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HomeMy WebLinkAbout53067-Z �aQf$a�r�a TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD., NY rou+m.r�' 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#: 53067 Date: 06/15/2026 Permission is hereby granted to: Scott Schulman 10974 Willow Grove Ter Boyton Beach, FL 33473 To: construct additions and alterations to an existing single-family dwelling as applied for per SCHD, DEC Non-Jurisdiction letter&Trustees approvals. Premises Located at: 1575 Pine Neck Rd, Southold, NY 11971 SCTM# 70.-5-41 Pursuant to application dated 05/13J2026 and approved by the Building Inspector. To expire on 06/14/2028. Contractors: Required Inspections: Fees: Single Family Dwelling- Addition &Alteration $14223.50 CO-RESIDENTIAL $10,0,.00 Total $132,31.510 Building Inspector * Docusign Envelope ID:7096B5D2-8913-8D51-829C-A9C3CEEE3+674 -----------------------------------------------------................................ ..................-------------------------------------------------------- ° �� TOWN of OUT:HOLD--BUILDING DEPARTMENT,h k rAll Town Hall Annex 54375 Main Road P.N7 WIN �►. Box 1179 Southold NY� 119'71-4959 w� ° p Telephone(631) 7f5-18+ 2 Fax (631) 765-9502 tt v . utho dtowi, . w Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only fi PERMIT Nth. Building I�spector. J y M Ay 13 2026Applications and forms must be filled out in their entirety.Incomplete rr ry 9 1 applications will not be accepted. where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. ` Date:5l812028 OWNER(S)OF PROPERTY: Narne:JEN AND SCOTT SCHULMAN SCTM #1000-70-05-41 Project Address: 1575 PINE NECK ROAD SOUTHOLD NY 11971 Phone#:917-84 -44 1 1 Email:scottdschulman@gmaii.com Mailing Address:1575 FINE NECK ROAD, SOUTHOLD NY 11971 CONTACT PERSON: Name:KATHERINE SAMUELS Mailing Address:25235 MAIN ROAD CUTCHOGUE NY 11935 Phone#:631-7 4-6405 Email:KATE@SAMUELSANDSTEELMAN.COM DESIGN PROFESSIONAL INFORMATION: Name:SAME AS ABOVE Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ®Addition ❑Alteration CD repair ❑Demolition Estimated Cost of Project: ❑Other fi 500,000 Will the lot be re-graded? Yes ❑No Will excess fill be removed from premises? ❑Yes No ' Doeusign Envelope ID:7096B5D2-8913-8D51-829C-A9C3CEEE3574 PROPERTY INFORMATION Existing use of property:RE I D ENTIAL Intended use of property: RES I D E NTIAL Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-40 this property? ❑Yes No IF YES, PROVIDE A COPY. ❑ The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. 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,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(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name): katherine jean Samuels IIAuthorized Agent ❑Owner Signature of Applicant: -- OAXQ elzcs Date: 05/11/2026 Nevada STATE OF NE*MY RK) SS: COUNTY OF Clark Katherine Jean Samuels being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the agent (Contractor,Agent,Corporate Officer,etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this 11th day of May 2026 44m,NO, I Notary Public NOTARY PUBLIC d STATE OF NEVADA Notarized remotely using audio-video communication technology via Proof. . � PROPERTY OWNER Appt.No.2a-ssw"i .................... EX pl reS November 20.2027 (where the applicant is not the owner) 1575 Pine Neck End, Southold NY 11971 1, Scott Schulman residing at do hereby authorize THERINE SAMUELS to apply on my behalf t Wn&Southold Building Department for approval as described herein. sE 5/8/2026 Owner's Signature Date Scott Schulman Print Owner's Name 2 TM RE,, ck Compl,'iancie Certilficate Project Information Project Title: 1575 Pine Neck Road Energy Code: 2025 Energy Conservation Construction Code of New York State Location: Southold, New York Construction Type: Single Family Project Type: Addition Project Sub Type: None Glazing Area: 37% Climate Zone: 4a (5572 HDD) Project No: 1886200 All Electric: false Is Renewable: false Has Battery: false Has Charger: false Has Heat Pump false Construction Site: Owner/Agent: Designer/Contractor: Project Notes: Energy Credits Description Credits R408.2.6 Energy efficient appliances 1.0 R408.2.1.2 Improved fenestration 2.0 R408.2.11 Higher efficacy lighting 0.0 R408.2.3(2)(a):Gas-fired instantaneous water heaters(Option 1) 6.0 E nvelo pe Asse mbli es Prop. Req. Assembly Gross Area or Cavity Cont. um U_ Prop,, Req, Perimeter R-Value R-Value Factor/ Factor/ TC TC F-Factor F-Factor Ceiling: Flat Ceiling or 635 45.0 46.5 0.012 0.026 8 17 Scissor Truss Floor 1:All-Wood 235 45.0 46.0 0.011 0.033 3 8 joist/Truss Floor:Slab-On-Grade 80 26.0 0.630 0.480 50 38 (Unheated) Insulation depth:4.00' Insulation position: Horizontal Insulation Wall:Wood Frame, 16"o.c. 1251 36.0 38.0 0.015 0.045 10 30 Window:Wood Frame 438 0.210 0.270 92 118 Door 1:Solid Door(under 130 0.200 0.270 26 35 50%glazing) Door:Glass Door(over 27 0,200 0.270 5 7 50%glazing) Basement Wall:Solid 637 0.8 1.0 0.133 0.050 85 32 Concrete or Masonry Wall height:6.00 Insulation depth:2.00' Insulation position: Integral Insulation ........................................................................................................................................................... ............................... ............................ ................................................. ....................................... The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules.It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Compliance Statement The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2025 Energy Conservation Construction Code of New York State requirements in REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. VlAf: Q4 Name -Title Sign Ur We ' Date A,P . C, OIL F 1A 30 F n s pect i o n C h�ec ki'l st Energy Code: 2025 Energy Conservation Construction Code of New York State Requirements: 0%were addressed directly in the RESCheck software Text in the"Comments/Assumptions"column is provided by the user in the REScheck Requirements screen. For each requirement,the user certifies that a code requirement will be met and how that is documented,or that an exception is being claimed.Where compliance is itemized in a separate table,a reference to that table is provided. Pre_inspection/Plan Review ............. Section Plans Field Verified Verified & Req.11D Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions 105.1, Construction drawings and 0 Complies 105.2 documentation demonstrate Does Not I[PRI]I- energy code compliance for the building envelope,.,Therm al Comply envelope,air,boarders,energy Not credits, renewable eniergly, Observable battery storage,solar read systems and energy compliance E]Not path represented on Applicable I construction documents. 1105.1, Construction drawings and 0 Complies 1105.21, documentation demonstrate 1403.8 energy code compliance for Does Not (PR3], lighting and mechanical Pomply systems.Systems serving Not multiple dwelling units must Qservable demonstrate compliance with i the IECC Commercial Provisions. Not Olicabie Heal g:302,1j, Heatingand coolln�equipment ting: Heatin 0 Complies 4033 lissize per,ACCA anualS, Btu/hr Btu/hr P0 [PR211 based on loads calculated per Does Not ACCA Manual I or other methods mply approved by the code official. I Cooling:� Cooling: Not Btu/hr Bt,u,/hr servable E]Not App licable Additional Comments/Assumptions: High lm[)act(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) soon Inspection Section Plans Field Verified Verified &Req.ID Foundation Inspection Value Value Complies? Comments/Assumptions 303.2, Slab edge insulation installed Complies 1402.2.10 per"manufacturer's instructions. Does Not [F0211 Porn ply Not aservable 0 Not Applicable 1 303.2 1 Conditioned basement wall Complies [F05]' insulation installed per manufacturer's instructions, Does NotPomply PNot servable PNot licable 1403.8 Systerns,serving multiple 0 Complies dWelling units comply with [F191)2 Does Not 'Sections C,403 and C404 of the 0 commercial code. M ply QNot servable PNot licablep 7-- 403.9.1 Heating systems installed for Complies [F192]2 outdoor heating are radiant systems controlled by Does Not Pompl occupancy sensing or timer y switth, Not Observable PNot licable 403.9.2, Snow and ice-melting system Complies 403.9.3, controls installed to shut off Does Not 403.9.4 system when pavement [FI92]2 temperature>50F and n© Pomply precipitation or automatic QNot controls to shut off the system servable when outdoor temperature> 40 Not F. Applicable 303.2.1 i A,protectivecovering is 0 Complies tec,�,ex [F01112 in'stafledto,pro t ' osed exterior insulativ Textends Po Does Not a minimum of 6 in. below grade. mply QNot servable PNot pplicable S See the Envelope [FO1]1 Assemblies table for 402.1.2 Slab edge insulation value. Complies Does Not values (Unheated 9nheated romply 0 Heated 0 Heated Not Qservable Not pp licable t 402.1.2 Slab edge insulation ft P= Does Not s See the Envelope ft ]Complies [F0311 depth/length. Assemblies table for omply values QNot servable PNot livable .. ........... ................... .......... .................... .... .......... ........... .... .......... ...... Section Plans Field Verified Verified Req.lD Foundation Inspection Value, Value Complies? Comments/Assumptions 402.2.9 itioned basement wall ft 1 ft Complies See the Envelope Assemblies t.able for [F06]1 insulated in accordance with Does Not values Table R402.1.3 with insulation Po de th the minimum of 10 ft mply below grade or to the basement RNot floor. serva ble Not pp licable Additional Comments/Assumptions: ------------- ...........................---- act(Tier 1) 2 ier 2) 3 Low I M,Ract(Tier 3) High Imp j Medium lmr)act(T W Framing / Rough_' n Inspecti on Section Plans Field Framing/Ro?ugh-In Verified Verified & Req.lD Inspection Value Value Complies? Comments/Assumptions 303.1.3 U-factors of fenestration complies [FR4]1 products are determined in Does Not accordance with the NFRC test procedure or taken from the Pomply i default table. P Not Observable 0 Not Applicable 4�0 YA~ W........... 402.5.1.1 1 Air barrier and thermal barrier CD Complies i [FR23]1 installed per manufacturer's Does Not instructions. Pomply Not Observable PNot pp livable 402.5.3 h Fenestration that is not site built Complies [FR20]1 is listed and labeled as meeting Does Not AAMA/WDMA/CSA 101/i.5.2/A440 or has infiltration Pomply rates per NFRC 400 that do not P Not exceed code limits, 3servable PNot pplivable 11402.5.4 IC-rated recessed lighting 0 Complies [FR16]2 fixtures sealed at Does Not housing/interior finish and labeled to indicate----2.0 cfm amply Mply leakage at 75 Pa. Not Rservable Not livable ......................... ............... .................. 403.4 HVAC piping conveying fluids Complies ........................ [FR17]2 above 105'QF or chilled fluids below 55 QF are insulated to:>R- Does Not 3. Pomply Not servable ' Not P pplicable 403.6 Automatic or gravity dampers Complies [FR19]2 are installed on all outdoor air intakes and exhausts for Does Not mechanical ventilation systems. Pomply QNot servable PNot pplicable ........... —7 403.6.1 Ventilation systems in climate Complies [FR30]2 zone 6 shall utilize heat or Does Not energy recovery with balanced ventilation and a sensible Pomply recovery efficiency(SRE)>= ❑Not 65% F at 32 . Observable Not pp livable 403.3.3 'Suppt i �,and return ducts in attics Complies [FR1211 nsula ed>=R-8 where duct is >=3 inches in diameter and Does Not 0 >= R-6 where<3 inches. Pmply PNot oservable Not pplicable ............ ........................................................... ....................... ........... ..... ......... Section Plans Field Framing/Rough-in Verified Verified &Req.11) Inspection Value Value Complies? Comments/Assumptions A 1403.3.6 Ducts,air handlers and filter Complies [FR13]1 boxes are sealed with joints/seams compliant with Does Not International Mechanical Code amply or International Residential Not Code,as applicable. Rser►rable PNot pp licable 1403.4.1 Protection of insulation on HVAC Complies [FR24]1 piping. Does Not Comply QsNot ervable [3 Not Applicable ­­�...................... ,403.5.2 Hot water pipes are insulated to Complies [FRI8]2 1 inch of insulation. Does Not Po mply RNot servable PNot licable .......... 402.5.5 Air-sealed electrical and Complies [FR29)2 communication boxes installed Does Not in the thermal boundary of the envelope sealed to limit air Pomply leakage between conditioned Not and unconditioned spaces. Wservable C)Not Applicable 403.3.1 duct systems are design and 0 Complies [FR12]1 sized in accordance with ACCA P Does Not Manual D based on HVAC sizing 0 calculations in R403.7.Duct mply systems serving multiple ❑Not dwelling units is sized in Rservable accordance with ASHRAE Not Handbook of Fundamentals, ACCA Manual D or an equivalent pplicable methodology. 1403.3 Duct systems are design and E)Complies [FR31]1 sized in accordance with ACCA :P Does Not Manual D.Duct systems serving I Multipie dwelling units is sized mply in accordance with ASHRAE Not Handbook of Fundamentals, 93servable ACCA Manual D or an equivalent methodology. 0 Not Applicable 1 402.1, Door U-factor, Complies See the Envelope 402.4.4 U Does Not Assemblies table for [FRI]' 1�values amply Wat ervable PNot licable 1402.11 Glazing U-factor(area-weightedU U Complies See the Envelope 402.4.1, average). ............. Assemblies table for 402.4.3, Does Not values 402.6 o mply [FR2]1 ❑Not Observable Not pp y■�/y/licable Additional Comments/Assumptions: Insulation Inspection Section Plans Field Verified Verified & Req.ID Insulation Inspection Value Value Complies? Comments/Assumptions MIMI 303.1 All installed insulation is labeled Complies [IN13]2 or the installed R-values Does Not provided* Pomply Not Observable 0 Not Applicable .................................................................................................................1 303.2 Wall insulation is installed per 0 Complies [IN4]1 manufacturer's instructions. Does Not Pomply PNot servable PNot Ipicable 402.1, Floor insulation R-value. 0 Complies See the lope 402.2.6 ....... EnveAssem blies table�for [INI]l E)Wood 0 Wood Does Not values Pomply 0 Steel 0 Steel Not 9servable PNot plicable 303.2 Floor insulation installed per Complies 402.2.8 manufacturer's instructions,and Does Not [IN2]1 in substantial contact with the underside of the subfloor,or Pomply floor framing cavity insulation is Not in conta ct with the�top side,of Observable sheath or a combination of cavity an ud' continuous,insulation Not is installed so cavity insulation pplicable is in contact,wiffitop,side of connuou tis linisul'ation. 402.1, Wall insulation R-value. If this is C]Complies See the Envelope R= 402.2.6, a mass wall with at least'/2 of Rf Assemblies table for P Does Not 402.2.7 the wall insulation on the wall 0 Wood I[]Wood values 0 [iN3]1 exterior,the exterior insulation mply requirement applies(FR10). 0 Mass 0 Mass Not Steel Steel Wservable C]Not Applicable 402.2.3, Wood attic knee walls or roof 0 Complies 402.2.3.1 trusses separating conditioned Does Not [IN14]1 space from unconditioned attic P space comply with the omply I insulation requirements in Table Not R402.1.3.Attic knee walls Poservable contain an air barrier between the conditioned and Not unconditioned space. plicable PP ---------------------- Additional Comments/Assumptions., 1 High Impact(Tier 1) 2 Medium Impact(1-ier 2) 13 1,Low Impact(1-ier 3) Final Inspection Provisions Section Plans Field # Verified Verified &Req.1113 Final Inspection Provisions Value Value Complies? Comments/Assumptions 1303.1.1.1, Ceiling insulation installed per Complies 303.2 manufacturer's instructions. [F12]1 Blown insulation marked every Does Not 300 ft2. Pomply Not Oservable Not Applicable 303.3 Manufacturer manuals for Complies 18]3 mechanical and water heating [Fl systems have been provided. Does NotPomply PNat servable 0 Not pplicable .......... 403.1.2 'Heat pump supplementary 0 Complies [FI10]2 heat controls to prevent supplemental heat when heat Does Not pump compressor can serve pomply the heating load. RNot serva ble ONot licable 403.2 Hot water boilers have Complies [F126]2 automatic outdoor setback Does Not control to lower boiler water temperature based on outdoor Goes temperature, indoor Not temperature or water Pservable temperature sensing. Not Qplicable 403.3.6.1 Air handier leakage designated Complies [F124]1 by manufacturer at<=2'6/o of Does Not design air flow. Pomply PNot aservable ONot licable 403.3.7 Ducts,are,pressure tested in Complies [F127]1 accordance with 2 Does Not ANEI/RESNET/ICC 380 or cfm/100 ft2 cfm/100 ft omply i ASTME1554 to determine air leakage with either: Rough-in Not test:Total leakage measured Qservable with a pressure differential of 0.1 inchw.g.across the system Not including the manufacturer's Ppplicable air handier enclosure if installed at time of test. Postconstruction test:Total leakage measured with a I pressure differential of 0.1 inch I w.g.across the entire system includinathe manufacturer's air har f erg enclosure. 403.3.8 1 Duct tiqhtness test result of El Complies 1[F14]1 <=4 cfm/100 ft2 across the Does Not system or<=3 cfm/100 ft2 cfM/100 ft2 CfM/100 ft2 without air handier @ 25 Pa. Z:-Omply Duct tightness<=8 cfm/100 Not ft2 for ducts within thermal Observable envelope. For rough-InAests, verification may need to occur Not during Framing Inspection. p plicable 403.5.1 Circulating service hot water Complies [FIJJ]2 systems have automatic or Does Not accessible manual controls. Does Not Observable 0 Not Applicable Section Plans Field # Verified Verified &Req.ID Final Inspection Provisions Value Value Complies? Comments/Assumptions 403.5.1.1.1 Demand recirculation water )Complies [F132]2 systems have automatic controls to start pump when Does NotPomply hot water is requested. QNot 0 servable El Not Applicable 403.5.1.1 Heated water circulation Complies [F128]2 systems have a circulation Does Not pump.The system return pipe is adedicated return piple or,a amply cold'water,supply pipe.Gravity Not and thermos-syphon d1rculation Wservable systems are not present. Controls for circulating hot Not water system pumps start the Applicable pump with signal for hot water demand within the occupancy. Controls automatically turn off the pump when water is in circulation loop is at set-point I temperature and no demand for hot water exists. 403.5.1.2 Electric heat trace systems 0 Complies [F129]2 comply with IEEE 515.1 or UL 515. Controls automatically Pmol s Not p y adjust the!energy input to the heat tracing to maintain the Not desired water temperature in the piping. QOservable PNot licable 403.5.3 Drain water heat recovery Complies [F131]2 units tested in accordance with Does Not CSA B55.1. Potable water-side ressure loss of drain water Does eat recovery units<3 psi for Not individual units connected to Qservabie one or two showers. Potable water-side pressure loss of Not drain water heat recovery units i Applicable <2 psi for individual units connected to three or more showers. �O—f. Compliance certificate posted Complies [F17]2 with building specifications, compliance path, R408 energy Does Not credits,results and solar ready Pomply zone if prov"Ided. Not Wervabie E]Not Applicable 403.6.2 All mechanical ventilation Complies [F125]2 system fans not part of tested Does Not and listed HVAC equipment meet efficacyand airflow Pomply limits per Table R403.6.2. Not Observable PNot pplicable 403.6.3 Mechanical ventilation systems 0 Complies [F133]2 tested and verified to meet the Does Not minimum flow rates required by Section R403.6. Pmply qNot Observable Not Applicable .......................... 403.6.5 Intermittent exhaust for Complies [F134]2 bath roo ms/toi let rooms has Does Not automatic control,occupant sensor control, humidity� Pomply control or contaminant control. Not Mservable PNot licable ......................................................................... ............................... 4 5 E Conservaltmion Construction, Code, of , tate Energy Effit lency Cert"I'ficalte, Above-Grade Wall 74.00 Below-Grade Wall 1.80 Floor 91.00 Ceiling/Roof 91.50 Ductwork(unconditioned spaces): Window 0.21 0.20 Door 0.20 0.31 Skylight 0.00 ............ ....... Heating System: Cooling System: Water Heater: Name: Date: Comments: Envelope Assemblies Prop. Req. Assembly Gross Area or Cavity Cont. U_ U_ Prop. Req, Perimeter R-Value R-Value Factor/ Factor/ UA UA F-Factor F-Factor Ceiling: Flat Ceiling or 1645 30.0 32.0 0.017 0.026 28 42 Scissor Truss Skylight: Metal Frame 14 0.250 0.550 4 8 SHGC:0.31 Floor:All-Wood 1597 30.0 32.0 0.016 0.047 26 75 joistfTruss Wall:Wood Frame, 16" 3156 21.0 22.0 0.024 0.060 62 156 O.C. Window: Wood Frame 336 0.250 0.320 84 107 SHGC:0.31 Door:Glass Door(over 228 0.250 0.320 57 73 50%glazing) SHGC:0.31 MENEM ON11111101 I The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Slab-on-grade tradeoffs are no longer considered in the UA or performance compliance path in REScheck. Each slab-on-gr-ade assembly in the specified climate zone must meet the minimum energy code insulation R-value and depth requirements. Com pliance Statement The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2018 IECC requirements in REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name - Title Signature Date TOWN OF RIVERHEAD ~ OFFICE OF THE FIRE MARSHAL 0 N J, 4 West Second Street, Riverhead New York 11901 (631) 727-3200 ext. 601 CONSTRUCTION PERMIT APPLICATION TO BE SUBMITTED WITH: ONE(1)SET OF STAA4PED/SEALED BUILDING CONSTRUCTION PLANS AND APPLICATION FEE: under 10,000 sq. ft. - $310 101001- 209000 sq. ft. -$620 20,001-40,000 sq. ft. -$826 409001 —60,000 sq. ft. -$1033 609001- 80,000 sq. ft.-$1,239 801001— 100,,000 sq. ft. -$2065 Over 100,000 sq. ft add$.05 per sq ft Date of Application: 6/9/26 Tax Map No., TOR Permit No., (Office Use Only) (Office Use Only) New Construction: L3 Alteration: 0 Address of Construction/Alteration 480 TUTH ILLS AVE I Business Name of Building/Occupant,TERRAMARE/ CHRIS ARIENS Type of Building Occupancy(Specify from NYS Building Code) AG 41 # NEW FARIVISTAND AND RENOVATION OF EXISTING BARN Desc iption of work to.b,e- erfartned"I. El EMW Do you plan to install a Fire Alarm System? E]Yes 12No Fire Sprinkler System? E]Yes QNo Property Owner Name: CHRIS ARIENS Is Property Owner the Applicant? 2 Yes E] No Daytime Phone No: 917-536-8916 Mailing Address: PO Box 223 Laurel, NY 11948 i to be Applicant Information (10'whom-p , v grynilll avued. *CHRIS ARIENS Name: Mailing Address of Applicant: PO Box 223 Laurel, NY 11948 Name &Number of Contact Person for Additional information: Name KATHERINE SAMUELS Phone No.631-734-6405 SIGNATURE OF APPLICANT The accuracy of the information,plans, diagrams and facts submitted in conjunction with this application are the responsibility of the applicant.Anyfalse statement made herein is punishable as a misdemeanor,pursuant to Section 210.45 of the New York State Penal Law. Signature of Applicant 044 Date: 6/812026 *PLEASE ALLOW A MINIMUM OF 2-4 WEEKS FOR REVIEW PROCESS* Updated 9/2023 IA /r Albert J. Kru s i Jr. SIFOIRLIM[WA,�FIEIRL SUPERVISOR CA,..NA 1EJ\ 1ENN F SOUTHOLD TOV*rN HALL-P.0.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold CHAPTER 236 STORMWATER MANAGEMENT REFERRAL FORM .............. ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT IF ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) NAME: Katherine Samuels Date.- 5/14/26 (Pi,int) Aa& Contact Information: kate@samuels and steelman com IC'-Mail&'Felephone Nury)her) 631-734-6405 Property Address / Locat ion of Construct ion Site: 1575 PINE NECK ROAD S.C.T.M. 1000 .. .......................... District 70 05 41 rvrvrvrvrvrvrvrvrvrvrvrvrvry Sect ion Block Lot ............ .........-------- .......................... ................... ------ TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT A-ea of Disturbance is less than I Acre. No S.P.D.E.S. Perm lit is, 'ReciLlit"'ed ! Q - Project does Not Discharge to Waters of the State. No S.P.D.E.S. Permit_ILReqaired [, - Area of Disturbance is Greater than I Acre& Storm-water Runoff Discharges cres Directly to Waters of the State of New York. THE T O APPLICANT MUSBTAIN a S.P.D.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a BuildingPermit. ❑ - Area of Disturbance is Greater than I Acre& Storm-water Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN I a S.P.D.E.S. Permit through the Southold Town Engineering-De artment- Prior to Issuance of a Bui1d[n,Q perrilit Date: Reviewed By: J FORM # SMCP-TOS December 2024 W- 6 C V Y I I / wm r I �„ ,,,/; luury :..,r,lw. ;,� IV, "„ .,. � ,.uw., M. u0➢UI / ,m,;:, r,;. ,'. ," '"wiu y. ��,. f. ;r r ,,, ,.r,. "b �, r, ,.r,:l lmP r„:; � e' ✓ ,_, ,.u,' e r f ,,, I is rr ,;u r J '.V �. �J� rxwwww��r a �rr�axer f, �r o NY a r ✓ /f/ � U r I u. i..7 w rt .,.,,.,,,, WI"ranM�'11 > r.. Ir I..:. a. W ,.,. !r`✓ „, rur „ ,.w f 1 � EMI tl. I: W Jf I I u r y r� k I r I r o � , d f I i I � I tl /� I y,u�tlf,..G'roI.r J,f7i,txfwrr.w,.w.urrx Mw.w.",'rrirrdv.f,U U::.i.,..u»'wGif dbrv,.n.tlr arw,r rI Ylr mfm Uliuff,�u r+,k c.�:4 m uuIm u..mx fraa1,&Fr r,v.✓:,.R,Al�'N.MM,Y Gr'l.��.'r n..r.n.,.,m�J,w.0_uIwII..w.w'mvwrwuw.wy.M.Vrr w_.w.wuwvemn.moc ww nY taFMer✓dwtl"'..lihNH w�:mNwYr+»�wnm�v�::ail A16rfimm�nra� urn.. .. rzm r,rm'aw rvt m o,'.-r, N rv�p vrcrrvrii�riry,r»nrnrvrvw.Tmoo uawwnimmr.I wrw lr,'fYYW nrwu wvm�.w,.rN.xmramrcu'g7m xxMM1 t'J'.imn o uuu i'ucu:ws,B�t„r r r�'M��» NJ I r 1 ...............,n r„ MWnr! err.,,U V'QJI I BOARD OF SOUTHOLD TOWN TRUSTEESI i'I � r t 1 W f. OUTHOLD,NEW YOB a �� II � r/» / N N :PERMIT NO*10925 DATE: f I / ` 1r ISSUED TO: SCOTT&JENNIF ER SCHULMAN u µ, PROPERTY ADDRESS. 1575 PINE,NECK, ROAD,,SOUTHOLD B��, �/ llu l✓r i r -0� V uJ1, CTM# 1000-70-541 r I ,I I AUTHORIZATION L rl y � � I 2, 1 Off uant to the provisions of h Cod of the Town of Southold and in P`urXs p �r s Chapter��'�of the o►wn � I tl,�rt accordance with the Resolution of the Board of Trustees adopted at the meeting held on Febru 11�{1��,ar�+� « ' in consideration of application fee in the sum of 1250.0o paid by ,c l't nni er Scliulman and subject to ,air 'I the Tens and Conditions.ons as stated in�e Resolution,the Southold Town Board of Trustees authorizes and 1 f I permits the following: I f Wetland Permit to construct onto landward side of existing dwelling a 655sq.ft. 1 &2 I �I Vf, ft story garage/bedroom addition and. a 72sq.ft.or a-story entry addition with 75sq.ft. rr lu�Y:(�7W j / covered entry deck and steps in place of existing8'x20' covered entry porch and steps ���b� �� '�'Mw i to be removed; remove existing conventional septic system and install an I/A OWT sanitary system landward of dwelling* expand existing pervious gravel parking area,to be raised 21 above existing grade (EL 16.E using approximately 60 cubic yards of fill trucked Ynti'. from an approved upland source; and install associated 58sq.ft, of masonry `f b/rWr � P retaining wall with a maximum 2' exposure above grade screened with P lantin s�� J( I y,York f» � install storrnwa ter drainage s;ysterti; and maintain existing 51 wide non-turf buffer area y/ align to of bank as a vegetated non-turf buffer area with the condition to establish t g P g � and perpetually maintain a 101 vegetated non-turf buffer along the wetland boundar3� r and as depicted on the site plan prepared b Maresca &'Associates received on � rt; p p P p �' � J ry u� February 20,2026, and stamped approved on March 2, 2026. f r1 � r T� WI'FNE S WHEREOF the said Board of Trustees hereb causes its Corporate Sea]to be affixed, '�/r and these presents to be subscribed by a majority of the said Board as of the day and year written eve. f � Y I/ v 7: Ar Y7l� r I Ym "M'mw:w f rF r Q l II1111A" r �U �IIII ✓i; , u w mr a lvYJ IYb r , 0 r a mil ir40? r I II *JO 4 11V➢hrI�WW» WIYW r ! µ R rui w rm,rr ! r 9mwlww ww.w. rimrca errtrrr i lNVM.. �W✓uxXY�rIWMiAtaW,lf XYYNPNfNMF»➢➢i �...w�W,'✓iNNm'rv'b."rw`+'M#^w ww�wu vy;xwwww rvuN'm'v MV,.. ,I r r I'� :,r rM�. Ui� ` 1 r.n nl�l„yyY 1 N,�.:rr.b(fW,l1G,�fu MMfur,„?�r,M..� rA`, f, IN.G»4,.� .., ✓r lYl lU, !:r G I(�, I„ u>' /��17�rolir,. �.,,��.:: 1„,..0 tllmlwwMu .�r uorvY„r rr I Iu I,r�vl n ,amp Irv' r wc�w I Y I a J a f I I 1 1 ^a , r , ,ry I r rr; r r ito rrauw Y r '� , n r I w,M" � u;r ,�„y/ ,,r,� N� �.I�ry P� '�d�' �a f „I�`>;• rOi�mM, si 1 A l�r�"� E I JV.JRMiS AND CONDHIONS as part of The Permittee&att 10 Sc h 11575 in N ,S.o-,m- d.New"York Len,I* ,,k-Rpgd the consideration for the issuance ofthe Permit does understand and prescribe to the following.- That the said Board of Trustees and the Town of Southold are released from any and all damages,or claims for damages,of suits arising directly or indirectly as a result of any operation performed pursuant to this permit,and the said Permittee will,at his or her own expense,defend any and all such suits initiated by third parties,and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold, I That this Permit is valid for a period of 36 months,which is considered to be the estimated time required to complete the work involved,but should circurnstabees warrant,request for an extension may be made to the'Doard prior to expiration. 3. That this Perm it should be retained indefinitely,or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. A permit issued for work not including a demolition as per the definition in the Town Code, but subsequent to issuance,the work results in a demolition,the permit is voided and a new application must be submitted. 6. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 71, That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 8. That if future operations of the Town of Southold require the removal and/or alters ions in the location of the work herein authorized,or if, in the opinion of the Board of Trustees,the work shall cause unreasonable,obstruction to free navigation, the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 1 9" The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the,deed of the subject parcel. Such evidence shall be provided within ninety(90)calendar days of issuance of this permit. 10. That the said Bo"ard will be notified by the Permittee of the completion of the work authorized. 11. That the Permittee will obtain all other pennits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. 12. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perfonn the permitted work nor does it authorize ther-im'pairment of any rights,title, or interest in real or personal property held or vested in a person not a party to the permit. �� KATHY HOCHUL o attment of Governor Sy ZZE Environmental AMANDA LEPTON Conservation Commissioner LETTER OF NO JURISDICTION -TIDAL.WETLANDS ACT Scott and Jennifer Schulman April 1, 2026 10974 Willow Grove Terrace Boynton Beach FL 11971 Re: Application#1-4738-021 5/00007 Schulman Property— 1576 Dine Neck Road, Southold NY 11971 SCTIVI #1000-70-5-41 Dear Applicant: Based on the information you submitted, the New York State Department of Environmental Conservation (DEC) has determined that the portion of the above referenced property landward of the contour labeled "Landward Limit of NYSDEC Article 25 Jurisdiction Equals Topographic "Crest of Bluff' as Depicted by NYSDEC on 1998 Survey by Destin G. Graf Land Surveyor" which exceeds ten feet above mean sea level in elevation, as shown on the site plan prepared by Katherine Maresca, last revised on 2/18/2026,which references the survey prepared by Kenneth W. Woychuck Land Surveying, dated 8/10/2025, is beyond the jurisdiction of the Article 25 Tidal Wetlands Act. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 61), no permit is required to conduct regulated activities landward of that contour. This determination affirms DEC's 3/24/1999 decision which states that the jurisdictional limit is located at the topographic crest of the natural bank as identified by DEC on the survey prepared by Destin G. Graf, certified on 12/28/1998, please see enclosed survey and DEC 1999 letter. The submitted check#9319 for$300 will be voided. Be advised, 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 precautions are taken to prevent any sedimentation or disturbance within Article 25 jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the jurisdictional boundary and your Y project (i.e. a 15'wide construction area) or erecting a temporary fence, barrier, or hay bale berm. This letter shall remain valid unless site conditions change. Please note that this letter does not relieve you of the responsibility of obtaining any necessary permitsor approvals from other agencies or local municipalities. Sincerely, lfevin Kispert Permit Administrator cc: En-Consultants, BMHP, File Division of Environmental Permits,Region 1 50 Circle Road, Stony Brook NY 11790 1 www.dec.ny.gov I P: (631)444-03651 F: (031)444-0350 New York State Department of Environmental Conservation Division of Environmental Penn its,Region One Building 40-SUNY,Stony Brook,New York 11790-2356 Phone:(516)444-0365 FAX:(516)444-0360 John P.Cahill Commissioner March 24, 1999 Mr,Joseph Gergyes 46-3 0 241 Street Douglaston,NY'' 11362 RE: I-473 8-0213 5/0000 1 Gergyes Property a. 1575 Pine Deck Road, Southold u, Dear Mr.t iergyes: The Department has reviewed your request for a letter of non-jurisdiction to remove the existing single family dwelling and replace with a new dwelling and associated structures and has the following comments: .Ai field inspection by technical staff has determined that while the house is above the 10#1.elevatiob contour,this is not a naturally occurring grade as required for non-jurisdiction status. The actual topographic crest of the natural bank is located directly behind the existing house and this crest would be the jurisdictional limit for this Department. Therefore,any activity taking place seaward of this crest would require a permit, Since the proposed house and associated structures will be located no closer to the wetland boundary than the existing structure,the Department has no objection to the proposed project. Please submit 3 additional copies of the survey. Also,please advise me if any upgrading of the existing sanitary system is proposed since there is an indication on the survey to"replace existing septic system,"yet a new system is not located on the survey. If an upgrade or new systems is proposed;a cross-section of the sanitary system must be submitted showing the components of the system to be a minimuni of 2 ft. above groundwakt elevation. Test hole location,date and time taken must also be shown. Should you have any technical questions regarding this application,please call Mr.Chris Arfsten in the Bureau of Marine Habitat Protection at(516)444-0295. 1 can be reached at(516)444-0362 with any procedural questions. Very truly yours, ork Environmental Analyst ec C.Arfsten File m > V; < C c: > c m * -0 r- Q r- m O � m � m- r C7 p < om �• .� D m D o u' z � � c� Z j z tv � ZC) > :� — Cn \ K) r Z C z 4h, n 0 0 0 co M o rn Z > po � 07 � o � < ? z _1 D 3 0 c7 0�o cn p {� m flj o -� r 7 y m oo cl) -< 0 m m C) C) > � O 0 Z z C} � O O p � z p Dn � op �" � > z < mn 0 0) 0 c_n m "Tl m o Z 0 O in � c G) � > C-) CA & ASSOCIATES onsulting Engineers 03.16.26 REVfSED PROFILE AS PER NOI DATED 03.16.26 KM 188-04 W. Montauk Hwy02.16.26 ADD POOL HOUSE SEPTIC SEPARATE KM Bays, NY 11946 12•Q8•25 HEALTH DEPARTMENT SUBMISSION SET KM Campton 11.24.25 TRUSTEE SUBMISSION SET -KM- DATE REVISION BY