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Home My WebLink About31299-z '.1 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY liIo: Z-32753 Date: 11/27/07 THIS CERTIFIES that the building NEW DWELLING Location of Property: 4583 (HOUSE NO.) COUnty Tax Map liIo. 473889 Section 107 WICKHAM AVE (STREET) Block ~ MATTITUCK (HAMLET) Lot 6 SUbdivision Filed Map liIo. Lot liIo. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 24, 2005 pursuant to which Building Permit liIo. 31299-Z dated JULY 21, 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 SINGLE FAMILY DWELLING WITH ATTACHED GARAGE, COVERED FRONT PORCH & REAR DECK AS APPLIED FOR. The certificate is issued to IVAN TCHEBOTAREV SUPP.NEEDS TRUST (OWNER) of the aforesaid building. SlJFI'OLK COUIIITY DEPARTMENT OF HEALTH APPROVAL R10-04-0198 11/23/07 10/06/06 ELECl'RICAL CERTIFICATE RO. 2085552 PLUMBERS CERTIFICATIOliI DATED 01/19/07 JOHN C. RYCKMAN 4uzd1:!!:::- Rev. 1/81 - .......;;--lCJ ffi n w ~ ill r ~"-..._. n J. 'I !(~~~ t'~ U \ beO,.DEP,. ...--!t"";'tLQf5"UTHOcO GIG 5 ~ \ ~ 3 0 u~ uU ---.. APPLICATION FOR CERTIFICATE OF OCCUPANCY +B ,;) (,8; - ~C) l Y 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: 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, Commercial $15.00 / 1J5'g3 House No. Owner or Owners of Property: r\JClI'\ Date. t? g .( (1. 1!7 7 New Construction: Location of Property: Old or Pre-existing Building: t1Ir ckh a Yl1 JJv-f( Suffolk County Tax Map No 1000, Section fi1ebofav~v )07 (check one) fJ!I; U :fuc/<- Street Hamlet ~~rnelt1-bJ1 tJ~J.) ~U-t Block if Lot 6' Subdivision Date of Permit. 7/'7-1/0 > I t Filed Map. Applicant: Lot: Permit No. 312 q q Health Dept. Approval: Planning Board Approval: Underwriters Approval: Request for: Temporary Certificate Final CertIficate: (check one Fee Submitted: $ Applicant Signat ~.13>'i1.ji. ['('l-C~dI53 Ii 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) 21, 2005 PERMIT NO. 31299 Z Date JULY Permission is hereby granted to: C MESIANO FOR TUTHILL 12 MILL POND LANE E MORICHES,NY 11940 for : CONSTRUCTION OF A NEW SINGLE FAMILY DWELLING WITH ATTACHED GARAGE COVERED FRONT PORCH & REAR DECK AS APPLIED FOR at premises located at 4583 WICKHAM AVE MATTI TUCK County Tax Map No. 473889 Section 107 Block 0004 Lot No. 006 pursuant to application dated JUNE 24, 2005 and approved by the Building Inspector to expire on JANUARY 21, 2007. Fee $ 1,233.30 t~.;....~~ / Authorized Signature ORIGINAL Rev. 5/8/02 . ....... l!I.l!I ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I Located at ~ Application Number: I Section: ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I l!I. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~l!I BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT I{)?_ -~ ~(. Upon the appl ication of upon premises owned by LAGUN ELECTRIC 724 POLASKI STREET RIVERHEAD, NY 11901 IVAN TCHEBOTAREV 1675 CEDAR BEACH RD SOUTH OLD, NY 11971 4583 WICKHAM AVE MATTITUCK, NY 11952 2085552 Certificate Number: 2085552 Block: BDC: ns11 Building Permit: 31~q Described as a Residential 1800-2399 square ft. occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Lot: -- Basement, First Floor, Second Floor, new residence, Attached Garage, Outside, Attic, 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 6th Day of October, 2006. Name OTY Rate Rating Circuit ~ Alarm and Emergency Equipment Sensor Sensor Appliances and Accessories Dish Washer Exhaust Fan Air Conditioner Furnace 2 0 7 0 Carbon Monoxide Smoke 1.2 I 0 I 0 2 0 I 0 I 0 KW F,H,P. Amps Oil H.P. 40 Pump Motor Wiring and Devices Outlet Fixture Outlet Receptacle Switch Receptacle Receptacle Receptacle 67 0 67 0 73 0 39 0 47 0 I 0 I 0 I 0 Fixture Incandescent General Purpose General Purpose General Purpose Laundry Dryer Range 20 amp 30 amp 50 amp seal Continued on Next Page 1 of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indic~\ed. ~~~I!I ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I ~ I I ~ ~ ~ ~ ~ I ~ I ~ I ~ ,-"'" I!I~~~ ~ ~ ~ I I ~ ~ ~ I ~ ~ ~ I Located at ~ Application Number: I Section: ~ ~ ~ I I I ~ ~ ~ ~ I I I I I I ~ ~ I ~ I ~ ~ I BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by LAGUN ELECTRIC 724 POLASKI STREET RIVERHEAD, NY 11901 IVAN TCHEBOTAREV 1675 CEDAR BEACH RD SOUTHOLD, NY 11971 4583 WICKHAM AVE MA TTITUCK, NY 11952 2085552 Certificate Number: 2085552 Block: Lot: Building Permit: BDC: ns11 Described as a Residential 1800-2399 square ft. occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, Second Floor, new residence, Attached Garage, Outside, Attic, 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 6th Day of October, 2006. Name OTY Rate Rating Circuit ~ Disconnect 2 0 60 amp Air Conditioner Receptacle 10 0 GFCl Service 1 Phase 3W Service Rating 200 Amperes Service Disconnect: Meters: I 200 cb seal 2 of 2 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!I~ I tr<> ~i! ~~ ~ ;t~ R::J a# "..l....... ,j1llJ8 ::i,@"J..... Ii?~'" ............ :-rW'" ...... "J,.. / ' ~f:i'~ ::J",~ / V '" ,. ~ ~,:? ~" ,.. Ii) E ~ ~ U).t~ ~ ~~]Q =- "0 2::~ JI'.1fl '\""'- 02 CO.l::'; Q. Xl a ~ 8?: ___00:::( . C5 - - 8..a ~ ""iE- ~ ,gO :::J C/) SUbd' IVis' S IOn Mop .. uffolk Co WOlf Pit un ty fit Pond [ i'.I no.. Or fo e no. 896Jstotes" Olf Pit A rrnerly SSOCio t Lot 12 es - - ......<'5..3:9. ", .- now Or f, Eloine e orrnerly enedict --- --- ~ , , , , - - " " " " " " ", " " " '0> '1'1' , , , 0, ::i I I I I I I I I 'A -1 ~ <D. <b. l" , , , , , ~~ " o '6 ~ 'Z- '" ~ ~ 'a> o. U'l <- "" ., g..~~ ~., (\) ~9.. ("' 0'''1\0' o .....0"'\ ,-r ~';::i3 ~ ';::iJ) l!.. ..ol!..- l!..9--""" 00- 0."" --- - - / / <( \ \ U' \ (1). 'l.iA ~ o. . \~~ ~ 'i?- \ ~ \ \ \ \ \ \ \ \ \ Survey for: \ IVAN TCHEBOTAREV \ SUPPLEMENTAL \ NEEDS TRUST At \ Mattituck \ Town of \ SouthoLd ~ Suffolk County, New York '" S.C.T.M.: 1000-107.00-04.00-006.000 \ \ \ \ .4J o .0 . It) ~ ~ ,,'" ~ --- -- fi- ~.. ............- -- o ~ .< ," 0----- ....---- - s' \ \ \ ''!JrJ~ S6"'!J~ ~~.(~ vr;!, 'I) eM ( \0(0' \\\ J(' 0'" C:" -,\\..\'0 (\ 'I" ~oW'0 U~~~ ~ q l1' 'if, \ '0 - '~~ "/.. TIte st~-ap9 C1C.pof...::1 i!;od W;-;i:.U ;_: _\~;'/ :,~_C':;>'.:) '~. ;::' j~'....c;:':'~r: r,;'!~ M~n \ \ ".I'~. lrlSf.'i\",(,,~.:xi c~AGk:r ~~:,fif -; . ,-. '".::';' )lX;;"lJ ~l \~ '6. be sau..rectc'J ;'(x.~;' ";,.i' " ...~._ c.' '".~.' ,c>. "<'b ce,~ t:t/~ l:~_.,_' ~ ',<,"'.~ " . ~ Watt!);, j ~T<~';--;:,--:r--~ 'i'~.""'?~~~::?f-- ~ OIfilCe 0', 1M,;ot.~.:,::.',.,.: ::'~"":.' ,;".". tw...""._"",...-. "'.,,,,, _:_.' l;-.J.,l --.--.-------- ___.__._....._m..-._._ _____.._ __~,,_~_ \ \~ \ -". \'2, \~ mnTOlKCOUNTYDEPARnAE~rOFHcf~THSER~CES APPROV/'J. OF CO~<:TR'J(:T'D WGHKS FOR . SI~'l(':I'- ",'. ',:"" '-''''~~'.'''-'' ,...- NOV f","~ "'.':'-.ut: !"'~"__j'H~'l Kr./:.,Wl:.:.IIJ\,.,t.; Date. 2 ,) ?nnl M..:;. ':;:;If. No. .lil.c, - 0 '1 ~ 0 I q 8 JUN 9, 2007 JAN. 1 B, 2006 AUG, 9, 2005 JULY lB, 2005 02, 2005 FEB. 14, 2005 DEC. 10, 2004 OATE: NOV. 17, 2004 JOB NO: 2004-762 FINAL SURVU UNDERCONSTRUCTlON SURVEY ADDED CERllFlCA liON RE\o1SED LOC", liON Of HOUSE STK. FOR DEe DEe AMENDMENTS BUILDING PERMIT \ \ CERTIFIED TO: IVAN TCHEBOTAREV SUPPLEMENTAL NEEOS TRUST COMMONWEAL TH LAND TITLE INSURANCE COMPANY 40 1 o I I SCALE: 1"=40' 40 I \ \"! \ ~<l' \ t". \ \ NOTES, 1. AREA 43,241 S.F. AOJACENT AREA = 11,075 S.F. 2. . = MONUMENT FOUNO, 0 = PIPE FOUNO, 3. REFERENCE DEED L. 7046 P. 1 BB. 4. THIS PARCEL IS WITHIN THE AE FIRM ZONE (EL 11) AS SHOWN ON FIRM BOUNOARY MAP PANEL NO. 36103C0143 G LAST DATED MAY 04, 199B. DAVID H. FOX, L.S. P,C. N. Y.S.L.S. '50234 FOX LAND SURVEYING 64 SUNSET AVENUE WESTHAMPTON BEACH, N.Y. 1197B (631) 2BB-0022 'JE,NUE 'MCK\-\AM ,., UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VlOLAll0N OFSECTION 7209 OF TI-lE NEW YORK STATE EDUCATION LAW. COPIES OF" THIS SURVEY MAP NOT BEARING ~E LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A "AUD TRUE COPY, CERTIFICAllON INDICATED HEREON SHALL RUN ONLY TO mE PERSON F"OR WHOM ~E SURVEY IS PREPARED AND ON HIS BEHALF TO mE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF Tl-lE LENDING INSTITUTION. CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTlruTIONS OR SUBSEQUENT OWNERS. OWG: 2004- 762 I - I I ,I 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: 1/11/07 , , Building Permit No. ?I 2- '9 '7 Owner: IC/j~BOTf.)Re~ (Please print) Plumber: :TtJ1 It I'- ~ JCY?'/::","4~ (Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. }1 Sworn to before me this J q day of \Jf:);J , 20 0 ? ~~p~ ~ Cl- ~A~- __ c:7 (Plurrfi ersSignature) Notary Public, ~ uff-DfV-county ":,f&~~ ComrnlSsion~JulynJ.Q ------' - Albert J, Krupski, President J ames King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P,O, Box 1179 Southold, New York 11971-0959 ,', Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 2, 2004 Ms, Catherine A Mesiano Catherine Mesiano, lnc, 12 Mill Pond Lane East Moriches, NY 11940 RE: IVAN TCHEBOTAREV SUPPLEMENTAL NEEDS TRUST 4583 WICKHAM AVE., MATTITUCK SCTM#1 07 -4~ t.. Dear Ms, Mesiano: The Southold Town Board of Trustees reviewed the survey prepared by David H, Fox dated November 17, 2004 and determined the proposed single-family dwelling to be out of the Wetland jurisdiction under Chapter 97 of the Town Wetland Code and Chapter 37 of the Town Code, Therefore, in accordance with the current Tidal Wetlands Code (Chapter 97) and the Coastal Erosion Hazard Area (Chapter 37) no permit is required, Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm, However, any activity within 100' of a Wetland line or seaward of the Coastal Erosion Hazard Area would require permits from this office, NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER 1-4738-03445/00001 FACILITY/PROGRAM NUMBER(S) e - PERMIT EFFECTIVE DATE June 3, 2005 EXPIRATION DATE(S) Under the Environmental Conservation Law June 2, 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, Title 9; 6NYCRR 373 Hazardous Waste Management o Article 15, Title 15: Water Supply o Article 19: Air Pollution Control o Article 15, Title 15: Water Transport o Article 23, Title 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 Certifica- o Article 27, Title 7; 6NYCRR 360: tlon Solid Waste Manaaement PERMIT ISSUED TO TELEPHONE NUMBER Ivan Tchebotarev Suoolemental Needs Trust (631 \844-1 029 ADDRESS OF PERMITTEE 275 Broadhollow Road, Melville, NY 11747 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Catherine Mesiano, Inc" 12 Mill Pond Lane, East Moriches, NY 11940 (631 \878-8951 NAME AND ADDRESS OF PROJECT/FACILITY Ivan Tchebotarev Suoolemental Needs Trust ProperlJ, 4583 Wickham Avenue, Mattituck, NY 11952 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Lona Creek E: 707.2 N:4541.9 DESCRIPTION OF AUTHORIZED ACTIVITY Construct single family dwelling and associated accessory structures. All work is to be done in accordance with the attached plans stamped NYSDEC approved on June 1, 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 4 & 5) and any Special Conditions (see'page 2 & 3) included as part of this permit PERMIT ADMINISTRATOR: (KAF) Mark Carrara. De ut Permit Administrator ADDRESS Region 1 Headquarters Bid. #40, SUNY, Ston Brook, NY 11790-2356 AUTHORIZED SIGNATURE ~/L DATE 06/03/2005 Page 1 of 5. NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas. 2. Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. 3. There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activity. 4. All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion or prior to permit expiration, whichever comes first. The approved methodol- ogies are as follows: a. stabilization of the disturbed area with appropriate vegetation (grasses, etc.). 5. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than 100 linear feet from the tidal wetland boundary. 6. All disturbed areas where soil will be temporarily exposed or stockpiled for longer than one (1) week shall be contained by a continuous line of staked hay bales/silt curtain (or other NYSDEC approved method) placed on the seaward side between the fill and wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 7. If seeding is impracticable due to the time of year, a temporary mulch must be applied and final seeding performed at the earliest opportunity when weather conditions favor germination and growth, but not more than six months after project completion. DEe PERMIT NUMBER 1-4738-03445/00001 Page 2 of 5 4' NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 8. All fill shall consist of "clean" sand, gravel, or soil (not asphalt, flyash, broken concrete or demolition debris). 9. Necessary erosion control measures i.e., haybales, silt fencing, etc. are to be placed on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good condition until thick vegetative cover is established. 10. Roof runoff shall be directed to drywells a minimum of 100 feet landward of the tidal wetland boundary for immediate on-site recharge. 11. Driveways and parking areas shall be constructed of pervious material. 12. Sanitary system (bottom of tank and leaching pools) shall be located a minimum of 2' above seasonal high groundwater. 13. The permittee shall incorporate the attached Covenant (or similar language) to the deed for the property where the project will be conducted and file it with the Clerk of Suffolk County within 30 days of the effective date of this permit. This deed covenant shall run with the land into perpetuity. A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be submitted within 90 days of the effective date of this permit to: NYSDEC, Marine Habitat Protection Unit, SUNY Bldg. #40, Stony Brook, NY 11790- 2356. DEe PERMIT NUMBER 1-4738-03445/00001 Page 3 of 5 I' NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, Its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent acts Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, Including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee IS responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others In order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility, including relevant records, is-subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECl 71-0301 and SAPA 401 (3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for Inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, Issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained In such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. SubmiSSion of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg #40, Stony Brook NY 11790-2356 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification, suspension or revocation include: a) materially false or Inaccurate statements in the permit application or supporting papers: b) failure by the permittee to comply With any terms or conditions of the permit; c) exceeding the scope of the project as described in the permit application; d) newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e) noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental Conservation law or regulations of the Department related to the permitted activity. DEe PERMIT NUMBER 1-4738-03445/00001 Page 4 of 5 ~ NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION . ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 (TIDAL WETLANDS) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or fiood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. -2. The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 3. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 4. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across or along the bed of a waterway or fioodplain, deposits within any regulatory fioodway, or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 5. There shall be no unreasonable interference with navigation by the work herein authorized. 6. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 7. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302,303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. 8. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 9. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by Fox Land Survevina on November 17. 2004 last revised March 2, 2005. DEe PERMIT NUMBER 1-4738-03445/00001 Page 5 of 5 ,> , S' .. ',s , ? , , y-- ~\J€.~ut.. O--\~ . 1 ~I I n-2..4 I >I- I CESSPOOL Survey for: IVAN TCHEBOTAREV SUPPLEMENTAL NEEDS TRUST At Mattituck Town of Southold Suffolk County, New York S.C.T.M.: 1000-107.00-04.00-006.000 ~ " l~~~:_- c "--"i=::3~~-:='"-=~.J;~:-,~-;:'-";':';'-' SCALE: 1"=40' NOlES: 1. AREA = 43,241 S.F. ADJACENT AREA = 11,075 S.F. 2. . = MONUMENT FOUND, 0 = PIPE FOUND. 3. REFERENCE DEED L 7046 P. 188. 4. ELEVATIONS SHOWN HEREON ARE REFERENCED TO N.G.V. DATUM. 5. ZONING USE DISTRICT = R-40 6. THIS PARCEL IS WITHIN THE AE FIRM ZONE (EL 11) AS SHOWN ON FIRM BOUNDARY MAP PANEL NO. 36103C0143 G LAST DATED MAY 04, 1998. 7. APPROX. 35 CU. YDS. OF FILL REQUIRED. 00.= FT_13.0 ~.,. : 1:_.: ._to 1l_1I~ SUSONAl. .- GROUND WA 1ER SEPlIC TANK '200 GAL ~ \' I' Ii.' \.. .. ;. I '. -. I' \ : ~ 'l! H ',~ :; ,:--';:1 ,', '._; 'i I I, :<:" 4. I! '" "" I "\'\~'::\l:&-Q~'-lsl c<..ur\ 1"" "\~\D.0 .{.N=:.- Frrt. ~ 4, 2005 CEC ....,,[l<.:lW(NT'"":; DEC. 10. 2004 8JllJ)ING Pf'RtolIT DATE: NOV. 17. 2004 JOB NO: 2004- 762 CERTIFIED TO: IVAN TCHEBOTAREV SUPPLEMENTAl NEEDS TRUSI ~... ."., ...... "/ . -'. ",> DAVID H. FOX. L5. P.C. N.Y.S.LS. 11'50234 FOX LAND SURVEYING 64 SUNSET AVENUE WESTHAMPTON BEAD-l. N.Y. 11978 (631) 288-0022 UN"'_JH-C)';"'l.C; "~'l"''''- _'. 'i ...::.-::. - ..... ~:-, '"-'<; Sl.'''-''!.' IS A \IIC,."'l1:><, ,""l"SlCT.:-. ~:, --c' ,,;:... ,;::"". :'&Tl [DUe-All:)'. l A"" ',(,;',l . - ."t. ........ '.:11 ~''''-INc. rnl ,,,,.:. ""J".' ,~'" .; _ _ <,,:._ >" (..._",O';:S'::i::' $. ok, '>H"LI " :,' e, ~ ">'." -:r'- -: ~- ~ ,L,- ", f<- .:r ('" Cff'T;f'CAllO" ".J..~~F:. _,~"":" <;'-"__ ..-'N O',,~ r"l P(P~O" CO" ......0... n.,l ",,_'= ,<<;:. ~ >='"-O:P"."I[c ......C! .~, ...,'" :~~,:~f~~~ON,C';;;;:;. '~~: ~~~.~:7.:~:=- ~~~J?~:~t~~:..~G~::.~~~r<-f( "I'll N01 n<"N~-[,,"'B,[ -:: .::'J'" :J'_"'-- ,"'ST"y'1"I::JN':: l".. "",:\ OR SV8SLQV[N1 O_[R'O ~'\ DWG: IDD4- 762 : , '0 I ~'--- --...' ----.. ~ ---- '- ---..::---- " --::-- , , , , , , , , , , , , , , , , \.- .....~~.~:e.T , LOT COVERAGE: HOUSE &< PORCH 1774/43241 = 4.1~ ADJACENT LOT COVERAGE TEST HOLE DATA YcOONALD ctOSOENCE DEC. 03, 2004 El-9.5 DARK BRO\tIN SANDY lOAM . BRO'M'l SILTY SAND PAU: BRO"",, I ANE TO - ';.0 I ~J", , , / '\ \ \ L 'b ~ 1774 S.F. O.O~ 0.0 1.0 2.5 ~ , \ ~ ~ ~ . ,(. . /I', , I' /~. (09 /:;5 / / / ;' / , / ;' / / t\,)'tl.\ '>6 1 >-< .{j..... / I /A ---__.....y, ;1 II -'-l, .... /. / \-_'...."'~/ ,,0 / \;' \ \ / V ( ., \\ 'C\ 1<_ -/r~\~vCo V\ ~__/ \ J9J~' I ",./ ,0 I -'I 1 ~/ _....- \ c)i I .../ /' 0 P 1\ t ~ f~~~( / \ ~ ../' ~ / ).'; ~". '0 \ 1 1,/- / /' -----/ >;::+\ - <l- j.-I I.' . . '-' "".J.,.!1J-1 c' )/i I ( A!.c' h<.;- I \ 1'({.'7......<;;l,f. 9\ . , ; C'Y--<S.o.I. 1'\ ..> '-\~; 1<.::-:...... V .......' - / ~~'" / / /.~....~~ / .~ / ~=Q/ ~~O ""/ /\ C;J:S~ / , , oc. .. \cb _.X \ \ \ \ -\-- \ \ - - --<19.,,--:. .4., O. . ,0 Cb , I~ <rj . ,,1 <ry- .'v "- ~ ~. ~ \ \ \ \ \ % '0. ~ 1- .. \ \ , , - , - '" "'r. 0 lor. ~/..... .':<.1. J.sqo' ..... \ , , '\ I \ tt \ U'. \~'b. \"0 'b~ \ O. ~ I \ ~ To: Town of Southold Re: +, JAMESJ. DEERKOSKI, P.E. 260 Deer Drive MaUituck, N.Y. 11952 (631) 298-5506 First & Second Foundation Inspections Ivan Tchebotarev 4583 Wickham Avc. Mattituck, NY 11952 Pennit# 31299 To Whom It May Concem: 2005 "oj Tills lctter certifies that first & second foundation inspections were prefonned on the above mcntioned property and was all done correctly and mcct all state and local building codes. Any questions plcasc feci free to call. i\ " \ \ Jamesj. . ," \ \ J\J~\A' ; \ ~' - Date: ,----' June 14, 2006 To: Town of Southold Re: Insulation Inspection Ivan Tchebotrrev 4583 Wickham Ave Mattituck, NY 11952 Permit# 31299 To Whom It May Concern: I' JAMES]. DEERKOSKI, P.E. 260 Deer Drive Mattituck, N.Y. 11952 (631) 298-7116 An Insulation Inspection was preformed at the above mentioned property; all insulation was installed as per Plan and meets all State and local Building Codes. Any questions please feel free to call. _ "'1 , JAMESJ. DEERKOSKI, P.E. 260 Deer Drive Mattituck, N.Y. 11952 (631) 298-7116 " JUti \ A'. ~ \5J~~J}.I;.2006-.....J To: Town of Southold Re: StrappinglFramingIPlumbinglInsulation Inspections Ivan Tchebotarev 4583 Wickham Ave Mattituck, NY 11952 Permit# 31299 To Whom It May Concern: This letter certifies that all wind strapping on the above mentioned project is in tact, and meets all state and local building codes. A FramingIPlumbingllnsulation Inspection was also Performed on this Structure, and all framing, Insulation, and Plumbing was done correctly and also meets all state and local building codes. A pressure test was also performed on the waste/water plumbing systems. Any questions please feel free to call. -- . ~._~----.-.---- 1'/ P ;-- 1 . __. '5 'e 1 i . j. Ii /AN~9 !, /1 I , I '. '-'-...-..1_ ! _. I j .-.:_=~ JAMES J. DEERKOSKl, P.E. 260 Deer Drive Mattituck, N.Y. 11952 (631) 298-7116 To: Town of South old Building Dept. Re: Framing/Strapping Inspection Ivan Tchbotarev 4583 Wickham Ave. Mattituck, NY 11952 Permit #31299-z To Whom It May Concern: After a Framing, Strapping inspection was preformed on the above property, it is deemed that all work performed was completed to plans and meets all state and local codes. Any other questions please call. ~ 31 ;;L11 z f'~ V I Pi:: 5{GN[j) - TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 Tc ~ E:.Ba;~ INSPECTION " " " [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING P<l FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: r~~? L-- O~. ~~'J- JDt ~4- ~ ~ (Jv- ~ DATE ~'-I.>-- d 7 INSPECTOR # ~ /- 31 t--C( c;-c:- INSPECTION , " I' [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ [ ] ROUGttPLBG. [ ] I_TION [~NAL ] RRE SAFETY INSPECTION ] FIRE RESISt PENETRATION ~~ \ , I i / 3) :J.-9 ? Z- 572P ~'-VJDRk ,.- TOWN OF SOUTH OLD BUILDING DEPT. - 765.1802 # INSPECTION }<f.FOUNDATION 1ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] INSULATION [ ] FRAMING I STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION ~ (-1-;}-pL~~ ~J V () CJlrltJ o;ek /10 b J vt j) L vJe:: ~\j~ .r:bWV',/ L t> c,fr/I) JV :5f-fj'e V c,/ f DATE );-/r--t1b INSPECTOR~~/4- REMARKS: !- " . II FIELD INSPECTION REPORT I DATE I COMMENTS FOUNDATION (1ST) \)3... -l"i ,.,~ ..5:).... -S)"" "" FOUNDATION (2ND) <..~ _'7> \)l"i ROUGH FRAMING & PLUMBING z ~ X --- -- U\ oQ;!l ------- t:; l"i -----~--- ~ "" \'\ ^ ~ t"' l"i "" INSULATION PERN. Y. STATE ENERGY CODE ~ FINAL 1 \d . , ,F/>.-d'.. ,_'Oc " o b'~ ;:0 , . ~ ~ "" .... o z if: ~= Ol"i I ~ ~"" b; _l"i ..!>~ ~. I" I I' PERMIT NO. '1 /~?-r.; . , BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: , .' ~ ) TOWN OF SOUTHOLD BlhLDfflG DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 , FAX: (631) 765-9502 . . . www.northfork.netlSouthold/ '. . .. Examined Approved Disapproved alc_ n/:if ,20 S ? / ~J ' 2~.f2.L . . Expiration , r I l/J-i ,20..22 f . ~-4i... f ~ Bui . m~or Mail to: CATH HI E. MORICHES, NY 11940-1222 {p ~l . i'1 i . e 9 5' --'-"- , APPLICA nON FOR BUILDING PERMIT Date {g !.;zO . INSTRUCTiONS i ,20~' a. lbis application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plol pl.h to sc~le.Fee according to schequl!"... . \ , b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or ~rea.s, aljd w~t~I)Vay&., , .~. I ,;.' I ", I. ~ ;.. . "i l -. . ~ c. The work coverecl by,thi.s aPl?ljcatigirmay not be commenced before issuance of Building pbit. 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 ()ccupancy, f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or lias 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. .... . AJ>PLICATIQN IS HEREBY MADE to the Building Department for th~ 'iss\umce of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicabfe Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to C9!llply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. '",,' ." . . . r~ 1fItu'4.U lAM (Signature of applicant or uan(e, if a corporation) ,~nt1P /~in~SS~~::~)~ iifJJ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder A!1~f Name of owner of premises F. ILl.tJ.JJ . (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer /) eJr.. 1'\ " . " " (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/l work will be, 9sme: 45'9.3 Wlc..k.~ m ctlle. JVIA--rTrru6IL House Number Street' Hamlet County Tax Map No. 1000 Section / 0 -, Subdivision (Name) B~ck' A- Fil(jp Map No. '0' " . , Lot I~ Lot :'. .1 I .......- . . 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy V 12 /l t..-n-:r b. Intended use and occupancy CO IIS.J.r.u.cI- SI ~ J>e. ~ I It d/1Jej ///1.f 3. Nature of work (check which applicable): New Buildin~ Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost /) 50, 000 5. If dwelling, number of dwe1ling units If garage, number of cars i Fee (To be paid on filing this application) Number of dwelling units on each floor 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. , . 7. Dime~si~~s of eXisting s~dures, if any: Front~ 8 I {g /t Rear 3 R I " /. Height Number of Stories -a:- - Depth 3:il ~ Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Rear r; 8. Dimensions of entire new ~nstruction: Front~g' ~ .. Height Number of Stories ,.. 9. Size oflot: Front_' 01' Rear-.l2.~. ~ / Depth c;;l 7.3.".5 10. Date of Purchase thI. e.tmfi;/Uf l'~:r'F~~t~:r~IVAI\ Tc.hc.b..ta.r'l.v Suppl.,W1e..t1-1..J R N c u.$ ,fIl,us:;r 11. Zone or use district in which premises are situated . - 4-0 Rear-A-8' {, .. Depth "3 ~( 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO A- 13. Will lot be re-graded? YES_NO L Will excess fill be removed from premises? YES_NO ~ 14. Names of Owner of premiseslll cl-J.., /'11 Address Phone No. NameofArchitect.J....:.&'rrI..IIL I p. e . Address PhoneNo 2.0 'i-fl86 0 Name of Contractor Address Phone No. 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 ofa tidal wetland? * YES~NO_ (.4e~ o.A::1:f ."...J p.um~+) * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scal~, with accmate founda\ion 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) 55: I COl.1NTY OF~ _ ~UIYII' m PfJUI.^~ P (t~. being duly sworn, deposeS arid says-that (s )he is the applicant (Name of individual signing contract) above named, (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. Not 'c a)fh~~ iJL~ Signature of Applicant worn to before me this o day of DEBORAH A. NICOLA Notary Public, State of New Yoltl No.01N16004066 Qualified in Suffolk Cou~ 9\-1..... Commission Expires March 16, 20'::!...(J/ Date: 06/16/05 Transaction(s): 1 1 Cash Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Septic Permit - Construct - Resid. Name: Mesiano, Catherine 12 Mill Pond Lane East Moriches, NY 11940 Clerk 10: L1NDAC , ~I \D ^' I ~/\f Reference 3478 Total Paid: Subtotal $10.00 $10.00 Inlemal ro: 3478 'I, ,~ \ '.' '. . ,,.'., m-JfbB-IN&PL-+RMd~-{-VIEW. C-Fr-t~&btST Applicant!' . .f) .-.- -:ti.. Owners Name:, ---i:~, (C, . '"' -.er; , ~rc~ilect! l' f) JIJ- Engmeer. -&'~ SCTM #: Distri~l: Lilllli Section: ~ Block: ....-; Dale Reviewed' Qale Submitled. -~M #i~. Project Location: L Lei ,b-- . 1\~~-,^1.~/r~~,-11$ Subdivision Name" Sinlllc & separate Required . ) ~ <crllneation: (Yes I No) I" Ll. , 1\<:4, if" _oR> LL I\cq, ~ ./ ~L()IS"b,c: fl;uu........, ACl<<al: .."." a~1 (LOICo....CU,gc q_"('fOPUSt."J---/ Rcq. /<1. ./ R<q .' j' (Side Yard ~ Proposed: J (R~rYud ~ Prop{ls~d'_ Project~~~!tion: ,~y~ / ~A ~. l<\l\in~ Oisttici: R tio Rcq, . e-7Y . (From '\'J,ro ~{'ropoied: AGENC\VERMITS REQUIRED FOR REVIEW N.A, rill 1'.!J& Permit .~'\ f/uD-C1'f-OIJl Suffolk CoUIlty Health Dept. . ' Ni)w Yodc State, D. Be C. ./ L ......,: ! Town TI'\llJtOOs Town Zoning Board apJ?l'Oval: Town PhinM1ng Board approval: Flood Plane Elevation 111 Flood Zone: 7' ./ . -r----- (- '? - ~fie!{0 ~~ 1.'13 N~~t7; ti~. ~;:~'~~~A<f~~ ~w1--VAA~ . !( ~ '7 ~...~ , " .... ", .,,1 CATHERINE MESIANO, INC. 12 MILL POND LANE EAST MORICHES, NY 11940 PHONE/FAX: 631-878-8951 e-mail: cmesiano@optonline.net TO: PAT CONKLIN - BUILDING DEPT. FROM: Catherine Mesiano SUBJECT: TCHEBOT AREV (TUTHILL) SCTM # 1000-107-4-6 DATE: 7/20/2005 Pat: Enclosed is a revised survey/plot plan for the proposed house which indicates the 11' contour elevation and as you can see, the house has been move to be above elevation 11'. Please let me know if you need anything else. The parties are very anxious to close on the lot sale. Thanks Cathy Mesiano -~-- f"Ql '-'--'-G~ D " R [X~J,)"",,)_l~ ~ !UU: JUL 2 I;m; 1~ L-i:",::;:.i D~PT. i', TOW~' OF SOUF'01 P ~ I , CATHERINE MESIANO, INC. 12 MILL POND LANE EAST MORICHES, NY 11940 PHONE/FAX: 631-878-8951 e-mail: cmesiano@optonline.net June 20, 2005 Michael Verity, Chief Building Inspector Town of Southold 53095 Main Road Southold, NY 11971 Re: Ivan Tchebotarev Supplemental Needs Trust 4583 Wickham Avenue, Mattituck SCTM # 1000-107 -4-'6.J., Dear Mr. Verity: I am the agent for the above referenced applicant who is seeking a building permit for construction of a single family dwelling. Enclosed please find the following: 1. Three sets construction plans stamped by Jeffrey Butler, P.E. 2. Town Clerk's receipt for Septic Permit 3. Board of Trustees Letter of Non-jurisdiction dated 12/2/2004 4. NYSDEC Wetlands Permit #1-4738-03445/00001 dated 6/3/2005 5. Suffolk County Health Department #R10-Q4-0198 approval dated 6/13/05 6. Survey last dated 2/14/05 by Fox Land Surveying 7. My check #1566 in the amount of $150 for application fee 8. Building Permit application Should you require any additional information, kindly contact me. Thank you for your attention to this matter. , a enne Meslano President Enclosures Cc: David Olsen, Esq. Permit Numb... RFScheck Compliance Certificate Checked By/Date New York State Energy Conservation Construction Code RES check Sollware Version 3.6 Release 2 Data lilename: C:\Butl... Engineering FilesIJobslMlSCjOBS\Misc lobs 2005\050051 - Tchebotarev\en...gy.rck PROJECT TITLE: Proposed Tchebotarev Residence COUNTY: Suflblk STATE: New York lIDD: 5750 CONSTRUCTION TYPE: Detached 1 or 2 Family HEATING TYPE: Non-Electric WINDOW /WALLRATIO: 0.10 DATE: OS/27/05 DATE OF PLANS: 5/27/04 PROJECT DESCRIPTION: 1675 Cedar Beach Road Southold, New York COMPLIANCE: Passes Maximum UA = 415 Your Home UA = 321 22.7% Bett... Than Code (UA) Ceiling 1: Flat Ceiling or Scissor Truss Wall 1: Wood Frame, 16" o.c. Window 1: Vinyl Frarne:Double Pane with Low-E Floor I: All-Wood 10istITruss:0v... Unconditioned Space Fumace I: F oreed Hot Air, 82 AFUE Gross Glazing Area or Cavity Cont. or Door Perimeter R-Vahle R-Value U-Factor l1A 1314 30.0 0.0 46 2260 19.0 0.0 122 224 0.490 110 1314 30.0 0.0 43 COMPLIANCE ST ATEMENT: The proposed building represented in this document' specilications, and oth... calculations submitted with this permit application. The the New York State Energy Conservation Construction Code requirements. Wh and signed this page, they are attesting that to the best ofhis/h... knowledge, b specilications are in compliance with this Code. Build"'/Design...~ the building plans, designed to meet ional has stamped such plans or , ., REScheck Inspection Checklist New York State Fnergy Conservation Construction Code REScheck So1lware Version 3.6 Release 2 DATE: OS/27/05 PROJECT TITLE: Proposed Tchebotarev Residence Bldg. I Dept. I Use I I I I I I I [ ] I I I Ceilings: 1. Ceiling I: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Comments: Abov&Grade Walls: 1. Wall I: Wood Frame, 16" o.c., R-19.0 cavity insulation Comments: Windows: 1. Window I: Vinyl Frame:Double Pane with Low-E, U-flctor: 0.490 For windows without labeled U-flctors, describe btures: # Panes_ Frame Type Thermal Break? [ ] Yes [ ] No Comments: Floors: [] 1. Floor I: All-Wood Joist/Truss:Over Unconditioned Space, R-30.0 cavity insulation Comments: Heating and Cooling Equipment: [] 1. F umace I: Forced Hot Air, 82 AFUE or higher Make and Model Number Air Leakage: Joints, penetrations, and all other such openings in the building envelope that are sources ofair leakage must be sealed. Recessed lights must be I) Type IC rated, or 2) installed inside an appropriate air-tight assembly with a 0.5" clearance rom combustible materials. Ifnon-IC rated, the fixture must be installed with a 3" clearance tom insulation. Vapor Retarder: [] Required on the warm-in-winter side ofall non-vented limned ceilings, walls, and floors. Materials Idmtifieation: [ Materials and equipment must be installed in accordance with the manuflcturer's installation instructions. [ Materials and equipment must be identified so that compliance can be determined. [ Manuflcturer manuals ilr all installed heating and cooling equipment and service water heating equipment must be provided. losulation R-values, glazing U-flctors, and heating equipment elficiency must be clearly rruuked on the building plans or specifications. Duct Insulation: [] Supply ducts in unconditioned attics or outside the building must be insulated to R-8. .1 [ Retum ducts in unconditioned attics or outside the building must be insulated to R-4. [ Supply ducts in unconditioned spaces must be insulated to R-8. [ Return ducts in unconditioned spaces (except basements) must be insulated to R- [ Return ducts in unconditioned spaces (except basements) must be insulated to R-2.. Insulation is not required on return ducts in basements. Duct Conshuction: All joints, seams, and connections must be securdy futened with welds, gaskets, mastics (adhesives), mastic-plus-embedded-ftbric, or tapes. Tapes and mastics must berated UL 181A orUL 181B. Exception: Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa). The HV AC system must provide a means Dr balancing air and water systems. Temperature Controls: [] Each dwelling unit has at lesat one thermostat capable ofautomatically adjusting the space temperature set point ofthe largest zone. Electrie Systems: Separate electric meters are required Dr each dwelling unit. Fireplaces: [ Fireplaces must be installed with tight fitting non-combustible fireplace doors. [ Fireplaces must be provided with a source of combustion air, as required by the Fireplace conslniction provisions of the Building Code of New York State, the Residential Code of New York State or the New York City Building Code, as applicable. Service Water Heating: Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is patt of a cireolating system. Insulate circulating hot water pipes to the levels in T able I. Orculating Hot Wat... Systems: [] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: All heated swimming pools must have an on/o1rheater switch and require a cover uuless over 20% of the heating energy is rom non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [] HV AC piping conveying Jluids above 105 "F or chilled fiuids below 55 "F must be insulated to the levels in Table 2.