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Home My WebLink About33428-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 12/20/07 No: Z-32799 THIS CERTIFIES that the building ADDITION Location of Property: 660 CHABLIS (HOUSE NO.) County Tax Map No. 473889 Section 51 PATH (STREET) Block 3 SOUTHOLD (HAMLET) Lot 3. 11 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 17, 2007 pursuant to which Building Permit No. 33428-Z dated SEPTEMBER 27, 2007 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 WOOD STOVE & ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GERALD P & JENNIFER A. SCANNAPIECO (OWNER) of the aforesaid building. N/A SUFFOLK COUJIlTY DEPARTMERT OF HEALTH APPROVAL 12/03/07 ELECTRICAL CERTIFICATE NO. 3052154 N/A PLtlMBBRS CERTIFICATION DATED Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 \ APPLICATION FOR CERTIFICATE OF occllf,.4filc1\, \ ~ \ \','./ This application must be filled in by typewriter or ink and submitted to the BuildirigDeoartment with the following: )>V, A, For new building or new use: " ' I. Final survey of property with accurate location of all buildings, property lines, sQ'elltS: 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 2/10 of 1% 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, / / , / /IG/J . '?J I') '-\ '-' \ 5\ ) . . r"'/'/ '.,' B. For existing buildings (prior to April 9,1957) non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $ I 00.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 I :;/;'I/o '7 Date. New Construction: Old or Pre-existing Building: II f? 4FJ1- ( check one) Location of Property: 60 ~~<O Hamlet CJlrll5uJ House No. Street Owner or Owners of Property: JtlJd JEIV2'j ::;C.4I../A1A!l/Et"'../3 Suffolk County Tax Map No I 000, Section q "73:;$"9 . Block 0003 Lot :1.0// Permit No. 33 Lf ;)<;" Filed Map. Lot: Date of Permit. , /17/0"/ Applicant: ~ &tv>1lZVCrJ(JN . Underwriters Approval: ,/ Subdivision Health Dept. Approval: Plmming Board Approval: Request for: Temporary Certificate Final Certificate: ~ (check one) Fee Submitted: $ @...u.,.135'15 c. e ~31.1 ~q 'E!ffi!E!ffi!~ I I I ~ ~ ~ I ~ I ~ Located at I ~ I I I = = = I = = i = = ~ = ~ I ~ = I I E!ffi!JE!ffi!IiE!ffi!ffi!~E!ffi!ffi!JE!IiE!ffi!E!ffi!E!ffi!IE!ffi!IE~E!ffi!JE!ffi!Ii 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 GERALD P. SCANNAPIECO 660 CHABLIS DR. SOUTHOLD, NY 11971 GERALD P. SCANNAPIECO 660 CHABLIS DR. SOUTHOLD, NY 11971 660 CHABLIS DR. SOUTHOLD, NY 11971 3052154 Application Number: Certificate Number: 3052154 Section: Block: Lot: Building Permit: BDC: n511 Described as a occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, sun room, Outside, 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 3rd Day of December, 2007. Name OTY Rate Ratin. Circuit ~ Alarm and Emergency Eqnipment Sensor Panels o Carbon Monoxide 60 3 Wiring and Devices Outlet Fixture Outlet Receptacle Switch Paddle Fan Receptacle Receptacle 1 0 1 0 10 0 6 0 4 0 2 0 1 0 1 0 Fixture Incandescent General Purpose General Purpose General Purpose GFCI 20a Air Conditioner seal 1 of 1 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. E!ffi!ffi!E!ffi!JE!ffi!Ii~~1!I 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. 33428 Z Date SEPTEMBER 27, 2007 Permission is hereby granted to: GERALD P SCANNAPIECO 660 CHABLIS PATH SOUTHOLD,NY 11971 for : WOOD STOVE WITH ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 660 CHABLIS PATH SOUTHOLD County Tax Map No. 473889 Section 051 Block 0003 Lot No. 003.011 pursuant to application dated SEPTEMBER 17, 2007 and approved by the Building Inspector to expire on MARCH 27, 2009. Fee $ 200.00 ~~ I Authorized Signature ORIGINAL Rev. 5/8/02 j35LLP& TOWN OF SOUTH OLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION REMARKS: [ ] ROUGH PLBG. [ ] ~ATION [ .;(FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRAnON ~ v DATE /1[3 /07 INSPECTOR 3)f),- C(~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] RJ>>UGH PLBG. [ ] FOUNDATION 2ND [ ..(INSULATION [ ] FRAMING I STRAPPING [] FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRUCTION [ ] RRE RESISTANT PENETRAnON ~~::J 70 &~ REMARKS: !JC-. DATE II /ifJ 7 I ' INSPECTOR _. ~ 3 Jt-/- ~<g Z- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUND TION 2ND [ ] INSULATION FRAMING N [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONS1RUCTION [ ] RRE RESISTANT PENETRAnON REMARKS: -..... ~ ~dL, DATE 1/--J-07 INSPECTOR .ffi..u-: ~ 337 H Z- TOWN OF SOUTH OLD BUILDING DEPT. 765.1802 INSPECTION ~ "9.. [ ] ROUGH PLBG. )X( FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING [] FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUC'nON [ ] FIRE RESISTANT PENETRATION REMARKS: ~ DATE /b -/ ! - 0 7 INSPECTOR ~ ~ ?7tf;)8Z;; TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [~UNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING [] FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRAnON g .LJK. ~~ DATE Joj~ ;:7 I / INSPECTOR /U e L- ((/u::~ .' FIELD INSPECTION REPORT DATE I 1 ~//~h- 1/ , FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRAMING & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL . A COMMENTS /u:~ ,4"7 -PK. /...;;. ~/// _ A--. ~ . (-. 7 7 " \.N.., \Ntol -C,~ 'W.., 0<''''' t'\J I. ~'f~ ~ ~~ 1- // ..III! , JC 1t>...)f1.- 7 \\.,. ../), ,\~ o*' ,y./.Y_.... 7 U i 2 , " , / / f ~9 ,k}'~ 7 -".... - . - J.. A r'I'i I ./1, -..... flJlp "'.(]) K / y~~ A t'J.. 'T. air> P ,"" '. --,., (I.. 'r A 'J. _,' -.,. .-J.. ) ~ fil ~ /~ -v1 .i1--- ~'...- I~ I .'-.~ ~L.;::: 1.0. ~ tr (f ./ ~ 1'...1 ~ 17 .., r.--- f' ~ ~~ ~ l"l ..., ~--f--- 1!j!lfg7 pr.. P. ~_ -..-.. ~ ..,?. (~/.u / .111/. J '~':J V' /)-41-1, I "7 ..a.t: ~ 0 n I I I' // "A'#-:. ('oJ // 7 v t!\ o ~ -A,"'I//;t I /p::7 ... ~ ~ -' (L" Ju. / / , , ADDITIONAL COMMENTS lA R '".) ::> $>0 -o::E _.z g!ll o It'trl I ~ ~~ \ ..., L6~ , --rJ .... t 'f); ,. ~ ~ - , '~ ~ ,.,.. STREET DIST. - SUB. lOT \ I ock ~I I \t)O()-S\-'6 "3, , \ . OWNER TOWN OF SOUTHOLD PROPERTY RECORD CARD old S REMARKS FRONTAGE ON WATER TillABLE r ~, FRONTAGE ON ROAD WOODLAND ~ , DEPTH MEADOWLAND [, BULKHEAD HOUSE/lOT I o.&0t OD TOTAL . '. . . r 157 , COLOR, it.. k,,-j ~i0 . I~ 13 I ...k. i '. '" 64 /. c) z.:! 2t ~ luI- TRIM t.. trZU)L. .'.,. . ,........=! !;~47') 1'7 >- -, , I . I :2-M:=-Bl~~ 37 X t3 Jf%/ > 1Gb 5,$A- 410~ . ( ;c:, 2.-'/2- - Foundation Bath Di nette IS x ~ '375, -c:s: . I eit~sicrn ~ Y'IS Basement FULL) Floors OM Kit I I 2-0)(./:;;=~ 3,:--- SLAB Extension Ext Walls Interior Finish LA. I Extension Fire Place 'jfS Heat D.A. I Patio Woodstove BA. . 3 ~~ch" :..,fq \( (5 90 > .S-o I~Pf Dormer ~ 17-- 2 31 J( <? = Vl-i 33'S Deck 10 )( Ira =- 1(.0 > fl' ,~ bZ, Attic 1lEN \ 1ft. "2;]... -- 'i?~ 2 , I Breezeway Rooms 1st Floor Garage 2.7- 1- 2.:- - ,q)c, I.u:! , c;tJC, Driveway Rooms 2nd Floor b.B.. Pool ~,~Cf() PERMIT NO. 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 g 3 of di-f::s Check Septic Form N.Y.S.D.E.C. Trostees Storm-Watef' Aasessment Form_ Contact: Mail to: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 . , SoutholdTown.NorthFork.Jtet Examined fj,p 7, 20EL q /;- ? 20 07 Approved Disapproved alc Expiration .3 / ;Yr, 20 J2f- 1'------ ~ ~ If] ~ Q !W~I-'m lwl " \ BcD:,. DEPT. I TOWN OF S"UTHOLO IlidL- f Building Inspector Phone: 7105- ~ 7Lf '-I d'/ . 7bS IO~l.{ APPLICATION FOR BUILDING PERMIT Date ?0,,)J7 ,20 INSTRUCTIONS a. This application MUST be completely filled in by typ~er or in ink and submitted to the Building Inspector with 4 setsl)fplans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location oflot and of buildings on premises, relationship to adjoining premises or public streets or ateas, 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 aWlicant. Such a permit shall be kept on the ~ses 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 pen:nlt..$~! ~\~ if the {Vor~J!uthorized has not comm~cc:d withip 12 months after the date of issuance or has n~ been complaett~ . ,'l'ltinontlis frJ:>1l1.kuch date. If no ~olling'amen~t&'Or other regulations affecting the pro~~.~e ii:eA enacted in the interim, ~tl\1Rding.~ctor may alithoiize;m.Wriiliig,.the extension of the pery1it for an additiott'!ilX months. Thereafter, a new penmt shall be required. ,,';;'i APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pufSUant to the Building Zone Ordinance of the Town of South old, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the copstruction 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. ignature 0 ppli ant or name, if a corporation) P.b 841. 1643, JdV17Ilt/),A/Y /117/ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder rJ;€NttdL ttJPTl't/IdI,( ,6V/LIJ&X!.. , Nameofownerofpremises J€N JJEA!A!Y JCANNA-.t'I,EECO , (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. 2'~7 h -I/- Plumbers License No. Electricians License No. Other Trade's License No. 1. Location ofland on which"'pr9posed work..>rill be done: ~~() c;l/1J~S PA11I- House Number Street S IJvnhJl{) Hamlet County Tax Map No. 1000 Section S I Block O~ Subdivision CN.4I1AIJA/N,!/V WdIlLl' Filed Map No. , , /9LU) Sur 29,11187 Lot ::? .// S82:z.. Lot _/' -: (Name) I '> Oil '" ;,., ~." 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /ZU,P&uae. b. Intended use and occupancy 12~5/p~eL 3. Nature of work (check which applicable): New Building Repair Removal Demolition' Addition V Other Work Alteration 4. Estimated Cost .3I,()OO (Description) Fee 5. If dwelling, number of dwelling units If garage, number of cars / (To be paid on filing this application) Number of dwelling units on each floor 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 57 Rear G7 Height Number of Stories Z- Depth 3'11 Dimensions of same structure with alterations or additions: Front Depth 'If Height Number of Storie!! , , 1,'1 Rear t..t ,-" Depth D 8. Dimensions of entire new construction: Front Z Y Height /2- ' Number of Stories "?O I Rear 2""'""'. I 9. Size oflot: Front ~ vC} Rear / Depth 16],. , . 10. Date of Purchase Name of Former Owner , 11. Zone or use district in which premises are situated Ac... 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO V 13. Will lot be re-graded? YES NO ./ Will excess fill be removed frolll ~ses? YES NO ./ :Ji"IJJJUIZ'I 6hO CHINJIJS /l,91/f - - 14. Names of Owner of premises !>C4NNA{JIUC Address SdV11Nl.D Phone No. 7115"-' f'tO: Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet ofa tidal wetland or a freshwater wetland? *YES_NO V * IF YES, SOUTHOLD TOWN.:rRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 30~ .' ~a tidal wetland? * YES_NO_ * IF YES, D.E.C. PERMITS QUlRED. r,p, j . . ~_. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. l-iif elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES_NO L * IF YES, PROVIDE A COPY. '..I'. ~ 00-. ..... . ~\ l' \ . STATE OF NEW YORK) ss: being duly sworn, deposes and says that (s)he is the applicant (Name ofindiCiual . contract) above named, (S)He is the J./111.JIt;fU fL- (Contractor, Agent, Corporate Officer, etc.) ............. COUNTY .' -" 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. Swomt~beforemethis . C.~,.. \\)",nl, /7 day of J.1uJ'tllmlJA.." - 20rr rV~1'l "1\1. J"areJ.4U.--. C7f"" )IotarY Public ---....... _.':_.!l."': '. ,... . ~, I '.;_ licant '. ,"~ -------.. ""'("/1 fY1t.-"" 'I r IiI /..';t~' q (~, j I .~ , ,fI SUii' G~ s. ;>0. 1\1 D .... <'.1',., r ~l). . t:. .....~,--. , , . ""'ell ) -- .#' --_........,.- e '______ 80 . .~ COU 1.19.lj If> r ^ ~I Ji..-el/ ~'4i . .8 ~ ~ ~. CIJ ........ " Q:) Q: ~ () ~ Q.. "" .(}.-, ~. ~ ~ t ~ lOr ~ ~ \. ~ d {, 0' ~ olIN e/./ . ,n3 I ., :;;1 Lor@ The locations ot wells and cesspools shown hereon are from field observations and or from data obtained from others. ~ E1.EVA TIONS ARC REFERENCED ro AN ASSUIED DA 7tAII. AREA = 40.000 sq.ft. c.P. I UIIl IttItfIIdr wIlli IN STANDARDS FOR APPROVAL ytI C()H$TRf.lCT1ON QF' SUB$URF'AC~ SEWAGe $POSAL $YS11iMS FOR SINGU FAMlL Y R~SID~NC~S <I "", @/ft by ",. CMdfIlof/s B.I lorth ther.1n and on Ihe ",,"II to ron,lNIcl. SCDHS Ref.# RlO-96-/02 / W~/I ISO' & " SURVEY OF LOT 11 CHARDONNA Y WOODS AT SOUTHOLD FLED SEPT. ~ 79B9 FI.E NO. BB:l2 A T NORTH SOUTHOLD SUFFOLK COUNTY, N l": 1000 - 51- 03 - 3.11 Scale: 1" = 40' . June 20,1996 April 8., 1997 { (oundafion ) Aug. /4, /991 ( Fino/) 'r~ " ~ , ..... 'IY AL 7EiiA TION OR ADDITION TO THS SU'i'\IEY IS A VIOLA TION . SECTION 7209 OF TIE NEff Yair( STATE EDUCATION LAW. . CEPT AS PER SECTION 7209-SUIIDIIIISION 2. ALL CERTFlCAT10NS fiEON ARE VA/.t> rOR THS MAP AND COPIES THEREOF eN. Y F IJ) MAP OR COPES BEAR TIE I/PRES$ED SEAL OF TIE stIlVE"YOR OSE SIGNA TI.IRE APPE:ARS HERf:ON. DITIONAl.L Y TO COW'!. Y WITH $AI) LAW TIE TERM "AL TERED BY' 'ST Be USED BY ANY AND ALL stIl\IEYGRS U1I.JZM; A copy ANOTlER stm'f'Y~S /lAP. TE1/IIS SUCH AS "lNSl'ECTED" AND lCJU9HT-To-oATEo ARE NOT IN COMI'UANCE WITH TIE LAW. .5. LIe. NO. 49618 p~e (516J ." 0 P. O. BOX 909 1230 TRA VEL~R STRE~T SOUTHOLD, N.Y. 11971 flR _ 17Q Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. #: _.2L 03 3.1/ District Section Block Lot THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM.WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. ---------------------------------------------------- Item Number: (NOTE: A Check Mell< ( ~) for each Question is Required for a Complete Application) Ves No 1 ---------------------------------------------------- 2 3 4 5 6 7 8 9 Will this Project Retain All Storm-Water Run-Off Generated by e Two (2") Inch Reinfall on Site? (This item will Include all run..off created by site clearing and/or construction activities as well as all Site Improvements and the permanent creation of Impervious surfaces.) Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location? This Item shall include all Proposed Grade Changes and Slopss Controlling Surface WaterFlowl Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? Will this Application Require Land Disturbing ActiviUes Encompassing an Area in Excess of Five Thousand (5,000) Square Feet of Ground Surface? Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach? Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to One Hundred (100') of Horizontal Distance? Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Stann-Water Run-Off into and/or in the direction of a Town right-of-way? Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any Item Within the Town Right-of-Way or Road Shoulder Area? (This ilem will NOT Include Ihelnstallallon of Driveway Aprons.) Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse? v [J V [J [J ..; [J I - [J I [J ..; - [J .; - [J I [J V NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark In the Box, a Storm-Water, Grading, Drainage & Erosion Control Plan Is Required and Must be Submitted for Review Prior to Issuance of Any Building Pennlt! EXEMPTION: ---------------------------------------------------- No Ves Does this project meet the minimum standards for classification as an Agricultural Project? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan Is NOT Requiredl ---------------------------------------------------- :~~~::':... '"' ~m ",~= m'.. '"'''''''. '" """. 'm '~"' (~ame of individual SIg{!jD;;fiifJt('(j~ And that he/she .s the .................................................................................................................................................................... (Owner, Contractor, Agent, Corporate Officer, etc.) Owner and/or representative of the Owner of Owner's, 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 ~. STANDISH Sworn to before me this; Notary Public, staIB of New Yor1I No.01ST61 ...........!..L.......................... day of ......../RIJ.l.r;:m.CM............ ,200) COm~V:~~~~~19 2 :1.f.- NOtaryPUblic:d~.r:J..::7h.....h~.~............. ........h~~~I~;;Of ;;;,;;;.......................... FORM - 06/07