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HomeMy WebLinkAbout35982-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, CERTIFICATE OF OCCUPANCY No: Z-34759 Date: 12/28/10 THIS CERTIFIES that the building DECKING ADDITIONS Location of Property: 595 NORTH PARISH DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 71 Block 1 I~t 6 subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 22, 2010 pursuant to which Building Peruuit No. 35982-Z dated OCTOBER 27, 2010 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 ADDITIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to NIKOS THEODOSOPOULOS (OWNER) of the aforesaid building. ~uF~OLK COUNTY DEPARTMENT OF HEALTH APPROVAL BLE~'rRICAL c~KTIFICATH NO. PLIERS u~KTIFICATION DA'rl~3 N/A N/A N/A /ut~i zed Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII/)ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35982 Z Date OCTOBER 27, 2010 Permission is hereby granted to: N THEODOSOPOULOS 595 NO. PARISH DR. SOUTHOLD,NY 11971 for : RECONSTRUCTION OF DECK ADDITION TO AN EXISTING DWELLING AS APPLIED FOR at premises located at 595 NORTH PARISH DR SOUTHOLD County Tax Map No. 473889 Section 071 Block 0001 Lot No. 006 pursuant to application dated SEPTEMBER 22, 2010 and approved by the Building Inspector to e~ire on APRIL 27, 2012. Fee $ 200.00 /~r~d S~i~nature '~. 5/8/02 ORIGINAL 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: A. 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 amhitect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. 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. C. Fees l. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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 New Construction: Location of Property: Date. /~)- ~/O J Old or Pre-existing Building: (check one) House No. Street Hamlet Owner or Owners of Property: _ Suffolk County Tax Map No t 000, Section Subdivision Permit No. ~.~q' q~' ~ Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ _~'t0, ~'~Y/q~:5~ "~! Block I Lot Filed Map. Lot: Date of Permit./D-...~.C]-./O Applicant: ;/~ Underwriters Approval: Final Certificate: ~// (check one) ' Appiicaca{ Sig~qature TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ~-~OUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS: DATE /1'~ ~'-~/~ INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]F~DATION2ND [ ]INSULATION [/~ FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRUCTION [ ] FIRE RESISTAIfl' PENETRATION ELECTRICAL (ROUGH) EL~ICAL (FINAL) [R~MARKS: /~ [ ] DATE INSPECTOR~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] FRAMING / STRAPPING [~]~INAL REMARKS: [ ] FIREPLACE & CHIMNEY I ]FIRE SAFETY INSPECTION [ ]FIRERESlSTANTC(XG'TI~ [ ] FIRE RESiSTANT PENETRATION 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 /°/~7, 20 /o/~7,20 /,o Expiration sets ot 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 ~ Survey Check ~,X:30. OlD -TL~-~. ~ Septic Form ~..~v [d~"~ ~ N.Y.S.D.E.C Flood Permit Storm-Water Assessment Form Contact: Mail to: a. Thisa r I 'Tbecon , . _ Building Inspector ~PLICATION FOR BUILDING PERMIT Date INSTRUCTIONS Phone: letely filled in by typewriter or in ink and submitted to the Building Inspector with 4 ~e 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 wi'thin 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, y// //~ / ~ , c.~ (Signature of appF~t or name, ifa c~rp})ranon) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises JL)[~o.~ ~-[4e. otto ~>O~OO{0~ c~,~4 (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which provosed work will be done: House Number Street County Tax Map No. 1000 Section Subdivision Hamlet Bl6~k_': ,~,:[~,~; ,,,, ' "' ' Lot Filotlh~4ttl,~o,,,~ ,,, ,,.~.~,~,,,,oLot 3. Nature of work (check which applicable): New Building Addition Repair ~emoval Demolition Other Work 4. Estimated Cost ~<~ l~O}o00 Fe~>~.~)Oo~)O State existing use and occupancy of price, nd intended use and occupar~y of pr?os_ed construction: a. Existing use and occupancy ~ ~t~[~ ~r..,,~,~ [C~ ~OOd-~ ~ ~e b. Intended use and occupancy. ~ ~-OO4e-. -- ~¢C-m ~ Alteration 5. If dwelling, number of dwelling units If garage, number of cars (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type o f use. 7. Dimensions of existing structures, if any: Front ~O Rear ~ C~ Depth /'~ Height. ~ 0 Number of Stories I Dimensions of same structure with alterations or additions: Front 3CO Rear Depth q ~ Height. 2 ~ Number of Stories ~ 10. Date of Purchase Dimensions of entire new construction: Front 5'q Rear Height '3 Number of Stories ~ Size orlot: Front I O 0 Rear [ 0 0 .Depth _Depth /5 Name of Former Owner &~l'g O'°d ~c~(-[q'£~:X 11. Zone or use disthct in which premises are situated l 2. Does proposed construction violate any zoning law, ordinance or regulation? YES NO ~' × Will lot be re-graded? YES NO Will excess fill be removed from premises? YES 14. Names ofOwn~ ofpremises~ g*~ ~[~¢o~alo~Address ~qq~ ~t0~hone NameofArchitect ~o~4 ~ge ~ Address ?.0 . q20 Ue~l~ Phone No Name of Contractor ~e g~Pro~a~(on~tvc~ZAddress ~ 3f5 M~t~ ~Phone 15 a. Is this property within 100 feet of a tidal wetl~d or a freshwater wetland? *YES * IF YES, SOUTHOLD TO~ TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this prope~y within 300 feet of a tidal wetland? * YES ~ NO * IF YES, D.~C. PERMITS MAY BE REQUIRED. 16. Provide s~ey, to scale, with accurate foundation plan ~d distances to prope~y 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__ NOX · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) ~ t~[O~ '-'(h~'O¢,~O -~OeO(,d{O ~ beingdulyswom, deposesandsaysthat (s)heisthe applicant (Name of individual signing contract) above named, (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith· Sworn to before me this dayof ~c~(~' 20 I~0 Nota~ Public ~. os~ ~1~ · "Signature of~ NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER 1-4738-00331/00003 FACILITY/PROGRAM NUMBER(S) SAPP PERMIT' Under the Environmental Conservation Law EFFECTIVE DATE October 15, 2009 EXPIRATION DATE(S) ,October 14, 2014 [ TYPE OF PERMIT INew IDRenewal []Modification r~ Permit to Construct n Permit to Operate I [3 Adicle 15, 'lqtle 5: Protection of Wa- ters [] Article 15, Title 15: Water Supply [] Article 15, Title 15: Water Transport [] Article 15, Title 15; Long Island Wells [] Article 15, Title 27: Wild, Scenic and Recreational Rivers [3 6NYCRR 608: Water Quality Certification E3 Article 17, Titles 7, 8: SPDES [] Article 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamatioh [] Article 24: Freshwater Wetlands · Article 25: Tidal Wetlands E] Article 27, Title 7; 6NYCRR 360: Solid Waste Management [3 Article 27, Title 9; 6NYCRR 373: Hazardous Waste Management Article 34: Coastal Erosion Management [] Article 36: Floodplain Management [] Articles 1, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control PERMITISSUEDTO Nikos Theodosopoulos ADDRESS OF PERMITTEE 175 AldershotLane, ManhassetNY 11030 TELEPHONE NUMBER (917) 359-0825 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER NAME AND ADDRESS OF PROJECT/FACILITY Theodosopoulos Property, 595 North Parish Drive, Southold LOCATION OF PROJECT/FACILITY SCTM # 1000-71-1-6 COUNTY TOWN · Suffolk $outhold Description of Authorized Activity IWATERCOURSE Southold Bay NYTM COORDINATES E:717.5 N:4547.7 Reconstruct the existing deck and retaining wall in-place. All work shall be performed in accordance with the survey plan prepared by Nathan Taft Corwin III last revised on 10/2/09, and stamped NYSDEC approved on 10115109. * The portiOn of the property that is landward of the 10 foot elevation contour line as shown on the aforementioned survey plan is beyond the jurisdiction of Article 25 Tidal Wetlands (See page 3 of 5). By acceptance of this permit, the perrnittea agrees that.the permit is contingent upon strict compliance with the ECL, all applicable 'ec. lulations, the General Conditions specified {see pa~lea 2 - 4) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS · Laura J. Scovazzo IMRP.~ ~,~ I SUNY @ STONY BROOK, 50 CIRCLE ROAD. STONY BROOK, NY 11790-3409 ^UT.OR,Z S, N^TURE//r / D^TE · ~/'~ly,a~ /~/// .~/,~".~.~/1/~ . I Page 1 of 5 ,¥//vvv /?, ¥/t4y 7' I October 15, 2009 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. The storage of construction equipment and materials shall be confined Within the project work area and/or upland areas greater than 100 linear feet from the tidal wetland boundary, 2. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and/or protected buffer areas. 3. Necessary erosion control measures e.g., staked haybales, silt fencing, etc. are to be placed on the downslope edge of any disturbed areas. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good and functional condition until thick vegetative cover is established. 4. Disturbance to natural vegetation or topography greater than 25 feet seaward of the approved structure is prohibited. 5. All areas of soil disturbance resulting from the approved project shall be stabilized with appropriate Vegetation (grasses, etc.) immediately following project completion or prior to permit expiration, whichever comes fncst. If the project site remains inactive for more than 48 hours or planting is impractical due to the season, then the area shall be stabilized with straw or hay mulch or jute matting until weather conditions favor germination. 6. If seeding is impracticable due to the time of year, a temporary mulch shall be applied and final seeding performed at the earliest oppormrdty when weather favors germination and growthi but not more than~six months after project comPletion. 7. All disturbed areas where soil will be temporarily exposed or stockpiled for longer than 48 hours shall be contained by a continuous line of staked haybales / silt curtains (or other NYSDEC approved devices) placed on the seaward side between the fill and the wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 8. Any debris or excess material from construction of thisproject shall be completelY removed from the adjacent area and removed to an approved upland area for disPosal. No debris is permi.'tted in tidal wetlands or protected buffer areas. 9. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of, and understand the terms and conditions of, this permit. Within 30 days of the completion of the project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work.. I PAGE 2 OF 5 DEC PERMIT NUMBER 1-4738-00331/00001 SAPP NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Article 25 Tidal Wetlands qeBased on the information you submitted, the New York State Department of Environmental Conservation 0'qYSDEC) has made the following determination. The portion of the property located at 595 North Parish Drive, Southold shown on the survey prepared by Nathan Taft Corwin III last revised on 10/2/09 that is landward of the 10 foot elevation contour line, is beyond the jurisdiction of Article 25 Tidal Wetlands. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661 ) no permit is required under the Tidal Wetlands Act. PleaSe be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, aS indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent anY sedlmentatiqn or other alteration or diSturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction Which maY result from your project. Such ~recautions may include maintaining adequate work area between the tidal wetland jurisdictional oundary and your project (i.e.a. 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. , PleaSe be further advised that this determination does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. IPAGE 3 OF 5 DEC PERMIT NUMBER 1-4738-00331/00003 SAPP NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee: excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Depa_r~ent of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC") for all claims, suits, actions, and damages, to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the penuit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. 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: Permittee 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 can-y out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass tlpon 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 rights, 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 the Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of 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 accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind uny 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 written application to the Department for renewal, modification or transfer of this permit Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWNfl?), major Air Pollution Control (APC) and Solid Waste Management Facilities (SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, SIJNY ~ Stony Brook, 50 Circle Road, Stony Brook NY 11790-3409 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit in accordance with 6 NYCRR Part 621. The grounds for modification, suspension or revocation include: a) materially false or inaccurate statements in the permit application or supporting papers; b) failure by the permittee to comply with any terms or conditions of the permit; c) exceeding the scope of the project as described in the permit application; d) newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e) noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. PAGE4 OF 5 DEC PERMIT NUMBER 14738-00331/00003 SAPP NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6 NYCRR PART 608 (TIDAL WETLANDS) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the flee navigation of said waters or flood flows or endanger the health, safety of welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed, the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigabl~ and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. The Stgte of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels~ solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across or along the bed of a waterway or floodplain, deposits within any regulatory floodway, or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 5. There shall be no unreasonable interference with navigation by the work herein authorized. 6. Ifupon the expiration or revocation ofthis permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of EnvirSnmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject pmject will not contravene effluent limitations or other limitations or standards under Sections 301,302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they.are fully aware of and understand all terms and conditions of this. permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 9. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the · applicant or their designated agent as part of the permit application. Such approved plans were prepared by: Nathan Taft Convin III last revised on 10/2/09, and stamped NYSDEC approved on 10/15/09. DEC PERMIT NUMBER 1-4738-00331/00003 SAPP IPAGE 5__OF 5 Town o. f Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMEN? FOR..~. THE FOLLOWING ACTIONS MAY REQUIRE THE SUB*!$_~!ON OF h District Section Block lot 8_T_O_?M-WATEK, GRADING~ DRAINAGE AND ~P_n-_~!ON CONTROL PLAN G=K s IrkED BY A DESIGN PROF~.~iONAL IN THE STATE OF NEW YORK. Item Number:. (NOTE: A Check Mark (~) for each Question Is Required for a Complete Application) Ye.__~s N._~o 1 2 3 4 5 6 7 8 9 Will thIs Project Retain All Storm-Water Run-Off Ganemted by a Two (2") Inch Rainfall on Site? (This item will include all mn.off created by site clearing and/or consb'uction activities as well as all Site Improvements and the permanent crea0on of Impervious surfaces.) Does the Site Plan and/or Survey Show All Prolx~ed Drainage Stmcturas Indicating Size & Location? This Item shall include all Proposed Grade Changes and Slopes Controlling Suriace WaterFIowl Will this Praject Require any Land Filling, Grading or Excavation where thom Is a change to the Natural Existing Grade Involving mom than 200 Cubic Yards of Material wffhin any Parcel? Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000) Square Feet of Ground Surface? Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction or within One Hundred (10ff) feet of a Wetland or Beach? Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rice to One Hundred (100') of Horizontal Distance? Will Driveways, Parking Ames or other Impewlous Surfaces be Sloped to Direct Storm-Water Run-Off into and/or in the direction of a Town right-of-way? Will this Project Require the Placeraent of Material, Removal of Vegetation and/or the Construction of any Item Within the Town Right.of-Way or R°ad 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 Bulldthg Permltl EXEMPTION: .Y~s N._.~o Does this project meet the minimum standards for classification as an A~lriCultural Project? \/ Note: If You Answerad Yes to this Question, a Storm-Water, Oredlng, Drainage & Erosion Cordrol Plan IS NOT Requirod!/~ __ Sworn to before me this; STATE OF NEW YORK, COUNW ............... Ss That I, /'~ [..~..~..~....~....~..~....0..~- Q...flOC D ..o../..0..~- being duly sworn, de'poses and says that he/she is the applicant for Pexmit, And that he/she is the ...... ...~.......c...~..(.:2 ~ ...~_. ................................................ Owner and/or representative of the Owner of Owner's, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and beliet} and that the work will be performed in the manner set forth in the application flied herewith. ' FORM /6 ~-'7/-/-~ TOWN OF SOUTHOLD PROPERTY RECORD CARD 7.,,~ ~ OWNER, STREET ,~- (.~" VILLAGE DIST. SUB. LOT LES.~/O ~ sEAs. VL , FA~ COMM. CB. MISC. Mkt. Value ~ND IMP. TOTAL DATE REMARKS FARM Acre Value Per Value ' wampland FRONTAGE ON WATER / ~ - ruShland FRONTAGE ON ROAD louse PIct DEPTH Otel ~ ~ DOCK COLOR ~ Bidg, Bath Floors InteriOr Finish Heat Rooms ]st Floor Rooms 2nd Floor Dinette ~n-e~t, ~nacc~ & Van ~Veele, P,C, RL"v1510~: dOB NO. A0201~ TOPOCI~APHIC ~URVEY DAli ~ ~e, 2002 DR, A.V.R. C~t, W.d,B. SCALE: 1" - 50' DIST, 100 ~EC, 71 EILK, 1 LOT 6 I "x X xJ X* NOTES: 1. EL 2. FLO FLC Z Z 'APP AN~i PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I,A.L.S. AND APPROVED AND ADO FOR SUCH USE BY THE NEW YORK S TITLE ASSOCIATION. N~ OCT 2 7 2010 I BLDG. DEP[ TOWN OF S(]UTHOLD , ,I - .--, ~ ._., ~ : ~ PURSUANT TO C; ,',k i ER 236 , , ..... ,,~:~,,~,, ~ ~ t)-~: k,~r., ,.. ,__. <... ~ E ~, ITHOUT CER1'Ir:ICATE ,c& .-. ,, ,, ~'-) ~:: .... --- ~-~' ~A~ B~.~5t~ ~"'~ - '--.~ ~ ~ ~ ~' _~ ~= _ / ~ ~ FOUNDA~ ~ON TW° REQUIRED ~ Z 40'-~" , ~ t 3 ~NSU~TION P~OPOSEP FOUNPATION/F~AMINe PIE~ OONST. NOTE: ~E, 1/4"=l'-O" ~" ¢ONO~BB ON BI.FOOT 20 · 5BE 5PEG 5NEET5 FOR ALL OODE JOB ~: I~ POOTIN~ D'-O" BELOH ~DE 5~APPIN~, HAN~E~5 ~ HOLD POHNS~ DA~: ~-12-10 DECK 14 9 ~ ~ ~G~DEI0'3 ~, ~ ~ ~ 40'-~" ~O~O~E~ DE~ PLAN 5OA~E: ~": I'-O,, P~: J.~ ' OE 40F7