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Home My WebLink About34074-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33793 Date: 06/25/09 THIS C~KTIFIES that the building ALTERATIONS/ADDITIONS ~ocation of Pro~rty: 1135 COREY CREEK LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 4 Lot 20 Su]~division Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 10, 2008 pursuant to which Building Permit No. 34074-Z dated JULY 25, 2008 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ALTERATIONS AND ADDITIONS, INCLUDING DECK AND SUNROOM, TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GALLAGHER LIVING TRUST ( OWNER ) of the aforesaid building. S~FOLKC~)I~l~fDEp~/~E~TOFHF2%LTHAPPROlKAL N/A ~3.R~-rKICAL C~KTIFICATE NO. 8803 05/05/09 CERTIFICATION DA-I-~u3 06/22/09 MATTITUCK PLUMBING & HEAT Rev. 1/81 Form No. 6 TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY application must be filled ia by typewriter or ink and submitted to tho Buildln~ Dcpextmcnt with the following: For new building or 'new use: 1. Final survey of proporty with accurate location of ell buildln~, pmporty lineS; streets, and unusual natural or topographic fcatur~. 2. Final Approval from Health Dept, of water aupplyand acwomgc-diSpoaal (~-9 form). 3. Approval of electrical installation f~om Board of Fire Undeanvfit~s. 4. Sworn statement from plumber ccrfi-fyiag that the solder ue~d in systcm COl~inn le~ than 2/10 of 1 °A lead. 5. Commercial building, industrial buiMin~ multipl~ rcsidcncc~ and slmllar buildin~ ~d ~l~o~,a ~fi~ of Code Compliance from architect ur engin~ responsible for thc building. 6. Submit Planning Board Approval of completed sit~ plan rcquir~monts; For existing'buildings (prior to April 9, 1957) n0n-eonformiag u~es, or buildings and "pre-existing" land uses: 1. Accurate ma'vey ofprop~n~y showing all property linc~, str~a,.buildlnE and.unusual natural or topographic features. 2. A properly completed application and COnsont to inspoct signed by the applicant. If a Certificate of Occup~¢y.is denied, the Building Inspector shall'state the reasons therefor in writing to. the applicant. C. Fees L Ce~ficate'of Occupancy - New dwelling $25,00, Additions to dwelling $25.00, Alterations to dwelling $25.00, 3. 4. 5. New Construction: Location of Property: . House No.. S,~ot Suffolk County Tax Map No 1000=, ~ection "~ [BI~' - ~' Lot Subdivision Filed Map. P mitNo. ,%NO?q DateofPe t, -6,/a Appear: .~ff~ l Underwritera Approval: Swimming pool $25.00, Accessory building $25.00, Additions to aCceSsory building $25.00, Businesses $50.00. Certificate of Occupancy on Pre-e~dstiag Building - $100.00 Copy of Certificate of O~cupaney - $.25 Updated Certificate of Occupancy - $50.00 Temporary Certificate of Oceupaney- Residential $15.00, Commemial $15.00 Date. / Old or Pre-existing Building: /~ (check one) Hamlet Finai Certificate: I-]k~t~ D~t. Approval: Planning Board Approval: Kequest for: Temporary Certificate Fee Submitted: $ ~ o~. O C~ Applicant Signature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34074 Z Date JULY 25, 2008 Permission is hereby granted to: ANDREW P GALLAGHER 1135 CORY CREEK LA SOUTHOLD,NY 11971 for : ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR; FLOOD PMT. INCL. at premises located at County Tax Map No. 473889 Section 078 pursuant to application dated JULY Building Inspector to expire on JANUARY 1135 COREY CREEK LA SOUTHOLD Block 0004 Lot No. 020 10, 2008 and approved by the 25, 2010. Fee $ 479.20 Authorized Signature ORIGINAL Rev. 5/8/02 To~,n Hall, $309S Main Road PO Box il79 '~:.,!,,oc Ne~ York 11971-0959 BUILD{N~'DEPARTMENT TOVCN OF SOUTHOLD Fax (631) 765 9502 Telephone (631) ?65:5.L CERTIFICATION Date: lead I certify that the solder used in the water supply system contains less than 2/10 of 1% £,,'om to before me this d~,' ol'-,~D~, , Notary Publi County //~" "' (PlUmbers Signature) DENISE KING Notary Pubrio, State of New York Registration #01K16041757 Qualified in Suffolk County My Commission Expires May 15, 2 Ma~ oa 09 oG:53p M Rnd 9 Electrical Contr 6315095856 p.1 Nassau Suffolk Electrical Inspections,Inc. P.O. Box 549, Aquebogue, New York + 11931 Tel: 6~1-591-3097 Fax: 6~i-591-3098 Application: 8~03 Date: lssued to: Gallagher Address: 1135 Cory Creek Rd Introduced By: M&B Electric Village: Southold License#: Residential [] Commercial The following was examined and apl~roved up to the above date and found to be i~ compliance with the NEC: Attic 1~t Floor [] 2"~ Floor 3~ Iqoor Renovation [] Basemenl Ho/Tub Addition Detae#ed Garage Pool Swi~chcs Rcceptaclc Fixtures G. FI Microw~vc H~d Smoke Dc/cc~ors 12 12 14 6 4 Far~ Dishwulter W~h~/~ D~r/Am~ Ov~ ~ge/Amps ~ Mon~idc 2-Exh~usl 2 Fum~ Oil G~ ~ ~ ~ifl~ot ~ Boil I 5/5/09 This certificate must not be altered in any manner FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII~DING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34074 Z Date JULY 25, 2008 Permission is hereby granted to: for : ANDREW P GALLAGHER 1135 CORY CREEK LA SOUTHOLD,NY 11971 ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR; FLOOD PMT. INCL. at premises located at 1135 County Tax Map NO. 473889 Section 078 pursuant ~o application dated JULY Building Inspector to expire on JANUARY COREY CREEK LA SOUTHOLD Block 0004 Lot No. 020 10, 2008 and approved by the 25, 2010. Fee $ 479.20 Authorized Signature COPY Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] ROUGH PLBG. [ ] INSULATION ~..FINAL ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION REMARKS: DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ~ INSULATION [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION REMARKS: [ ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION DATE )"~-/7"- o ~ INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND INSPECTION ~,~ROU G H PLBG. ] FIREPLACE & CHIMNEY ] FIRE RESISTANT CONSTRUCTION [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~r ~ ~ DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ 3 FOUNDATION 1ST [ ] ROUGH PLBG. [ 3 FOUNDATION 2ND [ ] INSULATION ~FRAMING~ [ ]FmNAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~ DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ~.~FOUNDATION 1ST [ [ ] FOUNDATION 2ND [ [ ] FRAMING / STRAPPING [ [ ] FIREPLACE & CHIMNEY [ [ ] FIRE RESISTANT CONSTRUCTION [ REMARKS: ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION DATE vou~x'r~o~ (~ST) ~ FOUNDATION (21'41)) STATE E~E~GY CODE i ~DI~ON~ CO~S : ~ ,~m ; TOWN OF SOUTHOLD BUILDINO DEPARTMENT TOWN 'HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined ~, 2~J> Approved ~ 20~)~ Disapproved a/c Expiration PERMIT NO. 2~' BUILD1NG PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Buitding Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Storm-Water Assessment Form Contact: Phone: ?_q Building Inspector APPLICATION FOR BUILDING PERMIT ' ' 33L ~ ~ "~ Date xff,.)/ ~ .!~ ~ INSTRUCTIONS Ia. Thi~?~°Pl~c_~atf~fiJ '~mpletely filled in by typewriter or in ink and submitted to the Buildin Inspector with 4 sets of l~aS-~curate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjdining 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, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as heroin described. The applicant agrees to comply with all applicable laws, ordinances, building colleT?~ing code, and reg~ations, and to admit authorized inspectors on premises and in building for necessary inspection~~ ~ (Signature of applicant or name, ifa corporation) address o~applicant) I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises ~q..~pe~--'W ~>. ~ ~,~, (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. " Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section ~ -'] ~ Block 1224- Subdivision Iq~'0¢-6o~,f34 C4v,~l:. r~-ll~-~,3 ~.r 15~¥~eq~JFiled Map No. ~/ (Name) O20 Lot Lot 2~ 2. 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. Addition X, Alteration Repair Removal Demolition Other Work O OO Fee 4. Estimated Cost [ 2-0 / 5. If dwelling, number of dwelling units ~ if garage, number of cars (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 ~ ~' ' Height Zl' Number of Stories 2.- Rear -%~c Depth Dimensions of same structure with alterations or additions: Front Depth ~-~F ' Height "2:1' 8. Dimensions of entire new construction: Front ~O ~ Height I,~" Number of Stories 9. Size of lot: Front I '7 ~ J Rear ]'~>~' 64-' Rear Number of Stories 2. Rear _~o' Depth Z4 Depth I '~ t 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated ~ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES __ NO 13. Will lot be re-graded? YES__ NO )q Will excess fill be removed from premises? YES ){ NO__ 14. NamesofOwnerofpremises~,6rO ~-~ddress C~'~--~CleI~EL-LN PhoneNo. NameofArchitect ID0ta~-~ :~1..,o'~, Address Name of Contractor ~t ~¢ 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 ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. ~_ I:~V ~'t,~c~ 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 ,r~ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ~[~C~ j~l~ 4~ ~-~---~ ~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) 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 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 this / / 7 .j~ay of ~ 20 O~:~ t PATRICIA RICHERT Notary Public Notary Fublic State of New York No. 3~-4741154 Qualified in Nassau /Suffolk, Ccur,Xes,--; Commission Expires ./¢//,,,~/v/'~d/~' yow____ n 0_f Southold Erosion, Sed~mentation & Storm-Water Run-off ASSESSMEHT FO~M PROPERTY LOCATION: S,C.T.M. #: District o7~, od- THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER~ GRADING, DRAINAGE AND EROSION CONTROL PLA.%" CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. 1 2 3 4 5 6 7 8 9 (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) Will this Project Retain All Storm*Water Run-Off Generated by a Two (2") Inch Rainfall on Site? (This item will include all run-off created by site clearing and/or construction activities as well as all Site Improvements and the permanent creation of impervious surfaces.) Does the Site Plan and/or Survey Show All Proposed Drainage Struclures Indicating Size & Location? This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterDowl Wilt this Project Require any Land FiNing, Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Matedal within any Parcel? Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5.000) Square Feet of Ground Surface? Is there a Natural Water Course Running lhrough the Sile? Is this Project within Ihe Trustees jurisdiction or within One Hundred (100') feel of a Wetland or Beach? Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to One Hundred (100') of Horizontal Distance? Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Slorrn-Water Run-Off into and/or in the direclion of a Town dght-of~'ay? Yes No Will this Project Require Ihe Placement of Ma!edal, Removal of Vegetation and/or Ihe Construction of any Item Within the Town Right-of-Way or Road Shoulder Area? (This item will NOT include the Installation of Driveway Aprons.) Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any 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 Permit EXEMPTION: Yes No Does this project meet the minimum standards for classificat on as an Agricultural Project? Note: If You Answered Yes to this Question. a Storm-Water, Grading. Drainage & Erosion Control Plan is NOT Requiredl STATE OF NEW YORK, COUNTY OF ...~..~...~.J~.~ .................. SS That I ~ being duly sworn, deposes and says that he/she is the applicant for Permit, And that be/she is the ....... ~..~....[.T.~T ...................................................................................................................... Owner and/or representative of the O ~ner of Owner s, and ~s duly authortzed to perform or have performed the said work and to make and file this application; that all statements contained in tkis application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this; eub Jc: Notary Public, State of New Ydfk - (Slgna~re o~/Appl~c,~ ..................... No. 30-4741154 ~, Uual~Tle~ in massau / SuffoA Coj~TJ~ FORM - 06107 Commission Expires ffuDITH T. TE:I~RY TOWN CLER~ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall. 53095 imam Road PO. rlox 117q St)ufl~old. New 'ft~rk 11(171 Fax (316) ~6~-I~ THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that 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 Development in Special Flood Hazard Area [C/C(93)]. 8L,~G. D£~T. TOWN OF SO'UTHOLD [ Southotd Town Clerk August 25, 1993 APPLICATION PAGE 1 of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT to read and si~Tn): L No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced w/thin six months of issuance. 6. Applicant is hereby informed that other permits may be required to ffxWfll local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make ieasonable inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY TI-IJYT~,6LL STATEMENTS HEREIN AND IN ATTACHMENTS TO SECTION 2: PROPOSED DEVELOPMENT (To be com'~fl~ffd bv APPLICAI~'I') NAME ADDRESS A~PLICANT ~ BUILDER TELEPHONE L N: To avoid delay in processing the application, please provide enou.v2a information to easily identify the project location. Provide the street addre.~, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or 'a~il-k~own landmark. A sketch attached to ~'h;q appLication showing the project loca6on would be helpful. FOP(93} APPLICATION PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTUIKAL DEVELOPMENT ACTIVITY [] New Structure Addition Alteration [] Relocation [] Demolition [] Replacement ESTIMATED COST OF PROJECT STRUCTURE TYPE ~"~Residential (1-4. Family) U] Residential (More than 4 Family) [] Nou-resideudal (FloodprooFmg? [] Yes) [] Combined Use (Residential & Commercial) [] Manufactured (Mobile) Home (In Manu- factured Home Park? [] Yes) B. OTHER DEVELOPMENT ACTIVITIES: [] Fill [] Mining [] DrilLing [] Grading J~, Excavation (Except for Structural Development Checked Above) [] Watercourse Alteration (Including Dredging and Charmel Modifications [] Drainage Improvements (Including Culvert Work) [] Road, Street or Bridge Construction [] Subdivision (New or Expansion) [] Individual Water or Sewer System [] Other (Please Specily). After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. i~ECTION 3: FLOODPLAIN DETERMINATION (To be completed Ipv LOCAL ADMINISTRATOR) The proposed development i~ located on FIRM Panel No. , Dated The Proposed Development: [] h PIOT located in a Special Flood HaTard Area (Notify the applicant that the application review i~ complete and NO FLOODPL.AIN DEVELOPMENT PERMIT IS REQUIRED). [] Is located iu a Special Flood H=~ard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) [] Unavailable [] Thc proposed development is located in a floodway. FBFM Panel No. Dated [] See Section 4 for additional instructions. SIGNED DATE APPLICATION PAGE 3 OF 4 SECTION 4: ADDITIQNAL INFORMATION REQUIRED (To be completed bv LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: [] A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dLmensious and proposed development. [] Development plans, dram to scale, and spedfications, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the ftrst floor, details of floodprooFmg of utilities located below the t-trst floor and details of enclosures below the first floor. Also, [] Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not other~4se available). [] Plans showing the extent of watercourse relocation and/or landform alterations. [] Top of new l-ali elevation Ft. NGVD (MSL). [] Floodproofing protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. [] Certification from a reg/stered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. Other: SECTION $: PERMIT DETERMINATION (To be comeleted 1~¥ LQeAL ADMINISTRATOR) I have determined that the proposed activity:. A. 121 Is B. [] Is not in conformance with provisions of Local Law ~ , 19 attached to and made part of this permit. __. The permit is issued subject to the conditions SIGNED , D)kTE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BQX B iS checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPEALS: Appealed to Board of Appeals? [] Yes El No Hearing date: Appeals Board Dec/sion --- Approved7 [] Yes Conditions [] No APPLICATION PAGE 4 OF 4 SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued) The following information must be provided for project structures. This section must be completed bY a registered profeasional engineer or a licensed la~d surveyor (or attach a certification to this application). Complete 1 or 2 below. Actual (As-Built) Elevation of the top of ihe lowest floor, including basement (in Coastal High Hazard ' Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproo£mg protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of thc above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be completed bv LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete tkis section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSP]EL~YION$: DATE BY DEFICIENCIES? [] YE~ [] NO DATE BY DEFICIENCYE~? [] YES [] NO DATE BY DEFICIENCIES? [] YES [] NO SECTION 8: CERTIFICATE OF COMPLIANCEiTo be completed bv LOCAL ADMINI~;TRATOR/ Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD ~ AREA, (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [] NEW BUILDING [] EXISTING BUILDING [2 VACA._NVF LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: Ao COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19__, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C(93) Permit Number Checked By/Date REScheck Compliance Certificate New York State Energy Conservation Construction Code REScheckSoffware Version 3.5 Release 1 Data filenmne: C:~Progntm Files\Check'~R~EScheck\Gallagher Residenee.rck TITLE: GALLAGHER RESIDENCE COUNTY: Suffolk STATE: New York HDD: 5750 CONSTRUCTION TYPE: Detached I or 2 Family HEATING TYPE: Non-Electric DATE: 02/26/08 COMPANY INFORMATION: Donald G. Feiler COMPLIANCE: Passes Maximum UA = 168 Your Home UA = 165 1.8% Bffaer Than Code (UA) Gross Glazing Are~ or Cavity Cont. or Door perimeter R-Value R-Value U-Factor UA Calling 1: Flat Ceiling or Scissor Truss 703 30.0 0.0 Wall 1: Wood Frame, 16" o.c. 887 21.0 0.0 Window 1: Wood Frame:Double Pane with Low-E 242 Door 1: Solid 21 Hoot 1: All-Wood JoistJTruss:Over Unconditioned Space 703 30.0 0.0 25 36 0.320 77 0.190 4 23 COMPLIANCE STATEMENT: The proposed building represented in this document is consistent with the building plans, specifications, and other calculations submitted with this permit application. The proposed systems have been designed to meet the New York State Energy Conservation Construction Code requirements. When a Registered Design Professiomll has stamped and signed this page,~"F~e attesting that to the best of~his/her knowledge, belief, and professional judgment, such plans or specifications ar~ ~ co m~liance/~4?l~ s((3_,~ e. ~ Build er/Designer .X,.k~d~ '"--.,3g4.,L~ ~ '~,,~J Date (~l-//~ DONALD G, FELLER .ARCHITECT 11725 Main Rd · Box 1692 · Matiltuck, NY 11952 * 631 298.5453 · Fax 298.1380 July 24, 2008 Mrs. Patdcia Conklin Town of Southold Building Department Town Hall, Main Road, Southold, NY Re: Additions & Renovations to the Galla_aher Residen¢~. 1135 Corey Creek Lane, Southold, New York Dear Mrs. Conklin: Based on the scope of work and the value of the existing building, it is my belief that this project is not substantial and conforms to F.E.M.A. regulations. Please note: the existing dwelling includes two bedrooms, with one proposed bedroom, for a total of three bedrooms. DONALD G, FELLER *ARCHITECT 725 Main Rd · Box 1692 ~ Mattltuck, NY 11952 * 631 2985453 · Fax 298 1380 f lD Ob ~q~q 6' ~.¢, ~r~,,T,~ ~-~ ~ ~ , C'~ '' ~ , , , ~__, ,.~_~ ..... ~ .....: C~"~ ~ '~- ~_ _ _- _~' .~, ._ ~ ..~,~. ,!~'~'T''"~',?.~.,~. -'· ' .~'~'--~.~ ~ - ~T.~.,.~ ~. - j j , ~"T' ,~'~ ~ ~ :7; "' '-' ' L ' ;: 3 G'~" o.n,ng ~oleml.n shall be provided ii .t the Build,~ Coda ~ N~ YO,~ ' MEET THE REQUIREMENTS OF THE CERTIFIC/ CODES OF NEW YORK STATE. NAILING ~ CG ~ ~,;,.~ ..... ~, ~LIN NEED ....... ' ...... '"' ........... ............ ,.. , ...... :: ,~ ~ ~ : ~:"" ....... '~"- '"-'='='- "~ ~/ ~E~~*~~4 .(,)J ..... ._ ,..... ...... , ~ ~ ~ 7 ............. ;:: ::::: ~ov~ oNLE~DC N~ENTBEFORE / . . ...... ¢, ~ /~ CERTIFICATEoFOCCUPANC~ [~ ~-r'' ,,.~-' ," ~.~ '~:'= I SOLDER USED IN ~ i TER ~ .............. " = t I ~ .......... '" -.- 1---3 ' T .1 ~ < ....... ~. ~ ~ ~~ ~OT ............ ..... , _ ¢ USE~ UN~WFUL "-'~ : ...... ' ' *': '-~"~- J ~1 =~ (~~ &~ " ~=.- , ....... , ~ ,, ~ i, ,~ , ~ ' ~ ~ ~-' ;' -~ -' -'"""~ '"'"'-"'"-~'"~. ~ " ~ I ~ ~ I~I' "~ -' -' ~'~-'~' ~ · ~**" ' - ~ ~ : ~* ~ * * ~ , WIT~ JT CERTIFICATE ............................... ... - ., .] -- ~ ~__ : ~_._~ ,- ~ ---~ ~D AS NOTED J NOT~Y BUILDING g._PARTMENT ~ ~ d a~ m~ or dtm~ ~ ~ Dr~p and 8~mm. ~L~I, IL~=~] ~ ~:o" ~ ~m.~. ~'-0" (~) ~ 765-1B02 8AM TO 4PM FORTHE 3. E~STI~ CONDITIOn: ~ ~ m~ - I~ ~ n~ lim~ ~). ~ ,, ~ r ___ ~ ~ -- ~, -- ~ ~" FOLLOWING INSPECTK;NS: ~ ~, .~. =,=,..~.~ ~.~, ~.,, ~, .~, , ,, ~ ~,r~. .... ~. FOUNdATiON - ~'".'0 ~U~ .._ z ~---- ~ ' ~ ~ / 'CC MPL'/~,~,'ITH CHAPTER "46" ~. ROUGH - FRAMING & PLUMBING .',, FLOOD !qu~AEE PREVENTION 3. INSULATION t, ~NCR~E ~RE~: 30~2~;~ ' SO~TFIOLD TOWN ~,_, 4. RNAL - CONSTRUCTION MUST ~ ALL 60NSTRUOTION SHALL MEET THE ~; ~i~¢~f~"~. - ' YORK S~ATE, NO~ RESPONSIgLE FOR 3 FOUN~ON WALLS: r ~ ~ ~e, ~ ~r- 4~" Ce. DESiGN OR CONSTRUCTION ERRORS. ~. z ~.z: z .=:_=.- z:=?y£S _n: ~-_=-: :- =.. -: m- ¥: ~-5-_-_'zzT'z=== h / / / :L¥ I i I t ~l OF., T b~ E> ~E_~ ~' ' ~L~: N~m, $. ENTRY~R&81DELIG~-~. . 5. ~RBELL: NuIoneP~LPB ~ WALLTORIMJ~T 1,' ? - - -'~u LJ z t-',q ~