HomeMy WebLinkAbout37142-Z ,r`"~OFFO(KC-_ Town of Southold Annex 7/8/2013
,t=~ P.O. Box 1179
Fi ~ ~ 54375 Main Road
~ ? ~ Southold, New York 11971
.y
CERTIFICATE OF OCCUPANCY
No: 36334 Date: 7/8/2013
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 15437 Route 25, East Marion,
SCTM 473889 SecBlock/Lot: 23.-1-6.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this ofSced dated
4/5/2012 pursuant to which Building Permit No. 37142 dated 4/16/2012
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:
accessory in ¢round swimmine pool fenced to code as anolied for.
The certificate is issued to de la Vega, Frederick & Higgins, Lawrence
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37142 8/15/12
PLUMBERS CERTIFICATION DATED
_
u oriz Signa ure
t,,s~-.., ` TOWN OF SOUTHOLD
BUILDING DEPARTMENT
° TOWN CLERK'S OFFICE
~'a~~;' SOUTHOLD, NY
±~1,~, .
r__. BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit 37142 Date: 4/16/2012
Permission is hereby granted to:
de la Vega, Frederick 8 Higgins, Lawrence
344 W 23rd St
New York, NY 10011
To: construct an In round Swimmin Pool
g g ,per Trustees 8~ DEC fenced to code as applied
for
At premises located at:
15437 Route 25, East Marion
SCTM # 473889
Sec/Block/Lot # 23.-1-6.1
Pursuant to application dated 4I5I2012 and approved by the Building Inspector.
To expire on 10/16/2013.
Fees:
SWIMMING POOLS - IN-GROUND WITH FENCE ENCLOSURE $250.00
CO -SWIMMING POOL $50.00
ELECTRIC $100.00
Total: $400.00
Building Inspector
Funn No.6 ~
TOWN OF SOUTHOLD
BiJiLDING DEPARTMENT ~ ~ j (p~
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. oCwatersupply 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 I% 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.
B. For existing buildings (prior to Apri! 9, 1°57) non-conforming uses, cr buildings and "pre-existing" land uses:
1. Accurate survey of property showing all property lines, sweets, building and unusual natural or topographic
featurei
2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall stale the reasons therefor in writing to the applicant.
C. Fees
I . Certificate of Occupancy -New dwelling $50.00. Additions to dwelling $50-00, Alterations to dwelling $50.00.
Swinunin, pool $50.00, Accessory building $50.00, Additions to accessory buildinu $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
Date. _
New Construction: ~ ~ _ Old or Pre-existing Building: (check one)
Location of Property: _J 5 I'Y`r-~ I .1 E I/l~} ~r p Iti
House No. Street ' I / Hamlet
Owner or Owners of Property: r- ?~I" ~ -P~f+`1 Ck 1~~ / V~~~fJ ~ L~~.1~2~Pn
f_ 1 ~1~ ~t~J~~
Suffolk Count fax Ma No 1000, Section n
y" p ,~3 Block ~ Lat~ ~
Subdivision Filed Map. Lot:
Permit No. ~ I ~ Date of Permit. JI ~ ' I ~ Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval _
Request for Temporary Certificate Final Certificate: (check one)
v
c
Fce Suhntittcd $
diy~
Applicant Si~na[ure
pF SO(/j
Town Hall Annex ~ ~ Telephone (631) 765-1802
54375 Main Road ~ Fax (6311 765-950?
p B°"' I'y roger.richert antown.southold.ny.us
Southold, NY 1 1 97 1-0959 ~ ~
~~d00UNTy 0~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Fred Delavega
Address: 15427 Rt 25 City: East Marion St: NY Zip: 11939
Building Permit#: 37142 Section: 23 Block: 1 Lot: 6.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
contractor: DBA: Sweet Hollow II Inc License No: 4300-me
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only
Commerical Outdoor X 1st Floor Pool X
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 4
Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks
Disconnect Switches Twist Lock Exit Fixtures TVSS
other Equipment: in ground swimming pool and spa, to include, bonding, 3-pool lights, 1-blower,
1-salt generator, 1-control panel, 5-GFCI circuit breakers
Notes:
Inspector Signature: ~ ~ Date: Aug 15 2012
81-Cert Electrical Compliance Form.xls
~ ~ ~~,OF 80~/%
~ h~ ~1
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
1 NSPECTION
( ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING /STRAPPING [ ]FINAL
[ ] FIREPLACE A CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ] FlRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ] ELECTRICAL/(ROUGH) [ ]ELECTRICAL (FINAL)
REMARKS: _ ~ ~d3i .l
U~~ <'rc.t ~ .~'T z~z.~,`
T
J lIV/~-- ~
DATE ~Y INSPECTOR
7l ~L-~-- ~~,OF SO!/?,y_
#®~F
TOW OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ FOUNDATION 1ST [ ]ROUGH PLBG.
4~ [ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING /STRAPPING [ ]FINAL
[ ] FIREPLACE ~ CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUG) [ ] ELECTRN:AL (FINAL)
REMARKS: B~C--
DATE ~ L' INSPECTOR
3 ~ ~ ~ j - ~~,OF SOUT,y~
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] IN TION
[ ]FRAMING /STRAPPING [ FINAL
[ ]FIREPLACE 8~ CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL)
REMARKS: ~L~''"z
,k~~~,
r
DATE ZZ ~ INSPECTOR
3 ~ ~ ~ ~,~OF SOUT~o
~ 6
#®f
TOWN OF SOUTNOLD BUILDING DEPT.
765-1802
1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] IN ATION
[ ]FRAMING /STRAPPING [ FINAL
[ ]FIREPLACE 8~ CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL)
REMARKS: `
~ v~ L
J
ti `
DATE ~ a~ -3 INSPECTOR
DATE cal~nv~rrrs.
b
FOUNbA~'ION (1ST) ~ ~
~r
a
FOUfi1tAT]:4N (2ND) ~ ~
' o
y
• ROUGH x'1tAl~G ~ y
PLiJ1VtBTNG
l
7
1N3UI.ATiON PER N. Y. ~ "3
STATE ENERGY CODE ~
• a~ ~t .
FINAL
ADDITIONAL C01tIlYl~NTS
~ to 0
~ ~
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following, before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans_ _
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. 3~/`~~ Check
Septic Form______ _
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined_ 20~,~ D ~ (t~ f2 ~ ~ ~ Single & Separate__.
NJ LS D S[orm-Water Assessment Form___
APR - 5 2012 contact.
Approved 20 ~ ~ Mail tno: y~
Disapproved a/c BLDG. DEPT. P~ C'K LI
_ TowN or souTHOLO Pnone: 5 ~ 6 -]-7 ~j - ~
Expiration _ ~ , 20~ `Td~1-~.~
Pte-
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date ~ .3 .20
INSTRUCTIONS
a. This application MUST be completely tilled 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 htspector 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 fa' the issuance of a Building Permit pursuant to the
Building lone 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.
nI1VI rv1~~IH~~Lia I t`~~ ~pI1 AIAICI ~~(Signature of applicant or name, ifacorporation)
ENCLOSE POOL TO CODE t-1" I' ~ IWLl1YV f_ U i \ ~
UPON COMPLETION 1I"`~~ a. ~'ERT1F9(~A,~~1 ~~lJ`'f 1~16~
BEFORE "WATER" ` i ~ (Mailing address of applicant
State whether applicant is owner, lessee, agent_ architect, engineer, general contractor, electrician, plumber or builder
A~'PROVED AS NOTED
~t,.l
~ a. u
Nariic ofawucr of preiitiscn ~~e~'`er~ ' (v? t p
t
~ .I
(As on the tax II or latest dee
If applicant a co or• n, s' nat of duly authorizeyd officer \ - 1
-~-c~t.• i+-~~ t ~ ``~'1Ca'1 n ~r~`~.`\ INS~•E~~,:IUNS:
(Name and title of corporate of tcer) iz)~ra0•V - PNO REQUIRED
Builders License No. ~c~~j~~,~ {->v, k`~~u~REP, ;;r~NCi<ETE
Plumbers License No.
Electricians License No.
Other Trade's License No. ~ t^INkI-. coNSTe~Plael g F_ECiR; „r
MUst gEC01r1PLtTE FOR C.O.
1 . Location of land on which proposed work will be done: CtJN5T2WCTI0N SHALL MEETTHE
di('cF~IeNTS OF THE CODES OF NEW
_ 1 S`i ~ ~ +~,ir, ~ d m ~ ~ RESPIINSIBL~F~1R
House Number Street i~I6~OR CONSTRUCTION ERRORS.
County Tax Map No. 1000 Section Block_ ~ Lot
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises nd intended use and occupancy of proposed construction:
a. Existing use and occupancy PAS, c~,-~A
b. Intended use and occupancya,,~C~ ~~„-,~p 5~,~,,,~,,,,~_~ P,~p~ ~,,yC,
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work tgx ~6z Q~o~
(Description)
4. Estimated Cost _ Fee
(To be paid on filing this application)
5. [f 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 naht<e and extent of each type of use.
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase I ~ Name of Former Owner
11. Zone or use district in which premises are situated t r~~tA 1
12. Does proposed construction violate any zoning law. ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO ~WIII excess fill be removed from premises? YES~NO
NK N'T a
14. Names of Owner of premises rr to Address3Y`/ w'T3 rrf~ Ph~ne~o.
Name of Architect r9c~ Address/ »a~~ ~I_ Bone o 63/o~fl - Y/O
Name of ContractorTn.nen.a ~„~.3~_ Address 4f'y ~1'>'Vx'GiecA Phone No. ~/J? -0:x'73
] 5 a. Is this property within l 00 feet of a tidal wetland or a freshwater wetland? * YES ~ NO
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES ? NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
.
.i ~:t~
17. If elevation at any point on property is at 10 feet or below, must provide topographical d'ata~n survey.
18. Are there any covenants and restrictions with respect to this property? * YES j/ NO
* IF YES, PROVIDE A COPY.
CHARLES F NlOEIiR
STATE OF NEW YORK) Notary Public, State of New York
Regr~]•a?ion #Ot W06162360
~ Qualified In Nassau County
C/O~UNT"Y OF Commies~.c Fxn~.res March 12, 2015
[ yn-r,~-y~~~~~~ ~ _ being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the ~~~-,~t'2~~~_
(Contractor, Agent, Corporate Ofticer, 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 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 before me this
ay 20 V"~- ~
Notary Public Signature
of/~A~p/p/lic~ant~
j ~o~~6F Sli(/ryo6
Town Hall Mnex ~ Telephone (631) 765-1802
54375 Main Road ~~rt (63 U 76$.y5pg
P.O. sox 1179 yG • ~ fOQer.rlChertfo2tOwn.SOllthOltl.nV.US
Southold, Nl 11971-0959 ~~~//yypp~`,,,,~~
"W~II~
BUII.DIIVC AF.PARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: pate: S la
Company Name: ee f~-ol~oe~t.1~ 1Y
Name: 5acc
License No.: H 0 - <
Address: / 1~e -~I~e;~ ~ /l7d'`~
Phone No.: 63i - H a?-H'f36
JOBSITE INFORMATION: (*Indicates required information)
*Name: Fred bzla. v'~g
*Address: I SH a r] %,-1- a25 fas } 111A~-i a n N
*Cross Street: hon e
*Phone No.: 5 i6 - ??9 - D80 S
Permit No.: 3 ? r y ,Z
Tax Map District: 1000 Section: a3 Block: j Lot: ~
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) SW_m
rn
~ ~ i0r~, ~ (~u;~,,P ~b~txe(
y t~ I~rS , 3 I i S k~S , (~-foCo~ r C~vaS /-jcci~-cr
(Please Circle All That Apply)
*Is job ready for inspection: NO Rough In Final
*Do you need a Temp Certificate: YES
Temp Information .need
rr a
*Service SIZe: r a&E ~
~ 3r~h~e, Ir ~~0 150 200 300 350 .400 Other
*New Service: nnect Undergroun mbar of Meters Change of Service Overhead
Additional Informati MAY 1 5 2012 MENT DUE WITH APPLICATION
r%v~ or:;orinoiu
82-Request for Irrspoctlon Form ~ I U O ,
~o~~Of Stil/jy0~
Town Ha8 Annez ~ *Tel~epjh~one (631) 7&Z1802 ~~'i
54375 Main Road rpQer_flCheft(mi (~1) 7659502
P.O. Box 1179 ~ OWr1.SO O .BV.US
Southold, ~ 11971-0959 ~,/y~~,,,~
"Wtrl 1,
BUILDING DEPARTMEN'!'
TOWN OF t30iJTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date: I i
. Company Name: ~ N a~lo~u '$I~
License No.: -3 o - M~
Address: 18 o v~l AJ ~ ~
1 F~+.?.in 'pJ -`l , l l ~ ~ ~
Phone No.: l '7 , t(- ~ ~
JOBSITE INFORMATION: (*Indicates required information)
'Name: ~`rc~ ~P~l~11NPr~
*Address: ~ $ i} : _ 7 2-~- ~ t`
r. cif- cNtr,..?ti cs vi '~,~~t
*Cross Street: R l ,L
*Phone No.: S t 6 -~nl - t~$O.S
Permit No.: ~-1 1 c} Z
Tax tvlap District: 1000 Section: 23 Block: ` Lot:
*BRIEF DESpCRIPTI1ON OF WORK (Please Print Clearly) •tid~ i~i61~.~ iJo~{c, otn
EKib~~w.e QZCYu~-f- ~i7rit~ Ltc~••S~
~y N~PIW DaoC ~`P~a ~~v~e ,Pym.D~f_ZV
i o Lt clti+ ~
(Please Circle All That Apply)
*Is job ready for inspection: YE Rough in Final ~
*Do-you rimed a Temp Certificate: YES ~ O
'J Ol'~~1' 1 i.
Temp information (If needed)
*Servks Size: 1 Phase 3Phase 100 150 200 300 350 .400 Other
*NeW Service: Re-connect Underground Number of (Meters Change of Service
Additional Infortnaiion: PAYME T DU I
JUL 1 3
$2-Request farlnspecfion Forth - j
BLDG. DEPT. f
TOl'P P: Pf RO;IIHOLD
Town of Southold -Chapter 236 - Stormwater Management
SWPPP -Storm Water Pollution Prevention Plan Assessment Form
GENERAL INFORMATION: Requested Information is Required for a Complete Application)
APPLICANT NAME: Owner-A ent-COnsuOant- ontrat or ONer (Ci¢le One) Property OWNS '(If Different than Applicant)
v
dres ~ Add ss~
C (./A
hon ~ O~ Tekphorro Faz
E-MaO: ~ ~ E-Mail:
P arty rasa: lJ I Brie(Desmption of ConsWClion Activity, Proposed Struchual BMPs, Soil
B.C.. . ~ 000 L Stabali~ation BMPs, Project Scope and/or Sequence of ConsDUCtion Activity
nbbM a~" tumor (hwae naaiumel repn as nealeo7
Name of ontrattor andor Contaet Person Responsible for M lemenbtlon or SWPPP: .i`k~~;~' ~ ~ ~t y V v
Address: ~qy .c~-/.~E ~-~~~-1F__~(J\
_~'cC*~_..y~i~C.~N.~-t/~1_~._
Tekphorre 7l: Faz#: ~..f>(~ .(./l.S!191.1r~ _
E-Mail:
Nams o/ Persona Responsible br Imtellation 6 Malnlsnanes of Erosbn Control Proctlce: ~
Atldresa:
Telephone Fu
E -Mail:
Total Area of All Total Area of Land Cleadrg
Protect Parcels' anNor Grountl DlsNrbance:
ISF. /AVes) (S.F. /Dues)
Project Duration: Sfad End ~ - - _ _ _
(Anticipated) Data: Date: _
luwae,dcaunearo
nl
Will this Project Disturbe fWe (Sj or More Acres at Q - - - ~ _ _ .
Any One Time During the Proposed Development? Yes No - "
If yES: Please Answer Na Follovrirgl
a. Does the Applicant have a Qualified Inspector On Q Q
Staff To Conduct the Required Inspections ? Yes No
b. Does the SWPPP Indicate How Frequen0y the Site O O List the NAMES or description of all Potentially Impacted Waterbodiea and/or Wetlands:
Inspections will Occur and for What Period of Time? Yes No
c. Does the SWPPP Adequately Identify All Temporery ~ 0 - ~ -
andlor Permanent Soif Stabalization Measures ? Yes No ~ " " - " ~ -
d. Does the SWPPP Adequately Identify a Complete Q 0
Project Phasing Plan ? Yea NO Status of Impacted Walerbody: (eg. TMDL, l03(d) Llsted, Impaired...)
e. Does the SWPPP Indicate Additional Site Specific Q Q
Practices that Will be Utilized to Protect Water Quality? Yes No
f. Has the Applicant Submitted a Completed DEC Notice Typa of Impacted Waterbody: (eg. Lake, Creek, Bay, Pond, $Oalld, Freshwater Wetlantl...)
Of Intent and SWPPP Acceptance Form for Review Q Q
by the Town of Southold ? Yes No
STATF. OF NF.W YORK, CONNIE D. BUNCH
COUNTY OF ....~I,J SS Notary Public, State of New York
No.01BU6185050
That I, 1~ .............5 ._.~L............ being duly sworn, deposes and ~aliYadl7/tl4iuiNQlte(a Ilfdn for Pemut,
("°"'°°finaividualalgningDOw q Commission E>~ifnsApril d, 2_~
And that he/she is the .....1..:? .......-..~^..16L.a.`'.~L.N
(Ovmer, Canlredor, Agent Corporate Officer, etc.)
Owner and/or representative of 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 we to the best of his knowledge and belief; and
[hat the work will be performed in the manner set Corth in the application filed herewith.
Swom to bef/Ioppre me [his; MM
day of ..6..!..~... , 20..~.a
Notary Public:....4%A1fl...M.. y.......1-J...~.,~1.~..~%><Y~^'-- l
(Signature of Applicant)
SWPPP Assessment FORM: 03-12
James F. King, President ~Of SOUjh, Town Hall Annex
~ 54375 Main Road
Bob Ghosio, Jr., Vice-President h0 l0
P.O. Box 1179
Dave Bergen 1~f ~ Southold, New York 11971-0959
Joha Bredemeyer H ~e
Michael J. Domino ~0 ~ ~O .Telephone (6312 765-1892
Fax (631) 765-6641
~y~OUNTY,
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
January 18, 2012
Mr. Robert E. Herrmann
En-Consultants
1319 North Sea Road
Southampton, NY 11968
RE: FREDERICK DELAVEGA & LAWRENCE HIGGINS
15437 ROUTE 25, EAST MARION
SCTM# 23-1-6.1
Dear Mr. Herrmann:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, January 18, 2012 regarding the above matter:
WHEREAS, En-Consultants on behalf of FREDERICK DELAVEGA & LAWRENCE
HIGGINS applied to the Southold Town Trustees for a permit under the provisions of
Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of
Southold, application dated December 23, 2011, and,
WHEREAS, said application was referred to the Southold Town Conservation Advisory
Council and to the Local Watertront Revitalization Program Coordinator for their findings
and recommendations, and,
WHEREAS, the LWRP Coordinator issued a recommendation that the application be
found Consistent with the Local Watertront Revitalization Program policy standards,
and,
WHEREAS, a Public Hearing was held by the Town Trustees with respect to said
application on January 18, 2012, at which time all interested persons were given an
opportunity to be heard, and,
WHEREAS, the Board members have personally viewed and are familiar with the
premises in question and the surrounding area, and,
-
> z
WHEREAS, the Board has considered all the testimony and documentation submitted
concerning this application, and,
WHEREAS, the structure complies with the standards set forth in Chapter 275 of the
Southold Town Code,
WHEREAS, the Board has determined that the project as proposed will not affect the
health, safety and general welfare of the people of the town,
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees have found the application to be Consistent
with the Local Waterfront Revitalization Program, and,
RESOLVED, that the Board of Trustees approve the application of FREDERICK
~ DELAVEGA & LAWRENCE HIGGINS to construct an 18'x36' in-ground swimming pool
including 8'x8' spa); on-grade masonry pool patio, pool enclosure fence, 65 linear feet
of 2' high retaining wall (with existing boulders added to each end to avoid need for
additional retaining wall), and steps; construct masonry stoop and steps from house to
pool patio; remove existing Bluestone patio in back of house and construct new
masonry on-grade patio; place stepping stones from proposed patio to proposed pool;
enclose existing outdoor shower with wood panels; replace existing driveway with new
pervious gravel driveway; plant native red maples, acer rubrum, along property line;
legalize previously completed relocation of sliding glass doors to outer wall of previously
existing porch to completely enclose porch space; and establish approximately ± 5,600
square feet of permanent non-turf buffer adjacent to and landward of the wetland
boundary; and as depicted on the site plan prepared by Marshall Paetzel Landscape
-o~ Architecture, P.C., last dated February 7, 2012, and stamped approved on March 2,
2012.
Permit to construct and complete project will expire two years from the date the permit
is signed. Fees must be paid, if applicable, and permit issued within six months of the
date of this notification.
Inspections are required at a fee of $50.00 per inspection. (See attached schedule.)
Fees: $100.00
Very truly yours,
ames F. King
President, Board of Trustees
JFK/eac
BOARD OF SOUTHOLD TOWN TRUSTEES
SOUTHOLD,NEW YORK
PERMIT N0.7715 DATE: JANUARY 18.2012
ISSUED TO: FREDERICK DELAVEGA & LAWRENCE HIGGINS
PROPERTY ADDRESS: 15437 ROUTE 25. EAST MARION
SCTM# 23-1-6.1
AUTHORIZATION
Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and m
accordance with the Resolution of the Board of Trustees adopted at the meeting held on January l8, 2012, and
in consideration of application fee in the sum of $250.00 paid by Frederick DeLaVeea & Lawrence Higgins
and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees
authorizes and permits the following:
Wetland Permit to construct an 18'x36' in-ground swimming pool (including 8'x8'
spa); on-grade masonry pool patio, pool enclosure fence, 651inear feet of 2' high retaining wall
(with existing boulders added to each end to avoid need for additional retaining wall), and
steps; construct masonry stoop and steps from house to pool patio; remove existing bluestone
patio in back of house and construct new masonry on-grade patio; place stepping stones from
proposed patio to proposed pool; enclose existing outdoor shower with wood panels; replace
existing driveway with new pervious gravel driveway; plant native red maples, acer rubrum,
along property line; legalize previously completed relocation of sliding glass doors to outer wall
of previously existing porch to completely enclose porch space; and establish approximately f i
5,600 square feet of permanent non-tort buffer adjacent to and landward of the wetland
~ boundary; and as depicted on the site plan prepared by Marshall Paetzel Landscape
I ArchiteMUre, P.C., last dated February 7, 2012, and stamped approved on March 2, 2012.
IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Sea( [o be affixed,
and these presents to be subscribed by a majority of the said Board as of this date.
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TERMS AND CONDITIONS
The Permittee Frederick DeLaVeKa & Lawrence Hi¢gins residinP at 15437 Route 25, East
Marion. New York as part of the consideration for the issuance of the Permit does understand
and prescribe to the following:
1. That the said Board of Trustees and the Town of Southold are released from any and all
damages, or claims for damages, of suits arising directly or indirectly as a result of any
operation performed pursuant to this permit, and the said Permittee will, at his or her own
expense, defend any and all such suits initiated by third patties, and the said Permittee
assumes full liability with respect thereto, [o the complete exclusion of the Board of
Trustees of [he Town of Southold.
2. That this Penttit is valid for a period of 24 months, which is cottsidered to be the estimated
time required to complete the work involved, but should circumstances warrant, request for
an extension may be made to the Board at a later date.
3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to
maintain the structure or project involved, to provide evidence to anyone concerned that
authorization was originally obtained.
4. That the work involved will be subject to the inspection and approval of the Boazd or its
agents, and non-compliance with the provisions of the originating application may be cause
for revocation of this Pennit by resolution of the said Board.
5. That there will be no unreasonable interference with navigation as a result of the work
herein authorized.
6. That there shall be no interference with the right of the public to pass and repass along the
beach between high and low water marks.
7. That if future operations of the Town of Southold require the removal and/or alterations in
the location of the work herein authorized, or if, in the opirrion of the Board of Trustees,
the work shall cause unreasonable obstruction to free navigation, the said Permittee will be
required, upon due notice, to remove or alter this work project herein stated without
expenses to the Town of Southold.
8. The Pertnittee is required to provide evidence that a copy of this Trustee permit has been
recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction
to the deed of the subject parcel: Such evidence shall be provided within ninety (90)
calendar days of issuance of this permit.
9. That the said Board will be notified by the Permittee of the completion of the work
authorized.
10. That the Permittee will obtain all other permits and consents that may be required
supplemental to this pennit, which may be subject to revoke upon failure to obtain same.
James F. King, President hO~~OF SDU~yO/_ Town Hnll Annex
Bob Ghosio, Jr., Vice-President ~O 54375 Main Road
P.O. Boa 1179
Dave Bergen J~I * Southold, New York 11971-0959
John Bredemeyer
Michael J. Domino ~ ~ ~ Telephone (631) 765.1892
~ Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0837C Date: Januazv 25, 2013
THIS CERTIFIES that the installation of an in-ground Wool with spa, on-grade
masonry Wool patio, pool enclosure fence property line fencin~• f65' long retainine wall with
steps maso stoop and steps from house to Wool patio• masonry on ~•ade patio in back of
house: stepping stones: enclosed outdoor shower new pervious eravel driveway nlantin¢s along
property line: existine enclosed north on dwelling and approximately f5 600 sauaze feet of
Non-Turf Buffer which is to be subsequently maintained.
At 15437 Route 25. East Marion. New York
Suffolk County Tax Map # 23-1-6.1
Conforms to the application for a Trustees Permit heretofore filed In this office
Dated January 18, 2012 pursuant to which Trustees Wetland Permit #7715 Dated
issued and Amended on October 17.2012 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 installation of an in-ground pool with sna on-grade mason_rv pool patio
pool enclosure fence• property line fencing• f65' long retainine wall with steos• masonev stoop
and steps from house to pool patio' masonry on-¢rade patio in back of house' stepping stones'
enclosed outdoor shower new pervious Kravel driveway plantines along pronerty line' existing
enclosed north on dwelling, and approximately t5 600 squaze feet of Non Turf Buffer which is
to be subsequently maintained.
The certificate is issued to FREDERICK de la VEGA & LAWRENCE HIGGINS owner of the
aforesaid property.
Authorized Signature
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-00835
PERMIT
Under the Environmental Conservation Law ECL
Permittee and Facility Information
Permit Issued To: Facility:
FREDERICK DELAVEGA DELAVEGA & HIGGINS PROPERTY
344 W 23RD ST #PHB 15437 MAIN RD~SCTM# 1000-23-1-6.1
NEW YORK, NY 10011 EAST MARION, NY 11939
(212) 353-2200
LAWRENCE HIGGINS
344 W 23RD ST #PHB
NEW YORK, NY 10011
(212)353-2200
Facility Application Contact:
EN-CONSULTANTS INC
1319 NORTH SEA RD
SOUTHAMPTON, NY 11968
(631)283-6360
Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: EAST MARION
Facility Principal Reference Point: NYTM-E: NYTM-N:
Latitude: Longitude:
Authorized Activity: Construct a pool, patio, and retaining wall, and install stepping stones and a
fence, all as shown on the attach plans prepared by Stacy Mazshall Paetzel, dated 12/19/11, stamped
"NYSDEC Approved" on 2/23/12.
Permit Authorizations
Tidal Wetlands -Under Article 25
PermitlD 1-4738-00835/00003
New Permit Effective Date: 2/23/2012 Expiration Date: 2/23/2017
Page 1 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATIONir•
Facility DEC ID 1-4738-00835
NYSDEC Approval
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict
compliance with the ECL, all applicable regulations, and all conditions included as part of this
permit.
Permit Administrator: GEORGE W HAMMARTH, Deputy Regional Permit Administrator
Address: NYSDEC REGION 1 HEADQUARTERS
SUNY @ STONY BROOK~50 CIRCLE RD
STONY BRO_O,,K~,
~N/Y 117 0 -3409
Authorized Signature: ~~'~~a~~j~""~~ Date ~~3
~1~
Distribution List
EN-CONSULTANTS INC
Habitat - TW
KEVIN A KISPERT
Permit Components
NATURAL RESOURCE PERMIT CONDITIONS
GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS
NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS
Permit Attachments
Site Plan 12/19/2011
NATURAL RESOURCE PERMIT CONDITIONS -Apply to the Following
Permits: TIDAL WETLANDS
1. Conformance With Plans All activities authorized by this permit must be in strict conformance
with the approved plans submitted by the applicant or applicant's agent as part of the permit application.
Such approved plans were prepared by Stacy Marshall Paetzel, dated 12/19/11, stamped "NYSDEC
Approved" on 2/23/12.
- Page 2 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID t-4738-00835
2. Notice of Commencement At least 48 hours prior to commencement of the project, the pernvttee
and contractor shall sign and return the top portion of the enclosed notification form certifying that they
aze 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.
3. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous
location on the worksite and adequately protected from the weather.
4. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal
wetlands or protected buffer areas as a result of the permitted activities.
5. No Construction Debris in Wetland or Adjacent Area Any debris or excess material from
construction of this project shall be completely removed from the adjacent area (upland) and removed to
an approved upland azea for disposal. No debris is permitted in wetlands and/or protected buffer areas.
6. No Drywells in or near Wetland Dry wells for pool filter backwash shall be located a minimum of
75 linear feet landward of the tidal wetland boundary.
7. No Pool Discharges to Wetland There shall be no draining of swimming pool water duectly or
indirectly into wetlands or protected buffer azeas.
8. Concrete Leachate During construction, no wet or fresh concrete or leachate shall be allowed to
escape into any wetlands or waters of New York State, nor shall washings from ready-mixed concrete
trucks, mixers, or other devices be allowed to enter any wetland or waters. Only watertight or
waterproof forms shall be used. Wet concrete shall not be poured to displace water within the forms.
9. Straw Bales or Other at Tidal Wetland A row of staked straw bales or approvable erosion control
devices shall be placed at the landward edge of the buffer area or as shown on the approved plans lineaz
feet from the tidal wetland boundary, or as per the NYSDEC-approved plan, prior to commencement of
any regulated activities and remain in place and in good, functional condition until the project is
completed and all disturbed azeas are stabilized with vegetation.
lo. Storage of Equipment, Materials The storage of construction equipment and materials shall be
confined within the project work area and/or upland azeas greater than 75 lineaz feet from the tidal
wetland boundary.
I1. Area of Disturbance for Structures Disturbance to the natural vegetation or topography greater
than 25 feet seaward of the approved structure is prohibited.
12. Establish Vegetated Buffer To protect the values of the tidal wetlands, a permanent vegetated
buffer zone shall be established. There shall be no disturbance to the natural vegetation or topography
within an area extending as shown on the approved plans lineaz feet landwazd of the tidal wetland
boundary.
t3. State Not Liable for Damage The State 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.
Page 3 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-00835
14. State May Order Removal or Alteration of Work 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 free
navigation of said waters or flood flows or endanger the health, safety or 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 navigable 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.
15. State May Require Site Restoration If upon the expimtion or revocation of this pernut, 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 Environmental Conservation may
lawfully 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.
16. Precautions Against Contamination of Waters 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.
GENERAL CONDITIONS -Apply to ALL Authorized Permits:
i. 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 Departtent) 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 pernuttee 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 pernrit, 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.
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 any order
or determination previously issued by the Department or any of the terms, conditions or requirements
contained in such order or determination.
Page 4 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4739-00835
3. Applications For Permit Renewals, Modifications or Transfers The permittee must submit a
separate written application to the Department for permit renewal, modification or transfer of
this
perrnit. 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. Submission of
applications for permit renewal, modification or transfer are to be submitted to:
Regional Permit Administrator
NYSDEC REGION 1 HEADQUARTERS
SUNY @ STONY, BROOK~50 CIRCLE RD
STONY BROOK, NY 11790 -3409
a. Submission of Renewal Application The permittee must submit a renewal application at least 30
days before permit expiration for the following permit authorizations: Tidal Wetlands.
5. Permit Modifications, Suspensions and Revocations by the Department The Department
reserves the right to exercise all available authority to modify, suspend or revoke this permit. 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 Depardnent related to
the permitted activity.
6. Permit Transfer Permits aze transferrable unless specifically prohibited by statute, regulation or
another permit condition. Applications for pemut transfer should be submitted prior to actual transfer of
ownership.
Page 5 of 6
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Facility DEC ID 1-4738-00835
NOTIFICATION OF OTIIER 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 hazmless the
Department 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
perntittee'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 permit. 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 carry out the activities that aze authorized by this permit.
Item D: No Right to Trespass or Interfere with Riparian Rights
This perntit does not convey to the permittee any right to trespass upon the lands or interferg 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.
Page 6 of 6
1319 North Sea Road
4~ Southampton, New York 11968
631-283.6360
EN=CONSULTANTS Fax: 63,_283~t36
www.enconsultants.com
ENVIRONMENTAL CONSULTING
Mareh23, 2012
Fred de la Ve~a
344 West 23 Street, PHB
New York, NY 10011
Re: 15437 Route 25, East Marion. SCTM 1000-23-1-6.1
Dear Fred:
As requested, I am writing to clarify the determination of yards on your property as I discussed it with Michael
Verity, Building Inspector, prior to our obtaining wetlands permits for your swimming pool and other proposed
improvements from the New. Yotk State Department of Environmental Conservation and Town Trustees.
Pursuant to Town of Zoning Code, swimming pools are only permissible in a rearyard or in a Stunt yard on a
waterfront property. Because your easterly yard was the most desirable location forthe pool and really the only
practicable one given other constraints on the property, it was important to verify that yard could be treated as a
front or rear, thus allowing you to locate the pool there without the need for variance relief.,
At first glance, one might assume the easterly yard is a side yard because Route 48 is located t0 the north of the
property, but at the time of its development, vehicular access to the properly was and remains restricted to the most
southwesterly corner of the property, where the driveway is located at the end of a 25' right-of-wayproviding
prescribed access from Route 48. Therefore, based on this specified point of access, Mr. Verity explained that he
could treat that southwest portion of the properly as the Sant yard and thus treat the yard to the east of the house as
the rear yard. This original layout is depicted on a 1993 survey by Roderick Van Tuyl (original. Health. Department
approved copy enclosed), which I reviewed and discussed with Mr. Verity.
Mr. Verity's only caveat was that you would have to demonstrate that the 1 S right-of-way that runs along the
southerly and easterly boundaries of the property prescribes only pedestrian access and not vehicular access, as the.
latter case would force both the southerly and easterly yards to be treated as front yards. Based on the legal
documentsprovided by David Olsen, Esq., this 15' right-of--way indeed prescribes only pedestrian access. And
because the right-of--way prescribes only pedestrian access, the required sido-yard setback to the poolmay be drawn
finm the easterly property line rather than Snm the interior boundary of the right-0f--way, the latter of which would
be the case for a vehicular right-of--way.
Therefore, it is my belief and understanding that the pool as proposed complies with all zoning regulations so that
when you apply for your Building Permit, you should be able 10 obtain your approval without requiring relief from
the Board of Zoning Appeals. If you wish, you may provide a copy of this letter with your application so that the
plans examiner is aware of my conversation with Mr. Verity and can verify the accuracy of the above with him.
Sin ly yours,
Ro E: Hemnann
Coastal Management Specialist
STATE OF NEW YORK
WORKERS' COMPENSATION BOARD
CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW
PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier.
1a. Legal Name and Address of Insured (Use street address only) 1b. Business Telephone Number of Insured
(631 } 244-0073
IMPERIAL GUNI7E, INC. 1c. NYS Unemployment Insurance Employer Rrgistration
Number of Insured
81 COMMERCIALAVENUE z5-oas2z
OAKDALE, NY 11769 1d. Federal Employer Identification Number of Insured or
Social Security Number
11-2788167
2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier
Coverage (Entity Being Listed as the Certificate Holder) STANDARD SECURfTY LIFE INS. CO., OF NEW YORK
TOWN OF SOUTHHOLD
BUILDING DEPARTMENT 3b. Policy Number of entity listed in box "1a":
TOWN HALL E6336D-000
SOUTHHOLD NY 11971 3c. Policy affective period:
06/01/1999 to 07/17/2012
4. Policy covers:
a. ~ All of the employer's employees eligible under the New York Disability Benefits Law
b. ~ Only the following class or classes of the employer's employees:
Under penalty of perjury, I cenify that I am an authorized repress five or licensed agent of t insurance carrier referenced above
and that the named insured ha6 NYS Disability Benefits insuran cov rake as ribed a ~
Date Signed 07!19/2011 By
' (Signature el insurenrs ra iafs euttwdzed re senteave or YS Licensed InsurencaAgent of that Insurance Carrier)
Telephone Number (212) 355.4141 Title SUPERVISOR-DBL/POLICY SERVICES
IMPORTANT: If boz "4a- u checked, and this form le elgned by the Insurance ashler S authorized representative or NVS Licensed IneuranceAgent bthat
carrier, Mia certificate is COMPLETE. MaII it directly to the cerMiWte holder.
I/ Dox "4D'rs Chalked, this certificate la NOT COMPLETE for purposes W section 220, Subd. 9 of Ue Disadlity 8anefts law. It must be mailed 4or
mmWetron to the Wwkars' Compensation Beard, Da Plans Acceptance Unit, 20 Park Street, Albany, New Vark 12207.
PART 2. To be completed by NYS Workers' Compensation Board (only if box "4b" of Part 1 has been checked)
State Of New York
Workers' Compensation Board
According to information maintained by the NYS Workers' Compensation eoam, the above-named employer has complied with the NYS
Disability Benefits Law with respect to ell of his/her employees.
Date Signed gy
(Signature o} NYS riUrkers' Gompensativn 0vartl Employee)
Telephone Number Title
Please Note: Only insurance carriers licensed to write NYS dlsahllily benefits insurance policies and NVS Ilcensetl insurance agents of those
carriers are authorized to issue form DB-120.1. Insurance hrokers are NOT authorized fo issue this form.
DB-120.1 (5-06)
STATE OF NEW XORK
WORKERS' COMPENSATION BOAIZD
CERTIFICATE OF NYS WORKERS' COMPENSATION INSTJRANCE CO'V'ERAGE
la. Legal Name & address of Insured (Use street address only) 1 b. Business Telephone Number of Insnred
Imperial Gunite, Inc. 631-244-0073
81 Commercial Avenue
Oakdale, Tl1' 11769 lc. NYS Unemployment Insurance Employer Registration
Number of Inswed
Work Location oflnsured(Onlyreguiredifcoverageisspecfically 25008221
limited ro certain locations in New York State, i. e., a Wrap-Up Id, Federal Employer Identification Number of Insured or
Po!lcyJ Social Security Number
1i-2788167
2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier
Coverage (Entity Being Listed as the Certificate Holder) National Union Flre Ins. Co of Pittsburgh, PA
3b. Policy Number of entity listed in box "l a"
Town of Southold W0007124251
Building Dept 3c, Policy effective period
Town Hall 04/18/11 to 04/18/12
Southold, NX 11971 3d. The Proprietor, Partners or Executive Officers are
? included, (Only cheek haz i£all partners/offittra included)
® ell excluded or certain partners/officers excluded.
I
i
This cenifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers'
compensation under the New York State Workers' Compensation Law. (To use [his form, New Xork (NY) must be listed under Item 3A
on the INFORMATION PAGE of the workers' compensation Insurance policy). The Insurance Cattier or its licensed agentwill send
this Certificate of insurance to the entity listed above as the certificate holder in box " 2".
77te Insurance Carrier will also notify the above certificate holder within IO days IFa policy is canceled due to nonpayment ofpremitmts or
within 30 days IF there are reasons other than nonpayment of
premiums that cancel the policy or eliminate the insured
from[ the coverage
indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certtjlcate !s valid
for one year after this form
is approved by the insnrance carrier or us licensed agent, or until the policy expirasion date listed to bos r`3c whichever is earlier.
Please Note; Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be
named on a permit, Ifcense or contract issued by a certificate holder, the business must provide that certificate holder with a new
Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory
coverage requirements of the New York State Workers' Compensation Law.
Under penalty of perjury, I certify that 1 am an authorized representative ar licensed agent of the insurance carrier referenced
above end thst [he named insured has the coverage as depicted on this form.
1
Approved by: _ _ f U ti ~ -1~y~
(Pr~int?,name ofauthorized rc/p~rcy/cntative_o_r l~icen~sed agent of inzuegnce carrier)
Approved by: 1,~ C~~Q '1~~l~
Q 1I
(Sig/na~ture) ( oDk)
Title: C.L.`` ~ L j l
Telephone Number of authorized representative or licensed agent of insurance carrier: ~ cPl 6 - / 6 Q CJ
P/ease Noeer Only insurance carriers and their licensed agents are authorized to issue the C-105.1 form. Insurance brokers are NOT
authorized to issue tt.
C-105.2 (9-07)
u'VM', Webstate.ny.us
SURVEY OF PROPERTY
f•
~ AT ORIENT
i ' TOWN .OF SOUTHOLD
SUFFOLK .COUNTY, N. Y.
1000-27-01-04
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LAINtSNCE N/OpfIS ANO FFfO£R/LK OE a 4£CA ~ry [ ~ ~ -
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P.O. BQX 909
- 1501/IHC/D.VEN
Y 5197 ~4-a~~
i
- ~ -
J
(1)THl5DE51GNlSBASEDONADRAINAGE 36.0' /I _ DE51GN DATA
SOIL WITHLE55 THAN lO% 5/LT.
GROUNDWATER SHALL NOT EXIST WITH/N
THELIM/T50FTHEEXCAVATION.IF _ FILTEKTYI'E: GAtZTRIDGE
GROUNOWATERDOESEXISTWITHlNSIX - - NO BACKWASH REQUIRED
FEET BELOW GRADE, SPECIAL - - - _ _ _ i TURNOVER RATE --72 HR5
DEWATERING FAGILITlE5 WILL 8E I I PUMP CAPACITY--100GPM
REQUIRED. WATERD15P05ALl5LlM/TED • I FILTER RATE--88GPM/SQFT
TO THE OWNER 5 PROPERTY. I
(2)N05URCHARGEW/LL BE ALLOWED I I FILTER AREA: 300 SQFT.
WITHIN 4 FEET OF SHALLOW END AND 6 18.0' I I
FEET FROM DEEP END.
(3)THEPNEUMAT/CYAPPLIED I I ~ I i ~
CONCRETE,(GUNITE), SHALL BEA MlN/MUM I ~ eC,~
MlXOF1.•5WlTHAMAXIMUMOF3.5 I , J - - - ` L.O.A 36
GALLON5 OF POTABLE WATER PER 98 ~ W.O.A. 16'
LB50FCEMENT. I - - FREE AREA 576 sqq,,ft.
(4)REINFORCEMENTSTEELSHALLBE ~ VOLUME:? 26,OOOgals.
INTERMEDIATE GRADE BILLET STEEL WITH WATER DEPTH: 3.5' TO 8'
A M/N/MUMLAPOF308AR DIAMETER5.
(5) POOL wATERSUPPLYBYOwNERS AVERAGE DEPTH: 5.5'?
GARDENH05E, FILL 5POUTORAUTOMATIC 36'
FEEDER.
(6 PUMPGAPACITY/S TO BE5UFFlCIENT ~
Tb EMPTYPOOL /N 24 HOURS. POOL l5 TO 3.5'
BE KEPTFULL DURWGFREEZ/NG This ppool conforms to the latest
(7) OUTDOOR POOLSSHOULOBE 8' N.Y.9 and Riverhead Town safety
PROTECTED BYA FENCE, WALL OR mandates. Namely:
BU/LD/NG/NACCORDANCETO THE N. Y.S. ~1~ One "Aqua Guard's digital pool alarm
BU/LD/NGCODE. ?r-UB$O/L with in house and pool side remotes.
(8) lN5TALLATION l5 TO BE DONE IN
ACCORDANCE WITHALL FEDERAL, STATE
AND LOCAL BUILDING CODES A5 WELL A5
NSPI SUGGESTED STANDAR05()
LOCATION OFOVERHEAD WIRES TO MEET
REQUIREMENTS OFN. Y.5. BOARD OF FIRE OP7 50LAR
UNDERWRITERS i ARRAY
~F--
HORIZONTAL 5TEEL
REINFORCEMENTS HAIR AND
12" ON TER LINT TRAP
~ ~ i~l ~ 10-1/2"BEAM SKIMMER
6"9LATETILE '~I~ ~
WATERLINE
PUMP ~ r
i
IMPERIAL GUNITE ,-.1~QT,1'V~1TER TO TOP RE
INC. VER ICAL STEEL 4 RODS IN '
< OF ~ ~ HOT WATER TO DEEP RETURN5
REINFORCEMENTS, -o
OAKDALE & 12" ON CENTER < 5' ~v` eM qC
6" ON CENTER >5' ~ 4 , F
SOUTHAMPTON , z ~ n ~'1
~ + ` GUNITE DETAILS FOR:
Scale: 1" = 8'-0" _ . m
/ WHITE ~ ~ ~~P 2Jofl ~I 1 N~
f 1 a MARBLEDUST ctjgT u gg05 yOZ~- c c./
~ NEB ~ J / ~ / Y)~ll~ /c->~i'~/?
~ 5kimmer5 ~ ~ lights eturn5 ~fluto feeder -e Vacuum line ~ M~ dr~ih beep ~eater5~ ~ ~ /'/'7,42/ N'
'SITE DATA:
SCTM# 1000-23-1-6.1
TOTAL LOT AREA: 139,337 Sq. Ft. (3.19 Ac)
UPLAND LOT AREA: 43,052 Sq. Ft. (0.98 Aa)
C0~i/EJjAGE ~A[¢uJ. ATIo N S::
EXiSTInG ~.o~CO¥~I~A~E: 2,89G Sq.Ft. (6,71%)
PROPOSED LOT-COVERAGE*: 8,659 Sq.Ft. (8.B%}
*includes Proposed Swimming Pool and (2) ra/sed mason~ stoops/steps
10
SHORELINE
PROPOSED
NON-TURF BUFc'.:i~
(~,600
*See KEY MAP for entire buffer are,~
90'-7"
EXISTING
FLAG POLE
EXISTING ..'
SANITARY ..'
SYSTEM .'
TO REMAIN
LP
EXISTING OUTDOOR
SHOWEE TO BE ENCLOSED
WITH 8'X6' WOOD PANBLS
PROPOSED PERVIOUS GRAVEL
DRIVEWAY
WJTI~ STEEL EDGING
EXIST,
2ND
STORY
DECK
///
$ $3° 3p, $~
/~ EXISTING DRIVEWAY
TO BE REMOVED
,/
/
,/
DAM POND
,/
,/'~/
/
L PROPOSED FREESTANDING
STONE GARDEN WA!.'
32 LINEAR FT X 2' HT.
208 SF PROPOSED
STONE WALKWAY ON-GRADE
......... EXISTING GRADE
PROPOSED GRADE
DAM POND
EXISTING
BLUESTONE
PATIO- TO
BE REMOVED
PROPOSED
480 SF MASONRY/STONE
PATIO ON-GRADE
PROPOSED STEPPING
STONES IN GRASS
EXISTING
RELOCATED TO AVOID
WALL CONSTRUCTION
AS SHOWN
RESIDENCE
EXISTING
COVERED STOOP
TO REMAIN
PROPOSED
40 SF MASONRY
STOOP/STEPS
EXISTING BOULDERS
TO REMAIN
82 SF PROPOSED STONE
LANDING AND STEPS
ON-GRADE
PROPOSED 70 L,F,X 4'
POOL FENCE WiTH
4' SELF-CLOSING,
SELF-LATCHING GATE
4
231.??,
PATIO
.... POOL
2' WALL
.................. **NOTE: Regrading to be accomplished with ams/re material; no additional till to be trucked in.
PO.N.9. ........
..J
,/
KEY MAP
Scale 1'=100'
SECTION A --
APPROX.
LOCATION
OF EXISTING
FOOTPATH
TO REMAIN
\
\
\
PROP. CRUSHED STONE
PATH ON GRADE
SECTION A --
Well
· EQUIPMENT
TIDAL WETLANDS
AS DELINEATED BY
EN-CONSULTANTS, 8-3-I 1
BW 9,0
232 SF MASONRY~
/STONE PATIO ON GRADE
PROPOSED
18'x36'
POOL
Top of Coping = 11.25' PROP.
8'x8'
SPA
PROPOSED
18'X9'X 9' NT,
CEDAR PER~O~A
DW
PERGOLA
SECTION A
Scale 1"=10'-0"
PROPOSED
POOL
PROPOSED 106 L.F. x 4' HIGH
POOL FENCE WITH 4'
SELF-CLOSING
GATE
PROPOSED 65 LINEAR FT. X 2' I
STONE RETAINING WALL
WITH MASONRY STEPS
~ROXIMATE LOCATION OF
STONES TO REMAIN
/
/
/
/ /
/
/
/
/
PROPOSED PROJECT
LIMITING CONSTRUCTION FENCE
10' CONTOUR AS SHOWN ON
AMENDED SURVEY BY R~ VAN TUYL,
P.C JUNE 2, 1997,
LIMIT OF NYSDEC ARTICLE ')5
JURISDICTION PURSUANT TO NYSDEC
LE~ER DATED FEB. 7, 1994
FILE NO. 1-4788-00835/00001-0.
~x'x"'"~ EXISTING BOULDERS,
RELOCATED TO AVOID
WALL CONSTRUCTION
AS SHOWN
PROPOSED 159 L.F,X
6' HT. STOCKADE FENCE
PROPOSED
(,5) ACER RUBRUM
@ 3-4" CALIPER BLgG DEPT.
REVISIONS
DATE DESCRIPTION
4DD APPROX. ED~E OF EXISTIN~ LAWN. INCREASE
02.07.12 =ROPOSEDNON-TURFSUEFERAREA, ASREQUESTED
9Y SOUTHOLD TOWN TRUSTEES.
NOTES:
h Existing conditions base map as per survey prepared by
Kenneth M Woychuk, L,S. dated May 19,2011. 10' Contour and Septic System
as per survey prepared by Rodeflck Van TuyL PC, dated March 15, 1993,
2. This plan is for the purpose of obtaining permits only. Ndt for Construction.
3. All elevations as per L.A.'s own Reid measurements and are approximate.
SITE PLAN
DE LA VEGA / HIGGINS RESIDENCE
Main Road, East Madon, New Yo~k
mplo
studio
landscape architecture
I
marshal( paetzel
landscape architecture, pc
PO Box 478
12830 Main Road
Mattituck, NY 11952
ph 63~-209-2410
mall@mp[astudio.com
ale
1"=10'-0"
SP-1
SHEET '1 OF ~,
TOTAL LOT AREA: 139,337 Sq.Et. (3.19 Ac) ~ /~ / ~ AS DELINEATED BY ~-~-.J~/ / / / / / / / / ~/ / / //
UPLANDLOTAREA: 43,052 Sq.Ft. (0.98 Ac) ~ ~,~ ~ ~ ~ ~ ~ ~ ~ ~ ~ OFEXISTING / ~~ / //
~ APPR
~ ~ EXISTING ~
~ ~ BLUESTONE ~ ~
~ ' PATIO- TO~
~ ~ PROPOSED STEPPING ~ ~ ~ ( ,
: WITH 8'X6' WOOD PANELS ~ . ~. ~. .... ' ~ ~ STONES IN GRASS ~ +~ +~ ~ ~ PROPOSED 106 L,F, x 4 HIGH
/ .." .... .. I STORY ~x~ .' ', - ~ ~ ~ q ~ / ~ PROPOSED aS LINEAR FT. X2 HIGF
-- ,.' ' ' ' ' ,. I DECK ' PROPOSED '. -- X ~ / / STONE RETAINING WALL
. ." ".. , , 4 0S ASO RWSTO : / / W TH ASONRYSTEPS
~ / .~ PROPOSED PERVIOUS GRAVEL EXISTING BOULDERS, ~ ~- ~
/ ~ / .'" WITH STEEL EDGING WALL CONSTRUCTION ~ /~ ~ /~ / ~ LIMIT OF NYSDEC ARTICLE 25
/ TO REMAIN J ~ .,' j .. ~ ~ , ~ .' .......... 40 SF MASONRY x ~ PROPOSED ~ ~ ~ '
AS REQUIRED AND CONDITIONS OF
~" /,.,,'"' ~ ~ ) ~ ~ EXISTING BOULDERS ~ ~ ~ ~ ~ ' / / PROPOSED ..... ~DTOWNP~NNING~A~D
~ 3-4" CALIPER ~ ~DTOWN TRUSTEES
." PROP CRUSHED STONE
~ ( ~ ~82SFPROPOSEDSTONE ~ . = ~ 9'~' ~ /~' --~ ............. ~ N.YS. DEC
ANDiN~~-~T~"- ~ PATH ONGRADE : ~ ~z DW ',~ /W / REViSiONS
/ ~ ./ ~ 32 LINEAR ~ X 2' HT, / SECTION A ~ ~~/~ ~/~ ' ADD APPROX, EDGE OF ~I~TING
/ ~0 ~.~, ~ PROPOSED 70 L.F.X 4' HIGH ~ / ,' ~% , 02.07A2
' / ~a~3~'80"~, ~ ' POOL FENCE WITH ~ ...... ~ / ]YSOUTHOLDTOWNTRUSTEE&
~ 4 SELF CLOSING,
/ ~ SELF-LATCHING GATE ~-- ~ ~ PROPOSED /
/ POO: '
~ ~ h ~lsting conditions base m~p as per survey prepared by
Kenneth M Woychuk, L.S. dated May 19, 2011. 10' Contour and Septic System
// ~.~ / as per su~ey prepared by Roderick Van Tuy,, PC, dated March 15, 1993.
// MM*'~ ~ /W : / 2. This plan ,s for,he purpose of obtaining permits only. Not for Construction.
" ~ ~ ~ ~ ~ 3. All elevations as per LA.'s own field measurements and are approximate.
marshall paetzel
a architecture, pc
., ......... EXISTING GRADE 4' FENCE, / ~8~ &~,~ ~ ® ~ ~ . e
('~ CEDAR POOL GATE DETAIL
WIRE MESH POOL FENCE
___,___
DE LA VEGA / HIGGINS ~ESIDENCE
6' STOC~DE FENCE DETAIL
' ~ sectlonSOLID CEDAR ~o,~o Sc,lc O LILY POND - FOUNTAIN DETAIL ~ga m,rsha,I paetzel
I~ndscdpe ~rchi~ecfure, pc
IO
12830 Main Road
Mattduck, NY 11952
landscape architecture ph 631-209-2410
mall@mplastudlo.com
, Scale as noted