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HomeMy WebLinkAbout39636-Z rr=' ��Q�SUEFQI,fcoGf Town of Southold 9/25/2015 P.O.Box 1179 a y 53095 Main Rd �4,, o` Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37791 Date: 9/25/2015 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 2404 Camp Mineola Rd Ext,Mattituck SCTM#: 473889 Sec/Block/Lot: 122.-9-7.20 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/4/2015 pursuant to which Building Permit No. 39636 dated 4/2/2015 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: ACCESSORY IN-GROUND SWIMMING POOL AS APPLIED FOR The certificate is issued to Antoniello,Richard&Antoniello, Cheri of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39636 07-22-2015 PLUMBERS CERTIFICATION DATED /ut4rll Signa ure �SOVFoa,Y�o TOWN OF SOUTHOLD 'k BUILDING DEPARTMENT TOWN CLERK'S OFFICE o • 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#: 39636 Date: 4/2/2015 Permission is hereby granted to: Antoniello, Richard &Antoniello, Cheri 440 E 57th St Apt 3B New York, NY 10022 To: Construction of an in-ground swimming pool as applied for per ZBA, Trustees and DEC as applied for. At premises located at: 2404 Camp Mineola Rd Ext, Mattituck SCTM # 473889 Sec/Block/Lot# 122.-9-7.20 Pursuant to application dated 2/4/2015 and approved by the Building Inspector. To expire on - 10/1/2016. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 I Building Inspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from 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 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. :�-, 2.5 - ` S New Construction: 1,1Z Old or Pre-existing Building: (check one) Location of Property: 9. x-i (yl kA,-C—o(,A- 2_0 House No. Street Hamlet Owner or Owners of Property: 1 Cts AA-�d N` 1-L Cp Suffolk County Tax Map No 1000, Section 1 2 2 Block q Lot z G Subdivision Filed Map. Lot: PermitNo. Co aj�p Date of Permit. L4 - 2- ' IS- Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ vv, Applicant Signature pF SOUjy®lo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G �Q roger.riche rtAtown.southoId.ny.us Southold,NY 11971-0959 ®lyC®UNTV,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Cheri Antoniello Address: 2404 Camp Mineola Road Ext. City: Mattituck St: New York Zip: 11952 Budding Permit#. 39636 Section: 122 Block: 9-Lot 7.20 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Elec-Tec Inc. License No: 4814-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 2 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 2 Disconnect Switches Twist Lock Exit Fixtures 11 TVSS Other Equipment: In Ground Swimming Pool To Include, Bonding, 1-Control Panel, 1-Gas Heater 3-GFCI Circuit Breakers, 1-Pool Light Notes: Inspector Signature: Date: July 22, 2015 Electrical 81 Compliance Form.xls qf so coum, k6 \s� V v /V TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION I FOUNDATION IST ] ROUGH PLUMBING FOUNDATION 2ND INSULATIO14 FRAMING /STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (FINAL) ELECTRICAL (ROUGH) ] CODE VIOLATION CAULKING REMARKS: DATE INSPECTORV5Z 0 Q ho��Of SO(/TyOlo - �ycourm,��' TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 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 [ ] CAULKING REMARKS: DATE 2'� r INSPECTOR - SOF 3so(/j�, � O �ycoum,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ],I ULATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLA ION [ ] CAULKING REMARKS: DATE INSPECTOR SOUlyolo 1 co TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTI [ ] FOUNDATION 1 ST [ ] RO GH PLUMBING [ ] FOUNDATION 2ND [ ] SOLATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE INSPECTOR r • r r � u r t� • r: t ` IN IMULATION STATE ENEROY • r K" -, - K"Of WE M -0.1,N I �C/ _ AR- r � • �•�f 11 �i 1. � - -- - M.Pa"Jill Ind �� • _. r-"yam„ � M .. ' 15 - r�. lif[�/�� .r I f, 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 - _ + 41 sets of Building Plans t TEL: (631)765-1802 Planning Board approval, FAX: (631)765-9502 / b ','Check,,- Survey SoutholdTown.NorthFo_rk.net PERMIT T NO. • (� ,`Check,.• " Septic Form s N.Y.S.D.E.C. Trustees C.O.'Application Flood Permit Examined 20 _- . Single&Separate ' Storm-Water Assessment Form 1 - Contact: :• ; Approved 120 Mail to: OAeCZN Ac rj+0jJ\eU O Disapproved a/c -}`-1-o ax.�y Phone: Expiration D 20 _ lug uivu r; ~ - PPLICATION FOR BUILDING PE FEB- - 3 2615• F _ . . J , .. _ . • . • „ ' ., .. . _ t Date -lam_ n :20 -- e. INSTRUCTIONS SLUG Lii t 1 +,, _ ; . • n a.T1ii 'I' p ionGLD ST becompletelyfilled 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;anew, 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.- , (Signature'of applicant or name,if a'corporation) �-l `t`"'S- ,4Ail-3zuvl 1' S zZ ® cL (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,general contractor, electrician,"plumber,or builder S C�-�e r Name of owner of premises R k<.tt _D C Hag-\ A• iye m m LL O (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 Lice'n'se No, J' Other Trade's License No. <n4-- k6 1L ` orF6cS tl-'b -f* 1' 1(_4 — 1 1. Location of land on which proposed work will be done: House Number Street Hamlet- County Tax Map No. 1000 Section 1 Block Lot ,Z" Subdivision — Filed Map No. Lot 2. State existing.use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ESobe&/C.,45 b. Intended use and occupancy (2-r-, og��CP- L.-. V1,j.vr�, T- 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal . Demolition Other Work (Description) 4. Estimated Cost Fee S� (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 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any:Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth = Height :Number of Stories 9. Size of lot:Front Rear Depth 10.Date of Purchase '12C& 201 Z Name of Former Owner 11.Zone or use district in which premises are situated 12.Does proposed constructiori'violate'am%'zoning law, ordinance or`r'egulation?YES' NO f 13.Will lot be re graded?YES_)L'NO Will excess fill be removed from premises?YES,X NO " Ie-W c 14.Names of Owner of premises&LgAv- -Address tiMEC-ST -S-V Phone No. �$\�-��$1-S 3o`Z Name of Architect " -_Address Phone No Name of Contractor Ct- ` LTA Address GLhy,404cl6 Phone No. &S i- 4-3,q-3 3 6 6 15 a.Is this property within 100 feet of a-tidal wetland or a freshwater wetland? *YES_)�- NO * IF YES,'SOUTHOLD TOWN-TRUSTEES &D.E.C.PERMITS MAY BE REQUIRED.' b. Is this property within 300 feet of a'tidal wetland? *'YES X' -`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 COUNTY OF Klee!for '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. Sworn to b fore me this— (9 V"c4 day of LeYUG✓ .205 - Notary Public LEFRN MEEK Sign tore of Applicant " L,,ota,y Public State"of New York NO 01 ME6202198 ualified in Bronx County 17 mission Expires ,�. /rr';u 1"`fit" •1;i�' r a; f�t\" t-' •�f`.\ :: �' - •J._,�� L "`- BOARD OF SOUTHOLD TOWN TRUSTEES ' SOUTHOLD,NEW YORK • � PERMIT N0. 8497 DATE: SEPTEMBER 17,2014 ISSUED TO: CHERI•ANTONIELLO- PROPERTY ADDRESS: 2404 CAMP MINEOLA ROAD,MATTITUCK SCTM# 122-9-7.20 t AUTHORIZATION Pursuant to the provisions of Chapter 275 oI town-Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting field on September 17,2014, and in consideration of application fee in the sum of$250.00 paid by Richard&Cheri Antoniello and subject the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and a �} jpermits the following: Wetland Permit to install a'15'x30' in-ground swimming pool with a 2' high -- f build-up above ground; and a 4' high pool enclosure fence around perimeter; and as depicted on the project plan prepared by Cheri Antoniello, received on August 8,2014 and stamped approved on September. 17,2014. ? ! Trustees hereby causes its Co orate Seal to be affixed, IN WITNESS WHEREOF,the said Board of y Corporate I and these presents to be subscribed by a majority of the said Board as of this date. g i gpFF01 r l `" ��o�A COGy pF Sol/Py John M. Bredemeyer III,President ��Vv ®�® Town Hall Annex Michael J. Domino,Vice-President 54375 Main Road P.O. Box 1179 James F. King,Trustee CA Southold, New York 11971-0959 Dave Bergen,Trustee ® �� -' F. P ® Tele o (6�1�1769-1892 '11 Charles J. Sanders,Trustee lycOU 41 — �� AUG 2 1 2015 i BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD T CERTIFICATE OF COMPLIANCE # 1158C Date: August 21, 2015 THIS CERTIFIES that the installation of a 15'x30' in-ground swimming pool with a 2' high build-up above ground; and a 4' high pool enclosure fence around perimeter At 2404 Camp Mineola Road, Mattituck Suffolk County Tax Map #122-9-7.20 Conforms to the application for a Trustees Permit heretofore filed in this office Dated August 8, 2014 pursuant to which Trustees Wetland Permit#8497 Dated September 17, 2014,was issued and Amended on March 18, 2015 and also Amended on July 22, 2015 and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the installation of a 15'x30' in-ground swimming pool with a 2' high build-up above ground; and a 4' high pool enclosure fence around perimeter. The certificate is issued to CHERI ANTONIELLO owner of the aforesaid property. Authorized Signature 4 MOW NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-03533 PERMIT Under the Environmental Conservation Law ECL Permittee and Facility Information Permit Issued To: Facility: CHERI ANTONIELLO ANTONIELLO PROPERTY 440 E 57 ST APT 3B 2404 CAMP MINEOLA RD EXTISCTM 1000- 122-9-7.2 NEW YORK,NY 10022 MATTITUCK,NY 11952 (917) 549-5732 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility Principal Reference Point: NYTM-E: 708 NYTM-N: 4539.6 Latitude: 40°58'51.9" Longitude: 72°31'39.4" Project Location: 2404 Camp Mineola Road Extension,Mattituck Authorized Activity: Construct a 15 foot by 30 foot in-ground swimming pool,patio,pool filter and plumbing,and two(2) drywells for pool filter backwash. All work shall be performed in accordance with the plans prepared by Chituk Pools LTD on 11/6/14, and stamped"NYSDEC APPROVED" on 1/12/15. Permit Authorizations Tidal Wetlands-Under Article 25 Permit ID 1-4738-03533/00002 New Permit Effective Date: 1/12/2015 Expiration Date: 1/11/2020 NYSDEC Approval By acceptance of this permit,the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations,and all conditions included as part of this permit. Permit Administrator:JOHNrLAN�lrDeu Depegional Permit Administrator Address: NYSDGIOUARTERSUNYONY BCIRCLE RD ONOK,N409 Authorized Signature: Date6lcl Page 1 of 6 S NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-03533 Distribution List Habitat-TW Environmental Permits Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS,APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS -Apply to the Following Permits: TIDAL WETLANDS 1. Conformance With Plans All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by Chituk Pools LTD on 11/6/14,and stamped "NYSDEC APPROVED" on 1/12/15. 2. Notice of Commencement 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. 3. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. 4. Straw Bales or Other at Tidal Wetland A row of staked straw bales or approvable erosion control devices shall be placed at the landward edge of the buffer area or 60 linear feet from the tidal wetland boundary,or as per the NYSDEC-approved plan,prior to commencement of any regulated activities and remain in place and in good,functional condition until the project is completed and all disturbed areas are stabilized with vegetation. 5. Storage of Equipment,Materials The storage of construction equipment and materials shall be confined within the project work area and/or upland areas greater than 75 linear feet from the tidal wetland boundary. Page 2 of 6 w NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-03533 6. Concrete Leachate During construction,no wet or fresh concrete or leachate shall be allowed to escape into any wetlands or waters of New York State,nor shall washings from ready-mixed concrete trucks,mixers, or other devices be allowed to enter any wetland or waters. Only watertight or waterproof forms shall be used. Wet concrete shall not be poured to displace water within the forms. 7. No Drywells in or near Wetland Dry wells for pool filter backwash shall be located a minimum of 100 linear feet landward of the tidal wetland boundary. 8. No Pool Discharges to Wetland There shall be no draining of swimming pool water directly or indirectly into wetlands or protected buffer areas. 9. Contain Exposed,Stockpiled Soils All disturbed areas where soil will be temporarily exposed or stockpiled for longer than 48 hours shall be contained by a continuous line of staked haybales/silt curtains(or other NYSDEC approved devices)placed on the seaward side between the fill and the wetland or protected buffer area. Tarps are authorized to supplement these approved methods. io. Clean Fill Only All fill shall consist of clean sand,gravel,or soil(not asphalt,slag, flyash,broken concrete or demolition debris). 11. Seeding Disturbed Areas All areas of soil disturbance resulting from the approved project shall be stabilized with appropriate vegetation(grasses,etc.) immediately following project completion or prior to permit expiration,whichever comes first. If the project site remains inactive for more than 48 hours or planting is impractical due to the season,then the area shall be stabilized with straw or hay mulch or jute matting until weather conditions favor germination. 12. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activities. 13. No Construction Debris in Wetland or Adjacent Area Any debris or excess material from construction of this project shall be completely removed from the adjacent area(upland) and removed to an approved upland area for disposal. No debris is permitted in wetlands and/or protected buffer areas. 14. State May Order Removal or Alteration of Work If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if,in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State,the owner may be ordered by the Department to remove or alter the structural work,obstructions,or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit,the structure, fill, excavation,or other ' modification of the watercourse hereby authorized shall not be completed,the owners, shall,without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require,remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. Page 3 of 6 �s NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-03533 15. State May Require Site Restoration 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 lawfully require,remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 16. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants,epoxy coatings,paints,concrete,leachate or any other environmentally deleterious materials associated with the project. 17. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation,or for other purposes, and no claim or right to compensation shall accrue from any such damage. GENERAL CONDITIONS - Apply to ALL Authorized Permits: 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. 2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms,conditions or requirements contained in such order or determination. Page 4 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-03533 3. Applications For Permit Renewals,Modifications or Transfers The permittee must submit a separate written application to the Department for permit renewal,modification or transfer of this 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. Submission of applications for permit renewal,modification or transfer are to be submitted to: Regional Permit Administrator NYSDEC REGION 1 HEADQUARTERS SUNY @ STONY BROOK150 CIRCLE RD STONY BROOK,NY11790-3409 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Tidal Wetlands. 5. Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify,suspend or revoke this permit. The grounds for modification, suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; d. newly discovered material information or a material change in environmental conditions,relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issued permit conditions,orders of the commissioner,any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 6. Permit Transfer Permits are transferrable unless specifically prohibited by statute,regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. Page 5 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-03533 NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee,excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC")for all claims, suits,actions, and damages,to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of,the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims,suits,actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions,or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors,employees, agents and assigns of their responsibility to comply with this permit, including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits,approvals,lands, easements and rights-of- way that may be required to carry out the activities that 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. Page 6 of 6 M «os or 'VI3 s N ��N ?fes K. X00.0T QA / co 104V W �BEZ zo / V �r 04 se g z9i.tr►� _ / totat Jv-u `•j / � ad SV MypAf(1O8 ONifU3N+op � 10F vt MU DV Sbr7j�A7 / �O -+°k °k l-1 041, ""A GNV vao.,da000 f 5 ;a " tCtiti .y p ati Jts 0 ���wGtc1 aro w•a.ac��r"`u'�°.�a►max �� / ��,�'��i�t� xro imo-wift Xri an ,gyp f x« 7) omisc, �v etvo wear�07 mw) ,f ip Zs Ich t Scott A. Russell ��10SUFFQ/r STORMWA IER. SUPERVISOR MAIN AG]EMTENT SOUTHOLD TOWN HALL-P.O.Box 1179 v' g 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold yaa- FEB 18 2015 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) ❑® A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑[� B. Excavation or f illing involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑[� C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ]❑ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. E. Site preparation within the one-hundred-year f loodplain as depicted on FIRM Map of any watercourse. ❑Q' F. 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 Ox%ner,Design Professional,Agent,Conti actor,Other) S.C.T.M. #' 1000 Date. ' Dbtrict NAME: � �11TJ11j l E 1-l.0 17-L •Zc3 ar�u Section Block Lot FOR BUILDING DEPARTMENT USE ONLY**** Contact Information ���--5 LA G� _- �-f 3� Reviewed By&-y-n frelcphmrc�umbrn — — — — — — — — — — — — — — — — - - - - - - - -Date_ — - - - - - Property Address/Location of Construction Work: — Approved for processing Building Permit. L4 o 14 can-,%2 ansti-E-oLA- go "F'r-4- Stoimwater Management Conti of Plan Not Required. oU1"l{tick N\-j Stormwater Management Control Plan is Required. R (Forward to Engineering Department for Review.) FORM * SMCP-TOS MAY 2014 APPLICANT S.C.TM. 1000236 (Property Owner,Design Professional,Agent,Contractor,Other) —� �OSUF�� � T R %,A'g, -4 -7Z Stormwater Management Control Plan CHECK LIST NAME 4Lk4ei P, GLLe' Section Blocs. Lot o ZS M C P -Plan Requnements Provide ONE copy of the Building Permit Application. Date: he applicant must provide a Complete Explanation and/or Reason for not pi oviding a-2-A S' all Information that has been Required by the following Checkhstl Sl�nalun: 7Ne,ane umber 1. A Site Plan drawn to scale Not Less that 60'to the inch MUSTIf You answered No or NA to any Item, Please Provide Justification Here! YES NO NA If you need additional room for explanations, Please Provide additional Pa show all of the following items: Y P Per. a. Location& Description of Property Boundaries CONTROLS b. Total Site Acreage. Shall include but not be Urnited to* c. Existing-Natural& Man Made Features within 500 L.F. A well jildintained Construction Entrance, �® of the Site Boundary as required by §236-17(C)(2) d. Test Hole Data Indicating Soil Characteristics&Depth to Ground Water. �� Ire Backed r e. Limits of Clearing & Area of Proposed Land Disturbance. Seeding of exposed an dlor inactive sails. f. Existing& Proposed Contours of the Site (Minimum 2'Inteivals) 0 g. Location of all existing& proposed structures, roads, driveways,sidewalks, drainage Improvements& utilities. h. Spot Grades& Finish Floor Elevations for all existing& proposed structures. 1. Location of proposed Swimming Pool and discharge ring. 0 51}owU 011 PL>AIJ PS - n 2 L- 5 j. Location of proposed Soil Stockpile Area(s). k. Location of proposed Constiuction Entrance/Staging Atea(s). I. Location of proposed concrete washout area(s). 0DRAINAGE INSPEC111IONS ARE REQUIRED M. Location of all proposed erosion&sediment control measures. 0 Contact TOS Engineering at 765-1560 before 2. Stormwater Management Conti of Plan must include Calculations showing Backfill OR Provide Engineer's cpi-tifiratinn that the stormwater improvements aie sized to capture,store,and infiltrate that thp dragnage has been installedcode. on-site the run-off from all impel vious sur faces genet ated by a two(21 inch rainfall/storm event 3. Details&Sectional Drawings for slormwater practices at a iequned for approval items requiring details shall Include but not be limited to. a. Erosion&Sediment Controls. OAA D Z((,T d CO GT W61LAND b. Construction Entrance&Site Access. c. Inlet Drainage Structures (e.g.catch basins,trench drains,etc.) 0 d. Leaching Structures (e.g infiltration basins,s%vales,etc) ****FOR ENGiNEE N DEPAR E USE ONLY**�* Additional Information is Required. I Reviewed& I Stor Bmwater Management Control Plan is Not Complete. Approved y. — — — — — — — — — — — — — — — — — — — — — — — ti Stormwater Management Control Plan is Complete. Date: Z !9 /6 I SMCP has been approved by the Engineering Department. FORM * S Check List-TOS MAY 2014 I'Q�e1_�a•4•. C.�� �Me►t�'e�-� fel �'�y ,; ►b o ss yoy cep Mvicak4 aVE'"SSG' , ti o�JG e ' " Maty i tvc�l ' . SJR c.-� k G. �► 30 CIO COVERAGE DATA DES tRfanoxUnn tcovr +ora.a rte L-7[ M '` '• Q,O �1QC�� EXSTM HOUSE AREA x for CUVERA4 �/ AL __CK 1,238 ea H. 3ax DOQ 1 Z_L—Olt._ �-.Z� � GWAM 36o6,q'¢n. 1.17E ust Toru.O . 0.8% z.1sa,q• NM:s1xE,�of MANUS � Odx .,;n 1,.,• 7. yFc-fly i•` p D uutCEHr,A T b H. .t�'i '��'i.;.l'... v i:i e>^• 1 pp/� V �j prG A5g aq.H. r •t13'"rg�ii�.,. 9�s1 �VQO "C ' QakO VPoo�. '; —7/,a/j /f/S ^" Q � ,y amu' ,•, } R4 �OC�' ��/✓ ,soy QV -A;5 aw - _OPZ51 IME FLAB zn A �j W�tANiQ gpUNDARY AS PER SOUTHOLD ?OWN TRUSTEES FLAG t8 /F► a9 y .!'�: AA �u :e r� .yy CJ�..77L Rp • !. 35 yp Hz .tea : •: . DRAM► IN ONS REQUIRE ```a A v' Contact TO ngi eerinj _1S60 rPO 19 • BapVill,OR Pr ngin icatidw • \ t w thadrainage s een o Code, -- —--, sc s' < g�,� :Q yOS o^ 113V /� of _ , 1 .�• vti M. EROSAfiI&SEDIMENT, LS �y},¢yy� �� a =¢- =: "' © •" Shall include but not be limite A well maintained Construction cei Gos��c►�' / ° _'- Wire Backed-At Fencing,stablft ti 9 // �-� b c FtOVA OF STORMWATER M Seeding of exposed and/oQ8act've soi FO _ n Co C ter 236 Date: 217 • '•'• �e 4� Approved by ' `h• #jZL �VjpANr c Be 50'50D' ,� ly pt S�Ur�'o - Town Hall Annex !�t Telephone(631)765-1802 54375 Main Road �x �� QQ P.O.Box 1179 ' roper d hertldtOWll s)OU 015 nV us Southold,NY 11971-0959 y BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY.- �'{-�,�1� 2o, bCisY\' ; Date: Company Name: ,ec_ c Name: License No.: Address- C2e- j Phone No.: j d - JOBSITE INFORMATION: (*Indicates required information) *Address: rn f Y) c n P ex Q UL� nY, *Cross Street: - *Phone No.: Pennit No.: Tax Map District: 1000 Section: I pt::,','�. Block: *BRIEF DESCRIPTION OF WORK(Please Print Clearly) =�a �m M N1� (Please Circle All That Apply) r 0 OAY10 e:i-1 *Isjob ready for inspection: OYE� / NO Rough In Final *Do you need a Temp Certificate: YE NO Temp Information (If needed} *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION , 82-Request for Inspection Form C ��\ 0 TOWN OF SOUTHOLD PROPERTY';' R CORD CARD !0 Z' 7-T- 9 - 7-.:?- 0 OWNER STREET ? VILLAGE DIST. SUB. LOT iA- n,,fAO FORMER-OV1 NER N E ACR. r a�� a led vlm Ovb I<Ye= k ei-Z .O. VAct �c�. S W TYPE OF BUILDING RES. 7t� SEAS. VL. P FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS , /SOCA � � O O � 0 0 � 20 / 5//3, 9/ � {1/a•tee G���� AD u k/a r�-,a�� 'i ���i/�� r��P fo fly- L +p :SAnrainnn =far- 4✓5�r>v 0 0I 8ps35039 new so'v��le a+n�'!v dwe✓tIi I ►rzo, �v0 61 10-L I Rl . L g04'.�(Anon 4'0--rr � t'��Yic o z a 6 -- LIZ �Z - w r�1� Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH House Plot , 9 q t 19oc) BULKHEAD Total - "Wl- 31� ■■■■■■■■■■■■■■■■ ■■■ OEM soon- 0001iffiffive � , • '; .�..: ',� ��; _ ■■■■■■■■■■■�4■■ILII■■■ .:� 'r ' - . - �- ■■■■■■■�■■■■■�■Ilii■■ ■■■■■■ ■■■■■■■ ■■■■■ ■■■■■■ ■■■■■■■■■■Foundation ■■■ ■■■■■■ ■■■■■■■■■■■■■ lnteriorFinish M: Fire Place Pool I • . rr -_ �® Patio RECET1/ED1 JAN 0 6 2011 BOARD O KRAUS ROAD l4gP SURVEY OF PROPERTY SITUATE MATTTTUCK TOWN OF SOUTHOLD SUFFOLK COUNTY. NEW YORK SC TAX N0. 1000-122-09-7 20 LOT COVERAGE DATA 1•� SCALE 1'030' (MA JULY 2_1001 DLSCNIPTN)N ML i WT Noa>v ®I.d�aTn[G m3f010 MOUS[ 1.13!R K 11i 0 POSI00 OELI atl 4 fl. IAB TOTAL PO31a10 I.N..y Il 4.Si � n� ~N�O'Y/IM ROIOYD OYAGC SW y.M 0.oi O b P Mem P90P03m PaoL 812.a n 1� 0 AT, 10 rva�m m�a.a TOTAL POST.!PROPO. 2,571 q M 6n ARCA,40.817.p 11 M M AM OF,LTIAIP3-792-A 0937 aa. IVINO AO3ICOM NRA 40 1.D liQ 1.[![NATIONS M[Rf[II[IIC20 TO M-CYA 192.OAI1111 Q FINAL MAP u�i 3�,2N,RCITURDHM REVIEWED BY ZBA ry TAW ° M`A'O SEE DECISION# 1A42 4i• DATED 3 13Anoo IDOL 71• 4r mu] ILC 4 Paul lY 3.• r DOYG. LFKNNo PoaL �. �. COV[.3 IZACNDW POOL 92 C0VO1' Mr 1/OLE DATA C0m7 root W, ,�. 1 -Y. (11sF 1A[OLO O AWM2-QM23 T w—m]WS AI Ittlbm) AL ir4',l A e� o45�r" �d� i.-r � e.0�e�o.r• Std L a1� p ra ► A. b AL AL 160 M—MIMMAMM A. '. A a EEO— lid ►,�P • '•�;• Ll t W �i � weir �.� e�nr As ern e► � • '. Nf 5y souab0 � �• N C�� ��.1�•1 yp Nathan Taft Corwin III Land Surveyor •s r 130.00, '���4'✓P"Wr 'L 5 84'50'50" W TV` ,� m m.+r-9a•a4..-m re.-cr,m.Ia1.4 O PION[(W)151-79.6 Fm(01)117-1727 mia Wr Tm u NYIN Amax la re rm rn m 1. An.yvl IIw ran Ilan An,.wl IN.TVL IIPFJ C-ftlr:,gk AA6 Al%I&Q) At ol y py cep M,-Jeo14 P-VG � O� o M Mall 4 i h�clsAl P o (MM uq�vp� GE DATA w rt uEscNOJSEwrnaq ""`^9°M � M-R"Exmnr o� 1.238 w.ft.ARM x LOT PJMNM wraaer C®O^ 17-Z.^��- .Z 0 � TOT aAnACE awQwe ft.n .Ox q. f5.0 OP1A�0WETLANDS ADJACENT q� 2tµH. j_kgrl`i�V Y:•C�xa A�PER w 4� - 10AA t0.fl. tif?yd1?1-4,,T;q4,0 3J'� ®®ova ie G proP�eO rQGol $0 •Pc:'rte:�S[�Vie.. ,�••�•^•"' � y v�u 0 <_ , F Iy "n -Y.-j \, Q�,`v •`v� Q�p�a 1P `��� t �' 7E5r HOLE Ae FLAG 2A �tAND BOUNDARY AS PER SOUMOLD TOWN TRU5TES / O .` / FLAG t8 / �� ` ?�Caa.+.t?L �� :� `�•. 19 00 LAI �D�jd� `, 'r ur jam µ '�:.4 r; 4•. �` .• tisNc�° z p sas• N rd 'I OAN Coe AL fouto FLAB :. any 130.00 #jlZ f� 1�c s 84. 50'50" 11j,�j ILA Of- POOL DIMENSIONS - A 1 n G D E F G N 1 IC I L M =4 -W I ZV.W is -O' 4a" 9Q90 - Wan IV--V 21'-& W-r d 10.900 _ MaT50 IiJClaa_ 'i W-! •0 3 '-o a3oo • soxw -0• b• �o i n'i w'a b' D'a" -0 r e e'� a � IiXl4 K-0'34 -0 bi'bi i-3" D-! >D900 �R %V-: MTI - 1T'r ' 91 0 t \ �®,..,t soxw -0 '-� -0 -�•44 x-s•4'•i• T4590 DATE: � --B-�J• B.P.#r LJJV I.IJCIB lt' 78-0 b !g'-0" 1Y 4- -0 i,S" -0 1;100 P.— FEE- g� I ` " DINu uL'ARTMENT AT • NOTIY BU1� 55-1802 8 AM TO 4 Plot FOR THE IE,:�a DIVII IG BOARD � " Q1 LLO�vING INSPECT'OrvS: A�� y1, 1. FOLP;DA T ION - TWO REQUIRED FOR POURED C'ONCRETE '•�OFPAANLO-L" --_-_ 2 ROUGE; - FRAMING & PLUMBING I +ASSHOWND CtTiER -____________TTT_______ INSULATION °i AumUUM COATING FINAL - CONSTRUCTION MUST T BE COMPLETE FOR C.O. ` Al CONSTRUCTION SHALL MEET THE R - UIREMENTS- OF THE CODES OF N%L�I YO STATE. NOT RESPONSIBLE FO ;., . _I ll ®� s —�BTGAlA1T� ll DESIG OR CONSTRUCTION ERRORS. `" + a t IN UNLAWFUL - 1 - POOL PLAN WITHOUT CERTIF9OAT[ OF OCCUPANCY I D TIP. PANEL S7"I FFN EFS MIN.r-THICK VERMICuuTE .� 10,VX •SELF0fftl GSCREWS AGGREGATE TAMPERED b � CONCPXTS OR=.&I VOTCO S.OPEOAWAYIi(OIlPCIOLPM7EL H G ALU �• Mt1YUM t:OPaBG LONGSTEELANGLE o o COMPLY %"" Tt� ALIL'CODES OF F E • .dTTYP6ALULU NUM COATING NEW YORK S T A i L: & TOWN CODES SECTIONS I � O sG ML VINYL LINER AS REQUIRED AN!Y {CONDITIONS OF SSS `,;FFRAMEBASE�' O STEEL WALLPANEL � SOUTI;')..D TOWN ZBA 3IE•-16x1'BOLT.NUT.(2)WASHERS SOIL;4-9;1441 R64MING BO R-9 �pPN IM M E AT E L 11 90 C• STMANME r ENCLOSE POOL 1 O CODE CREWESTACE _ �% SOu I i')'D TOWN T�4US I ESS UPON COMPLETION D BEFORE"WATER",, TIIOIHQDWITH. �_��e-� Id.Y.�.�II..•d ---�.- 3 CU.Fi CONCRETE SHM r THICK VERMICULRE AGGREGATE MBC I `I sTm HAM BOTTOM 5114r wA6H R (CA Rl WE E�YS o ANGLE RUBBER FULCFB111011 o C, ITOPCORFILER PAD t;.. W REINFORCiiG ROD I( L _ 14 T1 M '1 11= 'Ili III 11= U= I-I IV - IrLONG I STEEL REINFORCING ROD CURVED F ULM �. INTOI111DLSTU(iB�EARTHTFROUd1 UPIDISTURBED EARTH I �, HOLES IN BOTTOM OF PANEL B® L "- dllfi�+G BOARID CARRIACEBocTs - N.T.S. L=11 N�1q=A 1=81� POOL TYPE: - AGLE REV. SCALE N.T.S. TYPICAL WALL SECTION AT 'A' FLAME CORNER COIVI�iEC` ON ®ETAIL POOL CCfA�$Wrrrl� S 4,APOW G � Kos+a.P.E DATE DESIGN IS ACC s: ABLE FOR DEER PATH DRAWING NUMBER ALL C®!IIMDAt - - S M AT,7 NEW YORK 11952 OF