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HomeMy WebLinkAbout33314-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33421 Date: 12/09/08 THIS c~TIFIES that the building ADDITION & ALTERATION Location of Property: 420 LAKEVIEW TERRACE EAST MARION (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 31 Block 9 Lot 11 Subdivision FiledMap No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 27, 2007 pursuant to which Building Permit No. 33314-Z dated AUGUST 13, 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 SKYLIGHT REPLACEMENT, RE,iR DECK ADDITION WITH PERGOLA AND SIDE COVERED PORCH ADDITION (WHICH MUST REMAIN UNENCLOSED AS PER ZBA #6153 DATED 5/8/08) TO AN EXISTING ONE F~24ILY DWELLING AS APPLIED FOR. ~e certificate is issued to MICHAEL & KIM KENIN (OWNER) of the aforesaid building. SUFFOLK COUi~I~fDEPARTMENTOFBF-~J~THAPPROVAL ELECTRICAL CERTIFICATE NO. pLiERS CERTIFICATION DA'rEm N/A N/A N/A Rev. 1/81 This application must be filled in by typewriter or iuk and submitted to the Building Department with the following: A. For new building or new nsc: 1. Final survey of property with accurate location of all buildings, prope~'ty lines, streets, and unusual uatural or topographic features. 2. Final Approval from Health Dept. of water supply and sexverage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement frmn plumber certifying that tbe solder used in system contains less than 2/10 of 1% lead. 5. Cmmnercial building, industrial buildiug, multiple residences and sinfilar buildings and installations, a certificalc of Code Compliance fkom architect or engineer responsible fbt Ihe building 6. Submit Planning Board Approval of completed site plan ~equirements For existing buildiugs (prior to April 9, 1957) non-conforming uses, or buildings aud "pre-existing" land uses: 1 Accurate survey of pmpe~%.' showing all property lines, sheets building and uuusual natural or topographic features 2. A properly completed application and consent t(~ inspccl aigmd b) the appltcmm Ifa Certificate of Occup:mcv is denied, the Building Inspecto~ sh~ll state the reasrms therefc~ in writing to the applicanL C. Fees Ce~tificateof(Dccupa~% New dwelling $)5 0 .kddhic~;I,)dx~.ellmgSPqA)0, Altemtions to dwelling $25 00, Swi~mning pool $25.00, Jkcccsst~y building 525 00. Additions; 2. Certificate of'Occupancy on 3 Copy of Ce~ificate of Occupancy $25 4 UpdatedCe~ificatcof()CCUlgancy- $5000 5 'Fempo~ary Ce~lificalc of()cctq~ancy }4¢sidential 51 q I~). (:~nnme~cia/$15 0(~ Ne Constm~tmn: Old o~ Pm-existing Buiklmg: (check one) Location of Prope~y: ~ ~e '~ _ ilouse Nu Slteel ' flamlet Suffolk C(~unty Tax Map No 1000, Subdivision Ii lcd Nlap Lot: Pemxit No ~'b~ l ~ Health Dept. Approval: 1 lnderwril ers Appi oval: Platming Board Approval: Request for: Tempora0' Certifical¢ Fee Submitted: $ ?r~- ,'~~ c.. Y 3'3'5 FinalC. ertthcatc:' - / (check one) Applicant Signature' FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII~JING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PER~4IT NO. 33314 Z Date AUGUST 13, 2007 Permission is hereby granted to: MICHAEL KENIN 200 EAST END AVE NEW YORK,NY 10128 for : REPLACEMENT OF SKYLIGHTS AS APPLIED FOR; AMENDED TO INCLUDE A COVERED ENTRY (PER ZBA 6153) & REAR DECK AS APPLIED FOR at premises located at 420 LAKEVIEW TERRACE EAST MARION County Tax ~ap No. 473889 Section 031 Block 0009 Lot No. 011 pursuant to application dated JULY 27, 2007 and approved by the Building Inspector to expire on FEBRUARY 13, 2009. Fee $ 200.00 / Authorized Signature ORIGINAL Rev. 5/8/02 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. 33314 Z Date AUGUST 13, 2007 Permission is hereby granted to: MICHAEL KENIN 200 EAST END AVE NEW YORK,NY 10128 for : REPLACEMENT OF SKYLIGHTS AS APPLIED FOR at premises located at 420 LAKEVIEW TERRACE EAST MARION County Tax Map No. 473889 Section 031 Block 0009 Lot No. 011 pursuant to application dated JULY 27, 2007 and approved by the Building Inspector to expire on FEBRUARY 13, 2009. Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0388C Date December 3, 2008 THIS CERTIFIES that the removal of the swimming pool, construction of a new 9'X 13' covered deck, 9'X 28' wood deck, 13'X 24' semi-circular stone patio, 12'X 12' pergola, gutters and drvwells At 420 Lakeview Terrace, East Marion Suffolk County Tax Map #31-9-11 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 4/21/05 pursuant to which Trustees Wetland Permit 6127 Dated 5/18/05 and Amended on 10/17/07 was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the removal of the swimming pool, construction of a new 9'X 13' covered deck, 9'X 28' wood deck, 13'X 24' semi-circular stone patio, 12'X 12' pergola, gutters and dry, veils. The certificate is issued to MICHAEL KENIN owner of the aforesaid property. Authorized Signature James F. King, President Jill M. Daherty, Vice-President Peggy- A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 17, 2007 Mr. William J. Lohn Suffolk Environmental Consulting, Inc. P.O. Box 2003 Bridgehampton, NY 11932-2003 RE: MICHAEL KENIN 420 LAKEVIEW TERRACE, EAST MARION SCTM# 31-9-11 Dear Mr. Lohn: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, October 17, 2007: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #6127 to construct a 9' x 13' covered deck and steps on the northern side of the existing dwelling; 9' x 28' wood deck and steps with associated planter on the eastern side of the dwelling; 13' x 24' semi-circular stone patio on eastern side of dwelling; and 12' x 12' pergola with benches and associated planter on eastern side of the dwelling, with the condition of the installation of drywells and gutters to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Runoff, a line of staked hay bales to be installed prior to construction, and as depicted on the revised survey prepared by John C. Ehlers Land Surveyor, last revised October 25, 2007, received on October 31,2007. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, President, Board of Trustees JFK:eac APPEALS BOARD MEMBERS Gerard P. Goehringer. Chairman Ruth D. Oliva James Dinizio, Jr. Michael A. Simon Leslie Kanes Weisman http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 · Fax (631) 765-9064 Mailing Address: Southold Town Hall 53095 Main Road · P.O. Box 1179 Southold, NY 11971-0959 Office Location: Town Annex/First Floor, North Fork Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 FINDINGS, DELIBERATIONS AND DETERMINATION MEETING HELD MAY 8, 2008 ZBA it 6153 - MICHAEL KENIN Location of Property: 420 Lake View Drive, East Marion CTM 31-9-11 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further steps under SEQRA. BASIS OF APPLICATION: Request for a Variance under Section 280-124, based on an application for a building permit to construct and the Building Inspector's March 10, 2008 Notice of Disapproval, amended April 1, 2008, for the reason that the proposed additions to the existing single-family dwelling will be set back less than the code-required minimum of 35 feet from the front yard lot line. CHAPTER 280 OF TOWN CODE .(formerly Chapter 100): Zoning Code Section 280- 124 which states that non-conforming lots measuring less than 20,000 square feet in total size shall have a minimum front yard setback of 35 feet for an addition to a dwelling. FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on April 24, 2008, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant: AREA VARIANCE RELIEF REQUESTED: The Applicant proposes to construct a covered deck with steps (open, roofed-over porch) as an addition to the existing single- family dwelling, with a setback of 30 feet from the front yard lot line. REASONS FOR BOARD ACTION: On the basis of testimony presented, materials submitted and personal inspections, the Board makes the following findings: Page 2 - May 8, 2008 ZBA # 6153 - Michael Kenin CTM 31-9-11 1. Town Law §267-b(3)(b)(3)(1). Grant of the variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The dwelling is presently 16.8 feet from the adjacent 20-foot right-of-way at its closest point. The wood deck is proposed at 30 feet from the right-of-way and is small (9 feet long and 4 feet wide) and minimally visible from neighboring properties. 2. Town Law §267-b(3)(b)(2). The benefit sought by the applicant, adding a covered porch and steps, cannot be achieved by some method feasible for the applicant to pursue other than an area variance. 3. Town Law §267-b(3)(b)(3). The variance relief requested is not substantial. It amounts to 14.3% of the code-required 35 foot front yard setback. The variance concerns only the short side of a proposed 4' x 9' open porch (covered deck with steps). 4. Town Law §267-b(3)(b)(5). The difficulty is self created only insofar as it is the result of a desire to add a porch to an existing house. 5. Town Law §267-b(3)(b)(4). No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. 6. Grant of the relief requested is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of an unenclosed, roofed-over front porch, while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In consideripg all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Simon, seconded by Chairman Goehringer, and duly carried, to GRANT the variance as applied, as shown on the 3/01/08 site survey prepared by John C. Ehlers, and on the October 4, 2005 Plan View-Elevation Sheet Do1 amended 1/12/07 prepared by Metz Design, signed by Joseph Fischetti, P.E., Page 3 - May 8, 2008 ZBA# 6153 Michael Kenin CTM 31-9-11 subject.to the following condition: That the proposed porch shall remain open on three sides and not be enclosed or screened4n. Any deviation from the variance given such as extensions, or demolitions which are not shown on the applicant's diagrams or survey site maps, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. Vote of the Board: Ayes: Members Goehringer (Chairman), Dinizio, Oliva, Simon, and Weisman. This Resolution was duly a~~. ~..~-~'" ~-~ ,/~z ~. Gerard P. Goehrm~er, Chm~nan 5/20/2008 ?" Approved for Filing f: NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER 1-4738-03574/00001 FACILITY/PROGRAM NUMBER(S) PERMIT Under the Environmental Conservation Law EFFECTIVE DATE November 15, 2007 EXPIRATION DATE(S) November 14, 2017 TYPE OF PERMIT III New []Renewal [] Modification E3 Permit to Construct E] Permit to Operate E] Article 15, Title 5: Protection of Waters [] Article 15, Title 15: Water Supply [] Article 15, Title 15: Water Transport E3 Article 15, Title 15: Long island Wells [] Article ~15, Title 27: Wild, Scenic and Recreational Rivers [] 6NYCRR 608: Water Quality Certification [] Article 17, Titles 7, 8: SPDES [] Article 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamation · Article 24: Freshwater Wetlands [] Article 25: Tidal Wetlands [] Article 27, Title 7; 6NYCRR 360: Solid Waste Management Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management Article 34: Coastal Erosion Management Article 36: Floodplain Management Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control PERMIT ISSUED TO Michael & Klm Kenin TELEPHONE NUMBER (212) 722-5230 ADDRESS OF PERMITTEE 1236 Park Ave. New York, N.Y. 10128 CONTACT PERSON FOR PERMITTED WORK (631) 537-5160 Suffolk Environmental Consultants P.O. Box 2003, Brid~ehampton, N.Y. 11932-2003 NAME AND ADDRESS OF PROJECT/FACILITY Kenin Property, 420 Lake View Terrace, East Marion COUNTY Suffolk TOWN Southold WETLAND # TELEPHONE NUMBER NYTM COORDINATES E: N: DESCRIPTION OF AUTHORIZED ACTIVITY: Construct a covered deck/steps, deck with steps/planter, stone patio, pergola with benches and fixed dock. All work is to be done in accordance with NYSDEC plans stamped approved on 11/15/07 and prepared by John C, Ehlers Land Surveyor on 10/25/07, By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified and any Special Conditions included as part of this ~ermit, DEPUTY PERMIT ADMINISTRATOR: Roger Evans (CAF) AUTHORIZED~~ IADDRESS Region 1 Headquarters SUNY (~ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 November 15, 2007 Page 1 of 4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. Any work, disturbance, and or storage of construction materials shall be confined to within the limit of clearing and ground disturbance shown on the approved plan. 2. Any demolition debris, including excess construction materials and or excess excavated materials, shall be disposed of on an approved upland site more than 100 feet from any regulated freshwater wetland by the close of business on the day such material was generated. 3. Heavy equipment, including bulldozers, backhoes, payloaders, etc., shall not be operated in the wetland. Dock must be installed with hand tools only. 4. Prior to commencement of any construction activities, a continuous row of straw bales shall be staked end to end as shown on the approved plans. The bales shall be maintained, repaired and replaced as often as necessary to ensure proper function, until all disturbed areas are permanently vegetated. Sediments trapped by the bales shall be removed to an approved upland location before the bales themselves are removed. 5. Straw bales shall be recessed two to four inches into the ground at all times. 6. All fill shall consist of clean soil, sand and gravel that is free of the following substances: asphalt, slag, flyash, broken concrete, demolition debris, garbage, household refuse, tires, woody materials including tree or landscape debris, and metal objects. 7. All equipment and machinery shall be stored and safely contained greater than 100 feet landward of the regulated wetland or waterbody at the end Of each work day. This will serve to avoid the inadvertent leakage of deleterious substances into the regulated area. Fuel or other chemical storage tanks shall be contained and located greater than 100 feet landward of the regulated wetland or waterbody at all times. If this requirement cannot be met by the permittee, then the storage areas must be designed to completely contain any and all potential leakage. Such a containment system must be approved by NYSDEC staff prior to placement of equipment, machinery or tank storage within 100 feet of the regulated wetland or waterbody. 8. All areas of soil disturbance resulting from this project shall be seeded with an appropriate perennial grass and mulched with straw immediately upon completion of the project, within two (2) days of final grading, or bythe expiration date of this permit, whichever is first. Mulch shall be maintained until a suitable vegetative cover is established, if seeding is impractical due to the season, a temporary mulch shall be applied and final seeding shall be performed as soon as weather conditions favor germination and growth. 9. Suitable vegetative cover is defined as a minimum of 85% area vegetatively covered and no unvegetated areas larger than one (1) square foot in size. 10. 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, Bureau of Habitat Regional Manager, SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790-3409 DECPERMITNUMBER I PAGE 2 of 4 1-4738-03574/00001 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 ( FRESHWATER WETLANDS) 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. 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 im provem ent of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 3. Ail necessary precautions shall be taken to preclude contamination of anywetiand or waterway bY suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 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 floodplain, deposits within any regulatory floodway, 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. 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. 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. 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. 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 John C. Ehiers Land Surveyor on 10/25/07. DEC PERMIT NUMBER I PAGE 3 of 4 1-4738-03574/00001 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, excepting state or federal agencies, expressly agrees to indemnity 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, 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 attdbutable 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 prevision under federal or state laws. 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 can3/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 Envirenmental 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 modity, 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 iAPC) 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, SUNY ~ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 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. DEC PERMIT NUMBER I 1-4738-03574/00001 IPAGE 4 of 4 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG, [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [/~/FINAL /~ ', [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSUL~,TtON FRAMING / STRAPPING [/,~--FINAL FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION FIRE RESI~T CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~~:~~~~'~ DATE/©/'~ / TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 SPECTION [ N 1ST [ ] ROUGH PLBG. INSULATION FINAL FIRE SAFETY INSPECTION FIRE RESISTANT PENETRATION ] FOUNDATION 2ND [ ] FRAMING / STRAPPING ] FIREPLACE & CHIMNEY ] FIRE RESISTANT CONSTRUCTION REMARKS: ~'~ DATE INSPECTOR/~~-/~~ F1E, I~D IkNSPECTION REPORT I DATE [ COMMENTS ~ -, / ~ /~ ~ FOUNDATION (1ST) ~_ ~ FOUNDATION (2ND) c~.~~ ~~. ~~. ~.~' , ~'- ~DITION~ COUNTS ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL * SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ ,i Examined [//1~ ,200 Approved ~//{) ,200~ Disapproved Wc 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 -~ Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: authorized inspectors on premises and in building for necessary inspections. ALL CONSTRUCTION SHALL (Signature of applicant or name, if a corporation) MEET THE REQUIREMENTS OF THE _ _ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder n<(- APPfl VED AS DT.ED Name of owner of premises ~'lC-' k0~,' I~e-FI {'~ ~A~IE:~ (As on the tax roll o : - ' , If applicant is a corporation, signature of duly authorized officer 765-1802 8AM TO 4PM FOR THE th~l ID ^ kl/~V (Name and title of USE IS UN WFUL Builders License No. lill~l I~ l~ ~*l~l~ a *~ Plumbers License No. UII I ~O IuC :l!KIU~ I C Electdci~s License No. ~ Oth~ Trade's License No. 1. Location of land on which proposed work will be done: House Number Street County Tax Map No. 1000 Subdivision (Name) Section '"~ I FOLLOWING INSPFC'7ONS: 1. FOUNDATION - T ':3 REQUfRED FOR POURED CC SREIE 2. ROUGH. FRA!~:,NG & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL OONSTRUOTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW '~C i:,!r ~CT~.TE, Ni~T~ RESPONSIBLE ~Ol;i Hamlet Lot'S.. I[ Fil$8'Map No. ? Lot !'~i~ (~'~'.-~ ~--~i;:' 'Building p tor t~it~"~ ';["?' ' ~'' L-~ ~ ~APPLICATION FOR BUILDING PE~IT : ;.~oE~:. · Date l,20 a. This application MUST be completely filled in by t~ewfiter or in i~ and submitted to the Building Nspector with 4 sets of plus, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing locmion of lot and o¢ buildings on premises, relmionship to adj oin~g premises or public streets or areas, and wate~ays. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon approval of this application, the Building Nspector will issue a Building Pe~it to the applicant. Such a pe~it shall be kept on the premises available for inspection t~oughout the work. e. No building shall be occupied or used in whole or in pa~ for any pu~ose what so ever until the Building Inspector issues a Ce~ificate of Occupancy. L Eve~ building pe~it 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 ~om such date. If no zoning amendments or other repletions affecting the propeNy have been enacted in the interim, the Building Inspector may autho~ze, i~ writing, the extension of the pe~it for an addition six momhs. Thereager, a new pe~it shall be required. ~PLICATION IS HE,BY M~E to the Building Depa~ment for the issuance of a Building Pe~it pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Re~lations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicam agrees to comply with all applicable laws, ordinances, building code, housing code, and re~lations, and to a~it State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost ~ 72_ ( ~ -~ Fee 5. If dwelling, number of dwelling units If garage, number of cars //' Addition Alteration OtherWork (0,-eO.[~a:e~n~ e~4- o4 _~ r~4 1, ~-~ (DescriptiOn) Number of dwelling units on each floor (To be paid on filing this application) 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front /~ Rear // Depth Height /~ Number of Stories ,// // Dimensions of same structure with alterations or additions: Front /"- ,Rear ,,// Depth J Height ~ Number of Stordie~ tt ' 8. Dimensions of entire new construction: Front ~ Rear ~ Depth Height y Number of Stories ,// r-''/ ,//' 9. Size of lot: Front Rear .Depth 10. DateofPurchase ~e~.> Name of Former Owner tt~'~fr- CLt~/q/P,J 11. Zone or use district in which premises are situated f~'SCe~ ~-(-t q~c . ~ 5-'/- /ffJ&r-~csx9 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO / 13. Will lot be re-graded? YES__ NO ~'1 excess fill be removed from premises? YES.__ NO__ 14. Names of Owner of premises ~ £t)~*,e ~ ~¢m'O~ddress Name of Architect ~ Address Name of Contractor ~['oo~ -J~'~4 ~or~ 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 of a tidal wetland? * YES ~' NO t/ * 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 b~]ow,,must provide tOl~Ographical data on survey.~ 18. Are there any covenants and restrictions with respect to this property? * YES __ NO c/ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) ~ SS: COUNTY OF~ ~4ft-~ ~ e-. [ ~<~ ~ i v~ being duly swo~, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, "· ~ ' (Contractml Agent, Corporate Offic~,'~t~.~2 ' 3 '~ ]{"~i ' ': ' 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 tree 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 th~-- / ~., 'z~r~ dayo~.~ ~ 200 7 t~otaW ~uvnc N~y Public, State of New ~ No. 314772735 Qual~ied in N~ YORK C~ Signature of Applicant '~-~/-?_// TOWN OF/SOUTHOLD PROPERTY RECORD CARD OWNER ~.~R'~ET "~'~:~ L) VILLAGE DIST. SUB. LOT ~.~ f~,~.~.nt.. ~ . ~ND I~P, TOTAL DATE REMARKS ' ' L FA~ Acre ~ . Value Per r ~alue / / ~ Oo ~ 1 'r*l,nd ~ O~' '~ FRONTAGE ON ROAD fotol ~ ~ 31.-9-11 1/IF/ · BIdg· :tension reezeway 31-9-11 3/03 ~ z-/O~._ Basement ~, zS- .~C~c~- Ext. Walls Fire Place Roof ~tion Roorr )rmer Both :loors nterior Finish Heat Dinette K. LR. DR. 1st Floor - '2-- ? BR. Rooms 2nd Floor FIN. B. COLOR TRiM M. Bldg. Extension :oundation osement Ext. Wolls Fire PIoce l Both Floors nterior Finish LR. Ix COLOR TRIM lation ~ ,, ~ Basement Int~rinr Pinich ~nette ~_ !OR M. Bldg. 31-9=11 3/03 K.Dinette pitched or fiat ro.f. · ,lio_hts ~ Ac~ic double dome, se~f llashed or step flashed model, for pitched roof OIN 0-) 3o"y 30~ Z~-" Y 30" ~LMmt, tmapefed over laminated or Imsolaklr il Safe/Glass, one piece sel~ G,=i~d coppec for fiat roof Acrylic double dome, serf flashed, for fiat roof Heat? Duty Aluminum Outer Frames also avaitabk' in stock and custom colors c-.J.,IRVE'f' OF PROPERTY 51TUATE.. E. AST HARION TOHN.. ~XYFHOL~ SUFFOLK COUN'P~, Iff' ~VEYED O5-i~-2OO~ REVIS, ED IO-22-2OO1, IO-25-2OO-'/, 1241-2OO-/ SUFFOLK COUNTY TAX # I000- ~1 - =1- II CERTIFIED TO~ MICHAEL KENIN · ,9 PIPE ROOF AREA I,qOO 5.F. X .I-/' = B2~ G.F. PROVI[:~ 2 ¢' PlA. X 4' DEEP DRY I'*ELL5 FOR ROOF [;~2~IN~ = ;~"/ C,.F. ~TORA6E ®RAPHIC 5DALE I"= 20' 24' R.O.W. 210.0' o Lond no~ or ~:ormerl~ oF: N55o4?'20"E S. 132.12' LIMIT 9¢ .d S55o47'20"W 191.17' JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.-TIGER~PROSk99-202 R E ¥ I S I O N $ , ';~LCH';~L ~, }AII-,I 420 LARE VI IH RES. ~&ST MAF VIEW, ~- -: ~/~,TI'O. i>'5 A ~,eel,O,n~d gO :m,eet/, Oho m,l:n i m, u m I:lve,,~load ~ee, id¢,nt, lal Cone~rtu=t, ion Code. UpIif'c, Con~e~tione for Jotete-1;o-~irder / H,eade~ ,58~ L~ ,wJ~h m ,n, mum ~ (5) R~:~e ~an~a~ ueed e "Wood P~a.me Cone~ruoSlon Ma,~ual" for $ and 2 'Family E~ V I/ $ I 0 't N rS A T'[