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Home My WebLink About33819-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33896 Date: 08/13/09 THIS c~KTIFIES that the building INTERIOR ALTERATIONS Location of Property: 2030 MILL RD (HOUSE NO.) (STREET) County Tax Map NO. 473889 Section 67 Block 7 Subdivision Filed Map No. __ Lot NO. __ PECONIC Lot 10 (N3~4LET) conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 31, 2008 pursuant to which Building Permit NO. 33819-Z dated APRIL 14, 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 INTERIOR ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to PINDAR DAMIANOS (OWNER) of the aforesaid building. S~FOLKCOL~I~fDEpART~T OF }~ALTH~_PPRO~-~J~ N/A ELECTRICAL c~KTIFICATE NO. 8822 11/15/08 ~U~BERS C~KTIFICATION DA'r~ 07/01/09 WILLIAM GREMLER Authorized Signature Rev. 1/81 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. 33819 Z Date APRIL 14, 2008 Permission is hereby granted to: PINDAR DAMIANOS 2030 MILL ROAD PECONIC NY, for : INTERIOR ALTERATIONS TO AN EXISTING DWELLING AS APPLIED FOR; FLOOD PMT INCL. at premises located at 2030 County Tax Map No. 473889 Section 067 pursnant to application dated MARCH Building Inspector to expire on OCTOBER MILL RD SOUTH/PEC Block 0007 Lot No. 010 31, 2008 and approved by the 14, 2009. Fee $ 300.00 Authorized Signature ORIGINAL Rev. ~18102 APPLICATION.FOR CERIILFICATE OF OCCUP~ BtOG. DEPI. ,~N OF SOUTI4OLD aNCY "~ lifts, application mus~ b~ filled in by typewriter or ink and ~ubmitt~d to tl~ Building l~'pama~mt with the following:. For new bliill&inE or'new use: 1. FhUd survey of protna~ with acotuate location of all buildings, pwpeny lin~; streets, and un .u~uat natural or . topogmpMc featm~.' . . Z ..Fi.s! Approval from Hcal~ Dept. of:water, supplyand sewerage-disposal (S-9 form). Approval ofel~ricslinstallation ffomBoardofFire Uaderwriters. 4. Sworn ~n. ent from plumber certify/ag thnt~h~ ~old~' u~ed ~11 ~ ~°ntsin~'~8 than 2/10 0.f l ~A lead. 5. Ceremonial' I~ilding; iaduatrlal buildin~-.multipl~ f~lid~ and similar buil~n~ andinstallafio~,, a ~fi~ of Cod~ C. omplia~ frOm ar~hit~t or e~n0~' r~al~naibl~ for.the building. 6. Submit planning BoardAppmval of completed sit~ plan For ~xi~ting'buildlngs (pri0r to Ap~l 9, 1957) n0n~onformlng .u~s, oF .bnildi~s ~d ,p~s~' I~d us~: 1. Ac~arate sta'vey of prepay ~howing all prope~ liaes, str~x~,.bui!diag and.unusual natural or to~Mc features. 2. A?pr~p~ly eomploted'applicaiio~i and eOn.~at to ~ signed by th~ applicant. If a Certificate of Oecupancyis denied, the Building Inspector shall state the rexona therefor in writing to the applicant. C. Fees l. Certi~cate~ ~f`~u~an~y - New dweA~mg $25.~ Ad~dti~n.q t~ dwe~ng $25~ A~teraft~ns t~ dwe~ing $25.~ SWilmmin~ [~O1 $25.00, A~88olwf building $25.00, Additions to accessory building $25.00, Busine~aea $50.00. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. IJpdatedCertificate of Occupancy - $50~00 T~mP°mry Certificate Of OCCupaney- Residential $15.00, Commercial $15.00 ' 0id or Pre-existing Building: New Constmctibn: . L0eationofProperty: ~0~0 ~_~ . HoUSe No. ,. Street- .Owner or 0Whets of Pwperty: ~ ~t;~r- Suffolk County Tax Map bio 1-000, Section 0 ~ --? Sub~vidon Permit No..~ ."~'% I q 7_.. · .Date of Pemfit. (check one) Hamlet Health Dept. ApprovaE Block .000'7...' Lot Filed Map. Lot: Applicant: ?;vu:l~n- 9c~v~o~hoe~ Underwfiter~ Appwvah Planning Board Approval: Request for: Temporary C~rtificate Fee Submittbd: $ / Finai Certificate: ~_ (~k o~ : Applicant ~ture ARCHITECTURAL SERVICES (631) 399-9100 AUGUST 6 2009 PINDiI~ ~O~ P.0, ~ 041 ~O~Ug, N.Y. RESIDENC~, LOCATED AT: 2080 MILL B0in PF£0NIC, I~I.Y. I1~58 AUG 1 2 200g BLDG. DEPT. TOWN OF SDUTHOLD ENERGY NOTES ALL ~ ~HAL,L ~ IN STI~T ~ VZTH CHAPTER 11, · E:NE:R~ EFFICIENCY' ilr TH~ ~ RES,I:]~ENTZAL ~ ~' NE'V YDRK STATE, HAXIHLIH I:'E~TRATII]N ~1f FACTDR = 0.31 HININUH CEILIN6 ~ VALUE - 49.0 H~N~¢I~ .~nrm FRN4E VACL ~ VALUE ~" ~ NINZNUN F'L.i~R ~ V~ =30,0 .JCff~T~, ~, PENETRA1'X[]~ AND ALL. ITl'HER ~ QmENINGS IH THE ~m. DXNG ENVELDPE 'I'H6T ARI~ ~ ~ 13F I.EAKAG~j ~T ~E GNJt.l(ED , 66$:K~ED o ~T. ATHE~TRIPPED flTHERVZgE :,~T. AI. ED VXTH A SUZTA~IL.E AIR BARRIER ENTRANC[ ]~ NU~T HAVE A $1'QRH I)QQR [IR CER~ 'U" VALUE I~' ,3~ QR LIE~ OVER 20 YEARS OF RESIDENTIA-I~ ARCHITECTURAL EXPERIENCE 1K.E.D. ARCHITECTURAL SERVICES (631) 399-91OO ~ H,V,A,C, SYS'I'D~ ANI) EGUIPNENT HUST {~qPLY VITH NEV ~ ~TATE: EIIE:RGY CI:Ilq~:RVATII~ I:~N~~ 6, FI[REPL..ACES: ~ ]~E EGU*IPPL'~ VI. TH GLASS TIGHT VENTING I)~4PER, ~N]) I~:q~E:~ CDI4~US~£Ifl ~ VEATHI~ S~ AU.. VINIX:P~ 61~ ~ Ti] ~: I~ITH~R INSULATED DR 9. ~ VATER P/P~S IN UNINSUI~TE~ SP,~2ES I'D ~ INSUI.ATE~D II~JLA~ FTIR PIPING I 1/4' '~o 2 l/g~'. lO, HEATIN~ ~ CDDU~ SY~,'PKHS SHALL CllqPLY , IN AL/. I~SPECT , VITH ~CTIDN Iq 110~ -. THIS PRDJEiCT ~ ~L'EN I~E:S~:iNF~ , 'ID THE ~..~T DF' NY ~ :~I.IEF, ~ UI~ER:ST~])IN~ ~ OVER 20 YEARS OF RESIDENTIAL ARCHITECTURAL EXPERIENCE Ph. t631) 298-3894 Fax (631) 298-1920 BEST QUALITY P&H Plumbing * Heating * Water Treatment * Fire Protection Suffolk County Master Plumber License 1643-MP 3905 Ole Jule Lane Mattituck, NY 11952 CERTIFICATION Building Permit No. (Please print) Plumber: (Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. X(~lumber's signature) Swom to before me this~ Notary Public ~ County ELAINE T. VILLANO Notary Publio, State of New Yo~ No. 01VI6029229, Suffolk County Commission Expires Aug. g, ~ Nassau Suffolk Electrical Inspecfions , P.O, Box 549, AquebOgue, New York + 11931 Tel: 631-591-3097 Fax: 631-591-3098 Apphcat~o : 8822 Date: 11/15/08 Issued to: Pindar Damianos Addregs: 2030 Mill Lane Introduced By: Village: Peconic Big Blue Electric Residential [] Commercial The f~llowing was examined a~qd approved up to the abev~date and~tOu.d te be in compliance with the Attic [] 1"t Floor [] 2~l~r~or [] 3rd Floor Renovation Basement [] Hot Tub [] Addition Detached Gar. age Pool Switches Receptacle Fixtures 26 21 Fans Dishwasher 2-Fixtures 2-Outside fixtures 2,Motion n Monoxidc Furnace Oil Exit Signs Motors Limited Insp. Final lnsp. Mctel Amps Phase Other Equipmem:l-Well Pump, 1-4. SKW Water Heater.~-Eleetri~c Baseboards,2'A/C~'*-;~C ~ altered in ~ THE NEW YORK BOARD OF FIRE 8083848 BUREAU OF ELECTRICITY ~ 40 FULTON STREET, NEW YORK, NY 10038 D~e }4AY 17,2001 AppZ~o, No. on rite 12199001./O1 H 071444 THIS CERTIFIES THAT only the electrical equ~ment as described below and introduced by the applicant named on the above application number is in the premises of KL~T Y~G, 2030 MTT.T, LR~, P~ONIC, NCANI~SCE- FL~; ~uoX~REUs~R EE SN; OTHEI~ I~ANOES DRYERS EUENACE MOTORS FUTURE APPLIANCE FEEDER~ SPECIAL I~C'PT. TIME CLOCKS BELL I UNIT HEATERS MULTi-OUTLET DIMMERS *tRVlCt ~¢0~'~ lo. 1' ' 11~0 ~ HOLE DI~%rE~ ~ : - : _, HkC.C.L'[~, Fl, 11952 Thl, c4~flC~/e ~?tg~~ g~red In any monne~; ream to the O~Ce of rn® Bored If lnc0,,e¢t. Inape~m mey be ~en#,ed by rnel, creden#ob. I J TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY ROUGH PLBG. INSULATION FINAL FIRE SAFETY INSPECTION [ ] FIRE RESISTANT~UCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~ DATE ~ ~,~, ~ ~, INSPECTOR ~/~. ~~-~ 2030 Mill Lane Peconic, New York 11958 June 30, 2009 Town of Southold Building Department Main Road Southold, New York 11971 To Whom It May Concern: 1, Pindar Damianos, am the owner ora residential house located at 2030 Mill Lane in Peconic. 1 have completed interior renovations to the existing house. The remodeling did not exceed $25,000. Please do not hesitate to contact me if you need any further information. My cell phone number is 631-445-0398. Thank you. Pindar Damianos ,*~L~, .s~'~c~:~o~ m. oR:r FOLIATION (1ST) ..................................... FO[~DATION (2ND) LNSULA'I ION PER N. Y. STATE ENERGY CODE /DrOo.-~ 7- 7 OWNER TOWN OF SOUTHOLD OPERTY RECORD CARD (}(}(~_,~ ;TREET ~_~7~ ~' - VILLAGE DISTRICT . SUB. LOT .fi// LAND IMP. TOTAL FARM DATE BUILDING CONDITION NORMAL BELOW Acre Value Per Acre AGE Form I-illoble 1-illoble 2 [illoble 3 ~cedlond ;womplond ~rushl~nd ~ouse Plot Fota I W TYPE OF BUILDING M. Bldg. I~.~'X ~.~'z- ~.o ~7_.7.J J? 4' ,~ Foundation ~ , Bath Extension Z/~/Vt ~. I ' '" Basement I Extension ~t. Walls ~-~ Interior Finish YX ~ ~ ' ~~ je ~ ~" ~¢~ Porch _ Attic J~[~ SS Porch , ~ .: Rooms 1st Floor Breezewoy P~tio Rooms 2nd Floor Garage Driveway O.B. ' / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined ~ W 20 Of Approved ~ I'~ 20. 0~ Disapproved a/c Expiration [,tO I I0(, 20 O~ PERMIT NO. BUILDiNG PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 4 sets of Building Plans Planning Board approval SurveK Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Building Inspector ~' i: "~' / 'APPLICATION FOR BUILDING PERMIT ¥, ,,-", "" ",, Date ~J/~?//t ~ ,20_ ~,r. ~5;(e' ?> ' . k INSTRUCTIONS I / a. T~'Xapplication MUST ~y filled in by t~ewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot pCn'~-~. Fee according to schedule. b. Plot ~lan sko~in~ location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and wate~gys. c. The work covered by this application may not be commenced before issuance of Building Pemit. d. Upon approval of this application, the Building Nspector will issue a Building Pemit to the applicam. Such a pe~it shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pan for any pu~ose what so ever until the Building Inspector issues a Ce~ificate of Occupancy. f. Evew building pe~it shall expire if the work authorized has not commenced within 12 months a~er the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the prope~y have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the pemfit for an addition six months. Thereafter, a new pe~it shall be required. ~PLICATION IS HE,BY M~E to the Building Depa~ment for the issuance of a Building Pemit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Re~lations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulat~ and to admit authorized inspectors on premises and in building for necess~ inspections. (Si~amre of applier ¢ name3f a co~oration) (Mailing address of applicant) Stat~ wh~th~ applic~t is owner, less~e~~engin~er, general contractor, d~ct6cian, plumber or builder Name of owner of premises ]~/L)/'~/0/~ D/~4t/t~]/L/~SI'~'' (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. Loca~on of land on which proposed work will be done: House Number Street County Tax Map No. 1000 Section ~ 7 Block Subdivision Hamlet o? Filed Map No. Lot Lot /O State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~{xJ~ /~;'{ -~e'71¢Z ~'.~ b. Intended use and occupancy. ~"fif,~t ~ 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost.. 5. If dwelling, number of dwelling units If garage, number of cars ,.,.A-d~Jn,x Alteratior[ .{~ther Work )I,'OT'E.~"W/o,~ x.~ ~ (Description~ Fee (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, l~pecify nature and extent of each type of use. 7. Dimensions of existing structttres, if any: Front Rear .Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Rear 8. Dimensions of entire new construction: Front Height . Number of. Stories 9. Size of lot: Front ! Rear Rear .Depth Depth 10. Date of Purchase Name of Former Owner 11. Zone or use distr/ct 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 ~'Will excess fill be removed from premises? YES__ NO 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland. YES~x~_NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERM~IT/$ MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES~x~_ 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 OF ///~,_4~K ,JO ,~/.~/,~~ J'~--~ being duly sworn, deposes and says that (s)he is the applicant (Name $~ ihdividual signing contract) above named, (S)Heis the (C6ntracm~ Ag~9~, 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 tchbefore me this . NOi~ Public 203 MELANIE DOROSKI NOIARY PUBLIC, StateofNewYo~ No. O1D04634870 ~x~/~/~Signat&~ 6f A~ ~cant~ ~ Qualified in Suffolk County Commission Ex,oires September ~O,'/-f ) APPLICATION PAGE I of 4 TOWN OF: SOUTHOLD FLOODPLAIN DEVELOPMENT PER_MIT APPLICATION This form is to be filled out in duplicate. SECTION I: GENERAL PROVISIONS (APPLICANT to read and L No work may start until a permit is issued. 2. The permit may be revoked ii' any false statements are made herein. L 3. If revoked, all work mast cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is 5. The permit will expire it' no work is commenced within six moatb~ of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or Iris/her representative to make reasonable inspections required to verify compliance. 8. I, THE APPLICAN-F, CERTIFY THAT ALL STATEMENTS HEREIN AND 12,1 ATTACI-LMENTS TO . THIS APPLICATION ARE, TO TH.~B .E. ST OF ~I.Y..If2~VLEDGE, TRUE AND ACCURATE. NAME ADDRESS TELEPHONE APPLICANT BUILDER ENGINEER To avoid delay in processing the appllcafioa, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to tl~ application showing the proiect location would be helpful. FDP{93) APPLICATION # PAGE 2 OF d DESCRIPTION OF WORK (Check all appticable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY ~TR UCTURE TYPE [] New Structure t2 Addition Alteratiott Relocation [] Demolition t~ Replacement [] Residential (1-a Family) [] Residential (More than 4 Family) [] Non-residential (Floodproo£mg7 E] Yes) [] Combined Use (Residential & Co,~,'~erciad) [] Manufactured (Mobile) Home (Iu Manu- factured Home Park'?. [] Yes) ESTIMATED COST OF PROJECT B. OTHER DEVELOPMENT ACTIVITIES: [] FiLl [] Mining [] Drilling [] Grading iD Excavation (Except for Structural Development Checked Above) [] Watercourse Alteration (Including Dredging and Channel Modifications) [] Drainage Improvements (Including Culvert Work) iD Road, Street or Bridge Construction [] Subdivision (New or Expansion) [] Individual Water or Sewer System iD Other (Please Specify). After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. I~ECTION 3: FLOODPLAIN DETERMINATION (To be comuleted bv LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: [] la NOT located in a Special Hood Hazard A~ea (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REOUIRED). [] ls located in a Special Hood H~Tard Area. FIRM zone designation is 100-Year flood elevation at the site ia: Ft. NGVD (MSL) [] Uuavailable iD The proposed development is located in a floodway. FBF'M Panel No. Dated [] See Section 4 for additional instructions. S1GNED DATE AJ~PLICATION ~ PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATOR) The appl/cam must submit the documents checked below before the application can be processed: El A site plan showLng the location of all existing structures, water bodies, adj~tcant 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 basement), types of water resistant materials used below the £u-st floor, details of floodprooFmg of utilities located below the first floor and details of enclosures below the first floor. Al.so, Subdivision or other development plans (If the subdivbion or other development exceeds 50 lois or 5 acres, whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). [] Plans showing the extent of watercourse relocation and/or landform alterations. [] Top of new fill elevation Ft. NGV-D (MSL). Floodproofing protection level (non-residential only) Ft. NGV'D (MSL). For floodproofed structures, applicant mnst 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 ~crease in the height of the 100-year flood. A copy of all data and calculations supporting this Finding must also be submitted. [] Other: SECTION 5: PERMIT DI:,'I gRMINATION (To be completed 17¥ LOCAL ADMINISTRATOR) I have determined thai the proposed activity:. A. El 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 SIGI'.fED , DJ&TE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked the Local Administrator will provide a wri(ten summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from the Board of Appeals. APPEALS: Appealed to Boa. rd of Appeals? O Yes O No Hearing date: Appeals Board Decision --- Approved? [] Yes Conditious ~ No APPLICATION PAGE 4 OF a ~ECTION 6: AS-BUILT ELEVATIONS (To be submitted bv APPLICANT before Certificate of Compliance is issued) The following information must be provided for project structures. This section must be completed by a registered professional engineer or a liceused land surveyor (or attach a certifiemtion to this application). Complete 1 or 2 below. 1. Actual (A~-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard A~eas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGV'D (MSL). 2. Actual (A~-Built) Elevation of floodproo£mg protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION fTo be completed bv LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? [] YES I-I NO DATE BY DEFICIENCIES? {-I YES [] NO DATE BY DEFICIENCIES7 [] YES [] NO SECTION 8: CERTIFICATE OF COMPLIANCEFTo be comoleted ~¥ LO(~AL ADMINISTRATOR) Certificate of Compliance i~ued: 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 HAZA_RD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [] NEW BUILDING [] EXISTING BUILDING [] VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: to COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL I.,AW # ,19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS LOCAL LAW #, , 19__, AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: OF C/C(93) S.C.T.M. NO, DISTRICT: I000 SECTION: 67 BLOCK: 7 LOT(S): 10 GOLDSMITH'S INLET (PECONlC INLET) LINE REBAR FND. EL 7E.- -- -ct "G LOT 35 VINYL ~ SHED ~ 86.00' EL 6,6 MILL ROAD N~48 · NOTE: BEARING ALONG NORTH LINE AND EAST LINE CHANGE TO THAT SHOWN ON PREVIOUS SURVEY, ALSO AGREES WITH ADJOINING DEED AREA: 8,087.9 S.F. OR 0.19 ACRES NYT#47 THE WATER SUPPLY, WELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS, ELEVATION DA TUM: _IJ$__C_&_~_?~_~_ ............... UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE S1RUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDItiONAL STRUCTURES OR AND OTHER IMPROVEMENTS, EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALL Y EVIDENT ON THE PREMISES A T THE TIME OF SURVEY SURVEY OF: LOT 34 & PART OF LOT 33 MAP OF: BAILEY PARK AT PECONIC L.I., N.Y. r~LED:SEPTEMBER 26, 1939 AS #1097 SITUATED AT: PECONIC TOWN OF: SOUTHOLD SUFFOLK COUNTY, NEW YORK rILE # 27--148 SCALE: 1"=20' DATE: JAN. 12, 2008 N. Y. S, LIC NO, 50227 CERTIFIED TO: PINDAR DAMIANOS; KENNETH M. WOYCHUK L.S. Land Surveying and Design P.O. Box 3, Mattituck, New York, 11952 PHONE (631) 298-1588 FAX ($31) 298-1588 maintaininI the record9 of Robert J. Hennessy REVISIONS 11 I I I ' I ' ms'r~N~ ' SUNROOM ~'- I I il = --- ~ ~ ~ ...... I I _/ ~: ~CHEN ' ~ISTIN6 I I ~ ~ u~.~ ~oo~ ~ : ~ i~7 ~ I I II ~ ~ : l, [ I I ~ ~jsiiNG ~J~IING i ~IS~NG I II ~,BEDRO0~ 1 ~ BEDR~M 2 I~ LO~ ~ , ~ I I I Ii ~ ~ - , I U j I/ I I Z -- ~ ~ 0 -,, OOOUPANOY ~' ~~' --' '~ USE IS UNLAW [ ~ ] WITHOUT ~ V ~ OF OOCUP/l ~" Z I~ I IALL OON~T~UOT~( ~, ~ --J~J CODES OF ~ ~ ~ - REQUIRED. PLUMBING ~ cglb ~ ~ ~ l I ~ CERTIFICATE O~ OCCt:/FANC ~ ~l'lll~ ~ ~ ~ ~ I ~ EXIST. FRONT ELEVATION ION ~um~e~c~.,~,,.~o~ 0 ........ ~ ~ ~ ~ ~-...Z~ .... ~- 0 ~IS~NG ~ ~ ~IS~NG ~ ~ ~ ~ ~ ~ a. IkSULAT!ON BEDROOM [ ~ BEDROOM 2 ~ -- ~ B~ COMPk~I~ FOR C.O, - ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1 YORK STATE. NOT RESPONSIBLE FOR _ - ..... DESIGN OR CONSTRUCTION ERRORS. - U~DE~I~g~ 0~T]Fi~ATg COMPLY W TH ~ _ ~ ~ ~L~AMAG5 ;.,l:~, :~,1 ~LE: ~ NOTED ~ 11~ 2008 ~' ~'~~ EXIST. REAR ELEVATION EXIST. RIGHT SIDE ELEVATION .;~/,[; ~ PROPOSED FIRST FLOOR P~N ~' -.. I 1/4,,=1,.o,, EXISTING LOFT