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Town of Southold 7/11/2018 - P.O.Box 1179 C3 co 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39758 Date: 7/11/2018 THIS CERTIFIES that the building SINGLE FAMILY DWELLING Location of Property: 1695 Wickham Ave., Mattituck SCTM#: 473889 See/Block/Lot: 140.4-1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/20/2018 pursuant to which Building Permit No. 42590 dated 4/20/2018 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issuedd is: one family dwelling with covered porch as applied for. The certificate is issued to Waggoner, Stephanie&Anthony of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-06-0068 2/6/2009 ELECTRICAL CERTIFICATE NO. 42590 7/8/2018 PLUMBERS CERTIFICATION DATED 9 ' e Signature suFFnt�. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy,• o� SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 42590 Date: 4/20/2018 Permission is hereby granted to: Waggoner, Stephanie 1695 Wickham Ave Mattituck, NY 11952 To: Erect New Single Family Dwelling. Replaces BP#2950 At premises located at: 1695 Wickham Ave., Mattituck SCTM #473889 Sec/Block/Lot# 140.-1-1 Pursuant to application dated 4/20/2018 and approved by the Building Inspector. To expire on 10/20/2019. Fees: PERMIT RENEWAL $5.00 CERTIFICATE OF OCCUPANCY $50.00 al• $55.00 Building Inspector : -TOWN-OF SOUTHOLD: ;•�; BUILDING -DEPARTMENT TOWN-CLERK'S OFFICE: SOUTHiOLD; N. Y. , : BUILbik PEkMIT (THIS•PERMIT-MUST BE KEPT.ON THE-,PREMI$ES_UN'IL FULL: COMPLETION OF THE WORK AUTHORIZED), ill{:: '29'50 ' pate; .....:... .. :$ ## ply:..: ::.:...::..:, 1•9. '.Jf - Permission is hereby granted to:. .t ....................... .. =Y ...... .... .............:...:....::.........,.............:....:;. .,a to jeroot. ow. a ::....... .....`..... ..,.. ............. .0............................. ... .......... .• „ at premises located at• .!I��/.0•. ^....... . ..... ... =- ......•......: _ .......:..,: :: �►.:... ......:..: ; ..�...... • - .......-....................... - �. pursuant to,applicatiion elated ....:......:. . a � ,•;•••••� •.. ;., ? PP. Y " I• aria o roved- b 'the; •- r $uilding lrispectbr, 1 fit 9xlk: , , g. v*.' 1133 ' ) " �+ b + ' county 1 3G7 ► Fes $.. Q� Q,:..,..... ' : . .. LBUI Ing `n$P. tor,; `3•• `•.x`-.•i- �P_` .y.*. ,.} ..�La.r. -.rvr. :Y,:.`ui': .3- '•�: .v� vAr`•�..15'"+>F ' 4: - )y iS' `j.r t.uti!� y ��Y+'� i%n'-`•.. •_��S�',• •�:=`.L - i, _t ;c4;•-- -�'t� .r--�..•�•;, .•pts"-+.i.:y' r;,::x-at_��i.�zi1rcc`Y��•..,*�..c' 2�,i'�_r =;. �4>•�,, .y�-.� i°`^.h...V�i 's•L"'�5r �}`� 4i.- 'kik"•fi�fk� �¢�3•ry§ .%b- '`lha.9.sri`t..x�,c.i�i==ou3..���'Y'..{a"f.'. 4'� �-��t ��i�"'L'�" nr_" 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: Old or Pre-existing Building: y (check one) Location of Property: 16 15 House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Block ( Lot I Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ x GHQ Applicant Si tore . vd- - Form lVo.6 D At TOWN OF SOUTHOLD c BUILDING DEPARTMENT TOWN HALL. 765-1802 ��P APPLICATION FOR CERTIIFI-CATE OF OCC CY —OLB aF souifr 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 ldings 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 applicatioti 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$25.00,Additions to dwelling$25.00,Alterations to dwelling$25.00, Swimming pool$25.00,Accessory building$25.00,Additions to accessory building$25.00,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 Jute. 0(\\ \\ New Constriction: Old opr�Pre-existing Building: (checkone) Location of Property: House No. Street Hamlet Owner or Owners of Property:-`• -� ,�„, Q >�F,�— ��Y\e-tom Suffolk CountyTax Map No 1000, Sections f® Block ' Lot Subdivision Filed Map. Lot: Permit No. °j�C� Date of Permit. l�6 31�J Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: (bequest for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 1 RIO pplicant Signature ul so Town Hall Annex Telephone(631)765-1802 54375 Main Road CA -,tic Fax(631)765-9502 P.O.Box 1179 • �Q roger.richert(a-town.southoId.ny.us Southold,NY 11971-0959 ®�yc®Uff BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Waggoner Address: 1695 Wickham Avenue City.Mattituck st: New York zip: 11952 Building Permit#: 42590 Section 140 Block: 1 Lot: 1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor. DBA: Goodale Electric License No: 783- SITE DETAILS Office Use Only Residential X Indoor X Basement X Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph 100A Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel 100A A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency FixtureTime Clocks Disconnect 100A Switches Twist Lock Exit Fixtures 9 TVSS Other Equipment: Install New Meter and Mast to Existing 100A Overhead Service. Notes: Inspector Signature: •. Date: July 3, 2018 0-Cert Electrical Compliance Form.xls ® SOF SOUly # TOWN OF SOUTHOLD BUILDING DEPT. `�cnurmN�' 765-1802 1 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [L�/FINAL W4 [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: 4 • l" 'Y r"or, . real LPi Co � a • lig. v age%..- &S m x. �• in � Gb�v�nh �^ �t�c� iw v �l 6r w ws, env AA I�- t cc '19 � Fos, IJ 2w $P.� o•n t,��r'c / DATE ! INSPECTOR Of SOUT�o� , * # TOWN OF SOUTHOLD BUILDING DEPT. �o • �o `ycom, 765.1802 4z, -?eq INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE INSPECTOR �o sf SO(/l�o/_ h� `o # TOWN OF SOUTHOLD BUILDING DEPT. °`yoourm, 765-1802 INSPECTION . [ ] FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULA[ N [ ] FRAMING /STRAPPING [ FINAL • [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) -------------------------------------- 'FOUNDATION (2ND) E 'd z � ROUGH FRAMING& H PLUMBING 3 1'l tl1f r �� ccw Y c rNsrf AT .y; bsWego AhrtG 6i/ t 1Nli H coDE A4-rite T 'r i sem. -t' tri ��.n.e�✓ Av d•+�J o ' ` M 0y v n✓w hnvilehn?,C, FINAL _LW ADDITIONAL COMMENTS P K),e. (6014 a &65 Co 5 0 z .lt;o . rn z , a CD d cs— . 1�'OftttiI N0. 1 TOWN OF SOV�THOLD .�� BUILDING DEPARTMENT \ �`"" cJa 3 -�• TOWN CLERIC S OFFICE13 �( �J,°• �'��r-0� �''�` 9�r�^� --f SOUTHOLD, N. Y. f- t)ND✓ . '%r.{,' 1\tn th1,A•(i n., JtNtr Examined ....r '�...................... .. 19 ' Application No. J .L .........�• (� �ro ?/36/73 dAN ur u' " /*/r1 /"n Approved .......'lc:� - ........,�....... �19.�"1. Permit No. .. .1.. � arc ll'e,,�• J y,�-,r( N P*> �p Disapproved a/c.... r° r ......L:`.............. . .. {z •5............... ...�:.. .�......��4�Y,. .le9C,?rrr.v.....�U. ."............... � f" 3if" f� B r� � G/i�LN.ct I.r �- �JF�•-t,�rr�<i �f�'t (�� l .Building Inspec ..��.................. .. . .... oto<<C y�in•�t. }o� :t;;J�. ;CI 'ZG� Crrl�l t£L• G� APPLICATION FOR BUILDING PERMIT Date .............................l ovPmb.er,...24.. , 19.f'?,>...... INSTRUCTIONS (� a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas,and giving a detailed description of layout of property must be drown on the diagram which is part of this application. 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 permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. 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 and regulations. George L. ,RgnW..... /C, yJ�ltPr„t�J311iams (Signature of applicant, or name, if a corporation) .............................................................. (Address of applicant) State whether applicant is owner, lessee,agent,architect, engineer, general contractor, electrician, plumber or builder. .............. ....................A ent..()X..Qianer................................. ............................ .... .. ...........,...,................................. Name of owner of premises .....W,-l.ter...i 11.11ams.................... ............................................ ......................... ............... If applicant is a corporate, signature of duly authorized officer. ................................................................................................ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .......XXXX....................... Lot No.: ........:C7CX.,,,,,;, Street and Number .....11</8 ......• ........... .......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... a.cant..1.ot.................................................. b. Intended use and occupancy ,..........onF..f�xnily„clw�7,lin; 3. Nature of work (check which applicable): New Building ...?P;XA..... Addition .................. Alteration .............. ... Rep1air .................. Removal .................. Derrio'6ioti..'......:........ Other Mirk' (Describe) .................................... ... 4. Estirnated Cost ...........I.Q.p,Q.0 Q ......................Fee .........IQ.. ................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....QAO.................Number of dwelling units on each floor ....................... ... Ifgarage, number of cars ........................................................................................................................................ ... 1 6. Ifusiness, commercial or mixed occupancy, specify nature and extent of each type of use ....................... ... 7. Di Ilensions of existing structures, if any: Front............................ Rear ................................ Depth ................... Height ........................ Number of Stories ............................................................................................................ ... Dimensions of same structure with alterations or additions: Front .................................... Rear ....................... ... Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ................36............... Rebr.......36..............1. Depth......P-I+ Height .................... Number of Stories .....Me..................................................................................................... .... 9. Sizfi of lot: Front ....120................. Rear .......... .1.20..•P/......... Depth ...JjOl/...110...P/.... 10, Date of Purchase ........................................................Name of Former Owner ................................................... 11. Zone or use district in which premises are situated .............PAP...dist............................................................... .... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....................X19.............................. 13. Norine of Owner of premises ...1-1,9-Tter...W1311ama.Address ..............1`1,91 UWQI�........ Phone No. ............... ... Nam: e of Architect ......................................................Address ............................................ Phone No. ............... ... Nai,6 of Contractor ........S=D...................................Address ...........................!!............... Phone No. ............... ... I PI-CIT DIAGRAM Locate clearly and distinctly all buildings, whefher existing or proposed, and indicate all set-back dimensions fr)M property lines. Give street and block number or description according to deed, and show street nornes and indicate whether interior or corner lot. Ce, T7[ 1LI p 501 -.6q Lto I \� I 1 0-0 STATE OF, NEW YORK, COUNTY OF '91IEf-olk...............S S.S. ................!........................Gearg•...L....P.Q=y......................being duly sworn, deposes �ncl says that he is the applic int ((Name of individual signing application) abovenamed. He is the .................................Umit...qX..Qmmx................................................................................. .... I (Contractor, agent, corporate officer, etc.) of said oYyner or owners, and is duly authorized to perform or have performed the said work and to make and 'ile this application; that all statements contained in this application are true to the best of his knowledge and belief, ( nd that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..... ..I....... ... day of ..............November........... 19-6.5, ...... ..................... .. .... M antlylky., rf f applicant) Notary Public, 1.11. .?; �,,,-T i�n-c�ture�o �-- RY PUBLIC, 8ja[, ;f j%j,)YOIX No. 52-3233120 Suffolk Coullty Jerm Expires March 30, 19_Q � ^ romrAmm 1- TOwqN OFSOWTHOLD ' BUILDING DEPARTMENT TOWN CLERK'S OFFICE ' SOUTHOL0, N. Y. Exom|ned —..[v.v.w.. . --.—' L�- /\pn|ioohon No. .......... Approved —.'�x/.�.a .—._ ...... 19L.1—Pennit No. - `.-~ r'i\.2 — Disapproved o/o ___ ~'~"°''~~^~T'^^ (-. *='^��''=''^'................ /-� .......... .................................. (m/mIng Inspect. APPLICATION FOR BUILDING PERMIT Date .............................NO.VoUtber'� ..... INSTRUCTIONS p. This application mat be completely #Uod in by typewriter or in ink and submitted in duplicate to the Building (nnpwcmc b. Plot plan showing |ocoti6n of lot and of buildings on premises, relationship*oadjoining premises n,public streets or areas,and giving a detailed description of layout of property must be drawn on the diagram which iupart nfthis application. c. The work covered by this application may not becommenced before issuance of Building Permit. d. Upon approval ofthi |/ d the Building Inspector will issue a Building Permit to the applicant. Such permit uho||be kept on the premises ovpi|u6|e for inspection throughout the progress ofthe work. o. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted bythe Building Inspector. APPLICATION |3HEREBY MADE*vthe Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Covn'y, New Tn,4 and mhp, applicable Lows, D,Jhnamcoa o, Regulations, for the construction of buildings, additions or o|»e,odon4 or for mmo,o| or demolition, as herein described. The applicant agrees to comply with all opp|icp6|o |pvm, ordinances, building code onJ regulations. George L° . _A/ guus___,______ (Signature of applicant, or name, /focorporation) ---- ............................................................. (Address of applicant) State whether applicant is owner, |uxuem' agent,architect, enoin»er, o*ne"o| contractor, o|oot,icia»' plumber o, builder. ------------.. .A9N111te..x��..Wler............................... ............................. .... _.._______..___._____ Name vfowner ofpremises .............. .................. ...................... . ............................................... If applicant Is o corporate, signature of duly authorized officer. ...........----^~^^'--^^^^^—~--~^^~^'----^--'— (Name and title ofcorporate officer) l. Location ofland onwhich proposed work will bvdone Map No' ........XXXX................... ..Lot No.: .........=7o....... Street and Number —..l�/o..... --_________,_____________. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy .........V.mmant-] ot................................................................................................. b. Intended use and occupancy ............���.f . ���----____________________ ` Nature of work (check which applicable): New Building ..... Addition .................. Alteration ............. .... Repair .................. Removal .................. Demolition............:..... Other Work (Describe) ................................... .... 4. Estimated Cost ........... WX......................Fee .........3,Q.. ....... .... (to be paid on filing this application) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ....................... .... i Ifgarage, number of cars ........................................................................................................................................ .... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....................... .... 7. Dimensions of existing structures, if any: Front............................ Rear ................................ Depth ................... Height ........................ Number of Stories ............................................................................................................ .... Dimensions of some structure with alterations or additions: Front .................................... Rear ....................... .... De7th ................................ Height ............................Number of Stories ..............................1. 8. Dim,ensions of entire new construction: Front ...............36............... Rear.......3l61................ Depth ...... ........ .... Height .................... Number of Stories .....One..................................................................................................... .... 9. Size of lot: Front....120................ Rear .......... .120..P/......... Depth ...1J01/A1Q..P/.. 10. Date of Purchase ........................................................Name of Former Owner ................................................... 11, Zone or use district in which premises are situated .............!W!Aiat............................................................... .... 12. Doesproposed construction violate any zoning low, ordinance or regulation? ....................Aq................................. 13. NoMe of Owner of premises ...Walter...WillISMS.Address .............. ....... Phone No. ............... .... Name of Architect ......................................................Address ............................................ Phone No. ............... Norile of Contractor ........1111A O..................................Address ...........................!.............. Phone No. ............... ... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr m property lines. Give street and block number or description according to deed, and show street names and indic to whether interior or corner lot. 46 %6 11 Lo Q k-f, N VV_ STATE OF IN EW YORK iss COUNTY OF ftfbAk..............f .............. ......................Geor.g..I.—Panny......................being duly sworn, deposes and says that he is the applicalt (Name of individual signing application) abovenamed. He is the ................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applicqtion; that all statements contained in this application are true to the best of his knowledge and belief; a, d that the work will be performed in the manner set forth in the applicati filed therewith T, Sworn to bQfore me this c a2� I ......... day of ..............A9:F9A1PA:P........... 19AI. -7 .................................. .................... ..... .......... .... .. Notary Public,719..1.9:4&,., .. ......(a_.11r,".1 7......... County rill (Si nature of applicant)"' 1AAMON A ra, potARY PUBLIG, Sial c, h? No. 52-3233120 Sufh)[!. U„ujlf Term Urns March 30 iq 4"1 PSEG Long Island IECDIVE, DD Building&Renovation Ser ces i5 Park Drive JUN - 7 2018 NlehaNYNY]]e. 117!^r PSE—la-1 B�gT�E�77f��.���77,,w�v 1�s,��y� 11`r'i1f11kT 1/71ifS4 iLHTI:farsr�tl_ 4JPII.NJluV�Sf�1'E Yi - TOWN OF S®UTH®LD I r DATE: Please disconnect the following electric facilitie for demolition purposes at the following address: ,,, C1 14, c ' [� k 15 L II I Electric Meter number(s) and/or Account numb r(s): �.o e-A 1-5 Please forward the demolition letter to: Address: a,.�.5 V',/- it 3S E-Mail: Any questions or concerns please contact: Name: Phone: '(R)1 - 7 3 E-Mail: Print Name: Sigq�iame: � v • ° • • national.prt • Verification • e b • Fes_ For questions,please call:631-348-6150 or email:ngridliriidprocessing@nationalgrid.com Purpose(check the box): D [ECIR OVE ❑Request that an active gas service fine be altered by disconnecting the gas pipe at t ie property line. D [�C]Request that National Grid verify that an active gas service line does not exist at the ocation. JUN - 7 2010 Instructions: 1.A separate application must be submitted for each building structure being altered,re iovated or elevated. 2.Application must be made by the owner or lessee,or agent of either,or by the archit� t,engineer,builder,excavati i�IN�i DEPT. Company employed in connection with the proposed work.Where such application i made by a person other than fiL� MOLD be accompanied by an affidavit of the owner or applicant that the proposed work is a ithonzed by the owner and that the applicant is authorized to make such application. 3.Requests must be received 15 to 30 business days prior to the scheduled demolition`date. 4.There is a$700.00 charge to alter an active gas service line and to obtain the National Grid Service Line Disconnect Letter.A separate invoice will be mailed to the contact person for the disconnect fee.Payment must be ade in advance prior to work being performed. 5.There will be a charge of$57.28 per foot if the applicant requests National Grid to re tivate the gas service line in the future. A.Owner Informationf,(,print): ! Are you the owner of the property?❑Yes ❑No Name `Oh Le AA 9 g-2 0P,1-r^ ({ Phone MailingAddressh9 qS 41=GkAe,&, Ave 1zip_!_Lf2. ___2_ Email Address Cell Phone B.Address`/Of Structure To Be Demolished/Elevated/Renovated/Co i firmed No Gas(print): f' Address 1�b Z S 1A1U K!n Ca�, v C;ty �r ' v�'SState `" Y zipZ- General Contractor Name �� fk Office Phone General Contractor Email e'er' L fi� C Cell Phone 5c9 `l" 3 V - g`7 7 C.Job Site Information: ❑Commercial [*esidential 1.Is this a Tax Exempt site?If yes,provide Tax ID certificate. ❑Yes CRNo 2.Does an active gas service line exist at this location? ❑Yes [�:No ❑Unknown 3.Are there plans in the future that natural gas will be used at this location? ❑Yes [RNo ❑Unknown 4.Are the gas meters located inside the budding or not readily accessible? ❑Yes ETNo ❑Unknown 5.How many gas meters exist at the location? Meters) Account No: Gas Meter No: �- Customer's Name Signature •Date U a Applicants may either mail or email the completed application.Please sign and mail form to:National Grid;Customer Fulfillment Department,1650 Islip Ave,Brentwood,NY 11717 or email:ngridlirudprocessini@nafionalgrid.com New York State Department of Environmental Conservation Division of Environmental Permits Rm 121, Buildiri'g'"4O=SUNY Stony Brook,`New York 11790-2356 Telephone (631)444=0365 taboo Facsimile (631)444-0360 Erin M.Crotty COn risiOnx LETTER OF NON- MSDICT.ION Mr. Anthony Waggoner February 25, 2003 1695 Wickham Avenue Mattituck NY 11952 NYSDEC # 1-4738-03152/00001 ` Waggoner Property 1695 Wickham Avenue Mattituck NY SCTM#1000-140-1-1 Dear Mr. Waggoner: Baged on the information you have submitted, the New York State Department of Environmental Conservation has made the following determination. The property landward of the 10-foot elevation contour interval on a natural gradual slope, as shown on the survey prepared by Joseph A. Ingegno on 7/23/02, is beyond the jurisdiction of Article 25 (Tidal Wetlands). Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6 NYCRR Part 661) no,permit is required under the Tidal Wetlands Act. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. 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 which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project(i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that this letter does not relieve you of the res ty of obtaining any necessary permits or approvals from other agencies. 1 i epi y truly yo CS, { ohn A. Wi and Deputy Permit dministrator CC: Diamond Star Construction BMBP, File NEW Department of Office of Depart G'V[E YaRlc Environmental General Se Ices of State STATE US Army Cares Conservation i JUN ® 7 2010 of Engineers 1 JOI T APPLICATioN FORM For Permits for activities activities affecting strea s,waterways,waterbo � �i �LD s,sources of water, and endangered and threatened species. l You must separately apply for and obtain Pen iits from each involved agency before starting work.Please read all instructions. = 1. Applications To: >NYS Department of Environmental Consery tion 54 Check here to confirm you sent this form to NYSDEC- Check all permits-that apply: [Dams an impound- [Nidal Wetlands ❑Water Withdrawal ❑Stream Disturbance ment Stru tures ❑Wild,Scenic and ❑Long Island Well ❑Excavation and Fill in F__1401 Wate Quality Recreational Rivers ❑ Incidental Take of Waters Navigable Certificati.n 9 ❑Coastal Erosion Endangered/ ❑ Docks, Moorings or ❑Freshwat r Wetlands Management Threatened Species Platforms >US Army-Corps of Engineers Check here to confirm you sent this form to USACE. Check all-permits-that-apply: ❑Section 4 04 Clean Water Act ❑Section 10 Rivers and Harbors Act _ Is the project Federally funded? [ J Yes (j No If yes, name of Federal Agency: General Permit Type(s), if known: Preconstruction Notification: C Yes No >NYS Office of General Services ❑ Check hereto confirm you sent this form to'NYSOGS.- Check all permits that apply: ❑ State Owned Lands Under Water ❑ Utility Easement(pipelines conduits,cables,etc.) ❑ Docks, Moorings or Platforms >NYS Department of State ❑ Check here to confirm you sent this form to NYSDOS. Check if this applies: ❑Coastal Consi lency Concurrence 2. Name of ApplicantLI Ta a er ID(if applicant is NOT an individual ntllgah V AZAQ� 0' M+aili`nn -Address p Post Office/CityState Zi @��T�i 6!'i��as�iC� 7 t� Ave,, AAT-*e� r � � Jl�J 7> I11�?ib�`f� lir1�C �J ��5 z, Telepbon a.. y _ °" . Applicant Must be(check all that apply): Owner ❑ Operator ❑ Lessee 3. Name of.Property Owner if different" ,A licant Mailin Address Post Office/City State Zi E, Telephone E ?ail --- -- - _. = �.• _ For Actencysllse Only ` _ggericy Application umi;er''° ` ONE � =-x Page 1 of 4 JOINT APPLICATION FORM 08116 r f - JOINT APPLIcATioN FORM—Continuec Submit this completed page as part of your Application. 4. Name of Contact/Agent Mailing Address Post Office/City State Zi Soo )-c,6j L14he- Tele hone " I 5. Project/Facility Name t Tax Ma Section 1 Block/Lot Number: 9 C675 Lam, -, '�tuv� /1v� � Ri-0t; aIV-0T0 1— 0(9 8 Project Street Address, if applicable Post Office/City State Zi W-754,kA,;,. -t— I T-.,,,c ::1 IVY 11 5-? Provide directions and distances to roads, inters"ctions,/bridges and bodies of water to 4Tr+✓ - Lf I 14 :V ® Town ED Village G Cit Cou8ty Stream/Waterbody Name Project Location Coordinates: Enter Latitude anc 11-on itude in degrees, minutes, seconds: Latitude:®- `f g 5-0 Longitude:- �' �" I 6. Project Description: Provide the following information about your project Continue each response and provide any additional information on other pages.Attac plans on separate pages. a. Purpose of the proposed roject: C'JLJy.:�`E?ra of f�c� l 1 1 � Lll�i t� iln b. Description of current site conditions: c. Proposed site changes: � nop'c- -ro oz` b�: ►.meg ►� �m�� �oh �:f;oh. d. Type of structures and fill materials to.be insted,and quantity of*materials to be used(e.g.,square feet of coverage, cubic yards of fill material,structur{��ss below ordinary/mean high water, etc.): v yetp J5 49 f till e. Area of excavation or dredging,volume of material to be removed, location of dredged material. lacement: f. Is tree cutting or clearing proposed? _ Yes If Yes, explain below. No Timing of the proposed cutting or clearing (month/year): Number of trees to be cut: F-- Acreage of trees to be cleared: JOINT APPLICATION FORM 08/16 Page 2 of 4 f f JOINT APPLICATION FORM—Continue,. Submit this completed page as part of your Application. g. Work methods and type of a ui ment to be sed: �F�,:�11 ��GeLlrat tub` h. Describe the planned sequence of activities, I., K&,d ve S heti vY�' i. Pollution control methods and other actions I proposed to mitigate environmental impacts: j. Erosion and silt control methods that will belused to'prevent water quality im acts: k. Alternatives considered to avoid regulated �reas. If no feasible alternatives exist, explain how the project will minimize impact 3: B 9��L �' .. 0✓�Pi���i''j a'1 l fa'� d 7 f7 j� Ill�r lk�/ �! +�i(,f/` `�q �. - ��tgtl✓j'h�v'%•y�i d� S,{/1 jl �/1'L'/ �p'It� Irr'C7h�YD Ysa4'''''� I_ Proposed use: Private _ Public ❑Commercial' m.Proposed Start Date: Estimated Completion Date: . 1 S• 23-0 1 i No n. Has work begun on ro'ect? C Yes I Yes, ex Iain below. o. Willproject occupyFederal, State, or Muni fci al-Land? C Yes If Yes, explain below. No List any revious DEC,.USACE, OGS or 0O Permit I ApplicationLnumbers-for activities at this location: I j;l"'rid=Lr�'dL q. Will this project require additional Federal, State, or Local authorizations,including zoning changes? Yes If Yes, list below. �No Page 3 of 4 JOINT APPLIcAnON FORM 08116 JOINT APPLICATION FORM—Continued Submit this completed page as part of your Application. 7.Signatures. Applicant and Owner(If different)-must sign th application. -- - Append additional pages of this Signature sec Zion if there are multiple Applicants,Owners or Contact/Agents. i hereby affirm that information provided on thi4,form and all attachments submitted herewith is true'to the best of my knowledge and belief. Permission to Inspect- I hereby consent to Igency inspection of the project site and adjacent property areas. Agency staff may enter the property without n,tice between 7:00 am and 7:00 pm, Monday-Friday. Inspection may occur without the owner,applicant or age I t present. If the property is posted with"keep out"signs or fenced with an unlocked gate,Agency staff may still nter the property.Agency staff may take measurements, analyze site physical characteristics,take soil and vegetation samples, sketch and photograph the site. I understand that failure to give this consent may result in deniafof the permits)sought by this application. False statements made herein are punishable s a Class A misdemeanor pursuant to Section 210.45 of the NYS Penal Law.Further,the applicant accepts full 'esponsibility for all damage, direct or indirect, of whatever nature, and by whomever suffered,arising out of the p''I�I ject described herein and agrees to indemnify and save harmless the State from suits, actions, damages and gists of every name and description resulting from said project. In addition, Federal Law, 18 U.S.C., Section 1001 provides for a fine of not more than $10,000 or imprisonment for' not more than 5 years, or both where an applicant knowingly and willingly falsifies, conceals, or covers up a material fact;or knowingly makes or uses a fa 6e,fictitious or fraudulent statement. Signature of Applicant 1 Date 3a 2- (� Applicant"Must be(c c I that apply): - Owner F-1 Operator .F-1Lessee Printed Name `• Title 2� �t �IG ��JG�G IJa� rll Signature of Owner if different than Applican#) Date Printed Name Title Signature of Contact/Agent �I� Date Printed Name Title — .r----_•.. .�,.y�,ar.;=t;i�F f:.:.._t<�,_�;^-�.��.�.-s- -�.• .;• A enc [sent ===w ;_ � DTE �O u Y -; y ., �!) F i -.-��" Z�h.. �;5..� .".s'�l'+ �'i�^".sty +.��•,.. "7'`' .:.Y,^..,•ls"*dr'wi•. r, �..- i 'w`.a+�• '-r i 't="yC,t:, ',•tie ?�•` T"^_..,srr4 p9+t'..•� y�r�.ii' T ..7� .' F""" '"'"`_ -.r. ? a.z . L� . s > ,� A eAcy~ ppl�cation Urn er _ :{?;�,x r:.xa. ; _ S •i• KlMi:t.�D. 'd''ro;'}a:s'.:? .'ir`3C3,s: �ts,+.'2:i :-'P.,t.:ie't+..-}•"Xi3cm`s.:3''•+' 'Y:r�sfr:,,"....� .ss...... ..s l.-w'.:�. 'C'S'-' ..• •r- _ b1.�;..`,:..J�r..f,T.:e'.01..�,.c.i�r.^i{�w�i=r-'nJe,�a-�.'_d�..5K'"-�'f'ro`-AA`m��-ro'�tiai+i.s.Q�-,:$>..'^e£en?":vrzeSYf...,.a�-l„f�-o'ria_r°S`.-t.er-iYi?e:,.y.i,."4:s.=l•:'t7.�,i*�c)ss,:oYi 1.'.t.etFc-yt'�'.di✓YYer.s.�;.+c:rva-^•'+.'ufif-':r.=.e.:rdi..%�-'_i'L="t•t'hui..�r-s{i"�va�A d'TM.t",�•^r-sI:`w.lT7c33Yiau:i-�,ta.l.,xo7 a..'_+�ri�'�!sa'✓"i+1�F.�7•'�.��'•>.;.".�..�{.i`' -r.v.;?:y�'ns-•*tr�a/z4.i".�e:-•'_y'."Ey.:i�`r•G C��•";•Y:f�r... n. 1i�i. = `:rc'n;..a.lth;=i•jfa -the tist.}ame�. _jemms 7e cwva • •�.�,;k=iY:._•:pJ,3w''-Lx^v•"o.n;.ei- . -- '.s•. - �°'.��_ �.�w .��L xrS��;::*t����•-?'mow.,.f„�l''.'`�r' X" _ ;Fr•,;: -.1yr-"•F;�_� - � _ __ :-Tr':�_ �:�. ..:tr, .a_ r.F�_' rte - _ _ _ _ :F ' _ .;Mr t Gi.'. „'-:...''-- :',`.=-c s.,•.. _-`::, .t,: t5...:::�:t r Agencj N:. a-1. - `.Prliited'. t+ �• Signature = Date JOINT APPLICATION FORM 03116 Page 4 of 4 Short Emir.�nmental Assessment Form Part -Project Information Insttrruchoiifor Completin Part I-Project Information. The applicant or.project sponsor is responsible for the completion of Part 1. Responses become part of the application for apprpval pr fund g,are subject tq public review,and may be subject to further verification. Complete Part I based on information currently avi�ilable. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly a possible based on current information. Complete all items in Part 1. You may also provid any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part f-Project and sponsor Information ` laiame of Actipn or Project:• • • - 1 -•" - -• - " Project Locafiori(descn%e,,d_and attach a location i{ap). - U �� ilkJiG '�1G1St ��o/ I► '�� �G�, IVY17 Brief Despription pf Prgposed Action: r,sA49tri in5 5fell t/,r' idl - ce7n �r��'x��, d41,�a �:l� f�� ��IS�" Name of Applicant or Slionsor: , Telephone: 'j l _ 7-0 y �:r•, ec-• - Addm s: � , �/1 c� G�L�r va- ✓`�- r Giiy/PO: State: f _Zip Gude: 1.I�ges the prgposed action only involve _ e'a ladve a$optign ctf$glen, oval law,ordinance, •- -- l�t(j - -YEs administrative rule,or regplatioh?._ - If Yes,attagh a nwritive descdptign Of the- ten of the proposed action and-tl►e environmental res -es that may be affected in the municipality And pioceed v Pant 2. If no,cQtrtinue to question 2. 2.-Does a proposed actiorr-regriiie a petntit;ag'rotral or f+,rttding from an}r other go�ernmental Agency? 1�I0. 4'ES If Yes,list agency(s)name-and permit br appfp '1-'- a :a 10� >t7�s ��rj jf7Gv� i�t/1 ��isttr '. - 3.a Total_acrq- pf the site of the proposed acts in?_ _ acres - b.Total acreage to be physically disturbed? 1 t� a�_ acres c.Total acreage(project site and any contiguo s properties)owned' or controlled by the applicant or project spo al sor? acres 4. Check all land uses that occur on,adjoining ' d near the proposed action. - j][Urban O Rural(non-agriculture) -❑Industrial [Commercial Residential(suburban) ]Forest ❑Agriculture OAquatic j^0ther(specify): Parkland Page 1 of 3 5. Is the proposed action, I NO YES NIA a.A permitted use under the zoning regulation ? a ' b.Consistent with the adopted comprehensive plan? b. is theproposed action consistent with the predominant character of the existing built or natural NO YES landscape?- i J. Is the site of the proposed action located in,or o_es ii adjoin,a'state listed_Critical Environmental Area? - No YES If Yes, identify: FT 8. `4. Will the proposed action result in a substan 'al increase in traffic above present levels? fVpI 'YES El b.Are public transportation service(s)availab at or neaLr the site of the proposed action? E3 c.Are any pedestrian accommodations or bic �le routes available on or near site of the proposed action? — -- 9.Does the action meet or exceed thc s `te energy code requireniepts? NO YES If the proposed action will exceed reg4iretttents, escri a design fgatures and technologies: ' 0. Will the proposed action cgnnect to•att exist public/prif jt�e water}supply? - NQ YES If No,describe method for providing pot !ble water. 43"!2 Iti,�.:r•�Gy yVA l 1.Win the p"roposed action connect to.existing *astewater utilities? NO YES If No, tdescribe met-hod for providing wasLater-> eatme'nt: --OC.--M 12�" �:a�n -a;9 (� I2. �.Does the site t<ontairi a structure that is listed on either the State or National Register of-Historic N4 Y)F�S f�.Is the proposed action located in an archeo�Qgical sensitive area? :� f' t• "T 13.a.-Does any portion of the'site of the praposed'action,or lands adjoining the proposed action,contain 1�0 YES wetlands or anther waterbodies regulated by( federal,state or local agency? b.Would the proposed action physically alter, r encroach-iato,any existing wetland or waterb90y? If Yes,identify the wetleAd or waterbody and ext i t of alterations in square feet or acres: .- 14. 1"Wed?,14 ratify the typieal'habitaf types that`oec r o or are likely to be found qn the project site. Check au that apply: horelllpe (Forest �Algncu lturdl/grassIands - Ql:arly mid-successional (�Urban- burban 15.Does the site of the-propgse-d action contain any species of animal,or associated habitats,Listed rI4 > by the State or Federal government as threatet>`igd or endangered? rA Li El 14.Is the project site located i i the.f Qpyear flop plain? N4 Yl;, TTI 17.Will the proposed action create storm water di'charge,either from point or non-point sources? NO A YES_ If Yes, a.Will storm water discharges flow to adjacent properties? EdNQ [ YES lJ b.Will storm water discharges be directed to es blished conveyance sy5t:Lrns'(run and storm drains)? If Yes,briefly describe: + -. Lo NO [LYES i Page 2 of 3 18.Does the proposed actic:,hiclude construction 'r other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,wase lagoon,dam)? If Yes,explain purpose and size: j � ❑ I=,l 19.Has the site of the proposed action or an adjoin' g property been the location of an active or closed NO YES solid waste management facility? I jj If Yes,describe: � ,❑ 20.Has the site of the proposed action or an adjoini property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Ye$,describe: I AFFIRM THAT TIME INFORMATION PRQ1 i DED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/s nsor name: Date: -5` 7 p t i5 Signature: c PRINT FORM Page 3 of 3 95-20-7 (12/98) New York State Department of Environmental Conservation Aft Supplement to Joint Application Form 9211® 1 STRUCTURAL ARCHAEOLOGICAL a ASSESSMENT FORM (SAAF) PART 1 -APPLICANT COMPLETES AP iLICANT INFORMATION 1. Applicant Name 2. Applicant Address Avet ' " ' pv% j 4 d 'IS- 1 - 1 P14OJECT INFORMATION 3. Project/Facility Name f 4. Project/Facility Location ` �i 1�►/� r�CJ i rvU ' I 5. Is the proposed project adjacen to, or does it contain a []Yes building or structure listed in the State or National Register of C�' o Historic Places? 6. Are there any buildings or structures 50 years old or older Lyes adjacent to or-within-the propo ed project area? ❑No If the,answer to question 5 and or 6 is yes, provide the following information for each building, and structure(use attachmentslif necessary): a. Name of structure 1 cation b. Lolam:�, r� ��- 0l'11�► "�' �: '�� c. Type of structure (ex. hoose, o,tbuilding, bam, bridge, dam, p ptt°;d;f ruins) kin 0 d. Approximate.age or-date-of co,struction �/�► 7. Might the proposed project ha �e any impact(physical/visual) es upon any buildings or-structur s listed in-the State or o - National Register.of Historic P,1 ces or 50 years old or older? If yes, describe briefly (use att chments if necessary): II - APPLICANT SECTION CONTINUES ON REVERSE SIDE 12/98 SAAF PART 1 —APPLICANT COMPLETES 8. Provide photographs of every b ilding and structure that may be impacted by the project as described in number 7, on the o recommended: ,posite side of this page. The following standards are 1 ® Minimum of 2 photograp s ® Photographs must be 3. tix 5" in size or larger ® Photos must be-clear an, focused ® Digital photographs mus The printed on photo paper and be produced at a printer setting of a minimum of EPO dpi ® Clearly label photos so it is obvious what is being illustrated; key photos to map or plan, if possible ® Photo 1: show both the a p1tire front and side of the structure in a single shot from as close to the building as p i ssible. Be sure the structure is not partially or fully blocked by trees or other obstruct ons ® Photo 2: show relationship of building or structure to roadway or surroundings 9. Has the land within the proposed project area been Egx'es previously disturbed or altered (e cavated, landscaped, ❑No filled, utilities installed)? If yes, describe briefly, includin I g ,ept�hGof disturbance (use attachments) if necessary): Jr11,i 1, �t p., ✓ems�rG, 1 l ov�,�! V=;1< rls/ .v.9 'v d1 a0. r - i 10. Approximate percentage of propos ed project area with = 0- 10% slopes: 10- 15% 15% or greater 11. Approximate percentage of proposed project site with the Well drained L� - following drainage characteristics: Moderately well drained Poorly drained % Prepared By(Print or type name): Sign Date: 3 G.,ZC I Eri L Dantes PLLC i Attorney Adi aitted in New York 500 Crown Land Lane Cu lichogue,NY 11935 May 30,2018 Anthony Waggoner and Stephanie Waggoner 1695 Wickham Avenue Mattituck,NY 11952 Tel: 631-856-0767 Email:twagl@aol.com Re: DEC applicantion I Authorize Eric Dantes Esq.to a as my agent with the Department of Environmental conservation to o fain approval to remove the dilapidated building on my property. Eric L Dantes Esq 500 Crown Land Lane Cutchogue,NY 11935 Office phone/fax 631-735-9025 Cell 804-349-8947 av6l,�, � ,ericdantes2@gmail.com Stephanie Waggon i 1 i ;§ 116E ERIC L. D NTES PLLC 6130 SC16ND AVE. MATTITUCK, Y 11952-3131 �'Z DATE �� _ 2'�[ J 2102985 PAY ORDEHE `V LU/" �C R O^F `�� DOLLARS w T � .� ' ' a �^�•''�— � 'rte - a a• . w e 77 f . t Ilk *' WIF a i. , s . l LIP It 40. Av I z w. ' Iy fig.'_, .,`. '?.1.�, • s� �l ! r -. ' s. R 1 e r a �. 7E + • R • _ � 'rl+ir WS F. �� y�ii,7FF. qty` s • � 'ht, s•�� � "l y�"�• e�„ t t• �.' � ,_ •' '� ,�_ - s' .� y`�ir.��. %`y ♦t �r.. � a=;/Si�,�.ti. x. �.. -'r .:.. _��.,r"•` ' i�S r' i 'k�- ,�S4 ��• -'a�, jw 2- { _ a LJ t yu 44 1 fry � .._'—•-------�_._ . r a s _0 it �JCt- ?av I P.• Ad q q t 1 I y 4 ly�j � o � VS 6�{ N V14, �i s / tisk a ! t Tb A ti u-S fi 4¢4¢.ar kr49 r—tet ➢WA nR rtr fcrlMgRw —^�trS pgi Mr4V •^ M"�- (p��14 Qh[Yrnl LL l/KL4*y Y4i l,i I•�4'•� --r-"`- 4..w.ney'..,w. 12:, n.w -....v,.. .._s...+u+ '.•�•_..••-. 0 rrw ,.al �LLlmw L78•w�r rx1,ACL - _ u�+o..•.r•,.� k•+•�•u• �•."`.\-:J^r ¢w+r,r..m.w........y.+.u,.n.. —.—......-._L4.•_�'-.•.>• Nw...aw..-sv..�+w4'o.+•r�a.>yw•w.u-.,.•-••-�ra•.r•-•.-••+•-- Lr°i�x.l��_'_'-.^..._'-.-.1•�-...--.-..�..".."..`.. mror aaat"r_"_"T"._.'r,.-..-,...,,,,.,, vrfcLi'�maupUtaufF*e�mcn2rmr +tax Yord na4+LnT w�mR io `COtT1OFwSUFFOLK A5AQ ttRud r1kl2li C ,oy bef., GvRs 0T IlyaX - y� a u3 er.6 '.u.¢¢ �•.�.•�� —H.--� �'_"`. him sa...�w-�.�-.� 441WIY 5 M„FIY�i.Y)iR YIF Ftl¢41¢t � ) _ " ="'�.'-=+�+�.,�•"•"mr=.,*w''�'d�}...0 r;n« ':� ',:..= `�kj.:. :td;;,�y,i. .sr- �'�y.�',y.r_, rlw: .5,�.�� _...:Ya i...'{ ....r."� ,:r,.Y ,.4.��4 .�..f�....�_.,_...d..._,.f.::.-._.�-...:_' _ _ ..,v. yam....._ _ -'._ UAIlltilpHdUSINtSb t-4 ivib t 1 95-193 (8/00)pfp JOINT APPLICATION New York state FOR PERMIT " ' United States Army Corps of Engineers d3 Applicable to agencies and permit categories listed In Item 1. Please read all instructions on hack dronal information as needed. Please print legibly or type 1.Check permits applied for. 2.Nam of Applica (Use full na '" ="r 1� 'Y'';'"r. = � Telephone NC (daytime) NYS Dept of Environmental Conservation U/U t1 Mai Ing Add J ` ❑ Stream Disturbance(Bed and Banks) / /�� J/ � �� ❑ Navigable Waters(Excavation and Fill) ! /7' Docks,Moorings or Platforms Post Office Code (Construct oi-Place) ❑ Dams and Impoundment Structures 3.Taxpayer ID (If applicant is not an individual) (Construct,Reconstruct or Repair) Freshwater Wetlands Tidal Wetlands 4.Applicant is alan: (check as many as apply) ❑ Coastal Erosion Control Owner ❑Operator ❑ Lessee ❑M lclpality/Gov tel Agency ❑ Wild,Scenic and Recreational Rivers 5.If applicant is not the tlfy owner here- otherwise, y ct Per n info ation. ❑ 401 Water Quality Certification Owner or Agent/ ontact Person []Owner[:]Agent/C to +uy flan Nu er (daytime) ❑ Potable Water Supply AV �J S'�-� Ccs..s GJ A Nt✓ 6 L ❑ Long Island Wells (t�yM` Ing Address ❑ Aquatic Vegetation Control s Post Office State Zip Code ❑ Aquatic Insect Control r��` R ❑ Fish Control w 6.Project!Facility Location (mark4focation on map, see instruction 1a.) NYS Office of General Services County: t l Town/CityNillage: Tax Map Section/Block /Lot Number. '(State Owned Lands Under Water) � t t� POIikk ❑ Lease,License,Easement or Location (inctudin Street or Road) Telephone Number (daytime) other Real Property Interest ❑ Utility Easement(pipelines,conduits, lJ� �TTf� cables, etc.) Post Office State Zip Code 7.Name of Stream or Waterb dy (on or near project site) ❑ Docks,Moorings or Platformsl'�U (Construct or Place) 8.Name of USGS Quad Map: Location Coordinates: Adirondack Park Agency ❑ Freshwater Wetlands Permit NYTM-E NYTM-N 4 ❑ Wild,Scenic and Recreational Rivers 9.Project Description and Purpose:(Category of Activity e.g.new constructionfinstallation,maintenance or replacement; Type of Structure or Activity e.g.bulkhead,dredging,filling,dam,dock,taking of water, Type of Materials and Quantities: Structure and Work Area Dimensions;Need or Purpose Served) Lake George Park Commission - / 'r ! � Docks(Construct or Place) ^ ❑ Moorings(Establish) --T� lC�G oTtgQ-� H �'`� WI-V- S ------------------------------ ----- - --�� --------- ------------------------- ! !� / US Army Corps of Engineers ❑ Section 404(Waters of the United States) d5" /)e -2 3 f ❑ 10(Rivers and Harbors Act) _Gh__ ----------- Nationwide -_© ---------- Section - - - - - � --nom- - ---- - - - ❑ Nationwide Permit(s) Identify Numbers) - - CJ S�'1y} - _ Cyti_�vR`S 1 LTT{q,��.�----------------- • For Agency Use Only. t 3yJ Ct DEC APPLICATION NUMBERlT - -`�---�Cz [Vi D - S, US ARMY CORPS OF ENGINEERS ropose Use: 11.Will Project Occupy 112.Proposed Start 13. Estimated Completion �` El El State Land?[:1 Date: Date: Private Public Commercial I Yes o 14.Has Work Begun on Project? (if yes, attach ❑ ❑ 15.List Previous Permit/Application Numbers and Dates: (I(Any) explanation of why work was started without permit) Yes No NQ `C 16. Will this Project Require Additional "P ❑ If Yes, ��Lb w" 130v egm c�— Federal, State,or Local Permits? es No Please List: V. If applicant is not the owner,both must sign the application I hereby affirm that Information provided on this form and all attachments submitted herewith is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. Further,the applicant accepts full responsibility for all damage,director indirect, of whatever nature,and by whomever suffered,arising out of the project described herein and agrees to indemnify and save harmless the State from suits,actions, damages and costs of every name and description resulting from said project In addition,Federal Law,18 U.S.C.,Section 1001 provides for a fine of not more than $10,000 or imprisonment for not more than 5 years,or both where an applicant knowingly and willingly falsifies,conceals,or covers up a material fact;or knowingly makes or uses a false,fictitious or fraudulent statement Date Signature of Applicant Title Date /-,ZF—O-� Signature of Owner Title DIAMONDSTAR 6912442893 09118104 10:01am P. 002 Town Hall Albert J.Krupski,President O�OSCO� 53o95 Route 25 James King,Vice-President P.O.Box 1179 .Artie Foster �Z+ y Southold,New York 11971-0959 Ken Poliwoda Peggy A.Dickerson ti x Telephone(631)'765-1892 Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 22, 2002 Mr. & Mrs. Anthony Waggoner 1695 Wickham Ave. Mattituck, NY 11952 RE: 1695 Wickham Ave., Mattituck SCTM#140-1-1 Dear Mr. & Mrs. Waggoner: The Southold Town Board of Trustees reviewed the survey dated July t 3be o0ut of the 2 and determined the proposed second-story addition to the existing garage Wetland jurisdiction under Chapter 97 of the Town Wetland Code and Chapter 37 of the Town Code. Therefore, in accordance with the current Tidal Wetlands Code (Ch ease beer )ad d the Coastal Erosion Hazard Area (Chapter 37) no permit is required. however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above,without a permit. it isyourrtatioresponsibility to alt sue that all necessary precautions are taken to prevent any 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. However, any activity within 100' of a Wetland line or seaward of the Coastal Erosion Hazard Area would require permits from this office. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. S TOWN OF S O UTH O L LA OFFICE OF BUILDING INSPECTOR ® TOWN CLERK'S OFFICE: �* S01JTHQLD, N. Y. Date .........4914ftoln�S.As..190...... Mr. Rudolph 10merar Commissioner of Public Works Suffolk County Yaphank Ave., Yaphank, N. Y. Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Laws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that ...................................... ...A#Atv�r �3i�,�lazz ............................................................................... has applied to the Town of Southold for a permit to construct a building as shown on the attached plot plan, submitted in triplicate, dated ... RPx.. +�t � By Otto..VanTI+tY:..!Dc ........and titled .�Vap o ...........roprt�7 for V` .tor :F 11, 1i o We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 239K. Very truly yours, Building Inspector Town of Southold, N. Y. TOWN OF 5 O LITH®L® OFFICE OF BUILDING INSPECT13R TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Dote ......... lovemibex..21+,...:99.� ..... Mr. Rudolph Kammerer Commissioner of Public Works Suffolk County Yophank Ave., Yophank, N. Y. Dear Sir: In accordance with Section 239K of the General Municipal Law of the consolidated Laws of the State of New York, this is to notify the Commis- sioner of Public Works of the County of Suffolk that ...................................... Milliamg.........................................................................I...... ........................................................................................................................ has applied to the Town of Southold for a permit to construct a building on ...W/,8.....Vtickh-,am..Ave...a.x.,...3.54...:U.x/... 7.4..kjC!t�ituck1 11'6 Y. as shown on the attached plot plan, submitted in triplicate, dated ....NOV.....22, 1965 By Orta..:ITaxz`):U;I1... .. 0 .......,and titled "�a off' ro Pr L for 'Walter Williams �?..........I?.....o:....:Y...... ............ CO) Matti t'uck We shall withhold further action on this application for ten days or as otherwise provided in the aforementioned Section 239K. 3.2/2/65 Approved to the Tmin of Southold Very truly yours, pursuant to ,Seco 239K of the General, Municipa.. Law; before building access to County .Road 27 a permit under Sec. 136 of the Highway Lava 1q, wi3..1. be required. o(.,j (2 Iz SUFMLK COUNTY DEPT PUBLIC WORKS R. M. Kammererp Commissioner Building Inspector Town of Southold, N. Y. 13Y William S. M sunatye.,Jr. Chief 1hgineer 1 t E I V F D 1465 NOV 26 Ali 6. 44 1. u, Nillt iC WORKS SUFFOL kt)UNI Y *pF SO!/j�Ql 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road cn Fax(631)765-9502 P.O.Box 1179 G • COQ Southold,NY 11971-0959 COU(VT`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD April 16, 2010 RE: 1695 Wickham Avenue, Mattituck In order to obtain the Building Permit for the Waggoner property, we need the following items: $330.40 due for the new building permit A 4th set of plans for the current building permit A septic permit from the Town Clerk's office is required. They will give you a receipt. We need the receipt. They will require a copy of the Suffolk County Health Dept. survey, which we have here if you don't have a copy. A Certificate of Occupancy application for the original dwelling. A $25.00 fee for the Certificate of Occupancy. Southold Town Building Dept. 30 0004 7008 1B 5485 2755 *pF SOUjyQI 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road e� Fax(631)765-9502 P.O.Box 1179 G �Q Southold,NY 11971-0959 'Q �yCOUNN,� BUILDING DEPARTMENT TOWN OF SOUTHOLD Stephanie Waggoner 1695 Wickham Avenue Mattituck, NY 11952 August 19, 2010 Re: 1695 Wickham Avenue, Mattituck SCTM# 1000-14-.-1-1 Existing Violation: Occupancy without CO Your building permit (#35180) for as built additions and alterations has been referred to my office because you have yet to provide the following to the building department: - The final permit fee of$330.40. - A fourth set of plans for the building permit file. - A septic permit from the Town Clerk's office. - A certificate of occupancy application for the original dwelling. - A$25 fee for the certificate of occupancy. Because you have not responded to building department requests for this information, you are currently in violation of Southold Town Code. Pursuant to 144-15A., of the Southold Town Code, "No building hereafter erected shall be used or occupied in whole or in part until a certificate of occupancy shall have been issued by the Building Inspector." Therefore, you have ten days from the receipt of this letter to contact this office, at (63 1) 765-1802, between the hours of 8:00 a.m. and 4:00 p.m. or legal action will be taken against you. espectfully o rs, Damon Rallis, Zon' g Inspe Southold Building Department BDG Bouler Design Group 12 Doxsee Place Islip, NY 11751 (631) 969 - 3335 (ph) (631) 969 - 3391 (fag) DATE: Thursday, April ?? TO: Township of Southold FROM: James Bouler, Architect SUBJECT: Waggoner Residence 1695 Wickham Avenue Mattituck, NY Dear Town of Southold, My survey of the existing one family wood frame residence located at the above address, indicates that the residence was constructed in the intent and general purpose of the building code at the time of construction. My observation was not destructive in nature, in that structural members were not exposed for verification or condition. My survey is not intended as a guarantee for future performance and longevity of the structure. Sincerely, James Bouler, R.A., A.I.A. BDG, Inc. 0 fey/r 20,Bout p sr` o2sn2 �OF . ; � ' T. TERRY 1 If` r+u� f rrwrt 11x11 5.1lYut 1•1a� 'iH F o- flr►x 1 17<l TOWN CLERK C �I;•r r stw1holrl Nc..- 1•ur1; .✓ (C� "' ~_ Fax (.S 16 765.1 R` ILEGISfRnR Of v1TN.STAT1S11C5 � 1 MARRIAOF OF•FIcrR _ . %OI _ �b0 TTcicphonc ( �16) M.S. TICEII()5 "AGEMENT o REEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLE TOWN OF SOUTHOLD SAY m 2 2010 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 f6 Devellc%pment in Special Flood Hazard Area (C/C(93)] . 8 E,G. C, FT TOW;4 OF SOUTHOLD AJudith T . Terry Southold Town Clerk August 25, 1993 •t • APPLICATION W r PAGE l of 4 TOWN OF SOUTHOL.D FLOODPLAJN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION I GENERA-L. PROVISIONS (APPLICANT to read and siQm): 1. No work may start until a permit is issued. 2 The permit may be revoked if any false statements are made herr-in- 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. S. The permit will expire if oo 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. Administrator or his/her representative to make raasonable 7. Applicant hereby gives consent to the Local inspections required to verify compliance. 8. I,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENT'S TO _ THIS APPLICATION ARE,TOTHE BEST OF MY KNOWLEDGE,TRUE AND ACCURATE. •. (APPLICANTS SIGNATURE)— j DATE - SECTION 2: PROPOSED DEVELOPt/(ENT (T(,, be completed by APPLICAITID rr�ltoN S 117,0 "'hie- AT vg ELEPHONE NAME ADDRESS bs �`c���/�t" APPLICANT eft.•fit�� IV Y �G�l;� �a t{" �� BUILDER-� ® 7071 ENGINEERT)9-0 A/ / PROJECT LOCATION: To avoid delay in processing the application, please provide cuough 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 wc-H-known landmark. A sketch actachcd to this appliestion showing the project location would be hclpfW- 1975 141-114 vn e,, FDP(93) APPLICATION PAGE 2OFd DESCRIPTION OF WORK (Check all applicable boxes) A STRUCTURAL DEVELOPMENT @CTIVITY STRUCTURE TYPE ❑ New Structure 9 Residential (14 Family) ❑ Addition ❑ Residential (More than 4 Family) ❑ Alteration ❑ Noo-residential (Floodproofing? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) 1�1 Demolition" ' P ❑ Manufactured (Mobile) Home (In Manu- El Replacement factured Home Park?- ❑ Ycs) ESTIMATED COST OF PROJECT S B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill ❑ Mining O Drilling O Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Culvert Work) j ❑ Roar), Street or Bridge Construction j ❑ SuFMivision (New or Expansion) / ❑ fv dual Water or Sewer System ❑ Other (Please Specify) After completing SECTION 2, A_PPL[CAJ,4T should submit form to Local Administrator for review. SECTION 3 FLOODPLAIN DETERMINATION fTo be completed by LOCAL AWIMSTRATORI The proposed development is located on FIRM Panel No. • Dated The Proposed Development: ❑ Is LDI located in a Special Flood Hazard Arca (Notify the applicant that the appLicatiou review is complete and NO FLOODPLAIN DEVELOPMENT PER iT IS REQUIRED). ❑ Ls located in a Special Flood Hazard Arca. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ff Uoavailablc ❑ The proposed development is located to a floodway. FBFM Panel No. Dated O See Scc_uon 4 (or additional (oscrucnoos SIGNED DATE APPLICATION 4 PAGE ] OF 4 SECTION 4: ADDfTI NAI, INFORMATION REQUIRED To he com Ieted bV L CALADMiNIST'RATOR The applicant must submit the documents checked below before the application can be processed: 0 A site plan showing the location of all ousting structures, water bodies, adjacent roads, lot dimensions and proposed development. O Development plans,drawn to scale, and specifications,including where applicable: details for anchoring structures,proposed elevation of lowest floor(including basement), types of water resistant materials used below the first floor, details of poodprooftog of utilities located below the first floor and details of enclosures below the first poor. Also O 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). O Plans showing the extent of watercourse relocation and/or landform alterations- 0 Top of new fill elevation Ft. NGVD (MSL). , 11Floodproofmg protection level (non-reFt:NGVDMSL . Forsidential only) (MSL). floodproofed structures, AppUcaot must attach certification from registered engineer or architect. ❑ Certification from a-registered engineer that the proposed activit in a regulatory lloodway will not result in any increase in the, height of the 100-year flood. A copy of alI data and calculations supporting this finding must also be submitted. O Other- SECTION therSECTION 5 PERMIT DETERMINATION (To be completed by LOt;AL ADMINISTRATOR) I have determined that the proposed activity. A. O Is B. O Is not in conformance with provisions of Local Law if , 1-9 The permit is fssucd subject to the conditions m attached to and made part of this permit. SIGNED DATE If BOX A is checked, the Local Admiaistrator may issue a Development Permit upon paycneut of designated (cc If BOX B is chocked, (bc Local Administrator widl provide a wri(tca summary of deficiencies. Applicant may revise and resubmi( an appbca(ion to the Local Administrator or may request a hearing from the Board of AppcaJs I f APPLICATION ?v PAGE a OF 4 APPEALS Appealed to Board of Appeals? O Ycs O No Hearing date: Appeals --- Conditions SECTION 6:. AS BUILT ELEVATIONS (To be submitted by APPLICANT bcforc Certificate of CQmpliance 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 ecr0cation to this application). Complete I or 2 below. 1. Actual(As-Built) Elevation of the top of the lowest floor, including basement(in Coastal Hieh Hazard Areas bottom of lowest structural member of the lowest floor, excluding piling and columns) is: FT. NGVD (MSL). L Actual (As-Built) Elevation of floodproofing protection is FT. NGVD (MSL)- , NOT Any work performed prior to submittal of the above information is at the risk;i[ the Applicant. SECTION 7 COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based oa inspection of the project to ensure compliance with the commuaiWs local law for flood damage prevention_ INSPECTIONS: DATE BY DEFICIENCIES? O YES O NO DATE BY DEFICIENCIES? O YES ❑ NO DATE BY DEFICIENCIES? O YES O NO ,SECTION 8 CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRAT R Cerdlicate of Compliance issued: DATE: BY: J Attachment B /� EAMP,LE CERTIFICATE 'F coMPLIANCE / for Development in a Sp / ecial Flood Hazard Area v ' I 1 i I s Rir ` TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAJARD A-REA (GVWE z MUST RCTAiN THIS CERTIFICATE) _ PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: 0 NEW BUILDING O EXISTING BUILDING O VACANT LAND ' f THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH TTHE REQUIREMENTS OF - LOCAL LAW # , 19_. SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: C/C ( 93) t GC { fi t,1 :/x t 's i � I i {i - i 1w` PLC q pe iko S 0 PUSe 0 Q2o ea� ,mac �A'vg) Se_ � ��"" .�+r�,+a.�.z.�..•,.Damm..._.....�.,.,�......a-�.�.-�.....,.._....m..e.-..A.,.."-.._.,.,......,.,.,_R-,_.,�.._,...............w_.,,_,.,-.,..,,,.vae..m.m. SURVEY OF PROPERTY SI T UA TED A T MATTITUCK N/0/F MATT—A—MAR, INC. X TOWN O I�c S 0 U T H 0 L D FFICE CONSTRUCTION YARD �-=-� USE PUBLIC WATER ° SUFFOLK COUNTY, NEW YORK �la J �, S.C. TAX No. 1000- 140-01 -01 SCALE 1 "=20' e�� `�. \� ��, a JULY 23, 2002 - Y. — �� !.) \ \\ e.a JUNE 20, 2008 ADDED PROPOSED ADDITION ;f-- 1 AREA = 28,276.81 sq. ft. i \ \ F 0.649 ac. ` L LO in CO Ln 1 \ \ d. o \ \ . GAF CERTIFIED TO: �o� ANTHONY WAGGONER ' Z .Q STEPHANIE WAGGONER y > X -_-- �J / CO a� SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Ily > �U H.S.REF.NO. / t this ed on the information submitted,it has been determl, tha Bas project does not require additional sewage disposa : water supply d .. G� P J facilities. p '�'^ 9� Tc al laximum Bedrooms py.. ° 4 . e �lb / / / / / / Lice of 'astewater Manigemepnf� - ,� to / / e d° d' y A / 4 � , �. �••• �� / / x 9S T B`� .n / �` \ �:.: ° °. / .'°tee:a• —'— �/ o���GC �jtn /OVERHEAD WIRES A, 0 RRL ti Q / X 12.6 ° d 8.9 12 / 10.3EDGE OF LAWN 10.3 / ��\ ..:..';:;'�; 13.9 5� lYe 001, z.i .......:.:.:. :: :: ( oma•::::::::: s iso vi —' /� ''� •`'�'-::�:� :�:��:�:; :;� Oic 0 i t NCA / �J ::•:.. .. s Fpic P ' d ° . ,.p 11.5 GS `C otitic 0' L� rt7 / Q os '6' ,50GsF� 4..: T 40 6- 15— _ / ` q \/ 4 TEST HOLE DATA `' 3 / � / ryti6 P �A15.2x \ (TEST HOLE DUG BY McDONALD GEOSCIENCE ON APRIL 1, 2008) ELEV. 11.8' 01 BROWN SILTY SAND SM 12'9X 3' PALE BROWN SAND SP 1�� / —5-7 C' ELEV. 3.6' 8.2' �v GROUND WATER 16 16.5 XWATER PA BR E OWN SAND SP O QJ •�i O\Y SEPTIC SYSTEM TIE DISTANCES (MEASUREMENTS PROVIDED BY OTHERS) PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I.A.L.S. AND APPROVED AND ADOPTED QA FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION.,,` SEPTIC TANK 24.8' 14.7' LEACHING POOL10 17' 24' LEACHING POOL 02 23.5 29.4 LEACHING POOL 03 40.3' 30' NOTES: N.Y.S. Lic. No. 50467 1 . ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN THUS: UNAUTHORIZED ALTERATION OR ADDITION EXISTING CONTOUR LINES ARE SHOWN THUS: — — —5— TO — — — Nathan Taft Corwin III SE THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. F.FL. - FIRST FLOOR G.FL. - GARAGE FLOOR Land Surveyor COPIES OF THIS SURVEY MAP NOT BEARING T.B. - TOP OF BULKHEAD THE LAND SURVEYOR'S INKED SEAL OR B.B. - BOTTOM OF BULKHEAD EMBOSSED SEAL SHALL NOT BE CONSIDERED T.W. - TOP OF WALL TO BE A VALID TRUE COPY. B.W. - BOTTOM OF WALL CETFICIONINDCAED HEREON SHAL RUN ONLYI TOATTHESPERSIONTFOR WHOM THEL LSURVEY 2. FLOOD ZONE INFORMATION TAKEN FROM: Title s Surve — Subdivisions — Site Plans — Construction Layout IS PREPARED, AND ON HIS BEHALF TO THE FLOOD INSURANCE RATE MAP NO. 36103CO481 G Y Y TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND ZONE AE: BASE FLOOD ELEVATIONS DETERMINED PHONE (631)727-2090 Fax (631)727-1727 TO THE ASSIGNEES OF THE LENDING INSTI- TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. ZONE X*: AREAS OF 500—YEAR FLOOD; AREAS OF 100—YEAR FLOOD WITH AVERAGE OFFICES LOCATED AT MAILING ADDRESS DEPTH OF LESS THAN 1 FOOT OR WITH DRAINAGE AREAS LESS THAN 322 ROANOKE AVENUE P.O. Box 1931 THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF 1 SQUARE MILE; AND AREAS PROTECTED BY LEVEES FROM 100—YEAR FLOOD. RIVERHEAD, New York 11901 Riverhead, New York 11901-0965 ANY, NOT SHOWN ARE NOT GUARANTEED. ZONE X: AREAS DETERMINED TO BE OUTSIDE 500—YEAR FLOODPLAIN.