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HomeMy WebLinkAbout42187-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Doo ave or need the followin ,before applying? TOWN HALL Board'.of Health �fi SOUTHOLD,NY 11971 4 sets of Building Plans �S TEL:(631)765-1802 Planning Board approval V LQ_ FAX:(631)765-9502 "_ey SoutholdTownNorthFork.net PERMIT NO. 4� Check SeptrcFonn ... N,YSDh.0 [EVE C.O.tees - ply tion V1t t. I FloodPermit �4 f'5 Examined, 20Single&ScparatL jet,- OSI. 16 Z Storm-Water Assessment Forms t Contact: p i� Rtpproved 20 [ Mail to: P dl C.r S R&"1.: 1t.OLD ' Disapproved alc___....... ......... ...... _. UTH �..f_ ... t per. ?I t kG�,N Y 11133 Phone: b31— b*9 —7a QQ- Vi Expus ion 1,401 - 461-1 -1 Roo w .. ... lrw ect _... ...m or APPLICATION FOR BUILDING PERMIT Date.. i�� g 7 20 l') INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule_ b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d_Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit shall be kept on the premises available for inspection throughout the work. e_No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy_ f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described..The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. (Signature o7lbqipKcant or name,if a corporation) LAhe- . SL}ak kr- 1-4_q 033 ai lmg address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder holoT ......... ........ 1 __.............. Name of owner of premises De-K 1S `5 pcL4 rxy (As on the-tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer ......______._m (Name and title of corporate,officer), Builders License No. I C1 4 2 — H— Plumbers License No. 2 .� Electricians License No. - 1 . ... Other Trade's License No. 1 Location of land on which pro od wor�lt�rill be done: q 5 House Number Street Hamlet County Tax Map No.1000 Section„ IT�,�_Block Lot oZ 'ITIT IT Subdivision " ,"O"t,,,.%C�4. 0`"�'C t Filed Map No -7'7 12- Ck I.�ot " ................ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a_ Existing use and occupancy VSA C A Aj IC 1 M _..................... b. Intended use and occupancy A% 3. Nature of work(check which applicable):New Building_„ Addition. Alteration Repair Removal Demolition-.—Other Work (Description) 4. Estimated Cost ft° "t 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. 7. Dimensions of existing structures,if any:Front hear 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___A Rear I Depth a Height {,t" �4 Number of Stories t t,.° t 9. Size of lot Front ��' Rear Depth 10.Date of Purchase ej—4—Name of Former Owner i A-�c 14 11.Zone or use district in which premises are situated 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO 13.Will lot be rewgraded'?'YES_NO Will excess fill be removed from premises?YES NO p 4 �- e G w4". 14.Names of Owner of premises ��w�5& "° e4'( As t 4—PhoneNo.one No Q f'l'l oy " , Name of Architect �° ""( '� Address � � ( tt Name of Contractor T;T 0, a 1" Address 4" 6`1"'1 Phone No. 44'"7 okd4l 4,v 1 d� o ,,v%L,W"? t 11 S am 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 I�EQiJIRED_ b_Is this property within 300 feet.of a tidal wetland?*YES NO� *IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines.- 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property?*YES n ' NO *IF YES,PROVIDE A COPY. °6-flL POLLAC STATE OF NEW YORK) Note P"Nic State 0. N York No,0tP060712 t SS: Quallfie-d Cr Naasat6 u COUNTY OF Comrnisslon Expires being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the N (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. Swam to before me this N lac Signature of Xpplicant ►JCOLL. A. Russell SUPERVISOR 1\\4A\N ASG 1E1�[)EN T SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold CHAPTER'TER 236 - STORMWATER MANAGEMENT WORK SHEET _ ( TO BE COMPLETED BY_THE APPL1CANT m__ .e.,�.._) 0 . T � "'ii-ES . (CHECK All.1 AT APPLY Yes No 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 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.. ElE�. Site preparation within the one-hundred-year floodplain as depicted on FIRM Flap of any watercourse. Ellb 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. questionsIf you above, STOP! Complete the Applicant section below with your Name, Signatur�Conta t-Informatio ,Date-&,-Count-_-Tarr.- ap--Nu,mb_e t.� ha ter � -d(�es ot..a 1 eau .prciect— p pp If you answered YES to one or more of the above, . — — of e, 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. #= ...0 Dt APPLICANT= (Property Owner,Design Professional,Agent,Contractor,Other) Drstr mm S.C.T.M. ]00 NAME: o Section Block Lot d zv, a `/� �r ,-I -� .»-1'�� "i TUT T N 1: lO3r.r/.r,-''w _:..- r •-.l,' �. IN_� til_ :il: st_:v _, t. l� t Conuci InFormatrorr. ��"" .�"�„ � � """� � � Reviewed B � -...... 00 Date: Add1-ess PropertyWork: — Approved for processing Building Permit- NO / oca�o oNConstruction ....— SPA'(r.►�t T t- -m /y�ti/1,.M)(n� K1�V�i•• 1'Cn/ Stormwater Management Control Plan Not Required. �!!L1' ... ... -- .' _.. For lmwat Enaer r Management Control Plan a Required,. ward >>Department [or Review) FORM ` SMCP - TOS MAY 2014 t APPLICANT: S.C.T.M, L; Io0o � - - CHAPTER 236 tPrnperty Owner,Design Professional,Agent,Contractor,Other) — ia 2ECK LIST � 1 Stormwater Management Control Plan NA1vIE: � s' � sectlon stork U, S M C P Plan Requirements: Provide ONE cop} of the Building qrmit Application, s r•. . - Date: * The applicant must provide a Complete Explanation and/or Rea n for not providing , d ' all Information that has been Required by the following Checklist! I I. A Site Plan drawn to scale Not Less that 60' to the inch MUST YF NO ; NA If You answered No or NA to any Item, Please Provide tification Here! show all of Che following items; If you need additional room for explanations, Please Prov e additional Paper. a, Location & Description of Property Boundaries b. Total Site Acreage. - c, Existing - Natural & Man MadeFeatureswithin 500 L,F. - of Elie Site Boundary as required by §236-17(061 G,.,...t„;� ''��;,. 4 �*a4� I"+*�,�... rc� 4 � �":��ab (� � � .y�� �� �� � r. �,r try��f k•� �"� ��, 'nr,�t�.��� y '��' "l "�` "w..�, ,I^ � �a,.. •- BOARD OF SOUTHOLD TOWN TRUSTEES `' SOUTHOUD, NEW YORK „ 4 DATE: ,1UNE l l 2017 PERMIT .9040 I : SSE SP'ATNY m� P TY 1 N R O V RIVER ' Or ORIENT PROf, . ni M �-� Z 2 4 SCT � 7 I c dAUTHORIZATION r � 2 � and �r� f: i uxsuant to aiae pro tator�s of Chapter 7 of die Towwn Code of the Town o Southold ac or .with oiutio sof the 1 ,d oi"Tz I ado ted �t rbe meeti� fl�eld on Lune � �� and��� C10� s taoc + # pii tzoat f c its tae, qr of "�5 .Q iaaid by �� �t �d ,aa�ye t to Abe Tem-is a�ari auaia r as s as stated iti the csoloti��il, t.-e S4�w1 w h1 T 'Board of T t a�a�htare e aa�ci preratw tfto v r w` following- Wetland ollow gWetland Permit to construct a two-story,single-family dwelling with a 1, st1 ft«footprint; i all a sanita system; install a driveway; ,1 construct a 1,ll ils .ft. rndgara e;with the w condition that the engineer review plan,for stor ter co e ; o y perpetually maintain a 15'wide non-disturbance buffer landward of't e 'proposed road N w right-of-way; and as depicted on the survey prepared by Paul llaryls i Land Scar eying 4 E received on July 3,2017,and stamped approved on July 6, p1 . p sN S e said Darn of Trustees hereby causes its orate S to ba ix sy , s d e presents to be subscribed by a majority of a id o d of this te. r -. Ze J 4 sN A' ,M 4 I 0� +• �� � � ,� �'.a"""�".....""".�."--..,: +»c -y,'��'M°�6� �'�� ., ,�,r�,r^^.�. �,�.9 •a �" �4 —^,�N p:s'� 3' v.'N "h,,d� ^k �'�,.��"�r� rt""� � "� ��r'. iP� AOL vowma NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04529 PERMIT Under the Environmental s TI ) Permittee and Facility Information Permitad To: Facility- DENISE Facility-SPATNY SPATNY PROPERTY 15 5 NARROW RIVER RDISCTM#1000-27-2- 2.4 SETA ,NY 11733 ORIENT,NY 11957 Facility ca ` : in SOUTHOLD in SUFFOLK ®et Facility ci re : NYTM-E: 727.858 N- --N: 4557.567 Latitude: 41"08'18.011 Longitude: 72'17'05.2" Project Location: 4045 Narrow River load - Watercourse-FWW#0-8 Authorized Activity: Construct driveway(associated with construction of a dwelling, garage and septic systema more 100 feet from regulated es'hw,vater wetlands.and therefore beyond Article 2 jurisdiction). All authorized activities must be in strict conformance with the attached plans NYSDEC rove on 4/13/17. The parcel is landward of a pavedroad ear thari. 100 feet in length constructedprior t August 20, 1977 as evidenced on Tidale eri oto 77-2159 and therefore beyond Article 25 Cridal Wetlands)j `s 'co . Permit Authorizations Freshwater Wetlands -Under Article Permit ID 1-473 -04529/00002 New Permit Effective ate: 4/13/2017 Expiration Date: 4/12)2022 ApprovalNYSDEC By acceptance it,the permittee agrees thatthe permit is contingent compliance withle regulations, and all conditionsincluded -permit Permit tor:LAURA J SCOVAZZO,Deputy RegionalPermit or" Addtess: NYSDEC Regionl Headquarters SUNY @ Stony Broo50le Rd Stony Brook, 11790 -34 Authorized Signature: Date Page I of 6 See C 1.2 for enlarged site Plan / FAD- l z Ago 1 >� 0 / Sega of F; r fi'! �:,:•cicp L.n.ie�� jr f/��_--- Th s s a t}, A��:<so:9 � / r ZONI-ING 20 hrrwrir;3 E a 91.1l I d k fn l# d €llai INAt g IAdded 1 10 11N7 ler[j.-N..3 1)x91 E ' O - - lee cap c€�l t..'c-z€ it;, 4D = he- Pet—lu,d RESIDENTIAL A un€ -d LitR80 b ei Z :6� i2-290 1F400 RD RR' 50 Sen sirAailnLte t?jAdd E I 1 Niit€in nreguirrn vto, { t fsnwl} e1.n_E€_.., -. 75 Frontage Road ttw s'• North Stonington,CT Pots=Cerluxrefoctl: �'t' r ;ararw €srnsES s't° 06359 Esoslow&seolMeNT covrRols emai4drds@m castnet (_:t 203.314.7787' Shall include but not be limited to: +rohtvwrdU441, A t; r r, i ij m. 33i a(i: A well maintained Construction Entrance, Side�oi,dino) 2u IN zt`: 30 1 :31) 1 ist I 13 r __ o Wire Backed Silt Fencing,stabilization& `,s, t:ud=0,4 "} s"" so" as `" 3µ 66 Seeding of exposed and/or inactive soils, "-d "tx " '' 85 dd toy 35 50 X OPYRIGt T NOTICE-: Eee'telo noer4?4d'C4her 5otpor.dit=tifugnhil ci§`[i- 83t! 836 :KtG 850: ho SSU" 85(f _4150 83,) -- -. -. Those dratu one thew conleit are the _-. _ property or aDRDS L M e thy rid eaierse,;i_kn,t _.. "e6.. _"( - 20 tb 5 5 25 5 ?n DRAINAGE by Pi t:f6ofwlSAttf RE DtfaHcla€w hes hfZlkett' �S c :;S ,s. :, 3s They have elder p eared biesp cov.ldat laws. REQUIRED -_ - :.5 -� .. -i 35 They have bee arepar�.,e,e.rlce!ly for the Contact TTS Engineering at 7&5 2554 before N tnhbcn siay s 2s ;,3 13 a`•R.. :mss Pt: _ a,-� r[, 5 Edye•and re not to t e used or env ether rofoose wriller Provide Engineer's 3 CeFtiflGatl4fl N"c art et croin r Erd 0—f3•_ dh4annnvac.Lc m S i,d ,-rtph,ledk un,,, eCownerc'bs`p fe Lti dile'this Grohna from Backfill,OR Pr g set of p,as. that the drainage has be9 one structure. beer installed to Code. 3 F.,,..pt R€.h d.n nG ar sind n r n Et Id E tli x,t€sz 600, L%I i awn tfl.o,-w n.t ltz.dz€,.d ar 0lio ir.d-t sztd,c In,' +t d;i+el,n,,.c n u l* 5 r€ n 4 cL4 F r ee rd e=s of onv dterctiens o,modiRcoCces '��r 1 V".J t- h d,retro ar studfi o'nsuninP.l'od[ng mn5 h.o?n atcare n,51 to fhesa Fong. Frilure to ct',t:to.Fese wnd flees will result in the initmcement of fha aPp}r,'ght etetsee no the ria'ofar will he 1,11wd to Prosecution for damages of to to i APPROVAL OF STO ATER MR AGEMENT\' $100,00C per:n'nn;emerf .CC TRO R - ---ow Cod c 2aiS 4�'?RE01-T"AL UN Goo SERVICES.LLC ate: 17 r23S Test Ho C Data �0 Approv d_by; _.......... T i F (Not oq El(.Kotis5i& r-KK(DF,5&OP,h1551C1ti5 Although'ereri - rt is needs enme the doer 2°;v0 i g:OC h 1t� ecce ec,o these hone,4DRDS M. - - -- reserves the nit,to n owe a rec.ims;to -- cur pons ifcha�ges troth be reQuiree. cpsoii FT I V f� II r Water 4.G}'-�.-,� Wet gown E .J9 � sane i f L ?� FILED: MAY 4, 1984: FILE No. X29 w BY;ROY K.REISSIG. PE OCTOBER 29.2016 0 9;00AM TOWN OF S O U T H O L D THE NYS REGULATED FRESHWATER 0.6`-0.1' TOPSOIL SUFFOLK COUNTY, NEW YORK WETLAND BOUNDARY PT AS DELINEATED BY D. LEWIS ON x �.`� S.C.T.M. # 1000-27-2-2.4 S 73°56'30"E 1/Dile © 0.1-4.b dXUWN LLAYtY 'IL1 `aN AREA = 11.06 ACRES 12.08' POND a WATER " ' SCALE: 1��=100 L3.., RAD = 1800.00' 2.0 EL 409.0WET BROWN SAND SP LEN = 197.92' WETLAND ELEVATIONS REFER TO 1988 NAVD NAIL rLINE FNO EL` A1.101S SHD.', THUS + 50 RIGHT OF WAY SFOR POSSIBLE s'?° FUTURE HIGHWAY � �' PRp� A. � 7<?,;,30,x, DEDICATION LOT 86 'a, , `� �2 RAD = 550.00' VACANT >M���. a LEN =° COMMERCIAL LAND 128.55' PROPOSE gym ` ®Qr ova S 81°02'00"E GARAGEu y <A. Na�c 35,0' *BOAT YARD SLAB EL 10.0@'. BOND $ WATER PROPOSED °+ 0, $ SFTg',q c(�1Vp S 08°58'00"W !IZ y(/ a g a• \ LINE OW E- DETAIL) ,�(/ •. 4- � (SEE 4ETnIL1 g /�EOGE OF ,�_ 25.00' P n_ + tr Fr€_o. rare VACANT r 041 +'I,QC?�. PRG POSE TEST WELL '1 ,Z HOLE lb F 01 0 -10 NO SETIC WITHINPInspection50' txcavation Required i For Sanitary-System By Heafth Department ffF.F,lL.KCouJ- 'DEh Iit a O HEALT SP�4- FOR APPROY OF CONS MILT-Kl `OR A OCT 1 2 2017 11 s rr ( PtI _ 1 p. t> APPRovn di POOP__ 4 SII I, I u F 0sed I33 CJI D. �� VACANT ' 1, a. «_. 03 4 r aG -. .€L. LOT 5 RESIDENCE W11TH WELL SEPTIC NOTE: THE EXISTENCE OF RIGHT OF WAYS. E I G WETLANDS ANO/OR EASEMENTS OF RECORD ZRtr IF ANY. NOT SHOWN ARE NOT GUARANTEED. T- STOPPER OR SLATE OR OTHER SURVEYED p U Y: EKO PLUGSUITABLE COVER � 1 POLE HAUL Y Y ) HAUL LiAI-1YLSKI LANLI 9URL>tY1NU ../ �9 � „_ � •yrs�� ��ff PATCHOGUE NY 11772 10- 4• x B 10' B` DIA 10' �- POLELAhSts��� PHONE 631-294-696) I PIPING SEPTIC PIPING L.P. GRAQING Uj�L FAX 631-627-3380 4.0 F=F—Ell... -Il KING CASTING PAULBARYLSKI YAHOO.COM _ Tp GRADE) y Ktu ���� a 1 LOCKING CASTINr