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Home My WebLink About33508-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32919 Date: 03/11/08 mIS CBRTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 243 MAIDEN (HOUSE NO.) county Tax Map Il1o. 473889 section 140 LA (STREET) Block: L- MATTlTUCK (HAMLET) Lot 8 SUbdivision Filed Map Il1o. Lot Il1o. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 24, 2007 pursuant to which Building Permit No. 33508-Z dated NOVEMBER 2, 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 ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAYAMAHA FAMILY LMTD PARTNERSHIP (OWNER) of the aforesaid building. SUP'I1OLK COU!l'll( DEPAR'l'MBNT OF HEALm APPROVAL N/A ELECTRICAL CBRTIFlCATE 110. 121813C 02/29/08 PLUMBERS CBRTIFICATIOIII DATED N/A ~ ~()-- Authorized Signature Rev. 1/81 .,-...~-r (e. -[~-,';~.r,~" " "'" \, ~\ IL_~:__ . . .-'--..- iJ \1. \' n L \.,1' ( 'j ,U . --:~Z-~-> cr APPLICATION FOR CERTIFICATE OF OCCUPANC T w~.!~\'SS-UT'HO!.D 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: .;:-;' 1fr2 ./3 1/r4 If IrS 1"6 A. F()!' uel\' building or new use: /1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. Fmal Approval from Health Dept. of water supply and sewerage-disposal (S-9 fonn). Approval of electrical installation from Board of Fire Underwriters. Sworn statement from plumber certifying that the solder used in system contains less than 2/1 0 of I % lead. COlmnercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. Submit Plarming 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 ). Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swmuning 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 Celtificate of Occupancy - $50.00 5. Temporary CertIficate of Occupancy - Residential $15.00, COImnercial $1500 ])3te.--.31_7/2 <7i.f_~___ ./ 24-3 House No. Old or Pre-existing Building: ( check one) New Construction: Localioll or Property: )'"1 f"t:1: :J:>ErJ ~~~) "TV\ C K Street Hamlet Owner or Owners ofPropelty: T f"t'f PI t-) PI '1-\ p,., _F b p____~_____________ Suffolk ('ollnl)' Tax !\Iap No 1000, Section -1 4- (l'f Block ~ 00 \_~_ Lot __ 0 ~_8'_ Suhch\lSI'-\1l Filed Map. Lot: l'er111]1 No _235Qg'__ _ ~ Dale ofl'enniL_~~-f.rLJ_ Apphcanl _Do),} ~2t\/'I.'f'l.....:t:V\'_~r-t7'~PI'" Pt- Heallh Ucpt: Approval -~~___..1I-!-~ft___~__ Underwriters Approval: ---~/z-~fJ!!k__ Planning Hoard App[(wal' --_~_.y!i"r. ________ Rcquest for TC111pmary Certificate _________ Final Certificate / ----._- (check one) he SubulIlled.:;' __25_____ 3jrtJ"1 / ~'6 ----L_ DO'" L. -:sAY"'''''' A""" /'I ~.l}~r~ CO -'C32 ~ (q MAR-07-2008 01:26 AM HLV ELECTRIC 631 331 5205 P.01 Electrical Inspection Certificate Illue Date 2/2912008 ElectricallnlpectJon Service, Inc. 375 Dunton Avenue Ellt Patchogue. New York 11772 (831) 2811-8642 Application Number 121813C Issued To: Street: Village: Section: Mr. Don J 243 Maiden Lane Mattituck Block: Zip: 11952 Lot: Town: Southold Contrector: HLV Electrical Services Incorporated' Llc;# 31511-ME- Was examined and found to be in compliance with the National Electrical Code. o Commercial LJ NV Defecta CJ Pool 0 1st Floor 00 Indoor [J Basement [J Hot Tub li!J Resldentlel fJ Det. Garage n Attic ::J 2nd Floor !Xl Outdoor ,. Addition 0 Survey ..---..---.--. -.-...-.-- Swfll:hes Receptac/flS Fixtures GFI 3 3 5 1 Dishwasher Wesher/Amps Dryer/Amps Oven Heeters AIC Fans Range/Amps Microwaves Fumece 0/1 Ges Clrculetors Smoke Detector Be/l Transfonner Meier Amps Phase UGlOH Jacuzzi I re/ev/s/on CO Detector Bldg. Permit: 33508 Other Equipment ~~~:::~~~~~pe~er~::pt.-- I /fugD~ Ii ~, President Rough Inspection: 01i16i200s------- Inspector: John Me Mahon III Final Inspection: Inspector: o2l2ii2(j~" John Me Mahon III This certificate must not be altered In any manner. Inspectors may be identified by their credentials. 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. 33508 Z Date NOVEMBER 2, 2007 Permission is hereby granted to: DON & SHARIMINI JAYAMAHA 243 MAIDEN LANE MATTITUCK,NY 11952 for : ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 243 MAIDEN LA MATTI TUCK County Tax Map No. 473889 Section 140 pursuant to application dated OCTOBER Block 0001 Lot No. 008 24, 2007 and approved. by the 2, 2009. Building Inspector to expire on MAY ~.. Fee $ 200.00 ORIGINAL Rev. 5/8/02 N W+E 5 ~ ~ :J~ .-e <l) ~ Ib, ~G ~ , r , , , , , , , , , - <1l' ."2.J:: ~e! ....<1l' 2:E oS )--- + '>..~ ", + .;;>,"~ ,.... S es.......... +~ + ~+ ~+ /~ "1S,.xO S 1 ~o~ 0'<j7>~ I ,..... ~): '<: 0-- t::p.", ~ ~ I~ '% '>~ . Q' ,..... I! ~ '..,,'l ;1 '-"~ ~~ ~ -/ ~ ~ .g ~ 4-,,, / "/~~~ l "s ~ i~:" o. I!;;rm ,9"'0 ,~~ '115- , Uk I 0 sIE ,uo , i=fOfi I I ~ ).>- ~ ':t -----.----, ~f N"" ,-.-.-. :, _:E C\i 0 " \;Jl1 g')o; r :I-~ ll>0) I, cr ,... \ z \. ~ ': , .~.r:: .; ~e! { ..!.. CtJ / , 2:E 7 1 oS : : / )'- : f , i / ! I , I , I " I I I I I I I I I I '\kIc:IItI'orlzedGllteraUol'lorQdd!t.ICInWO""""eIJ ""'PI::JeaTqClI~lanc:l~"...allsa vlolatlonofHGUon"2O'I,~2,ofu.. tw..l'orkSl:ataEdJeatIonL::lloo.' "Onlljc.oplHtromtlworlgh::llol'thI5~~ :::1~~U:~aldta~'s~. 'Certlfk.<:tk:Jre~hereon5qvfljl:hatth15 ~_~I!'I<>c:<:.orGbl<.e...llhtlw_- ~~~~O<'k~'::-~Ion~~1 Lald s...-v~. Said c....-tIf1<.<ltlon5 ~II ru1 only tottwo~for,.;,omUl6!o\11'V9<j~prtlfXT"d. ~ ~ ~:~~~~~:l~ f:Jdt;~ to _ <>5fI~5 of _ """""hg ~Uwtlon GertIIIGa- tlore are rei tra"lef.....obIe to oddJtlonollrt!ltlt"tlon5 , , I , , I , . ,.. 'Y'" , I~~~~____k__ 7 +~ 'V<j7.>. +~ ~~/ +~. V~ +':1 ..-O'%- ~ ~~ ., ~"f ":.. 8~ ~""" <O'"'C;., ~ "l;;l< ~ '9/./0 S/- 0 . O"c)~;Y""o <?<?a YSt '/, ~ .&~, lSi,...,~..y U' <<./ c L~ Survey of Property Surveyed: 11-25-05 Amended: 03-05-06 04-04-06, 05-07-06, 11-19-06,02-06-08 SCT# 1000-140-1-8 Situate: Mattituck Town: Southold Suffolk County, NY Prepared for: Don Jayamaha I" = 30' ~0't;., o A_;;l< "Z /0 0",0 '''' 0 .,~'/. 0,,""0 s;,: Y,> ""- '9/;'0 "" <?.>. '?", ~.~ V'7, 'f. 0.,19 OVer '""A ~" it/" .jyo'j':f ~/ .~ ~~ s::> (\(;j o~ ~ .. ~ ROBERT H. FOX NYS PLS# 50197 POBOX # 366 AQUEBOGUE NEW YORK 11931 2/6/2ooe 5,20,32PH c.'6LM\J'"'JClFINAL.pro ..,~ -=- :3 3'> 0 K 2- TOWN OF SOUTH OLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING I>\! FINAL [ ] FIREPLACE & CHIMNEY [ .] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRUCTION [ ] RAE RESISTANT PENETRATION REMARKSy::- ~".t ~ .;t. 1:)* E~ ~"-4-il~1 ~\~-' ~~~ DATE :J- - )- 7 - () 0 INSPECTOR ~~ 3}SO g 7- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION ] FOUNDATION 1 ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION ] FRAMING I STRAPPING P<f FINAL ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] RRE RESISTANT PENETRATION REMARKS: /I!~ S/g If ~ ~ ~~(~4) ~. ~_A-~;, -t4-, / ~O?~~ . tJ-~~) aP.k- ~~~ - tI-~.. ,~-Ng-'rA. I-{~ aJ2j!~ I DATE .;L--J-l- 1) f" INSPECTOR ~~ * ~ -t;- ~ IAe ~ ck.I4, 335"0 'i Z. TOWN OF SOUTH OLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. .P<[ INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~ fl.,.~ tI-~ rJ- ~ ~(t/tf: DATE ) --17~d! INSPECTOR ~ ~ )3Sd Z- ~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION ~MIN~TRAPPI~ [] FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS. -:; ~ V- ~,'.,# ~ tJ~~~/~~ ~~pMz~ ~ ~ ~.-& ~ ;;2/y~j~ iJ.uI~~~~ ~~,~ DATE /-Lf-t:J't INSPECTOR ~ ~ ------- -'--- }3So ~ L TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION N FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING [] FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: P~y~ / L4- ()~, , { ~y~ DATE/:L~6~f)1 INSPECTOR~P-- ~ FIELD INSPECTION REPORT FOUNDATION (1ST) FOUNDATION (2ND) ROUGH FRAMING & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE . FINAL fJo..\Jl . ,,/) _ . ..,,/} .0. '" , DATE I . COMMENTS ~;g U\~ 0.., D<t"" ~ i'..:~ ...- ~ .-~ V:V\ /.... fJ .,;;, Pit- />>J l' , 11---1..- ,7 J ~. -h Il , I /I/IJ, I , :z o b' '- ..c. 'U. \)l~ 3'a :b _. ~ ~== J.~. ~/Qk ~ ~/ '1~ e .., l~lf--o ~ ~ - A ..t- A -hA. A. ":.. /lJ"tJ /) Y .l1 ~ ~"'A s../~<7-I/ ,'d" . (jt\04I....Jl~ /J ]I A 0..' -b.: ~.J.. .'. V 2!.A' f/ <7 --- -~ -[I'1f. "-~.- t'. ~ d-\ - . 3 IJ--H- g .YJ.. n",> to tJ..-- 1/ ~ . ~ A'""f-7;i- /~'/j -' r -'l 1/ ~:.z../I \....:. ~ " '" ~ J}...J.. A ~ . ~ ok'. . ~ ~ -fh. .' - . . ~ /'" a.rJ '\ J, ",{ .I-#i>: A\.. A:1T. V . V ~ ~~.1 ~ I_I::: t ~ J-, -l-7, '01 . ADDITIONAL COMMENTS . ~ 'A ~ , 0 ~~ z " m ;lJ J-Il/-pJ7 0)-' ~ // I~ ., cJ\i':i . ~ ';' ~ ..oj o :z 2-;a 'h~ == o i':i .", ~ , 1v14/0E2tv '-4~E2 SITE SURVEY s.c. SURV~Y OF PROPERTY SITUA'l'4: MATTITUCI( TOWN OF": SOUTH OLD SUFFOLK COUNTY, NEW YORK TAX No. t.tAP- 1000 - 140 - 1 - 8 CERTIFIED TO: DON L. JAYAt.tAHA SURVEYED 11-4-2004 .. AREA;: 21,808" S.F. SCALE:. 1":: 30' ~ 1 \ \ \ \ S,c:i "tA.ic " . I'trfA ;.,..~. 1000' '. ""~ Poiii~~e- 7 Q) . ~ . o .. ~Z '0 '1 1l 1$ cJ~ vj!f LU~ o~ z~ Wz o - en LU a: <( J: ~'. ' ~,."g ~ .~ ..,1 , < INFORhlA.nON 1"~ - FROM SUR~V, PREPARED BY IlOStRT H, FOIl POX 538. RlWRHEAO. N.Y. 1-10(:1\ 831-:)22-.a380 llOALWEtlANo BOUNORY c-I\ 01 . \ ~\ \ \ \ 1 \ \ \ 1 1 1 \ 1 1 1 \ 1 \U\ ~I c-ll ~\ ~ ~\ N -z. \ 47035,<O''W 1 \ O<oJ.~ \~~~ 1 \ S47o~ C5'10"E: \ \ \ \ \--- \ - --.:...- I \ . -----_ I ~~ " ..\ ----_ I ' ~t\ ----..J,'____' If' \ ---/- \ --- ' \ .... ' I I 1ilO'_ ,\ .0.,..; / 'F-\ \ \ I... \ ---l 10 \ ,----.;;" \ ;.,' \ I \,./ \ / \ \ .1 I AREA COveRAGE DATA: lOTALLOT SQ.FT._ 21,808 SQ.FT. EXIST1.... T(JTAL SQ.FT. S _' . ~ ,?' . -~': I..~~~. 1~; .~O rw.>:.!.-o~1 . '~'~'II;I'lI..l..C-~.1 DRAINAGE. SYSTEM ;r.==~"", --- eXI8TlNGI LOT COVERAGE PROPOSED CiARAOE ilL LOT"COVEMGE 1_TOTALW~ EXISTING LOT caveRAGlE TAKEN FROM srre SURVEY DA.TED: tt(18/f11 PREPARED BY: ROBERT H. FOX NYS F"L.S-'S0187 2.00s SQ. FT. 48) SQ.FT. 2..... SO.FT, -...n!M . 1 lIlOOP~see X.1e7--"CUJIT. 1lA8lN1-U8E('l)N/eN8o'r8lNI!I.4'D,4;HT.- 180 C....YOL s.c ~..~ 1 . '''''No />~ 1. 15 . 1000 ~'O::FI .:i! - OFlI..O"~O OSS 'o,,/(, OFl4J.t 1-_30' ~.., . TOTAl.. ROOF ANflFAU.. CN>JIICfTY _.. c.fl. YCL lIITE PI.AN ~~~~~ NO~~NIQ'ORMODlFlCA"0N8 8tW.l. BE WITHOUT WRITTEN AUTHOFlIZATION fl'fTHE . JIHf N:PAOouc'nOH......1"AM' 0fIl WHOlE 18 STFlICTL.V PAOHIBn"ED BY LAW. DWG. .:' A.SITE BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: TOWN OF SOUTHOLD .-..... BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.netlSoutholdl PERMIT NO.S SSb '8' -z:; Approved Disapproved ale Examined Mail to: Phone: Expiration ,20_ Buil l<t~.___._ .-------.------ - ,..,,; fr: i' "\ ,. PLICATION FOR BUILDING PERMIT I \: =:~l 2 4 i-J7Ll DateJ.priL It : . i INSTRUCTIONS ". .... ..-.\ a.\ThiS~~~ljpation'Mds:lLb letely filled in by-typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location oflot 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. APPLICA nON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South old, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. I ,2007 PI} (0)( 9'.3, l/d6kJ(ii; D\tjJLq~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~~- Name of owner of premises ~OAJ L;jtYaNtJ.f/k- (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: ;24 () 1-11J.1f)BO J-f}J,.)~ House Number Street NA-TT JT/)(',10 HawI,et"OTS!~,M J lUJ:!H:lIM >llIOY W"v. t., ,;,~ .\fa. OI.J~YRATOII Block I YTll1100 '1015 Filed Map Jiups ,T!; .V(;" 3 iHd;G :.~~~".". County Tax Map No. 1000 Section _140 Subdivision (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructlOh:, a. Existing use and occupancy fJ \' Y\~ \-c ${l1111- ~ "('f' l'. \& I{) ('lC'. r1 SoT'( Y\.1 I w r Je ~ ~0v\..CL0~ _ b. Intended use and occupancy S i1\~k J-a< J./ ~T~ i^)\ \ eo Ai &-t.(\~~J ~~_ \ C-(M) Q.;A:k<3.~ 8 ~, 3. Nature of work (check which applicable): New Building' Addition---->< Alteration Repair Removal Demolition -.../ Other Work ~c9-u-l'n 9- Q1u. o~ (DescI1Ption) 4. Estimated Cost rlS.OOO I Fee 5. If dwelling, number of dwelling units If garage, number of cars \ fo.rM (To be paid on filing this application) Number ~f dwelling units on each floor (l~r~\ , 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. - Dimensions of existing structures, if any: Front Height Number of Stories lJ,mensions of same structure with alterations or additions: Front 02/'6 II Rear ,..,l / ~ I( , D~th ,1.,)'3" ..., ,2/ '--0". Height 15'/ " +/- Number of Stories----1 Rear Depth 8. 'Dimensions of entire new construction: Front Height ,S Number of Stories Rear Depth 9. Sizeoflot: Front 8.7.(;0' Rear crQ.02' Depth,;;J.J o. q'O' ... () 7:;2. 31' 10. Date of Purchase Name of Former Owner II. Zone or use district in which premises are situated ~-yO 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO :x: 13. Will lot be re-graded? YES_NO y Will excess fill be removed from premises? YES_NO~ 14. Names of Owner of premiseSf)o n 30. 'jO \\\12 h~ Adqress,,'llt:? I!alolen In, Ha-!h-JJphone No.J,q f? - "( 2.. q 7 Name of Architect P<<.i\>\\c l"lo\-ruo Addressp.D,P>ovQ'1 t-ln-\\..i.trlPhone No r2q~ - \, ~q Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO Y . * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES X- NO_ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF8vfl'Ol.lc1,) Ac;,~IFf::7)(1I- J:>R07_'bOI.ObKiL being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ----B-j.e 1'1 +- (Contractor, Agent. Corporate Officer. etc.) of said owner or owners. and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this J~ day of otary Public MlCHELLIL MARTOCCHIA IIOI'ARY PURIC.ITATE OF NEW YORK NO. O1MMt5867t . ClUALI'lED..1UFFOI.K COUN1'I ." COI111111lON EllPIRES NOV. 'D. 2lIlQ ~en?"L ~Jnlf)~. Signature 0 pplicant ____ ~ TOWN OF SOU.a., PROPERTY RECORD CARD SCTM # . 11(X))-140-1-g I I Jr;s(r....\ I OWNER STREET o:?'t3 VILLAGE DIST. SUB. LOT fvt1iden ~e... MOJtti tude. q CooL,"t~h(Uimin; lA\I~ ACR. _ REMARKS rh; c..u ~ ).~~~ O,:::,ZS- 4 8hl1 t3P# ?'2..of/Cj ill'.>iMl so/o.K .......~s , TYPE OF BLD. , f<ee.te... Jr. t- ()(S, ~e.. ~e.. t- loT' Reev<- PROP. CLASS 210 C, fA- ~fj .iL LAND IMP. TOTAL DATE 2/00 '7300 / ;"~,~J~~O~ ! ! , - FRONTAGE ON WATER HOUSE/LOT . BULKHEAD TOTAL Ii 0 )> "'0 0 "8 CO) m m m ~ !:ll ?:> 0 ~ I>> )C )C )C 2- Cl iil - - CD . ~ ~ lJJ ". (Q :> :> :> 0: ~ ~ .. .. .. is- o' o' 'P 15' :> :> :> 0 m ." " lJJ ." 0 )C ::;. S' III 0 .., ,.. ~ oi" " 3 ~ "'0 ". ~ :> ~ ii Q) 3 Q. .., Q. ~ I>> jjj " :> - .~ !Jl - o' :> ~I~ (!l Ii ~o r'" m :Il J: :; ." lJJ ~ CD 0" I>> 2t 0 - .., ". o' .., .., .. ." S' iii' :r Ei I; " j;l1 lJJ lJJ !=' r Q .s1 " c: ~ ~ ;Il :> Q) ;Il ;Il ;::;: :I ~ C. .., !! -< Jl III . CD ~ ~ I"" - !!l II 3: o o 6 ... '" :J Q. 1 ., ! t " c , -:-.t '" ) ~ Q a . ,. ..c 1; I U , I- :! I.. ~ Q '" . l; 0 c U UI .. It> ;1 I- '. UI Q, 0 UJ Cl GIl: :s II:). -l 5> Q .... 0 :c I- ::) 0 VI .... l;:; 0 UJ C<: I- Z V1 ~ .0 I- ~ <->0 . I "' / Q ffi , Q Z ",'J\ii ~o }k~:,...~,.~.-,:~~: .,,8.S~" -8' LAND IMP. s-b () / t.l t'() (. ;L to ") d .'~ () ~.. i1 C' cZ/oo .370 .4<.HjQ / ;z. I r.) Q /5'DO ::JrQoc ORMAfoE Acre Tillable Tillable 2 Tillable 3 Woodland Swampland Brushland House Plot Total / .... ... TOWN OF SOUTHOLD PltOPERTY RECORD CARD -- o STREET 7.1.[ e.e..r1e... VI LLAGE it-ne /J1~ r kc 1'\ ~ II/~C/r (~e S HeY"b€", SWQ'i;S'~ i-I FARM COMM. I CB. I MISC. DISTRICT SUB. lOT 9 :e "reI TYPE OF BUilDING 2.. VL. K\-t+.fey I IND. TOTAL REMARKS e , DATE ]Jij tJ 0 1./ 2'0 5S"o &/ (.J(,) / 13) < (,,' f. j __' / vV FRONTAGE ON ROAD BULKHEAD .DOCK '7 c. 171 C v,,,L 2.-l- -z... <f 0 ! 111':,"."",'"""_: -.,-_.,-~.".""";';.",,,,-..,,>. ~ ...:...,. ",'. ..:-<.~"',"-, - ..... ',~ .... --,,",~-- '~ -"- i 'b (1.- vf/", J :::"': ./ ,I. ~ 'Z. ~ /.,,", I) , "" , , , I I I I "'11Ilol [ ~[.::= i I. i: ,.1--"" I/~ ',. !Il~ I !:;a...t~ _-It ii' v-' : I 1 _ ~.... j--r- r--:; I i I ,Y- , '! r! i r--t- ; , , i f-. i I I : I I 1 I 1 ' i ; I ! 2-\ ~i! i ,./~I~~ I I 1 11 . i,.,), :,-- i i : , '~ I I ,.... i I I , vi. Bldg. Floors <I.$:"()13 i'? ~ 2- '0 .. l..' ' i '1..1. ' ,Foundation Bath :xtension II 0 / Basement - s-d' Ext. Walls (1.4+- ~h' _I Fire Place I r ~: iltctf!.- 4/! 5 Porch J 'V Ii) C ,- Porch :xtensior'l I~ f' 4 )(It.!>- Interior Finish . ",tension Heat 0'/ Roof Type J"'d eCrU' ~ ,xI) ;~:k:--(~.r.:? f !( IV' , , I s " Rooms 1st Floor ,.. , 'Z '> 1,2.c; SOl Patio 3 3 /:) I Driveway Rooms 2nd Floor Dormer .:J(} ffKC }.q/! "z S,-'" I I' IT j' I r I i 1 I i I : r i, i : T I I I i I ,I 1 i - , 1 , I ; : ! I I I I , ! i I I I , 11 /e-~i' ~ <" ..1 ~) r /, N.- ,.. '.j .d I ,IT 6F-A- /> /," J- LJ. o i I I I I I , I' /i 'J /' I' Z/f,-{.t'.-f7 U. I .. ( - T' _'W'''_'''.''..".~._.",.. ,,,~ ~ .' '~"'~"I.' ,,..... ,.....;".... - - \ ' - - - -- -- - OWNER STREET VILLAGE DIST. SUB. LOT ACR. REMARKS / TYPE OF BLD. PROP. CLASS LAND IMP. TOTAL DATE - - --- _._ _____ _.u___ _'."_"_ .__.____.__._ .- FRONTAGE ON WATER TILLABLE ---- ._-- --._--- FRONTAGE ON ROAD WOODLAND - DEPTH MEADOWLAND I BULKHEAD HOUSE/LOT -.- -_..- --'-'- .--.- -1___. TOTAL -.-._-_... ~.- - - -- ---._~~- .-.._-.- '_.--~~ TOWN OF SOUTH OLD PROPERTY RECORD CARD ~',' Ii> - , ~ . . . '<- ,.., .... . "',,- .", COLOR - - .", "'". -- 7O.'f\ - - - 1 - -- I -- r. c_~.~ - - ? -- ----._--~ l'i:! -z. -~ . -- - ._-~ 1.1 - - ~ I" -~ -- - .r -- . > < 1> ~ ~ 4- ... TRIM i , - i.- ?, ~ '.",-.1 '"'-, ~,; -- -- "-' ~ I~ .V 140.-1-8 SI06 , .1\2- - --- - - -.-- - -T ,-, r r't~~ 0# ~.,. ~ l\..l o,t' I I I I I I- ( A.... 7 "" 1st 2nd - ~ BI1\9 24 '1(3<0 = 'i<. (,t..c Foundation ,A Ii~yB~ Bath Dinette ..--- \ .,3 }"7)., == ~ ~'1 11':>\ 2.7!:l 3\10 FULL or""'COMBO ~ / Extension Basement CRAWL Floors Kit -- - SLAB -' tik?d .j -- ...~t~~~Jsn I") '>I \:>.,; I<'J(o'-_ Ext Walls Interior Finish L.A. <64cf ,,10 <<;-- ,qqz. -- - --r --- Extension 2..-+ y..~~. Fire Place ~~5 Heat D_A. / -~_.._- .-.--- --- Patio Woodstove BA. t1 sT-- -- - ~~ 6.. ~~lf,,1~>IO~ ~SO ..~ Dormer Baths 1 _L - ./ Deck \ c>)\. :;(,0 ~ 2.Jt:YD .2'6 .5tL Dock Fam. Rm. --------- ./ - A.C. ~- Garage \.. y 27 "- zro4- \~ -.--_--ZW 'f Pw<<~ / -- ~ . J O.B -/ Pool 5'+67 5(06 -----'----- z. , , r- ff.:" , , , ~ , Q; <:: is r .~ ...i 1- ~ l!!I .. I z L.:: .c '" ... tI' al L It;;\- ~ ~J .v al: ~ .g' ~~ - u..., ~5 llll. i L :!; iY. ~~.' E#ifl .~ <:: I .J Li Q C :ft .'- '" Ol .d , "C I E ...l~ <:: Ol ~ ~ :J I '" ~I.a 0 I ., u. al I I ,-. 't r - .- i . ~. - r '. , , - r- - .1 I h,! I' ! {'--J , j~ A~.. ~ : :-;1 :.~~ :', " '" . .., ;1' Of' .... , 4' , i .... " ,;;//'~ I "". ~~ .. I \'/1. ..__....~ ~ I , r~~r... " , ~ .' I .. I .. ~ <:: , ( >' Q 0> :Et; '" , , <:: , " -s... al, Ol , ,J/; :; I x L W .. -A .\ "', , '" .!';' ';C'" ',~' '.<;-"'r.'.:\ " " , .. . - -..- NEW YORK, STATE DEPARTMENT OF ENVIRONMENTAL CONSERV A nON Facility DEC ID 1-4738-03687 o PERMIT Under the Environmental Conservation Law (ECL) Permittee and Facility Information Permit Issued To: DONJAYAMAHA 243 MAIDEN LN MA ITITUCK, NY 11952 Facility: JA YAMAHA PROPERTY 243 MAIDEN LNISCTM# 1000-140-1-8 MA ITITUCK, NY 11952 Facility Application Contact: ARCHITECNOLOGlES 13405 MAIN RD PO BOX 93 MA ITITUCK, NY I 1952 (63 I) 298-1129 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility Principal Reference Point: NYTM-E: NYTM-N: Latitude: Longitude: Project Location: 243 MAIDEN LN, MA ITITUCK WATERCOURSE: MA ITITUCK CREEK Authorized Activity: Construct 480 square foot garage and expand pervious stone drive. All work shall be done in accordance with the attached plans stamped NYSDEC approved on 10/18/07. Permit Authorizations Tidal Wetlands - Under Article 25 Permit ID 1-4738-03687/00002 New Permit Effective Date: 10119/2007 Expiration Date: 1011 9/20 I 2 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator: MARK CARRARA, Deputy Regional Permit Administrator Address: NYSDEC REGION I HEADQUARTERS SUNY @ STONY BROOKI50 CIRCLE RD STONY BROOK, NY 11790 -3409 ~~~~ IY Authorized Signature: Date/tJ /.t.'L!~ Page I of 5 . . New York State Department of Environmental Conservation Division of Environmental Permits, Region One SUNY @ Stony Brook. 50 Circle Road, Stony Brook, NY 11790 - 3409 Phone: (631) 444-0372 FAX: (631) 444-0360 Website: www.dec.state.ny.us ~ -.. ~ Alexander B. Grannis Commissioner October 19, 2007 Mr. Don Jayamaha 243 Maiden Lane Mattituck, N.Y. 11952 Re: Permit #1-4738-03687/00002 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 62 I) we are enclosing your permit. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions, please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Sincerely, ~~ Claire K. Werner Environmental Analyst CKW/dj Enclosure 'NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-03687 o PERMIT Under the Environmental Conservation Law (ECL) Permittee and Facility Information Permit Issued To: DONJAYAMAHA 243 MAIDEN LN MA ITITUCK, NY 11952 Facility: JA YAMAHA PROPERTY 243 MAIDEN LNISCTM# 1000-140-1-8 MA ITITUCK, NY 11952 Facility Application Contact: ARCHITECNOLOGIES 13405 MAIN RD PO BOX 93 MA ITlTUCK, NY 11952 (631) 298-1129 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility Principal Reference Point: NYTM-E: NYTM-N: Latitude: Longitude: Project Location: 243 MAIDEN LN, MAITITUCK WATERCOURSE: MAITITUCK CREEK Authorized Activity: Construct 480 square foot garage and expand pervious stone drive, All work shall be done in accordance with the attached plans stamped NYSDEC approved on 10/18/07. Permit Authorizations Tidal Wetlands - Under Article 2S Permit ID 1-4738-03687/00002 New Permit Effective Date: 10/19/2007 Expiration Date: 10/19/2012 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator: MARK CARRARA, Deputy Regional Permit Administrator Address: NYSDEC REGION 1 HEADQUARTERS SUNY @ STONY BROOKI50 CIRCLE RD STONY BROOK, NY 11790 -3409 ~~~/A ,y Authorized Signature: Date/I} /fL!~ Page 1 of S 'NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEe In 1-4738-03687 ~ Distribution List ARCHITECNOLOGIES Marine Habitat Protection CLAIRE K WERNER FILE Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS NOTrFICA TION OF OTHER PERMITTEE OBLlGA TrONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following Permits: TIDAL WETLANDS I. State Not Liable for Damage 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. 2. Concrete Leachate During construction, no wet or fresh concrete or leachate shall be allowed to escape into any wetlands or waters of New York State, nor shall washings from ready-mixed concrete trucks, mixers, or other devices be allowed to enter any wetland or waters. Only watertight or waterproof forms shall be used. Wet concrete shall not be poured to displace water within the forms. 3. No Construction Debris in Wetland or Adjacent Area 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 wetlands and/or protected buffer areas. 4. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activities. s. Storage of Equipment, Materials The storage of construction equipment and materials shall be confined within the project work area and/or upland areas greater than 100 linear feet from the tidal wetland boundary. 6. Clean Fill Only All fill shall consist of clean sand, gravel, or soil (not asphalt, slag, f1yash, broken concrete or demolition debris). 7. No Beach Excavation For Fill No excavation of the beach is authorized for the purpose of obtaining fill or stone materials. Page 2 of 5 'NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facifity DEC ID 1-4738-03687 1?_ - 8. Area of Disturbance for Structures Disturbance to the natural vegetation or topography greater than 25 feet seaward of the approved structure is prohibited. 9. Install, Maintain Erosion Controls Necessary erosion control measures, i.e., straw bales, 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 and functional condition until thick vegetative cover is established. 10. Runoff Directed to Upland Drywells Roof runoff shall be directed to drywells a minimum of 150 linear feet landward of the tidal wetland boundary for immediate on-site recharge. 11. Driveway/Parking Area of Pervious Material Driveway and parking areas shall be constructed of NYSDEC-approved pervious materials. 12. Notice of Commencement 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. 13. Conformance With Plans All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by Frank Notaro, dated 4/26/07, last revised 8/24/07. 14. State May Order Removal or Alteration of Work 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 flood 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. 15. Precautions Against Contamination of Waters 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. 16. State May Require Site Restoration Ifupon 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. Page 3 of 5 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC lD 1-4738-03687 e - GENERAL CONDITIONS - Apply to ALL Authorized Permits: 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. 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. 3. Applications For Permit Renewals, Modifications or Transfers The permittee must submit a separate written application to the Department for permit 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. Submission of applications for permit renewal, modification or transfer are to be submitted to: Regional Permit Administrator NYSDEC REGION I HEADQUARTERS SUNY @ STONY BROOKISO CIRCLE RD STONY BROOK, NYI1790 -3409 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Tidal Wetlands. 5. Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. 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; Page 4 of 5 .. . NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERV A nON Facility DEC In 1-4738-03687 o 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. 6. Permit Transfer Permits are transferrable unless specifically prohibited by statute, regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee, excepting state or federal agencies, 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 acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in 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 or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item 8: 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. Page 5 of 5 . , . , , , , \--- , ---- , .., ~, \\ ~\ ,\ ~\ , , , \--_--1.... '0 , ,----- , ~, , ~, , , , I s.c TAX LONQ IS~O. 1000 NOOYs' 140'1 T1;;Fi LLc' 23. 1 NYSDllC 'Al'P'R<JVnl AS PER TER.M8 .AND CONDITiONS OF: , ,1IlUift Ne.J_l/ls6-(~,,,&87 /IXXJOJ.- ;t>A'l'Il__--1Q)l&kZCl<~J L ( '" . , L ~ , l ~ . ;-Z ( 'I L c pl < !k (;,IP < &if . 4 < , ; < ~ M4/0E2N L4":J E2 v. ~ .... e.: e .... e :z c.. ~ Eo- .... I ~ ~ ~ g II ; , , S.c TJIX Fin-"; ""..2:'0. 1000 '''"V'fnN Po - 140 NS/Q', -1-7 ~ONE: "'- '0 .... .' ~ :::z. I ---AN ., I --- lli2(Y.4- --_ . I ..1._~~ 1S,C. TAX p40_1 No 1 O~Fi ~}./S.2' 000 , FiLOWSK? OE:aoFiA.H THESE DRA.WlNGBAS IN81'AlJtM5NT8 OF SSMOE, ARE THE &OLE P'AOPEFnY OF THE AAOHITEIOT. ~~~~"T1ON BYnEARCHrTECT. I>H'( REPAODUCTION IN IDMT 0Pl~188'1'R1CTl.Y~"'LAW. - . SITE SURVEY SURVEY OF PROPERTY SITUATE: MATTITUCK TOWN OF: SOUTHOLD SUFFOLK COUNTY. NEW YORK S.C. TAX No. MAP- 1000 - 140 - 1 - 8 CERTIFIED TO: DON L. JAYAMAHA SURVEYED 11-4-2004 AREA = 21.808 S.F. SCALE 1" = 30' tNF"ORMATlON TAKEN FROM SURVEY PREPARED BY ROBERT ~. FOX POX ~3a. RIVERHEAD. N. Y. 11801 831-722-3390 TIDAL WETlAND BOUNDRY N\ 0.1 ~\ \ \ \ \ 1 \ \ 1 \ \ \ \ 1 \ \ \ U1\ ~I ~\ N\ (:1)\ ~ ....\ 1..\ \ \ \ \ 1 'l-r:fJ6 \ ~O>J. \I-I'i"~ \ \ S47o.., <0'10"[2 N4,?03 o'<O"W AREA COVERAGE DATA: TOTAL LOT SQ.FT._ 11,808 SQ.FT. EXIsnNG TOTALSQ.FT. EXISTINQ LOT CO\IERAQe 2.003 SQ, FT. 2,483 SQ,FT. PAOPOeED GAAAc3E 480 sa.FT. TOTAL LOT" c:ovEAAaE 1.",. TOTAL. W/GARAGE EXISTINQ LOT OO'v'EFtAQE TAKEN FROM 8fTE SUFIVEV DATED: el19107 PREPAReD B't: AOBERT H. FOX NVS PLS#l50187 ~ 1 \ \ \ \ S.C 7"A)( Ft/7"A,' MA.F/i!,O. 100 INPo^ \ \ \ 1 1--- \ ----- \ ---- ~ \ ---- ~I -. \\ \ ,\ 0\ 1'\ \ \ 1 'r---I~'O \ 1 ---_~ \ "I \ ~I \ 1 \ 1 .... '. ..... .' ~~ ~ \ \ S,C 7"A)( LONG IS~O, 1000 NO On:..!40. 1 '~''''Ft -<?3 NYSDBe Ltc :AP1'ROITnJ AS PER TERMS AND CONl)ITl0NS OIl' ll'J!U<<I' Ne. J -l/l 5 B_::~ 8 7; 'DA1'll__ I o)1.&J!}.:J.4<~J ARCH - ]$:)06 ITECNOLOGIES AIlCIIlTI!CfURI PLANNlNG CONS'I1UJcrION SIlRVlCBS 1340SMoinIlood,_ NcwYad< 11952 631.298.1129 tu: 631.298.1128 --'-~- r .---:-- 1 1\ G) f" , ,..- , S lh " il l' ~"._. ~- '..~-- .. . , January 8, 2008 JAN~8 ' I l ' "~I L _ .... - :n.; '-.;-.,--' Town of Southold Building Department Southold, NY Re: Mr. Don. L. Jayamaha 243 Maiden Lane Mattituck, N.Y. 11952 S.C.T.M.# 1000-140-1-8 Per your request attached are updated plans and elevations indicating the removal of the existing chimney. If you have any questions please feel free to contact our office at 631-298-1129. Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: 5.C.T.M.#: /000 ...i!:it2 -.L ~ 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 Mark ( ~) for each Question Is Required for a Complete Application) Ves No ---------------------------------------------------- ~ [J ~ [J [d 'X [d ;f. [d ~ [d ~ [d )(I [J ~ [J .J- 1 Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? (ThIs Item will Include all run-off created by site clearing and/or constructlon activities as well as all Site Improvements and the pennanent 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 Slopes Controlling Surface WaterFlowl 2 3 Will this.Pi"oject 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 Activities EncompassIng an Area In Excess of Five Thousand (5,000) Square Feet of Ground Surface? 4 5 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? 6 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to One Hundred (100') of Horizontal Distance? 7 Will Driveways I Parking Areas or other Impervious Surfaces be Sloped to Direct Storm~Water Run-Off into and/or in the direction of a Town right~f-way? 8 Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any Item Within the Town Right~f-Way or Road Shoulder Area? (This Item will NOT Include the Installation of Driveway Aprons.) 9 Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse? 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 Pennitl ---------------------------------------------------- EXEMPTION: Ves No 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 \:J- ---------------------------------------------------- STATE OF NEW YORK, COUNTY OF .?Y.9?akl~............... 55 That I, ..ef,,!f,,;........N.l~~.~.............................. being duly sworn, de~oses and says that he/she is tlle applicant for Penni, (Name of individual signing Document) And tl,at he/she is the ...........A.~.?.~................................................................................................................................ (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 herewith. Sworn to before me this; ...............~~...~.~................ day of ......CI..(....f:.Q.6..~"".......... , 209..7 Notary Public: .~....C:::=~.......... hnM.Jud e a eo ew 0 FORM - 06/07 No. 01 JU6059400 Qualified In Suffolk County Commission Expires May 29, 20 1L ...~.~................................ (Signature of Applicant)