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Home My WebLink About34989-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-34388 Rte: 06/04/10 THIS CERTIFIES that the building ALTERATIONS Location of Pr~erty: 2440 VILLAGE LA ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map NO. 473889 Section 26 Block 1 Lot 16.1 subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 14, 2009 purs~-t to which Building Pemit No. 34989-Z dated SEPTEMBER 14, 2009 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 DECK ADDITION AND INTERIOR ALTERATIONS TO AN EXISTING HISTORICAL ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOHN & SARAH HENRY (OWNER) of the aforesaid building. SUFFOI~KCO~DEP~TOF}~ALTHAP~OI~%L N/A ~_~t-£KICAL C~KTIFICATE NO. N 532404 08/03/00 PLI~Ei~S CERTIFICATION DATED 06/02/10 KING PLUMBING Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: Ao For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. Bo For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a .Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. Co Fees I. 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 Temporary Certificate of Occupancy - Residential $1 $.00, Commercial $15.00 New Construction: Location of Property: '7, ~ qO House No. Owner or Owners of Property: ~ 0 ~ [J Suflblk County Tax Map No 1000, Section Subdivision permit No. c-D_Dk,j Ct ~ 9 Date of Permit. Old or Pre-existing Building: Street (check one) Y //% Hamlet Block ,/ Lot '~/~, I Filed Map. Lot: Applicant: d 0 1~ k/ H E K} P- }' Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~2,,_~ ~1'0o Final Certificate: (check one) Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631 ) 765-1802 Fax [631 } 765-9502 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: Building Permit No. ~ ~v/~' Owner: '~-~4''3 (Pleas~print) (Please pffmt) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~xcl day of ~,~c,.-Q~_ , 20 ~ ~ Notary Public~ ~'~ County (Plumbers Signature) CONNIE D. BUNCH Notary Public, State of New York No. 01BU6185050 Qualified in Suffolk County Commission Exoires April 14.20 ¥%~- THE NEW YORK BOARD OF FIRE UNDERWRITERS I~l~93 EUREAU OF ELECTRICITY ~-- 40 FULTON STREET, NEW YORK, NY 10038 DaW A~CdJS? 03,2~ App~.aMo. ~o. o.~ 2~187~/~ N 5324~4 THIS CERTI~ES THAT P~T NO. 26356 on~ ~ e~c~ eq~me~ ~ ~sc~ ~w ~ ~uced b~ ~e ~p~ ~ on ~ ~ve ~p~n nu~r ~ ~ ~e ~es of JOHN & SALLY HF~,RY, 2440 VILLAGE LAN~, ORIP, NT, NY was exa,~,ed o. JULY 28,2~ a~d found to be/n compliance witb the Nati~m~ Elect~cai Cede.. DRYEIfS FURNACE MOTORS FURJI~ APF, JANCE FEEDERS AMT. I~W. OJL H.P. QA~ H.P. , AMT. NO. A.W. G' SERV CE DISCONNECT NO. OF S AMT.I AMP. ,",~,'. ,,.. I ~ 24 R~NGES R ¥ I C MULTI-OUTLET SYSTEMS NO. OF FEET EXHAUST FANS DIMMERS G.F.C.I:-i DOROSKI ET.W.C. INC. 425 MONSRT.T. LANE CUTCHOGUE, ~, 11935 LIC. #2941 GENERAL MANAGER 11 This cm'flfle, ote must not be altorecl In any mannec, retum to the office of 0'il Board If incorrect. Inspectors moy be Identified 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. 34989 Z Date SEPTEMBER 14, 2009 Permission is hereby granted to: JOHN & SAPJtH HENRY 54 RIVERSIDE DR APT 16B NEW YORK,NY 10024 for : CONSTRUCT DECK & INTERIOR ALT TO EXISTING HISTORICAL 1 FAMILY DWLG PER TRUSTEES,DEC & LNDMK.BP # REPLACES EXPIRIED BP# 32822 at premises located at 2440 VILLAGE LA County Tax Map No. 473889 Section 026 Block pursuant to application dated SEPTEMBER 14, 2009 Building Inspector to expire on StaRCH ORIENT 0001 and approved by the I'?.~ 14, 2011. Fee $ 175.00 Authorized Signature ORIGINAL Rev. 5/8/02 (THIS FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 32822 Z Date MARCH 21, 2007 ~?ermission is hereby granted to: JOHN & SARAH HENRY 54 RIVERSIDE DR APT 16B NEW YORK,NY 10024 for : CONSTRUCT DECK & INTERIOR ALT TO EXISTING HISTORICAL 1 FAM DWLG PER TRUSTEES, DEC & LANDMARK. THIS PERMIT REPLACES 26356. at prer~ises located at 2440 VILLAGE LA County Taxx Map No. 473889 Section 026 Block ~Ursuant to application dated MARCH 21, 2007 ORIENT 0001 Lot No. 01~ and approved by the Building Inspector to expire on SEPTEMBER 21, Fee $ 175.00 2008. ~ '/~ri'~ed ~ure Rev. 5/8/02 ORIGINAL 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. Date FEBRUARY 24, 2000 Permission is hereby granted to: JOHN & SARAH HENRY 54 RIVERSIDE DR APT 16B NEW YORK~NY 10024 for : CONSTRUCTION OF NEW ENTRY DECK ADD & INTERIOR ALT FOR AN EXISTING "HISTORICAL" ONE F~/~ILY DWELL IN COMPLIANCE WITH TRUSTEES~ DEC & LANDMARK P.C.R at premises located at 2440 County Tax Map No. 473889 Section 026 pursuant to application dated JANUARY Building Inspector. VILLAGE LA ORIENT Block 0001 Lot No. 14r 2000 and approved by the Fee $ 175.00 / ed ature ORIGINAL Rev. 2/19/98 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] R/OU~q'H PLBG. / [ ] FOUNDATION 2ND [/_/]/INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLA~:~I~ & CHIMNEY REMA~I~-'~~ / DATE INSPECT~ 765-1802 BUILDING DEPT. INSPECTION [/_.,}~RAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY DATE /~//~/~ ~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]RRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. [ ] INSULATION [/~FI NAL ] FIRE SAFETY INSPECTION ] FIRE RESISTAI~r PENETRATION REMARKS: DATE INSPECTOR ~AT ION (lgT) ~t · O~H NO. TOWN OF SOUTHOLD · BUILDING DRPARTI~NT TOWN SOUTHOLD, N.Y. 11971 t,~,.,,,,~ ........ ....... , ~.: ~ ~ ................. : -J ~ICAT~ON FOR BUILD~NC ) INSTRUCTIONS BOARD OF liEALTO ............... --3 SETS OF PLANS ......... · ...... ----6URVEY .................... ... . --CI~CI~ SEPTIC FO~ ................... N~IFY: ~ ~',~ ~ ~IL TO: .................... a. This application ~ast be ca~letely filled in by type~iter or in ink and suhaitted to the IkLilding Imspector ~ sets of pl~s, accurate.plot plon to ac~l. e. Fee ~rdi~g to schedule. b. Plot plan ~ lona~ion of lot ard of lmil8i ~n~ on pee~ises, relationship ~o adjoining pmaises or public streets or areas, ~r~ giving a detailed descril~ion of layout of property mst be d,~m on the diagma vhich is part of this a~plication. c. The ~ co.red by this application my not be c~,~eo~d before issu~ce of lhildin~ Permit. d. Upm ~',~al of ~his application, the lhildin8 Inspector ~ill issue a Buildin8 Pemit to the applic~t. pemit shall be.kep~ on the l,,=.,~ses available for inspection thra~beut the ~rk. e. No building shall be o~?ied or used in ~/~ole or in part for any pmlx,,,~e ~aatever tmtil a Certificate of Occupancy dm11 have been ~,,~ed by the Building Inspector. APPLICATIal IS I~t ~ to the Building IIepartm~. for the issumce of a lhilding Pemit pursuant to the Building 2~e Ordln~nce of the To~n of ~outhold, Suffolk County, ~ York, and other applicable La~, Ordinates or Regulations, for the conat~ction of Imildi~gs, additior~ or alterations, or for rismval or ~lition, as herein described. The applic~t agrees to em~l. y vith all applicable laws, ordinm~es, building code, housing code, and regulati~s, and ~o mlalt authorized inspec~ora tm State ~/ae~er appliamt is amer, lessee, agent, architect, e~ineer, Eeneral ~C~tor, el~crici~, pl~r or ~il8 ~ o~ ~ o~ ~. ~o~ ~. ~Y (~ ~ ~ t~ mi1 or la.st ~) If ~li~t is a ~t~, siam of ~y m~i~ offi~r. (l/are and title of corporate officer) Builders License NV .......................... Pl~bers Li~e No ......................... . Electricians Li~r~e No ...................... Other Trade's License Nv .................... . !. l~cation of land on ~hich proposed ~ vi11 be ~ .............................................................. Paine ~her Street 11~1 et c~p~. ~ ~i~ .... ~. .... El~ ..... ~.1' ....... ~ ...L6.,.! ...... aivisim .................. ~il~ ~ ~ ...... bt . (~) 2. S~te ~sti~ ~ ~ ~ of ~s ~ int~ ~ ~ ~ of pio~ ~t~ti~: b. ~ ~ ~ ~ .... O.~.}~t~Y....~i.t~.~ ............................. · ,-.cm~ u~ ~,~. ~o~'c~ ~to~ appttc.~te): Ne~ ~ildi~ .......... ~itim .......... ~terati~ ~ir ............ ~1. ............ ~liclm ............ O~r ~ri,~ ~t...... % ~ .. ~.o .............. ~ ~ ~ ....~.~ ............................ (to ~ ~id ~ fili~ ~is ~li~ti~) If ~lli~, ~r of ~lli~ ~its ..... .~ ..... ~r of ~lli~ ~its ~ e~ fi~r ................ If ~, ~r of ~rs ........... If ~i~ss, ~'.,.,~rcinl or ~ ~, ~i~ m~ ~ ~t~t of ~ ~ of ~ ...................... Oi~i~ of ~sti~ st~s, if ~: ~t ..... ~.C..f. .... ~ ...~.~.~.~ ..... ~p~ ..~.~.~ ........... I~i~t ~ ( . ~r of Stories .... ~ .... O~i~ of ~ st~ ~th alterati~ or ~iti~: ~C ..~.~.:.. ~ar ..~.~ ..... ~pth .. ~ ......... ~i~t ..~ .......... ~r of Stories ...~ ......... Di~i~ of ~ti~ ~t~ti~: ~t.......... .... .. ~ar ......... . ..... ~p~ .:~ ........... ~i~t ......................... ~r of Stories.................. .. Si~ of lot: ~t ..~L~.z.~.~ ....... ~ .... ~J.~.:.~. .... ~p~ ..~..~0...~.~.. ~. ~te of ~d~ ..................... ~ of F~r ~r ........................................ I. ~ or ~ district in ~i~ p~,i~s a~ si~t~ .... .~.~.~ ............................................... 2. ~s ~ ~t~ti~ violate ~ ~t~ 1~, o~i~ ~ ~lati~: ........ ~.~. ........... ~. ~ill lot ~ ~ ..... ~.9. ......... ~ill ~ fill ~ ...................... o~ 5. Is ~is~~iu~ f~tofati~l~tl~? *~ ~ ..... ~ ...~ ....... PLOT Ol Aglh~l locate clearly and distinctly all buildings, ~herher existing or ~,,ul~d, znd indicate all set-back di~nsio~s ,~ p~erCy lines, give street and block r.m~er or description according to deed. and shoe s~rset -~s and indicate hether interior or corner lot. ........................................................ being ~ly ~, ~ of i~ivi~ si~it~ ~tr~t) ~ J~ ~lm...~ ................................................................... ..... ...... (~tr~tor, ~t ~t ffi ) [ ~d ~r ~ ~rs, ~ is ~ly ~t~ri~ to ~r~om or ~ ~r~ fl~ ~id ~ ~ to ~ ~ file this ~li~ti~; ~t ~1 star--ts ~tai~ in ~is ~li~ti~ ~ t~ to imt ~ ~ v[ll ~ ~r~ in tim m~r ~t forth i. ~ ~li~ti~ fil~ ~. ...,. ..... ......... ...... ~ ,~ (Si~ of ~ti~) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATZON OEC PERMIT NUMBER 1-4738-0247~/00001 FACILITY/PROGRAM NUMBER(S) PERMIT Under the EnviroreentaL Conservation LaN EFFECTIVE DATE January 31~ 2000 EXPIRATION DATE(S) January 31, 2004 ii TYPE OF PERMIT · New [] Renewal [] Modification · Permit to Construct [~ Permit to Operate [] [] [] [] [] ArticLe 15, Title 5: Protection of Waters Article 15, Title 15: Water Suppty Article 15, Title 15: Water Transport Article 15, Title 15: Long Island Wells Article 15, Title 27: Wild, Scenic and Recreational Rivers 6NYCRR 608: Water Quality Certification Article 17, Titles ?, 8: SPDES [] Article 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamation [] Article 24: Freshwater Wet[ar~s · Ar~i~; 25: ~idai*Uetlands Article 27, Title 7; 6NYCRR 360: Solid Waste Management Article 27, Title 9; 6NYCRR 37'5: Hazardous Waste Management Article 34: Coastal Erosion Management Article 36: FLoodplain Manage~nt Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control PERMIT ISLED TO John Henry TELEPHONE NUMBER (212) 854-6619 A~)DRESS OF PERHITTEE 54 Riverside Drive, Apt. 16B N~w Yorke NY 10024 CONTACT PERSON FOR PERMITTED ~ORK Hideaki Ariizu~ni - Studio A/B 111 Fourth Avenuef #2Mr Ne~ York NY 10003 ILRNE /[ND ~DRESS OF PROdECT/FACILITY Henry Property 2440 Village Lane TELEPHONE NUMBER (212) 677-7898 LOCATION OF PROJECT/FACILITY SCTM #1000-026-01-16.1 Orient COUNTY TOWM ~AT~RCOURSE NYTM COORD I HATES Suffolk Southold Harbor DESCRIPTION OF AUTHORIZED ACTIVITY: Construct a 5.5' x 8.5' deck addition to north west Co~e~ ~f ~('~ng single family dwelling. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all ai~pticabte regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as pert of this permit. ~ PER~IT AOMINISTRATOR: Mark C. Carrara Ck'~ AUTHOriZED SIGNATURE IADDRESS BLdg. ~O~f~U~Y~.Stony Brook, NY 11790-2356 January ~lf 2000 IPage I of 4 NEW YORK STATE DEPAR'R~IENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITFEE OBLIGATIONS Item A: Permittse Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnity and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, agents, and assigns for all claims, suits, actions, damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Perrnittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere With Rii~arian Rights This permit does not convey to the permittee any ri§ht to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any dghts, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by t'h~ Department The permitted site or facility, including relevant records, is Subject to inspection at reasonable hours and intervals by an authorized representative of the Depart~nen('0f EnVironmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to acC0rfiPan~, (h~ Department s representative during an inspection to the permit area when requested by the Department.' .... ' · A copy of this permit, including all reference~] maps~ ~d~aWings and special conditions, must be available for inspection by the Department at all times at th'e p~ipbt ~it~**0r facility. Failure to produce a copy of the permit upon request by a Department representative is a vi~iat!~l~,~*f th!s Permit. General Cond,t,on 2: Relat,onsh,p of this ~ermltto 0t½er Department Orders and Determinations Unless expressly provided for by the Depa?t~n~nt, is~d;~nCe*0f this permit does not mod fy, supersede or rescind any order or determination previously issued bY the DePartment or any of the terms, conditions or requirements contained in such order or determination. General Condition 3: Applications for Permit:ReneWals or Modifications The permittee must submit a separate wdtten application tothe Department for renewal, modification or transfer of this permit. Such application must include any"form~s 6r Su'P~lemental information the Department requires. Any renewal, modification or transfer granted by the Depa~m.e~nt ,.m.'uSt be in writing. The permittee must submit a renewal applic~ti0~'*~t le~t~ a) 180 days before expiration of p~rrflits~-fbt'~State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management F.~,ci![fie~ (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF)"a~l' ~i ~'.' ~" ' b) 30 days before expiration of all 0the~ I~erh~ittypeS. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administra!0r,;Regiod i; SUNY Bldg ~40, Stony Brook, NY 11790-2356 General Condition 4: Permit ModificationS, Suspensions and Revocations by the Department The Department reserves the right to mOdity, sUspend or revoke this permit. The grounds for modification, suspension or revocation include: . a) the scope of the permitted activi[~ ;is ~eecl~d 'oi"a Violation of any condition of the permit or provisions of the ECL and pertinent regulati0h's i~'fodnd;'' b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new matedal information s d scoWi'ed; or' · ' d) environmental conditions, relevant .tech~)olOgy, or applicable law or regulation have materially changed since the permit was issued ........... DEC PERMIT NUMBER 1-4738-02473/00001 "~ ' ....- I-.- ~PPROVED A~ PER TER~ AND CONDITIONS OF Eastern Permits Section DEPARTMENT OF THE ARMY NEW YORK DISTRICT, CORPS OF ENGINEERS JACOB K. JAVITS FEDERAL BUILDING NEW YORK, N.Y. 10278-0090 NSvember 24, 1999 SUBJECT: Joint Application with New York State Department of Environmental Conservation Hldeakl Arllzuml 111 Fourth Ave, # 2M New York, NY 10003 Dear Mr. Arllzuml: We have recently received a copy of the Joint Application for permit you filed with the New York State Department of Environmental Conservation (NYSDEC). Please be advised we have reviewed the copy of the Joint Application sent to this office by NYSDEC. Based solely upon the information provided, it appears that a Department of the Army permit is not required for your proposal. The Department of the Army regulates constructi0~ activities in navigable waterways and discharges of dredged or fill material into waters of the United States, including inland and coastal wetlands. If your proposal would involve such work, and has not been portrayed as such in your Joint Application, you should contact this office immediately so that a project-specific determination can be made as to whether a Department of the Army permit will be required. Any inquiries can be directed to this office at (212) 264- 6731. _ Sincerely, /J~mes W. Haggerty ief, Eastern Permits Section 10-1B-1999 ll:~M FROM ~t~dio ~/b TO 101~9715167651~B~ P.O~ 18-18-1999 11:49RM FROM studio a/b TO 101029715167651823 P.03 TOTAL P.03 jIfDITH T. TERRY TOWN CLER.~ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall. 53095 Mum Road P.O. Rox 1170 Southold. New York I 1~171 Fax (516) 765-1823 Tclcphonc (5161 765- I gO 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 two (2) new forms to be used under the of the Code of the Town of Southold: Application" [FDP(93)], and "Certificate Special Flood Hazard Area [C/C(93)]. Town of Southold hereby adopts Flood Damage Prevent regulations "Floodplain Development Permit of Compliance for Development in BLGG. , Tow so. , ou Southold Town Clerk August 25, 1993 TOWN OF SOUTHOLD APPLICATION # PAGE I of 4 FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PRQVISION~; (APPLICANT t0 read and 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements ate made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or octmpied until a Certificate of Complianc~ is issued. 5. The permit will expire if no work is commenced within six months of issuan~. 6. Applicant is hereby informed that other permits may be required to fulfill local state and federal regulatory requirements. 7. Appllcaat hereby gives consent to the Local Administrator or his/her representative to make ieasonable inspections required to verify compli~,~ce. 8. I, THE APPLICANT, CERTIFY THAT ALL $TAT,~EMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION AI~.E, TO THE BEST OF/I(~Y KNOWLEDGE, TRUE AND ACCURATE./ SECTION 2: PROPOSED DEVELOPMENT (To be comoleted bv APPLICANT) NAME A.,DDRF~S TELEPHONE APPLICANT To avoid delay in processing the applicatioa, 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 dlstaace to the nearest intersectiag road or weil-lmowa landmark. A sketch attached to this application showing the projecl location would be helpful. FOP(93) APPLICATION # __ PAGE 2 OF a DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ~.(TrlVITY TR RE TYPE 13 New Structure [] Addition .~f t er a ti~,~.} r/~,~o [] elocati6n ~ Demo~fion ~ Rcpla~ment [] Residential (1--a Family) [] Residential (More than 4 Family) Non-residential (Floodproo£mg7 [] Yes) [] Combined Use (Residential & Commercial) [] Manufactured (Mobile) Home (la Manu- factured Home Park? [] Yes) ESTIMATED COST OF PROJECT B. OTHER DEVELOPMENT ACTIVITIES: [] Fill [] Mining [] Drilling [] Grading [] Excavation (Except for S~uctural Development Checked Above) - [] Watercourse Alteration (Including Dredging and Charmel Modifications) [] Drainage Improvements (Including Culvert Work) [] Road, Street or Bridge Construction [] Subdivision (New or Ex'pansiou) [] Individual Water or Sewer System [] Other (Please Specify) After completing SEc'liON 2, APPLICANT should submit form to Local Administrator for reView. SECTION 3: FLOODPLAIN DETERMINATION ~T0 be completed bv LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: [] Its NOT located in a Special Flood H~7~rd Area 0Xloti~ the applicant that the application review ia complete and NO FLOODPLAIN DEVELOPMENT PE.RM1T IS REQUIRVmD). [] Is located in a Special Flood Ha?nrd Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) [] Unavailable [] The proposed development is located in a floodway. FBF'M Panel No. Dated 1'3 See Secsln,, 4 for ao~itional instructions. SIGNED ..... DATE APPLICATION PAGE 3 OF 4 SECTION 4: ADDITIONAL INFORMATION REQUIRED (To be completed bv LOCAL ADMINI~;TRATOR'} 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 dimensions and proposed development· [] Development plans, ch'awn to scale, and specifications, including where applicable: details for anchoring structures, proposed elevation of lowest floor (indudlng basement), types of water resistant materials used below the flu'st floor, details of floodproo£mg of utilities located below thc £~rst floor and details of enclosures below thc £trst floor. Also, [] Subdivision or other development plans Clf 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 otherwise available). El Pla~ showing the extent of watercourse relocation and/or landform alterations. Top of new l-ill elevation Ft. NGVD (MSL). Floodproofmg protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. Certification from a registered engineer that the proposed activity in a regulatory lloodway will not result i~ 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: ~E(~TFION $: PERMIT DETERMINATION (To be comuleted bv LOCAL ADMIIqlSTRATOR) I have determined that the proposed activity:. A. [3 Is B. vi Is not in conformance with provisions of Local Law s~ __, 19 __ attached to and made pan of this permit. · The permit is issued subject to the conditions SIGNED , D~.TE I~~r~, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is check~d~ the Local Administrator will provide a written summary of deficiencies. Applicant may ~evlse and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPEALS: Appealed to Board of Appeals? El Yes [3 No Heaxiag date: Appeals Board Decision -- Approved? [] Yes Conditions [] No APPLICATION PAGE 4 OF 4 SECTION 6: AS-BUILT ELEVATIONS (To be submitted bv APPLICANT before Certificate of Comoliance is issued'l The following information mnst be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. Actual (A~-Built) Elevation of the top of ~he lowest floor, including basement (in a al 'h Hazard ~a~'ea~, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGV'D (MSL). 2. Actual (As-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 (To be comvleted bv LOCAL ADMINISTRATOR~ The LOCAL ADMINISTRATOR will complete this section ns applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSP~ECTIONS: DATE BY DEFICIENCIF-~? [] YES El NO DATE BY DF-FICIENCIF-S? [] YES [] NO DATE BY DEFICIENCIES? [] YES [] NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be comoleted bv LOCAL ADMINISTRATOR) Cestificate 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 HkZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [3 NEW BUILDING [3 EXISTING BUILDING [3 VACAN~F LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: 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) Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Fax (631) 765-9502 Telephone (631) 765-1802 June 27th 2006 John Henry 54 Riverside Dr. Apt. 16B New York, N.Y. 10024 RE: 2440 Village Lane SCTM# 026 0001 016.001 Dear Mr. Henry, Please be advised that your Building Permit #26356 issued Feb. 24th, 2000has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of the structure. To renew your Building Permit, please submit a fee of $175.00 at that time we can schedule an inspection by one of our Building Inspector's. If you have any questions, please call us at 631-765-1802. Respectfully, SOUTHOLD TOWN BUILDiNG DEPT. To~ql 1 lall Annex 3 k373 Main Ri)ad P.O. Box 1179 SomhoM, NY 11971-0939 Tclcphlmc (63 l) 76,3-1802 Fax (631) 76,34 5 2 1',I !II,DING DEI'AI/TM1CNT TOWN OF $OUTHOLD August 13th, 2009 FIRST NOTICE ,Iohn & Sarah Henry 54 Riverside Drive Apt. 16B New York, N.Y. 10024 RE: 2440 Village Lane (beck & Interior Alteration) SCT3A: # 1000-26.-1-16.1 bear Mr. & Mrs. Henry, Please be advised that your Building Permit # 32822 issued 3Aarch 21st, 2007 have expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued before the use of the structure. To renew your Building Permit please submit a fee of $175.00; at that time we can Schedule an inspection by one of our Building Inspector's. If you have any questions, please call us at 765-1802. Respectfully, 50UTHOLD TOWN BUILD'rN~ DEPT 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 O1* SOUTI-IOLD February 20th 2007 John Henry 54 Riverside Drive Apt. 16B New York, N.Y. 10024 RE: 2440 Village Ln. (deck add./interior alter.) 2~d NOTICE SCTM: 26 1 16 1 Dear Mr. Henry, Please be advised that your Building Permit #26356 issued February 24th, 2000 has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of the structure. To renew your Building Permit, please submit a fee of $175.00 at that time we can schedule an inspection by one of our Building Inspector's. If you have any questions, please call us at 631-765 - 1802. Respectfully, SOUTHOLD TOWN BUILDiNG DEPT. JAMES C. McMAHON Administrator Telephone (516) 765-1892 Fax (516) 765-3136 TOWN OF SOUTHOLD COMMUNITY DEVELOPMENT OFFICE Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 December 1, 1999 Hideaki Ariizumi Studio A/B 111 Fourth Ave, #2M N.Y.N.Y. 10003 RE: JOHN HENRY SCTM #26-1-16.1 Dear Mr. Ariizumi, The Southold Town Board of Trustees approved the request for a Waiver at their regular meeting on Tuesday, November 30, 1999, for renovations to existing house, with condition that the applicant remove the drain pipe sticking out of the bulkhead. However, this does not constitute any permits from other agencies. If you have any questions, please call our office, at 765-1892. Sincerely, · Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. Telephone (516) 765-1801 SOUTROLD TOWN LANDMARK PRESERVATION COMMISSION Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 February 18, 2000 TO: Mike Verity- Building Inspector Dear Sir: The Southold Town Landmark Preservation Commission has reviewed the submitted plans for renovating the Henry residence at 2440 Village Lane, Orient; Tax Map #1000-026-01-16.1. The alterations as defined do not appear to alter the existing facade or historical streetscape. The Commission therefore approves the project, as proposed. If you have any questions, please feel free to contact us at your convenience. $outhold Town Landmark Preservation Commission cc - Jamie Richter Town ltal] Aimcx 54375 Main Road P.O. Box 1179 Soulhold, NY 1197L4)9,59 '1 'cie phollt' (631 ) 765-1802 Fax (63 I) 765-9502 BI qLDING I)EPARTMENT TOWN OF SOUTHOLD April 17, 2010 John Henry 54 Riverside Drive, Apt 16B New York, NY 10024 RE: 2440 Village Lane, Orient TO WHOM IT MAY CONCERN: The following items are needed to complete your Certificate of Occupancy: __ Application of Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. "'""J A fee of $25.00 __ Final Health Department approval. ~ Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84) __ Trustees Certificate of Compliance. __ Final Planning Board approval. __ Final Fire Inspection from Fire Marshal. __ Final Inspection from the Building Dept. __ Final Landmark Preservation approval. Building Permit: 34989-Z deck and interior alterations It ~4)9'Z06 1UVJ 0£ $¥ $391A;0 MO/ON¥ OWOS-;INV :~dIAO~d ~.SYM 9NIGV~flld llV ,~ONNVO /41-_71849 A7dWf)~ ,~lOd3B IN3.~ "QV37N~ ~VOI. LVOIdlJ. L _ ~ ~UOIz'I~ IIOUO~ISNO0 UO N~ilS'"Ja I,lO-I illlSNOdS:lll ION '$qOOO A~)UqNB · NOI&O/IMISNOO liVXI ~'N 21~ ~ SiN~I~BUII~OBM IH& laa~l 'n~#l NOILOiWI~NO0 TW J. snB IIMI~WNOO - lVNl-I '!' NOiiV-lnC:Hi '~ SNIENInd · SNIVIVldd ' HE)NOU i ~'illlill~l O~,L ' HOI.LVCINnO-I 1. iSNOILOgdSNI ~NIMOTIO,d BHli BI~/id If 01 b'dV 8 ~081.-gg,L Ill M 8Uldld ~lm~lSlP Jeie~ Jo/. ~ II ~ilqnl Jeddoo # :'~AONVdnOO0 JO gJ.VOI:EI~O J. flOH.LIM ~V'INfl 91 ]sn I10 AO~vdnooo -da~ w .moE. unog .et'. ~ ~ A'ld~O:) '[~):~, ~oz~oo~l Roof --~ ~w C0L~N 'i~-HiND ? 9 L.TED ~TI oN FLOOR PLAN, FRAMING pLANS, SECTIONS OWNER RENOVATI(~N OF HENRY RESIDENCE (Main House) AS NOTED 7/22/99 lO/w/ge studio a~ H~,oEr~ p n-ye, ~ 3" o,e_ , f WALL ~e NST: 1'22 ^Pelt o,x, ~ STP-PS I~ C~.A~A~E ~(~ O'J~CTIOI~-'=/'-~' 3"HP,,IJ YlODP.,ODH ¢ ge_Ck. ~EI EVATIct~ AS NOTED 712219~ A-M2 John and Sally Henry NORTH NEx,~ rP. it-~ T~ t,~-rcJd HEW ~.×~ c~-~)Alz- LAl'imc_~ ~EST ELF_ VAT IC~ /. J. x IF' t~ c30UTH, :~ ITCH ,,~¢'Ar:-~, EXTERIOR and INTERIOR ELEVATIONS 7122199 John and Sally Henry RENOVATION OF HENRY RESIDENCE (Main, House studio a/b A-M3 !E E~O CoBV~C'TIoH HE,~ ~ WASH ~ (~ PLL)N1BINC~/Nt~kTIt4G L~,YOOI , (~ ~:LE-C'T~IC_AL L/~C)0T PLUMBING, HEATING LAYOUT and ELECTRICAL LAYOUT John and Sally Henry 2440 Village Lane Odent, NY 11957 1/4"=1 '-0" 7/22/99 I~-/~ I RENOVATION OF HENRY RESIDENCE (Main House) studio a/b NO ME-M1