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HomeMy WebLinkAbout39259-Z Town of Southold Annex 12/8/2014 P.O.Box 1179 54375 Main Road 'v ¢ Southold,New York 11971 K CERTIFICATE OF OCCUPANCY No: 37313 Date: 12/8/2014 THIS CERTIFIES that the building ALTERATION Location of Property: 1120 Broadwaters Rd, Cutchogue, SCTM#: 473889 Sec/Block/Lot: 104.-9-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/19/2014 pursuant to which Building Permit No. 39259 dated 10/8/2014 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: FOUNDATION REPAIR TO AN EXISTING ONE-FAMILY DWELLING AS APPLIED FOR The certificate is issued to MacGregor,William (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Autho ' Signatur TOWN OF SOUTHOLD ( � BUILDING DEPARTMENT TOWN CLERK'S OFFICE 'e SOUTHOLD, NY bbl '>rr:rc:rrft' 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#: 39259 Date: 10/8/2014 Permission is hereby granted to: MacGregor, William 1 S Astor St Apt 402 Irvingtown, NY 10533 To: Alterations to an existing single family dwelling (foundation work) as applied for with flood permit. At premises located at: 1120 Broadwaters Rd, Cutchogue SCTM # 473889 Sec/Block/Lot# 104.-9-2 Pursuant to application dated 9/19/2014 and approved by the Building Inspector. To expire on 4/8/2016. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00 Flood Permit $100.00 CO -ALTERATION TO DWELLING $50.00 $350.00 C Buildi (cpe' -- 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 naturat 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 2110 of 1% lead. . 5. Commercial building,industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance-from architect or engineer responsible for.the building, 6. Submit Planning Board Approval of completed site plan requirements. 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 property eQmpleted 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 Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: CLd Cu� (�V 4 .� House No. Street Ilamlet Owner or Owners of Property: O A- Suffolk County Tax Map No 1000, Sectionloq Block 047 Lot G SubdivisionP'0 tyuw(ell 2exf4 Filed Map. SSP Lot: a s �-- Permit No. Date of Permit. Applicant: 1J tJl lel m e �► 1I�C Fyr� j u Health Dept.Approval: IJ �' Underwriters Approval:Q l 1-' Planning Board Approval: N3 I�- Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 2P S Applicant Signature I i oF so�ryo� i ia_ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 -�4NSPECTION [ FOUNDATION IST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: C � DATE `� t INSPECTOR i TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] F NDATION 1 ST [ ] ROUGH PLUMBING [,,,FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION),,. [ ] CAU LKIN REMARKS: DATE 1 INSPECTOR * "F TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ) ROUGH PLUMBING ( ] FOUNDATION 2ND [ ] 1 LATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ) FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION ( ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: �� �- �• DATE ��' INSPECTOR ` FIELD IbWZ QN WORT DATE CONZWMS FOUNDATION(IST) r- CA FOUNDATION(ZND) �. --- z _ 0 BOUGH FRAAMQ& PLUMBING rte' H Y. INSULATION PER N.Y. � y STATE ENERGY CODE • y FINAL ADOMMWC • C'v tv 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 www.northfork.net/Southoldl PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees Examined ,20 Contact: Approved ,20 Mail to: Disapproved a/c Phone: Expiration ,20 s e for ICATION FOR BUILDING PERMIT - !� SEP 18 2014 Date �//8 ��/ 520 INSTRUCTIONS a. TLS T6-e completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months.Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances,building code, housing code,and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. till (Signature of plicant or name,if a corporation) T� � �R^7 Peror�►L �Jy (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder G, eX�s e_x_ -f C b 0 Q �; Name of owner of premises Lv t tn `�'( xe (As on the tax rol or latest deed) If applicant is a corporation, signature of duly authorized officer C 1•IULRot� Yr tF0T C Vz r _`I-P Q_ (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 proposed work will be d : L 1 a6 'R cc dWaAAA �o e� c(4-*C-ti0u4V House Number Street Hamlet County Tax Map No. 1000 Secft 1 p � Block d Lot © `a• Subdivisio IA-SCAu Ph,�� 294Geti-1e% Filed Map No yneu-bed t Ste-, (Name) L F= CSS 4 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 1iJ 1C'►a hi t (� , ( � r • b. Intended use and occupancaT e hi I �� �cyeJ i q--h Go c,o3 A-'-(u�- 3. Nature of work(check which applicable): New Building Addition Alteration J� Repair Removal Demolition Other Work _ (Description) 4. Estimated Cost OC9C-, Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 1 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front S g L L� ---Rear--3,--Q f Depth Height V l V-- Number of Stories Dimensions of same structure with alterations or additions: Front �U Rear Depth Height Number of Stories 1 I* ,. r ..... 8. Dimensions of entire new construction: Front h� 1�14t Depth 'Y A' 14 Height Number of Stories 9. Size of lot: Front 3 Rear I LT. -_7Y Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated P,-e �,. t j t + t 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 AC 14. Names of Owner of premisesW i l l►r-K m�rRPge2Address 1 1,00 j�toacA6o 1, -Phone No. Name of Architect Address C0'°S"�- Phone No Name of ContractoreNU 10 0A rte& ZW AddressPo ao K i4 , , ,� crl Phone No.(o3J 7 S V 7 y 7L/ 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES 1/ 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 O(Od * 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. STATE OF NEW YORK) SS: COUNTY OF ) being duly sworn, deposes and says that(s)he is the 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 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. Swonl to before me thi day of 20 Notary Public CONNlE D. BUNCHSignature of Applicant Notary Public, State of New York No.01 BU618505o Qualified in Suffolk County �' Commission Expires Agri! 14,�1 tp Ji11 M.Doherty,President so Town Hall Annex Bob Ghosio,Jr.,Vice-President O 54375 Main Road P.O.Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen G Q John Bredemeer Telephone(631)765-1892 �. U01�� Pax(631)765-6641 y 1 f BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 9, 2011 Ms. Nancy Dwyer Nancy Dwyer Design Consulting, Inc. P.O. Box 632 Southold, NY 11971 RE: LYNN &JOE SFERRAZZA 1120 BROADWATERS RD., CUTCHOGUE SCTM#1049-2 Dear Ms. Dwyer. The Board of Trustees reviewed the survey prepared by John T. Metzger last dated March 2, 2011 and plans prepared by Nancy Dwyer dated April 29, 201 land determined the reconstruction of the existing deck to be out of the Wetland jurisdiction under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code. Therefore, in accordance with the current Wetlands Code(Chapter 275)and the Coastal Erosion Hazard Area(Chapter 111)no permit Is required. Please be advised, however,that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal and/or freshwater wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, or within 100'landward from the top of the bluff and/or wetlands jurisdictional boundary,without further authorization from the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary best management practices are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area,which may result from your project. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Since ly, PA Jill Doherty, President Board of Trustees JMD:Ims Scott A. Russell a°� � STOIKAWWA\T]EIK SUPERVISOR MANAGEMENT GEMEN T SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 119710 . Town of So u th o l d CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: Yes No (CHECK ALL THAT APPLY) ElA. Clearing, grubbing, grading or stripping of land which affects more han 5,000 square feet of ground surface. E]o B. Excavation or filling involving more than 200 cubic yards of material "ithin any parcel or any contiguous area. slopesF16'C Site preparation on which exceed 10 feet vertical rise to 10 feet of horizontal distance. ❑ Site preparation within 100 feet of wetlands, beach, bluff or coastal �/ ""erosion hazard area. ❑L� E. Site preparation within the one-hundred-year f loodplain as depicted X FIRM Map of any watercourse. ❑ Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT: (Property Owner,Design Professional,Agent ont ct they) S.C.T.M. #: 1000 Date: District NAME: Section Block Lot 1&gneNrc :R:F:tx #.#:iX ^'� FOR rivll._1:)1Nnw �. :i: t:>�1...Y . Contact Information: ���� ( ��� rri.•vi„�r Nwntxr7 Reviewed By: Date: _n f L Property Address / Location of Construction Work: — — — — — — — — — — — — — — — — ( ' C-0n �� r Approved for processing Building Permit. c,.,t �c�A Stormwater Management Control Plan Not Required. / — — — — — — — — — — — — — — — — C�-+ j ❑ Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review.) FORM SMCP-TOS MAY 2014 � w TOWN OF SOUTHOLD PROPERTY RECORD CARP � 3 M AVIC OWNER STREET �� VILLAGE DIST. SUB. LOT' ,. _ . me` . C G � t-D S d ► fl fJ c+ /C,r1(! v +e c S�'d t► 6 J„ ?CIR ERAyNER .ZZGt T ! �U�S N E - Vl f.t'7-GtZ.l,�. �. W TYPE OF BUILDING 14&- & 7 SEAS. VL: FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS 2 y46 13 d 0 4 '' /�! ,� r -� �s fir• Al 9 141" �2 �2, 7 ac, L--r-s36koo, - 2 zoo 4 300 (.Too z Cn Q `3 l to,rtxrl' '�i'G' C�C7X,,BUI L 6DINGDITIO i;t11; 9!0 — - cor754 '1 NEW NORMAL BELOW ABOVE r f'A li�k 2g FARM Acre Value Per Value ..I�Sfh Gtr" ►y�.,. 7hif Acre ! d '" ~�c5 $!5rrdfaA - Tillable 1 (� a Tillable 2 /6 9 41/ Tillable 3 jltot - Woodland Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD House Piot DEPTH Total DOCK w�. ...�. w MOO■■■ MMMMMM■ ■EMMMMMM■■■ _ -. • •' MEMO■■■ ■■■■E■■M■■■■E■■■■■■ ■■■■■ ■!!!O■E■■■ME■■■M■■■■ ■■■■■■ ■■�iE■■■■■■■■■■■■■■■ M■MM■ ...... ■■■■■M■■■■■■ NEON _. MEM■■.� ���■���. ■■■■■EM■■■EMM ME■■EE EE®(6 bilA WOMME■EMOEEE NFRMUMMONNOMMOMMO . , � �� - � - ■EMO■■i�..r�:�.����' L.��■■MM■■■■M Foundation Basement I Finish 'Fire Place .. Rooms I st Floor Rooms•- 2nd FloorlJll�� w iw Mlj)riveway Am Uft..t J ! 0 yqf ► _ JUDITH T. TERRY ; ,= C; .-. Town Hall. 53095 Main Road I TOWN CLERK N '� r', P.O. Rox 117c) Southold- New 1•ork 11471 REGlsranR OF VITAL,STATISTICS Fax (516) 765-1923 MARRIAGE OFFICER _ �j ���� Tcicphonc (516 1 765-1801 RECOR()S MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TH.1S IS TO CERTIFY THAT. THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93)1," and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)) . Dil Si i3. DEFT. TOWN OF SOUiHOI� df Judith T. Terry Southold Town Clerk August 25, 1993 APPLICATION # PAGE 1 of 4 TOWN .OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1: GENERAL PROVISION (APPLICANT to read and si l 1. No work may start until a permit is issued. 2 The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO _ THIS APPLICATION ARE, TO THE BEST OF MY KNOWLEDGE,TRUE AND ACCURATE. (APPLICANT'S SIGNATURE)-L����� DATE / (� SECTION 2• PROPOSED DEVELOPMENT(To be completed by APPLICAN D NAME ADDRESS TELEPHONE . APPLICA ��� BUILDER 73Iru ENGIIJEER -PROJECT LO CATION: To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. / FDP(93) i i APPLICATION PAGE 2OF4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYP OARTRE ❑ New Structure esidential (1-4 Family) l ❑Addition ❑ Residential (More than 4 Family) UAlteration ❑ Non-residential (Floodproofmg? O Yes) O Relocation ❑ Combined Use (Residential & Commercial) O Demolition ❑ Manufactured (Mobile) Home (In Manu- 0 Replacement factured Home Park? O Yes) ESTIMATED COST OF PROJECT S L a0 B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill O Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Culvert Work) Q Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) ❑ Individual Water or Sewer System ❑ Other (Please Specify) After completing SECTION 2,APPLICANT should submit form to Local Administrator for review. SECTION 3• FLOODPLAIN DETERMINATION ('I'o be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No.-------, Dated The Proposed Development: ❑ Is NOT located in a.Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). O Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable ❑The proposed development is located in a Goodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE 4 APPLICATION # PAGE 3OF4 SECTION 4: ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: ❑ A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑Development plans,drawn to scale,and specifications,including where applicable:details for anchoring structures,proposed elevation of lowest floor(including basement),types of water resistant materials used below the fust floor,details of floodproofwg of utilities located below the first floor and details of enclosures below the Furst floor. Also, ❑Subdivision or other development plans(If the subdivision or other development exceeds 50 lots or 5 acres,whichever is the lesser,the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofing protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: SECTION 5: PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity.A. ❑ Is B. O Is not in conformance with provisions of Local Law # , 19 . The permit is issued subject to the conditions attached to and made part of this permit. SIGNED , DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from the Board of Appeals. APPLICATION # PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? O Yes ❑ No Hearing date: Appeals Board Decision -- Approved? ❑ Yes ❑ No Conditions SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued) The following information must be provided for project structures. This section must be completed by 'a registered professional engineer or a licensed land surveyor (or attach a certification to this application).. Complete 1 or 2 below. 1. Actual(As-Built)Elevation of the top of the lowest floor, including basement (in Coastal High Hagard Areas. bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofing protection is FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be comvleted by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? OYES ONO DATE BY DEFICIENCIES? OYES ONO DATE BY DEFICIENCIES? OYES ONO SECTION 8: CERTIFICATE OF COMPLIANCE(To be comeeted by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: i • 1 1 Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area i TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: 0 NEW BUILDING 0 EXISTING BUILDING 0-VACANT. LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY_ CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_,1 AS MODIFIED BY VARIANCE DATED SIGNED: DATED: CIC(93) LOT NUMBERS REFER TO "AMENDED MAP OF PECONIC BAY ESTATES" FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON MAY 19, 1933 AS FILE N0. 1124. N SURVEY OF PROPERTY A T ARSHAMOMOQ UE TOWN OF SO UTHOLD oRE R°� SUFFOLK COUNTY, N. Y. BAY 1000-53-04-35.3 188 8g' SCALE.• 1'=30' a,4.7.3 OF P�w" 9.7.5 SEPTEMBER 26, 201.3 OCTOBER 3, 2013 (ELEVATIONS) N79-54too»E OT 90 � ,T w ' 3 (b r ry M Z X ' W 0 J b z m p J O 20.8 23. � 27.6 4 ONEAGE w pUSE a t G 7 ' # H FF. E1. � S8 Q Q • 7.1' 1 •� AO, 27.9' SIT.21-0 N N ' DEQ 1 LOT LOT It g a LOT 87 _ 91.63 a e.2 tly `�► �i � 5794 LOT 14pNE' O ���pF NEV;.y M U ST ACS, 0. 9107 ME Tic A COUNTY FILE SUFFOLK FLOOD ZONE FROM FLOOD INSURANCE RATE MAP MAP NUMBER 36103CO159H SEPTEMBER 25, 2009 ELEVATIONS REFERENCED TO N.A.V.D. 1988 C,aNtB LIC. NO. 49618 ANY AL 7ERA 77ON OR ADDI T701V TO THIS SURVEY IS A V70LA 770N PECONI C SUR I/EYORS, P.C. OF SEC770N 7209OF THE NEW YORK STATE EDUCA7701V LAW. EXCEPT AS PER SEC7701V 7209-SUBDIVISION 2. ALL CER77F7CA77ONS (631) 765-5020 FAX (631) 765-1797 nn HEREON ARE VALID FAR THIS MAP AND COPIES THEREOF ONLY IF P.O. BOX 909 AREA-17,239 SQ. F. SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRA VELER STREET WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 11971 113-2361 j ANY ALTERATION OR ADDITION TO THIS SURVEY /S A VIOLATION OF SEC77ON 7209OF THE NEW YORK STATE EDUCATION LAW. EXCEPT AS PER SEC710N 7209—SUBDIWSION 2. ALL CER77FICAPONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY /F SURVEY OF PROPERTY SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF 7HE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. AT NASSAU POINT LOT NUMBERS REFER TO "AMENDED MAP 'A' OF NASSAU POINT, NASSAU POINT PROPERTIES, INC. " FILED IN THE TOWN OF SO UTHOLD SUFFOLK COUNTY CLERKS OFFICE ON AUGUST 16, 1922 SUFFOLK COUNTY, N. Y, AS FILE NO. 156. _ _ ELEVATIONS REFERENCED TO N.G.V.D A�' 1000-104-09-02 SCALE.-,1�30'2 �Sj2• 14T +,MAROH_,Z 2011 N u �3,�8�E AUG. 2� 2014(FLOOD ONES) Sept. 10, 2014 (revisior0i) F� 7T. 4' 1 i � • Y i Y i r r r r , AA \ I P/0 LOT 252 O r FE ov ; o..t'w � Ir ----- EOEOFLA"v - - - - - - _ a��, p ; — v ! r / \ rr r � r \ LAlify / Ir � r h N i T r r Zll; r' L 6) '3w Q Q DECK DECK 3• Q+ 3- 0 3 WALL + 3 ,(� 0.2'E Me I'� ♦� �y FU' (-t Lb1 X0.4 w 3�6 i� e.N N • A�4� 0 �� A/C Lk i-I N41J UNIT 1?.5 0 / (� 0 � M GYVE S7URY O N S rrUl( C X1L Lu I�RAw ;O FF a. 12.00 �6. 0 �0 `. o20 n.O�/t°�i • GENERA TOR G� / 2 \ 8R/CK •IMp R GE' / 0 '2 0 wAcc � 0 0 1,110 a6lw OF NE1,,, - ME 1 cfi \ 6•Z�2o 1 / / ' �'� 4961$ FLOOD ZONES FROM FIRM 361030016 S�/ i" ' �i-� N. Y.S. LIC. NO. 49618 36103CO164H d ACTUAL CONTOURS r( �'t ECONIC S MORS, P.C. f _ (631) 765-5020 FAX (631) 765-1797 �gOA' AREA=29,485 29,435 SQ. FT. Po.. BTRAVELER STREET ■ =MONUMENT TO TIE LINESSOUTHOLD, N.Y. 11971 111-109 38.4' OS 3-4 C33 N 5.6' 12.6' 3.6' 12.8' 3.8' ol rn, S mA2T V`�,Ng`S y NOTE: M3N 3° y DECK STRUCTURE -------- -------------------- (AS NOT DRAWN ------------------- --, � SJR 16"X8" r-] ._ VENT_._, 1/060 F- 8"X16"CONC. BLOCK WALL 00 ON 16"X8" FTG. BETWEEN PIERS (TYPICAL) �/ Jt W --------- ------- --- -- O----------- --- ----- --- - - Q A CONC.BILK. EX. CONC.BILK EX.CONC. PARTITION WALL PIER PARTITION WALL PIER(fYP.) �-EX. FIN FLOOR _ _ W EX.GRADE P4 (SLOPED O J b M c - � 16"X8"CONC- ' PIERuj a (fYP, ' . , V STEP FOOTING AS REQUIRED FOR �""'• V SLOPED GRADE (VIF)MIN.3' BELOW GRADE EXISTING FOUNDATION b NO CHANGE TO STRUCTURE CROSS SECTION r-4. Xi o SCALE: 1/4" = V-0" (,� N APPROVED 14,9 NOTED DATE: I® cs .4 B.P.4 8"X16"CONC. BLOCK WALL FEE: Bl(: � 1 ON 16"X8" FTG.BETWEEN NOTI Y BUILDING DEPARTMENT AT PIERS (TYPICAL) 765-1802 $AM TO 4 PM FOR THE OCCUPANCY OR FOLLOWING INSPECTIONS: 7U 4�; � 1. FOUNDATION - TWO REQUIRED E IS UNLAWFUL _" EX.CONC. t�.. FOR POURED CONCRETE r JITHOUT CERTIFICATE _- :.... ------ -- -------, ------ -- ------------ ------ - PIER(fYP.) ------------ --- 2. ROUGH FRAMIi�JG & PLUMBING 3. INSULATION O OCCUPANCY 4. DRAWN BY: FINAL - CONti�TRUCTION MUST- - BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE 38.2' 10/1/2014 REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS, FOUNDATION PLAN SCALE: 1/4" = V-0" , �. , SCALE: 1/4" = 1'-0" COI > l—LY tr , � � ._I'-I r�LE. CODES OF _YORK SHEET NO `vti rJr� ST;�-��i-��. & TOWN CODES AS REQUIRED'A, '' OF 8 204 SGP minlnl pi alAW—BOARD _ ..._-. ---_.---- 'EES