::.:.:~-: .c.., ~::.:~.:::::-::::"0:7?'?:..~:~~G,.: ~ ... . .....,..... ............ "i !')'" , :::: ......44.0.............. ~ ~.......... '~..... ....... ~ ~ 7.6x 1-?,0 ~. 'D 8.1x {;!:! C, ~ ,:t1 ~ - A A A . A a . . ~. ~ ~ t;j Q.: x7.6 MAP OF PROPERTY SITUATED AT TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK SURVEY PREPARED FOR MUNICIPAL PURPOSES. CLIENT: DWYER LA 'S (631) 858-1675 Fax 858-1676 TAX MAP DESIGNATION 1000-061-04-011 Survey Solutions, Inc. 46 Hunting Hill Drive Dlx Hills. NY 11746 DATf 9/17/2005 (C) COPYRIGHT J%O; 10373 . ~~ ;Ie. - "' N.Y.S. LlC. NO. 49857 l!i '" iil I ... iil i I I Ii I iii !II I i' I Ii I I I I I I Ii Bl I ill I . I II ill I III ... a ill i ! I ... iii I iI I1l I ... I i I .., kwtJ,' 1> ;ffl0u+ '? TOWN OF SOUTHOLD ~ o/..R -tb 1( de. BUlI:DINGDEPARTMEN~ .~"^ J ~~-,. C5 TOWN HALL ^-I~.ce ", U........... SOUTHOLD, NY 11971 doe-';. (lqJ ~ TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.net/Southold/ PERMIT NO. ,., lit- 0\'\ Do you have or need the following, before applying? C<" Board of Health /4 sets of Building Plans Planning Board approval '/Survey Check Septic Form N.Y.S.D.E.C. ./ Trustees Cont t: Mail to: BUILDING PERMIT APPLICATION CHECKLIST Examined Approved Disapproved ale ,20_ ,20_ Expiration ,20_ ( / .,~"J r: I l' .' r~ '1~ ,". ! \ . / . . APPLICATION FOR BUILDING PER1\<{lT ". ( J.--, (.' \~. r I I I ~ ," i Date., .. I INSTRUCTIONS Lir.Tlrts apj5licat1NrM~j~ompletely filled m by typewnter or in mk 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 remeVal or demolition as herein described. The applicant agrees to comy.!x.w~~ all applicable laws, ordinances, building code, housing code, regulations, a~t authorized .insPectors o'i"pretJIises and in building for necessary inspections. .....' - ..., '\', ( \ 0_- ,'-(:' \-" \ ',I, \~;,. t"'., -, \ ,', .', " ~ ..~' 1 -, \', , ~', \ . \~ ' . Jfl-~ - A ol,o \...,- \ ,!', \ _r r . "2-.-- -~.----J ~...,/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder corporation) PO f>o'l. \O'-tlo S()LA~Dld "H lID) (Mailing address of applicant) {;f/leYQ} (lon-!rCAC .fvtz lld-hS, -I- Name of owner of premises ~e\v.. '1w~.eR (A on the tax rol or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. d 9 S f/O - N Plumbers License No. Electricians License No. Other Trade's License No. 1. Location ofland on which proposed work will be done: id-..O (\\e~\rY^('\.\c Ske e..-\- House Number Street ~\.i\. --\~\d Hamlet )i"'/ " ;~1 County Tax Map NO.1 000 Section Subdivision (0 \ Block y Filed Map No. Lot Lot \\ ~ .:) (Name) . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ('-('S\ Jef\~ 0... \ h-,N'\" b. Intended use and occupancy res i Je(yt'l'A \ hClYY\R 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost # 75. oCfJ, ./ I Addition Other Work Alteration X (Description) Fee 5. If dwelling, number of dwelling units < If garage, number of cars I / (To be paid on filing this application) Number of dwelling units on each floor Rear loCJ. I !J{) ~~( 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of}'xisting structures, if any: Front (00. Height I ~ Number of Stories / Dimensions ott>~e structure with alterations or~dditions: Front 60 Depth d:...d= Height /L Number of Stories , , Depth Rear 37---- 8. Dimensions of entire new construction: Front /6, ~ Height Number of Stories Rear fb.4> Depth /@ 10. Date of Purchase / ID .()[)' ;1 aID I Rear Depth /3 9. 7 f.p I Name of Former Owner ('~hn',<;~' V"ICA- ttf'.<0,e\ ~~. 95.(){J I 9. Size oflot: Front 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NoL 13. Will lot be re-graded? YES_NO.Kwill excess fill be removed from premises? YES_NO_ 14. N~llles of Owner of premises Address Name of Architect Address Name of Contractor Pr>ml\iC_ {~lj;\ di~qSo\lA~Address pD Rl\~ 10410 \.J Sou. kO \.1, 1\J'f 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO _ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES_NO_ * IF YES, D.E.e. PERMITS MAYBE REQUIRED. Phone No. Phone No Phone No. (o?k 7'-"S - f...o / Ie:; 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: COUNTYOF~ being duly sworn, deposes and says that (s)he is the applicant co tract) above named, ('O{\"trClC :kv (Contractor, Agent, Corporate Officer, etc.) (S)He is the 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. ~ 20~ ~~ /...~.-- L.>." ' ......- ;;/' ignatu pplicant HEGI STnAfl or VlTN. STATlSllCS MAnruAGF. oFrtCEn rtEcon.lJS M.J\NACEMENT OVPICl::ll FrtEEOOM OF INFOflMATION OFrlcErt , , 3l,13 ~ , ,....... . . . ,I ,j";" .' , . 'JUP'lTH T. TERRY e tOWN CLERK fllwn Ibll. 5)0'15 M,n" r.o. nil, 117'1 Snulholtl. New.Yurt.. . Fox IS 11" 7/)~'IR" T t:lcplH1nc t.'\ I (q 7(1,"': 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 2Q, 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 .J 0; the Code of the Town of Southold: f'pplication" [FDP(93)]. and /Certificate Special Flood Hazard A,'ea le/C(93)]. "Floodplain Development Pe rmi l i i of Compliance ?fr Develc!pmen t in . ! / :O\l5: I,G; !;~. I~i C 6i...:Ju. oc:rr TOW;j OF SOVT110LD -l l ; i~1 ,. ~. ~~ ~T.T~ Southold Town Clerk August 25. 1993 1-- ...., " '\ J~.. . " APPLICATION II rNjE I of 4 TOWN OF SOUTHOLO fLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be ailed our in duplicate, ~ , SECTION 1: GENERAL PROVlSIONS (APPLICANT 10 read and ,i",,); 1. No work way ,(art until a permit is issued. . 2. The permit way be revoked if any false stalewenl.l are made herein. 3. II revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certilie>le of Compliance is issued. 5. The permit will expire if DO work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fuJnIJ local, stale and lederal regulatory requiremenl.l. 7. AppUcanl hereby gives consent to the i.oCll Administrator or his/her representative to make reasonable . inspections required to verify compliance. . 8. 1, THE APPLICANT, CERTIFY TIlA T i}!..L STATEMENTS HEREIN AND IN A TTACHMEJ'ITS TO _ THIS APPLICATION ARE, TO TIllE BEST ~KNO D.QE, ~UEDANDA'T' EACCUrTf.:~ (APPLICANT'S SIGNATURE ~ ~ r2/..%f!212 . / / //SECTION 2: PROPOSED DEYELOer-hENT rrc/Se comDIc'ed bv APPLlCAnn NAME ADDRESS APPLICANT tJ/A-- -:J0l0. I-< ~ BUILDER ~ A7 JI, r :eL~ 'Oc..-" , ENGINEER TELEPHONE J/A.<;L d /~- .1<'>1( /W6&dtJt ~-6'IIS PROJECT LOCATIOt!: To .void delay io p=ing the .ppUcation, plcase provide eDough informalion 10 C3.Sily identify tbe projeel location Provide the street address, lot number or legal description (attach) and, otll.llde urban areas, lbe distaocc to the nearest intc.rscctlng road or \VCU-loOWTI lii:idmark. A 5~ctch an ached to lhi.s appLicalion sbowing the project location would be belpfuL /C)O rbi e--~~ I ~<- SOL- .$'I M- y~ ~- ----~._------------------ FDP(9J) .' . \'1' ;'1. ::". .' '- A1'PLlCA TION # PAGE10Fd DESCRIPTION OF WORK (Ched all applicable boxes): A <;TRUCTURAL DEVELOPMENT ACTJVITY STRUCTURE TYPE o New Structure ii'!-AdditioD o Alteration o RelocatioD o Dem<iUtioD' o ReplaccmeDI ~esideDtiaJ (1-4 Family) o Residential (More than 4 F>miJy) o Non-resideDual (Floodpraonng? 0 Yes) o Combined Use (Residential & CommercW) p. 0 Manufactured (Mobile) Home (In Manu- [actured Home Park? 0 Yes) ESTIMATED COST OF PROJECT S f->;I:DO. --- B. OTHER DEVELOPMENT ACTIVITIES: I , , / / o Fill 0 Mining 0 Drilling IlI-.Grading -e-Excavatioo (Except for Structural DevelopmeDt Checked Above) o Watercourse Alteration (IDdudiDg Drodging aDd Channel Modifications) o Drainage ImprovemeDLs (lDduding Culvert Work) o Ro.;i, Street or Bridge ConstructioD o SufuvisioD (New or Exp.nsioD) o ~dual Waler or Sewer System o Other (Please Specify) . NIL-r completing SECTION 2, APPUCAl'-IT shouJd subrnil form to Local Adrninisu-a[or for review. - SEcrlON 3; FLOODPLAIN DETERMINhTION (fo be camolcted bv LOCAL ADMINTSTRATOR) The proposed development i5 located 00 FIRM Panel No. Dated The Proposed DevclopmeDt: o Is l!IQI located in . Special Flood HaLafd Area (Notify the applicant that the application review is complete and NO FLOODPIJ..lN DEVELOPMENT PERMIT IS REQUIRED). o Is loated iD a Sped.1 Flood H aurd Area, FTRM LOne designation Ls 100- Year nood elevation at the sile l.<: Fl. NOVO (MSL) o UoavalJablc o The proposed development is loc<l(cd 10 a flood way FB FM Panel No. DaLed OSee SUllon ~ (or ,liirlitional "InslrlJClions SIGNED DATE C.,. ',' ,I. ;t ... , . Al'PLlCA TION >'I PAGE) OF 4 SECTION 4: ADDITIONAL INFORMATION REOUIRED (To he comnlcted bv LOCAL ADMINISTI\^TOR) The app~GlDt must submit the documents checked below before tbe app~cauon GlD be processed: o A site plan sbowing tbe loca(ioo of aJl cxisllng struclUfcs, watL.-r bodies, adj~ceDt roads, lot dimeosioD.5 and proposed devdoprnCDl. o Developm ent plans, drawn 10 scalc, and specifical40ns, includin~ wbere applicable; details (or :LJ]cborin~ struclures, proposed c1evation or lowesl Onor (including basement), lypes o( waler resistant matcrials used below tbe rust noor. details of Ooodproorwg of uLilities located below the firS! Ooor and details or enclosures below tbe firS! Ooor. Also, o Subdivision or otber development plans (If the subdivision or otber development exceeds 50 lots or 5 acres, whichever is tbe lesser, the appUGlDl must provide lOO-year fiood elevations if they are Dot otherwise available). o PI"1IS sbowing tbe extent of watercourse relocalioD and/or landform alterations. o Top oC DeW nIl elevation Ft. NGVO (MSL). o FloodprooCmg prolection level (non.residential only) fl.' NOVO (MSL). For OoodprooCed structures, ;,ppUcan! must attacb certificalion Crom r~gistered engineer or hi /' ~ arc lcet.! ,/. o Certification [rom a"r;g:i.stcred engineer tbat the proposed acti0.l iD a regulatory fioodway will not result La ill increase in the height of the loo-year flood. A copy of all data and G1.Jctda{ions supporting this rlDding must aJso be submitted. o Other: SECTION 5: PERMIT DETERMINATION ITo be completed bv LO...:AL ADMINISTRATOR) I hive detennined tb.t tbe proposed activity; A. 0 Is B.O Is nol in conformance with provisions of Local Law rf , 19 The permit is issued subject 10 tbe cooditlons attached (0 and made part of tbll ~rmiL - SIGNED . DATE If BOX A is checKcd, Ibc LDuJ Administrator may issue a Development Pcrmit upoo payrneol nC designaled fce. Ir ~OX B is checked, tbe Local Admirustralor 'Nill provide it wril(eo summa.ry or dcncicncics. Applica.nl may reVIse and fr.subrnil all application 10 the LDcal Adminislrator or may request a bear Lng (rom lbc Board or Appc,h " n . " " APPLICATION ~ PAGE40F4 APPEALS: Appealed to Baud of Appeals' 0 Yel 0 No Hearing date: Appeals BUiild D(..\.~;vu --- AppIVYl..d? 0 Ycs 0 ~IEl Conditions SECTION 6: AS.DUILT ELEVATIONS fTo be submilled bv APPLICANT before Ccrtiflcale of ComDlianee is issued) The foUowiog informatioD must be provided ror project slructwes.. Tllls section must be completed ~y a registered profcssioDal eDgineer or a lieeosed lood surveyor (or auoch a certification to this application). Complete 1 or 2 below. 1. Actual (N-Buill) Elevation of the top of ihe lowest Door, including basement On Coastal Hil!:h Hazard Areas. bottom of lowest structural member of tbe lowest Ooor, excluding piling and columns) is: Fr. NOVO (MSL). . L ' " Actual (N.Bu~t) Elevation of OoodprooflDg protectio. is Fr, NOVO (MSL). ! . ' ' .. NOj: Any work performed prior to SUbmillal/,bf the above information is at tbe risi,;r the AP~;:::aol. , ' .~. /" SECTION 7: COMPUA1'lCE AcnON (fo be comolctcd bv LOCAL ADMINISTRATOR) The LOCAL A.DfrflNISTRATOR will complete this section as applicable based 00 inspection of We project (0 ensure compliance \ViLh the community's local law for flood damage prevention. INSPt::cnONS: DATE DATE DATE DEFlCfENOES? 0 YES 0 NO DEFlCIENCfES? 0 YES 0 NO DEFlClENOES' 0 YES 0 NO BY BY BY SECTION 8: CERTIFICATE OF COMPLlANCE(fo be eomnleled bv LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: , " '" " . " " Attachment B / j ; 8A.HPiLE CERTI7'):CATEjJF COMPLIANCE fbr Development in a special Flood Hazard Are~ '. '. t... II t, ( c". if 11'.,' , . ., .. " . > . TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE Fan DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MTlST REn TN TI-TTS rERTlFICATE) PREMISES LOCATED AT: OWNERS NAME AND ADDRESS: / / J / j PERMIT NO, PERMIT DATE CHECK ONE: o NEW BUILDING o EXISTING' BUILDING o VACANT LAND THE: LOCAL ADMINISTRATOR IS TO COMPLETE A, OR B. BELOW: A, COMl'LlAl'iCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # .19 SIGNED: - - DATED: B COMPLlAl'iCE IS HEREBY CERTIFIED WITH TIlE REQUIREMENTS OF LOCAL LAW # ,19_. AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: C / C 193)