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HomeMy WebLinkAbout37908-Z"' ''• Town of Southold Annex ~,~ P.O. Box 1179 54375 Main Road '~ ~ ail Southold, New York 11971 •~~1 ~ .F,D~i~t'. ~,: No: CERTIFICATE OF OCCUPANCY ~Fan2 Date: THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1700 Park Ave, Mattituck, SCTM #: 473889 Sec/Block/Lot: 123.-8-5 7/16/2013 7/16/2013 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this ofliced dated 3/22/2013 pursuant to which Building Permit No. 37908 dated 4/4/2013 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: Addition to an existing accessory building as applied for per ZBA approval. The certificate is issued to of the aforesaid building. Kabakov, Emilia & Kabakog Ilya (OWNER) SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED A o zed igna re TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,NY 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 #: 37908 Permission is hereby granted to Date: 4/4/2013 Kabakov, Emilia _& Kabakov, IIYa _ _ 1700 Park Ave Mattituck, NY 11952 To: Addition to an existin accesso buildin as a lied for er ZBA a 9 rY 9 PP p pproval. At premises located at: 1700 Park Ave, Mattituck SCTM # 473889.. _ Sec/Block/Lot # 123.-8-5 Pursuant to application dated 3/22/2013 and approved by the Building Inspector. To expire on 10/4/2014. Fees: ALTERATION OF ACCESSORY BUILDINGS CO -ACCESSORY BUILDING $385.60 $50.00 $435.60 Form No. 6 `-' / ~ ~Q TOWN OE SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be 51ted 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 Phan 2110 of 1% lead. . S. Commercial building, iadustrial building, mtiltip[e residences and similar buildings and installations, a certificate of Code Compliance'from azchitect or engineer responsible for the building- 6. Submit Planning Board Approval of completed site p#an requirements. B. For existing buildings (prior to Apri19, 1957) rion-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 1. 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 Dale. !' - tf - J 3 New Construction: Old or Pre-existing Building: (check one) Location of Property: _~lJ ~) ~(~~ y.( ~[,'~ 1~ Cc .{>< i ~ y ~JG House No. Street Hamlet Owner or Owners of Property: E-f _~ ~{},g}l,~rj ~/ Suffolk County Tax Map No 1000, Section ~ ~ 7, Block . R Lot 5 Subdivision Filed Map. Lot: Permit No. ~ ~7 g' O ~ Date of Permit. y `~ ~ / _3 Applicant: /~ .~ Cl•/ u~ l~,e]" 7 . Health Dept. Approval: Underwriter's Approval: Planning Board Approval: Request for. Temporary Certificate Final Certificate: (check one) Fee Submilted_ $ ~ Q_, ~~ ~~~j6.~ pplicanl Signature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 ~o~a,,.. _,~ CO~~@ ~o O~ °a~l ~ ~~~ Telephone (631) 765-1802 Fax (631)765-9502 roper. richertCv7town.southold. nv. us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Kabakov Address: 1700 Park Ave City: Mattituck St: NY Zip: 11952 Building Permit #: 37908 Section: 123 Block: 8 Lot: 5 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE contractor: SBA: Lademann Electric Inc License No: 4141-e SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor 1st Floor X Pod New Renovation X 2nd Floor X Hot Tub Addkion Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt i6 Ceiling Fixtures HID FiMUres Service 3 ph Hot W ater GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture 6 Pumps Transformer Appliances Dryer Recpt Emergency Fixtures Time Clacks Disconnect Switches 6 Twist Lock Exit Fixtures TVSS other Eguipment: 33 ft Of Ilghting track Notes: Inspector Signature: ~„` Date: July 10 2013 Electrical Cert~cate.xls 37gp~~ o~~,oe soury~ f®# ~~~~ TOWN OF SOUTNOLD BUILDING DEPT. 765.1802 1 NSPECTION [ ]FOUNDATION 1ST [ [ ] F NDATION 2ND [ [ FRAMING /STRAPPING [ [ ]FIREPLACE & CHIMNEY [ [ ]FIRE RESISTANT CONSTRUCTION [ [ ]ELECTRICAL (ROUGH) [ ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION ] ELEC(FINAL) REMARKS: ~ DATE ~ ~`3 INSPECTOR ~Pv ~9 TOWN OF SOUTNOLD BUILDING DEPT. ~~ ~~ 765.1802 ~~°` INSPECTION [ ]FOUNDATION i ST [ ] ROUGN PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ] FRAMING I STRAPPING [ ]FINAL [ ]FIREPLACE 8~ CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [~C] ELECTRICAL (ROUGN) [ ]ELECTRICAL (FINALI 'RE`MARKS: DATE ~ ~ INSPECTOR ~} ~ ~ ~o~.~,OF SO//~yo6 "/ / #®'F ~~~~.~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ]FOUNDATION 1ST [ ] R GH PLBG. [ ]FOUNDATION 2ND [ INSULATION [ ]FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL) REMARKS: /'~ - 3 ©~~ ~~ DATE ~ ~ a/3 INSPECTOR v~ o~~~ souyO6 ~° "`~~~ ~ ~~ ~~ TOWN OF SOUTNOLD BUILDING DEPT. 765.1802 1 NSPECTION [ ]FOUNDATION 1ST ( ]FOUNDATION 2ND [ ]FRAMING /STRAPPING [ ]FIREPLACE & CHIMNEY [ ]ROUGH PLBG. [ ]INSULATION [ ]FINAL [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) ~ ELECTRICAL (FINAL) REMARKS: ~i ~y~ 1~- - G C~ DATE ~/ / U ~i INSPECTOR ~ ~7V ~ o~~,OF soayO6 f ®# ~~~~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 1 NSPECTION [ ]FOUNDATION 1ST [ ] R GH PLBG. [ ]FOUNDATION 2ND [ INSULATION [ ]FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL) REMARKS: DATE ~~ ~~3 INSPECTOR ` .~ ~-- 3?~0~~- TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 1 NSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING /STRAPPING FIREPLACE & CHIMNEY FIRE RESISTANT CONSTRUCTION ELECTRICAL (ROUGH) [ ]ROUGH PLBG. [ ]INS ION [ INAL [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (FINAL) DATE INSPECTOR F1HLD N REPORT DATE COMMENTS .. ~ro FOUNDATION 1ST ( ) O xc FOUNDATION (2ND ~ y G ~ ) ' z o ~. ~/ ~ n y ~~ ROUGH FRAMING & PLUMBING ~ y ~ , c m INSULATION PER PI. I'. STATE ENBRGY CODE ~, H . FINAL , ADDITIONAL COMMENTS l.vi ~ 3 u-cfC- L - Dt < C m ~ ~ /e 0 ~°z ~~ d TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Board of Health 4 sets of Building Plans Planning Board approval Do you have or need the following, before applying? Survey Septic Form N.Y.S.D.E.C Examined ,20 C.O. Application Flood Permit Single & Separate Storm-Water Assessment Porm ~p Disapproved a/c Expiration . ~0 Contact: ,/~ Mail to: /"[•q~~' C~fta/h~rZ. Phone: ~~y- ~~j _ Buildin~~ Inspector APPLICATION FOR BUILDING PERMIT Date ~~ Z , ~0 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with d 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 zbning,amepdments 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 HERF,BY MADE to the Building Deparhnent 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 demolitiat as herein described. The applicant agrees to comply with all applicable laws, ordinances. building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name, if a corporation) (Mailing address of applicant) Statc whether applicant is owner, lessee, ages t, architect. tgineer. general contractor, electrician, plumber or builder Name of owner of premises ,~ 1„ yam' ~ ~M ,EL/ ~ ~-'~'f3'~'~ (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. Plutnbers License No. _ Electricians License No. Other Trade's License N 1. Location of land on which ro osed work will be done: 17 ao P~K ~~ House Number Street County Tax Map No. 1000 Section ~ Z~ Block ~ CP~ Lot O BOARD MEMBERS Leslie Kanes Weisman, Chairperson James Dinizio, Jr. Gerard P. Goehringer George Homing Ken Schneider ,~~OF SOUTyo~ J ~~ • O i ~~OOUNIY,N~ Southold Town Hall 53095 Main Road • P.O. Box l 179 Southold, NY 11971-0959 Office Location: Town Annex /First Floor, Capital One Bank 54375 Main Road (a[ Youngs Avenue) Southold, NY 11971 http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 • Fax (631) 765-9064 FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF DECEMBER 6, 2012 ZBA FILE: 6602 NAME OF APPLICANT: Emilia and Ilya Kabakov SCTM#1000-123-8-5 PROPERTY LOCATION: 1700 Park Avenue (adj. to Great Peconic Bay) Mattituck, NY SEORA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further steps under SEQRA. SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk County Administrative Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its reply dated October 23, 2012 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community impact. LWRP DETERMINATION: This application was referred for review under Chapter 268, Waterfront Consistency review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standazds. The LWRP Coordinator issued a recommendation dated October I5, 20t2. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to us, it is our recommendation that the proposed action is EXEMPT from Coastal Consistency Review. PROPERTY FACTS/DESCRIPTION The applicant's property consists of a total land area of 102,812 square feet, of which 100,854 sq. ft. is buildable land, with 162.50 feet along Park Avenue, 640.61 feet along the westerly side property line, 154.71 feet along the Great Peconic Bay and 638.80 feet along the eastern property line. The property is improved with two wooden bulkhead structures along the shoreline of Great Peconic Bay and improved with a 3,803 square foot single-family dwelling and 602 square foot deck, plus two detached buildings totaling 6,762 sq. ft. The architect's site plan dated September 19, 2012 was taken from the survey prepared by Nathan Taft Corwin, LLS dated 12/14/2011. BASIS OF APPLICATION: Request for Variances from Article III Section 280-15(B & C) and the Building Inspector's September 24, 2012 Notice of Disapproval based on an application for building permit to construct an addition to an existing accessory building at: 1) more than the code permitted maximum height of 22 feet, 2) more than the code permitted square footage of3% maximum. RELIEF REQUESTED: The applicant requests variances to construct a small two story addition to an existing accessory building at a height of 25.33 feet where the code permits a maximum height of 22 feet and for total square footage afrer construction of 4496 sq. fr. where the code permits a maximum square footage not to exceed 3% which would allow for total square footage of 3362 square foot. Subdivision G 2. State existing use and occupancy of premises and intended use and a. Existing use and occupancy _ A ((i~f/Q/Z!~ /~ b. Intended use and occupancy Lot of proposed construction: w/ P®eaP. Z.~.b FL , 3. Nature of work (check which applicable): New Building Addition Repair Removal Demolition Other Work 4. Estimated Cost 5. If dwelling, number of dwelling uni If garage, number of cars 6. 7 8 9 If business, commerciael or m~pixed occupancy. specify nature and extent of each type of use. S~i li ! ~- Dimensions of existing struchu~es, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Dimensions of entire new construction: Front Rear Depth Height Number of Stories S~ ,E Sr ~ JoG~J Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated ~ g' D 12. Does proposed construction violate any zoning law, ordinance or regulation? YES / NO 13. Will lot be re-graded? YES NO `~ Will excess fill be removed from premises? YES / NO 14. Names of Owner of premises~~~¢~GO /~ Address Phone No. 2~~ ' GS3 0 Name of Architect ~G l~l'tn./f~'~% Z Address Phone No_ _ 73~ " ¢/ ~f Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUS"1 EES & D.G.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. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? *YES NO~ * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OFh~C~, ___ ~s~/e.~j G /wi/ie,~ Z being duly sworn. deposes and says that (s)he is the applicant (Name of individual signing contract) above named, CONNIE D. BUNCH ,7/~yJ ~-~ /~ ~~y ~-- Notay Pubii ~ a of NOw YoAc i'~b'~W~7G YOLfC// Ni ~` 54G0 (S)He is the n, - ,v i_ ;;mom _-- (Contractor, Agent, Corporate Offi er, etc.) Comm?s:r-,~~~ ~~~= of said owner or owners, and is duly authorized to perform or have performed the said work and to make and the this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to efore me this day of 20/~ Notary Public Filed Map No. I ce Iteration (Description) ("Fo be paid on tiling this application) Number of dwelling units ou each door Page 2 or 3 -December G, 2012 ZBA Fileghh02 - Kabakov CT)vl: 1000-123-8-5 AMENDED APPLICATION: During the hearing, the applicant was asked to bring the plan into more conformity with the code. The applicant on November l5, 2012 submitted revised plans indicating no increase on the first floor; the total increased square footage of the proposed second story and reduced the proposed ridge on the second story from 25.33 ft. to a conforming 22 feet. ADDITIONAL INFORMATION: On December 6, 2007, the applicant received a variance under Board File #6091, on this same accessory structure to maintain the height of 25.33 feet and for total square footage of 4174 sq. ft. However, the decision did deny any expansion of this large building to the north. The applicant at that time constructed a new detached storage building sometime after this variance was denied. At the hearing on Nov. 1, 2012 the applicant's agent was asked to define the proposed ridge height, and the proposed square footage to be added to the existing storage azea. In a letter dated November 13, 2012, the architect submitted an amended plan with a proposed conforming ridge height of 22 feet which was a reduction from the 25.33 feet as applied for. He also indicated in the amended plan a second floor addition at 35.4 feet by 21.1 feet or 746.94sq. ft. and eliminated ' the first floor addition to the plan as originally applied for. At the public hearing the adjacent neighbor made no objection to the proposed additions but voiced concern about the possible impacts to shared power lines that would be caused by increasing the existing 22 foot high ridge to a proposed 25.33 feet. FINDINGS OF FACT/ REASONS FOR BOARD ACTION: The Zoning Board of Appeals held a public hearing on this application on November 1, 2012 at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property and surrounding neighborhood, and other evidence, the Zoning Board finds the following facts to be true and relevant and makes the following Endings: 1. Town Law &267-b(3)(b)(1). Grant of the alternative relief will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The entire area of Park Ave. is residential on both the north and southeasterly side. The applicant has a very large lot with two existing free standing storage buildings totaling approximately 6762 sq. fr. Both structures are in the code conforming front yard of this waterfront property and are not visible from the road because of their substantial setbacks. The new alternate plan simply proposes to square off the existing second story, and eliminates the need for a height variance by lowering the proposed ridge to a conforming height. 2. Town Law &267-b(3)(b)(2). The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance. The applicant is requesting to add square footage to an existing storage building that is already non-conforming in size. 3. Town Law &267-b(3)(b)(.3). The variance granted herein is mathematically substantial because the existing storage building already exceeds [he total square footage of 3% of total lot area per single accessory structure permitted by code. However the proposed second story addition of 746.94.sq. ft. will no[ increase the existing lot coverage, and is far less intrusive on the subject property than the construction of another large accessory storage structure which the applicant could build as of right. 4. Town Law &267-b(3)(b)(4) Although no evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood, at the hearing the immediate adjacent neighbors were concerned with possible impacts to the power lines that stretch over the existing storage building to their property. However, since the proposed ridge height as amended has been lowered to conform to the existing 22 feet, no alteration to the lines will be necessary. The applicant must comply with Chapter 236 of the Town's drainage code. 5. Town Law 5267-b(3)(b)(5). The difficulty has been self-created. The structure was originally built without the benefit of permits and was granted substantial variance relief in the prior decision. The applicant purchased the parcel after the Zoning Code was in effect and it is presumed that the applicant had actual or constructive Page 3 of 3 -December 6, 2012 28A FilepA602 - Kabakov GfNi: 1000-123-5-5 knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase. 6. Town Law 6267-b. Grant of the requested alternative relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of additional space on the second story of their existing storage building while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law .267-B, motion was offered by Member Goehringer, seconded by Member Weisman (Chairperson), and duly carried, to Grant the altemative relief requested, as shown on the. architectural plans prepared by Mark K. Schwartz, Architect dated November 13, 2012 pages A-1 and A-2, subject to the following condition: 1. The accessory building shall be used for storage only, no sleeping or cooking facilities permitted Any deviation from the survey, site plan and/or architectural drawings cited in this decision will result in delays and/or a possible denial by the Building Department of a building permit, and may require a new application and public hearing before the Zoning Board of Appeals. Any deviation from the variance(s) granted herein as shown on the architectural drawings, site plan and/or survey cited above, such as alterations, extensions, or demolitions, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. . Vote of the Board: Ayes: Members Weisman (Chairperson), Goehringer, Dinizio. Schneider. Absent was Member Horning. This Resolution was duly adapted (4-OJ. ~~~~-._ Leslie Kanes Weisman, Chairperson Approved for filing /~ / ~~ /2012 / / ~'@~ Town of Southold -Chapter 236 - Stormwater Management ~ ~p'~ SWPPP -Storm Water Pollution Prevention Plan Assessment Form GF.IVF.R AT. INFORMATION: (All Requested In formation is Required for a Complete A plication) MPI.N:MIT NINE: pmK-Aa.nt•COnsJhnl-Congcbr or 0lba [CkcM Om) f . L P OWNER: pf gRM~pI Mw MKttl.+Ml ~ c~ q C .~ v c ~ ~ o ~i Tobplpno ~ r Fe M: 6 roMPb°n.R `i IO Faxk By /,:~c Pnvn4Ad8.w: dt:onWOCitoa ~~• Aopoetd SElact®1 BLPr, Sal 6.C.T.M.l, 1000 O bafiadoe BMp t. ProjeUSaope aodror Srytww~oe of Caoatrnation Activity p.Ytl aleY W IPirW AOebW Papr rNrro) Ntmea haetor wdQr Caba /.non Rapen.0:b Pbmx~bamaaWPPP: ~LLLC _![~•d~~~~.._~'V ~~IC.Af ____ ROO nbenar.r: FnPo ~t__~4iG O__ME r/__~.v~- NteraPrwn. tteaFOnsleb rrb.tw.eb.awbb~raaaPmelr, eoaeml Praatlcs: _r~~v12L,,~.---r~l~ -------- rxvpwo. s; Pvk ~~j _LN_~Y_"`L_;_---~~'-~ wCl.~.-s _____'__ E- NI: Q~ ~~~ vN0 --~ - y'~ --- -------~ -------F-~-' ~ \ Tao nroe ant Pn:Jaa Prat: Z.3G AW Taw ~r..at,aa Cbeane _~ maornrwm0isn,aana: O. s S N / ------ ^y~-- --------------------------"-- ---- ps.iA~ Rs.:by ______________ -- --------------------- Pm}a Oaneon: Sbrt Erd _.___________________ q.nrrar.r.agq __________________________.___ WlN thk Pmfect D4ltabe llre pq or Mae Aces at 0 `-_---..--_.._.._.._.____.--_- AtryOneTimeDurirgitte Propttsed Devalopment7 Yes No -'--'---- 9YECPins Anav~rtln FalbMrpl _____._____ a. Does ifte Applkant haves OueROetl Mrepeda On Q Q __,___________________ '-`---'------ SIaR To Conduct tha RequYed htepeabns 7 Yas No b. DoM Ote SWPPP Indcate Fltra FrequenSy the Silo O O WtM•NMtEe adnattWOnaM Pobabpr taWebdW.b~bodir ra'orWethntlc Inspeetlons wR Otxur and for Whet Pedod of Tkne 7 Yes No a Doss Rte SWPPP Adequately tdaMRyAM Temporary ~ ~ -------------------'------------------._..__ arM/or PerlnentmtSal Stabaaaatbn Measures? Yw No "-'-"----'---"-------'---'--..___.__..._..... d. Does the SWPPP Adegtatey ldensYya CompieEe O __...___..._.__......,_-_--..._..___... __._. _._...___,_. P1O1°f•1 8 F~ 7 Yes N o e. Does Me SWPPP Indicate Addltlanal 5lta Spedfic Q 0 Sbb. a tmFaa.a watmeey: (w• TtnN, sos[m t.bba,-nvtra~ Praalceg Mat WM Da UNtrod M Praea Water (]usury 7 Yea No f. F1as Ote AppNeant SUbmldedaCOmpletetl DEC Notlce __..._..._____._____.___.___ . OF intata and SWPPP Axeptatrs Fam for Review O ~ Tt'P' a bpeaed Wmrlwdp, (rp.lako, rt..e, e.y, Paed, aeund, Fra.nwtr,Nys.M,.,i by tla Town of SouMdd 7 Yes No S7'A7F OF NFW YORK, ' //// BONN ~ fJ BUP!CH CO 'Y OF.. r~~!~~~1~- SS .. ...... Nota F'uhii ~`[~.:wYOtk a ~ !// I ~ '7 ~ No. t 7 .~r.i, ainaMSrl agallq Doo.IrNj "'- -/ 1O8 my swam, deposes and uys tlfa~Jtnfahe;u the apdHc4xtilt>~erHq And thathyshe is dte Cor:R~r.~ . - 1 1 0 ~ ro~ t~+acto . na.a.Z~rpu.roiit"t:,"aej ". Owner arNl/or representative of the Owner or Owners, and is duly authorized W perform or have performed the raid work and to make and file this application; that all statrnrents conheincd in this application are tme to the best of his knowledge and belief and ; that the work will be tfotmed in the manner set forth in the apphcation filed herewith, Swo e this ~ ~ ; ~ /~ ~ , ........ _ .................... ..._....... day of ...........---• ~ ! 1 "'"4 ~~.._ .. Notary 1'dblic:........1~~......~.~.~ ,;~il~~.~........... 1tNPPP e«piSntPn4 FARM. fILi9 [ t Town xau aup: 54875 Mam Road - P.O. Box 1179 - Southold, NSf 11971-0959 o~D-~ Tdgihone (68U 765.1864 roger ridlert(c~"ov~m~aatl~o~ nV US BUILDING DEd'ARZ'hiF,NT TOWNI OF SOVFHOILD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Date: Company Name: _~ ~ .C C Name: ~ ti Lit~nse No.: ~- Addcess: ~ Phone No.: ~r o JOBSITE INFORMATION: (*Indicates required information} *Name: `Address: *Cross Street; *Phone No.: Penn# Na.: Tax~Map District: "BRIEF DESCRIPTION OF WORK (Please Print Clearly) "' ~ F (Please Circle AN That Apply} 'Is job ready for inspection: 4bo you need a Temp Certificate: J. NO Rough In YES !~ Final Temp Information (ff needed} *SeMce Size: 1 Phase 3Phase 100 150 200 300 X50 400 Other '~NeW Setvlce: Re-cenneot Underground Numi~er of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION -1 ~G i~~ - 82-Request for inspection Fonn ~~ I I