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HomeMy WebLinkAbout33233-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33803 Date: 06/26/09 THIS ~KTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 3180 MILL RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Taxi,ap No. 473889 Section 67 Block 5 Lot 1 Subdivision Filed Map No. __ Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated J~JLY 6, 2007 pursuant to which Building Permit NO. 33233-Z dated JULY 10, 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 ALTERATIONS AND ADDITIONS, INCLLrDING FOUNDATION AND PORCH ADDITION, TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to SWITZER HUGH LEE IRRV TRT ( OWNER ) of the aforesaid building. SUFFOLKCOD1TTYDEPART~T OF ~]~ALTHAPPRO~i~L N/A ~.Rt-rKICALCERTIFICATHNO. 3066563 04/03/09 CERTIFICATION DA'£~U 10/17/08 JOE WHITECAVAGE Rev. 1/81 Form N~. 6 TOW~ OF SOUT~OLD BUILDING. DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPA_N · -This. application mustbe filled in by typevaiter or ink and submitted to thc.Building I~ 010HIflOS 30 NMOI 'Id3(] 9Q18 For new bliildin~ or'new use: -1.. F~n~! allrv6'y of prolnn'ty with accurate location of all'buildings, pmpeay linea~;.sa~ts, and unoz'ual natural or - 'inal Api va from Health Dept 0f:w .suppty and seav sat.(a-p form). 3. ApprOval of eleCtrical-installation from Board ofFir~ U. adervnitom. 4. Sworn staten. ~t Dom plumber c~a-tifying that the solder used in system oontainn'~s than 2/10 of t °A lead. 5..Commc~'ial' building indnsaial buildi.~..mtitlipl~ realdanees'sud similar btli]~in~°s and installafions, a certificate of Co& Complianca from architea or e.~.~r r~sponsiblc fo?the building. 6. Submit Planning Board Approval of completed site plan requirem~ts; For ~istin~'bulldings (prior: to April 9, 1957) nOn-COnforming .us~s, or buildings and ~'pre-e~i '~sii!~" !and, uses: 1. Accmat~ st~eey Of property zh0wing ali property.lines, st~ve~,.buildi~ and,uansual nattual or topographic featul~. 2. A-pr~P~ly c~mpleted application and OOnsent to insp~t signed by the applicant. If a Certificate of Occupancy is d~niixi, the Building Inspector shall'state the reasons therefor in writing lo the applicant. C.. Fe~s , . . L Certificate:of Occupancy - New dwelling $25,00, Additions to dwelling $25.00, Alterations to dweBiag $25.00; · Swimming pool $25;00, Accessory building. $25.00, Additions to accessorybuilding $25.00, Businesses $50.00. 2~ Cet%iflcate of Occupancy. On Preexisting Building - $100.00 · 3.. Copyof Certificate of Occupancy - $.25 4.' Ug~lated:Certificate of Occupancy- $50~00 5, T~mPOrary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Constmctiom. L0catioa of Propony: Dato. Old or Pre-existing Building: ~' (check one) ' , Z .,c ' HoUSe No. .oWner orOwn~rsofProp~y: /-/t~..~ · Suffolk County Tax Map No 1.000,. Section Sub~vidon Filod Map.' Permit'No. Health Dept. Approval:, Underwriters Approval: · P~anning Board Appmvat: Request forl Temporary Certificate Fee Submitted: $ Hamlet a,y. oo Fin~ai Certificate: (check one) Applicant S.ignatu~ 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 OP SOUTHOLD CERTIFICATION Date:_ Building Permit No. (Please print) Plumber' (Please p~ int~ lead Sv, ern to before me this _/~' ~' day of' ~ I crucify that the solder used in the water supply system contains less than 2/10 of 1% ff"'~~ Signature) (Plumbers Notary Publi~ County BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by DANIEL WILCENSKI ELEC. CONTR. MR. SWITZER PO BOX 319 3180 MILL RD. SOUTHOLD, NY 11971, SOUTHOLD, NY 11971 Located at 3180 MILL RD. SOUTHOLD, NY 11971 Application Number: 3066563 Certificate Number: 3066563 Section: Block: Lot: Building BDC: ns11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, Outside, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the3rd Day of April, 2009. Nam¢ OTY Rat(= Rating Cir¢~tit~ Typ~ Alarm and emergency equipment Sensor I 0 0 Carbon Monoxide Appliances and Accessories Air Handler 1 0 20 Amps Dish Washer I 0 1.2 ~ Exhaust Fan I 0 F.H.P Wiring And Devices Dimmer 16 0 120 V Fixture 4 0 Fluorescent Fixture 65 0 Incandescent Heat Light Vent I 0 Outlet 69 0 Fixture Outlet 89 0 Gan, Purpose Paddle Fan 2 0 Receptacle I 0 20a Appliance Receptacle I 0 20a-laundry Appliance Receptacle I 0 30a Dryer Receptacle 11 0 GFCI seal Continued on Next Page ] of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by DANIEL W1LCENSKI ELEC. CONTR. MR. SWlTZER PO BOX 319 3180 MILL RD. SOUTHOLD, NY 11971, SOUTHOLD, NY 11971 Located at 3180 MILL RD. S0UTHOLD, NY 11971 Application Number: Certificate Number: 3066563 3O66563 Section: Block: Lot: Building Permit: 33233 BDC: ns11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, Outside, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ,herein, was conducted in accordance with the requirements of the applicable code and/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the3rd Day of April, 2609. Name OTY Rate Ratln~ Circuits Typ~ Receptacle 51 0 Gen, Purpose Switch 37 0 Gert, Purpose seal 2 of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. James F. King, President Jill M. Doher~y, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road 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 # 0438C Date June 19, 2009 THIS CERTIFIES that the two one-story additions to the existing two-story dwellino, gutters ~d drywells, foundation w/crawl space, retaining walls, garden and porch At 3180 Mill Lane, Peconic Suffolk County Tax Map #67-5-1 Conforms to the application for a Trustees Permit heretofore filed in this office dated 11/13/06 pursuant tO which Trustees Wetland Permit #6502 Dated 12/13/06 was Issued and was Amended on 8/22/07 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 two one-story additions to the existing two-story dwelline, gutters and drywells, foundation w/crawl space, retaining walls, garden and porch The certificate is issued to HUGH LEE SWlTZER IRREVOCABLE TRUST owner of the aforesaid property. Authorized Signature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 33233 Z Date JULY 10, 2007 Permission is hereby granted to: HUGH KENT TRUSTEE SWITZER 4651 SENTINEL VIEW RD ATLANTA GA, 30327 for : ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR PER DEC AND TRUSTEE APPROVALS at premises located at 3180 MILL RD SOUTH/PEC County Tax Map No. 473889 Section 067 Block 0005 Lot No. 001 pursuant to application dated JULY 6, 2007 and approved by the Building Inspector to expire on JANUARY Fee $ 200.00 /,~ ~., . ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN~JLATION [ ] FRAMING / STRAPPING [~ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: O/~ ~"~- DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ] ROUGH PLBG. ~ INSULATION [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION FIRE RESISTANT PENETRATION [ ] RRE RESISTANT CONSTRUCTION REMARKS: ~ ~._ o¥, ?~ o_~a-/s. iNSPECTOR '~f'7 ~ DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ L~OUGH PLBG. [ ]~UNDATION 2ND [ ] INSULATION [,/~ FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESlST~A~IT CONSTRUCTION .[ ] FIRE RESISTANT PENETRATION DATE _~~ INSPECTOR/~ ~/~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] Fou~NDATION~,,ND..~~ [ ] INSULATION [ ~FRAMING~_~..PPING_~,) [ ] FINAL [ ] FIRE SAFETY INSPECTION [/] FIRE RESISTANT PENETRATION [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION -~ REMARKS: DATE~iNSPECTOR~/~/'' ~- TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTI ON [ ] FOUNDATION 1ST [ ~rl~OUGN PLBG. [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]RRB RESISTANT CONSTRUCTION REMARKS: [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION DATE /' ~ '~ INSPECTOR INSPECTION [ ] FOUNDATION tST [ ~']' FOUNDATION 2ND [ [ ] FRAMING / STRAPPING [ [ ] FIREPLACE & CHIMNEY [ [ ] FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION REMARKS: DATE ]/-- 7-'' ~ INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [~FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRUCTION [ ] RRE RESISTANT PENETRATION REMARKS: DATE TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ PERMIT NO. xamin d Approved ,20 Mail to: Disapproved*ftc ~'~./ ~ Phone: c ~ ~ ~ ~-~'~ ~, ~ ~nglnsp~ ~v,, ~E'~. . * Date ~ ~Ow~' OF ~9"L~q ~ .... INSTRUCTIONS 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: ¢ 7J ,7 ,20o7 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 of lot 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 Southold, Suftblk 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. (sign~t~r~-of~ppli~(~)r name,~-f a corporation) (Mfiil(ng address of applicant) - State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises /¥~,.~-g lctc ,_~a.,,.Tt~el,-, .~s-clzoCo~/¢ W05'4 (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 31_,7. o House Number Street Hamlet County Tax Map No. 1000 Section Subdivision (Name) Block File&Map No: "~ Lot Lot State existing use and occupancy of premises and inten~ked use and occupanc, y of proposed construction: a. Existing use and occupancy ,~o/c 7~.,,'/~. b. Intended use and occupancy ~',~t~/c--- ,2~,',~, 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost g~ 30~ ooO. 0 o 5. If dwelling, number of dwelling units If garage, number of cars Addition v" Alteration /.,,,,'~ Other Work Fee (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 5~ / Height ~ .~' Number of Stones .7_ Rear 5/0 / Depth Dimensions of same structure with alterations or additions: Front o/kY" Rear Depth ."~0'' Height ..~' 6" '/ Number of Stories ,2 8. Dimensions of entire new construction: Front Height Number of Stories Rear _Depth 9. Sizeoflot: Front Rear _Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated Vc.¢,o/c,~'J~./ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES / 13. Will lot be re-graded? YES__ 14. Names of Owner of premises~__ Name of Architect Name of Contractor NO V/ Will excess fill be removed from premises? YES b/' NO__ Address Address Address Phone No. 5~5q ,?(or' 0'37tI Phone No T~, Phone No. ~"(- ~5'7 / 7 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. 9* b. Is this property within 300 feet of a tidal wetland. YES v" 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__ NO '~ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY O1~ U4213o [ L ) Q-~oc(-~--q [ ~e"x'v'x OS e)~ being duly swom, deposes and says that (s)he is the applicant (Name of individual signing co~tract) above named, (S)He is the '"(Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swom t9, before me this {z9~r''~ day of c2~ L,(Lca 20 D Q v I -Notary Pu~"lic .~ ._._._ ......... --- Sign'~"~6 f Applicant NOTARY PUBLIC STATE OF NEWYORK NO. 01MA6t56671 QUALIFIED IN SUFFOLK COUNTY MY COMMISSION EXPIRES NOV. 2'7, 20,_._~ New York State'Department of Environmental Conservation Division of Environmental Permits, Region One SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 Phone: (631) 444-0365 · FAX: (631) 444-0360 Website: www.dec.state.ny.us LETTER OF NON-JURISDICTION TIDAL WETLANDS ACT Hugh Lee Switzer PO Box 283 Peconic, New York 11958 March 21, 2007 Re~ Application # 1 - 1-4738-03655/00001 Hugh Switzer Trust Property, 3180 Mill Road, Southold SCTM# 1000-67-5-1 Dear Hugh Switzer: Based on the information you have submitted the Department of Environmental Conservation has determined that the property landward of the topographic crest of the bluff, as shown on the marked survey prepared by Stanley J. Isaksen Jr. dated 08 September 2006, is~eyond Tidal Wetlands Act (Article 25) jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 6~6!),.no permit is required. Be advised, no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Article 25 jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hale bay berm. Please note that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies or local municipalities. Sincerely, Mark Carrara Deputy Permit Administrator cc: Eh-Consultants BMHP file New York State Department of Environmental Conservation Division of Environmental Permits, Region One SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 Phone: (631) 444-0365 · FAX: (631) 444-0360 Website: www.dec.state.ny.us Rob Hermann En-Consultants Inc. 1319 North Sea Road Southampton, NY 11968 March 27, 2007 Re: Application #1-1-4738-03655/00001 Hugh Switzer Trust Property, 3180 Mill Road, Southold SCTM# 1000-67-5-1 Dear Mr. Hermann: Here is the Non-Jurisdictional boundary map you requested. Environmental Analyst I 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 August22,2007 Ms. Susan Gardner P.O. Box43 Orient, NY 11957 RE: HUGH SWITZER 3180 MILL LANE, PECONIC SCTM# 67-5-1 Dear Ms. Gardner: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 22, 2007: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #6502 to replace the existing foundation and extend basement to incorporate existing crawl space; and if necessary, replace footings and retaining wall to rebuild existing landward gardens and porch, and as depicted on the survey prepared by Stanley J. Isaksen, Jr., dated September 8, 2006, received on July 26, 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, James F. King President, Board of Trustees JFK:eac BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6502 DATE: December 13~ 2006 ISSUED TO: HUGH LEE SWITZER IRREVOCABLE TRUST PROPERTY ADDRESS: 3180 MILL RD, PECONIC SCTM#67-5-1 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on December 13 2006, and in consideration of application fee in the sum of $250.00 paid by Hugh Lee Switzer _Irrevocable Trust and subject to the Terms and Conditions as stated in the l~esolu~ion, the Southold To~vn B Trustees authorizes and permits the following: Wetland Permit to construct two one-story additions to an existing two-story dwelling located no closer to the wetlands than the existing structural areas, with the condition gutters and drywells are installed to contain the roof run-off, and a line of staked hay bales is placed down before any activity begins and maintained throughout construction, and as depicted on the survey prepared by Stanley J. Isaksen, Jr., last dated October 16, 2006. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a tnajority of the said Board as of this date. o__f S?utho Erosion, Sedlmentat,on & Storm Water Run off ASSESSMENT FORM PROPERTY LOCATION: $.C.T.M. ~ THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A District Section Block Lot STORM-WATER, GRADINGp DRAINAGE AND EROSION CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. Item Number: (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) Ye~s N~o 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 mn. off created by site cleadng and/or constmctiee 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 Watetl:low~ Will this Project Require any Land Filling, Grading or Excavation where them is a change to the Natural Existing Grade Involving mom than 200 Cubic Yards of Material within any Pamel? 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 Coume Running through the Site? Is this Project within the Trdstees jurisdiction or within One Hundmri (100') feet of a Wegand or Beach? Will them be Site preparation on Existing Grade SIopes 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 Ama? (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 Watercoume? 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 Permitl EXEMPTION: Ye~s 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 Requimdl -- STATE OF NEV/YORK, COUN OF ............. ss That I, ...~.~.x~..ff~-~...~ ./~../~-~.,0.....~.. ...................... being duly sworn, de'poses and says that he/she is the applicant for PenniL (Name of individual sig~ing Docu[]]~lj) ~, ~. ~ ( O'~,~r~C o ntra ct o r, Agent Corporate Officer. etc) Owner and/or representative of the Owner of Owner's, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application fried herewith. Sworn to before me this; ...... .................................... ................. / &~iC~i&IEEIL~r(~c~A .... si natureof '~' FORM - 06107 NO. e1MM1~71 TOWN OF SOUTHOLD PROPERTY RE( :ORD CARD-~/~ ~ /~ OWNER STREET 3/~.' ~.-~'~"¢~ VILLAGE ,DIST' SUB. LOC S ~__j, ~ _, ~/. W TYPE OF BUILDING : ~ND IMP. TOTAL DATE REMARKS AGE BUILDING CONDITION FARM Acre Value Per Value Acre tillable 2 ~rushland FRONTAGE ON ROAD ~ ~. ~ ~ BULKHEAD Fotal DOCK I M. Bldg. Extension Extension Extension Porch Porch Breezeway Garage Patio Total '2 >' 1' ~ b ;oundation Basement Ext. Walls Place Type Roof ~reation Roor~ Dormer Driveway Floors Interior Finish Heat Rooms 1st Floor Rooms 2nd Floo~ Dinette o/~u/zuui ~:Z~ PAGE 002/003 FAX Socvo~ ACORD,. CERTIFICATE OF LIABILITY INSURANCE PRODUCER ROY H. REEVE AGENCY. INC. CIO H.R. KELLER & CO., INC. 1520 SHERIDAN DRIVE BUFFALO, NY 14217 CHARLESTHOMPSONCARPENTRYLLC PO BOX 71 PECONIC, NY 11958 COVERAGES 0~/20/2007 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA'I1ON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE NAI~ IN~RER^ A'n. ANT~C CASUALTY INSURANCE CO 846 THE POLICIES OF iNSURANCE LrSTED BELOW HAVE BEEN ISSUED TO THE INSU RED NAMED ABOVE FOR THE POLICy PERIOD IN DICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. GEN'L AGGREGA3'E LIMIT APPLIES PER CARPENTRY ~ ~'~ 07/15/2006 07/1512007 GENERAL AGGREGATE $ OTHER THAN EA ACC AUTO ONLY AGG EACHOCCURRENCE AGGREGATE 50~,000 50,000 5,000 500~000 1,000,00( 5001000 CERTIFICATE HOLDER CANCELLATION TOWN Of $OUTHOLD BUILDING DEFT PO BOX 1179 SOUTHOLD. NY 11971 ACORD 25 (2001108) 'ACORD CORPORATION 1988 COUNTY OF SUFFolK ZONE AE-11 · 68' EL t TIDAL WETLANDS BOUNDARY AS DELINEATED BY EN-CONSULTANTS, EL 18 N/F 2700 MILL ROAD LLC BoAr.' .5TEES TOW ~ :UTHOLD DATE //':z.,/o ? DESCRIBED PROPERTY PECON/C, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR: i HUGH KENT SWITZER TM# 1000-067-05-001 13 NOTES, 1, ZONING FOR THIS RESIDENCE IS R-AG, PERCENTAGE OF LOT COVERAGE WITH PROPGSED IMPROVEMENTS IS. 1,989~ SURVEYED BY STANLEY J. ISAKSEN, JR. P.O. DOX 294 ' NEW SU~-FOLK. N,Y. 11956 rr~S LJ'~, ~. t4927Z 706R1524 COUNTY OF SUFFOLK N / / 62'23'00"71 ~:\~/ / ....... ;"' 36,58 / ~ "~ ...' ¢¢ N/F 2700 MfLL ROAD LLC $ 6g"46'31"E 4'L81' ' S 27'22'50"E \ 50.27' I~/ s ~'o7'~"~ 39.76' / / ..*'S 22'06'22"W " 54,01' 50'4-1 '39"W 38,15' SURVEY OF DESCRIBED PROPERTY PECONIC, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR: HUGH KENT SWITZER MAiN FLOOR ELEV = 27,0' SURVEYED BY STANLEY d. ISAKSEN, JR. P.O, BO~ 294 NEW S~/FFOLK. N.Y, 11,t956 65~ 7~4-5835 // _ /z NYS Lic. ~No.' 4927'3 05R1524 L COUNFy OF SU?FoLN .¢ PROPOSED NEW FOUNDATION WITH EIASEMENT UNDER EXISTING RESIDENCE. J N/F 2700 MILL ROAD LLC ".. S 69'48'51"E '.. 41,61' : S 27'22'50"E 50,27' S 49'07'59"E 59.76' '49"W 50'41 ," S 22'08'22"W " 54,01 ' APPROVED BOARD OF TOWN OF SOUTHOLD DESCRIBED PROPERTY PECONIC, TOWN OF SOUTHOLD SUFFOLK' COUNTY, N.Y. SURVEYED FOR: HUGH KENT SWITZER TM# 1000-067-05-001 MAIN FLOOR £L£V = 270' TOP OF N/S RIDGE = 47,1' TOP OF OODHOUSE (SAME SIDE ON ROOF AS N/E RIDGE) =45 4' SURVEYED BY STANLEY J. ISAKSEN, JR P.O. BOX 294 NEW SUFF,~LK. N.Y. (...,,/~YS Lic. No 49275 06R1524 APPJiO~DASNO/ED I ~/l~ I I~m~ I ~l~ I ~/~) I~1 ~"/~ I~TOEWm~L*OH~U ~/ m 2. PLUMBING & ~NSULATION NE W YORK STATE & TOWN CODE8 ~AIL~ ro ~ ml~ ~mlTl~N, Fo~ ~/:" *~ I SOUTHOLD TQ'¢r'N 'PC ~ FLOOm H~A~ 15 DE~I~D BY LOG~ 5~V~ A~ ~MA MA~ TOWN TRbSTEE8 ~EET THE REQUIREMENTS OF THE .m~ ~ ~ ~N~T~., *~ ~ s.*~ ~.m~ ~.~ ~m~ *~ ~u~rmo.s ~o~ ~ o~s ~vm~.. PLUMBING ~ TH~P~I~PLAN~ONTAI~H~I~I~TO~N~T~5~A~INT~TOPTH~5~D~51~N~CB~A~IN~ E~H pL~ (I'X4") B~ L~ INTO 5~ A~ ~IL~ AT ~ACH 5~ C~51N~ ~ITH 2-10~ ~IL5 CERTIFICATION OF ~ ~E~A~K~LLA~A~TB~E~NT~LL~T~L~L~L~B~N~T~EA~NPLA~EA~HAVEATTA~E~R2~ a NAILING,& CONNECTIONS ~. ~ ~/~" CONTENT BEFORE~0. ~L~o~[N~ STEEL 5H~L BE D~ED 6A~ OON~l~ T~ AS~ ~15, ~E 6G OR A1~5 ~0~ ~ATED ~HEN ¢~LEB ~T ON 2f ~m~5 ~ I-~lST5 (TJI), LAHI~ ~ER ~B~R (MIG~=LA~ PA~L ~ER ~HBER (~, m i/4. THI~ L~D SOL~ER IN 5~5-~7~5 447-70~7: UNOERWRI~RS CERTIFICA~ d ,N~RioR ~LS, ~/4" ~ DE~ LOA~, 20 PSF FRAMING UNTIL SURVEY me. A~ 5T~¢~ 5~EL 5H~L CGNFGR~ TO THE FOLLO~I~ ~ 5P~IFIGATmGN5 1ST PL~ D~ LG~, 20 ~ OF OCCUPANCY OROEBTIFICATION OF ~ NAILING & CONNECTIONS USE IS UNLAWFUL REQUIRED. WITHOUTCERTIFICATE KEY TO 5~MBOU5 L ZST OF P~AHIN05 _ OF OCCUPANCY x~x YORK STATE EWER*Y COPE NOTE5 A , ~ [55U~ SA~ ¢~E OF ~ Y~ 5TA~, TA5~ 502 2 4 (BI 5. FI~T FLOOR PL~ ~l~ ~ ETAIN ~Tn'R~ WATER RUNOFF F~z~zw DUILPINe BN~L~ ~UZ~T5....OBJ~T ~ NOTES ~~----'"" ~ O~ A~ r~ FAMILY ~LLINe5 ~URSUA~TOSECTION45'lOC H~H A~A 15 ~ OF ~ ~IOE ~LL A~A, 5. ~¢~ SYMI~OLS EXIOTIN~ POLJSE ~JkST APPITION ~ ~ ~ m ~ GARI) NER, BOX 45 .... ~ ORIENT, ~Y 119~7 651 5~5-~7~5 m ~ : NEW YORK, NY !0010 ~INF. ~TH (2)-¢4 FOUNDATION PLAN NEW FOUNIIATION LAYOUT / Xl~ EXIST]~ LIVIN6 ROOM PANT ~ - ~ Ii X FIIIST FLO01 PLAN saNu~u~ e~muo~ ~ SCALE: I/~".1'O" NEW IST FLOOII LAYOUT ~ ,~, ~ ~ ~/~' ~ ~ ~/~" [XI~T]N6 HOL.J.~ EAST AI::9IT[ON F/~ ~ ~ ~ ~ ~ /IICHITEGT ~ ~ ~ ~6~ Youths nOAD GONTINUOU~ ~I~ ~NT BOX ~ ORIENT, NY 119fi2 ~r~ ~ NEW25~ E. ~NI)NySTR~ETi0010 - YOIIK, 21~ 447-5625 [ ~ ~ I ~ [ I ~ ~ [ [ 212 447-7027: FAX BOOF PLA~ SCALE: 1/4".1'0" EXIST ~l) FL ~ ~EW ROOF I~iYOUT N~ A~P]TION ~XI6TIN8 HOUSE NE~ ~PlTION ~ GARDNER, ............................................ -::_::k~=:5=x2--~L-L-x::=r-L-L-L=:-=-==:~=~ ~ ~ ~B 3~ :::~:k: ::::::::S:: -:::~::::::5:q-Szr:_ ---' BOX 45 -:-- _/::--/:-._/////- _/x:/- __-/::--//- -- , _ --%E.%:_ - -kkkk%: .... - -'-%~-:-: ORIENT, NY IIO~ %:==-~_~==k::=- --:EE===------:~====-- -:---E:E<~-:~=--== 651 ~__=~==E=__ ~ .-==__=__~:;--==_====___; .... =====-5-====__. 651 ~23-22~2: FAX ........................... - ....................... :~::z::-- =~zz::<- - =-~-~z:~- -=~zzzz::~- - ~z:~<- ~ ~ : :<====- = __ z: :c====- -=_: z::: :~-:-:<<====--. NEW YORK, NY 10010 < SOUTH ELEVATION ~ SCALE: 1/4".1'0" ~ SOUTtl ELI~VATION ~ EAST II)I)ITIO~ ~ WE~T ADDITION ADDITION 0NORTH ELEVATION EAST AIHHTION ONORTH ELEVATION WEST ADDITION SUSAN B. GARDNER, ARGHITEGT 1465 YOUNGS EOAD BOX 45 ORIENT, NY 119~ 651 525-2~725 651 525-272~: FAX 255 E. 22NI) STREET NEW YORK, NY lO010 212 447-~625 212 447-702~: FAX NORTH ELEVATION SCALE: 1/4"'1'0" 1 6. - SUSAN B. GARI)NER, 1465 YOUNRS ROll) BOX 45 ~/ ORIENT, NY ~ ~ J o 25~ E. ~NI) STREET ~ ~ NEW YOBK, NY ~0010 cu~ ~o~a t / ~1~ 447-70~7: FAX ,,~, EAST ELEVATION WEST ELEVATION ~o~ WEST ELEVATION EAST ELEVATION SCALE ./-DI~4f=DON RIDE,~ ~TRAF TI5 LOTA 24 4'o - ~I~T ~LO0~ ~ I/2" O~US DOA~ R-DO INDULATION . ~ ~ ~Fi~H mi~m FLOO~ ~IJSAN IL ' ~oop ~0I~T5-555 PLAN ~ ~ % ~11~, ~O RIq _ ~55 ~ATED DILL PLA~ ~--~1 14lt8 YOUNG8 BOAD "~&" ~ 5 ~ / BOX L e e'-o" 651 525-2725 ~ -- % 651 525-2727: FAX .~,, ,~,,%,,. .. ~ NEW YODK, NY 10010 ~'r~'YJ~;~]~ -- ......... ' ": JOINT 5~ANT~ ~ ~ ~J~ 442-702~: FAX .,..,-- ................................... ~ ~,, ,~.. ~,, ~ aaa I0 ~IL VAPO~ DA~IER~~ · .  __ (2)-¢4 eARS OONT~ 2"0' NOBTII-SOUTlt SECTION GRUDHBB 5TO~ SCALR: !/4~. 1'-0" ~ ,~T WALL 8E¢TION ~ ~ ii ~AL~:I/a"' I'-0" < BUILDING SECTION ~ WALL SECTION SUSAN R. GARDNF~R, AREHITEET 140~ YOUNGS ROAD BOX ~5 O~IE~T, ~Y 1~957 651 5~5-~7~5 651 5~5-~T~: FAX 25~ E. ~Nll STREET NEW YORK, NY 10010 ~l~ 447-70~7: FAX INTERIOR ELEVATIONS NI~4 ¥O~K 5TAT~ t~NI~®¥ C, OD~ NOTI=5 LI&T O~ D~A!AIIN~5 SUSAN R. GARDNER, AREHITEET 1.t4l~ YOUNGS ROAD ROX 45 ORIENT, NY 65! 5~5.0-~.o5 651 5°-5-~.o~: FAX ~,'i/i E. O-2NI) STRBET NEW YORK, NY iOOIO ~1.o 447.56o. 5 ~!-° ~47-20~7: FAX GENERAL NOTES ENERGY CORE NOTES KEY TO SYMIIOLS LIST OF I)RAWINGS I 15'=o" I : I I ,, I ~ ~ ~ .. I r----~ / I t': i ,c I L__J I L .: "'~ "";' ¢ ~ ? ~ II ~ --- I/2" TJI ¢ ~ (~P) " I E , ~ ',, I t: I ~ x i ~ I , ~ m ~ ~ ~,, ~o~ ~i ? "' I ~' I xr n I ' ~-~ ~ .~ I · 5LAB ON I I ', , '/ , ' I , m .:: ",',J ',' SUSAN B. ~ ~' m t ] : IIm ", ~.~,~1 _ __ __ ~ I /IlCllITI~CT I ' I I. ", I II BOX 45 NY ................... ~ ' I TO BBOO~B BAS~NT ~ZN I~ mAOB ~P. ' I ~ I ~ I 6~1 ,, :p , 651 525-~7~7: FAX , H, , H, ii ii ~~ NEW FOUNDATION LAYOIJT ~5DUE PATE FOUNDATION PLAN SCALE: 1 5/4 x ~ ~ Jo~('~'P) III ILl III C~F III ~OC, AT~ RELOGAT~ DOOR ~O~NE~R K I T~HEN IST FLOOR LAYOUT MARVIN ~INDO~ ~ DOOR ~OHEPULE PO~ ADPITION~: LOOATION PROPUO% ~IZ~ KITOH~N GFOM4~D6 ~0 4~" X D~ ~/~" DININ~ ~H. OUDH2620 ~0 ~2 5/8" X 48 ~/8" ~ININ~ RM. GUDH2624 ~0 ~2 D/~" X 5~ ~/8" ~R~IN~ RM. OUDHI~I4 RO 22 D/~" X D~ ~/8" DR~IN~ RM. OUI~P~068 X ~ ~O ~8 ~/1~" X ~ I/2' GARI) NER, ARCHITECT 146~ YOUNGS ROAI) R0X 45 ~5~ E. ~1) STREET ~EW YORK, NY 100J0 2t2 447-5R25 212 447-7027: FIRST FLOOR PLAN SCALE: 1/4",'1'0" < E -L ~IOTIN~ OWN ~OOH OEXIST. °-lNI) FL. & INEW ROOF LAYOUT SUSAN B. (~,ARI)NER, ARCHITECT 1465 YOIJNf~S ROAR ROX 45 ORIENT, NY 11957 651 525-2725 651 525-2~72~: FAX 255 E. 22Nl)STREET NEW YORK, NY 10010 212 447-5625 212 447-7027: FAX ROOF PLAN SCALE: l/4".fO" NEI~ ASPHALT t~OOF _l_l ~t i ~, _,~ ,, =/_..r/~ z ~:~¢ .... TO HATGH EXISTI N~ - ~ ToNEHMATGHASPHALTExIST] N6~OF SUSAN B. ~ GARDNER, ~ ~ I I I: ~1 ~1 ~ ~BI ,I I ~6~ YOUthS ~OAD ~I I ORIENT, NY : 255 E. 22NI1 STIIEET EEEEEEEEE ~ ~ ~ NEW YORK, NY ~0010 /_ 212 447-5625 ~ x: .... 2~2 447-7027: FAX ~ ~ ' , ' - j ~ q/~/o~N~ FOUNDATION~ ..... mmm ' : ~ ~ ~ ~ ~ , ~ SOUTtl ELEVATION * ~ ~ ii k ~ ~ ~ ~ J ]/ 5 SOUTH ELE~rATION ~ Iii I: iii BBBB~EII ,11 %OU 121~B D©BEI L_LH-B I ~ii ~ _ SUSAN Il. ' ~ ~3~ : zz szzzzz z ~ ~ ~ 146~ YOUN~S ROAD ; ORIENT, NY 119~7 ~ , 25~ E. 22ND STREET , ~ NEW YORK, NY ~00~0 212 447-5625 BBEC BBBB ' IZBBB 3BEI3 E,B3E ~ i i 12 BBB,' - ~ ' ' ~,3 , J , NORTH ELEVATION N()RTH ELEVATION SCALE: 1/4'*1'0'' EAST AIHHTION WEST ADDITION SUSAN B. GARI)NEII, . AIICHITECT 1465 YOUNGS IIOAD ~ IlOl 4;5 ' 651 525.2725 ~ ~ E. ~NI) STREET ~ ~ - ~:, ~ '~ ~ N~W YORK, NY lO010 ~WEST ELEVATION EAST ELEVATION WEST ELEVATION ~ EAST ELEVATION = SCALE ~ I/2" TJI @ I~" ~ ~ORTH-SOUTH SI~CTIOIN SGALE: 1/4". I'-0" (2)-~4 BARe EXT~. WALL SECTION SCALE. I/~"' 1'-0" S1JSAN B, GARRNER, ARCHITECT 146~ YOUNGS ROAR ROX 4,5 ORIENT, ]NY 11957 651 651 525-2~27: FAX 25~ E. 22ND STREET NEW YORK, NY lO010 212 447-5625 21°. 44~-7027: FAX PATE BUILI)ING SECTION WALL SECTION SUSAN B. GARDNER, ARCHITECT 1:i6~ YOUNGS ROAR R0X 45 ORIENT, NY 119~7 651 5°-5-2~25 65I 5~5-~°~: FAX 25/i E. 22Nli STREET NEW YORK, NY 10010 ~12 447-5625 212 447-7027: FAX