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Home My WebLink About33849-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 08/05/08 Ro: Z-33194 mIS CERTIFIES that the building ADDITION Location of Property: 305 MULFORD (HOUSE NO.) COUnty Tax Map Ro. 473889 Section 14 CT (STREET) Block 2 ORIENT (HAMLET) Lot 3.23 Subdivision Filed Map Ro. Lot Ro. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 17, 2008 pursuant to which Building Permit JIIo. 33849-Z dated APRIL 24, 2008 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to BONNIE KAMEN (OWNER) of the aforesaid building. SUFFOLK CUUJ.u x DBPARTMBlIIT OF HBl\LTH APPROVAL N/A ELECTRICAL CERTIFICATE JIIO. N/A PLUMBERS CERTIFICATIOJII DATED N/A ~/-~ Aut ryed ygnature Rev. 1/81 . Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~- \.-.-.. ,,- ~. --""-"--"-, ;-' '.'r; !f r '\, , ' ~ i i"': ! I ']! AUG 4 2",ns UIJ ," I ~~J '.-,i APPLICATION FOR CERTIFICATE OF OCCUPANC J This application must be filled in by typewriter or ink and submitted to the Building Depart ,l.OC )[nl. - I" 0 UlHOLD A. For new building or new use: 1" 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: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. 7/;olot , I NI2W New Construction: ~ Old or Pre-existing Building: 3o'? HULAJ1Q) ~uff House No. Street BONNIE B. k AI'7E:N !&OO-/+-Z-- 3.2--3 Block (check one) {)f21ENT ?oINT Hamlet 1/15"7 , Location of Property: Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Lot 1'1 Subdivision Filed Map. Date ofPermit.-4~ Applicant: Underwriters Approval: Lot: Permit No. 3?' '8,4- '1 Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: / (check one) Fee Submitted: $ 2/S'veo Go 2:. ~ ~ \ "l L\ ~C 1l}""1) ~ ~~- ( Applic t Signature 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. 33849 Z Date APRIL 24, 2008 permission is hereby granted to: BONNIE KAMEN 305 MULFORD CT ORIENT,NY 11957 for : CONSTRUCTION OF A DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR; FLOOD PMT. at premises located at 305 MULFORD CT ORIENT County Tax Map No. 473889 Section 014 Block 0002 Lot No. 003.023 pursuant to application dated APRIL 17, 2008 and approved by the Building Inspector to expire on OCTOBER 24, 2009. Fee $ 300.00 i~~~ / Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 . TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdT own.NorthFork.net ~L-~- 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 Flood Permit Storm-Water Assessment Form ~ ... PERMIT NO. 3~ f?P1 C:- tfpy1 , 20 O~ 1/;1 ,20~ Examined Approved Disapproved ale Contact: Mail to: Phon"u~5 ~ Expiration /c>, I. J:::" r~20, OJ, I - '-~ '\' _ ,- "'- ~ \ , ", "'. n'l ;e ~g Inspector c- .\ \ 1 . ~J\ APPLICATION FOR BUILDING PERMIT Date .. '1- INSTRUCTIONS ,20_ l a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of South old, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. t(/ 0CiJ (Signature of a bBS +r",ck I\JE lLJC.hDl-U: ilBS (Mailing address of appli t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder A~ Name of owner of premises ~f'lN\!;"" K4'<.M<<'l'.\ (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. S (0 "331 - H Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which .l!.ropqsed work will be done: . :SO~ Mt.\.I'hlfC (t Ofit--'l-\ House Number Street -pt Hamlet County Tax Map No. 1000 Section Subdivision Itf Block .~- ;;z- File(l'M'ap No. Lot 3. 2 3 ::, Lot ~ _.t,. ", . t" ,.;~....(";;i-a:d~J 2. State existing use and occupancy of premises and intended use and occupancy-ofproposed construction: a. Existing use and occupancy . · b. Intended use and occupancy N E"~ o.ect 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition 'f.. Other Work Alteration 4. Estimated CostJO K (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 Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of en~ire new construction: Front y , ~ Height Aj>r1l i oS ' Number of Stories //1/ IClB' 9. Size oflot: Front lQ !Q Rear I . , Rear-3/ Depth J'i / 2 <f I I Depth I 2..15 10. Date of Purchase Name of Former Owner II. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO X 13. Will lot be re-graded? YES_ NOA Will excess fill be removed from premises? YES_ NO-X 14. Names of Owner ofpremises~""N;~ k~ddress 3'", ""'''I.It;/rd C-\- Phone No. ?z..?- Name of Architect Address Phone No Name of Contractor Sr"~1t F"'i.l:t1- Address b~ trJI<C.k: lA.,jE Phone No. 1-") ')-'-1 e7.15 C",~d.i~~ IS a. Is this property within 100 feet of a tidal wetland or a freshwater wetlan~1? *YES _NO L * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES_NO ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES_NOX * IF YES, PROVIDE A COPY. being duly sworn, deposes and says that (s)he is the applicant ame of individual signing contract) above named, r-J--\ (Contractor, .':~ ent 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. efore me th~'S' '\ .ri7J yof \ 20~ , , ) Cl Not SKI NOTARY PUBLIC. Stale of New'lll!tl No. 01004634870 Qualified In Suffolk County 11\ 1 D CoInmIIalon Expirlli Seplllmber 30. ~ cant _,j 6~~ 7 '2;-- TOWN OF SOUTHOlD BUilDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] RRE RESISTANT CONSTRlICnON [ ] ROUGH PLBG. [ ] I,.oLATION [ ~INAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRAnON DATE fo/,q!{)!? t l INSPECTOR FIELD INSPECTION REPORT . FOUNDATION (1ST) FOUNDATION (2ND) . ROUGH FRAMlNG & PL 1JJY[BIN G LNSULATION PER N. Y. STATE ENERGY CODE FINAL ~~ r-. '" i't'J . ~lA/ f~.r-:...-Hf., ~~ I 'h "\../. / '- 74 I r~~ . t/ '" g; ~,~ ~. )> " \ DATE I COMMENTS L.!to ^~ L.-r-' ~ -J.J: . I .~ . P' 'fo tiL- I '~I~.}-./..t.L.' /'~. -.7 ~_$.- .,,~ '~. 1~ './ '""\.'.. /# 1 , '/ftl "nJ>- J.?, ('f I ---- f----- . A ~.../ /;", ~._j {.-.e, / .4 -.... ~ JA 'f!-~;." //' ~""7.... 1/ ./ ~/.n ".//~" . /./ ;/ r /_ E. r_"p _/' II . 7/1<1-1 9f" /~ --- . ~ct; ~~ .tJ /;',/7;;- I r -c,..L L. g _ 9'--1J,,,~/' _'.~ I --z:r---r , ADDITIONAL COMMENTS . . . . . - -- - s~ ~~ ~~ 0:: ~~ , c; ~.>-l ~ . '\ " . 1 ~' ~ 0 ,~' ~ ~ m ~;o ~ , ~\ ~~ I ?;; ~~ I 5 ~z ! ~ ~ , ~ ',; . /'/ ./-3 ~ Condon Engineering, P.C. New York State Licensed Professional Engineers \ .~.. ~'._".--lJ, i"- ,0 0 1755 Sigsbee Road Mattituck, New York 11952 631-298-1986 Fax 631-298-2651 June 27, 2008 Gary Fish - Building Inspector Building Department Southord Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971 . RE: Kamen Property, 305 Mulford Ct, Orient, New York Pennit No. 33849 Dear Mr. Fish: The footings and piers installed for the proposed deck at the 305 Mulford Court residence are adequate and to the best of my knowledge are constructed and installed in accordance with the NYS Building Code. Please call me if you have any questions. JUDITH T. TERRY TOWN CLERK ~0\ Q\j 339, yel " flEGIS-mAR OF VITAL ST^1lS11CS MARmAGE OFFICER RECORDS MANAGEMENT OFFICEH FREEDOM OF INFORMATION OFFICER Town H;'lll. 5JOQ5 t\.'1alll RO<Jd P,O. Ilox 117C) Soullmld. Nl:w York 11t171 Fax (Sl{l} 765-1 R2.\ Telephone (:'i I (,1 7(1)' I XO I OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that th€ Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93)], and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)]. IfOI/3 (~, !~::- --- ~; ~- . - I - J "'1 ;"1 ,: .......,,-. -- Bi...:iu. o~n. TOWN OF SOtJTHOLD ~~ ~T.T~ Southold Town Clerk August 25. 1993 APPLiCATION # P^GE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. - SECTION 1: GENERAL PROVISIONS (APPLICANT 10 read and sim): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or oeenpied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable . inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL TATEMENTS HEREIN AND IN ATTACHMENTS TO _ THIS APPLICATION ARE, TO THE B OF M OWLEDGE, TRUE AND ACCURATE. (APPLICANT'S SIGNATURE) DATE 5 h 0/08 SECTION 2: PROPOSED DEVELOPMENT (To be comoleted bv APPLlCAJ','Tl NAME ADDRESS TELEPHONE APPLICANT S c-crt1 ~d.-~ ~ 5'5 +r~~ ~ ~ C\.<. \Lk~~ 2'5'5 '-l I) 2-8 BUILDER " ^ ~ /"' ., Po. .f b 0 . ~ l _~ +, o..-c. ~ "'N j '2.. ~) '-{-u '-<...J ENGINEER "S \....~ c.. 0 N d or-I PROJECT LOCATION: To avoid delay in prOCCS$ing the applicatioD, please provide enough informatioD to easily ideDtify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. ~~~ ~ ~ ~ ~~,t.( ON Li~,,-:el M:r~C-of.~~~~~\- ?*- ., ~( FDP(93) APPLICATION # PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicahle boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE oResidential (1-4 Family) o Residential (More than 4 Family) o Non-residential (Floodproofwg? 0 Yes) o Cnmbined Use (Residential & Commercial) o Manufactured (Mobile) Home (In Manu- Cactured Home Park? 0 Yes) ~ew Structure o Adclition o Alleration o Relocation o Demolition o Replacement ESTIMATED COST OF PROJECT S '30 K B. OTHER DEVELOPMENT ACTIVITIES: o Fill 0 Mining 0 Drilling 0 Grading o Excavation (Except Cor Structural Development Cheeked Above) o Watercourse Alteration (Inclucling Dredging and Charwel Modifications) o Drainage Improvements (Including Culvert Work) o Road, Street or Bridge Construction o Subdivision (New or Expansion) o Individual Water or Sewer System o Other (Please Specify) After completing SECTION 2, APPLICANT sbould submit form to Local Administrator for review. - SEeTION 3: FLOODPLAIN DETERMINATION ITo be eomnleted bv LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. . Dated The Proposed Development: o Is ~ loeated in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). o Is located in a Spedal Flood Hazard Area. ARM zone designation is lOO-Year nood elevation at the site is: Ft. NGVO (MSL) o Unavailable o The proposed development is 10C3led in a noodway. FBFM Panel No. Dated o 'See Section 4 ror additional instructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REOUIRED (To be comoleted bv LOCAL ADMINISTRATOR) Tbe applicant must submit the documents checked below before tbe application can be processed: o A site plan sbowing tbe location of all existing structures, water bodies, adj~cent roads, lot dimensions and proposed development. o Development plans, drawn to scale, and specifications, including where applicable: details for anchoring structures, proposed elevation of lowest Ooor (including basement), types of water resistant materials used below the first floor, details of floodproofUlg of utilities located below the frrst Ooor and details of enclosures below the frrst Ooor. Also. o Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide lOO-year Oood elevations if they are not otherwise available). o Plans showing the extent of watercourse relocation and/or landform alterations. o Top of new fill elevation Ft. NGVD (MSL). o Floodproofmg protection level (non-residential only) Ft. NGVD (MSL). For lIoodproofed structures, applicant must attach certification from registered engineer or architect. o Certification from a registered engineer that the proposed activity in a regulatory 1I0odway will not result in !!ill' increase in the height of the lOO-year flood. A copy of all data and calculations supporting this fUlding must also be submitted. o Otber: SECTION 5: PERMIT DETERMINATION ITo be comDleted bv LOCAL ADMINISTRATOR) I bave determined tbat tbe proposed activity: A. 0 Is B. 0 Is not in conformance with provisions of Local Law # , 19 The permit is issued subject to the conditions attached to and made part of this permit. -- SIGNED . DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated ree. If ~OX B is checked, the Local Administrator will provide a wriuen summary of deficiencies. Applicant may reVIse and resubmit an application to lhe Local Administrator or may request a hearing from the Board of Appeals. APPLICATION # PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? 0 Yes 0 No Hearing date: Appeals Board Decision --- Approved? 0 Yes 0 No Conditions SECTION 6: AS-BUILT ELEVATIONS fTo be submitted bv APPLICANT before Certificate of Comoliance is issued) The foUowing information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land swveyor (or attaeb a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal Hi"h Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodprooflDg protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION ITo be comoleted bv WCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE DATE DATE BY BY BY DEFICIENCIES? 0 YES 0 NO DEFICIENCIES? 0 YES 0 NO DEFICIENCIES? 0 YES 0 NO SECTION 8: CERTIFICATE OF COMPLlANCEITo be comoJeted bv WCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a special Flood Hazard Area . TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: o NEW BUILDING o EXISTING BUILDING o VACAl\'T LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19 SIGNED: - - DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # ,19_. AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: (/((93) Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T,M. #: /000 ~ ~ 3:2..3 District Section Block lot THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAH CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. Item Number: (NOTE: A Check Mark (I) for each Question is Required for a Complete Application) 1 2 3 4 5 6 7 8 9 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 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 Slopes Controlling Surface WaterFlow! 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 Activities 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 Storm-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 Item will NOT Include the Installation of Driveway Aprons,) Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse? Ves No ~~ ;(1& [d~ [d [d [db< [d:i [d~ [d'i ~ 'L( 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 Permltl 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 Requlredl ~ STATE OF NEW YORK, COUNTY OF ..,......................................., SS That I, S,c.a::H........E.d9~...............,.............. being duly sworn, deposes and says that he/she is the applicant for Pennit, (Name of indIVidu(;;~~~t~ment) ~ And that he/she is the ........~~~.+.../...(~.t.::!..~~..L9..g"........................................,............,..................... 11'.... (Owner, Contractor, Agent, Corporate Officer, etc.) Owner 'md/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 cont;uned in this application are true to the best of his knowledge ,md belief; and that the work will be performed in the manner set forth in the application filed herewith./ Sworn to befo4lne tins; J'l.. . ;1 ................n....:'~................. day of ...!1.j~.I..d........................ , 20.b..~ J:r..---k-: . ^'. I' I jC4J~ Not.uy PublIc: .... . .................~[ANi(fjfjROSKi........ .. .......... .......is;~;~t~;.;..;;... p''''''') NOTARY PUBLIC State of New York o. Qualified in Suffolk Cuuntv W Commission Expires September 30, ---!. Cl FORM. 06/07 FLOOD ZONE AE ELEV.9.0 MAP NO. J610JC0069 LOT AREA= 40,111 sq. ft. F.FL. ELEV.= 18.1 DATUM NGVD ~~~ LOT NUMBER 18 . WELL ----- ----- - 10' -;asement - -/- 198.84' (5.1) (Il.J) SET STI( (8.2) S 21'14'4O'E / -.l . -.9, "'~9, .L- ".,~ "%- ~ ~ ~ o u I'D. fIR b o ll'i ~ '" , ;., co N CD ~ ~ 0 ~ " ~ ~ ~ j.oJ 0 ffi ::s '" In ~ ::IE &:l ::l 2: CD ... 2: 0 ...J r N 21'14'40"W (9.7) , ~; '/ o '" '. ffi en 2 ;:) 2: ... 9 57.0' 2 1/2 SlY .. FR 'o,j q DWELl S.., \0 cO 1'"< WATER ........ UtE: ~" gra.. j:- 'tS'. ~parldng ~ a..... . ri\l ~ \1 ~ ~ \ 166.00' WEll. . (12.0)1'D. fIR 1.J'E, MULFORD COURT (10.7) 9-24-07 ADDED CESSPOOLS. WATER LINE B PROPOSED DRIVEWAY N/F WHITCOM INVESTMENT COMPANY NOTE: CESSPOOL, SEPTIC TANK. WELL AND WATER UNE LOCATION BY OTHERS 1111 ...,..,.,L OF ~ OF lM'IlI _ 011 ~ OF AECCIIJ. F NIf. NOT ~ 1M NC1T CJWMA IC&IIo _ llFFIE1'I (OR -> _ _ ..- lHE Il1IlC1\RS TOlHE ~IT UNES ME FllR A .-mFlC ~ _ UIi: _ _ #<IE NOT IN1UIIlED TO lIUI][ lItE _ OF -. __ wu.s. PllOI.S, I'o\nas, PlNfI1NO /IIfEJtII.. ADDmON TO ..... - JGIS OR NIt 01MER ~ UIWl1llllRlZEll ALTeRATlON OR AIlOITIClN TO TItS SUIM:Y IS A \IIOlA11ON Of" lIEC110N 72011 Of" 1111 NEW VllIlK STATE EIlUCA110N l.Mf. GI..WW.lu:.oa lNDICA1m HERON !tW.L RUN ONLY TO ntE PER!ION FOR WHOW 1HE Il.IM.Y IS . .41 VtED. NI) ON HIS IDW.F TO 1HE 1m.[ CD/JINIIf. exMJIJUENTN.. _ NIl ~ INSI1M1ClN U8lIII HERUlN, _ TO _. &I Of" lH[ LDDNO INI11'MION. GU:nIW lu.:Il _ NOT 1'1WIN~ TO ~ tNITIlUT10NS OR SI.-.:'N Dr OWNERS. coPIES Of" llilS SLJR\olEY _ NOT _ lliE LAND SUIlW'f'DR'S IlICED SEAl. DR EWIJOSSEl) so.L. .wJ.. NOT .-:: co.-Id':.--.v .TO IE A VN.J) T1tuE 0/JIII"f. CERTIFIED ONLY TO: BONNIE KAMEN PARTNERS LAND AGENCY, LLC. TITLE NO. 06190-5 li",,"l.( F T:. ~ ......L- ~ N.Y. L1C. No. 048992 HAROLD F. TRANCHON JR. PENN. L1C. No. 2115-E JOB No. 06-475 FILE No. GRANDVIEW ESTATES SURVEYED FOR BONNIE KAMEN LOT NUMBER 19 MAP OF GRAND VIEW ESTATES AT ORIENT SITUATED AT ORIENT TOWN OF SOUTH OLD - SCALE ," = 40' FILED MAP No. 7083 SUFFOLK COUNTY N.Y. DATE 12-20-2006 DATE 6-8-1982 TAX MAP No. (REF ONLY) 1000-14-2-3.23 DISK 500 HAROLD F. TRANCHON JR. P.C. LAND SURVEYOR 1866 WADING RIVER-MANOR RD. WADING RIVER, NEW YORK, 11792 631-929-4695