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Home My WebLink About28032-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33548 Date: 02/17/09 THIS c~KTIFIES that the building NEW DWELLING Location of Property: 2975 NORTH BAYS;IEW RD SOUTHOLD (HOUSE NO.) (STREET) (N3~4LET) County TaxMap No. 473889 Section 71 Block 1 Lot 35 subdivision Filed Map No. -- Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 23, 2002 pursuant to which Building Permit No. 28032-Z dated JARUARY 23, 2002 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 ONE FAMILY DWELLING WITH COVERED PORCH AND ONE CAR GARAGE UNDER AS APPLIED FOR. SUBJECT TO SUFFOLK COUNTY HEALTH DEPARTMENT COVENANTS AND RESTRICTIONS. T~e certificate is issued to ROBERT G & CAROL A BOHN ( OWNER ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-08-0007 02/10/09 EI~t-rKICAL C~KTIFICATH NO. N 533130 08/11/00 PLD~E~S ~KTIFICATION DA'£~D 02/17/09 PECONIC PLUMBING & HEAT ~/i/ze~Si~ gna ture Rev. 1/81 Ill III xow OFSOUmO D 'J /11 III BUILDING DEPARTMENT ' ~ 2009 [L~ I TOWN HALL [ I 765-1802 D~H. APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 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 2/10 of 1% lead. 5. Commemial 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, Commemial $15.00 New Construction: ~ Location of Property: c~ q 7 5 House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Date. /~/c~7// /J ~ Old or Pre-existing Building: Street Block (check one) Lot Subdivision Filed Map. Lot: Date of Permit. Applicant: "~ Underwriters Approval: Permit No.'~ ~ O ~'"'~ Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ c~ 3 . O O Hamlet Final Certificate: ~ (check one) Applicant Signature Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 Fax (631) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTI-IOLD CERTIFICATION Date: cry /.7'~'/~ Building Permit No. Owner: Plumber: lead. (please print) /' ~ ¢le~e pfin~ I ce~i~ that the solder used in the water supply system contains less ~ 2/10 of 1% ' - /(Pt~ml~ers Sil~a~)x Sworn to before me this ]~.~ ,:0o¢ Notary Public,&~-O]](_~ County ~2~ THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 2 _~ BUREAU OF ELECTRICITY 40 FULTON STREET, NEW YORK, NY 10038 D~. AUGUST 11,2~ /.~pl~..o. No. o.f~ 19475699/99 N 53313 THIS CERTIFIES THAT on~ tke electrical equ~ment as described below and introduced by tk# applicant named on the above application number is in the premt~es of ROBERT & CAROL BOHN, NORTH BAYVIEW ROAD, SEC. #1~-071-01-35, SOUTHOLD, NY in ~, fo"owinS ~."o.; [] ....m.., ~1 X,, ~' [] 2.~ F' GAR/OUT S.c".. .~* was examined on AUGUST 07,2~q~ and found to be in compliance with the National Electrical Code. Lot FIXTUI~ OUTtE~ FIXTURES , R. ANGES DRYERS I FURNACE MOTORS FUTURE APPLIANCE FEEDEI~ ~ I[-~'PT. TIME ¢1.OCK$ SELL SERVICE DISCONNECT I NMO.~C~I s E R V , MULTI-OUTI. ET SYSTEMS NO. OF FEET EXHAUST FANS AMT. H.P. DIMMERS PAUL R. BURNS LIC.: ~~ PO BOX 1061 ~[3THOLD, NY, 11971-0932 GENERAL MANAGER/ ~llceetlll~:ltemultn~ ~al~r~lnanymafln®fim~m~the~c®of~®BoaMIfinco~ct. ln.pec~r, may~ ~fllMcl~thelrcm~enflal.. THE NEW YORK BOARD OF FIRE UNDERWRITERS RAC , 1~1 BUREAU OF ELECTRICITY ~ 40 FULTON STREET, NEW YORK, NY 10038 ~ AUGUS? 11,2~r ~4~p~aMo. No.o.~ 19475699/99 N 53313~ THIS CERTIFIES THAT only the electrical equipme~t as described below and introduced by the applicant named on the abo~e applicaMon number is in the premises of ROBERT & CAROL BOHN, in the/o~wing ~0¢~.; [] ~eme.~ w~ ex~.ined on AUGUS? 07,2~ OUTLETsFIXTURE RECEPTACleS SWITCHES 14CAMTE~ FLuof~scEmFIXTURES 43 36 48 43 J.RYER'SK.w. IolL FURnaCE M~O~ORSH.i,' SERVICE DISCONNECT I No. OFI MklER I 2~ CB 1 X NORTH BA%"v~IEW ROAD, S~C. #1~-O71-O1-35, SOUTHOLD, NY ~ fou~ ~ be M co~l~nce w~h the N~l E~c~ C~. - MUL~-~ NO. ~ FE~ R T1ME CLOCKS BELL IUNIT HEATERE FUTURE APPLIANCE FEEDERS AMT. NO. A.W.G. EXHAUST FANS AMT. [ H.P. DIMMERS 2/0 1 1/0 WELL RUMP- 1 5 TON A/C-1 MOTORS:l-5 H.P. ,1-F H.P. PANELBOARDS:I-i CIR. 60 ELEC. WATER H~ATERS::i-4.5 K.W. G.F.C.I:-10 ~{OKE DETECTOR: -4 <<< Cont±naed on Pa~e 2 >>> GENERAL MANAGE~ . GOPY-FOR BUILDING U~FAHLMENI. T~[~ UQFY -DP' CERTIFIGATE MUST NOT BE ALTERED IN ANY MANNER, 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. 28032 Z Date JANUARY 23, 2002 Permission is hereby granted to: ROBERT G & CAROL ~2NN BOHN PO BOX 55 PECONIC,NY 11958 for : CONSTRUCTION OF A TWO STORY SINGLE FAMILY DWELLING WITH COVERED PORCH AND GARAGE UNDER AS APPLIED FOR. THIS PERMIT REPLACES BP#24934. at premises located at 2975 NORTH BAYVIEW RD SOUTHOLD County Tax Map No. 473889 Section 071 Block 0001 Lot No. 035 pursuant to application dated JANUARY 23, 2002 and approved by the Building Inspector. Fee $ 1,182.00 ORIGINAL Rev. 2/19/98 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 24934 Z ~ Date JUNE 10~ 1998 Permission is hereby granted to: PREMISES UNTIL FULL for : ALFRED T YOUNG & WF PO BOX 745 SOUTHOLD~NY 11971 CONSTRUCTION OF A TWO STORY SINGLE FAMILY DWELLING WITH COVERED PORCH AND GARAGE UNDER DWELLING AS APPLIED FOR. at premises located at 2975 County Tax Map No. 473889 Section 071 pursuant to application dated MAY Building Inspector. NORTH BAYVIEW RD $OUTHOLD Block 0001 Lot No. 035 15 1998 and approved by the Fee $ 763.00 ORIGINAL Rev. 2/19/98 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ],~JSULATION REM~ DATE INSPECTOR.,~~~-~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] ~)ULATION [ ] FRAMING [ ~/]~FINAL [ ] FIREP~CE &CHIMNEY DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY ROUGH PLBG. INSUlaTION FINAL DATE INSPECTOR .~ 765-].8~2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ],~ULATION [ ] FRAMING [ /J FINAL [ ] FIREPLAC~.,E & CHIMNEY 765-3.802 ~ ~ BUILDING DEPT. ~/~-~~ ~ INSPECTION/ ] FOUNDATION 1ST [ ] RO~J~GH PLBG. ] FOUNDATION 2ND [/.~" INSULATION ] FRAMING [ ] FINAL [ ] FIREP~AC~/~,&. CHIMNEY ~ARKS. *~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [/---']"~OUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ~"~AMING [ ] FINAL [ ] FIREPLACE & CHIMNEY 765-1802 BUILDING DEPT. INSPECTION [ ] FRAMING [ ] FINAL [ ] FIREPLA_~ & CHIMNEY DATE ~///~/~'~ INSPECTOr' 765-1802 BUILDING DEPT. 4NsPECTION [~I/~OUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMAR, KS: .~ 76S-1802 BUILDING DEPT. INSPECTION [ ~FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ]FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~~ ~ '"'-- ~ ,,2~.~, DATE ~////~f INSPECTOR FOUNDATION (1st) FOUNDATION ( 2nd ) ROUGH FRAME & .FLUMBING e INSULATION PER N. STATE ENERGY CODE Ye FINAL / FORH NO. I TO~/N OF SOUTIIOLD BOIl. DING DEPARTHEEIT TO$/N BALL SOUTIIOLD, N.Y. 1197 I TEl.: 765-1802 Disapproved a/c .................................. BOARD OF DEALT/IIb~'.~.~...' ......... 3 SETS OF SURVEY ....~ .~ ............ CI1ECK .... ~OT~Y. ~o~!!.! :.~ ........ .%~..:~.~..~ ~ ........... ~1 ,, BLCG. ~ TCWNOF SC ........ APPLICAT~OIq FOR B~IL~I~G PgR~IT 'Dare ................ ,19 a. '~i* a~li~rlm ~t ~ ~letely fill~ in ~ ~iter or in i~ a~l mitt~ to fl~ ~fildi~ ln~ctor ~ ~ts o[ pl~, ~ate plot pl~ to ~ale. F~ ~i~ to ~le. b. ~lot pl~ ~ l~tlm of lot ~ of ~ildi~ ~ ~8, mlati~fip to ~joini~ pr~ ar struts or are~, ~ givi~ a ~tail~ &~ri~im of l~t of pm~r~ ~t ~ dr~ ~ ~ di~ ~fich is ~rt of this a~li~ti~. c. ~ ~ ~ ~ ~is a~li~ti~ ~ ~t ~ ~ ~fore isle of ~ildi~ ~mit. d. U~ ~l~al of ~is a~li~ti~, ~ ~ildi~ I~ctor will is~ a ~ildi~ Pemit to t~ ~li~r. i~mit ~all ~pt ~ ~ ~s ~ail~le for i~tim that fl~ e. ~ ~ildi~ ~11 ~ ~i~ or ~ in ~le or in ~rt for ~ ~ ~at~r ~til a ~rtlficate of ~ Jmll ~ ~n ~mt~ ~ fl~ hildi~ I~tor. · ~I~ IS ~t ~ to t~ ~ildi~ ~r~nt for ~ issue of a ~ildi~ ~mit ~r~t to t~ I~ildi~ ~ ~i~ of ~ ~ of ~ld, ~ffolk ~, ~ Yo~, ~ o~r a~li~le ~, ~i~es or ~lati~, f~ t~ mt~ti~ of ~ildi~, ~iti~s or alterati~, or for ~al or ~llti~, ~ ~in ~ri~. ~ ~li~c ~s to c~ly wi~ all a~li~le 1~, o~i~es, ~ildi~ ~, ~i~ ~, ~ ~..~.~.../~ .......... / (~ili~ ~ss 8f ~li~t) Stat,i ~d~ether applicant is O~er, lessee, agent, architect, engineer, general contractor, electrician, plmt~er or tmilder (as on the tax roll or latest deed) applicant is a corporation, sil~ature of duly anttmrized officer. (l~ne and title of corporate officer) Plumbers l.lcer~e I~o .......................... Electricians License No ...................... Od~er Trade's License No ..................... I. l~ti~ of l~ ~ d~ich ~ ~rk will ~ ~ .............................................................. ..................... ~. ~2~g.~.. ~...~ ~ ~:~ ....~: .... ~.~ ~. ~ .... t~ ~r / St~t l~et ~ ~p ~. ,~ ~i~ ...~.ZL ....... ~ ..~d ......... ~ ...~.~... ...... livlsi~ ............. ,, . ~ ................ till ~p ~. ............... l~t .............. , (~) 2. SLate exi s~i~ .. ~i~ti~ ~ ~ ~ ...~ ....................................... b. ...... ..... ......... · 1' . ........... ~movat ............. l~l~tlOn ............ Otlmr 14ork . ....... .... ....... '~ ............ ; .................... [ ......... .~.0~ - - / tto If ~r~e, s~r of cars ........... ~ ....................... If Ixmi~mss, ~rcial or mi~ ~, s~ci~ ~ture ~ ~tenc of ead~/~ of ~ ...... ~ ......... ~i,~nsions of ~isti~ st~mms, if ~: ~mt...~.~ ........ ~ar .~....~ ..... ~pth ...~.~..~ ...... lgi~lt ........ ~ ............ ~i~r of Stories l)i~nsi~ oL~ stn~r~ with alrerati~ or ~iti~s: ~t .............. ~qF ............... l~l'th ....... x ............ l~lr ..................... 8. l I~i~lt ....... ~ ............. ~r of Stories ..................... II. ~ or ~ district in ~id~ prmi~a am si~t~ ~ ' .' 12. ~ pro~ mt~tim viblate say ~i~ 1~, o~i~te or re~latim: ..... ~Q ............. ' I~. ~ill lot ~ ~r~ ..... ~....~.. ~ill ~ ~ o[ ~ffi~it~t .................................... ~resa .............................. ~ ~ ............... ....... ....... ......... 15. ls thi* p~rt~ wi~dn ~ ~t o[ a till ~tl~ · ~ .... ~ .... ~ .......... PLOT DI~GRA~ I~ate clearly ~ di~ti~tly ~11 ~ildi~ ~fl~r ~i~ti~ or pm~, ~ i~i~re all ~t-~ di~n~im~ ~d~tl~r interior or m~r lo~ ~ (l~ma of i~lividual si§nh~g contract) nlx~ve mqn~l, · .beirut, duly s'~on;, deposes arm says tlmt he is tim applicant lie is the ........................................................................................... (('xmtracto~orlx~rste officer, etc.) of said e~n~er or o~mers, and is duly autl~arized to perform or have performed the said ~rk m~l to make and file this applicati{n;; that all stat~rents c~mtained in this appllcation are true to the lest of his knowledge mgJ b6liefi at~l that the seork will be perfomed in tim maoner set forth in the application filed tberestifl~. ~rn to |)eEo[;e/ma this (Sig~ml:ure of: Appticsat) Thursday, January 24 2002 3:13 =M John C Ehlers 631 3~9 8267 FEDERALNATiONAi_EMERGENCYFLOOD MANAGEMENT AGENCY [ O.M.8. No. 3067-0077 INSURANCE pROGRAM Expires July 31,2002 ELEVATION CERTIFICATE Important: Read the ~nstruction5 on pa~e_~! - 7, . ................ --~ - p-"~ERTY OWNER [NFORMA~ SE~iON B - ~OOD iNSU~NCE ~ ~ (R~) INFO~A~ON ~1 NF~M~i~E&~MMUN~NUMBER ] ~2. COUN~E ~.STA~ 10. I~e~ ~ ~ mo Base F~ B~ (BFE) da~ or ~ ~ d~ mt~ed in Be. IJ FIS Pr~ ~1 FIRM t~ ~m~n~y Dete~n~ ~ ~r ~scdbe): ~12. ~ ~e ~i~g [~t~ in a ~a~l B~er R~s S~tem (CB~] a~ ~ ~e Pmte~ed ~ (UPA)? ~__~ Yes ~1 No p.02 SECTION C - BUILDING ELEVATION INFOR[~/ATION {SURVEY REQUIREO) : I. Building eiewtior~ am based on: LlConstruction Drawings* {__)Bulld[n9 Under Conebuction' {.~Fin,sh6d C. onsu:,cti0n . : 21 Building Dbgram Number ~ (8el~ the building diagram ~st ~mibr to ~e building for which this ce~ifi~le 5 being completed - see pages 6 a~ 7. If no d~gram a~umtety repmse~ the bui~ing, pr~ide a sk~h or pho~raph ) ;3. EleVens -~ AI~0. AE, ~, A (wilh 8FE). VE. V 1-V30. V (~ BFE), ~ ~ ~AE, A~AI-A~, ~, A~AO ~mplMe I~ms ~a4 ~1o~ a=rdi~ b the buildin~ d~gmm spedfmd in I1~ C2. S~te the datum us~, If ~e datum is d~emnt from ~e datum ~ for ~e BFE in Se~n B, ~n~K the da~m to ~at ~ed faf ~e B~ Show fie~ m~sd~ements and dalum ~vers~n C~vemi~m~nts __ Q a) T~ ~ b~ ~ {including b~e~nt or ~c~sure) ~ . ~ ~(m) ~ b) Top of next higher floor Q c) Be~m of lowest horizontal structural member (V zones only) ~ d) Attached garage {top of slab) Q e] Lowest e~e~a~o of machinery and/or equipment '} R _.~ ft.(m) Cl l} Lowesl ad}acent nrad. (IAi) ~ . __ ~.(m} ~ ~' Q i) T<Aal ama o( all perm. an~,~t openir~s (floo~ verbs) in C3h I4~, SECTION D - SURVE_YOP~ ENGINEER, OR. ARCHITECT C~:~{ Ii:ICA[ION Th~ certif~[[o~ ~ to be eigned and ceased by = m~ sumeyor, engi~, ~ n~i~ a~zed by ~ to ceA~ ~afion inflation. I ~ ~t ~ ~ in S~ ~ B, a~ C ~ t~s c~le m~s~s my ~ ~ods to inte~ t~ ~ta ~a~a~. I ~de~ thai any ~lse LICENSE NUMBER Thursday, January 24, 2002 3:13 PM John C. Ehlers 631 369 8287 IMPORTANT: 'In fl~ese spaces, copy the conespondlng Information from Section A. BUILpING STREET ADDRESS (Including A~L Ur~ SuKe, and/or Bldg. I~o.} OR P.D. ROUTE AND BOX NO. STATE ZIP CODE SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CEI~q'IFICATION (CONTINUED) Co~y both sides of this Elevat;en Cedil~cate for (1) community official, (2) insurance egel~,/company, and (3) bui!ding owner COMMENTS ]--I Chec~k here if attachments SECTION E ' BUILDING,ELEVAIlON INFORMATION (SURVEY HOT REQUIRED} FOR ZONE AD a~d ZONE A {WITHOUT BFE) -or Zo~o AD and Z. ooe A (wffhout BFE}, eomplele Items E1 through E3. fftheEJevatio~CerlJticatel$intendedforu~ea~supporting rtforme~o~7 fore I. OMA or LOMR4=, 3ectfon C murine completed -~1. Building Diagram Number (Select tnb buildiog diagram most simiJar to the b~ilding for which this celtificate is being cornptoled - she pages $ and 7. If no diagram accurately represenls the building, provide a sketch or photograph.) =2. Thc top of ~ .bottom floor (including basemeot or onclosore) 01' the buiKilng is I--[--I fl.(m) L_l_l[n.(cm) L_l.al~ove ~ I--I below (ched(one) iI~e highest adjacent grade. [3. For Zone AD only: I~ no ~ depth r~mOer is available, Ls the top of the bottom fleet ele~raled in accordance ~th the community's floodplain management on.raaco? I--I Yes I_(No I---I UnWiown. The local oiTlcial rr~st cerlJ~ this informatJo~ in Sectioo G. SECTION F -PROPERTY' i~NI, IER (OR OVI/N ER~S REPRESENTATIVE) CERTIFICATION The proper~7 orator or mvDer's authorized representative who completes SecluDes A, B, and E for Zone A (without a FEMA-Issue~ or corrlmurdly-lss~ed BFE] or Z~te AD must sign here. PROPER'IY OWNER'S OR OWNER'S AUTPIORIZED REPRESENTA-IVE'S NAME ADDRESS CITY STATE ZIPCODE ' ~ SIGNATURE DATE TELEPHONE COMMENTS Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) he local ett"~al ',,/no is authorized by law or ordinance to administer the mmmunity's floodplain managerne~l ordinance can complete ;actions A, B, C (or E), and G of this Elevation Cerl~cete. Complete the applicable item{s) and sign below, ' ' ~1. [_t The .infermalion 'n Sectiu~q C was taken from other docurnentatio~ that has been si!Tried and embossed by a, lic~rtsed surveyol', engineer, or architect who is authorized by state or local law to certify eleYeli~ i~formation. (Indicate the source and d~e of the elevation data i~ the Celtlrnents area below.} ;2. I--I A community c4rlcial completed Section E for a building located in Zone A (without a FEMAgssued o~ community-issued BFq) or Z~ne AD. ~3. I--! The following information (Items G4-Gg) is provided for community floodplain rn~nagemeut purDoscs. G4. PERMIT NUMBER I SS. DAlE PERMIT ISSUED I G6. DATE CER¥1FICA~E OF COMPLIANCE/OCCUPANCY I I ISSUED ;7. Th~s permit has been issued fo~:. !__1 New Construction I--I Subsl~ntial Improvement ~6. E/evadeD of as-built lo.test t~o~' (lllcltlding ~n~ ~ ~e bu~mg is: ~9.8FE ~ (m Z~e AO) ~h ~ ~0 at ~ ~i~ing site ~: L~ ~CIAL'S ~E TITLE . __ O.(m) Datum: · __ ~[.(m) Datum: CO MM1JNITY NAME TELEPHONE SIGNATURE OATE COMMENTS I__1 Che~k here i1 attachmenls DECLARATION OF COVENANTS AND RESTRICTIONS THIS DECLARATION made by ROBERT G. BOHN and CAROL ANN BOHN, this 31st day of JULY, 2008, both residing at North Parrish Drive, Southold, New York,, hereinafter referred to as the DECLARANT, as the owner of premises described in Schedule "A" annexed hereto (hereinafter referred to as the PREMISES) desires to restrict the use and enjoyment of said PREMISES and has for such purposes determined to impose on said PREMISES covenants and restrictions and does hereby declare that said PREMISES shall be held and shall be conveyed subject to the following covenants and restrictions: DECLARANT has made application to the Suffolk County Department of Health Services (hereinafter referred to as the DEPARTMENT) for a permit to construct, approval of plans or approval of a subdivision or development on the PREMISES; and 2 o THE DECLARANT appeared before the Board of Review requesting a variance to the DEPARTMENT'S construction standards which require that a sewage disposal system be installed with minimum prescribed separation distances between sewage disposal system structures and building foundations, property lines or other structures and the Board of Review of the County of Suffolk Department of Health Services granted a waiver by letter dated May 29, 2008, attached hereto as Schedule C and made a part hereof, provided a covenant be filed, the DECLARANT, its successors, heirs, or assigns, agrees: a.) notice is hereby given that the location of the sewage disposal system does not comply with the separation distance requirements to the swimming pool, and that extensive costs may be incurred in. the future if any repair, replacement and/or expansion of said system are necessary. b.) DECLARANT, its successors, heirs or assigns, further agrees to hold harmless, indemnify and defend the County of Suffolk, its employees, offices, or agents harmless from any claim for damages or injuries that may arise out of the installation or use of the sewage disposal system. o The DECLARANT, its successors and/or assigns shall set forth these covenants, agreements and declarations in any and all leases to occupants, tenants and/or lessees of the above described property and shall, by their terms, subject same to the covenants and restrictions contained herein. Failure of the DECLARANT, its successors and/or assigns to so condition the leases shall not invalidate their automatic subjugation to the covenants and restrictions. Ail of the covenants and restrictions contained herein shall be construed to be in addition to and not in derogation or limitation upon any provisions of local, state, and federal laws, ordinances and/or regulations in effect at the time of o o execution of this agreement, or at the time such laws, ordinances, and/or regulations may thereafter be revised, amended, or promulgated. This document is made subject to the provisions of all laws required by law or by their provisions to be incorporated herein and they are deemed to be incorporated herein and made a part hereof, as though fully set forth. The aforementioned Restrictive Covenants shall be enforceable by the County of Suffolk, State of New York, by injunctive relief or by any other remedy in equity or at law~ The failure of any agencies or departments of the County of Suffolk, the DEPARTMENT or the County of Suffolk to enforce the same shall not be deemed to affect the validity of this covenant nor to impose any liability whatsoever upon the County of Suffolk or any officer or employee thereof. These covenants and restrictions shall run with the land and shall be binding upon the DECLARANT, its successors and assigns, and upon all persons or entities claiming under them, and may be terminated, revoked or amended only with the written consent of the DEPARTMENT. If any section, subsection, paragraph, clause, phrase or provision of these covenants and restrictions shall, by a Court of competent jurisdiction, be adjudged illegal, unlawful, invalid, or held to be unconstitutional, the same shall not affect the validity of these covenants as a whole, or any other part or provision hereof other than the part so adjudged to be illegal,~ unlawful, invalid, or unconstitutional. Local Law #32-1980 - The DECLARJkNT represents and warrants that he has not offered or given any gratuity to any official, employee, or agent of Suffolk County, New York State, or of any political party, with the purpose or intent of securing favorable treatment with respect to the performance of an agreement, and that such person has read and is familiar with the provisions of Local Law #32-1980. ROBERT G. BOHN CAROL ANN BOHN · SCHEDULE A DESCRIPTIOI~ OF PROPERTY DECLARANT - ROBERT G. BOHN AND CAROL ANN BOHN H.S. REF. NO. or NAME OF SUBDIVISION HD REF: R10-98-0007 ALL that certain plot, piece or parcel of land, situate, lying and being at Bayview, in the Town of Southold, County of Suffolk and State of New York, bounded and described as follows: BEGINNING at a monument at the intersection of the easterly line of the North Bayview Road with the southerly side of North Parish Drive, from said point of beginning running along said southerly line of North Parish Drive, two courses: 1) North 75 degrees 34 minutes 40 seconds East, a distance of 28.19 feet to an iron pipe; THENCE (2) South 75 degrees 54 minutes 50 seconds East, a distance of 174.06 feet to land now or formerly of Lois D. Anderson (formerly of Carl Deek): THENCE along said land, South 14 degrees 05 minutes 10 seconds West, a distance of 100.0 feet to other land of now or formerly of Robert Anderson (formerly Sayre); THENCE along said land, South 63 degrees 17 minutes 30 seconds West, a distance of 136.55 feet to said easterly side of North Bayview Road; and THENCE along said easterly side of North Bayview Road, North 14 degrees 25 minutes 20 seconds West, a distance of 200.0 feet to the point or place of BEGINNING. ~CHEDUT~E B CONSENT OF DECLARANT -ROBERT G. BOHN Al,ID CAROL ANN BOHN H.S. REF. NO. or NAME OF SUBDIVISION R10-98-0007 NAME OF MORTGAGEE~ FLEET NATIONAL BANK LIBER NO. 20327 ~®. MP 599 In the matter of the application of Robert ~. Bohn and Carol /tnn Sob_n, the undersigned, a holder of a mortgage or lien on premises described in Schedule A annexed hereto, hereby consents to the annexed covenants and restriations on ~id premises. ~y Sheila D. Pelln~ Fleet National Bank- STATE OP NEW YORK ) ) :s~.: cous~Y oF ~ ) On the ~ ~ day of /L/'~. in the year 2008 before me, the undersigned, personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he execuced the same in his capacity, and that by his sipnature on the instrument, the individual or the person upon behalf of which the individual acted, executed the instrument. sc~ c ~D ~ t ~XO-~S-0007 . SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES DMSlON OF ~,,NVIRONM~NTAL QUALITY BOARD OF REV~W ARTICLE 2, SECTION 220, Sm OLK Cotr rry SANITARY CODE To: Humayan J. Chaudhry, D.O., M.S., Commissioner From: Stephen A. Costa, P.E? Chairman, Board of Review Subject: Findings and Recommendations of the Review Board Regarding: RI0-98-0007 - Property of Bohn, s/e/e North Bayview Rd. & North Parrish Dr., Bayview- fro Southold- SCTM: 1000-07100-0100-035000 Hearing Date: May 15, 2008 Screening Board Members: Robert Farmer, P.E., Andrew Rapiejko Reviewer: Edward Lyons Statement of Problem The department's construction standards require that a sewage disposal system be installed with minimum prescribed separation distances between disposal system structures and building foundations, property lines or other structures. The applicant is proposing to construct the sewage disposal system with less than the minimum separation distances. Findings 1. and Facts The applicant is proposing to construct a 3 bedroom, single-family dwelling with an un-site sewage disposal system and a public water eounection. 2. The site is located in Groundwater Management Zone 4. Depth to groundwater is 5.2 feet below existing grade at elevation 1.2 feet above mean sea level according to the submitted test hole. 4. Soil conditions are good with sand at 3 feet below existing grade. o The proposed sewage disposal system consists of a 1,000 gallon septic tank and five 8-foot q> by 2 feet effective depth leaching pools with room for expansion for two leaching pools. o A construction application was approved for this lot on March 4, 1998. The sewage disposal system was inspected by department staff on November 3, 1999 and found to be acceptable. Final paperwork submitted on February 21, 2003 showed that a swimming pool, not on the original plan, was installed 8 feet from the septic tank. The separation distance required by standards is 20 feet. Humayun J. Chandhry, D.O., M.S., Commissioner Hearing Date: May 15, 2008 Subject: Findings and Recommendations of the Review Board Regarding: R10-98-0007 ~ Property of Bohn, s/eric North Bayview Rd. & North Parrish Dr., Bayview - fro Southold - SCTM: 1000~07100-0100-035000 10. A field inspection was performed to verify the location of the swimming pool. The inspector verified that the septic tank was 8 feet from the swimming pool and also was installed under a patio area. Staffwas told by the septic installer in 2003 that the tank would be abandoned in place and replaced with a new tank. Additional final paperwork was received on January 28, 2008. The septic tank was not moved, but cast iron covers to grade were installed on both septic tank manhole openings giving accessibility in the patio area. Determination It was a 3 to 0 determination of the Board to grant the variance, provided the applicant covenants, in language acceptable to the County Attorney, that the location of the sanitary system does not comply with separation distance requirements to the swimming pool, which may result in extensive costs to repair und/or replace the sewage disposal ' system should it be necessary in the future and that the septic tank shall be maintained with cast iron covers to grade. As per §760-609 of the Suffolk County Sanitary Code (Sanitary Code), the approval of the variance is in harmony with the general purpose and intent of the Sanitary Code to protect groundwater and drinking water supplies, surface water and other natural resources, and public health, safety and welfare. May 29, 2008 Chairman - Board of Review PECONIC ABSTRACT~ INC. AGENT FOR FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK P.O. BOX 1267 405 OSTRANDER AVENUE RIV~RttEAD, NY 11901 (631) 369-0222 Fax: (631) 369-4020 Title No. PAC-3928 TITLE CERTIFICATION PECONIC ABSTRACT, INC., agent for FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK hereby certifies to THE COUNTY OF SUFFOLK that it has searched the records in the Suffolk County Clerk's Office for a period of 20 years last past for the purposes of determining parties who must consent to the filing of Covenants and Restrictions affecting the premises described in Schedule A annexed hereto. Based on said records, the Company has determined that the only parties who must consent to said filing would be as follows: 1. ROBERT G. BOHN and CAROL ANN BOHN, as husband and wife Fee Owner by deed in Liber 11901 cp 196 2. FLEET NATIONAL BANK First Mortgage by Mortgage in Liber 20327 mp 599 District: 1000 Section:071.00 Block: 01.00 Lot: 035.000 The Liability of the Company under this Search is limited to $5,000.00 for any reason. DATED: 12/5/08 Page 2 Title No. PAC.3928 Schedule A herewith (full description of the premises) PECONIC ABSTRACT, INC. By. ~ O~,~~ Jeanne Anstett, Office Manager FIRST AMERICAN TITLE INSURANCE COMPAI~Y OF NEW YORK Peconic Abstract, Inc. Title No.: PAC-3928 Schedule A Description ALL that certain plot, piece or pamel of land, situate, lying and being at Bayview, in the Town of Southold, County of Suffolk and State of New York, bounded and described as follows: BEGINNING at a monument at the intersection of the easterly line of the North Bayview Road with the southerly side of North Parish Drive, from said point of beginning running along said southerly line of North Parish Drive, two courses: 1) North 75 degrees 34 minutes 40 seconds East, a distance of 28.19 feet to'an iron pipe; THENCE (2) South 75 degrees 54 minutes 50 seconds East, a distance of 174.06 feet to land now or formerly of Lois D. Anderson (formerly of Carl Deek): THENCE along said land, South 14 degrees 05 minutes 10 seconds West, a distance of 100.0 feet to other land of now or formerly of Robert Anderson (formerly Sayre); THENCE along said land, South 63 degrees 17 minutes 30 seconds West, a distance of 136.55 feet to said easterly side of North Bayview Road; and THENCE along said easterly side of North Bayview Road, North 14 degrees 25 minutes 20 seconds West, a distance of 200.0 feet to the point or place of BEGINNING. TICOR TITLE INSURANCE COMPANY 185 OLD COUNTRY ROAD, P.O. BOX 218, RIVEP~, NEW YORK 11901-0206 (516) 727-4455 FA~( (516) 727-4407 VARIANCE SEARCH TITLE NO.: 1298-05047 COUNTY OF SUFFOLK STATE OF NEW YORK } }ss } THIS IS TO CERTIFY THAT ALFRED T. YOUNG JR. IS THE OWNER(S) OF RECORD OF INTERSECTION OF THE EASTERLY SIDE OF NORTH BAYVIEW ROAD WITH THE SOUTHERLY SIDE OF NORTH PARISH DRIVE, DIST. 1000 SEC. 071.00 BLOCK 01.00 LOT 035.000. THAT HE ACQUIRED TITLE THERETO BY DEED DATED 11/9/66 RECORDED IN LIBER 6233 CP 193 ON 10/5/67, THAT WE HAVE MADE A SEARCH OF THE RECORDS OF THE SUFFOLK COUNTY CLERK, AND THAT SAID SEARCH SHOWS THAT NEITHER THE SAID OWNER NOR AATy PREDECESSOR IN TITLE OF THE SAID PREMISES OWNED CONTIGUOUS PROPERTY AT ANY TIME SINCE 4/1/57 EXCEPT AS FOLLOWS: EAST AND SOUTH THAT THE APPLICANT HEREIN DOES NOT OWN ANY CONTIGUOUS PROPERTY EXCEPT AS FOLLOWS: NONE THIS CERTIFICATION IS MADE WITH THE INTENTION OF THE RELIANCE THEREON BY THE BOARD OF APPEALS AND/OR BUILDING DEPARTMENT OF THE TOWN OF SOUTHOLD. THE LIMIT OF LIABILTY UNDER THIS CERTIFICATE, FOR ANY REASON WHATSOEVER, WHETHER BASED ON CONTRACT OR NEGLIGENCE, SHALL NOT EXCEED $1,000.00, AND SHALL BE CONFINED TO THE APPLICANT TO WHOM THIS CERTIFICATE IS ADDRESSED, OR THE COUNTY OF SUFFOLK. TICOR TITLE INSUR3%NCE COMPANY SWOP, N TO BEFORE ME THIS 13TH DAY OF MAY , 1998. ' TOMSON S. SHEH ' NOTARY PUBLIC, STATE OF NEW YORK VARS~G NO., 52-3627510, SUFFOLK ~0UNI'~7~ COMMISSION EXP RES AUGUST 31, 19--.~ VARIANCE SEARCH (Continued) TITLE NO.: 1298-05047 SUBJECT PREMISES~ DIST. 1000 SEC. 071.00 BLOCK 01.00 LOT 035.000 DEED THE NEW YORK TRUST COMPANY AND WILLIAM C. MAYER, AS EXECUTORS OF THE LAST WILL AND TESTAMENT OF MARY L. DAYTON TO F. HAROLD SAYRE DATED: 4/15/56 RECORDED: 4/18/56 LIBER 4450 PAGE 89 DEED F. HAROLD SAYRE TO ALFRED T. YOUNG, JR. AND AUDREY M. YOUNG, HIS WIFE DATED: 11/25/66 RECORDED: 10/5/67 LIBER 6233 PAGE 193 LAST OWNER OF RECORD PREMISES ON NORTH: PARISH DRIVE PREMISES ON EASTs DIST. 1000 SEC. 071.00 BLOCK 01.00 LOT 034.000 DEED THE NEW YORK TRUST COMPANY AND WILLIAM C. MAYER, AS EXECUTORS OF THE LAST WILL AND TESTAMENT OF MARY L. DAYTON TO F. HAROLD SAYRE DATED: 4/15/56 RECORDED: 4/18/56 LIBER 4450 PAGE 89 DEED F. HAROLD SAYRE TO CARL A. DECK AND ROSE B. DECK, HIS WIFE, AS TENANTS BY THE ENTIRETY DATED: 5/27/63 RECORDED: 6/3/63 LIBER 5356 PAGE 191 VARCONT - CONTIN-JED - 2 VARIANCE SEARCH (Continued) TITLE NO.: 1298-05047 DEED CARL A. DECK AND ROSE B. DECK, TO JOSEPH A. SHIPULE DATED: 10/28/67 RECORDED: 10/30/67 LIBER 6247 PAGE 173 HIS WIFE DEED JOSEPH A. SHIPULE TO SHEPARD M. SCHEINBERG, EMIL F. DEPETRIS AND MURPJ%Y B. COMMON DATED: 3/26/69 RECORDED: 3/27/69 LIBER 6525 PAGE 596 SCHATEPS, AS TENANTS IN DEED SHEPARD M. SCHEINBERG, EMIL F. DEPETRIS AND MURRAY B. COMMON TO EMIL F. DEPETRIS DATED: 12/22/69 RECORDED: 12/22/69 LIBER 6679 PAGE 286 SCHNEPS, AS TENANTS IN LAST OWNER OF RECORD PP.~MISES ON SOUTH~ DIST. 1000 SEC. 071.00 BLOCK 01.00 LOT 040.000 DEED THE NEW YORK TRUST COMPANY AND WILLIAM C. MAYER, AS EXECUTORS OF THE LAST WILL AND TESTAMENT OF MARY L. DAYTON TO F. HAROLD SAYRE DATED: 4/15/56 RECORDED: 4/18/56 LIBER 4450 PAGE 89 VA~CONT - CONTINUED - 3 VARIANCE SEARCH (Continued) TITLE NO.: 1298-05047 DEED F. HAROLD SAYRE TO CARL A. DECK AND ROSE B. DECK, HIS WIFE, AS TENANTS BY THE ENTIRETY DATED: 5/27/63 RECORDED: 6/3/63 LIBER 5356 PAGE 191 DEED CARL A. DECK AND ROSE B. DECK, HIS WIFE TO JOSEPH A. SHIpLTLE DATED: 10/28/67 RECORDED: 10/30/67 LIBER 6247 PAGE 173 DEED JOSEPH A. SHIPULE TO SHEPARD M. SCHEINBERG, EMIL F. DEPETRIS AND MURRAY B. SCH1TEPS, AS TENAATTS IN COMMON DATED: 3/26/69 RECORDED: 3/27/69 LIBER 6525 PAGE 596 DEED SHEPARD M. SCHEINBERG, EMIL F. DEPETRIS AND MURRAY B. SCHNEPS AS TENANTS IN COMMON TO MURRAY B. SCHNEPS DATED: 12/22/69 RECORDED: 12/22/69 LIBER 6679 PAGE 284 DEED F~U~RRAY B. SCH/~EPS TO ROBERT AA~DERSON DATED: 10/27/72 RECORDED: 11/29/72 LIBER 7292 PAGE 223 LAST OWNER OF RECORD PREMISES ON WEST~ BAYVIEW DRIVE VARco~r - CONTINUED - 4 ENDORSEMENT Attached to and forming a part of COMMITMENT No. 1298-05047 Issued by TICOR TITLE INSURANCE COMPANY OWNERS [] LOAN [] ATT: RICHARD LARK, ESQ. LARK & FOLTS, ESQS. MAIN ROAD P.O. BOX 973 CUTCNOGUE, NEW YORK 11935-0000 RE: YOUNG/BOHN CORxNER OF NORTH BA~IEW ROAD & pARISH, SOUTHOLD PLEASE BE ADVISED OF THE FOLLOWING: ENCLOSED PLEASE FIND AMENDED DESCRIPTION. ALEXAArDR BOSSUNG AAB/CM CC: ATTN: PAUL CAMINITI, ESQ. CAMINITI & GIBBONS, ESQS. This endorsement is made a part of the policy and is subject to all of the terms and provisions thereof and of any prior endorsements thereto. Except to the extent expressly stated, it neither modifies any of the terms and provisions of the policy and any prior endorsements, nor does it extend the effective date of the policy and any prior endorsements, nor does it increase the amount of insurance. Dated: APRIL 1, 1998 Authorized Sig~a~//o~y Note: 7~is endorsement s~all ~t be valid o~ binding until countemig~ed by aa authbdzed ~ato~. ENBI.KTG TICOR TITLE INSURANCE COMPANY TICOR TITLE INSURANCE COMPANY LEGAL DESCRIPTION Title Number: 1298-05047 ALL THAT CERTAIN PLOT, PIECE, OR PARCEL OF LAND, SITUATE, LYING, AND BEING AT BAYVIEW, IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK AND STATE OF NEW YORK, BOUNDED AND DESCRIBED AS FOLLOWS: BEGINNING AT A MONUMENT AT THE INTERSECTION OF THE EASTERLY LINE OF THE NORTH BAYT;IEW ROAD WITH THE SOUTHERLY SIDE OF NORTH PARISH DRIVE; FROM SAID POINT OF BEGINNING RUNNING ~J~ONG SAID SOUTHERLY LINE OF NORTH PARISH DRIVE, TWO COURSES: (1) NORTH 75 DEGREES 34 MINUTES 40 SECONDS EAST, A DISTANCE OF 28.19 FEET TO AN IRON PIPE; THENCE (2) SOUTH 75 DEGREES 54 MINUTES 50 SECONDS EAST, A DISTANCE OF 174.06 FEET TO LAND NOW OR FORMERLY OF LOIS D. ANDERSON (FORMERLY OF CARL DEEK) THENCE ALONG SAID LAND OF SOUTH 14 DEGREES 05 MIN73TES 10 SECONDS WEST, A DISTANCE OF 100.0 FEET TO OTHER LAND OF NOW OR FORMERLY OF ROBERT ANDERSON (FORMERLY SAYRE) THENCE ALONG SAID LAND SOUTH 63 DEGREES 17 MINUTES 30 SECONDS WEST, A DISTANCE OF 136.55 FEET TO SAID EASTERLY SIDE OF THE NORTH BAYVIEW ROAD; AND THENCE ALONG SAID EASTERLY SIDE OF NORTH BAYVEIW ROAD NORTH 14 DEGREES 25 MINUTES 20 SECONDS WEST, A DISTANCE OF 200.0 FEET TO THE POINT OF BEGINNING. FOR INFORMATION ONLY DISTRICT 1000 SECTION 071.00 BLOCK 01.00 LOT 035.000 -AMENDED LEGAL DESCRIPTION- 04/01/98 /:.>.,~., ?>_/_.~:,TTOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER FORMER OWNER RES:~/O SEAS. LAND IMP'. l.!-,?_o / AGE FARM Tillable Wo~land ~.. Meadowl~d House Plot Total 'Z TOTAL. BUILDING CONDITION NORMAL DATE VI LLAGE w CO"M~. . CB~ .MICS.. SUB. ACR. ~0~ TYPE OF BUILDING Mkt. Value BELOW ABOVE Value Per Value Ac re LOT REMARKS FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD DOCK 71-1-35 10/00 Extension 32- × ,'5 Foundation Basement Porch Ext. Walls Breezeway Garage Patio Total j Fire Place Type Robf Recreation Room Dormer Bath Foors Intedor Fi'nish Heat Rooms 1st FloOr Rooms 2nd Floor Driveway I/.z~ Dinette BR. FIN. B _ _TOWN OF SOUTHOLD PROPERTY RECORD CARD /~ .~ ?/--/ ~ · OWNER s'rRE~r ~----q75 , V,LLAGE D,ST.su~. ~ ~ ow~ ~ ~ ~: ~, . ' s ~'~ ~' w~" ~ RES: SEAS. LAND ~ IMP. AGE NEW FARM Tillable Woodland. ',- Meadowland VL ,.y// House Plot Tn~ol TYPE OF BUILDING FARM COMM. CB: MICS. Mkt. Value LOT TOTAL DATE REMARKS BUILDING CONDITION NORMAL BELOW ABOVE Acre Value Per Value Acre FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD · " , ,j'~iTH T. T. EP-~Y · T 0 V.2~ CLERK OFFICE OF THE ']]'OWN CLERK TOWN OF SOUTHOLD P 0 rlox I THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 2q, 1993: RESOLVED that the 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 Oevelopment in Special Flood Hazard Area [C/C(93)). B L:7,G. DEFT.. TOWN OF $OUTt{O? . Terry v Southold Town Clerk August 25, 1993 APPLICATION PAGE ! of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. ~;ECTIQN 1: GENERAL PROVISIONS (APPLICANT to read a~d 1. No work may start until a permit Lq L.~ued. 2. Thc permit may be revoked il any fal~e statemen~ axe made herein. 3. If revoked, all work mnst cease until pemit Lq re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance Ls L~ued. 5. The permit will expire ff no work is commenced within six moath.~ of issuance. 6. Applicant is hereby informed that other permits may be required to fulBil local, state and federal regulatory requirements. 7. Applicant hereby gi~ consent to the Local ^dmln~trator or his/her representative to make iensonable inspections required to verify compliance.. 8. I, THE APPLICANT, C'I~RTII='Y THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO SECTION 2: PROPOSED D[TVELOPMENT J~PLICANT d'~./, To avoid dclay in processing thc applicatio~ please pro'Adc enough information to easily identify thc project location. Provide the street address, lot number or legal description (attach) and, outside urban are. as, the gLstance to the nearest intersecting road or woll-lmown l~ndmark. A sketch attached to ~ application showing the project location would be helphll. A_PPL/CATION ~ -- PAGE 2 OF ~ DESCRIPTION OF WORK (Check all applicable boxes): A STRUCTURAL DEVELOPMENT [] Addition [] Alteration U Relocation gl Demolition [] Replacement .STRUCTURE TYPE F_.~FIMATF-.D COST OF PROJECT [] Residential (1~. Family) [] Residential (More than 4 Family) [] Nou-residenfal (Floodproo£mg7 [] Yes) [] Combined Use (P,~iden6al & Commeroal) [] Manufactured (Mobile) Home (In Manu- factured Home Park.'? [] Ye.s) B. OTHER DEVELOPMENT AC fiVITIES: O F'fll O Miulng O Dr;lli-g VI Grading gl Excavation (Except for Structural Development Checked Above) · gl Watercottr~e Alteration (Including Dredging and Channel Modifications) gl Drainage Improvements (Including Culvert Work) gl Road, Street or Bridge Co~truction .gl/,g-~od!vision (New or F. xpanxioo) ~ Individual Water or Sewer System O Other (Please Specify) A~tcr completing SECTION 2, APPLICANT should submit form to Local Adminixtrator for review. ~;ECTION 3: FLOODPLAIN DETERMIN.~.TION {-Fo be completed bv LOCAL ADMINISTRATOR) The proposed development is located on ~ Panel No. , Dated Thc Proposed Development: gl I.~ NOT located in a Special Flood I4aTard Area (Noti~ thc applicant that thc application review is complete ~nd NO FLOODPLAIN DEVF_,LOPMENT pERMIT IS REQUIRED). gl I.~ locate~ lo a Sp~ial Flood Hazard A~rca. F1RM zone de.~ignation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) [] Unavailable [] The proposed development is located in a floodway. F'BFM Panel No. Dated [] See Section 4 for additional inslructions SIGNED. DATE .~p PLICATION · PAGE 3 OF 4 .SECTION ,1: ADDITIQINAL INFORMATION I:(EQUI REDJ~o hc~leted by LOCAL ADMINISTRATOR) Thc appEcam must submLi thc documents checked below be[ore the appLication can be processed: E3 A site plan showing the location of alt cxJtstiag structures, water bodies, adjacent roads, lot dimensions and proposed development. [] Development. plans, drawn to scale, and specifications, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basemeut), types o( water resistant materials used below the flu-st floor, details of floodproo£mg of utilities located below the fa'st floor and details of enclosures below thc £u-st floor. A~o, [] Subdivision or other development plains (If the subdivi~inn or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not othcrvfisc available). [] Plans showbag the extent of watercourse relocation and/or landform alterations. [] Top of new fill elevation Ft. NGVD (MSL). [] Floodproo£mg protection level (non-residential only) Ft.' NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. [] Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in ~ incre~e ia the height of the !00-year flood. A copy of all data and calculations supporting this £mding must also be submitted. Other: ~EGTIQ[A 5: PERMIT DETI~RMINATION {To be completed by LOCAL ADMINU3'TRATQR) I have determined that the proposed activity:. A. I-; Is B. [] Is not in conformance with proviaiona of Local Law ~ ,19 . Thc permit ia issued subject to the condltlona attached to and made part of this permit. SIGNED , DATE fL[BOX A is checked_, the Local Administrator may issue a Development Permit upon payment of designated If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from the Bo~d of Appe.'~ls. APPEAJ~: Appealed to Board of Appeals? [] Yes [] No Heaxmg date: Appeals Board Decision --- Approved7 [] Yes Conditiorm E3 No APPLICATION PAGE ~ OF 4 SE(TFIQN 6: A~-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued) Thc following iaforma6on mtmt be provided for project structures. This section must be completed bY a registered professional engineer or a licctmed land surveyor (or attach a ct:rtilication to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of thc lowest floor, induding basement (in Coastal High Hazard Areas. bottom of lowest structural member of the lowest floor, excluding piling and columns) is: Fr. NGVD 0~SL). 2. Actual (As-Built) Elevation of floodproo£mg protection is Fr. NOvD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. ~ECTION '7: COMPLIANCE ACTION I-Fo be completed bv LOCAL ADMINISTRATOR] The LOCAL ADMINISTRATOR will complete th.La section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? [3 YES El NO DATE BY DEFICIENCFES? [3 YES ~ NO DATE BY DEFICIENCIES? [3 YES [~ NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be comoleted by LOCAL 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 SPECIA~ FLOOD HAXARD ,aA:LEA (o~rNER MUST RET,adN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [] NEW BUILDING U] EXISTING BUILDING [] VACAN'r LAND THE LOCAL ADMINIS'ITL4TOR IS TO COMPLETE A, OR B. BELOW: Ao COMPLIANCE IS HEtLEBY CERTIFIED WITH THE REQUIREME/WFS LOCAL LAW #_ , 19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS LOCAL LAW #, , 19__, AS MODIFIED BY VAR/ANCE # DATED SIGNED: DATED: OF OF C/C{93) ENERGY CODE CALCULATIONS (For Non-Electric lleat) Design Criteria 6,000 Degree'ga}'s O.A. ID"F I.A. 7U"F DESIGN 'I'HE I%MEL REMARKS SUBSYSTEM AREA "U" RATING wans (0 ,aque) /7 ceiling/Roof (Opaque) /g~3 , O~ 0 Skylights % ~ Floor /~b · O~ ~ ~ oundatzon Walls Slab Insulation TOTAL ~ / 0 ~ ['.lu be s: l]uildlng Envelope Systems to meet requirements of 7815.2 HVAC Equipement to meet requirements of 7815.11 IIVAt Systems ko meet requirements of 7815.r2 Duct Systems to meet requirements of 7815.13 Ventilatio~s Systems to meet requiremeuts of 7815.14 Iusulatiun of Piping Systems to meet requirements of 7~15.15 Service Water Heating Systems & Equipment to meet requirements o~ Electrical & Lighting Systems & Equipment to meet requirements of To the best of my knowledge, belief, & professional judgement, these plans are compliance wltil tile code. '1~15.21 7~15.31 , % . SUFLYE¥ OF: ~ SEP1 lC, ~ETAIL not to scolo TF:~T~tH~ ~I~%AIL GRAPHIC S EL= 7.J SITUATE: DAYVIEI~I TOIAIN OF SOUTHOLO SUFFOLK COUNTY', NY' ~ EL: 5:~JRVEYE D lO-2l-q] :~ 6.5 ANiNENDE[? 01-21-q6 ~ AI'4I"IE NI?E ~ 02-0~-q8 ~L=~ 875'54'50 EL: lO00 0~1 om ~5 7.5 /- ~ EL= i CERTIFIED TO: 7, i~ ~O~E~T ~. ~HN ~ ~ ) - ~ ~ ~SEO ~ ~ CAROL ANN ~HN ~ .¢C [ ~'J ~ TICO~ TITLE GUARANTEE ~ ~ / ~ ~ '~ ~ , . ~ ~ 1 ~ ] [~ ~ ~ / t HZN Ix/ ~EF~OEO TO M.S.L. - N.G.V.D. '2q , ~ ~ ~ L. ] _ ~, ~0 .<. ~ ~ ,,,.,, .... , ,...,,..,,,, 30' "~ ~ / ~ ~ ~~dLAND SURVEYOR // , " ~n. ~ ~IN STREET ~VERHEAD, N. Y. ~_ 369-8288 Fax 369-8287 REFERENCE ~ 97-0068 0 30 60 90 BAYVIEH .... NOT~: ~ ~ \ / 9~~ ~,¢. .... ~"~/;,.~:?-_ '..~ : ' ~ EABT MA~N :TREET : .: ~, RIVERHEAD, N.Y. 359 82BB Fax 369 8287 REFERENCE # 97 68E l l"O $ 21:) 19~ 3 '5o', 174.06, 'Nr¥,S~ LT~ NO, 50467 SURVEY OF PROPERTY S[TUA BAYVIEW TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-71-01-55 SCALE 1"=20' MARCH 21, 2008 22.456 sq. ff. 0,561 THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD~ IF ANY, NOT SHOWN ARE NOT GUARANTEED· Nathan Taft Corwin III Land Surveyor PHONE (631)727-2090 Fox (631)727-1727 28-06: tlr J L LVL a~ i