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HomeMy WebLinkAbout34344-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34178 Date: 01/29/10 THIS CERTIFIES that the building ALTERATIONS & REPAIRS Location of Property: 1940 MASON DR CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 104 Block 7 Lot 16.1 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 3, 2008 pursuant to which Building permit No. 34344-Z dated DECEMBER 12, 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 REPAIRS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to SCOTT A & SUSAN A AMBROSIO ( OWNER ) of the aforesaid building. SuFMOLKCOI~TYDEPAR~NT OF ~ALTH;~PPRO~ N/A RT~C'~RICAL C~KTIFIC3%TH NO. 4013896 08/14/09 PLD]~B]E~S c~KTIFICATION DA'r~u 01/04/10 SCOTT AMBROSIO Rev. 1/81 81/21/2810 02:53 5162946147 REBMANN Ferm No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF 0 This application must be filled in by typewriter or ink and submitted to the Br A. For new building or new use: 1. PAGE 02 ildinlt Dermrtment with the,fdllowi RLI)O. TOWN OF $0UTHOLD 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 (8-9 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. Commemial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible fbr the building. 6. Submit Planning Board Approval of completed site plan mquiremems. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all properly lines, streets, building and unusual natural or topographic featur,s. 2. A properly completed application and consent to inspect signed by the applicant. Ifa 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, Commercial $15.00 Date. Old or Pre-existing Building: ~ (check one) Street f Hamlet New Construction: Location of Properly: lqqO House No. Owner or Owners of Propetny: C~ro Suffolk County Tax Map No 1000, Section Subdivision Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fcc Submitted: $ Oo 5¼\q% ' Date of Permit. Filed Map. __ Lot: Applicant: Underwriters Approval: Final Certificate: C~ (check one) Town Hall Annex 54375 Main Road P.O~ Box 1179 Southold, New York 11971-0959 Telephone (631 ) 765-1802 Fax (63 I) 765-9502 BUILDING DEPARTMENT TOWN OF SOUTHOT,n CERTIFICATION Date: Building Permit No. Owner: ~t'o ¢( Plumber: (Ple~ print) I certify that the solder used in the water supply system contains less than 2/10 of 1% Swom to before me this CI['~ day of -~ Ct c~ ~xtgtr ,.I , 20 I 0 CONNIE D. BUNCH Notap/Public, State of New No. 01BU6185050 Qualified in Suffo h County Commission Expires April 14. Notary Public, 5U nO~__. County 01/21/2010 02:53 5162946147 REBMANN PAGE 03 v ,I BY THIS CER'rlFICA'I'E OF COMPLIANCE THE YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NL=W YORK, NY 10038 CERTIFIES THAT Upon the agplication of upon premises owned by ALSERTSON ELECTRIC INC. 901 WILLIS AVE ALBERTSON, NY 11507. SUSAN & SCOT[ AMBROSIO 1940 MASON DR CUTCHOOUE, NY 11935 i Located at 1940 MASON DR CUTCHOGUE, NY 11935 Number: 4013896 Section: Block: Lot: Certificate Number: 4013896 Building Permit:' BDC: n$11 DeScribed as a R~iden~ial occupancy, wherein the premises electrical system consisting of 'electrical devices and wiring, described below, located in/on the premises at: First Floor. Outside. Attic, A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ilerein, was conducted in accordance with the requirements of the applicable code and/or standard promull~ated by the State of New York, Department of Stats Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the14tk Day of AuSust, zoo,). ~ OTY Rmm Rmt~. Circui~ :, Alarm.aad emergency eq#lpm~mt Applilnm and Acccssori. ' Air Condl~o~r Exheca[ Fan F~ ~20~ms Wi~n~ And ~evl~s ~t P~le Fnn R~e R~e 3 O 0 Smoke 1 0 P~ove 15000 BTU t 0 F,H.P 1 0 Gas 20O cb 4 0 120V 2 0 LOW Volt~ge 17 0 Incandescent 19 0 i~lxtum 33 0 Gan, Pu~ose 2 0 1 0 20a-laund~y Appliance G 0 erCl seal This cerUficate may not be altered in any way and is validated only by the p~eSence of a raised seal at the location indicated. BY THIS CERTIFICA'I'E OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY .... 40 FULTON STRF_rr ~ NEW YORK, NY 100;3~ CERTIFIES THAT Upon the appliCation of ALBERT$ON ELECTRIC INC~ 901 WILLIS AVE ALBERTSON, NY 11507, 1940 MASON DR CUTCHOGUE, NY 11935 ~lumber: 4013896, upon premises owned by · SUSAN & SCO'I'r AMBROSIO ,1~0 MASON DR 'cUTCHOGUE, NY 11635 Certificate Number: Block: Lot: Building Permit:. BDC: ReeMentlal occupancy, wherein the premises electrical system cons~ wiring, described below rocated in/on the 13rerniSes at= · Fir~ Floor. Out~ide. Attic, of the premises electrical system, limited' to electrical devices and wiring[ to the extent was conducted n accordance with the requirements of the applicable code and/or the State of New York. Department of' State Code Enforcement and Administration, urisdiction, and found to be in'compliance therewith on thel4d~ Day of Aa[,m, zoe~. OTY P. ztn ~11~'. Cireuitz Tyne 24 0 Gen. PLlrl~le 14 0 Gaff+ Pufl~ stal 2 of Z .... ' ..... "· seal ~ not be altered in any wa~ Date: To: Re: JAMES J. DEERKOSKI P.E. 260Deer Drive Mattimck, NY 11952 (631) 774 7355 January 19, 2010 Town of Southold Building Dept Strapping/Framing Inspection Ambrosio 1940 Mason Dr. Cutchogue, NY 11935 Permit # 34344z To Whom It May Concern: This is to certify that all fire caulking and insulation on the above mentioned project is in tact, and meets all state and local codes. A framing/strapping inspection was also performed and all framing is as per plan and meets all state and local codes. If you have any questions, please do not hesitate to contact me. Thank You. Sincerely, es J Deerkoski 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. 34344 Z Date DECEMBER 12 2008 Permission is hereby granted to: S & S AMBROSIO 1940 MASON DRIVE CUTCHOGUE,NY 11935 for : MINOR ALTER3kTIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR PER TRUSTEES PMT 7002A; FLOOD PMT. INCLUDED at premises located at County Ta~ Map No. 473889 Section 104 pursuant to application dated DECEMBER Building Inspector to expire on JUNE 1940 MASON DR CUTCHOGUE Block 0007 Lot No. 016.001 3, 2008 and approved by the 12, 2010. Fee $ 300.00 / Authorized Signature Rev. 5/8/02 ORIGINAL TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. ~INSULATION [ ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION REMARKS: ",t'.,...!~-~,.~ ,-..,- ,...__-,~v_ ,---.-,~/~- ./ DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [~ROUGH PLBG. [ ] FOUNDATION 2ND ,~INSULATION ~ [ ]FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION ROUGH PLBG. INSULATION ~'FINAL [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION REMARKS: DATE /(~- ~o- ~ ~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FOUNDATION 1ST ] FOUNDATION 2ND ~ STRAPPING [ ] FIREPLACE & CHIMNEY [~.].~R 0 U G H PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: DATE ~ -/l'-- ° ~ INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork. net Examined Approved Disapproved a/c Expiration 14I 7/ .20 0g PEI/.MIT NO. {) L~ 3 'f 5/ g~ 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 Flood Permit Storm-Water Assessment Form Contact: ng Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS 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, 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 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. (Signature of applicant or name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~¢ 6~4~ (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. Location pf land on which, proposed w,.qork will be done: iqq0 I.)c. House Number Street County Tax Map No. 1000 Section IO~/ Block Oq Subdivision Filed Map No. Lot //~. t Lot 2. State existing use and occupancy of premises and inte~Kied use and occupancy of proposed construction: a. Existing use and occupancy co~r~e- ~L~t/I,t;[~ b. Intended use and occupancy ~t ~ ~. ~----~b~A' ~.~ 3. Nature of work (check which applicable): New Building Addition Alteration Repair ~ Removal Demolition Other Work /LCco ~c~ i tL~x q ~ (DesoIfiption) 4. Estimated Cost ~ I~,0't~O Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions' ofexistingt ,, structures,,, _ if any: Front ~ ~ '- 0,9" Rear ~ c/ . 09 Depth ~,9~ '-// Height /~ -~' ~- Number of Stories / Dimensions of same structure with alterations or additions: Front Depth ~,=~ ;- //" Height /[ ' ~'" ~ 8. Dimensions of entire new constru~nt Rear Height Number of Stories 9. Size of lot:Front o~9[~, ~'7' Depth ~t_O ', Number of Stories 10. Date ofPurehase ~Off'J'. a~OO°c~ Rear ~-~" / Depth Rear t~/'e~ c, [~ J 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 ~<~ Will excess fill be removed from premises? YES NO ,~ 14. Names of Owner of premises ~Ce~L4 ~c, [~rOa~ddress Name of Amhitect ,3 t~ '~.~lc~k-~ Address Name of Contractor O~on.t~r Address Phone No. Phone No 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. PERMIT, S~4AY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES fi'-- NO ['~/~(~ - t~.O. * 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 (Name o~f 'mdO~ivid~u~ signing co~t) above named,being duly sw°m' dap°ses and says that (s)he is the applicant b CONNIE D, BUNCH (S)He is the ~/~(/A~ ~( Notary Public, State of New York No. O1BUfi185050 (Contractor, Ag~t, Corporate Officer, etc.) Qualified in Suffolk County Commission Expires April 14, 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. Sworn to before me this ?-~v'd day of-~ c-~r'.~( 200~ Notary Public I Signa~ of A~pp le~t TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET /~f/.~/~ VILLAGE DIST. SUB. LOT R~. ~ ~ S~. ME ~ FARM CO~. CB. MI~. Mkt. Value Til~bt, j FR~TAGE ON WATER ~C~ Z ,;,2~ ~~' W~le~ FRONTAGE ON R~D ~ ) ~ ~ SOUTHOLD PROPERTY RECORD CARD STREET VII-I.~GE DIST. SUB. LOT W TYPE OF BUILDING SEAS. VI- :ARM .~OMM. CB. MISC. Mkt. Value ^GE BUILDING ¢ONDI?ION NEW NORMAL BELOW ABOVE FAP, M Acre Value Per Value tillable Voodland ~m.~,lo~a F~ONTAGE ON ROAD ~ -"", BULKHEAD ~1 DOCK Porch Porch Breezewoy Gor~e Total II II I I I L I,I .1111 III I Ill I I t" I"f;~' I I I I I I .1~1 '1,4 ,L~I I I I I I I ;"JllAr--I I I I I I I'1 I I I I '.,I-'11~,~ I I I I I I I I I I I I Floo~ Interior Finish Heot ~ Ist Floor ~o~ns 2nd Floor James F. King, President Jill M. Doherty, 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 (531) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0441C Date June 22, 2009 THIS CERTIFIES that the .replacement of the siding, windows, doors, and installation of two(2) new windows on the existing dwelling, trimming of trees upland of wetlands, removal of a fallen tree, 10' non-turf/no-mow zone landward of wetland boundary, and trimmin~ of phragrnites by hand to 12" At 1940 Mason Dr, Cutchogue Suffolk County Tax Map # 104-7-16.1 Conforms to the application for a Trustees Permit heretofore filed in this office dated 11/3/08 pursuant to which Trustees Wetland Permit #7002A Dated 11/19/08 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the replacement of siding" windows, door~ and installation of two(2) new windows on the existing dwelling, trimming of trees upland of wetlands, removal ora fallen tree, 10' non- turf/non-mow zone landward of wetland boundary, and lyimmine of phragmites by hand to 12". The certificate is issued to SCOTT AMBROSIO owner of the aforesaid property. Authorized Signature NEW YORK STATE D~PARTMF2qT OF ENVIRONMENTAl, CONSERVATION Fad#ty D~C ID 1-4738-e38~ NYSDEC Approval Permit Administrator: GEORGE W HAMMARTH, Depmy Regional Permit Adminisuator sm STO aRoor. 0 CaC .E Distribution List NANCY DWYER SHERRI L AICHER Permit Components NATURAL REBOURCB PERMfI' CONDITIONS GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PEPJVHTS NOTIFICATION OF OTHER PERlVfii-t~E OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following Permih: TIDAL WETLANDS ] L Notiee of Commencement At least 48 hours lmor to commcncemcnt of the project, the permittee and co~tractor s~all si~n and ~ the top poflim~ of the enclosed nofi~w..~tion form cer~fyin~ thnt ~hey ar~ fully aware of md ~ ail tee'ms and oonditiom of ~is penniL Wilhin 30 ds~ys of completion o£ptojec% the bosom po~on of the form must ~ be signed and r~ned, along with photographs of the completed work. 2. Confommantt WRh 19mm All aotivities au~oti~d by this permit must be in strict conformanc, e with the approvM plans submitted by the npplicant or N~plican~s agent as part of the mit application. Such Nopro¥~l plato w~e ~ by Nan~y Dwyer lasl revimi May 4, 2009 mci stm4~t 9qYSDEC Approved" on May 6, 2009. 3. No Comtruetion Debrb in Wetland or Adjneent Are~ Any debris or excess nmterial from construction of this project shall be completely rcmoved from the adjacent area (upland) and rcraovcd to Page2 ors ~W YORK STATt DEPARTMENT O! ~NVIRO~NM~J~TAL CONSI~¥ATION rlicillty DEC 1D 1-4738438'12 PERMIT Under the Envirottmentsl Cmuerv**im._ l~lw (ECL) Permiflee and FfucWty Information Permit Issued To: SCOTT ALAN AMBROSlO 25 BRIAN LN EAST NORTHPORT, NY 11731 AMBROSIO PROPERTY 1940 MASON DR~SCTILM 1000-1(M~7-16.1 CUTCHOGUE, NY SUSAN AMBROSIO 25 BRIAN LN EAST NORTHPORT, NY 1173 ! ,J rncili~/Apphdon Contact.' NANCY DWYER PO BOX 632 SOUTHOLD, Ny 11971 (631) 765-8667 Fmillly Lo~tion: in SOUTHOLD in SUFFOLK COUNTY Fm~ty Prindpsi JMercucc Poht: NYTM-E: 714.2 NYTM-N: 4543.4 Latitude: 41o00'49.2" Longitude: 72°27'09.6" Aufhorized Affiv#y: Construct roof over front stoop, recoflsUuct ~xisting porch~ resurface patio, remove and r~place ha~k stoop. Remove Irces, imtall new slime driveway, relocate shed, and.in~all drywells. All wc~k must be done in accordance with d~ attached plsm p~Tascd by Nmcy Dwye~ last r~viscd May 4, 2009. Permit Authorizations Tidal Wetlands = Under Ar~Lde 2S Permit ID 1-4738-03872/00002 Now Pcnnit Effectiv~ Date: 5/~009 Expimion I~tc: ~ Pfige I of S 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 Permit No.: 7002A Date of Receipt of Application: November 3, 2008 Applicant: Scott Ambrosio SCTM#: 104-7-16.1 Project Location: 1940 Mason Dr., Cutchogue Date of Resolution/Issuance: November 19, 2008 Date of Expiration: November 19, 2010 Reviewed by.' Board of Trustees Project Description: To replace the existing siding, windows, doors and rotted wood on the existing dwelling; install two (2) new windows in back area left and dght side of existing back wall; tdm trees upland of wetlands and remove a fallen tree; and trim phragmites by hand to 12'. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by John T. Metzger last dated November 25, 2008. Conditions: This permit is issued with the condition of a 10' non-turf/no- mow zone landward of the wetland boundary line and no removal of trees on the east side of the property. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jame .~King, PresiC~de~ Board of Trustees ]Ea~t Not~..t, :N~ 1173 ~ ~t'~- [~ 1MIO-104-T-16.1 Town of $outhold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T,M. #: /ooo/ lt./ District Section Block Lot THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING~ DRAINAGE AND EROSION CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. Item Number: (NOTE: A Check Mark (4~) for each Question is Required for a Complete Application) Yes Nc, 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 sur[acas.) Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location? This ~tem shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFIowl Will this Project Require any Land Filling, Grading or Excavation where them is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Matedal 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 Course Running through the Site? Is this Project within the Trustees jurisdiction or within One Hundred (100') feet 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 ,o 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 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 Watercourse? 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 Euilding Permit! EXEMPTION: Ye~s N._.0.o 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 Requlredl __ ~ STATE OF NEW YORK, COUNTY OF%...LA :~ ............ SS ~v~L,~ [~:;/,ud 44' (Name of individual signing Document) ~NNIE D. BUNCH ~ ~) ~ ~, . / N~ ~blic, ~ ~ N~ York ~d ~at b~./shc i~ dm ............................................. [~%.~_~r,~ .......................................... ~,O.tBU6[8~ ..................... {Owner, Contractor, Agenl, Co.orate O~ficer etc ) Q~J~ in S~dk ~un~ , ~ Commission Ex~ir~ April 14, 20 I ~ Owner and/or reprcscntafive of tim Owner ot O~ner s, md s rh I~ a[ tb ~r ze t to perform or have pertCh'med the s~d q~ and to m~e m~d file ~is application; ~at ~1 smtemenCs con.ned in ~s application are u'ue to ~e best oflfis ~mwledge and belief; ~d · at Ore work ~411 be per[ormed in dm m~mcr sd [oHh in tim application filed here~qth. Sworn to belbre me this; ................. ................. ........... Notary Public: ,,,,~.~....,.~..,...,~.~ ....................... FORM - 06/07 TOW~/ CLERK OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE $OUTHOLD TOWN BOARD AT A REGULAR MEETING HElD ON AUGUST 2ti, 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 Developmen.t Permit Application" [FDP(933], /Jnd "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)}. TOWS oF sorrow_ [ $outhold Town Clerk August 25, 1993 TOWN OF SOUTHOLD APPLICATION # PAGE I of 4 FLOODPLAIN DEVELOPMENT PERMFI' APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISIONS (APPLICANT ~o rcad and si~b~L_ 1. No work may start uno a permit is issued. 2. The permit may be revoked ff any false statements are made herein. 3. If revoked, all work muzt ceaxe until permit ix re.issued. 4. Development shall not be wed or occupied until a CertilSc2t¢ of Compliance b issued. 5. The permit will expiu: il J5o work ks commenced wltbin six months of issuance. 6. Applicant ks hereby b/'ormed that other permits may be required to fisJFdl local, state and federal regulatory requlrement~. 7. Applicant hereby I]~¢¢ conxemt to the Local Admiaixtrator or hks/her reprexentafiv~ to make in~pectio~ required to verify compliance. 8. I, THE APPLIC. ANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATIACHMF-..NTS TO . THIS APPLICATION ARE, T0'(rf'HE I~5~T OF MY/.~OWLEDGE, TRUE AND ACCURATE. SECTION 2: PROPOSED DEYCELOPMENT {To bc com~lctcd by APPLICAB~I) NAME ADDRESS TELEPHONE pR, O JECT LOCATION: To ,void delay in pcoce~ing thc ~pptica6oa, please pro'Adc enou~ ~omatioa to ~s~y ident~ the project 1~6om Pro, de the ~eet addr~, lot numar or le~ deception (aHab) ~d, ou~ide ~ ~, the dNt~ to~cn~Mt~sc~groador~H-~o~ml~fidm~k AsEct~ atta&cdto~ appB~tiousho~g (he proje~ 1~6ou wood be help~ FDP(93) APPLICATION PAGE 2 OF 4 DESCRIPTION OF WORK (Check ,:all applicable boxes): A STRUCTURAL DEVELOPiVIEhF[ ~ACTIVF]-Y ~TRUCTURE TYPE [] New Structure E1 Addldoo [] Aheratioa [] Relocation El Dcmolitioo' /~Rcplacz:meat ESTIMJ~TED COST OF PROJECT RReSideo6al (14 F~mily) esidentiaI (More than 4 F~mily) [] Nee-residential (Floodprool-mg? El Yes) E] CombLned Use (P,.esideafial & Commercial) [] Ma,aufactured (Mobile) Home (In Manu- hctured Home Pazk?. [] Yes) B. OTHER DEVELOPMENT ACI1VITIES: 0 Fill O Mining 0 Drilling [] Grading [] Exoneration (Except for Structural Development Checked Above) · El Waterco~se Altexation (Including Dredging and Chan~el Modificaeon~) [] Drainage lmprovcment~ (Including Culvert Work) Ul Road, Street or BHdge Coastrudioo C] Subdivision (New or Expaasioo) C] [nc[ividuM Water or Sewer System [] Other (Please Specil'y) Al'let completing SEC'~I'ION 2. AP?LICAIqI' should submit form to L~caJ Admbxistrator for re~4¢w. ~;EC'TIO~ 3:FLOODPLAff4 DETERMINKTIOIR (To be completed by LOCAL ADMIFUSTRATOR) Thc proposed development is Io*~xted au ~ Panel No The Proposed Development: , Dated [] b I~ located in a Special Flood HaTard A~ea (Nod.fy the apptic.aat that the application review is complete a~d NO FLOODPL-&[Iq DEVF. IJDPMEFIT p,FcJ:LMIT IS REQUIRED). [] Is located in a Spedal Flood Hazard A~ca. FIRM rent de.dgnadon is 100-Year flood elevation at thc silt is: Ft. NGVD (MSL) a Uaavailablc Thc proposed development is located in a floodway I~XIFM Panel No Dated [] c~,q.~. Scg~rr~n 4 for addhional iosuuctio0s SIGNED '~ DATE APPLICATION PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REOUIRED (To hc comp_Jlctcd bv L~)CAL ADMliNISTRATORJ Thc appticanl must submit thc documents checked below before thc appticadon ca~ be processed; [] A site pla~ sbo~dng thc location of all c~tLog struct~cs, water bodies, adj~ccal roads, lot dh~enslons a~d proposed development. [] Development plans, draw~ to scale, and spedficatiOus, iocludhag where appticablc: details for a~choring structures, proposed elevation of lowest floor (badudhag basement), types of water resistant materials used below thc Ftrst floor, dctaJ.Ls of floodproo£u~g of usL~6es located below the £trst floor and details of euclosuses below the first floor. [] Subdivision or other development piano (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, Lhe appticant must provide tOO-year flood elevations ff they are not otherwise available). I-I Pla~ showing the e.x~ent of watercourse relocation and/or landform alterations. 12] Top of new £tll elevation Ft. NGVD (MSL). C] Floodproofmg protection level (non-rcsideutial o~ly) Ft.; HG'V'D (MSL). For floodproofed structures, appticaot must attach cert~cation from registered er~glneer or architect. [] Certification from a registered engineer that the propose~d acfi¼ty ha a regulato~ floodway w;li not result ~n a~2t increase in the height of the 100-ye~ flood. A copy of all data and calctdations supporting this l'mdLng must also be submitted. C] Othec ~E(~TTIQIN 5: PERMIT DETEPd"dIHATION (To be completed DY LOCAL ADMINI~'TR~TOR_] I have determined that the prol:msed activity:. A. 12] Ls B. [3 Is not Ln conformance with provisio~ of Loom Law ~ , 19 . The permit is i~sued subject to the conditlor~ attached to and made part of this permit, SIGNED , DATE f[[~QX Aj~, thc Local Administrator may is;ut a Development Pcrtnit upon pa%nco( of desiffnated feel If BQX 13 is checked, Ibc Local Admiaistralor '~dl provide a ~'~iltcn summa,'? of dc. Scicncics. AppliCant may ~evise arid rcsubmil an application to thc Uocal Administrator or may request a bearing from the Boa-~d of Appe~l~ APPF~,LS: Appealed to Boazd o[Appcals? [] Yes [] No He.tag date: A~peals Board DccLqoa--- Approved? O Yes Conditions © No APPLICATION # PAGE ~ OF ~ SBqTFION 6: A~-BUILT ELBYATION$ (To be submitted by APPLICAJtT before Certificate of Compliance Ls issued~ Thc following b. formadon must be provided for project stract~es. This sccdon must be completed bY a registered profcgioaal engineer or a licensed la~d surveyor (or attach a c~rtificadon to thb application). Complete 1 or 2 below. t. ^ctual (As-Bunt) Elevation of tla¢ top of ~he lower floor, bdudbg basement (in Coastal Hieh Hazard ' Areas, bottom of lowest structural member of lbo lowest floor, exdudbg pilbg and columns) is: ~. NOV~ ~SL). 2_ Actual (As-BuLk) Elevation of floodproofmg prot¢ctioa b FT. NGVD (MSL). NOTE: ,a~ny work performed prior to submittal of cCc above bzfonmation is at thc risk of the Applicant. / ~qECTIOH 7: COMPLLA3~CE ACTION (To be completed by LOCAI~ ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on ir~pcction of the project to easurc compliance w/th CCc commtmicy's local law for flood damage prevemioa. INSPIECTIONS: DATE BY DEFICrENCIES? [] YES 0 NO DATE BY DEFICIENCFES? 0 ~ [21 NO DA'FE BY DEFICIENCIES7 [] YES C] NO SECTION 8: CERTIFICATE OF GOMPLIAN(TE(To be comialeted bY LOCAL ADMII'IIb'TKATOR} Ce. rtWmate of Compliance Lssued: DATE: BY: Attachment B ~A~PLE CERTIFICATE OF CO~PLIA/~CE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD (OVSqYER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE O'WI',rERS NAME AND ADDRESS: CHECK ONE: El NEW BUILDING [] EXISTING BU[LDIHG [] VACA/~F LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: COMPLIANCE IS ITEREBY CERTIFIED WITIf T~{E REQUIREMENTS OF LOCAL LAW # , 19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW #__., 19__, AS MODIFIED BY VA1/JA~CE # , DATED SIGNED: DATED: CTC(93) N SURVEY OF PROPERTY AT EAST CUTCHOOUE TOI~N OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-104-07-18-~ $CAL~ 1~-40' OECMEBE~ ~4, 2OO8 DECEMBER 28, 200~ (REI4SION) NOV~-R ~, 200~_£L_oa_ ~eTLANO FL~GS ,~ CERT~; NOV. IQ EO0~ ~ NOV. :20~ 2008 (PHRAGMITE$ TRIM ~RE~) NOV. ~ ~008 [10' BUFFER]. CERTIFIED TO: SCOTT AMBROSIO SUSAN AMBROSIO AREA=62,612 SO. FT. TO TIE LINES ANY AL~RATION OR ADDITION TO THIS SURVEY/S A ~'IOLAT/ON OF SECI~ON 72090F' THE NEW YORK STATE EDUCAtiON LA~ EXCEPT AS PER SECllON 7209-SUBOI~ISION 2. ALL CER11FICAllONS &=WETLAND FLAG HEREON ARE VAUD FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF' THE SURVI:--YOR I=MONUMENT Yd4OSE SIGNATURE APPEARS HEREON. e =PIPE AMBR0510 RESIDENCE MASON D~-.IVE ,l/ .-' 4/ \ 3'7 .' %[,' Ill ALL CONSTRI %TI,?N SHALL ~EETTHE REO~ ii,q" ,.' !:-, OFTH CODES OF NEd cbt,,, oTATE UNDERWRITr~: %RTFICA'iE RETAIN STORM WATER RUNnrr PURSUANT TO CHAPTER n-' OF THE TOWN ~.- z M AGE, fAS P-,~QUlP. XD) OVe~ POP. CH A[~'~ ~ / ~ ~ LJ~ ~_ ~ ~ - _~_L~ _U. Z ~ .. NORTH ELEVATION EAST ELEVATION o ~ ~ Z~z (AS ~QUI~D) OVEA PORCH A~_ __ ~ ~ ~ ~~ liT O~ ~ISTING OUTDOOR /// R /] WITH NEW SRIC~ PACED POUND - ~ ~z ~ WEST EkEVATION 50UYH ELEVATION (wa~6rs~d6) z~ I I ~ I i ALTER.NATIVE FOP.. OPENING PROTECTION WINDOW ¢ DOOR SCHEDULEI i : i I WITH ND,M BRICK FACED POURED ~.I WIN~OW5 TO nAVE T~DITIONAL 5WL~ LOC~ ¢ HAADWAEE AND FULL ~TE~IOR ~RX~N5 i Ii I CONC~E STOOP I ~EMOVAbLE INTEEIO~, COLONIAL ¢~LE, ~ SHOWN ON ~VATION5 I % I ' I ~ CALCU~TION5 FOEW]NDOW5~5ED UPON EXPOSURE B i i CLIMATIC AND GEOGRAPHIC TABLE R 30 ~ ,2 (2) N~W YORK STATE ~UILDING CODE, I ~ ME~¢ NY ~TATE EGR~55 EEQUiREMENT5 TE~ITE MODE~TE TO J J ' FOR PIABITABL~ 5FACE, , J ~- ~CUSTOM GKILLE5 SEE ELEVATION5 DECAY 5LIGHT TO MODE~TE N~4"X 4" POSTS, DESIGN LOAD CALCULATION5 TABLE R301 .G I ~TE~IO~ ~ALCONIE5 GC 5TAUCTUKAL MEMTEK ALLOWABLE DEPLECTION EILING MATE~AL ~ ~ II~ All obher I = D j ACTUAL W~IGHT~ OF MATE*[AL5 R=F=~NCED TO A.I.A. J I ~ II r~q~ II - k II ill I'~ II I' II~ r II II II 4 ~ 4 ~POSU~ CAT=¢OKY -- ~ ~C ~'LING ~ 'T~AL HALL [ ,, o,, c... ROOF KITCHEN OUTLIN= O~ ~ ,~ ~* ' I - ~ II ~ BEDROOM I ~[~ ~ ~ IL~-- <l ~ B ~ ~ ~ i: II ~ N~WBATH~OOM A~IC ,~ ~ ~ l, ,, ~u~ B~ ~ZISTING ~ ~ m ~ TO TI~MA~ INS?AL~TION D.Wi ~ ~/ ~ CUSTOM F~ME~S'Gm$ FIRST FLOOR PLAN ~HC  Z,, ILO" FIRST ffLOOK ~H~TH~N~, HOU~ W~F~ ~.,.~ CLIMATIC AND GFOGRAFHIC DE,~IGN CRITEP-.IA WEATHERING SEVERE FROST LINE DEPTH 3LO" TERMITE MODERATE TO H~JNVY DECAY 5LIGHT TO MODERATE WINTER DEDIGN TEMP. I ICE DHIELD UNDER- A5 PER-, MANU?ACTURER5 LAYMENT REQUI~Z'D 5?ECIPICATIONS/STATE CODE FLOOD HAZARD5 DESIGN LOAD CALCULATIONS MINIMUM UNIFORMLY DISTRIBUTED LIVE L©AD5 [XTER.IO P. BALCONIES ~C DECF,5 4C ATTICB WITHOUT DTOP-,AGE 3C ATTICB WITH STORAGE 4C I:Npg;%TE ORy I; 0 m?h TADLE R.30 I .G I ALLOWABLE DEFLECTION OF STRUCTURAL MEMEBER5 STRUCTURAL MEMBER. ALLOWABLE DEFLECTION ~E$WZ/~X NE.~'~-COlqBTP'-g'~TI~' ~ . ~_~ CRAWL 5PACE )~TERIOR WAEL ~ ~ A% ' ~oA~ ON ~NT~O~ *tNT~O~WAb- ¢ 5LOPE" I/4" PER ~OOT PITCH TO MOISTU~ ~ISTANT 50A~ IN PLUMDING RISER DIAGRAM iCONC~ STOOP X Z CONCRET~ FATIO ~ .... SCALE: ~"= I'-0" 2  ~IST[NG ~ALL TO ~MAIN ~ ~ ~ ~ ~ (A~ i I ; I I I I ALTERNATIVE POP-, OPENING PROTECTION ~5'-o' IWINDOW 4. DOOP., 5CifEDULEI ~ ' ~ ~ I ~ i ~ ~ ' NEW' 4" X 4" ?OBTB, i ~ILLE5 -DEE EL[rATION5 I  BOLTED TO CONCRET[ WALL OPENING5 INCLUDING WINDOW5 AND DOOR5 5HALL BE P~OTECTED WITN ~MQ~ABLE 5/~ WOOD 5TRUCTU~L PANEL5 , WINTE~ D[51GN T~MP. J I [JELEME~sN~W3-7~"LVLH~DE~ ~ d ~ ~ ~ I. ~LOOD~AZA~5 I B~DBOA~--~ -~ I A~bFENING PKOTE~I6~ I " I " i I I  ILING MAT~AL ~ E j M z A DE&ION LOAD CALCULATION& TABLE R301 .G J CLIMATIC AND GEOGRAPHIC DESIGN CR. ITER. IA DE&ION LOAD CALCULATIONS MINIMUM UNIPOP-,MLY DIST~.IDUTED LIVE LOAD5 IGROU ND 5NOW LOAD j45 Ib~. J DESIGN CATEGORY I TABLE R30 I .G J ALLOWADLE DEFLECTION OF 5TRUCTU PAL MEMEDER5 STrUCTUrAL MEMBE~ ALLOWABLE DEFLECTION COVERED PATIO b) D j = MINIMUM U NIPORMLY DI~TR.IDUTED LIVE LOAD5 (Ib~f) ALLOWABLE DEFLECTION OF ~TRUCTU PAL MEMEDER,D J ~ ~a I ENTERIORDALCONIE5 I ~o 5TRUCTURAL MEMBE~ ALLO~ABLE DEFLECTION ~ ..... ~ __ _ ATTICS WITHOUT STOOGE 30 ~han J __ I __ ~ ........ ] ATTIC5 WITH 5TO~G~ 40 u LIVING ROOM u ~ u ~ ~ __~ ~ ...... ~ ~ ~POSURE CATEGORY I I I J x / xl E~ ~, X ,, ~ ~ : ~o CEILIN~gDOA~MA~AL-- %~ p / ~l~"2'X ~' O.C.~'R' / ~jU~OOM~ ~UNDAY~]A~ %~ %~ TIL~ .............. ALL ~AL~ ~HIN Ii ~ ~E~ CU~ BACK ~I~TING ~ ~ ~ ~ ~. ~ . ~PP[NG COLUM N ON ~ISTING STOOP ~IH-% ~ ~/2~X g, C.j' ~ I ~ ~ +0 ~ [~M~- NSTAL~TION 2" X 4~' STUD WALL ~ FO~N~COV=~DRNTRY~ ~ * ,¢"0C. ''~) I ~CUBTO~F~MELR55G~5~ , GYP,SUMBOA~ ~CAL=, ~" = J'-O" ! ~OUNDATION WALL* ~OOTING J ~~OUNDATION WALL WALL LE~D: ~ TO ~MAI" · ISTING WALL TO *MAIN ~ISTING ~ALL TO BE ~MOVED EWCONSTRUCTION BUILDING SECTION "A" ~" x ~" w~r J ~ ~" HEADER NOk~S: , I ' I