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HomeMy WebLinkAbout42703-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans x TEL:(631)765-1802 Planning Board approval FAX:(631)765-9502 Z— Survey x SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. X Trustees C',O.Application X Flood Permit 20 Examined Single&Separate_---_ Storm-Water Assessment Form X 17 Contact: d_ Approve2- 20-11 Mail to: En-Consultants, 1319 -- -' Disapproved a/ iNorth Sea Rd., Southampton, NY 11968 Pho= 631-283-6360 20 Expiration —20 APPLICATION FOR BUILDING PERMIT AY � 2018 Date r 20 18 )5- INSTRUCTIONS BUILDING DEF`r- be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets orTPV 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. Robert E. Herrmann, En-Consultants ........................— (Signature of applicant or name,if a corporation) 1319 North Sea Rd., Southampton, NY 11968 ................................... (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Robert E. Herrmann, En-Consultants, Agent for owner ............................ -------- ............................. Name of owner of premises Justin-...Schwartz. .. . L Allison Schwartz .......... (As on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer N/A (Name and title of corporate officer) Builders License Plumbers License No, Electricians License No. Other Trade's License No 1. Location of land on which proposed work will be done: 2793 Cox Neck Road Mattituck ............... ..................... House Number Street Hamlet County Tax Map No. 1000 Section 113 Block 08 . Lot .......... ..................... 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 Single family dwelling b. Intended use and occupancy Single family dwelling .......................... 3. Nature of work(check which applicable):New Building Addition— .........-*Alterationl--...-..-- Repair Removal Demolition Other Work Gunite Swimming Pool_... (Description) 4. Estimated Cost N/A Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units N/A Number of dwelling units on each floor N/A If garage, number of cars N/A 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. N/A 7. Dimensions of existing structures,if any:Front see survey Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front see survey —Rear Depth Height Number of Stories 8. Dimensions of entire new construction:Front '/A Rear Depth Height Number of Stories 9. Size of lot: Front..............see survey Rear Depth ................................... 10.Date of Purchase 9/24/14 Name of Former Owner Laurel Fontana Franklin ............................................ 11.Zone or use district in which premises are situated R80 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO x 13.Will lot be re-graded?YES x NO Will excess fill be removed from premises?YES-NO x Allison Schwartz & 166 E. 35th St., Apt. 3G 917-509-0502 14.Names of Owner of pa Justin Schwartz Address New York, NY 11116 Phone No. Name of Architect HM Engineering, P.C, Address 3 Cherrywood Dr. Phone No 516-476-5392 Name of Contractor Aqua Coastal Inc. Address-V -- E. Northport, Z hone No. 631-728-7704 Po Box 226, Islip Terrace, NY 11752 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO--x *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of 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 x NO *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF SUFFOLK ), Robert E. Herrmann, En consultants being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the Agent -------- ... ......... (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 before me this day of 20 18 Notary Public ANNE ILLIONS Signa o4f�Ap�p Applicant an t Notary Public,State of Now York No.01 IL5084744 oua,lified in Suffolk Cnipn",r CofnMssion Expires 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. New Construction: x Old or Pre-existing Building: (check one) Location of Property: 2793 cox Neck Road Mattituck House No. Street Hamlet Owner or Owners of Property: Justin Schwartz 113. .. ...........m ...... .._._ a�6 Suffolk Coun Tax Ma No 1000 Section Bl aLot County P Block._ _.... Subdivision ..... .. _ Filed Map. ....Lot: Permit No. Q03 Date of Permit. Applicant: En-consultants, Agent _.. Health Dept.Approval: ....... ................. Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate w Final Certificate: -,heck one) ) Fee Submitted: $ Appfl of Signature /r Scott A. Russell STORKOMIt A41E]k SUPERVISOR J\\11 AN AG 1E MI]EN T SOUTHOLD TOWN HALL-P.O.Box 1179 0 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town o Southold )f NJ 'ioA CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) -- ---------- !)OES THIS PR, 0J1:CT I.N'VOLVE AIN_Y OF THE FOLLOWIING; -U'l 'Wr YC6 \o **REE'ER TO STORNWATER. MANAGE4E�11�"? C"bW C I NN WITH BUELDING PEPMIT NO. 4:1.2 a8 E]Ej 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 vards of material within any parcel or any contiguous area. [:][3C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ME] D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. [Z]rl E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of aStOl­mwater 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. ................... ... mwm 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. ii Piofe�z;,-mal,Agtnl,CnHerrmann [iti actDi,()th,,i S.C.T.)d. 1000 Date P t rt 0 D --------------- .be N\ME En-Consliltants, Agent 113 8 section B-1—Ick Lit f 0R I.R.11 i.) V.' \R1 F LJI�[: ()\I Y Contact 631-283-6360 Rev te\�ed B\: . . ........ - — — — — — — Date: Pro perl", Addles 1-rical v'm of Coilstrttct toll Work: -\ppi-o\ed for pi-oce�iiig Building Permit. Cox Neck road d ..... .............. S-tol'111\\ate[ Maiiauemenl Control Haii Not Rcqwred Mattituck Storm%\atei� Maiiagemei-it (own)l Pli-,ReqUlFed. .................... ............. (Forwa[-d to Ejigiiieennq Depailment foi-Revie�\.) FORNI '. 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New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FUR,MELVILLE,NEW YORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 202506176 PROACTIVE BROKERAGE INC 926 SUNRISE HIGHWAY WEST BABYLON NY 11704 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER AQUA COASTAL INC TOWN OF SOUTHOLD P O BOX 226 53095 ROUTE 25 ISLIP TERRACE NY 11752 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11415789-5 362509 04/01/2017 TO 04/01/2018 3/19/2018 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1415 789-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/MIWW.NYSIF.COM/CERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. MYKHAYLO ABRAMCHUK(PRES) OF ONE PERSON CORP AQUA COASTAL INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:48505700 U-26.3 DATE(MMIDDNYYY) CC) CERTIFICATE OF LIABILITY INSURANCE 3119/''2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer ri hts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT PROACTIVE BROKERAGE INC ALC-N Ext,b, 1§11)482 1860 _� .Nol 88�„859 6455 C MAIL 926 Sunrise Highway pppff,ss: infoq,pr9g9tivebro.com ....... West Babylon,NY 11704 .. ..... .,.,_... INSURER( I_AF,Eq qlkCOVERAGE FkAIC .... my INSURER A:: Atlantic CaaltIsurnace Co. ....... i , y ... INSURED INSURE Re,INSURER C: Pr0Iye Insurance _�.�..,............................___ Aqua Coastal Inc. , press' INSURER D PO Box 226 INSURER E Islip Terrace NY 11752 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION,NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN RTYPE OF INSURANCE ADI Li LP%tk...,.,..._ POLICY NUMBER MMID Y/WWI(MOLICYEXP LTR (MgIOD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S ­­--11000 000 �... Li�,`wd"Ad W T S�RFINTCCI r� ........ CLAIMS-MADE ®OCCUR I",f.i.).�rvAl"h('') t1'�LS'}rrn;+nccJ, S 1,QQ,,�00 �. -m-„ MED EXP(An ADV INJURY s 1,p05,000 2ne person) A Y L035013818 7i3a2on 7/3o/lois PERsoNAL� ......., 0 000 GEM L Ah"SRESA"fE.LIMIT APPLIES PER: GENERAL AGGREGATE 5 2 000 000., POLICY JEC .�LOC n 000 OTHER: $ "AhABdfY�iICOMEP OPG.G S 1.000.000 ........ LITAT AUTOMOBILE LIABILITY 1 f" ANY AUTO ` BODILY INJURY(Per person) S ....._ OWNED X SCHEDULED BODILY INJURY(Per accident) 5 B AUTOS ONLY AUTOS 03861607-1 7/22/2017 7/22/2018 .....�.,.., HIRED NON-OWNED P'R OPERTf DAMAGE S _ AUTOS ONLY ............. AUTOS ONLY Pit aa-v,Idurat:N..,,.,,,, UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LAB ..... - .----- CLAIMAGGR,EGATE — . DED. . _ RETENTIONS S $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY ,STATI,JTE E.R E1 DIS m ANY OFFICEOPRIET ER EXCLUDED?ECUTIVE EL EACH ACCIDENT—S YIN NIA (Mandatory in NH) - EMPLOYEE S If yes,describe under E.L DISEASE--POLICY LIMIT S DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The following are included as additional insured required by written contract subject to the terms and conditions of stated polices:Town of Southold CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 Route 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Southold NY 11971 AUTHORIZED REPRESENTATIVE f 6-2aai5 A0 1 CORP RA . Allrights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD HM ENGINEERING P.C. 3 CHERRYWOOD DRIVE EAST NORTHPORT,NY 11731 TEL:516-476-5392 EMAIL:HMARNIKA a�OPTONLINE.NET April 17,2018 Town of Southold Building Department Town Hall Southold,N.Y. 11971 Dear Sir/Madam: This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of- Schwartz fSchwartz Residence 2824 Cox Neck Road Mattituck,N.Y. 11952 will not require draining because the pool is of gunite construction. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash is nominal and will not interfere with the public water supply, the existing sanitary facilities or public highways. Sincerely, HM En ineering P.C. arvojvViamika P.E. w John M.Bredemeyer III,President ��` ' ? c Town Hall Annex Michael J.Domino,Vice-President * J 54375 Route 25 Glenn GoldsmithP.O.Box 1179 Southold,New York 11971 A.Nicholas Krupski " + Telephone(631) 765-1892 Charles J.Sanders °�t, 11 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 30, 2016 Robert E. Herrmann En-Consultants 1319 North Sea Road Southampton, NY 11968 RE: JUSTIN &ALLISON SCHWARTZ 2793 COX NECK ROAD, MATTITUCK SCTM#: 1000-113-8-7.6 Dear Mr. Herrmann: The Southold Town Board of Trustees reviewed the survey prepared by Kenneth M. Woychuk, Land Surveying, PLLC last dated January 28, 2015, and determined that the proposed dwelling, swimming pool, drainage system, and sanitary system are out of the Wetland jurisdiction under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code, Therefore, in accordance with the current Wetlands Code (Chapter 275) and the Coastal Erosion Hazard Area (Chapter 111) no permit is required. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal and/or freshwater wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, or within 100' landward from the top of the bluff, without further authorization from the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. 2 This determination is not a determination from any other agency. If ypu have any further questions, please do not hesitate to call. Sincerely, ohn M. Br demeyer, III, President Board of Trustees JMB:dd WE HAVE READ THE FOREGOING AND AGREE TO ITS CONTENTS: JUSTIN SCHWARTZ ALLISON SCHWARTZ NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region I SUNY,11 Stony Brook,50 Circle Road,Stony Brook.NY 11790 P:(631)444-0365 1 F:(631)444-0360 www.dec.ny.gov April 20, 2016 Mr. Justin Schwartz 116 E 35th St., Apt. 3G New York, NY 10016 RE: Permit No.: 1-4738-04455/00001 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit for the referenced activity. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather and a Notice of Commencement/Completion of Construction. Please note, the permit sign and Notice of Commencement/ Completion of Construction form are sent to either the permittee or the facility application contact, not both. Susan Si ce ely, Si ely, S usan V. Ackerman Permit Administrator SVA/Is Rartment of i ronmental Conservation A& NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04455 PERMIT Cinder the Environmental Conservation Law (ECL) Permittee and Facility Information Permit Issued To: Facility: Justin Schwartz Schwartz property 116 E 35th St apt 3G 2793 Cox Neck RdISCTM# 1000-113-8-7.6 New York,NY 10016 Mattituck,NY 11952 (917) 509-0502 Facility Application Contact: EN-CONSULTANTS 1319 N SEA RD SOUTHAMPTON,NY 11968 (631)283-6360 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: Mattituck Facility Principal Reference Point: NYTM-E: 705.618 NYTM-N: 4541.146 Latitude: 40°59'44.1" Longitude: 72'33'19.4" Project Location: 2793 Cox Neck Road Authorized Activity: Remove existing single family dwelling and construct new dwelling with new driveway, septic system, decks, walkways, pool and patios. Much of the work is not within the "Limit of NYSDEC Tidal Wetland jurisdiction" as shown on the survey by Kenneth M. Woychuk revision dated 4-12-16 and stamped NYSDEC approved on 4/20/16. Permit Authorizations Tidal Wetlands -Under Article 25 Permit ID 1-4738-04455/00001 New Permit Effective Date: 4/20/2016 Expiration Date: 4/19/2021 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: SUSAN ACKERMAN,Deputy Regional Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ Ony rookJ50 Circle Rd Stony Broo -, 'N. 1 790 -3409 Authorized Signature: - -.:_- Date , Page 1 of 6 Am Oboe NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04455 Distribution List EN-CONSULTANTS Habitat-TW SUSAN ACKERMAN 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 — _J 1. 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. 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. 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. 4. 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. 5. 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. 6. 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 100 linear feet from the tidal wetland boundary. Page 2 of 6 Aft dahow NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04455 7. 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. 8. Clean Fill Only All fill shall consist of clean sand, gravel, or soil (not asphalt, slag, flyash,broken concrete or demolition debris). 9. Department Jurisdiction The department retains jurisdiction of all regulated lands where fill has been permitted. Placement of fill shall not be used to alter the department's Ti dal Wetland jurisdictional area at the project site. The area remains a regulated area subject to Tidal Wetland Land Use restrictions of 6 NYCRR Part 661. lo. 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 as per attached plans, 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. 11. No Pool Discharges to Wetland There shall be no draining of swimming pool water directly or indirectly into wetlands or protected buffer areas. 12. 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. 13. 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. 14. State May Order Removal or Alteration of Work If future operations by the State of New York require an alteration in the position o`f'the structure orwork herein aaithorized, or if, in the opinion of the Department of Environmental Conservation it ,shall caaase 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 catase 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 call 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 Am NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04455 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. 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 Kenneth M. Woychuk revision dated 4-12-16, stamped NYSDEC approved on 4/20/16 . 18. 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 Aft NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04455 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 BrookJ50 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 finless specifically prohibited by statute, regulation or another permit conditioct. Applications for permit transfer should be submitted prior to actual transfer of ownership. Page 5 of 6 Aft tamw NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04455 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 witli 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 FFL EL(27.6) TYPICAL SILT FOUNDATION SCREEN SECTION WALL C.I. LOCKING GEOTEXTILE FABRIC COVER TO GRADE UP PORT POSTS CELLAR SLAB EL(17.$) FINISH GRADE / �wcDD OR METAL DIRECTION 1/4—FT. 1'M�IN COV R 0"MI 1/8'—FT, 6(p6 �B (10,0) FLOWBACKFILLED TRENCH t V INVERT—/ AND (m.ee) (1ots)INVERT fNVERT �,� < ExlsTl (9.15) (9.68 ���F 1 I7 FLOW s`m 3'COLLAR p�j�gll_III J lBl lII SIV �1 IS III II IG1�11116 BAFFLE MI POOL CLEAN �7 i7! COARSE . ��� BVI III m 3, g„ T'sAND& �IIIII�i �IIly1lTllllll� CrIIIIIHIII�VIpr�lll�ill: TANK 3'MIN GRAVEL 2'ni"Intdi USE 4"DIA. APPROVED SEWER PIPE 1,500 GAL. S.T. WATER SERVICE DETAIL HIGNWATE%PELTED GROUND WATER EL 27 20' X.1" COPPER TUBING TYPE "K" SOFT COPPER TUBING 'IN.M. TO DWELLING 2" PLASTIC PIPE :TY LINE (605' RUN±) INGRESS&EGRESS NfT"^F'HU pV+ °'{ RIGHT OF WAY c ,/'ys' F LIBER 12310 PG, 357 p° u k1 ypN pf MPUL DWELLING p2""' l" G/ 1 PROPOSED WATER SERVICE W/WELL WATERp"� ✓Y .,( O,:S 25"jg 1'TPP W/2-SUPPLY LINE .w fNGE �O.P, 112.00, OA' N'77.16'30 f:c. ... ©3 N C,�`-'yti, LAND N/F ry CYl, OF CO ,,..+2 COYOTE PROPERTIES LLC eFwcE 113 DWELLING VIN'dU W/PUBLIC WATER 16'al) v 0 0. N 7 n �.1'W �1 A TO I U � W d TOWN OF SOUTHOLD LOT COVERAGE (UPLAND AREA LANDWARD OF TIDAL WETLANDS BOUNDARY) Ic (113,192 SOFT, or 2.60 ACRES) a a EXISTING PROPOSED 5 HOUSES BiS5F 1,B69 S.F FRONT PORCH:46 S.F, 68 S.F. BRICK.rTEPS:4 .. N A r REAR DECK W/STEPS: 327 SF, 652 5.F. P RvIOISNEWAY: 1.9 S.F, N A 5,700 S.F. (N/'A) T.f7 W M I,N a L: 950 S,F. An L A LK: 1,188 S.F. 3,539 S.F. or 3.1% MEDWAY AVENUE OR 1.05% NYSDEC LOT COVERAGE (UPLAND AREA LANDWARD OF TIDAL WETLANDS BOUNDARY TO ELEVATION 10.0) DRAINAGE CALCULATIONS: (36,050 S.F. or 0.83 ACRES) EXISTING PROPOSED FC HOUSE: 815 SF' N A 1,869 S.F, N A o:a'w PIPE POSED DWELLING W/COVERED PORCH: 7,913 S.F,. FRONT PORCki: 46 S F. (N A A 68 A- �, MON, 73 x 0.166=317.55 < 3180 REQUIRED 4 F; N2 B 4 TEPS: B'DIA x 8'DEEP DRYWELL=338cf PROVIDED R DECK W PEPS': S.F; N A 652 S.F. N/A) ER DRIVEWAY=2,200 SQ.FT. P RV OUS RVVEWAY: 1,9 0 S.F.. N A 1,180 S. (N A) LOT 66 10 x 0.166=365.2 <366cf SWfMMiNG POOL: (N/A) 950 S.F. 'DIA x 6' DEEP= 410cf PROVIDED POOL PATIO: 1050 S.F.. 'ER DRIVEWAY=3,500 SQ.FT. MASONRY WALK: 277 S.F. )0 x 0.166= 581.0<581cf )10'OIA x 5'DEEP= 684cf PROVIDED ALL EXISTING STRUCTURES 2,277 S.F. or 6.3%PROPOSED COVERAGE ARE LANDWARD OF ELEV. 10.0 LAMING POO L BE EQUIPPED WITH A PUMP-OUT EXISTING COVERAGE 0.0% r MINAMU PMELL FOR POOL DISCHARGE. 6�CJS l X' J EXISTING SANITARY LOCATION ZONE© R—f (TO BE ABANDONED AND BACK FILLED GRAPHIC SCALE WITH CLEAN COARSE SAND.) FRONT YARD: Pau NOrNT REAR YARD: 0 20 40 80 160 s.r. z0' 26 SIDE YARD: L.P.17 L.P.#2 28 35.5' LP.fj3 28' 27.5' ( IN FEET } POGRAPHY, SEPT I inch = 40 ft. M A-Izalm2 m GOA maiM m w cow -i�9m o £ r z -rio Oz p o z�A Ao 0 x OZ Mrn O p2 - - _ �Oz oA z= *-u>A �w Opazm II ;um Doz zo Km z,m °= �oF Fo'r M �..�g u W=z A 11 No M z b x 0 O D mom 106c> z oN' c (Do ;a M, cm ND M Z p r D Z A r -1 a CD p A"1O0 v0 ; Z. 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