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HomeMy WebLinkAbout40673-Z J SnFFnc,��© Town of Southold 3/9/2018 G y P.O.Box 1179 53095 Main Rd ®4,1 o`� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39552 Date: 3/9/2018 THIS CERTIFIES that the building COMMERCIAL REPAIRS Location of Property: 5775 Mill Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 106.-6-3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/26/2016 pursuant to which Building Permit No. 40673 dated 5/6/2016 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: structural repairs to an existingbuilding uilding as applied for. The certificate is issued to Glebe Associates LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED u ho Signature SUFEoI,��, 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#: 40673 Date: 5/6/2016 Permission is hereby granted to: Glebe Associates LLC 10 Great Circle Dr PO BOX 1291 Shelter Island Heights, NY 11965 To: structural repairs to an existing building as applied for per DEC and Trustees with FEMA permit. At premises located at: 5775 Mill Rd., Mattituck SCTM # 473889 Sec/Block/Lot# 106.-6-3 Pursuant to application dated 4/26/2016 and approved by the Building Inspector. To expire on 11/5/2017. Fees: CO -COMMERCIAL $50.00 COMMERCIAL ADDITION/ALTERATION $250.00 Flood Permit $100.00 To $400.00 /7 uilding In pector 1 �Of SOFT coum, TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] SULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS:/ lwcwd��Vk) DATE INSPECTOR so TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ rFINAL ULATION FRAMING / STRAPPING ( f4� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE wbgigINSPECTOR DAVID S. CORWIN, PE 639 MAIN STREET, GREENPOR Y631-477-0184 D gft [Je DD October 24, 2017 OCT 3 1 2017 Building Inspector BUMDING DEPT, Town of Southold TOWN OF SOUTHOLD Building Department ` Town Clerk's Office Southold, NY Subject: Old Mill Inn 5775 West Mill Road Mattituck, NY 11952 SCTM No. 1000-106-6-3 Town of Southold Building Permit No. 40673 Dear Sir: inspected the above referenced structure on October 24, 2017, to determine compliance with the permit drawings dated December 21, 2015. I found the work to be in substantial agreement with the permit drawings and of good quality. 0 NEW Sincerely, S. co v cc David S. Corwin, PE w 2 d:CS1,6lOP !/ �FQ 065969 A9®FESSI -•....�1 --^rte+' "'�'"_` y.,r'��e�� Yi 77 `^ ,a 's !� ! I 0 • • " f 11 1 !. J • rt — - _ AN ., M)TE Wi TIM sommWOMM�iW4 i - AW �'''�►. 900, W. RIO. NAM gmf _0 �.. ' , 1 • n rr 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 TEL: (631) 765-1802 Planning Board approval' FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees • ® Flood Permit C.O.Application ' Examined ,20 �- Single&Separate a�� Storm-Water Assessment Form 2 6 2016 Contact:, Approved ,20 Mail to:Costello Marine Contracting Corp. Disapproved a/c ®WN®F SQPO Box 2124,Greenport,NY•11944'I1'1'g® D Phone:631.477.1199 Expiration 120 - Building Ins for APPLICATION FOR BUILDING PE Date APRIL 25 , 20 t6 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 Pen-nit 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 regulation's 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.. � ZBbk gnature of applicant or name,if a corporation) 2124, GREENPORT,NY 11944 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder AGENT AND CONTRACTOR Name of owner of premises GLEBE ASSOCIATES,LLC (As,on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer ; Jane P. Costello,VP/Secretary (Name and title of corporate officer) Builders License No. 46234-H(Suffolk County) Plumbers License No. N/A Electricians License No. N/A Other Trade's License No. -N/A 1. Location of land on which proposed work will be done: 5775 WEST MILL ROAD SOUTHOLD House Number Street Hamlet , r County Tax Map No.,1000, Section 106 Block 6 'Lot 3 Subdivision N/A Filed Map No.N/A Lot N/A 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: , a. Existing use and occupancy WATERFRONT RESTAURANT b. Intended use and occupancy SANTE-NO USE CHANGE 3. Nature of work(check which applicable):New Building Addition Alteration Repair X Removal Demolition Other,Work (Description) �, tL 4. Estimated Cost $50,000 ; f x ! ee`� r`�"` (To be paid on filing this application) 5. If dwelling,number of dwelling units N/A z*.. �� Ntbert of dling um `s on each floor N/A If garage, number of cars N/A 6. If business,commercial or mixed occupancy, specie nature;ai d_r tent pf each type of use. N/A a:il.x 4 7. Dimensions of existing structures, if any: Front 70.6' Rear 67.6' Depth 51.2' Height 27.5' Number of Stories 2.5 Dimensions of same structure with alterations or additions: Front SAME Rear SAME Depth SAME Height SAME Number of Stories SAME 8. Dimensions of entire new construction: Front 70.6' Rear 67.6' Depth 51.2' Height 27.5' Number of Stories 2.5 9. Size of lot: Front 112' Rear 98.35' Depth 46.58' 10. Date of Purchase 7/25/06 Name of Former Owner Elizabeth &Jeremiah Daly 11. Zone or use district in which premises are situated M11 12.Does proposed construction violate any zoning law, ordinance or regulation? YES NO X 13. Will lot be re-graded? YES NO X Will excess fill be removed from premises? YES NO X 3610 Washington Street 14. Names of Owner of premises Bia Lowe Address San Francisco,CA 94118 Phone No. 631.295.1199 Name of Architect N/A Address N/A Phone No N/A Name of Contractor Costello Marine Contracting CorpAddress PO BOX 2124 Phone No. 631.477.1199 GREENPORT,NY 11944 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES X NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal•wetland? * YES X NO * IF YES,D.E.C.PERMITS MAY BE REQUIRED'. 16. Provide survey,to scale,with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO_X * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF Suffolk ) Jane P. Costello being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the Agent and Contractor (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 ay of 20/(P L Al E STEVENS oG1ic-State of New York Notary Public 7NO.OIST6269424 Signature of Applicant Qualified in Suffolk County Commission Expires .•ISPs .r,{� � < ��,�y�•—�'!� i. a_�t q"_u� 7fj�.f VIM �r��' .(i C- E � �'�^CI Cl/! Z � 3 'iha ! 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'� /•. �4a/v..Yr i•�kta�urfr V t l� ��.. r,dF .req in •.,.,, ' "5•� �u4. rKt Michael J.Domino,PresidentoF' QUjP Town Hall Annex John M.Bredemeyer III,Vice-President? 54375 Route 25 P.O.Box 1179 Charles J.Sanders ;i - Southold,New York 11971 Glenn Goldamith - G: Telep on (6 7 1`892_ A.Nicholas Krupski '� "�vz� F864 ' � 1 - r. NOV 2 0 2017 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD `�''Qs•i`rJi�T O�uO::i 1`'f�0)I.D CERTIFICATE OF COMPLIANCE # 1422C Date: November 20,2017 THIS CERTIFIES that the replacement-of_suhAort�struetures-around'and underneath the existing one,and one and one-half story fi•aiiie building with attached declt wiiieli,,will consist of the following; in Area A-remove 35"of,existing bulkhead below,buildintand construct 35' of new bulkhead, in-place;Area B—remove 15' of existing bulkheadbelow,dock area and construct'l 5' of new bulkhead, in-place;Area,C—remove 34' of existing north area bulkhead and construct 34' of new bulkhead, in-place;Area D—install steel shims'below ekisting"I"beam and pour structural concrete in void area on top of existing concrete su plport'pier,Area'8—Remove and re-drive,three existing pilings, ,in-place;Area F—reframe and-pour concrete in voidarea beneath the wood framed existing concrete box, Arca G—Install.thi•ce concrete'filled=sonotube support,columm beneath ekisting steel"I"b"earn floor beams; At 5775'Mill Road', Mattituck Suffolk County Tax Map#1000-106-6-3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated February, 2,2016 pursuant to which Trustees Wetland Permit#8751 Dated March 23,2016,was issued 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 i_placement of support structures around and underneath the existing one,and one and'orie-half story frame building with attached deck which will consist of the following; in Area A- 'remove 35' of existing,bulkhead below building and construct 35' of new bulkhead, in-place; Area B—remove 15' of existing bLilkhend below deck area and construct 15' of new bulkhead, in-place -Area C—remove 34' of existing north'area bulkhead and construct 34'_of new bulkhead, in-place;Area D—install steel shims below existing"1" beam and pour structural concrete in void area on top of existing concrete support pier;Area E—Remove-and re-drive three existingpiling, in-place; Area F—reframe and pour concrete in void area beneath the wood framed existing concrete box; Area G—Install three concrete filled sonotube support dolunms'benedth existing steel"I" beam floor _beams. The certificate is issued to GLEBE ASSOCIATES; LLC c/o BIA LOWE owner of the aforesaid property. Authorized Signature NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY 3s Stony Brook,60 Gree Road,Stony Brook,NY 11790 P,(631)444-03651 F;(63t)444-0360 www dec.ny gov r PERMIT MODIFICATION Jane Costello Costello Marine Contracting Corp April 7, 2016 PO Box 2124 Greenport, NY 11944 Re: Permit#1-4738-02881/00007 Dear Ms. Costello: The Department of Environmental Conservation (DEC) has reviewed your request to modify the above referenced permit in accordance with the Uniform Procedures Regulations (6NYCRR Part 621). It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therefore, the permit is hereby modified to authorize: rebuild existing foundation and add supports to foundation as per the revised plans prepared by Costello Marine Contracting last revised on 12/15/2015 and stamped NYSDEC approved on 4/7/2016. This letter is a modification to the original permit and must be available at the job site whenever authorized work is in progress. All other terms and conditions remain as written in the original permit. Sincerely, Mark Carrara Permit Administrator cc: Glebe Associates LLC, c/o Bia Lowe BOH-TW File t�►yoittc Department of OPPORTUNrtr Environmental Conservation J Lo�va�ls,[�wo Souvo a ' iN�47llT+�C,1� ��zca��GT Locs�7')o,J �.M tea• �X L� 0 _ s ? 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ZDiff Td/L 0 2� Z-LC /�.O.Tla®at laLq/ 57?13 MIZ4 =o dry M.4 7ri7-,UC.k--, N.y. 111732- ,7o�p.g� �/��t�e�o�r----�wY•ilq,��+. LSC�.��>" _Ss�tr'• ��' �� 12 A {Q Jc�oo� �•PZ�,Xai//yG� t _4_ •3.�4 � s I 2;•�•�O.G. � ::• �s� rxs+-r� YT-'/CAL TaETid/L x "x�/6 s�-��L ��,e�► T���srE d VTJy��� 23h5e rRLA74ff A PIN. �?O, �✓a� /ZVI S��LT�•� /S�.�isT!5�•�//9Gy �IittJD AY: 5775 �i�ZL ,¢o.rn ,Cagpa u"AfAMM R e*Nat.s�0*40r Pr�it/�• M�Tr�TXcsc> ^/. 0 952 �.mp� tt2f s �r�►�®ems t Y°c�7a� xT.�,vr- /coo-�o�o-aw'.�3W�+q y .�oij�;' Sam i2 �2 t DEPARTMENT OF THE ARMY U.S.ARMY CORPS OF ENGINEERS,NEW YORK DISTRICT JACOB K.JAVITS FEDERAL BUILDING 26 FEDERAL PLAZA , NEW YORK NY 10278-0090 REPLY TO ATTFNTION OF REGULATORY BRANCH APR 15 2016 SUBJECT: Permit Application File Number NAN-2016-00159-EMC by Glebe Associates, LLC for bulkhead_maintenance and minor dredging in Mattituck Creek tributary of Long Island Sound at Mattituck, Town of Southold, Suffolk County, New York 1. PERMITTEE: Glebe Associates, LLC Care'of Bia Lowe 3610 Washington Street San Francisco, California 94118 (631) 298-8080 2. On February 2, 2016, the New York District of the U.S. Army Corps of Engineers received a request,for Department of the Army authorization to remove 84-linear feet of existing bulkhead, in three"different sections and replace it in-place, remove and re-drive three existing piling in-place, install steel shims below existing "I" beam and pour structural concrete in void area on top existing concrete to support pier, reframe and pour concrete in void area beneath the wood framed existing concrete box and install three concrete filled sonotube support columns beneath existing steel "I" beam floor beams. The project is located in Mattituck Creek tributary of Long Island Sound and 5775 West Mill Road, Mattituck, Town of Southold, Suffolk County, New York. 3. The specific applicant—provided details are as shown on the enclosed dated permit drawings. 4. This determination covers only the work described in the submitted material. Any major changes in the regulated work may require additional authorizations from the New York District of the U.S. Army Corps of Engineers. 5. Based on the information submitted to this office and accomplishment of any required notification in accordance<<with the applicable federal requirements, our review of the subject work indicates that an individual Department of the Army permit is not required. It appears that the activities within the jurisdiction of this office could be accomplished under Department of the Army Nationwide General Permit Number 3 — MAINTENANCE. The nationwide permits are prescribed at Reissuance of Nationwide Permits in the Federal Register dated February 21, 2012 (77 FR 10184). The subject work may be performed without further authorization from this office provided it complies with the permit conditions listed in Section B, Number 3 - MAINTENANCE; Section C; any applicable New York District regional conditions; the following work-specific Special Conditions listed below; and any applicable regional conditions added by the State of New York. t ` .. APR 15 2016 REGULATORY BRANCH SUBJECT: Permit Application File Number NAN-2016-00159-EMC by Glebe Associates, LLC for bulkhead maintenance and minor dredging in Mattituck Creek tributary of Long Island Sound at Mattituck, Town of Southold, Suffolk County, New York 6. Other than the work-specific Special Conditions listed below, the 2012 nationwide 'general permits in the State of New York, including their final regional conditions, water quality certifications, and coastal zone concurrence statements are available at: New York City Public Notice— http://www nan usace army.miI/Portals/37/docs/regulatory/geninfo/natp/NWP PN 30M AY12.pdf If you require a specific paper copy, please contact our Regulator-of-the-Day at 917-790- 8511 to request one be mailed-to you. Please be sure to have the above eighteen-character file number readily available when you call. 7. Work-specific Special Conditions: (A) The permittee, and their agents, shall take actions to prevent construction materials, including debris, from entering any waterway to become drift or .pollution hazards. (B) The permittee shall contact the appropriate state and local government officials to, ensure that the subject work is performed in compliance with their requirements. (C) � The permittee shall,sign and submit the attached compliance certification form to this office within 30 days of the completion of the regulated activity authorized by this permit and any mitigation work required by Special Condition. 8. Please note that this nationwide general permit (NWGP) verification is based on a preliminary jurisdictional determination (JD). A preliminary jurisdictional determination (JD) is not appealable. If you wish, prior to commencement of the authorized work you may request an approved jurisdictional determination (JD), which may be appealed, by contacting the New York District, US Army Corps of Engineers for further instructions. To assist you in this decision and address any questions you may have on the differences between preliminary and approved jurisdictional determinations, please review US Army Corps of Engineers Regulatory Guidance Letter Number 08-02, which can be found at: http://www usace army mil/Portals/2/docs/civilworks/RGLS/rg108-02.pdf 9. This verification is valid until March 17. 2017, unless the nationwide general permits are modified, reissued, or, revoked before then. This verification will remain valid until March 17, 2017, if the subject work activity complies with the terms of any subsequent modifications of the nationwide general permits. If the nationwide general permits are suspended, revoked, or modified in such a way that the subject activity would no longer comply with the terms and conditions of a nationwide general permit, and the proposed REGULATORY BRANCH APR 15 2016 SUBJECT: Permit Application File Number NAN-2016-00159-EMC by Glebe Associates, LLC for bulkhead maintenance and minor dredging in Mattituck Creek tributary of Long Island Sound at Mattituck,town of Southold, Suffolk County, New York work activity has commenced, or is under contract to commence, the permittee will have twelve (12) months from the date of such permit action to complete the regulated work. 10. In order for us to better serve you and others, please complete our Customer Service Survey located at: http•//www nan usace army.mil/Missions/Regulatory/CustomerSurvey.aspx 11. Any inquires should be directed to Courtney McCathern at 917-790-8091. Please be sure to have the-above eighteen-character file number readily available when you call. Ronald R. Pinzo_ Chief, Eastern Section Encls 1. Dated Permit Drwgs 2. Completion Form CF: w/o encls NYDOS NYSDEC Region 1 Jane P. Costello Costello Marine Contracting Corp. P.O. Box 2124 Greenport, New York 11944 A �n t ' TERRY S3Ou5 Alain 18T. P 0. BOX 1 17O � r I-OWN CLERK �. S-11,01d Nc' - fork I 1 (IEGiSfRAR OF V1TA1.STATIS"1ICS l �� (��,� 0� Fax (S 1 h) 765-192:x MARRIAGE OFTICI:R - TcicPlic,nc (5 101 765. 1 I RECORDS MANAGEMENT OITICEII .i FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 : RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" (FDP(93) ) , and "Certificate of Compliance for Development in Special Flood Hazard Area (C/C(93)) . TOWN OF SOUPIOLD �Ju T . Terry Southold Town Clerk August 25, 1993 APPLICATION PAGE l of 4 TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMFT APPLICATION This form is to be filled out in duplicate. SECTION I• GENERAL PROVISIONS (APPLICANT to read and sign): 1. No work may start until a permit is issued. 2- The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if uo work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO THIS APPLICATION ARE,TO E BEST OF MY KNOwL.EDGE,TRUE AND ACCURATE. -� (APPLICANT'S SIGNATURE) DATE i SECTION 2: PROPOSED DEVELOPMENT fl o be complctcd by APPLICA1r'T) � 1 sfY��. o NAME ADDRESS�t4 EfthX8L ,k q� i TELEPHONE APPLICANT BUILDER �p �® kav(y ®I� C ' 021 �wEWJ—Iq" ENGINEER ( >1-4D-01� PROJECT LOCATION_ To avoid delay in processing the application, please provide enough information to easily identify the project location_ Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark_ A sk-etcb attached to this application showing the project locadou would be helpful. FDP(g3) , 1 APPLICATION PAGE 2 OF a DESCRIPTION OF WORK (Check all appbcable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure ❑ Residential (1-4 Family) ❑ Addition ❑ Residential (More than 4 Family) —❑A1Tdr-5uon on-resi en ' Floodp�oofur ?—E)Yes)— ❑ Relocation ❑ Combined Use (Residential &.Commercial) ❑ Demolition P ❑ Manufactured (Mobile) Home (In Manu- 'VReplacement factured Home Park?. ❑ Yes) ESTIMATED COST OF PROJECTS B. OTHER DEVELOPMENT ACTIVITIES: O FIB O Mining O Drilling O Grading cavation (Except for Structural Development Checked Above) `O Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Culvert Work) ❑ Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) a ❑ Individual Water or Sewer System ❑ Other (Please Specify) - - -Aftcr-complet' - "SECTION-2,-, PPL(CANT should submit form-[o Local Administrator-for review SECTION 3- FLOODPLAIN DETERMINATION fro be completed by LOCAL ADMINISTRATOR) The proposcd development is located on FIRM Pancl No. . Dated The Proposed Development: O Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is comptete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). ❑ Is located in a Special,Flood Hazard Arca. FTRM zone designation is 100-Year flood elevation at the site is:" Ft. NGVD (MSL) ❑ Uaavailablc O The proposed development is located in a (loodway. FBFM Pancl No. Datcd O Scc Sccuon 4 (or addulonal loslrucnoos SIGNED DATE 0 APPLICATION # PAGE ] OF 4 SECTION d ADDITIONAL INFORMATION REQUIRED (To be completed by LQCAL ADMINISTRATORI The appGcan( must submit the documents checked below before the appbcadon can be processed: ❑ A site plan showing the location of aJl existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑Development plans,drawn to scale, and spccificatipns,including where applicable: details for anchoring�trjjr1-ur_es,propsQscdslevaLon of lowest floor including basement), types of water resistant materials used below the first floor, details of floodproofing of utilities loca Led below the first floor and details of enclosures below the first floor. Also ❑Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ plaj.s showing the extent of watercourse relocation and/or landform alterations_ ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofmg protection leFt:NGVDMSL . Forvel (non-residential only) (MSL). floodproofed structures, applicant must attach certiftcatio%from registered engineer or architect. % ❑ Certification from a registered engineer that the propoae'd acliviry in a regulatory floodway will not result in any increase in the height of the 100-year flood. A copy of all data and - --- - - - calculations--supporting this finding must also be submitted. ❑ Other. SECTION 5 PERMIT DETERMINATION fTo be completed by LOCAL ADMINISTRATOR-1 I have determined that the proposed activity. A. ❑ Is B. ❑ Is not in conformance with provisions of Local Law , 19 The permit is issued subject to the coodilions attached to and made part of this permit. SIGNED DATE if BOX A is chcckcd, the Local Administrator may issue a Development Permit upon payment of designated fcc. If BOX B 15 checked, (be Local Admiustrawr will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from lbe Board of Appeals Y . 1 APPLICATION A+ PAGE 4 OF 4 APPEAi S Appealed to Board of Appeals') ❑ Yes ❑ No Hearing date: Appeals Board Decisioo --- Approved? O Yes ❑ No Conditions SECTION 6• AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual(As-Built)Elevation of the top of the lowest floor, including basement in Coastal High Hazard ALca& bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). L Actual (As-Built) Elevation of floodproofng protection is FT. NGVD (MSL). NOTE: Any work performed prior to sty rnittal of the above information is at the risk of the Applicant. f _ SECTION 7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR wil! complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO (SECTION 8• CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issucd: DATE BY: .3 Attachment B SAMPLE CERTIFICATE OF COMPLIANCE J for Development in a Special Flood Hazard Area rr • 1 1 1/ 1 n i TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (O'VNNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: 0 NEW BUILDING O EXISTING BUILDING 0 VACANT LAND _ THC LOCAL,ADMINISTRATOR_,IS TO_COMPLE_TE_ A. .OR B. BELOW:_ A. COMPLIANCE IS HEREBY_ CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW #_? 19 SIGNED: DATED: B. 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BOX 2124 • GREENPORT, NEW YORK 11944 • (631)477-1199/477-1393/477-0682 FAX(631)477-0005 April 26,2016 Mr. Michael Verity Southold Town Building Department Pb Box 1179 Southold,NY 11971 RE: Foundation Maintenance for Glebe Associates,LLC (aka Old Mill Inn) 5775 Mill Road,Mattituck SCTM#1000-106-6-3 Dear Mr. Verity: Enclosed is a Building Permit Application consisting of the following items: • Check#13641 in the amount of$200.00 • Completed application form • Engineer stamped project plans (4 copies) • Property survey(4 copies) • Southold Town Trustees Permit • NYSDEC Permit • Army Corps of Engineers Permit If any additional information is needed,please do not hesitate to contact me. Sincerely, ane P. Costello Permit Manager SURVEY OF PROPERTY SITUATE MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000- 106-06-03 S.C. TAX No. 1000- 106-06-4. 1 • ' �, SCALE 1 "=20' JULY 289 2008 c0tic � S 10. coq a .. p \ ��' AREA DATA � \ �i `S�• NNI °�, e ;• ° S.C. TAX No. 4,829 sq. ft. ?�O �•�:` •. , °. . 1000-106-06-03 0.111 ac. C. �9. F e• �'�. : N�OgO��xOLD S.C. TAX No. 10,010 sq. ft. 1000-106-06-4.1 0.230 ac. OF E ��� O'. C}, r :. tea.•. . TOWNZ�0 . . ° E6 • �' bro '�,�� '8J • • .•!!.• i'a 4'... .•• _ tea• J. oN ��n •� e C"a:ERHCAO MRES ••. • \ \ �Y{ Sp` O� CERTIFIED T0: ° GLEBE ASSOCIATES, LLC • ° �--� BRIDGE ABSTRACT, LLC �F ° ° g� FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK . lfi m 000 ate. THE BRIDGEHAMPTON NATIONAL BANK VII / 'C1 ? JSP �b • . ate (j, 0 3 �, ro X01 \ L �y� •. I COP N - � a -- y °. . . . O J o G Y O ° O O 70 00 'd'.' 9!, .. b_ -� f Flo \ !O V�, .. .:�• • � ° .: ; .e .. j 00 X89 a� d 1 . O �+ O • f • f • \ V' l u CAr .� � irN a ° p .. 0, 10 41, p .. W" ✓/�/ W(� 9lDC1S.9 CON • (P ,sa /✓ C ��• �•+0 tux, tl� 3.f, '.•e.. 5't Z .• r oO.�m, . I d Za �' �•. . o rn N • ; �Z PREPARED IN ACCORDANCE WITH THE MINIMUM R 4 Q cN'o 0e�y STANDARDS FOR TITLEtP5QN J ABLISHED l� C�, BY THE LIALS. I�D �`� p • • ' ,' •',' tj9•/ FOR SUCH USE A D `,� Z ° ' • • .. �9 TITLE ASSOCIA .4 . • .• �' 3�f 1 • / • ��.! ; •� '' S ' 'LJ,' -•Rdb YA N.Y.S. Lic. No. 50467 LP ~� 1710, 3.4!S. t3� (JT UNAUTHORIZED ALTERATION OR ADDITION Nathan Taft Corwin II O O_ TO THIS SURVEY IS A VIOLATION OF �O N c� SECTION 7209 OF THE NEW YORK STATE 2 EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING Land S u ry Y®r ■ FOUND THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED — . B N 17.0 TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S. FOUND A ACHED TO ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S. M/JL FENE ST CIADFENCE (TSP) IS PREPARED, AND ON HIS BEHALF TO THE 4.o-S. em"CUNK 68. 0 ���»i TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys — SubdiVisions — Site Plans — Construction Layout „ W LENDING INSTITUTION LISTED HEREON, AND 84.08 290 oyrN TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 Fax (631)727-1727 S UNKN TUT10N. CERTIFICATIONS ARE NOT TRANSFERABLE. OWNER THE EXISTENCE OF RIGHT OF WAYS OMCES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947 L APPROVED A'S NOTED DATE: FEE-. NOTIF '` BUILDING DEPARTMENT AT ^ - X02 8 AM TO 4 PPI FOR THE OLLOWING INSPECTIONS: NDATICN TIN REQUIRED J"j OR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE- FOR C.O. ' vow NSTRUCTION SHALL MEET TH 7r � "NTS OF THE CODES OF NES YOR STATE. NOT RESPONSIBLE FO DESIGN OR CONSWUCTION ERROR. 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