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HomeMy WebLinkAbout32882-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33403 Date: 11/21/08 THIS CERTIFIES that the building ADDITIONS Location of Property: 980 DEEP HOLE DR MATTITUCK (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 115 Block 12 Lot 14 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 4, 2007 pursuant to which Building Permit No. 32882-Z dated APRIL 4, 2007 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 ADDITION WITH ROOF TOP DECK, FRONT AND REAR DECK ADDITIONS AND BILCO DOOR ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to LORRAINE WENDT (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 4016131 10/24/08 PLUMBERS CERTIFICATION DATED N/A IJ horized Signature Rev. 1/81 Form No.6 .:_ TOWN OF SOUTHOLD �' r 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$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 .�� Date. New Construction � Old or Pre-existing Building: (check one) Location of Property: of 8-0 An, Q-4-1 A TAXXA House No. Street bjlx� Hamlet Owner or Owners of Property: n Suffolk County Tax Map No 1000, Section Block Z Lot o Subdivision V I Filed Map. Lot: Permit No. „3 a �{ �eZ, Z Date of Permit: Applicant: ti j�� ►_44_7 W Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: . (check:one) Fee Submitted: $ o? . 0(3 (�C10 ►CQ C/� A plicant Signature (MIN �jRrL3r3r�r�r�cPtlrJ7r.l'c1�t.fcftJ7t:.tt:Pt1rJ�r�r�tJ�rJ�rJ�rJ�r.Pr�r�r__I'tPlt��Pr__tr�rJ�r.PrJ�c.I�tJ�rJ'tTJrJ�r�J�r�r�cfrJ�r�r_f0 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 5_ BUREAU _ ®F ELECTRICITY 5 .40 FULT.ON STREET 'NEW. YORK, NY 1003� 5 _ 5 5 5; CERTIFIES 'TFIA►T 5 5 Upon he application of Upon premises owned by 5 5 5 ..' BRIAN BROOKS ELEC.:INC. RIE WENDT 5 L� BOX 1001 455 BEEB..E DR. 980.DEEPHOLE DRIVE CUTCHOGUE,NY 11935, MATTITUCK, NY 11952 5 S _ S` 5 cj Located at 980 DEEPHOLE DRIVE-""�`rTITUCK,NY-11952 - -- —. 5� _ S: Application Number Certificate Number: 5 4016131 4016131 5 5 rj Section Block: Lot Budding Permit: „ BDC: ns11 5 5 . occ.0 anc wherein the premises electrical system consisting of 5 S5 Described as a Residential p y, 5 electrical devices:a ld wiring, described below; located in/on:. a premises at 5 First Floor,sun room,0utside, 5 _ Cj A visual inspection of the premises electricaF system, limited to electrical.devices and wiring to the extent detailed 5 herein- was conducted in :accordance with the requirements of the applicable code and/or standard -01 5 promulgated by the State of New York, Department of State: Code_..Enforcement and Administration, or other 5 5 authority fiaving jurisdiction, and found to be in compliance therewith on the 2atn Day of October, Zoos. S 5 %Name ..Rate Rattn� TYe 5 . AdditionalCharges _ Cir cuits _ 5 _ S as built2000 5 sunroom and servlce(100a) 5 5 Service 5 cb Seance Disconnect o 100 5 :.SeNi6e1Phase3w Serdice. 5 Ratm9100Ampares .. 5 Wring And Devices . Dimmer. 2 0 120 V 5 descent Fixture::: 7 0 Incandescent 5 5 5 5 Outlet.. 7 0 Fixture Outlet Gen,Purpose 5 Receptade 2 0 GFCI 5 5 ReceptaGe 7 0 ,Purpose ...5 Gen Switch: . .... 2 0 Gen,Purpose 5 5 5 _ 5 . Sea/ 5 . 5 5 Continued on Next Page 1 of 2 k : 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 57 i _. 5 a t�r�t�tJr.!cPr.Jar..I'ar.1r�c1r..1'3cPrJ��.trJ��.tr1�r.Pr�c.(t�cPrJ�rJ�r_1"JrJ't.P�L3PLr PtIr�t�r l�rJ�rlcPt�r..['t l�cPr�tJ�rJ�r�rJ�tJ�rJ�r�_I'r l JtJ�r��frJ�r�i�t�tJ�r�t�r..l"� 0 © rJ�c.(7rJ�r�rJ'rJr.PrJ�rJ�t�rJ�r�cPc1cPr�cPr�i::, �cPcfr l�c.(7c1'rJ'cPcPc l��frJ'r�c.I�rJ��t�1r�tPcfr�rJ�r.PrJ�r�r��1�r�rPr l�cnrJ�r�rJ�r��r�r�r�r�cnr�rJ� �C 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 � 5 5 NEW YOLK` BOAFD =0F FIRE UN®EF�V�R1TE�� 5 5 BUREAU :OF _ ELECTfR:ICITY 5 cc 40 FULTON STREET NEW: YORK, :NY 10038 S .. 5 CERTIFIES THAT 5 5 5 5 Upon he application of upon premises owned by 5 5 Lj BRIAN BROOKS ELEC INC LAURIE WENDT 5, BOX 1001,455 BEEBE DR 980 DEEPHOLE DRIVE CUTCHOGUE NY MATTITUCK N 11935 Y 11952 5 - 5 980 DEEPHOLE DRIVE MA'i TITUGK NY:11952 - i 5 Application.Nurnber - Cate Number Certifi 4016131 5 4016131 c5 _ rj Section Block: Lot Buildmg;Permit: „ BDC: ns11 5 5 5 occu` anc wherein the remises electrical system consistin of 5 Described as a Res,dent�al P y�. y g S p 5 5 electrical devices and wiring, described below:' located''in/On"the prernrses at C� 5 First 1 loor,sun room,0utstde, 5 5 5 SA visual inspection of the premises electrical system, limited to electrical deices and wiring.to the extent detailed 5 Sherein, was conducted' m accordance with the requirements of the applicable code and/or standard promulgated by the State of `New York, Department ofStafie :Code :Enforcement and Administration, or other 5 5 authority having Jurisdiction, and found to be in compliance therewith on the lath Day of October, coos. [5', 5 Tiame QT1'_ Rate Raftn� Circuits T1 5 5 An as built usua l mspechon,ofthe delineated electrical mstallat►on determmedahat an obvious hazard is not present and the installation is 5 believed to be in conformance with the applicable:reference,standard for the estimated petiod of construction of the premises wiring system. . 5 5 = ;5 5 .5 5 5 _ 5 5 5 5 5 5 5 5 5 seal 5 5 2 of : 2 5 5 -5 5 5 This certificate may not be altered in anyway and.is validated only by the.presence of a raised seal at the location indicated. S r�rJ�r[�.pr Pr PLrC.Pc.rr3rC3]1 �r�r�r�r�r�rJ�c.r�.rr�rJ�c.1�rJ�r�r�r��,-r�l.rr llr?PrJ�c.r� 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) PERMIT NO. 32882 Z Date APRIL 4, 2007 Permission is hereby granted to: LORRAINE WENDT 28 FIDDLERS GREEN DR HUNTINGTON,NY 11743 for CONSTRUCTION OF ADDITION & TWO DECK ADDITIONS TO AN EXISTING SINGLE FAMILY DWELLING THIS PERMIT REPLACES BP # 29644 at premises located at 980 DEEP HOLE DR MATTITUCK County Tax Map No. 473889 Section 115 Block 0012 Lot No. 014 pursuant to application dated APRIL 4 , 2007 and approved by the Building Inspector to expire on OCTOBER 4, 2008 . Fee $ 150 . 00 ize Sig ORIGINAL Rev. 5/8/02 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. 1 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 29644 Z Date AUGUST 12 , 2003 Permission is hereby granted to: LORRAINE WENDT 28 FIDDLERS GREEN DR HUNTINGTON,NY 11743 for CONSTRUCTION OF ADDITION & TWO DECK ADDITIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR; THIS PMT REPLACES BP26575Z. at premises located at 980 DEEP HOLE DR MATTITUCK County Tax Map No. 473889 Section 115 Block 0012 Lot No. 014 pursuant to application dated AUGUST 12 , 2003 and approved by the Building Inspector to expire on FEBRUARY 12 , 2005 . Fee $ 150 . 00 Authorized Signature ORIGINAL Rev. 5/8/02 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) PERMIT NO. 26575 Z Date JUNE 13, 2000 Permission is hereby granted to: LORRAINE WENDT 28 FIDDLERS GREEN DR HUNTINGTON,NY 11743 for CONSTRUCTION OF ADDITION AND TWO ATTACHED DECKS. at premises located at 980 DEEP HOLE DR MATTITUCK County Tax Map No. 473889 Section 115 Block 0012 Lot No. 014 pursuant to application dated MARCH 2, 2000 and approved by the Building Inspector. Fee $ 175 . 00 Authoriz d Signature ORIGINAL Rev. 2/19/98 Y FORM NO. 1 SETS OF PLANS TOWN OF SOUTHOLD -"SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT (CHECK . . . . . . . . . . . . . . . . .. . . . . . . . TOWN HALL S . . . . . . . . . . . . . . . . . . . SOUTHOLD, -N.Y. 11971 TEL: 765-1802 MOTIF ,! CALL (o.73:7 (, -1_i. Examined... ............ 20.... MAIL TO:LQ�M1.YJg::"':�4�.1 /I... f l n Approved..ld t 0� ........ �0. Permit No. ..:.......:..... o�� '4L .1��?-e lm , I V Y I / j � ........................................ ......... Peer - �-� `fry�....._..._,.� _ :C�J•l�.. m.� )' - (Building I •tor) ....... F o MIND 1 i.} i APPLICATION'FOR BUILDING PERMIT Date. .` . . . . . . . . . . . . 20.0_ .4 (j BLDG.nE FT. ,INSTRUCTIONS TOWN urS66THOLD a. This application must be completely filled in by typewriter or: in ink and submitted to.the Building Inspector wii 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 application. c. The work covered by this application may not be cemTenced 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 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 HEEEBY 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 ilding for metes in pections. (•ignature of applicant, or name, if a corporation) a�.......!......(:ems i� (Mailing address of applicant) 1Prbuilder State whether licant is owner .lesapp , see, agent, azchitect, engineer, general contractor, elecCrician, plumbe Name of•ourner-of...emises.....�.�.�.�{.. ...�..:.........�.�.�' .....�......................................... Pr -- in�•ku" �. .............................................. (as on the tax roll or latest deed) If applicant is a co* ration, signature of duly authorized officer. .............J.:l. .r.,.................................. (Name and title •corporate officer) Builders License No. ......................... Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... L Location of land on which proposed work will be done.............................................................. m � I ....` �..... e� :.....�?�.e-:.. a.�'�...............M. :.�.�t:. :. � .............. House Number Street Hamlet County Tax Map No. 1000 . Section ...... Block .../.Z'........ Lot ..0 1L4....... Subdivision ...................................... Filed Map No. ..........:.... lot ............... (Name) 2. State existing use and occupancy of premises and 'intended use and occupancy of proposed construction: A � a. Existing use and occupancy b. Intended use and occupancy ..Gas•:. ...... .............................. rt 1,aL[Jte uL- avr ku".:K wilich applicable): New Mil ding .......... Addition N/.......,Alteration M......... Repair .............Removal ............. Demolition ...... Other Work ...................................... (Description) 4. Estimated Cost ... C ... fee .............................................. (to be paid on filing this application) .5. If dwelling, rxiiher of dwelling units A......... Number of &A-Ali ng units on each floor .....I .......... If garage, number of cars ........Y\ ................... 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 same structure with alterations or additions: Front ............... Rear ............... Depth ................ ..... HeijoiL .................... Nuiber of Stories ............... 8. Dimensions of entire new construction: - Front ................ Rear ............... Depth .............. — lie i gh t ......................... Nuni)er of Stories ..................... 9- Size of lot: Front .................... Rear ........................ Depth .............. 10. Date of Purchase ......... Name of Former Owner .10':1A e-re_OL'M Lou 11. Zone or use district in which promises are situated ............................... ..... 12.. Does proposed.cPnstri.j.ction violate any zoning law, ordinance or regulation: ..................... 13. Will lot be regraded Will excess fill be removed from premises: YES 14. Names of Owner of ........................ Phone No.,,')JL.(VUP.(3XY Name o . . cj&�.Kt- f Archite��t ...... Address .............................. Rxx-ae No. .............. Name of Contractor .................................... Address ...............................Phone No. .............. 15. Is this property within 300 feet of a tidal wetland? * YES .1/ ..... NO .......... *IF YES, S0L11XXD MM MMMS PERMIT MAY BE WqRRM. PLOT DIAGRAM 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. amw or Mw Yow, Cowly or, ................being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named, Ile is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work atw] to make am file Z'this application; that all statements contained in this application are true to the best of his kDowledge and.b6liefi and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this C41.......day of Notary Public ... . ...... .......... ....... ........ .......... (Signature of • Applicant) LINDA J.COOPER )lie,State Put f New Yor k: No.4P,22563,Suffolk Ceunty Term Expires December 31,ig�60 OF S0UTy0lo w. 7, coUMY,�`� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING FINAL [ ] FIREPLACE & CHIMNEY [ ] IRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: r DATE INSPECTOR ' 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROU H PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE � 0 INSPECTOR j. 765-1802 BUILDING DEPT. INSPECTION [ -.-FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: 4z DATE '� �� INSPECTOR � ,65-1SOZ e BUILDING DEPT. INSPECTION [ ] FO NDATION iST [ ] ROUGH PLBG. [ ] F UNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLACE &�CHIMNEY REMARKS: i'62�� �/I�.v �� � 7-1 w2 w� DATE off- INSPECTO ass-isoa BUILDING DEFT. INSPECTION [ ] F NDATION iSY [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: L/ ,DATE INSPECTOR r65-sao2 BUILDING DEFT. NSPECTION [' ] FOUNDATION iST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR FIELD_INSPECTION REPORT II DATE up _ - COMMENTS _ -__ ---------- - __ --===== _ p_ I f / FOUNDATION O ST) zz jj Ij II d FOUNDATION (2ND)__ II II - ------------------ -- ----------- - --- ------------------- ----------- ---------------- - - ROUGH FRAME & n u PLUMBING II IITf--�i U Jor- ----___`-_-____=___- ------- INSULATION PER N. Y. I _ -i1 \ STATE ENERGY .41 I -- CODE I 16 ,01 ---------------- lit UI II ij � Icy III c II ji • FINAL I u-------- ----- ---- ---------------------______________ o ADDITIONAL COMMENTS: ` e-41 Z ,b r� r� ro H NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-02251/00001 ® February 14 2000 FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S) Under the Environmental Conservation Law February 14, 2005 TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Permit to Operate ❑ Article 15, Title 5: Protection ❑ 6NYCRR 608: Water Quality ❑ Article 27, Title 7; 6NYCRR of Waters Certification 360: Solid Waste Management ❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR Supply 373: Hazardous Waste Management.- 0 Article 19: Air Pollution ❑ Article 15, Title 15: Water Control ❑ Article 34: Coastal Erosion Transport Management ❑ Article 23, Title 27: Mined ❑ Article 15, Title 15: Long Land Reclamation ❑ Article 36: Floodplain Island Wells Management ❑ Article 24: Freshwater Wetlands ❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37; Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control PERMIT ISSUED TO TELEPHONE NUMBER Lorraine Wendt (516) 673-6084 ADDRESS OF PERMITTEE 28 Fiddlers Green Drive Huntington, NY 11743 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Nelson Pope & Voorhis, 572 Walt Whitman Road, •MelviH e; NY 11747-2188 (516) 427-5520 NAME AND ADDRESS OF PROJECT/FACILITY Wendt property, 980 Dee hole Drive, Mattituck, NY 11952 LOCATION OF PROJECT/FACILITY SCTM #1000-115-12-14 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold Deep hole Creek E:709.3 N:4540.4 DESCRIPTION OF AUTHORIZED ACTIVITY: Construct a 12 foot by 20 foot addition, a 6 foot by 12 foot platform/step, and a deck for an existing single family dwelling. Remove existing concrete patio and plant with non-fertilizer dependent grass. All work shall be performed in accordance with the plans stamped NYSDEC approved on 2/14/00. By acceptance of this permit, the permittee agrees that the permit is contingent upon strict.compliance with the ECL, all applicable regulations, the General t t specified (see page 2 & 3) and any Special Conditions included as part of this permit. _ PE T AD INISTRATOR: ADDRESS Jo n eland (MRP) Building 40, SUN Room 121, Stony Brook, NY 11790-2356 AUT I D SIGNATURE DATE /i\ Gi Page 1 of 4 February 14 2000 NEW YORK DISTRICT;CORPS OF EiJGINEERS \\� JAC013 K.JAVITS FEDERAL BUILDING NEW YORK,N.Y.10278-0090 REPLY TO ATMIMON OF April 22, 1999 ' Eastern Permits 'Section SUBJECT: Joint Application with New York State Department of Environmental Conservation . Lorraine Wendt 28 Fiddlers Green Drive ' Huntington, New York 11743 Dear Ms. Wendt: - We have recently received *a copy of the Joint Application for permit you filed with the New York State Department of Environmental Conservation (NYSDEC) . Please be advised we have reviewed the copy .of the Joint Application sent to this office by NYSDEC. Based solely upon the information provided, it appears that a Department of the Army permit is not required -for your proposal. The Department of the Army regulates construction activities 'in navigable waterways and discharges of dredged or fill material_ into waters of the United States, including inland and coastal wetlands . If your proposal would involve such work, and has not been portrayed as such in your Joint Application, you should contact this office immediately so that a project-specific determination can be made as to' whether a Department of the Army permit will be required. Any inquiries can be directed to this office at (212) 264- 3.912, 3913 , 6730, or 6731. Sincerely, JaresW. Haggerty C astern. Permits Section Fig. Board Of Southold Town Trustees SOUTHOLD, NEW YORK � •" / I \ PERMIT NO. .. ` '� R DATE: ..,Sept.... 23,... 1998 I. ISSUED TO ..........LORRAINE. . WENDT ...... Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893.; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS '% IN AND ON TOWN WATERS AND PUBLIC LANDS and the a ` s REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;'..'. and in accordance with the Resolution of The Board adopted at a meeting held on 9/23/98 .r 19............, an in consi eration of the sum of $--150.oo......... paid by 98 d d ...............Lorraine..W..-ndt....._.. ..... ............................................................... :.................... Mattituck.......................................................... N. Y. and. subject to the „r- of ......... ..-... Terms and Conditions listed on the reverse side . hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to relocate basement storm door from westernp' 1I side of house to southern side, remove existing porch and replacd'4 K% !' with a 12'X20' enclosed room, a raised 12'X28' deck to same heigh ` as en loted ro m, a r, f ove a 'X5' . or�� & re 1 e in front in accordance w���i the dretailtec� spec rlFicafions as prg�ent $its G.. � . the originatinglcation. of . application' house with new steps, .place haybales here- along wetland g }�� v Ness Wfit6� Wntsai of u f IN ITN a said oar o' °IfrJstees here- � I by causes its Corporate Seal to be affixed, and these presents to 1 `` be subscribed by a majority of the said Board as of this date. Absent Albert J. Jr. �s ' I o�p Cpy ;,� �..�.. ..... .. ......... / FN E ......... ,Trustees � v .o �s��"°�4r.=�.dG::�/i:.��''7��r`!:a���'�t w+i'^�°• z=a�';��y��.r�L Town Hall, 53095 Main Road JU DITH T. TERRY TOWN CLERK .7 P.O. [lox 117() LO Soudiold w, Ne 1'ork- 11971 Ni Fax (516) 765-1823 RE cIs-rnAR OF VITAL STA-DS71C3 MARRIAGE OFFICER Tdcphonc (516) 765-1 XO I RECORDS MANAGEMENT 01-FICEIZ FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 : RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93) ] ,' and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93) ] . �77 TOWN OF SOU TiAOLD /Judith, T. Terry Southold Town Clerk August 25, 1993 APPLICATION # PAGE l of 4 TOWN OF SOU THOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1• GENERAL PROVISIONS (APPLICANT to read and sign): 1. No work may start until a permit is issued. 2. The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re-issued- 4- Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no 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. T. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO _ THIS APPLICATION ARE,TO E BEST OF MY OWLEDGE,TRUE AND AC/CURAT//E. (APPLICANT'S SIGNATURE) DATE b / b SECTION 2• PROPOSED DEVELOPMENT (To be completed by APPLICANT) ' NAME ADDRESS TELEPHONE APPLICANTi, f JV � 1 BUILDER , 014N� ENGINEER � y PROJECT LOCATION: To avoid delay in processing,the application, please provide enough information to easily,identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(93) APPLICATION PAGE20F4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE ❑ New Structure ❑ Residential (1-4 Family) ❑ Addition ❑ Residential (More than 4 Family) ❑ Alteration 0 Non-residential (Fioodproofmg? ❑ Yes) ❑ Relocation ❑ Combined Use (Residential & Commercial) ❑ Demolition ❑ Manufactured(Mobile) Home (In Manu- ❑ Replacement factured Home Park? ❑ Yes) ESTIMATED COST OF PROJECT S B. OTHER DEVELOPMENT ACTIVITIES: ❑ Fill ❑ Mining ❑ Drilling ❑ Grading ❑ Excavation (Except for Structural Development Checked Above) ❑ Watercourse Alteration (Including Dredging and Channel Modifications) ❑ Drainage Improvements (Including Calvert Work) ❑ Road, Street or Bridge Construction ❑ Subdivision (New or Expansion) ❑ Individual Water or Sewer System ❑ Other (Please Specify) After completing SECTION 2,APPLICANT should submit form to Local Administrator for review. SECTION 3 FLOODPLAIN DETERMINATION (To be completed by LOCAL ADMINISTRATOR) The proposed development is located on FIRM Panel No. , Dated The Proposed Development: ❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application review is complete and NO FLOODPLAI:N DEVELOPMENT PERMIT IS REQUIRED). • ❑ Is located in a Special Flood Hazard Area. FIRM zone designation is 100-Year flood elevation at the site is: Ft. NGVD (MSL) ❑ Unavailable ❑ The proposed development is located in a floodway. FBFM Panel No. Dated ❑ See Section 4 for additional instructions. SIGNED DATE APPLICATION # PAGE 3 OF 4 SECTION 4• ADDITIONAL INFORMATION REQUIRED (To be completed by LOCAL ADMINISTRATOR) The applicant must submit the documents checked below before the application can be processed: ❑ A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑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 floodproofing of utilities located below the first floor and details of enclosures below the first floor. 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). ❑ Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). ❑ Floodproofng protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer or architect. ❑ Certification from a registered engineer that the proposed activity in a regulatory floodway will not result in.any increase in the height of the 100-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other: - SECTION 5• PERMIT DETERMINATION (To be completed by LOCAL ADMINISTRATOR) I have determined that the proposed activity. A_ ❑ Is B. ❑ Is not in conformance with provisions of Local Law # , 19 . The permit is issued subject to the conditions attached to and made part of this permit. SIGNED , DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from the Board of Appeals. APPLICATION # PAGE 4 OF 4 APPEALS: Appealed to Board of Appeals? ❑ Yes ❑ No Hearing date: Appeals Board Decision --- Approved? ❑ Yes ❑ No Conditions SECTION 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures: This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a certification to this application). Complete 1 or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling and columns) is: -FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproofing protection is FT. NGVD (NiSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as applicable based on inspection of the project to ensure compliance with the community's local law for flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? ❑ YES ❑ NO SECTION 8: CERTIFICATE OF COMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN'A SPECIAL FLOOD HAZARD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: ❑ NEW BUILDING ❑ EXISTING BUILDING ❑ VACANT. LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY_ CERTIFIED WITH THE 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) REF Ot4r.. 1000- 11.5 -M-014 SEG. 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Engineer: lbc)(WkA ��� l Submitted: ",)'oU SCTM#: District: 1.000 Section: Block: 1 a— Lot: r Project Q Subdivision Location: 1 o �►�2 ,d 1 me A A.L�1✓�� Name: Single&separate Required certification: (Yes/No) Rey. Req. Zoning District: (Lot size: Actual: ] (Lot coverage Proposed: ] Req. Req. Rey. (Front Yard Proposed: (Side Yard Proposed: 1 (Rear Yard Proposed: 1 Project Description: AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. LL t-47 38- / New York State D. E. C. ,,o Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation??? Flood Zone: Notes: - �. .- .,, .. .. K •,•�••,4. .,. - ,a w-, , .. ,.. _ . , ., ., .. . . .,_ .. .. ., . . ,. - t , ,. . .. .. ., T, ..... ... 1. �. a .,. ..�a- ,�,. �. t v �i� Y lr - r �' .. .. - L . - i �t' - , r` r .. t - - -. . .y� .. _ - S': , .. �# ,y i r , .. �' .. - . � f . _.. ' - .`57•�.�."� ."G��. �cc�:ii•l�•�Sc.�s� �-Ir��ttE� � - . � .� ' , ` ' fl .,� _,�. 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