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HomeMy WebLinkAbout28110-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28230 Date: 02/26/02 TRIS CERTIFIES that the building ADDITION Location of Property: 5400 GREAT PECONIC BAY BLVD LAUREL (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 128 Block 2 Lot 12 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 25, 2002 pursuant to which Building Permit No. 28110-Z dated FEBRUARY 25, 2002 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 SECOND FLOOR ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to THOMAS M & SUSAN E HUDGINS (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N 516943 03/01/00 PLUMBERS CERTIFICATION DATED N/A tho ized S gnature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28110 Z Date FEBRUARY 25, 2002 Permission is hereby granted to: THOMAS M & SUSAN E HUDGINS 179 E 70TH STREET NEW YORK,NY 10021 for CONSTRUCTION OF A 2ND FLOOR ADDITION OVER AN EXISTING 1ST FLOOR AS APPLIED FOR. THIS PERMIT REPLACES BP#26174 at premises located at 5400 GREAT PECONIC BAY BLVD LAUREL County Tax Map No. 473889 Section 128 Block 0002 Lot No. 012 pursuant to application dated FEBRUARY 25, 2002 and approved by the Building Inspector. Fee $ 150 . 00 1 Author i7S/haturV COPY Rev. 2/19/98 a19- areae Form No.6 TOWN OF SOUTHOLD --7 BUILDING DEPARTMENT ;a TOWN HALL 765-1802 y ( j L �,�;�; FEB 2002 APPLICATION FOR CERTIFICATE OF OCCUP . CYL-,,,_ �._._. ....._.! This application must be filled in by typewriter or ink and submitted to the Building De Ta A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building,multiple residences and similar buildings and installations, a certificate of Code Compliance from 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 properly completed application and a 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$25.00,Additions to dwelling$25.00,Alterations to dwelling$25.00, Swimming pool$25.00,Accessory building$25.00,Additions to accessory building$25.00,Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Photocopy of Certificate of Occupancy-$ 0.25 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:_ X (check one) Location of Property: �"yO u U G c.-.rc 0j!y je/j. House No. S eet Hamlet Owner or Owners of Property: -72o^&J '1 .S u.1'yJ N 1ja o Suffolk County Tax Map No 1000, Section Block Lot Subdivision - JT ,, „ o Filed Map. Lot: Permit No. Date of Permit. Applicant: i Health Dept.Approval: Underwriters Approval: L Planning Board Approval: n��} Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted- $ (p D D Applicant gnatur THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1175@03 BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10038 MARCH 01,2000 19716300/00 N 516943 DateA . THIS CERTIFIES THAT gWqp8•0'161f74 only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of MR. THOMAS HUDGINS, 5400 PECONE BAY BLVD. , LAUREL, NY in the following location• ❑ Basement ❑ 1st Fl. El 2nd Fl. OUT Section Block Lot was examined on FEtRUARY 22,2000 and found to be in compliance with the National Electrical Code., FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENTI FLUORESCENT I OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. N.P. 2 6 1 2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT.HEATERS MULTI-OUTLET DIMMERS SYSTEMS AMT. K.W. OIL H.P. GAS N.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS 2 600 SERVICE DISCONNECT NO.OF S E R V I C E METER NO.OF CC COND. A.W. A.W.G. A.W.G. AMT. AMP. TYPE EQUIP, 1 0 2W 1 0 3W $0 3W 3 0 4W PER 0 OF CC. D. NO.OF HI-LEG OF HIAEG NO.OF NEUTRALS OF NEUTRAL OTHER APPARATUS: PADDLE FAN F-1 ELEC. ROOM HEATERS:1-.875 K.W. Q.C. ELECTRIC INC. LIC.#3823-E P.O.BOX 518 LAUREL, NY, 11948-0518 GENERAL MANAGER 11 Per This certificate must not be altered in any manner;return to the office of the Board if incorrect. Inspectors may be Identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTEr ED IN ANY MANNER. Aug 31 99 02: 50p Cronir and Condon Consult 516-734-7014 P• 1 Albert J. Krupi-ki,President Toviti Hall Jamee King Vice-President ��' Q e3d95 Main Read Henry Srnith P.U.Box 1179 Artie Foster 4 Southold,New York 11971 Ken PoliwcdaG �} Telephone(516; 765.1892 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 30, 1999 Mr. Mark K. Schwartz 1755 Sigsbee Rd. Mattituck, NY 11952 RE: THOMAS & SUSAN HUDCINS SCTM#128-2-12 Dear Mr- Schwartz: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 25, 1999: RESOLVED, that the Southold Town Board of Trustees grant the request for a Waiver to THOMAS & SUSAN HUDGINS to construct a room over an existing 18.4 'X 15 ' second floor deck. This approval does not constitute approvals from any other agency. If you have any questions, please call our office at 765-1892. Sincerelyy,, /'I. Albert J. Krupski, Jr. President, Board of Trustees AJK:ims cc: Building Dept. NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER ■ EFFECTIVE DATE 1-4738-01687/00005 September 30 1999 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental September 30, 2002 Conservation Law TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Permit to Operate ❑ Article 15, Title 5: Protection ❑ 6NYCRR 608: Water Duality ❑ Article 27, Title 7; 6NYCRR of Waters Certification 360: Solid Waste Management ❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR Supply 373: Hazardous Waste Management 11 Article 19: Air Pollution ❑ Article 15, Title 15: Water Control ❑ Article 34: Coastal Erosion Transport Management ❑ Article 23, Title 27: Mined ❑ Article 15, Title 15: Long Land Reclamation ❑ Article 36: Floodplain Island Wells Management ❑ Article 24: Freshwater Wetlands ❑ Article 15, Title 27• Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Thomas Hudgins (516) 734-7250 ADDRESS OF PERMITTEE 179 East 70th Street New York NY 10021-5109 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Cronin and Condon Consulting Engineers 1755 Sigsbee Road Mattituck NY 11952 (516) 734-7250 NAME AND ADDRESS OF PROJECT/FACILITY Hudgins Property 5400 Peconic Bay Boulevard LOCATION OF PROJECT/FACILITY Laurel COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Great Peconic Ba DESCRIPTION OF AUTHORIZED ACTIVITY: Construct a 15' x 18.41 addition over existing deck. All work shall be done as shown on the attached plans prepared by Mark Kevin Schwartz last dated October 3, 1996 and stamped NYSDEC approved on September 30, 1999. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Mark C. Carrara JJK Bldg. #40, SUNY, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE / DATE Page 1 of 4 September 30 1999 ROBERT H. WHELAN, P.E. P.O.Box 590 •Mattituck,NY 11952 Tel:631-722-5875 Fax:631-722-7835 February 19, 2002 Town of Southold Building Department Main Road Southold,New York 11971 Att: Mr. Gary Fish Re: Hudgins Residence 5400 Peconic Bay Boulevard Laurel,New York Permit#261742 Ji e. c1 a 110 Dear Sir: On Thursday, February 7, 2002,the above referenced residential addition was inspected to verify the existence of insulation installed in the building envelope. It is my professional opinion that the as-built installation is in conformance with the general intent of the New York State Energy Conservation Construction Code. Thank you for your time and cooperation on this matter. If there are any questions relative to the above please do not hesitate to call. OF N E W G�� Very Y Trul Yours ' ,a t h NA", ca . 4 N©, 614`" FESSTP Robert H. Whelan,P.E. cc: Mr. Fred Milner New York State Department of Environmental Conservation Division of Environmental Permits, Region One .� Building 40 - SUNY, Stony Brook, NY 11790-2356 Phone: (516) 444-0365 Fax : (516) 444-0360 John P. Cahill Commissioner September 30, 1999 Mr. Thomas Hudgins 179 East 70th Street New York, NY 10021-5109 RE : 1-4738-01687/00005 Dear Permittee : In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit . Please read all conditions carefully. If you are unable to comply with any conditions, please contact us at the above address . Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather. Very truly yours, Ceo-p�� Janet Kolodziejski Agency Program Aide JJK:cg enclosure NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-01687/00005 ■ September 30 1999 FACILITY/PROGRAM NUMBER(S) P E RM I T EXPIRATION DATE(S) Under the Environmental September 30, 2002 Conservation Law TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Permit to Operate ❑ Article 15, Title 5: Protection ❑ 6NYCRR 608: Water Duality ❑ Article 27, Title 7; 6NYCRR of Waters Certification 360: Solid Waste Management ❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR Supply 373: Hazardous Waste Management ❑ Article 19: Air Pollution ❑ Article 15, Title 15: Water Control ❑ Article 34: Coastal Erosion Transport Management ❑ Article 23, Title 27: Mined ❑ Article 15, Title 15: Long Land Reclamation ❑ Article 36: Floodplain Island Wells Management ❑ Article 24: Freshwater Wetlands ❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Thomas Hudgins (516) 734-7250 ADDRESS OF PERMITTEE 179 East 70th Street New York NY 10021-5109 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Cronin and Condon Consulting Engineers 1755 Sigsbee Road Mattituck NY 11952 (516) 734-7250 NAME AND ADDRESS OF PROJECT/FACILITY Hudgins Property 5400 Peconic Bay Boulevard LOCATION OF PROJECT/FACILITY Laurel COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Great Peconic Ba DESCRIPTION OF AUTHORIZED ACTIVITY: Construct a 15' x 18.41 addition over existing deck. All work shall be done as shown on the attached plans prepared by Mark Kevin Schwartz last dated October 3, 1996 and stamped NYSDEC approved on September 30, 1999. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as part of this permit. PERMIT ADMINISTRATOR: ADDRESS Mark C. Carrara JJK Bldg. #40, SUNY, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE / DATE Page 1 of 4 H ��e September 30 1999 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, agents, and assigns for all claims, suits, actions, damages, and costs of every name and description, arising out of or resulting from the permittee's undertaking of activities or operation and maintenance of the facility or facilities authorized by the permit in compliance or non-compliance with the terms and conditions of the permit. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: 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 are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. GENERAL CONDITIONS General Condition 1: Facility Inspection by the Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. General Condition 2: Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. General Condition 3: Applications for Permit Renewals or Modifications The permittee must submit a separate written application to the Department for renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. The permittee must submit a renewal application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous Waste Management Facilities (HWMF), major Air Pollution Control (APC) and Solid Waste Management Facilities(SWMF); and b) 30 days before expiration of all other permit types. Submission of applications for permit renewal or modification are to be submitted to: NYSDEC Regional Permit Administrator, Region 1, SUNY Bldg#40, Stony Brook, NY 11790-2356 General Condition 4: Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulation have materially changed since the permit was issued. DEC PERMIT NUMBER PAGE 2 OF 4 1-4738-01687/00005 PERMIT.TW,rev.6199 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15(TITLE 5),24, 25, 34 AND 6NYCRR PART 608 (TIDAL WETLANDS) 1. If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the 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. 2. 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. 3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any other permission, consent or approval from the U.S.Army Corps of Engineers, U.S. Coast Guard, New York State Office of General Services or local government which may be required. 4. 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. 5. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large refuse piles, ridges across the bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway. 6. There shall be no unreasonable interference with navigation by the work herein authorized. 7. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall,without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 8. If granted under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject project will not contravene effluent limitations or other limitations or standards under Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions listed herein are met. 9. At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work and, if required, a survey. 10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by Mark Kevin Schwartz last dated 10/3/96. stamped NYSDEC approved on 9/30/99 DEC PERMIT NUMBER PAGE 3 OF 4 1-4738-01687/00005 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix trucks, mixers, or other devices enter tidal wetlands and or protected buffer areas. 2. 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 area for disposal. No debris is permitted in tidal wetlands and or protected buffer areas. 3. The storage of construction equipment and materials shall be confined to within the project work site and or upland areas greater than 75 linear feet from the tidal wetland boundary. 4. Roof runoff shall be directed to drywells a minimum of 75 feet landward of the tidal wetland boundary for immediate on-site recharge. DEC PERMIT NUMBER PAGE 4 OF 4 1-4738-01687/00005 9&20-1 (Wn-9d New York State Department of Environmental Conservation vNOTICE v The Department of Environmental Conservation (DEC) has issued permit(s) pursuant to the Environmental Conservation Law for work being conducted at this site. For further information regarding the nature and extent of work approved and any Departmental conditions on it, contact the Regional Permit Administrator listed below. Please refer to the permit number shown when contacting the DEC. Regional Permit Administrator Permit Number 5 JOHN W. PAVACIC Expiration Date 0 7-30 —a 00 a NOTE: This notice is NOT a permit Rug 31 99 02: 59p Cronin and Condon Consult 518-734-7014 p. l Alberti. Krupski,President �$U�F�(�' Town Hall Jamee King;Vice-President ' 03095 Main Read ' Henry Smith ~' � P,O,Bos 1179 Artie Foster N Southold,New York 11971 Ken Poliwcda ' + Telephone(5!6) 765.1892 Fax(816) 785-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 30, 1999 Mr. Mark K. Schwartz 1755 Sigsbee Rd. Mattituck, NY 11952 RE: THOMAS & SUSAN HUDGINS SCTM#128-2-12 Dear Mr- Schwartz: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 25, 1999 : RESOLVED, that the Southold Town Board of Trustees grant the request for a Waiver tc THOMAS & SUSAN HUDGINS to construct a room over an existing 18.41X 15 ' second floor deck. This approval does not constitute approvals from any other agency. If you have any questions, please call our office at 765-1892 . Sincerely, //.. Albert J. Krups_kil, Jr. / President, Board of Trustees AJK:lms cc: Building Dept. BUILDING PERMIT REVIEW CHECK LIST Applicant/ -((� Date Owners Name: I ' �`� `� S V150.11dq t Reviewed: Architect/ r' Date Engineer: M a t S c. �°Cj'fiz Submitted: SCTM #: ll District: 1.000 Section: Block: c) Lot: d� ProjectD Subdivision Location: 5A 00 (-%*- 1 e el-O 6 1 6PV-CY Name: Single&separate Require certification: (Yes/ o Req. Req. Zoning District: [Lot size: Actual: l [Lot coverage Proposed: ] Req � Req. /S� Req. / [Front Yard ✓" Proposed: [Side Yard Proposed: ) [Rear Yard ..5V Proposed:Ole ) Project Description: AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number Suffolk County p Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation??? Flood Zone: Notes:. pus-1802 BUILDING DEPT. INS CTION [ ] FOUN TION IST [ ] ROUGH PLBG. [ ] F NDATION 2ND [ ] INSULATION [ FRAMING [ j FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE l � o*t7 INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] �NLATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE l� 11"'/INSPECTOR ...�1 1 ,f: i i-PECTION REPORT DATE COMMENTS tII -------j- -- ---- -- -- --- - ---------- --- ---------- LJ -MAT I * r I ST) - --- --- --- ---- - --- _jI II II dDATION (2ND) __________________ ___ ___ _________-___________________________________________= d u II • �� II GH FRAME & _ _-- PLUMB I NG II II IIit it II ^V II 1% 14, ULATION PER NY. I ON. STATE ENERGY by CODE _---it- it II N A N II p — ---------- CCm, H it u . �.. u N111111P1 O N- FINAL , ADDITIONAL COMMENTS: H` Ham• 00 Z , BOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: g / CALL . . . . . . . . . . . . . . . . . . Examined. 020Z-- 19.7- () MAIL TO: . . . . . . . . . . . . . . . . . . . . �+�+ ................................... Approved. .......:��., 19 l.J. Permit No. ............... Disapproveda/c .................................. I ................................... .....................................................� ... .......... .. .... .. - __. ... (Building tor) OCT 29 APPLICATION FOR BUILDING PERMIT Date. . . . .. . . . . . . . . . . . 19. . . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wi 3 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this application. 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 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 airy purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HMff MALE 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 bu lli rfgr necessary nspect�sU .. Aid AU-o!o(fi;U 7.-Z.......`...............-...'J� (Signature of applicant, or name, if a corporation) !lsS Sl4.f#fir.n.. ..ti tlrlz-q(.!19.sz� (Mailing address of applicant) State whether applicant is owner, lessee, agent, chitect, a r, general contractor, electrician, plumber or builder Name of owner of premises ....LJ U.::'/. .�....`.L X ................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .....:................................................... (Name and title of corporate officer) Builders License No. ......................... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... b. Location of land on which proposed work will be done.............................................................. ........... -r�.. .��... N(�.....�. V t, V1 ...... . ..................................................... House mer Street Hamlett County Tax Map No. 1000 Section ..`.L-( ...... Block ... .?...... Lot ..... ..v... Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) State existing use and occupancy of premises and/intended use and occupancy of proposed construction: ' a. Existing use and occupancy ......ill .�C.1.km�......... A . AMM ............ ..... r MW to Msle ouuSLA rM111Y0N b. Intended use and occupancy ..........................................s�oes deto.oN................... #woo ADiW tO bad*A ,,,_ 02.6I ouM amigx3 rmeT Miture of work (check whiem applicable): New building .......... Addition .�, `.... Alteration .......... Repair ......... Removal ............. Demolition ............ Other Work .................................. •Z ........................(Description)..... Estimated Cost Q`�•`r........ fee .... 1' �(to be paid on filing this application) If choelling, number of dwelling units ............ il<rmber of dwelling units on each floor ................ Ifgarage, number of cars ...................................... If business, commercial or mixed occupancy, specify nature a9d extent of each of A use...... . ........... r� Dimensions of exis�i structures, if any: Front...&s7 �.. Rear ..�..":.... Depth .�........ Heiglht ......�L.: ...Y ....... Number of Stories ......L....... (� Dimensions tructure with alt tons or additions: Dont ... 7 .;:•Rear............. Depth .... :.... Height .. �... Irof Stories Dimensions of entire new construction: Front .... .c. .. Rear ./X.:..T...... Depth .I �. ..... Height ...................,.//...... kmber of'Stories J..................... Size of lot: Front .....fOa......... Rear ....L�.,I..T... ... Depth .. ,,l :✓..��..... IDate of Purchase ..................... Name of Former Owner ........................ `........ I. Zane or use district in which premises are situated .............................................................. 2. Does proposed construction violate any zoning law, ordinance or regulation: ........................ 3. Will lot be regraded .................... Will excess fill be removed from premises: YES ND i. Names of Owner of premises ........................... Address .............................. Phone No. .............. Name of Architect .................................... Address .............................. Phone No. .............. Name of Contractor ................................... Address ...............................Phone No. .............. 5. Is this property within 300 feet of a tidal wetland? * YES........... ND .......... *IF YES, SQTI EM Tadd TI3ISIMS PERMIT MAY BE REQUIRED PLOT DIAGRAM I,ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions ran property lines. Give street and block number or description according to deed, and show street names and indicate Nether interior or corner lot. rA.IE or N-Vi S �.. s ;JUDTIY OF ..._ •/ •• `•kti! Z......:....................being duly swonn, deposes and says that he is the applicant [lame of individual signi.rhg contract) bove named, eis tine ....... .. ...................................................................... dtracL1,']!:nt, corporate officer, etc.) J7 said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and hat the work will be performed in the manner set' forth in the application filed therewith. worn to before mr>? this /1 Notary Publ.• .......... . .. .. •(Signature• .•••'•..•.'•. of Appli. ) w"IL MM Norm K IC ftft of NMU* ���In 8�WQh 20 , QO JP J� 0 +00' �. 00 o ti y q O'Q o" fp ho - �L lb °/F NO 9e . f� °gIN °sit 0 CA ,NZ R 0. R Q o N Y S D E c 0 + APPROVED AS PER Tula j C0NDITIONS OR AND °dens K \ PEa� NO6 �OIQP1 psis 0°°RE tY Ic .:c"g7R y Kit!,� .d.. - •y +rte' -• 1 d t +,� ..,, -,- - 0ch� AREA = 431402 s q. f t. a - 41 3 TO TIE LWE .. c� C6'RTIFwED TO+ p � THOMAS M. HUDGINS SUSAN E. HUDGINS � \ THE NA (NATIONAL CHASE BANK A SSOCIA TION) COMMONWEALTH LAND TITLE sucvAf IS.vow cG WSURANCE COMPANY el�k 91=ti a �• ��__ � gyp � SURVEY O PROPER T YIlk, M1ry. � •o \ A A T L A UREL �{ R3 y . e " "' 6'� '�� �, �`�r"�'',� TOWN OF SOUTHOL D SUFFOLK COUNTY, N. Y. - '` V. ,� �''*' ,lb Ilk 1000 — 128 — 02 — 12 o/f 3 °�e` ,, # SCSI& 1" = 40' MooRE S&P .t 21 1989 15 R PNY�L Sept. 23, 1996 (fi�7Al) r g �, err �` u Oct. 31 1996 (addition) pF NEw yD g ' z 9° lora t. MEljC� ELEVA TIONS AND CONTOURS ARE REFERENCED P N.G.V.DA TUM ,0 G Y.S NO. 496/8 P,rore,vy is .� FZoov Zw gs 4*(# pip,".. 30+0wn . • Fj,eM Memo ( 940813 0019 c ) EC RS, arod M aaawdwpao wfb t o wbdwrr 49 6�' ,� for NtNIaw�pwryos as&a/� d . O' B ND S�� �sr� 1IN IYrw r dtito[and 3OUNOLD, N.'Y. 119T1 OSA� eE��ss� 3 is/93 AAOdT. 21WW .�16�i, •oar 2 Zz/9 o CER TIRED 09/26/96 \✓ QO �P J� 0 ti y �t �OiF F G N ROSio ROBIN NEINtit1P G. BRi4 Q 0 � W � � ftb N�Off MOpRE R• Yetis ti �`g �6 Y PN isleV Y} AREA = 43, 402 s q. f t. TO TAE tNE CERTIFIED TO* of Off R o THOMAS M. HUDG/NS Ytlo SUSAN E. HUDGINS Ro' \. THE CHASE MANHATTAN BANK BEY f 3 M TIONAL ASSOCIA TION) 5T P COMMONWEALTH LAND TITLE „ INSURANCE COMPANY el41 4.k O SURVEY OF y. PROPER T YrAyl ~ �' AT LAUREL �y y �,t �a' yt��. ►2.4 TOWN OF SOUTHOL D �9 ' 4,�,►. �,u SUFFOLK COUNTY N. Y. 1000 - 128 - 02 - 12 ,F �: °1*1 ,rte Scale 1" 40' "�� MoORE ; Sept. 21 1989 I5 ft. .y �23PHY�� a ,'� 9DItA/IpIT�Tr � , (final OCt. 3, 1996 (addition) / 'air c. NEW yo 8 z 9• A�p MEELEVATIONS�'� ELEVA TIONS AND CONTOURS ARE REFERENCED >° i 'a N.G.V.DA TUM N. * 1C. NO. 49618 Rto+i,r<rv, is m Acooc ZomEs A+('l e) 8 Q ;.: . ♦s .5Movn bra. F/QM 11AQ 3bo811 olla c ) ECL 0 .C. 11�aoeor c� w,ttA tlw w� 6) -'�O�i ` �haw"Yo w ah-NSA-d P . O. • %;roAA.rw� �l��rt Bta�a d SOUTHOLD, 11971 PRW. . DW, -3//$/93 Q` /r, CER MED 08/26/96 �o �P J ti 1�90eool 0 o4k., %u Nto/F Ne ~ 0 vM c ROSIN RGgIN �jC) "E►NG'1tP G v c aC\ BR Q ID �\ NY SDE C 0 AppROVED AS PER TERbA / AND CONDITIONS OF dda PERMIT �0�e� \ DATE ' D J N1G1F MGGRE R• \ g' co �s CO Aqc OLE " ss G AREA = 43, 402 sq. f t. M' TO TIE LINE „ CERTIFIED TOt THOMAS M. HUDGINS SUSAN E. HUDGINS THE CHASE MANNA T TAN BANK (NA TONAL A SSOCIA TION) COMMONWEALTH LAND TITLE sl P„ PM1S $jrw�f Hqv pro iv INSURANCE COMPANY -A-Tv;w" Oty AW.A K S el +'k 78 IAjGIG¢TL M/ZyoC� SURVEY O ��4 ar �A t1tK PROPER T Y 'so- N \ / + tih� d �o C � KHEA A T L A UR EL Y� R3 cy y orf \A. `V NY- .5 \S.Oy PROVO4 -ev TOWN OF SOUTHOL D o`' a SUFFOLK COUNTY, N. Y. 1000 - 128 - 02 - 12 �01F 3 °�e�� Scale 1" = 40 01 R MG°RE Sept. 21 1989 P ��s Q' NYS '� 9mcArwArEn � u Sept 23, 1996 (final) a A y wooncN rerr 1P CA Oct. 3, 1996 (addition) �M �0�a n o h NEW 1, ME r,? � EL EVA TIO&S AND CONTOURS ARE REFERENCED -° 'ZIs? N.G.V.DATUM 1� �1 Y. NO. 496/8 Pp`'Oe� is .n FC000 Zo,i6s 4t(0! s) F 8 AS Srrown .�. F/QM MAA / 36o813 oil& C- 7 - �( :CON RS, Preeppared in accordance with the mWWmas ` 16) 7 e Q96I J atandarda /or W4 swveys as eatabNahed O. H S�� by th.L 4A 1.8. ad�p�r�red acid.do�oted ND for such use by The=row York Stat and K, �o JP J ' 0 *° 0 0 0 a J0 00 • N1 0ROSIN ROSIN GG N HEINZ c' .91 o �\ Q � Nlolf 0RE R' MOr ,T PNY�LIS �, LloLg �� V J ' A S013 L AREA = 43, 402 s . ft. \ P� MIcw TO TIE LINE ; 3 �s CERT/FLED TOrOAF \ THOMAS M. HUDGINS N� PYNoR o\� SUSAN E. HUDGINS R THE CHASE MANHATTAN BANK NjEY vEs'� (NA TONAL ASSOCIA TION) S'(P COMMONWEALTH LAND TITLE cL INSURANCE COMPANY e 2T N D V SUR VE Y OF 'A rr\µ i Y wUUK AD PROPER T Y A T LAUREL 1ti 3 0 KNEA "� P� sz ��. i 'E 3 ��y trr ?' yt°�E � X2.0, L P ,,5 l: pk\,thy' � F TOWN OF SOUTHOLD �•6� e' u , � SUFFOLK COUNTY, N. Y. cm. 1000 - 1'18 - 02 - 12 ,F �0 �0 3 Scale 1" = 40 ' " R Mo°RE �In .4P y Sept. 21, 1989 PNY``1s �.r DILA Sept. 23, 1996 (final) r y ✓ETT Oct. 3, 1996 (addilion) i �,r,pF NEW y0 8 ' z 9' 0 �4 p k° �P S. MEh /� c.� ,1•d cF ELEVATIONS AND CONTOURS ARE REFERENCED � 04• V� ' PP 4 N.G.VIDA TUM .� I,; p T N. S 1G NO. 49618 AJ is "' 4( >4>,o Z .,ks A+C•/ s a: 1SHown •r F/2M M,00 ( 3Go813 S OR .C. Proopprod In aocordanoe with the m ww '1 - staadrds for do* swvoys as oataAllaeod ey the LILA" aid o rowel and tad 0 S for uoh ua� TM Iww vork drab Land .4t CJ y ; - (?y P;cnu� C7`If lcny) I -_AW 41 3r_�ow�Lw N 2xGelo'uc Ear 19TUOY TA DATE: AP RO ED AS NOTED 11 B.P. �� .. ,NEW Ca wr,> nn7ch FEE: 7S� BY: ' PROVIDE SMOKE-DETECTING / 4 I NOTIFY BUILDING DEPA EN7 A I N N F- 7615-1802 9 AM TO 4 PM FOR THE ALARM DEVICES I ✓ " uua�1 _ _ _ -M ' ' SrJ_p_j _ " FOLLowIDA ION - TWO AS TO PART. 721.1 Foe cA re-r ___ ,af W 1 1 FOUNDATION - TWO REQUIRED N.Y.S BUILDING CODE. '-e�t�yF Zu tsibvc -- d' � �-y`I 'TI���' FOR POURED CONCRETE 2. ROUGH • FRAMING 6 PLUMBING luSrALL 1 5T, - EAG-m, As, J�15r CF ��t�Ll,vv 2_13/4„7'/4"Mlcrce L_AFl _. __{� v� 3. INSULATION ,3rrrrya/ AS Sf�vwN, �E OF:hl4 �� •, � �, 4. FINAL - CONSTRUCTION MUST 3$�4 a 1p6 3-z.�,A L - BE COMPLETE FOR C.O. N�1 pnG K � � CHN dy Po5( ° now ALL CONSTRUCTION SHALL MEET T - - - -- - nM-(LTHE REQUIREMENTS OF THE N.Y f0 C�;�WG �+ Di ';Nu lwn STATE CONSTRUCTION & ENERGY M C I ve,:, F1 Ex; ! PTw' �--"-�— CODES NOT RESPONSIBLE FOR 5EFlM coo„ New x DESIGN OR CONSTRUCTION ERRORS -$Xl�: pgG.IL/ 11T � 3-Z�!4 P051'il yp p.N A6au C„ . 0MUPANd.rY OR - -- -- - --- --_ USE I5 UNLAWFUL 1V4ITNCUT CERTIFICATE 71 �-nl� - OFF CCCUPANCY1 - -- ----- - - - 1/4 UNDERWRITERS CERTIFICATE REQUIRED PROVIDE OPENINGS FOR I EMERGENCY ESCAPE AS REQUIRED BY PART. 714 OF Z-12/4 4- rncruc fl l N.Y. STATE BUILDING CODE. I : I W� [{yI4 hP9r�NG A/-1U i L � 2 9F ,zAs I wrmr — — - - -- -- r -- — cwru�tf�: rb - ; I �I ceC,,4 -row pAI wlNu✓','(D MFlIkM rk+ T J25Awsc�t Q mo 'Ic Cly ' - - - ; 114 1 - — -- _- _ '- - I; Fr if � I II i I' II II h i I VIII 'i I � ff � l WALL. SECTION 0 Ape + �i 'J 1 caul �lv 1 El1bGl_NINS r - CoN�U�'TIYtiC� E-NGuUi1GIZ `"`'�� 18, i��9 �q-� PECc�,llc. �7 (ywD l �ukc � Newit v s wsc �� MA�r�GG I Gv9 2iT plus