HomeMy WebLinkAbout40092-Z ep' Town of Southold 1/7/2016
P.O. Box 1179
3 ' 53095 Main Rd
S,4
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 38026 Date: 1/7/2016
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 1145 Major Pond Rd, Orient
SCTM#: 473889 Sec/Block/Lot: 26.-2-39.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/4/2015 pursuant to which Building Permit No. 40092 dated 9/16/2015
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:
UNHEATED SCREENED PORCH ADDITION TO AN EXISTING ONE FAMILY DWELLING, AS APPLIED
FOR
The certificate is issued to Heller,Peggy&Wyden,Anne
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 40092 11-24-2015
PLUMBERS CERTIFICATION DATED
u o ' Sign re
r
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 40092 Date: 9/16/2015
Permission is hereby granted to:
Heller, Peggy & Wyden,.Anne
1145 Major Pond Rd
Orient, NY 11957
To: construct addition/alteration to an existing single family dwelling as applied for.
At premises located at:
1145 Major Pond Rd, Orient
SCTM # 473889
Sec/Block/Lot# 26.-2-39.1
Pursuant to application dated 9/4/2015 and approved by the Building Inspector.
To expire on 3/17/2017.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $525.60
CO -ALTERATION TO DWELLING $50.00
Total: $575.60
IttirlaP
Buildin: . • - or
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- $100.00
3-. Copy of Ceftificate-of Occupancy-$:25 -
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00
Date. �—��- i5
New Construction: Old or Pre-existing Building: (check one)
Location of Property: I/T 5 MAJdg f"M0 App 0/V
House No. /� /�}� Stree
t
e/ �/�/ Hamlet
Owner or Owners of Property: P/i yiILL r/l� 4, "' ` O A)
Suffolk County Tax Map No 1000, Section 2 6 Block 4 Z Lot 9�
1
Subdivision Filed Map. /f,,� Lot:
Permit No. �(O G> Date of Permit. Applicant: �O6 $i¢ rm9
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
`- 00
Fee Submitted:$ .V
1 .� ature
•••1& SO//14,—
.•
' ~ 0Town Hall Annex
Telephone(631)765-1802
54375 Main Road i ; Fax(631)765-9502
PO Box 1179 4, N \
Southold,NY 11971-0959 Oly ..o 1` roger.richerttown.southold.ny.us
OOUNT`1,�1 ,��'
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To Heller
Address: 1145 Major Pond Road City: Orient St: New York Zip: 11957
Building Permit#* 40092 Section: 26 Block. 2 Lot: 39.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Jim Sage Electric License No 3635-E
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor X 1st Floor X Pool
New Renovation 2nd Floor Hot Tub
Addition X Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 3 Ceiling Fixtures 1 HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel NC Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 2 Twist Lock Exit Fixtures TVSS
Other Equipment: "SUN ROOM - 1- Paddle Fan"
Notes:
e17Inspector Signature: 1).�—.._ Date: November 24, 2015
Electrical 81 Compliance Form.xls
C-(40
s?L—e7-- (1/ti OF SO(/ly�<o,,
TOWN ,OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FO DATION 1ST [ ] ROUGH PLUMBING
[ ] OUNDATION 2ND [ ] INSULATION
[ FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS: L
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DATE io('45 (i-5/-
INSPECTOR
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• TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLUMBING
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [)K ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
C,1411' 020/14
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DATE t/1 'Z`l C INSPECTOR-Z.
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4010 Ofr S0041;--..
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH P ING
[ ] FOUNDATION 2ND [ ] IN ATION
[ ] FRAMING / STRAPPING [ INAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE-RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS: �
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DATE INSPECTOR /1-'"(
FIELD INSPECTION REPORT DATg COMNIE I'S . �"' ,
FOUNDATION(1ST) , ' ; V
44e440 F,t
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FOUNDATION(2ND) \�
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STATE ENERGY CODE . ,•., / . . . .• V . • m
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-r TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT ,Do you have or need the following,before applying?
TOWN HALLBoard of Health
SOUTHOLD, NY 11971 • _ • 4 sets of Building Plans .‘TEL: (631) 765-1802 Planning Board approval t-
FAX: (631) 765-9502 - ', , Survey
SoutholdTown.NorthFork.net PERMIT NO. �w 0 �-- Check
Septic Form
N.Y.S.D.E.C. }
- Trustees ' ' ',;
C.O.Application 1,I,
Flood Permit v
Examined ,20 Single&Separate
, Storm-Water Assessment Form
4: s tact:
Approved ,20 ( Mai .:
,1 ,
Disapproved a/c -
z \ Phone. ,
Expiration YT ,201' 7
'''I , 1, Bui •ing-Inspector ti �.
(�1 11� 1 ! ,
U APPLICATION FOR-BUILDING P;R1VII'
T
r1.1 SEP - g Mb
i:.te , 20
•
INSTRUCTIONS
\--
rLpr DPI
' , a. This'ap ettorr-lvitTS11e-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. c
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'wh'ole 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
propertyhave 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,/
regulations, and to admit '
authorized inspectors on premises and in building for necessary inspections: .-
/
' ,
. of applicant or name,if a corporation)
Po ,mak 72-4eab 1vef 0 ri/qq1
(Mailftfg address of applicant)
D , I
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
' E/4i- loo ,
Name of owner of premises _
' (As on the tax roll or latest deed) '-'`, '
I/. .plic nt 's a gqrporati n, si nat re of dul ,=' �. ed officer
(Name and title of corpora e offic- '. `.' . , , , ,
Builders License No. j/ 3 /I ”
Plumbers License No. . , ,
Electricians License No. ,, - - , ; .
Other Trade's License No. , •
1. Location of land on wis proposed work will be done: -
. 6 17,5rapo en QIQis../4-
House Number - Street -; ,,, - Hamlet
rU•_IY �� S e3OArlT
-:r-r: W7M 30 3'rA-r 01.18u9 YFIATOII '
County Tax Map No. 1000 Section- • 00 ; ': B3loekO.CIV Z. Lot 3 7,
Y:i itI():;/1101:11R,14I(JE.11.91.1AU0
»_5 ME 3:-1CUL 211FWS iX J L'O122IMMO3
Subdivision Filed Map No. Lot V
2. State existing use and°occupancy of pre ises and int nded use and occupancy of proposed construction: -
a. Exi ing use'and occupancy /DtAl ./i(il'i .
'el-
b. Intended use and occupancy p✓�'/ 7/4'(Y
lir'? 3. Nature of work(check which applicable):New Building Addition Alteration
1 t i Repair . Removal Demolition Other Work
Si (Description)
J 4. Estimated Cost ZO Av. DO 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
•
6. If business,-commercial or mixed occupancy, specify nature and extent of each type of use.
i
7. Dimensions of existing structures, if any: Front /0 ‘i Rear /041 / Depth 'd
I.. Height 321 Number of Stories Z.,
i
Dimensions of same structure with alterations or additions:'Front /D y Rear /041
Depth y$ / - - Height qZ Number of Stories Z
U , i /-
8. Dimensions of entire new construction:,Front /07 . Rear /a'' Depth Y$
Height 32 ' Number of Stories i CMS 8 — f7o
9. Size of lot: Front . , — — Rear Depth
10. Date of Purchase /Q l S ' Name of Former Owner W/Lt G w T42.em4GOa-r-tealki
11. Zone or use district in which premises are situated ,k 9 d
12. Does proposed construction violate-any ning law, ordinance or regulation?-YES NO _
13. Will lot be re-graded? YES NOV 'Will excess fill be removed.from premises? YES NO ✓
g
14. Names of Owner of premises ' Address 'Phone No.
Name of Architect Address Phone No
Name of Contractor 5D�E, �°� � Addres oPhon No. 6.5,..941--3-7a0
e� ti -765-
15 a. Is this property within 100 feet of a tidal wetland ora freshwater wetland? *YES ' NO
* IF YES,"SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITSJMAY BE REQUIRED. '`
b. Is this property;within 300,feet of a tidal wetland? * YES V NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED. -
j
16. Provide survey, to scale, with accurate foundation plan and distances to property lines. e
, 17. If elevation at any poi• nt on property is at'10 feetor below, must provide topographical data on rvey.
18. Are there any covenants and restrictions with respect to this property? * YES NO
* IF YES, PROVIDE A COPY. - ,
STATE OF NEW YORK) -
SS: - . _ • _. 4 "r'
COUNTY OFSu-r-in4 k ) •
6'4,61_;isz,-t ‘1 I11 being duly sworn,deposes and says that(s)he is the applicant .
(Name of individual signing contract)above named, , ,
(S)He is the 2 fsc.4-01L
(Contractor,Agent,Corporate Officer,etc.) • , -
.�, 1 l ,,i„ \
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 before me this ,...4,
d15t , ,d'ayof pi- bcr 20 .1.5 , ,
JA � TRACEY L. DWYEFj ����Ovr NOTARY PUBLIC,STATE OF NEW YOR -��. -
GU�,Qk/Notary Public NO.Ot DW6306900 �,r,, f Applicant
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,201g
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,/ ' ...; 44%:''. '' '. ..:
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‘1,:., a!:•�:,µ:,i. ::•`!fr:1�.�.t.:a. .n.-,!` ‘. I • -.e,iU�,���•l t. i r•, ':, i .'...;',..'e,..:-:,•
L.
- Board Of Southold Town Trustees
., SOUTHOLD, NEW YORKN=°•
` '' :: PERMIT NO Y DATE: 30, 1995 r"
1f. June •.
-i .• ...�r' ISSUED TO ... Peggy Heller and Anne Wyden Y+,
Antlinrization F:
'x ' Pursuant to the provisions of Chapter 615 of the Laws of ;' ".
-' Y k' the State of New York, 1893; and Chapter 404 of the Laws of the k,-,1,--.--
: . ,
State of New York 1952; and the Southold Town Ordinance en- -':i
,'� titled "REGULATING AND THE PLACING OF OBSTRUCTIONS . : .'
I .r:`; IN AND ON TOWN WATERS AND PUBLIC LANDS and the •' => •i
-•c...' "" REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM .• '`'
\ :24 LANDS UNDER TOWN WATERS;" and in accordance with the ' '
June 29 ,..`f''';
;, Resolution of The Board adopted at a meeting held on �.:•
19 95, and in consideration of the sum of $ 150.00 paid by i+ ', /.t
'c= I
S .Environmental..Cons.al,ting,.In.c.. a,
... .... N. Y. and subject to the �` = '
of
, ' - Terms and Conditions listed on the reverse side hereof, • �-' j=
..1. , of Southold Town Trustees authorizes and permits the following: - ,
to `- : '
x: .,.7,;;,..,:', to construct a 2,982+/- s.f. single family dwelling, an '�
;;c, 800+/- s.f. attached deck; an 840+/- s.f. attached garage, an .
„ 876+/ gravel driveway; a 318+/- s.f. walkway, well and septictic `''
s 'h
' ` ',".i--.--,, system as per pans dated June 29, 1995, also to include drywells
..1 ,, . j. all in accordance with the detailed specifications as presented in :•f
i:.;,;_-_ the vrigineting application. ', i
' ` and haybales duringconstruction. No clearing beyond limits.
; IN.,WITNESS WHEREOF, The said Board of Trustees here-
_1,, ". }' by causes ifs Corporate Seal to be affixed, and these presents to ! :'.,,
i ..:
1°1�,, be subscribed by a majority of the said Board as of this data. :'-.;. '
' `
sIF
.)i ' .;-:.:;,.. `�'��( ..
O DC�G a /. ,� ...�. -.
, 4:Itli.J(1,.....-..„.Q.. - ) ,
‘ )
•R ; ,°,�� TrusteeE? 4Ti )y
. _ w- a.-r v. .-i. -v-orh wr•vr+� —.e++�, -a. : - -
I } � / ;S �H h �, R�• i/r}'\�• S::iJ51� I. � :••,a�►�ql\��yft �r
:%.,::.,-,,,,•,.:,,, _ n Vf('cF.iJ` '�, r
V '� -- -:�•-_ ��-..2 ��,..--" --.ice
John M. Bredemeyer III,President• ��10 Vv*Of SDUly� Town Hall Annex
• Michael J. Domino,Vice-President ��� ~� ' l0 54375 Main Road
P.O. Box 1179
41
James F.King,Trustee Southold, New York 11971-0959
G
Dave Bergen, Trustee
/e' � Telephone(631) 765-1892
Charles J. Sanders,Trustee �: ljf'`,OMMw Fax-.1Z"���• Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
August 19, 2015
•
Robert Saetta
PO Box 72
Greenport, NY 11944
RE: PEGGY HELLER & ANNE WYDEN
1145 MAJORS POND ROAD, ORIENT
SCTM# 1000-26-2-39.1
Dear Mr. Saetta:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, August 19, 2015:
WHEREAS, Robert Saetta on behalf of PEGGY HELLER & ANNE WYDEN applied to
the Southold Town Trustees for an Amendment to Wetland Permit#4489 under the
provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the
Town of Southold, application dated July 8, 2015, and,
WHEREAS, said application was referred to the Southold Town Conservation Advisory
Council and to the Local Waterfront Revitalization Program Coordinator for their findings
and recommendations, and,
WHEREAS, the LWRP Coordinator issued a recommendation that the application be
found to be Consistent with the Local Waterfront Revitalization Program policy
standards, and,
WHEREAS, the structure complies with the standards set forth in Chapter 275 of the
Southold Town Code,
WHEREAS, the Board has determined that the project as proposed will not affect the
health, safety and general welfare of the people of the town,
2
NOW THEREFORE BE IT,
RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to
Permit #4489 to remove the existing screened porch and construct a new 27'x24'
screened porch attached to dwelling; and as depicted on the site plan prepared by
James J. Deerkoski, Engineer, received on July 8, 2015, and stamped approved on
August 19, 2015.
Fees must be paid, if applicable, and permit issued within six months of the date of this
notification.
Inspections are required at a fee of$50.00 per inspection. (See attached schedule.)
Fees: $50.00
This is not a determination from any other agency.
Sincerely,
dot-- 67"N
John M. Bredemeyer III, President
Board of Trustees
JMB:eac
/ OUr Town Hall Annex
John M. Bredemeyer III, President / y�
,`O
Michael J. Domino,Vice President o� !O \ 54375 Main RoadP.O.Box 1179
James F. King,Trustee Southold,New York 11971-0959
cza
Dave Bergen,Trustee
• .c` Telephone(631) 765-1892
Charles J. Sanders,Trustee Fax
Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 1194C Date: January 7, 2016
THIS CERTIFIES that the construction of a 1 Y2 story single family dwelling, an
attached deck, an attached garage, an 876 +/- gravel driveway, removal of existing screened
porch and construction of new 27'x24' screened porch attached to dwelling; well and septic
system and for the installation of gutters to leaders to drywells on the dwelling, the removal of
dead and diseased trees by hand and remove by hand vines endangering existing trees and
remove debris including a junk car;
At 1145 Majors Pond Road, Orient
Suffolk County Tax Map#1000-26-2-39.1
Conforms to the application for a Trustees Permit heretofore filed in this
office Dated March 30, 1995 pursuant to which Trustees Wetland Permit#4489
Dated June 30, 1995, was issued and Amended on May 22, 1996 and Amended again on
November 25, 1996 and Amended again on August 19, 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 construction of a 1 '/2 story single family
dwelling, an attached deck, an attached garage, an 876+/- gravel driveway, removal of existing
screened porch and construction of new 27'x24' screened.porch attached to dwelling; well and
septic system and for the installation of gutters to leaders to drywells on the dwelling, the
removal of dead and.diseased trees by hand and remove by hand vines endangering existing trees
and remove debris including a junk car.
The certificate is issued to PEGGY HELLER &ANNE WYDEN owners of the
aforesaid property.
doe,— 604102,70
Authorized Signature
Nr ORK STATE DEPARTMENT OF ENVIRONMENTAL CONS: 'TION
,
DEC PERMIT NUMBER EFFECTIVE DATE
1-4738-01114/00001-0 8/30/95
FACILITY/PROGRAM NUMBER(S) PE I T EXPIRATION DATE<S)
8/31/98
Under the Environmental
ss Conservation Law
I TYPE OF PERMIT I New 0 Renewal ❑ Modification 0 Permit to Construct 0 Permit to Operate
0 Article 15, Title 5: Protection 0 6NYCRR 608: Water Quality 0 Article 27, Title 7; 6NYCRR 360
— ---- --of-Waters----- Certification ---- Sol-id-Waste-Management --
O Article 15, Title 15: Water 0 Article 17, Titles 7, 8: SPDES 0 Article 27, Title 9; 6NYCRR 373,
Supply Hazardous Waste Management
O Article 19: Air Pollution
•
0 Article 15, Title 15: Water Control 0 Article 34: Coastal Erosion
Transport Management
❑ Article 23, Title 27: Mined Lend
0 Article 15, Title 15: Long Reclamation 0 Article 36: Floodplain
Island Wells Management
/ Article 24: Freshwater Wetlands
O Article 15, Title 27: Wild, 0 Articles 1, 3, 17, 19, 27, 37;
Scenic and Recreational Rivers 0 Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control
O Other:
PERMIT ISSUED TO TELEPHONE NUMBER T N
Peggy Heller and Anne Wyden
ADDRESS OF PERMITTEE
42 Farm Lane
Great Neck, NY 11020
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
Suffolk Environmental Consulting 516-726-1919
PO Box 2003 Bridgehampton, NT 11932-2003
NAME AND ADDRESS OF PROJECT/FACILITY
Majors Pond Road, Orient
--- LOCATION OF-PROJECT/FACILITY
SCTM# 1000-26-02-39.1
COUNTY TOWN WATERCOURSE MYTH COORDINATES
Suffolk Southold Majors Pond (FMO-10) ,
+CBT Pi iQV CF ALM-CR IZED PCrI Vf7Y
Construct a single family dwelling with attached deck and garage, a gravel driveway, walkway, welt and septic system.
All work shall be in accordance with the attached NYSDEC approved plan.
b
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the
ECL, ail applicable regulations, the General Conditions specified (see page 2) and any Special Conditions included es part of
this permit. '
PERMIT ADMINISTRATOR: ADDRESS
Roger Evans Bldg. 40, SUNY, Room 219, Stony Brook, NY 11790-2356
AUTHORIZED SIGNATURE i/ DATE ~
8/30/95
eV Page 1 of 6
GEMBRALCCNDITICNS
' Inspections
1 . The permitted site or facility, including relevant records, is subject to in-
spection at reasonable hours and intervals by an authorized representative of
the Departrent of Enviromental Conservation (the Department) to determine
vlhether the permittee is co plying with this permit and the El. Such represen-
tative rray order the vork suspended pursuant to EOL 71-0301 and SADA 401(3) . A.
copy of this permit, including all referenced rreps, drawings and special
conditions, must be available for inspection .by the DepartTent at _all times at_i_
_1__
the project site. Failure to produce a copy of the permit upon request by_a
Department representative is a violation of this permit.
Permit Changes and Senenels
2. The Department reserves the right tornodi.fy, suspend or revoke this permit Wien:
a) the scope of the permitted activity is exceeded or a violation of any
condition of the permit or provisions of the BCL and pertinent regula-
tions is found;
b) the permit vves obtained by misrepresentation or failure to disclose
relevant facts;
c) newrraterial inforrration is discovered; or
d) environmental conditions, relevant technology, or applicable lary or
regulation have rreterially changed since the permit wes issued.
3. The permittee mist sutrni t a separate written application to the Departrrent for
renanel , modification or transfer of this permit. Such application rrust include
any fours, fees or supplemental information the Department requires. Any
reneAel , modification or transfer granted by the Department rust be in writing.
4. The permittee must submit a renenel application at least:
a) 180 days before expiration of permits for State Pollutant Discharge
Elimination Syste-n (SPDES) . Hazardous Vlbste Nbnagurent Facilities
{l'I+UVF}_,__rrB_!_o.r Air -Po l i_ut-i on_Cont rof (4P_C)-_and. Solid.Vlbste -1v13nagarent ..
Facilities (SAW) ; and
• b) 30 days before expiration of all other permit types.
5. Lhless expressly provided for by the Department, issuance of this permit does
not modify, supersede or rescind any order or determination perviously issued by
the Department or any of the tears, conditions or requirements contained in such
order or determination.
Other Legal Obligations of Permittee •
6. The permittee has accepted expressly, by the execution of the application, the
, fuil legal responsibility for all dareges, direct or indirect, of vwhatever
nature and by vrever suffered, arising out of the project described in this
permit and has agreed to indemnify and save harmless the State frau suits,
actions, damages and costs of every name and description resulting fran this,
project:
7. 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.
8. The permittee is responsible for obtaining any other permits, approvals, lands,
easerents and rights-of-v.ey that rimy be required for this project.
•
Page 2 of 6
95.20-br 171921-25c
' ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34 and 6 NYCRR Part 608( Freshwater Wetlands
9 That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the
teration in the position of the structure or work herein authorized,or project.
if, in the opinion of the Department of Environmental Conservation 13 Any material dredged in the prosecution of the work herein permitted
it shall cause unreasonable obstruction to the free navigation of said • shall be removed evenly,without leaving large refuse piles.ridges across
waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a
the people of the State.or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of
resources of the State,the owner may be ordered by the Department to a waterway
remove or alter the structural work, obstructions.or hazards caused
thereby-without-expense-to-the State-and-if-upon-the-expiration-or 14. There shall be no unreasonable interference with navigation by the work _
revocation of this permit, the structure• fill, excavation, or other herein authorized.
modification of the watercourse hereby authorized shall not be corn- 15. If upon the expiration or revocation of this permit,the project hereby
pleted, the owners. shall, without expense to the State, and to such authorized has not been completed.the applicant shall,without expense
extent and in such time and manner as the Department of Environmental to the State,and to such extent and in such time and manner as the
Conservation may require,remove all or any portion of the uncompleted Department of Environmental Conservation may require.remove all or
structure or fill and restore to its former condition the navigable any portion of the uncompleted structure or fill and restore the site
and flood capacity of the watercourse.No claim shall be made against to its former condition.No claim shall be made against the State of
the State of New York on account of any such removal or alteration. New York on account of any such removal or alteration.
10 That the State of New York shall in'no case be liable for any damage 16 if granted under 6 NYCRR Part 608. the NYS Department of Environ-
or injury to the structure or work herein authorized which may be caused mental Conservation hereby certifies that the subject project will not
by or result from future operations undertaken by the State for the contravene effluent limitations or other limitations or standards under
conservation or improvement of navigation,or for other purposes.and Sections 301. 302,303,306 and 307 of the Clean Water Act of 1977
no claim or right to compensation shalt accrue from any such damage. (Pt.95-217)provided that all of the conditions listed herein are met,
11 Granting of this permit does not relieve the applicant of the responsi- 17 All activities authorized by this permit must be in strict conformance
bility of obtaining any other permission, consent or approval from with the approved plans submitted by the applicant or his agent as part
the U.S.Army Corps of Engineers.U.S.Coast Guard, New York State of the permit application.
Office of General Services or local government which may be required.
PreccrEd
12 All necessary precautions shall be taken to preclude contamination Such approved plans were prepared by Per `a�Vey
of any wetland or waterway by suspended solids, sediments, fuels, iktn Matzgac&tad 1127/95 last mvjgoi 6/29/95.
solvents,lubricants,epoxy coatings,paints,concrete,leachate or any
SPECIAL CONDITIONS
1. Any work, disturbance, and storage of construction materials
shall be confined to within the "Limit of Clearing and
Ground Disturbance" as shown on the approved plan.
2 . A snow fence or other temporary project-limiting fence shall
be erected prior to the commencement of any permitted
activities along the upland edge of the designated buffer
area in order to prevent the inadvertent intrusion of
equipment into the protected area. The fence shall be
maintained until project completion.
3. Prior to commencement of any construction activities, a
continuous row of straw bales shall be staked end to end
along the base of the snow fence (or other temporary,
project limiting fence) on the upslope or project side of
the fence. The bales shall be maintained, repaired and
replaced as often as necessary to ensure proper function,
until all disturbed areas are permanently vegetated. The
average useful life of a bale is approximately 3-4 months.
Sediments trapped by the bales shall be removed to an
approved upland location before the bales themselves are
removed.
4. Straw bales shall be recessed two to four inches into the
ground.
DEC PERMIT NUM11ER
1-4738-01114/00001-0
PROGRAM/FACILITY NUMIIER
6
Page 3 of
95-70-61(71871-75c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION �!
SPECIAL CONDITIONS
For Article_ 24 Freshwater Wetlands
5. Any demolition debris, excess construction materials, and/or
excess excavated materials shall be immediately and
--- -- -compietely-disposed-of-on-an-approved-upland-site-more-than
100 feet from any regulated freshwater wetland. These
materials shall be suitably stabilized so as not to re-enter
any water body, wetland, or wetland adjacent area.
6. Use of wood treated with pentachlorophenol or creosote is
prohibited. Standard pressure treated lumber is treated
with CCA and its use is permitted.
7. All equipment and machinery shall be stored and safely
contained greater than 100 feet landward of the regulated
wetland or water body at the end of each work day. This
will serve to avoid the inadvertent leakage of deleterious
substances into the regulated area. Fuel or other chemical
storage tanks shall be contained and located at all times in
an area greater than 100 feet landward of the regulated
wetland or water body. If the above requirement cannot be
met by the permittee, then the storage areas must be
designed to completely contain any and all potential
leakage. Such a containment system must be approved by
NYSDEC staff prior to equipment, machinery or tank storage
within 100 feet of the regulated wetland or water body.
8. All areas of soil disturbance resulting from this project
shall be seeded with an appropriate perennial grass, and
mulched with straw immediately upon completion of the
project, within two (2) days of final grading, or by the
expiration of the permit, whichever is first. Mulch shall
be maintained until a suitable vegetative cover is
established. If seeding is impracticable due to the time of
year, a temporary mulch shall be applied and final seeding
shall be performed as soon as weather conditions favor
germination and growth.
9. Suitable vegetative cover is defined as a minimum of 85% •
area vegetative cover with contiguous unvegetated areas no
larger than 1 square foot in size.
10. The permittee shall incorporate the following language as a
notice covenant to the deed:
"Regulated freshwater wetlands associated with Majors Pond(NYSDEC
#0-10) are located on the eastern portions of Majors Pond Road
SCTM# 1000-26-02-S9. 1 Orient the properties of Peggy Heller and
Anne Wyden and their heirs, assigns or successors. This property
DEC PERMI NUM t to the- provisions of Environmental Conservation Law
1-4738-01114/00001-0
FACILITY ID NUMBER PROGRAM NUMBER
rage 4 of 6
-- —�
95.20.61(71871-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
SPECIAL. CONDITIONS
For Article 24 -� Freshwater Wetlands
(ECL) Article 24 , and the conduct of regulated activities may
- occur only pursuant to ECL Article 24 if prior approval is given
by the New York State Department of Environmental Conservation
(NYSDEC) or its successor( ) . —Regulated activities include, -but
are not limited to clearing of vegetation; application of
chemicals; excavation; grading and filling; and erection of any
structure(s) . "
This deed covenant shall be recorded with the Clerk of Suffolk
County within 90 days of the issuance of this permit. A copy of
the covenanted deed or other acceptable proof of record, along
with the number assigned to this permit, shall be sent within one
calendar year of the issuance of this permit to: NYSDEC,
Regional Manager BE?, SUNY Building 40, Stony Brook, New York
11790-2356.
Supplementary Special Conditions A Thru F Attached.
DEC PERMIT NUMBER
1-4738-01114/00001-0
FACILITY ID NUMBER PROGRAM NUMBER
Page 5 of 6
sUPPLEMENTARY S 'ECTAL colaDITIoNs
The following conditions apply to all Tidal Wetlands; Freshwater .
Wetlands; Coastal Erosion Management; and Wild, scenic, and
Recreational Rivers Permits:
A. A copy of this permit, including all conditions and
approved plans, shall be available at the project site
whenever authorized work is an progress_ The permit
sign enclosed with the permits shall be protected from
__ _ ____ the weather and posted in a conspicuous location at .the
work site until all authorized work has been completed.
B. The permittee shall require that any contractor,
project engineer, or other person responsible for the
overall supervision of this project reads, understands,
and complies with this permit and all its general,
special, and supplementary special conditions. Any
failure to comply precisely with all of the terms and
conditions of this permit, unless authorized in
writing, shall be treated as a violation of the
Environmental Conservation Law. If any of the permit
conditions are unclear, the permittee shall contact the '
Division of Regulatory•A.ffairs at the address on page
one or telephone (516) 444-0365.
C. If project design modifications become necessary after
permit issuance, the permittee shall submit the
appropriate plan changes for approval by the Regional
Permit Administrator prior to undertaking any such
modifications. The permittee is advised that
substantial modification may require submission of a
new application for permit_
D. 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 the permitted work, the bottom
portion of that form shall also be signed and returned,
along with photographs of the completed work and, if
required, a survey.
E. For projects involving activities to be undertaken in
phases over a period of more than one year, the
permittee shall notify the Regional Permit
Administrator in writing at least 48 hours prior to
recommencing work in subsequent years.
F. The granting of this permit does not relieve the permittee
of the responsibility of obtaining a grant, easement, or
other necessary approval from the Division of Land
•
Utilization, Office of General Services, Tower Building,
Empire State Plaza, Albany, 'NY 1224-2 (516) 474-2195, which
may be required, for any encroachment upon State-owned lands
underwater.
DEC Permit No. 1-4738-01114/00001-0 page 6 of 6
•4iis late
•
114.
Scott A. Russell •r''�°� �FRI 4.. Slr(o)RM[wAT ER
SUPERVISOR MANAGEMENT
G EMUENT
SOUTHOLD TOWN HALL-P.O.Box 1179 ' "'
-,,
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold
� ' �- •�
- GHAP--T-ER 236---S-T-ORM-W- -A-T-ERMANAGEMENT-W--O- -RK S--HEFT-- . -. _
( 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 filling involving more than 200 cubic yards of material .
as
❑ Sitewithin preparationanyparcel onor slopesany whichcontiguouexceed area.
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.
❑I=1/
E. Site preparation within the one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
11 . . 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.Contractor,Other) S.C.T.M. #: 1000 Date:
��j��f! - �1 Lf District q
NAME. 1 6"` 6SE`S� !/b OZ f /. I
Section Block Lot
/
01174,
• ,7� t ''":`:` FOR BUILDING DEPARTMENT USE ONLY ``4'
Contact Information (Q 3q4 4
:fno awnbcri 0,13-Y\
,�
Reviewed By- 0,13-I `'gypY iiVe
Date: 9-_ J'"
- Property Address / Location of Construction Work.
w \I-k5 HATee t*OP K-� Approved for processing Building Permit
Stormwater Management Control Plan Not Required.
EKA- NY /II S ❑ Stormwater Management Control Plan is Required
(Forward to Engineering Department for Review.)
FORM " SMCP -TOS MAY 2014
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P. O. Box 1179 co .- ...-'s =,:•:.::•:. -
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NOTICE OF UTILIZATION.0F,:.TRUSS TYPE CONSTRUtTION., PRE-ENGINEERED
WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION, -
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P.O. Box 1179 • G, . �� roger_nchert(a town.soutfiio�d ny.us
Southold,NY 11971-0959 \.'<, r, • • �s �/
1COUf�f('I,''�, 'd
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
I
'
1REQUESTED BY: Date: / /
'Company Name: -J0 E2c (C____
-Name: - =
�•1_ - - _-
License No.: 56.5 5 --
Address: 3 (n#912/ -i' i p r,' - 6 tut/ /i9 wII
• Phone•No.: _ 65/ 'V?? c2-//
•
JOBSITE INFORMATION: (*Indicates required information) - ' .
*Name: 11- 12(241
-
*Addr-ess: - II (c fr 2,e) 16)-1 GI- 12 , O►7A a4
*Cross Street: Y, `�,"„( Si
*Phone No.:
"�
Permit No.: k/0 _
Tax•Map District: - 1000 Section: - Block: . Lot:
•
*BRIEF DESCRIPTION OF WORK(Please Print Clearly) • - _
? 4 Pa-e_ili) • - - -
(Please Circle All That Apply) •
*Is job ready for inspection: dat: / NO. Rough In alb
*Do-you need a Temp Certificate: YES 0 • -
Temp Information(If-needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other I .
*New Service: Re-connect Underground Number of Meters Change of Service Overhead C '
Additional Information: a7c1)
PAYMENT DUE WITH APPLICATION VAb ��D�d .C? '619
461 v/
.82-Request for Inspection Form
i
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Town Hall Annex ��� ~� l0 : Telephone(631)765-1802
54375 Main Road Iill 4 ; Fax (631)765-9502
P.O.Box1179 G ,,_ ,�'
Southold,NY 11971-0959 i0 I
='COuri,V,
--... 05
01
December 14, 2015
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Peggy Heller
Anne Wyden
1145 Major Pond Rd
Orient NY 11957
TO WHOM IT MAY CONCERN:
The Following Items(if Checked)Are Needed To Complete Your Certificate of Occupancy:
Application for Certificate of Occupancy. (Enclosed)
Electrical Underwriters Certificate.
A fee of$50.00.
Final Health Department Approval.
lumbers Solder Certificate. (All permits involving plumbing after 411/84)
Trustees Certificate of Compliance. (Town Trustees#765-1892)
Final Planning Board Approval. (Planning#765-1938)
Final Fire Inspection from Fire Marshall.
Final Landmark Preservation approval.
Final inspection by Building Dept.
Final Storm Water Runoff Approval from Town Engineer
BUILDING PERMIT - 40092 —Addition/alterations
- x 1 LOT `
„..---
ANY AL/EIT.A now OR ADDITION To THIS S,AR 6 A VOL,9 7ON .�.//•r W/LL OW TERRACE FARMS, WG N
Of SECTION MOS Or TIE AEI?YORK STATE FALL T/°N Ll
EXCEPT AS PER=HON TroaaODIVISION L ALL CERTIFICATIONS "�.y P.O. BOX 773
WHEW ARE VALQ FOR MS NAP AND CAPES THEREOF ONLY r 1.£ 88715o'E Ell-11'\ ORIENT M Y. ' Y O
SAID!NP OR LAS A DEAR DE A SEALI OF T16 SURVEYOR T.
„ V.I. s� ' c- O=
//HOSE&6ivA TUE APPEARS t17£01A sp,r
ADDITIONALLY TO COWLY t9h SAID LA/THE TEAT'ALTERED Dr Ser, V' =QO N Z `
1IUST DE USED BY ANY APO ALL SURVEYORS LF11. E A Ca'Y • - r'O D•
OF ANOTHER SLRVEYLp'S MAP. TOWS..Uf AS 7YSPECTED'AND I "I 00 11 Qe
'BADLg1T-1V-OA7E'ARE MTT N fA11KE ellN DE LAW / -, T
1 am familiar with the STANDARD$FOR APPROVAL s •
AAV CONSTRUCTION OF SUBSURFACE SEWAGE c` cn -IF =
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES /� ..i
EDM IN abide by the ccnitbons set forth Harsh and on the j - a",$ / -+ ---�' m
WWI to construct 1 ' -.(r, a 'CA D •
e U p' 1, 4
-----ZONWG_DISTRICT R80 - 1 0___ d_ ' 11
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LOT 3(5 REFERENCED TO WILLOW TERRACE FARMS,INC Q - v .....
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SUFFOLK COUNTY FLE NO. 9572 '11°1 W /'Ford o ''�
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