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21826-Z
1 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23410 Date DECEMBER 14, 1994 THIS CERTIFIES that the building NEW DWELLING Location of Property 890 WILLIS CREEK DRIVE MATTITUCK, NY House No. Street Hamlet County Tax Map No. 1000 Section 115 Block 17 Lot 17.14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 26, 1993 pursuant to which Building Permit No. 21826-Z dated DECEMBER 9, 1993 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is A ONE FAMILY DWELLING WITH ATTACHED TWO CAR GARAGE AND DECK AS APPLIED FOR. The certificate is issued to STEPHEN & ELAINE SPARACINO (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 93-SO-86 NOVEMBER 1, 1994 UNDERWRITERS CERTIFICATE NO. N326953 SEPTEMBER 14, 1994 PLUMBERS CERTIFICATION DATED JUNE 20, 1994 WALTER F. KOPP Y X vi ding Inspector Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD,N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ly Date ..........EG��??./P� ......9.. ............... 19..(..3.. N 21826 Z Permission Is hereby granted to; TFryO.H ..9` .EL.�� ✓E.....S�!�k�lcsr/Q...... /Y)Ai L l o; . o...... ..... ....... ......... PO. /Sox /3 00 /y� ��r.. ........ ........i� .......... y Po -,4 y ... ... . ............ 117 ✓�z ....... T 4s d.......P?..... ow-... ............. .. ......4�4........ dE�tc.............. ....................`.............. ......... ............................................................. ....�usr�Es.........��.. ............/>Ar k.............0..��-r�.�3 � ....i y../�.9 .... ...kc.......19r4?c.r...... ./.... plc ......................... ........ ....J . :........ at premises located at..................a..`.. ...........!!i!tl�/.3.......`f���L . -...... �i9/2f1C-1 ✓o� ........................................................................V .0��.............................................................. County Tax Map No. 1000 Section......8.��7......... Block........�7.....p.... Lot No. .... .. �.... pursuant to application dated ...../ l7flEr??f l�....... ..�v........... 19...1�3....... and approved by the Building Inspector. p �. Fee $...7..s� /cw �Looi� -t- /moo , ago /O .......... .......... . ............................... uilding Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD Inv 1810 BUILDING DEPARTMENT IOO�i TOWN HALL 765-1802 BLDG.DEPT. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: 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 a 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. 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 - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ew Construction. . . . . .x^ Old Or Pre /-existing Building. . . . . . . . . . c � . T. �_ ti . . . . .ocation of Property. . . .C1.g . . . . . . . c . . . . .�.. : . . . M4T House No. / Street / Hamlet nwer or Owners of Property.,_.)fl. .C. . . . . C'. . . . . . . . . . ./. 7. . ./. . . . . . . . . . . . . . . � / ounty Tax Map No 1000, Section. . . . . . . . .Block. . .7. . . . . . . . . .Lot. /.! .'./. Y. . . . . . . . . . . . . ubdivision. . . .r�.. .. . .... . . ...7 �/. . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . _rmit No.�1.(J.�5 . LDate Of Permit. ./�. . . �7 pp _' ?IEYycN Ci �f�.�C/ 2alth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Lanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . ,quest for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . i .e Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . " . . ..� . . . . . . . . . . . . . . . . . . . . APPLICANT • Its/4"i_,� ��t11 � ��✓///!.-.. /.�I� .ii� /-'r�4a..� /ir� • i I ,l i J /I al- � INSPECTORS -10 -. rr SCOTT L. HARRIS, Supervisor W Southold Town Hall Thomas Fisher +;.Building Inspector P.O.Box 1179, 53095 Main Road " Q• '�` " ' +, �` rJ Southold, New York 11971 Building Inspector Gary Fish ri o`4,r Fax (516) 765-1823 t= _ Telephone (516) 765-1800 Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: Building Permit No. ���� Z Owner: (please print) Plumber: G(/4-C7 F/e f�C1�f (please print) I certify that the solder used in the water supply system contains less than 2/10 of IZ lead. (P umbers Signature) Sworn to before me this �U day of 19 �I n Notary Public, 4?-- County — Notary Public ROSEANN GRIFFITH Notary public, State of Nei+ Turk No. 4n14567, Qurdified in Suffolk Cun^C✓ Commission Expires n+ .. is THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1035137 BUREAU OF ELECTRICITY F— 88 JOHN STREET, NEW YORK, NEW YORK 10038 Date SEPTEMBER 14,1994 Application No.on file 8 380 2 1 94/94 N 326953 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of STEVE SPARA, 890 WILLIS CREEK DRIVE, 77MryryATTITUCK, N.Y. in thefollowinp locat _Base1rLen�99[J Ist Ft. L Ynd Ft. GAR/ATTIC/OUT 'Sertion Block Lot was examined on EERR ��OO``!! 444444 and found to be in compliance with the National Etectrical Code. RXTURE RXTURES RANGES COOKING DECKS OVENS DISK WASHERS EXHAUST FANS OUTLETS TACliS SWITCHES INCANOFSCEM FL1/011ISM OTHER AMT. K.W. MT. K.W. Mli. K.W. MIT. K.W. MIT. M.P. 57 62 39 56 i 1 8.6 1 1 1.4 DRYERS SURNACE MOTORS FUTURE APPLIANCE FEEDERS SPROALKSC7T TIME CLOCKS EML UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL H.P. OM H.P. "T. NO. A.W.G. T. AMP. WT. AMPS. TRANS. WT. N.P. OF SYSTEMSTEEi WT. WATTS NO. 2 F 3 20 1 5 600 SERVICE DISCONNECT NO.OF S E R V 1 C E WT. AMP. TTPe , 1/]W I 1]W ]/]W ],I Aw NO.�PERISCOND. OF CC COND. NO.OF nAEO 00A NO.OF N un` IS Oi NEUTTRAL 1 200 1 CS 1 X 1 2/0 i 2/0 OTHER APPARATUS: JACUZZI-1 MPPORStl—F H.P. G.F.C.II-5 SMDKE DETECfORt-2 JUPITER ELECTRIC LIC.*3992—E JOHN CANGEMI 6 JUPITER ROAD GENEeu MANAGER ROCKY POINT, NY, 11778 11 Psr This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be-tdiii0ed by their credentials. COPY FOR BUILDING DEPARTMENT.THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ass-lW2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ( ] ROUGH PLBG. ( ] F NDATION 2ND [ ] INSULATION XRAMING [ ] FINAL REMARKS: i.E �1 y ! ii7J Cd K�G�L iG' �ll�Zo ltyc 60,1 �"•C/yr�`LJ�' �Q ,7X/b �j�leygd�E" d��S nvie .lrf�/off �.RsteatC��'' ` DATE a` 2 `/ INSPECTOR 765_1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: i` DATE INSPECTOR �T / , � v -Av 0 ) 765-1302 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ J ROUGH PLBG. ["'FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ J FINAL REMARKS: DATE_i' �� / A INSPECTOR4z ass-lW2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ I ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE Y INSPECTOR J 1 M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ( ] ROUGH PLBG. ( ] FOUNDATION 2ND [ ] INSU TION [ ] FRAMING [ FINAL REMARKS: DATE Al INSPECTOR, M-lW2 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULA N [ ] FRAMING [ FINAL I REMARKS: - Z i DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ) ROU BG. [ ] FOUNDATION 2ND NSULATION [ ] FRAMING [ ] FINAL REMARKS: ' lZ Z�- DATE `'A Off/ INSPECTOR qLk !'yG�i M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FO DATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL REMARKS: c DATE INSPECTOR COUNTY OF SUFFOLK WV 2 61993 ROOERT J. GAFFNEY TOWN 01- SOV,ill SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES MARY E. HIBBERD. M.D.. M.P.H. COMMISSIONER PERMIT THE ATTACHED PLAN, WHEN DULY SIGNED BY A REPRESENTATIVE OF THE DEPARTMENT, CONSTITUTES A PERMIT TO CONSTRUCT A WATER SUPPLY AND/OR A SEWAGE DISPOSAL SYSTEM FOR THE PROPERTY AS DEPICTED. CONSTRUCTION MUST CONFORM WITH APPLICABLE STANDARDS INCLUDING THE STANDARDS FOR CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES AND STANDARDS AND PROCEDURES FOR PRIVATE WATER SYSTEMS. THE PERMIT (PLAN) EXPIRES THREE (3) YEARS AFTER THE APPROVAL DATE. ANY MODIFICATIONS WHICH MAT" AFFECT THE PROPOSED SEWAGE DISPOSAL SYSTEM OR WATER SUPPLY REQUIRE SUBMISSION OF A REVISED PLAN AND ANN' ADDITIONAL FEES, PRIOR TO CONSTRUCTION. NO INSPECTIONS WILL BE PERFORMED BY THE DEPARTMENT ON EXPIRED PERMITS. PERMITS MAY BE REISSUED UPON THE SUBMISSION OF NECESSARY APPLICATIONS, PLANS AND FEES, AND WILL BE REQUIRED TO MEET THE STANDARDS IN EFFECT AT THE TIME OF REISSUANCE. A PERMIT NTAY BE TRANSFERRED INTO ANOTHER PARTY'S NADIE UPON RECEIPT OF WRITTEN PERMISSION FROM THE ORIGINAL APPLICANT AND THE RECEIPT OF ANY REQUIRED TRANSFER FEES. IN THIS CASE. THE PARTY PAYING THE ORIGINAL APPLICATION FEE WILL BE CONSIDERED TO BE THE ORIGINAL APPLICANT. WWM-058 PAGE I OF 2 COUNTY CENTER RI�ERME4D NY 11901 33Q� 6 G2-2 100 18 380..1 2;92 INSTRUCTIONS FOR FINAL APPROVAL OF CONSTRUCTED SYSTEMS " It is the applicant's responsibility to call the Department to arrange inspections of the sewage disposal system and watcl supply facilities prior to backfilling. These include inspections of the soil excavation for the sewage disposal system and inspections of the water supply well, well lateral, public water supply line, disposal system, piping and final grading. Other inspections may be required. Following satisfactory construction and inspections: I. The applicant must submit 4 prints of an as-built plan(up to and including I 1"xl7"), by a licensed design professional, of the subject property showing the following: a. the lot location and dimensions; b. the lot number(s) and the name of the subdivision, if applicable; c. permanent structures (i.e., buildings, driveways, walkways, swimming pools, decks, etc.); d. the exact location of the private well, if applicable (give at least 2 dimensions measured from the comers of the building); e. the exact location of the public water line, if applicable; I. the exact location of the septic tank and leaching pool(s), if applicable. Give 2 dimensions from the building corners to the covers of the septic tank and each leaching pool; g. the exact location of the sewer line from the dwelling to the street; if applicable; and h. have a clear area at least 3"x5" for the Department's approval stamp. 2. The applicant must submit a certificate from the sewage disposal installer attesting that the system has been installed according to the criteria of the Suffolk County Department of Health Services, when applicable. 3. If a well has been installed as the potable water supply, the applicant must submit a current well water analysis (within one year) and a well driller's certificate. If the well or water quality does not conform to standards, proof of corrective measures will be required. Refer to "Standards and Procedures for Private Water Systems." 4. In those cases where public sewers are utilized for the dwelling, the applicant is also to submit one (1) copy of the sewer line inspection approval from the public sewer district. In districts operated by Suffolk County. two (2) copies of Form S-9, duly executed by the Suffolk County Department of Public Works, are required. 5. In those cases in which the installation and connection of the public water service line has not been inspected by the Department of Health Services, a tap letter from the appropriate water company is required. HEALTH DEPARTMENT REFERENCE NUMBER MUST BE ON ALL CORRESPONDENCE OR DOCUMENTS SUBMITTED. SUBMIT ALL NECESSARY FINAL PAPERS AT THE SAME TIME. PHOTOCOPIES OF DOCUMENTS WILL NOT BE ACCEPTED. WWW058 PAGE 2 OF 2 18 380.12/92 TRUSTEES oOgpFFO SUPERVISOR John M. Bredemeyer. [II. President C SCOTT L. HARRIS Albert J. Krupski, Jr., Vice President tip' Gy Henry P. Smith ti < Town Hall John B. Tuthill ,. T 53095 Main Road William G. Albertson y �� P.O. Box 1179 Telephone (516) 765-1892 �Ol # �a0 Southold, New York 11971 Fax (516) 765-1S23 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD MVV26M October 12 , 1993 TOW. ... _ Young & Young - - Planning, Engineering & Land Surveying 400 Ostrander Avenue Riverhead, NY 11901 RE: Sparacino Property SCTM #1000-115-17-17. 14 DEC #1-4738-00847/00001-0 Dear Mr. Wolpert: The above referenced property was inspected by a representative of this office. As per survey dated August 2, 1993 , this proposed dwelling is out of the Trustees Jurisdiction. If you have any further questions, please do not hesitate to contact this office. nc rely, John M. Bredemeyer, III President, Board of Trustees JMB:jmd CC: Stephen Sparacino Marilyn Peterson, DEC ` NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-00847/00001-0 November 15, 1993 FACILITY/PROGRAM NUMBER(S) PE IT EXPIRATION DATE(S) November 30, 1996 Under the Environmental Conservation Law TYPE OF PERMIT ■ New 0 Renewal 0 Modification ❑ Permit to Construct ❑ Permit to Operate 0 Article 15, Title 5: Protection ❑ 6NYCRR 608: Water Quality ❑ Article 27, Title 7; 6NYCRR 360: of Waters Certification Solid Waste Management 0 Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPINES ❑ Article 27, Title 9; 6NYCRR 373: Supply Hazardous Waste Management 0 Article 19: Air Pollution 0 Article 15, Title 15; Water Control ❑ Article 34: Coastal Erosion Transport Management 0 Article 23, Title 27: Mined Lard ❑ Article 15, Title 15: Long Reclamation ❑ Article 36: FloodpLain Island Wells Management ❑ Article 24; Freshwater Wetlands ❑ Article 15, Title 27: Wild, 0 Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control 0 Other: PERMIT ISSUED TO TELEPHONE NUMBER Stephen Sparaccino ADDRESS OF PERMITTEE P.O. Box 1300, Rocky Point, NY 11778 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Thomas Wolpert, Young 8 Young 400 Ostrander Ave., Riverhead, NY 11901 NAME AND ADDRESS OF PROJECT/FACILITY Sparaccino Property - Willis Creek Drive LOCATION OF PROJECT/FACILITY Mattituck COUNTY TOWN 7[WATERCOURSE NYTM COORDINATES Suffolk Southold EE91RIPTIM CF AA-M= PCrIVI1Y �lace Construct a single family dwelling, swimming pool, deck, driveway, sanitary system and pproximately 1400 cubic yards of clean fill. All work shall be in accordance with the attached NYSDEC approved plan. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, the General Conditions specified (see page 2) and any Special Conditions included as part of this permit. REGIONAL PERMIT ADMINISTRATOR: ADDRESS Robert A. Greene Bldg. 40, SUNY, Room 219, Stony Brook, NY 11790-2356 AUTHORIZED SIGNATURE DATE November 15, 1993 / C Page 1 of 5 G8431AL 03DITIUS Inspections 1 . The permitted site or facility, including relevant records, is subject to in- inspection at reasonable hours and intervals by an authorized representative of the Department of Envirorrrental Conservation (the Departrrant) to determine whether the permittee is carplying with this permit and the ECL. Such represen- tative ray order the v%ork suspended pursuant to ECL 71-0301 and SQPA 401 (3) . copy of this permit, including all referenced maps, drawings and special conditions, crust be available for inspection by the Department at all tirres at the project site. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. Permit Changes and Flenemis 2. The Department reserves the right to modify, suspend or revoke this permit when: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regula- tions is found; b) the permit v%as obtained by misrepresentation or failure to disclose relevant facts; c) neNrraterial inforrration is discovered; or d) envirorrental conditions, relevant technology, or applicable law or regulation have materially changed since the permit v%as issued. 3. The permittee rrust submit a separate written application to the Department for reneAel , modification or transfer of this permit . Such application rust include any forms, fees or supplefrental inforration the Department requires. Any rental , modification or transfer granted by the Department must be in writing. 4. The permittee must submit a renenel application at least : a) 180 days before expiration of permits for State Pollutant Discharge Elimination System (SECS) , Hazardous VAbste kbnagarant Facilities (FM/F) , major Air Pollution Control (APC) and Solid Este rvbnagament Facilities (S/9VF) ; and b) 30 days before expiration of all other permit types. 5. Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirerants contained in such order or determination. Other Legal CbIi gat ions of Piermittee 6. The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature and by Manever suffered, arising out of the project described in this permit and has agreed to indemnify and save harmless the State fran suits, actions, damages and costs of every narra and description resulting from this project . 7. Th i s 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 perform the permitted work nor does it authorize the irrpairrent of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit . 8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-vkay that ray be required for this project . Page 2of Seto,j-,.� ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34 and b NYCRR Part 608 ( ) 9 That it Future operations by the Slate or New fork require an al- other environmentally deleterious materials associated with the teration in the position or the structure or work herein authorized. or project. it. in the opmeon of the Department Or Environmental Conserv,eo°O 13 any material dredged in the prosecution or the work herein permitted it.hall cause unreasonable obstruction to the free navigation of said .hall be removed evenly.without leaving large refuse piles.ridges across haters or Flood Flow, or endanger the health. sarety or welfare or the bed of a waterway or rloodplafn or deep holes that may have a the people of the State. or cause loss or destruction or the natural tendency to cause damage to navigable channel,or to the banks or nroourres or the State,the owner mat be ordered by the Department to a waterway remove or alter the structural work ob,tructions, or hazards caused 14 Th thereby without expense to the State, and if. upon the expiration or ere shall be no unreasonable mterrerence with naxngation by[he work revocation of this permit. the structure till, excavation, or other herein authorized modihcatmn of the watercourse hereby authorized shall not be.-on, 15 If upon the expiration or revocation of this permit. the project hereby pleted the rnvnen :hall werhout expense to the State, and to such authorized has not been completed the applicant shall without expense extent and in;itch time and manner as the Department of Fmnonmenml to the State. and to such extent and in such time and manner as the Conservation mac require.remove all or am portion or the uncompleted Department or Ern fronmenral Conservation may require.remove all or ,rrucfure or rill .mil restore to u, former condition the nesipable am portion of the uncompleted structure or rill and restore the site .tied flood capacnn or the watercourse No Claim shall be made agann.t to is former condition No claim shall be made against the State of the State of New 'York on ud count of snv such remmal or alteraum, New fork on account of anv such remmal or alteration 10 that the Sr, , or New York hall in no,..i,e be liable For am damage Ih it granted under a NYCRR Part b08 the NYS Department of Emuon- OF Minn to the structureorsvork herein authorized which may becamed mental Conservation hereby ceranes that the subject project will not bx or result from Future operations undertaken by the State for the onrr,nene errluent limitations or other hmdrrtiom or standards under consereauon or mimo%ement of navfgaucen or For other purposes and Ser t,on, 301 302. 303 3Ub and AC or the Clean Water Oct tit 197- no claim OF right to compensation had accrue from am such damage tPL `e 5-_s1"I provided that all or the conditions listed herein are met I I c:;anting or thfe perm,[does not relieve the applicant or the resportsn- 17 All aanyitie,authorized bV this permit must be in strict conrormance ih hn of ohqunueg .uey n[her perms,fon content or approval From with the approved plans submitted by the applicant or his agent as part the U S :\rmy Corps of Engineers IJ S Coat Guard New Cork State of the permit application OFF,,e or General Services or local government which may be required Such approved plans Here prepared by I_' \II sec e.sx precautions •half be taken to preclude contain mabnn or an, wetland or waterway hs su,pend ,o ec1 6ds sed invents to el, SEE SPECIAL CONDITIC1N #1 On ,oNents lubricants epoxy coatings paints concrete fear hate Or anv SPECIAL CONDITIONS 1. A permanent 25' no disturbance buffer area must be established immediately landward of the tidal wetland ! boundary, and a revised plan must be submitted to the Department within 30 days of commencement, indicating this buffer area. 2 . All necessary precautions shall be taken to prevent contamination of the tidal wetlands and/or waters of New York by silt, sediment, fuels, solvent, lubricants, epoxy coatings, concrete leachate and any other pollutant associated with project work. 3 . Any debris or excess material from construction of this project shall be completely removed from the adjacent area (upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands. 4 . The storage of construction equipment and materials shall be confined to within the project work site and/or upland areas greater than 50 linear feet distant from the tidal wetland boundary. 5. A row of staked hay bales or approvable erosion control devices shall be placed as per approved plan at commencement of regulated activities and remain in place until project is completed and all disturbed areas stabilized with IIFC PERMIT NUN e, a lon. - _0 PR OG RAM F A C I U Ti NUNI HER Page of 95-206f t 971-25, NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS For Article 25 f Tidal Wetlands I 6. If seeding or soil stabilization is impracticable due to the time of year, a temporary mulch shall be applied and final seeding shall be performed at the earliest opportunity when weather conditions favor germination and growth, but not more than six months after project completion. 7 . Roof runoff shall be directed to drywells a minimum of 100' landward of the tidal wetland boundary for immediate on-site recharge. 8 . Dry wells for pool filter backwash shall be located a minimum of 100' landward o the tidal wetland boundary. 9. There will be no draining of swimming pool water directly or indirectly into tidal wetlands. 10. Project must comply with all local and federal floodplain regulations. 11. All fill shall consist of "clean" gravel and soil (not asphalt, slag, flyash, broken concrete or demolition debris) . Supplementary Special Conditions (A) thru (F) attached. DEC PERMIT NUMBER _ 7 _ r ACII ITV ID NUMBER PROGRAM NUMBER Page of SUPPLEMENTARY SPECIAL CONDITIONS The following conditions apply to all permits: A. T copy of this permit, including all conditions and approved plans, shall be available at the project site whenever authorized work is in progress. The permit sign enclosed with the permit shall be protected from the weather and posted in a conspicuous location at the work site until all authorized work has been completed. B. The permittee shall require that any contractor, project engineer, or other person responsible for the overall supervision of this project reads, understands, and complies with this permit and all its general, special, and supplementary special conditions. Any failure to comply precisely with all of the terms and conditions of this permit, unless authorized in writing, shall be treated as a violation of the Environmental Conservation Law. If any of the permit conditions are unclear, the permittee must contact the Division of Regulatory Affairs at the address on page one or telephone (516) 444-0365. C. If project design modifications become necessary after permit issuance, the permittee shall submit the appropriate plan changes for approval by the Regional Permit Administrator prior to undertaking any such modifications. The permittee is advised that substantial modification may require submission of a new application for permit. D. At least two days prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of the authorized work, the bottom portion of that form shall also be signed and returned, along with photographs of the completed work and, if required, a survey. E. For projects involving activities to be undertaken in phases over a period of more than one year, the permittee shall notify the Regional Permit Administrator in writing at least 48 hours prior to recommencing work in subsequent years. F. The granting of this permit does not relieve the permittee of the responsibility of obtaining a grant, easement, or other necessary approval from the Division of Land Utilization, Office of General Services, Tower Building, Empire State Plaza, Albany, NY 12242 (513) 474-2195, which may be required for any encroachment upon State-owned lands underwater. DEC Permit No. I-" ���0 — Lk' 'J 7 cc-cci1l Page 5-of BOARD OF HEALTH . .-. . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . TOWN OFSOUTHOLD SURVEY .. . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CtIECK ✓. . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 NOTIFY , CJ7 9�f q Q CALL Examined . . . .� J• . . . . .. 199,3 � :=.0 Approved . . . �iVl. . . . . . 19/ . Permit No.rtIQ �P' lJr _ cc _ Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t i*2 PM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)i'"idin.- . . . , , SLLt;. 0 'OF S66*Ot . . . . . . . . . . . . Inspector) APPLICATION FOR BUILDING PERMIT Date . . . �. . . . . ., 19I✓� INSTRUCTIONS r a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp .t' s. . . . . . . . . (Signat e of applica , or name, if a corporation) 'Pa do .idea. �`a�r ./Z Y. IX (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . fry?/J.t./� . . f/-��draC/./;.0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v✓ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) . r�L_ - I Builder's License No. . . . . . . . . . . . .4 .7 lr (AC V) Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . L 1. Location of land on which proposed work will be done. . . �ff.TT/. �GCC./� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . / . . . . . . . . . . . fm r l-� .k. . . . . . . . . . . .. Ilouse Number Street Hamlet County Tax Map No. 1000.I!�Seection . . . :. . �/� . • • • . . .. Block . . . . . ' . . . . . . . . . . Lot . . . I. !. . .�7. . . . . . . Subdivision ./f1�A0./. /e64j . 4 . 1.//,/7-r/.TUGC1 iled Map No. . . . . . . . . . . . . . . Lot . . .�.,y . . . . . . . . (Name) , 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . ,w. . . . .). . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,/ b. Intended use and occupancy . .'.leAd. . Olff.. . F�Zf7.l ly . . dwe llm 3. Nature of work (check which applicable): New Building . .Y.. . . . . sddition Altelatlor. Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition Description) 4. Estimated Cost . . . . aael . . . . . . . (to be paid on filing this application i 5. If dwelling, number of dwelling units . . . . . /. . . . . . . . . Number of dwe llim, units on cacti lluot If garage, number of cars . . . . . Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . N e ries . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of some structtons or additions: Front Rear _ Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . 8. Dimensions of entire new construction:, t . . . '.�. . . . . . . . Rear . . . �`� . . 4 . . Depth . . .'. Height . . .3F. . . . . . . . . . Number of-4Toifn . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . .. . . . . . . . . . . . . . .`�,-. ) . . . . . . Depth . . . .. . . .Rear . . . . . . . . . . . . . 10. Date of Purchase . .9Cl , l✓+�. .��93 . . . . . . . . ,Name of Former Owner . .Ld 11. Zone or use district in w uch premises are situated . ./E.�'S<t��i./T.!f?l. . . . . . . 12. Does proposed construction��c}olate any zoning law, ordinance or regulation: . . ./.Vii. . . 13. Will lot be regraded . . . . . .XG.S. . . . . . . . . . . . . . . . . . Will excess fill be rerno 'ed from premises: r Yes G 09 14. Name of Owner of premises .Steppe.n. pu r.ACt/1Piddress k�)LiC �. .i'XX•. Y Bh�m e No. Name of Architect F/R/��. . `?�./l.T(�.E�R. . Address /Ilt. Si/d/.az. .,4I. ��/f phone No. Name of Contractor Shen. .��fO.0 14!'. . . . . Address�.t., �C._k4fl . Phone No�? j%�J 15. Is [his property within 300 feet of a tidal wetland? *yes. . . . . . [10. . . . . . . . . *if yes, Southold Town Trustees Permit may be required. PLOT DIAGR.,"I Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. G't STATE OF NEW PORK, 1r SS COUNTY OF . .,Jr.t{: .. .... . . . . . .C; . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Ileis the . . il, M( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . . . . . . . . . . . . . . . . .day . . . . . . . .. 1 i" Votary Public. —fiCI'lx-)./. .>�:. . . 1 `. t`Sj. . 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FOUNDATION SURVEY OF z IIII \ f Fir*eryvaF i�s�,rr.�v 5*1,Nix�r r ttxf t I'N.TLFIn LOCATION { �4"PE.56b ' \ I i I I � � Ii \ � � \\''� I1 kJf whY w+rwa�N�a,rn N r�J�laJ fr�M.ff F WAS 6 u�Fv�olr,�cuc►��r.rreF:lJsr,n�rc. BEEN APPROVED 31/2"LL.(1w) i n 1 I /` / \ \ V A.^ j IIII - (III 2h' x2� x16 C rfr.)/ / \\ / o \ NrYOCCUPA OR *** � (" ...� // / �' �\ \\ UNDERWRITERS CERTIFICATE y xrgV 5r t i II11 \ \ USE � UNLAWFULREQUIRED r I--H#{--"- 31/2"I-.C.c ff) M I I N -__�I►__ _--- = IIIiW17"OUT CERT1 Ff CATE � � r tubi r,Wy �' I1►I _ IIII / / \ \ tar wat r distrtb�utino +► OFOCC��P`ACY syst.frfr>w;Piping 1 I 11�krDF�MtS / \ PiP shell bo 4 of ft" K or Lion APPRO 0 AS IIOTEO DATE: B.P.# PLUMBING fil i —— —-- —--———--.__ / '� \ \ FEE. r BY PLUMBING VWASTE NOTIFY BUI ING DEPARTMENT AT & TER LINES(NEED r— r / � TESTING BEFORE / �`� / 765-1802 9 AM TO 4 PM FOR THE OitE COVE INSPECTIONS: - �1,11 �I i .. �� n i i N ( i / '� 1. FOUNDATION 2 6 \ j / / 0 TWO REQUIRED 1, x FOR POURED CONCRETE PLUMBER CERTiIFI , 2. OUCH FRAMING £x PLUMBING � ON - LEAD CON E T NU .x T BE I , F O / G a s; .'INSULATION N �. k a i CERTII� I I 4 ,MU N T " 5 U� IO ,.:.� . Ic.�rE .. 4 PC. � FINAL cONsTRUGTIQ s OF OCCUPAN Y ``� zi . ---- --------- ------- \ 8E COMPLETE FOR C.O. SOLDER USED IN WAALL CONSTRUCTION SHALL MEET TE ,`" THE REQUIREMENTS OF THE N.Y. SUPPLY SYSTEIV� CANNO 24"X 24�� x I(c p•G•F �O STATE CONSTRUCTION & ENERGY EXCEED 2 # k . / CODES. NOT RESPONSIBLE FOR ��4 of �/o LEA DESIGN OR CONSTRUCTION ERRORS 15'-811 10'-III ry .ice I.S. 1Mll7L " 0.9,e 518 Plywd . 0.78 r' \ \ Airspace 1.f 4 ou 0C/I I on \ \ 6" Batt.1n.�nai 19.00 k' _ ✓ \ \ 0.S. Film 0.92' \\ R= 22.76 ��-oil \ \\ i° U1/R= .0414 \ \ /� 0 Code U= .05► \ \ Termite Shield s ' / brawn \ R19 Batt InsuI G �� Grade n i (2) 2"x a Treated As .: 112" 0 x fir A.B. 0 8' A.B. ., a F Checked • a-I�� - •il� 8" P.c> Fdn # �•. T�:I l ,O Damproof "?;?•:c 4" P,C. 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