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HomeMy WebLinkAbout22319-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No: Z-29205 Date: 01/21/03 THIS CERTIFIES that the building NEW DWELLING Location of Property: 2235 BRIGANTINE DRIVE SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 79 Block 4 Lot 62 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 23, 1994 pursuant to which Building Permit No. 22319-Z dated SEPTEMBER 12, 1994 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 ONE FAMILY DWELLING WITH ATTACHED OPEN PORCH AS APPLIED FOR. THIS CERTIFICATE OF OCCUPANCY UPDATES CO #Z-23446. The certificate is issued to WILLIAM S KELLY & SANDRA L SIKORSKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10940067 12/21/94 ELECTRICAL CERTIFICATE NO. H 044156 01/25/95 PLUMBERS CERTIFICATION DATED 01/05/94 M ALGOZZINO PLUMB & HEAT Authorize Signature Rev. 1/81 T''!k FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23446 Date JANUARY 11, 1995 THIS CERTIFIES that the building NEW DWELLING Location of Property 2235 BRIGANTINE DRIVE - SOUTHOLD NY House No. Street Hamlet County Tax Map No. 1000 Section 79 . Block 4 Lot 62 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 23, 1994 pursuant to which Building Permit No. 22319-Z dated SEPTEMBER 12, 1994 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 OPEN PORCH AS APPLIED FOR. The certificate is issued to WILLIAM KELLY & SANDRA L. SIKORSKI (owner's) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R-10-94-0067 12/21/94 UNDERWRITERS CERTIFICATE NO. PENDING PLUMBERS CERTIFICATION DATED JANUARY 5, 1994 M. ALGOZZINO PLUMB & HEAT Building Inlector Rev. 1/81 i FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD,N.Y. IBUILDING PERMIT ' (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) I I N0 22319 Z Date ... 112 ............................................ 19.��. .... Permission is hereby granted t .. ..�.... . .. .l...Y... .......................................... to ....L' .. �,.-......G�. ..�..1 .........."lr�....� ....... .. ��....... ...... .................................................... ... .P .. . . .....-6......./._:.. .7.., .:-. .....a.Qo./-'��.......1. ....... ... .... .. ..-. . . �ra . ......... d �� ,d�% �` c .............................................................................................................................................I.................... at premises located at...� .�.6..... .. . . ...... .. .....:.... >......................................... ........................................................... County Tax Map No. 1000 Section ....... ,,9......... Block........., ......... Lot No. ......16..7—.......... pursuant to application dated ...........� ..2.--'............................... 19..1 ..... and approved by the Building Inspector. Fee$.. %z.. - P 7 ilding Inspector.......... Rev. 6/30/80 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT JAM i I TOWN HALL 1 765-1802 T_ APPLICATION FOR CERTIFICATE OF OCCUPANC�— _'_,_ _ 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-$25.00 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: f C�v� ✓�� ��`� ��� House No. /Street` Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Block Lot �o a Subdivision t�CW(oor, �.�c, 5 E� C�ioy� Filed Map. S Lot: 7 Permit No. as 31 1 - Z Date of Permit Applicant: Health Dept.Approval: �60k7 J-Aaq 1253nderwriters Approval: - p Planning Board Approval: - ch Request for: Temporary Certificate Final Certificate: ec rone ) Fee Submitted: $ �S(D•o 70 �� c (-0,5 - A licant Signature Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL [: JA1� 1. 1995 765-1802 1 APPLICATION FOR CERTIFICATE OF OCCUPANCY OWN O FS�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. 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 - $1.00.00 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 . `. . ��J. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . New Construction. . . .( . . . . Old Or Pre-existing Building. . . . . . . . . . . . Location of Property. . . .'.y. . . . . . . . . . . . 9XAJW - . , , , , . k-. .1.... . . . . . . . . House No. Street • • Hamlet j� Onwer or Owners of Property. . ` �'f"`f1.?V.� , ,��, . , , , , , ,`�, , , . . . • . . . • . . County Tax Map No 1000, Section.<�7 . . . . . .Block. . . . . . ?. . . . . . . . .Lot. . . . Z. . . . . . . . . . . . . II � rrjj Subdivision. .4 . . . . . . 7:� . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . . . Permit No. . . . . . . �, j;, Date Of Permit. ...l. . (Z' ,Applicant. Health Dept. Approval. . . . . .. . /. . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. .0* ./�:� . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . .!� . . . . Fee Submitted: $. . ,��,��„ , . . . . . . , • „ . . . . s THE NEW' YORK� BOARD OF FIRE UNDERWRITERS SAGE 1 8050592 BUREAU OF ELECTRICITY F 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date J.•WJARY 25,:1995 Application No.on file 86123894/94 H 044156 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by_the-opplicaant named on the above application number in the premises of WILL IAM S ITLLY, 2330 BRIGANTINE DRIVE(rOUTHOL6, 4.Y. in the following location; M Basement ❑X lst Fl. FP-End Fl. `l' .Section Block Lot was examined on DE'cf'MER 28►1994 and found to be in compliance with the National Electrical Code., FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 34 5i 43 .^�30 14 1 1.2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS 1 F 1 2/1i - 4 20 SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER L,,4W L 0 3W 3 0 3W 3,0'4W NO.OF CC.COND.0' OF CC.COND. OF HI. A.W.G. NO.OF HI-LEG A.W.G. NO.OF NEUTRALS A.W G. EQUIP. PER -LEG Of NEUTRAL 1 200 CB 1 X 1 4/0 3 2/0 OTHER APPARATUS: MOTORS:2-F H.P. , G.F.C:.I:--4 SI►OKE DETECTOR:-2 WILLIAM NELLY 2325 BRIGANTINE DR P 0 BOX 1680 GENERAL MANAGER SOUTHOLD, NY, 11.971. Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THM COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. L UVIN MCIAUGNUN Attorney At Law Winds Way Professional Center 44210 Rt.48,P.O.Box 1210 Southold,New York 11971 Telephone(631)765-6085 Facsimile(631)765-1856 January 17, 2003 Southold Town Building Department Southold Town Hall 53095 Main Road Southold, NY 11971 Gentlemen: Please be advised that I represent Susan Evans, the contract vendee regarding the purchase of 2235 Brigantine Drive, Southold, New York from William Kelly and Sandra L. Sikorski. I have enclosed my application for an Updated Certificate of Occupancy, along with my check in the sum of$50.00. The original CO, a copy of which is attached to the application, listed the Underwriters Approval as"pending". 1 have attached a copy of the Underwriters Certificate to the application. Upon issuance of the Updated Certificate of Occupancy, kindly call me at 765-6085, so that 1 can pick it up from your office. Very t yo r J. vi cLaug lin Enos. Hand Delivered Town Hall, 53095 Main Road Fax (516)765-1823 P. O. Box 1179 5 �: ` r� Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I -O N DATE: Building Permit No. Owner: (�'T�Li(!� �it/dCiatf (please print) MICHAEL ALGOZZINO Plumber: $ plumbing&Heating (plea., �1� EACH, Ny U97 IVES I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumb `rs ig a�ure) Swo/rn to before me this day of 19 ;� Notary 'Public, County NOTARY(PUBLIC STa OFF EW ORk NO.52-7075900 COMMISSION ERPIRES APRIL 30,1 fl y� Town Hall,53095 Main Road C Z Fax(516)765-1823 P. O. Box 1179 W- Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD January 10, 1995 Mr. William Kelly P.O. Box 1680 Southold, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : xx An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. xx The check is not on file. $25.00 No Health Department Approval on file. No final inspection has been made. xx No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 22319-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. • rh 0—Ow—A.0 IN—M. p 9 NO MIM wd n FEW ICI �ALL- I M Yd;AAWWWi •- �✓� �.[�, ._ice_ %cam : r M-18a BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING [ FINAL REMARKS:. DATE J NI SPECTOR 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ } .FRAMING [ FINAL REMARKS: DATE A' -INSPECTOR 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 15T [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION [ FRAMING ( ] FINAL REMARKS: z a um iv ' DATE //0 IN8PE 765-isoz BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST ROUGH PLBG. [ } FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ( ] FINAL REMARKS: � -- /f-cicea- DATE �I Z INSPECTOR �oc��FFOIK��G� JUDITH T.-TERRY !� Town Hall, 53095 Main Road TOWN CLERK =v rZ P.O. Box 1179 u's Southold, New York 11971 REGISTRAR OF VITAL STATISTICS VO �. Fax (516) 765-1823 MARRIAGE OFFICER Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3284-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner KELLY, WILLIAM / SIKORSKI, S. ---------------- ------------- Mailing Address 1 P. O. BOX 1680 ------------------------------ Mailing Address 2 ------------------------------ City St Zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Property Address 1 2235 BRIGANTINE DRIVE ------------------------------ Property Address 2 ------------------------------ City St Zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Owner Telephone No. 516-765-3121 Tax Map No. section 79.00 block 4 lot 62.000 ------ --- ------ Cross Street NORTH BAYVIEW ROAD ------------------------------ --- -r_e__44W,, ----- V/ Issue Date: 11/21/94 Judith T. Terry -------- Southold Town Clerk (TOWN SEAL) ... •,.v"r/y. .\.f�, IW Y' `y\\�' s i ��, +``5''r� - �l ':`_tt_—�y'�s` � rt'�'a"' ,,L' �i'��""pi�.�.g._1.!,.r!_y'r"�rrt� + ss'�" F:°"'.a''v"^i!'✓^TY;:�"i?r ' Board Of Southold Town Trustees SOUTHOLD NEW YORK ik•,- " PERMIT.'N.O• 4309 DATE: Aril 30 1994 s EDTO: William.•Kelly................................. 6 • `\A i1 Pursuant to the provisions of Chapter 615 of the Laws of lE i the State of New York, 1893; and Chapter 404 of the Laws of the �- �I State of New York 1952; and the Southold Town Ordinance en- ! 'y FBI titled REGULATING AND THE PLACING OF OBSTRUCTIONS ib• IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM �Fn �a r Ji LANDS UNDER TOWN WATERS;" and in accordance with the M Resolution of The Board adopted at a meeting held on ...April 28, . 19.....9..4.., and in consideration of the sum of $ ' 150.00 �tA 1 William .................... ...... paid y - ............. ..................................................... .. -\ i am...Kelly a: N Y. d :,. . ...............L....... ................." an subject to the Terms and Conditions listed on the reverse .side hereof, It of Southold Town Trustees authorizes and permits the following: ., 1; to construct a single family dwelling with septic system,dr wel i . excavate and backfill distrubed areas, seed berm pond area. `.' a, iy, there shall be a non-turf area between the 15' contour line and*,' "a the pond. A staked row of hay bales will be placed at the 15' jwt ' t..( ►•; all in accordance with the detailed specifications as presented in the originating application. contour' line. Driveway will be re- S` algraded to form a swale to recharge the water. " : IN WITNESS WHEREOF, The said Board of Trustees here- N by causes its Corporate Seal to be affixed and these presents to be subscribed by a majority of.the said Board as of this date. it i 1 I 1. 5�F ...........,............. ..... ... ........... IE � o � 1/ I ;• ��, 1 � .......................r............ , .................................... Trustees 'kk d.Lr...+=-' ,.�...dF J •:�f �.t ut y."' :,ram�� � � T a•'*��l.fie '; r Ai r � iYi k \ I fin, r k i :• '� TERMS and CONDITIONS The Permittee William KellV residing at Brigantine Dr. Southold N, y.� as part of the consideration for the issuance of the Permit does understand and prescribe"to the,fol- lowing: 1. 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 oper- ation performed pursuant to this permit, and the said Permit-tee 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 2. That this Permit is valid for a period of 24 mos. which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit 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 auth- orization 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. That there will be no unreasonable interference with navigation .as a result of the work herein authorized. 6. 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. 7. That if future operations of-the-Town-of_Southold-require the"removal-and/or alterations 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 or project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work auth- orized. 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. t -i A NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSLt(VA110N DEC PERMIT NUMBER EFFECTIVE DATE 1-4738-00892/00001-0 June 21, 1994 ""FACILITY/PROGRAM NUMBER(S) P E 1 lIV1I T EXPIRATION DATE(S) Under the Environmental June 30, 1997 Conservation Law TYPE OF PERMIT I New 0 Renewal ❑ Modification 0 Permit to Construct ❑ Permit to Operate I 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 0 Article 17, Titles 7, 8: SPDES 0 Article 27, Title 9; 6NYCRR 373: Supply Hazardous Waste Management ❑ Article 19: Air'Pollution ❑ Article 15, Title 15: Water Control 0 Article 34: Coastal Erosion Transport Management 0 Article 23, Title 27: Mined Land 0 Article 15, Title 15: Long Reclamation 0 Article 36: Floodplain Island Wells _„ Management 2r� p� M Article 24: Freshwater Wetlands 0 Article 15, Tit V : d\� 0 Articles 1, 3, 17, 19, 27, 37; Scenic and Recr ,e nal Rivers.. - P Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control 0 Other: PERMIT ISSUED TO -�n-,J, TELEPHONE NUMBER 2' William S. Kelly and Sandra L. Sikorski (516) 765-3121 ADDRESS OF PERMITTEE 2325 Brigantine Drive Southold, NY 11971 CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER Same as above NAME AND ADDRESS OF PROJECT/FACILITY Kelly/Sikorski Property 2225 Brigantine Drive LOCATION OF PROJECT/FACILITY Southold SCTM #SO-40 COUNTY TOWN WATERCOURSE NYTM COORDINATES Suffolk Southold USMIffIQV a: AM-MIM X71VITY _ Construct a single family dwelling, septic system and driveway. All work shall be done 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. DEPUTY REGIONAL PERMIT ADMINISTRA- ADDRESS TOR: Bldg. 40, SUNY, Room 219, Stony Brook, NY 11790-2356 Roger Evans AUTHORIZED SIGNATURE DATE June 21, 1994 Page 1 of 6 c CM341. =ITICAB 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 Envirom-ental Conservation (the Department) to determine v�hether the permittee is ca-rplying with this permit and the ECL. Such represen- tative may order the v%ork suspended pursuant to ECL 71-0301 and SAPA 401 (3) . A copy of this permit, including all referenced mops, drawings and special conditions, rrust be available for inspection by the Departrnt at all times at the project site. Failure to produce a copy of , the permit upon request by a Department representative is a violation of this permit . Pe rmi t Changes and rename Is 2. The Department reserves the right to modify, suspend or revoke this permit v�hen: 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 vies obtained by misrepresentation or failure to disclose relevant facts; c) new material information is discovered; or d) envirom-ental conditions, relevant technology, or applicable law or regulation have materially changed since the permit vas issued. 3. The permittee rrust submit a separate written application to the- Departnent for reneAel , modification or transfer of this permit. Such application crust include any forms, fees or supplemntal information the Departrmnt -requires. Any reneAel , modification or transfer granted by the Department crust be in writing. 4. The permittee rrust submit a renanel application at least: a) 180 days before expiration of permits for State Pollutant Discharge Elimination Systen (SFCES) , Hazardous V\bste Nhnagerent Facilities (h'Vff) , rre j or Air Po I I ut i on Control (APC) and Solid Vloste Nhnagemnt Facilities (S/ 17) ; and. b) 30 days before expiration of all other permit types. 5. Unless expressly provided for by the Departmnt, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the tears, conditions or requiremnts contained in such order or determination. Other Legal Ch l i gat i ons of IPemni ttee 6. The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all dareges, direct or indirect, of vrhatever nature and by Ma-rever suffered, arising out of the project described in this permit and has agreed to indem ify and save harmless the State from suits, actions, damages and costs of every narE and description resulting from this project. 7. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in ,.o.r.,iie::r' to perform the permitted v\ork nor does it authorize the irrpa i anent .of-^`ariy, rights, title, or interest in real or personal property held or vested in- a"person o� a party to the permit. pp. 8. The permittee is responsible for obtaining any other ,permi{s, approvals, lands, easerents and r i ghts-of-v\ey that may be .requ i red for th i s .pro j ect; Page 2of6 r' 95-20-6a(7/92)-25c Freshwater Wetland ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34 and 6 NYCRR Part 608 ( ) 9. That if future operations by the State of New York require an al- other environmentally deleterious materials associated with the teration in the position of,the structure or work herein authorized,or project. if, in the opinion of the Department of Environmental Conservation 13. Any material dredged in the prosecution of the work herein permitted it shall cause unreasonable obstruction to the free navigation of said shall be removed evenly,without leaving large refuse piles,ridges across waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State, or cause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of. resources of the State,the owner may be ordered by the Department to a waterway. remove or alter the structural work, obstructions, or hazards caused 14. There shall o iz unreasonable interference with navigation by the work thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other herein authorized. modification of the watercourse hereby authorized shall not be com- 15. If upon the expiration or revocation of this permit,the project hereby pleted, the owners, shall, without expense to the State, and to such authorized has not been completed,the applicant shall,without expense extent and in such.time and manner as the Department of Environmental to the State, and to such extent and in such time and manner as the Conservation may require,remove all or any portion of the uncompleted Department of Environmental Conservation may require,remove all or structure or fill and restore to its former condition the navigable any portion of the uncompleted structure or fill and restore the site and flood capacity of the watercourse.No claim shall be made against to its former condition. No claim shall be made against the State of the State of New York on account of any such removal or alteration. New York on account of.any such removal or alteration. 10. That the State of New York shall in no case be liable for any damage 16. If granted under 6 NYCRR Part 608,the NYS Department of Environ- or injury to the structure or work herein authorized which may be caused mental Conservation hereby certifies that the subject project wil I not by or result from future operations undertaken by the State for the contravene effluent limitations or other limitations or standards under conservation or improvement of navigation,or for other purposes,and Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 no claim or right to compensation shall accrue from any such damage. (PL 95-217)provided that all of the conditions listed herein are met. 11. Granting of this permit does not relieve the applicant of the responsi- 17. All activities authorized by this permit must be in strict conformance bility of obtaining any other permission, consent or approval from with the approved plans submitted by the applicant or his agent as part the U.S.Army Corps of Engineers, U.S. Coast Guard, New York State of the permit application. Office of General Services or local government which may be required. per survey by 12. All necessary precautions shall be taken to preclude contamination Such approved plans were prepared of any wetland or waterway by suspended solids, sediments, fuels, Roderick Van Tuyl dated 1 1/ IU193 dated 5/20/94 S_>solvents, lubricants,epoxy coatings,paints,concrete, leachate or any SPECIAL CONDITIONS 1. Markers used by this Department to delineate/define the boundary of the wetland or the extent of the permitted structures shall be left in place and remain undisturbed for one (1) year following completion of the project. 2. Any work, disturbance, and storage of construction materials shall be confined to within the "Limit of Clearing and Ground Disturbance" as shown on the approved plan. 3. A snow fence or other temporary, project-limiting fence shall be erected prior to the commencement of any permitted activities along the upland edge of the designated buffer area in order to-prevent-the-inadvertent intrusion-of-------- - —-- equipment into the protected area. The fence shall be maintained until project completion. 4. Prior to commencement of any construction activities, a continuous row. of straw bales shall be staked end to end along the "Limit of Clearing and Ground Disturbance" shown on the approved plan. The bales shall be maintained, repaired and replaced as often as necessary to ensure proper function, until all disturbed areas are permanently vegetated. The average useful life of a bale is approximately 3-4 months.. Sediments trapped by the bales shall be removed to an approved upland location before the bales themselves are removed. I)EC PERMIT NUMBFR 1-4738-00892/00001-0 PROGRAM/FACILITY NUMBER --FPage 3 of -6— r AM 95-20-6f(7/87)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 24 Freshwater Wetland For Article 5. Straw bales shall be recessed two to four inches into the ground. 6. The driveway must be surfaced with a permeable material. 7. All equipment and machinery shall be stored and safely contained greater than 100 feet landward of the regulated wetland or water body at the end of each work day. This will serve to avoid the inadvertent leakage of deleterious substances into the regulated area. Fuel or other chemical storage tanks shall be contained and located at all times in an area greater than 100 feet landward of the regulated wetland or water body. If the above requirement cannot be met by the permittee, then the storage areas must be designed to completely contain any and all potential leakage. Such a containment system must be approved by NYSDEC staff prior to equipment, machinery or tank storage within 100 feet of the regulated wetland or water body. 8. All areas of soil disturbance resulting from this project shall be seeded with an appropriate perennial grass, and mulched with straw immediately upon completion of the project, within two (2) days of final grading, or by the expiration of the permit, whichever is first. Mulch shall be maintained until a suitable vegetative cover is established. If seeding is impracticable due to the time of year, a temporary mulch shall be applied and final seeding shall be performed as soon as weather conditions favor germination and growth. 9. Suitable vegetative cover Iis defined as a minimum of 85% areal vegetative cover with contiguous unvegetated areas no larger than 1 square foot in size. 10. The permittee shall incorporate the following language as a notice covenant to the deed: "Regulated freshwater wetlands associated with NYSDEC Wetland SO- 40 are located on the southeast corner of the properties of William S. Kelly and Sandra L. Sirkorski and their heirs, assigns or successors. This property is subject to the provisions of Environmental Conservation Law (ECL) Article 24, and the conduct of regulated activities may occur only pursuant to ECL Article 24 if prior approval is given by the New York State Department of Environmental Conservation (NYSDEC) or its successor(s) . Regulated activities include, but are not limited to clearing of vegetation; application of chemicals; excavation; grading and filling; and erection of any structure(s) . " DEC PERMIT NUMBER 1-4738-00892/00001-0 FACILITY ID NUMBER PROGRAM NUMBER Page 4 of 6 J t 95-20-bf(7/87)-25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS For Article 24 Freshwater Wetland This deed covenant shall be recorded with the Clerk of Suffolk County within 90 days of the issuance of this permit. A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be sent within one calendar year of the issuance of this permit to: NYSDEC, Regional Manager BEP, SUNY Bldg. 40, Stony Brook, New York 11790-2356. Supplementary Special Conditions (A) through (F) attached a DEC PERMIT NUMBER 1-4738-00892/0001-0 FACILITY ID NUMBER PROGRAM NUMBER Page 5 Of 6 400 SIIPPLF-4ENTARY SPECIAL, CONDITIONS The Following Conditions Apply To all TIDAL WETLANDS; FRhIWATER WETLaNDS; COASTAL EROSION MANAGEMZINT; and WILD, SCENIC, and RECREATIONAL RIVERS P=E MITS: A. '• A 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 shall 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 small 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 48 hours 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 permitted 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 (516) 474-2195, which . may be required for any encrcae-hment upon State-owned lands underwater. DEC PERMIT NO. 1-4738-00892/00001-0 Page 6 of 6 BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . AUG 2 31994 TOWN OF SOUTHOLD SURVEY . . . . . . _ . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . _... TOWN HALL SEPTIC FORM _ . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 NOITIFY �� Examined .�. ./.�A . . . . . . . 19 CALL - . : . . . . . . . . . . . . . . . . MAIL J !' TO: Approved . . .�/�0. . . . . . .. 19/.Permit No. : g . . . . . . . . . . . . . . .. . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . `. . . . . .. . . .. . .. . . . . (Buil mg Inspector) APPLICATION FOR BUILDING PERMIT Date .� . Z . . . . . . .. 19`!Lf INSTRUCTIONS 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 i gections. (Sign at f applican r e, if a corporation) . c. .1. T• -rJ ./ bl�1671. . . (Mailing address of applicant) State whether applic t is ol see, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . .1.1. . . . . . . . . . . .... . . . . . . . . . . . . . . .. . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises .Y� . .cam.•. . D. 6W. .CPA. 6u—,KC05 J4. . . . . . . . . . (as on the tax roll or latest deed) If applic s a corporation, sie�f�uly authorized officer. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer') f' Builder's License No. .�. 3.�. �� �? Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . ... . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed-work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Secti�orn . .�.791. . . . . . . . . . . Block . :. . . . . . . . . . . . . . Lot . .�?�. . . . . . . . . . . Subdivision . . �. . 4Z6i#Ts. . . . . . . . . . . . . . Filed Map No. . . . . . Jam. . . . . . . Lot . . . �; 7 . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . .lVa L . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . .� . . � �' . . -Ef� 4 . . . . : . . . . . . . : . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . .x. . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . " (Description) 4. Estimated Cost AIX,400 . . . . . . . . . . . . . . . . . . . . . . . . . Fee . .5a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) S. If dwelling,number of dwelling units . . . �-7. . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . If garage, number of cars4 . . . .�. . .A . . . 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 A,001t. . . . . . . . "Height . f . . . . . . . Number of Stories . . ./ . . . . . . . . . : . . Dimensions of same structure with alterations or addit'ons: Front . �� . . . . . . . . . Rear �4 . Depth . -NOW rLr. . . . . . . . . . . . . Height . . Al 4; . . . . . . . . . . . Number of Stories .� j. . . . 8. Dimensions of ent,ir�e new construction: Front �� . Rear .'� . . . . . . . . . . . Depth Height Zcl*I/P T'. . Number of Stories . . . . 9. Size of lot: Front �� Rear `( Depth• - 0.� 1.. Date of Purchase :A�.-r.'. . /.p, `�1. 'il . . . . . . . . . . Name of Former . ( ormer Owner Zone or use district in which premises are situated . , 12. Does proposed constructip�,violate any zoning law, ordinance or regulation: ./.(�(� . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded ; . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .�&44W .j . . Address . 7 -D. . Phone No. dal Name of Architect . . . . . . . Address �. . . Phone No. :zcl?-7. . . Name of Contractor . Address 6W7/7'b4-�. . . . .Phone No. 7. `9��0 15. Is this property within 300 feet of a tidal wetland? *Yes. . .X. , , No. . *If yes, Southold Town Trustees Permit may be required. 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. SfAr-- Ar7AOh-c-D STATE OF NEW YORK S.S COUNTY OF . �� . . . • • • • • • • • • • . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 of. . . . . . . . . . . . . . . . . . . .. 19 Notary Public, . . . . . . . . . ./. . , , • ,.' �., County JOYCE M.WILKINS Notary Public,State of New York ' ' ' ' ' ' ' ' • • No.4952246,Suffolk County (Si • ture of applicant) Term Expires June 12,19 j I I /� SUFFOLK CO. HEALTH DEPT. APPROVAL n�} �\ I• AP F�1IOPE Q#- \`i H. S. NO. V ! � � _► - i l� � ' �f yv� 'V ^� r'. '�9 ✓'�I t ,r -`r ��� { STATEMENT OF INTENT ,yam .N I 1 1 ,0 --- -- -- ----- -•----- THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL - -- r �� u,`; Pc20P• r�� �o przo 1� jj' -;� ' CONFORM T -•THE STANDARDS OF THE j I �— i wE��� �, �` I_�., j , �, I jr- 5. t r `/ SUFFOLK T. OF EA SERVICES. _ r� \r � it 1 f Jl ./'o`�l�'�, 1• _.✓ t e Y rr Ip_ \``a% / ' 1 ` u' APPLICANT *1 \� %' �°�� / } T PMatE SUFFOLK COUNTY DEPT. OF EALTH 507o EKP.h1. Ci SERVICES - FOR APPROVAL FOR ]ceo, CONSTRUCTION ONLY I +1f3f}!� tilt$ DATE:« lvON-TU2F� �rzFa . to u c� 3 r SU 1� BE{_OW IS' CQWTOU2 11 �t� �E. !�A 1 ans H. S. REF. NO. /a 0 6 - 1 V dish #aIC>it�}} S / �_ �. \ -/ �, � . C� APPROVED: 4 ad I / In d' `� O '+/ `•�. < \` SUFFOLK CO. TAX MAP NATION: DIST. SECT. BLOCK PCL. Nf,(Et ! ��� ti �,1-722 r=g t(J \/k� ` l 1 1000 079 4 rQ ` " G'PCCL(•REPU•(.REPUTE- OWNERS ADDRESS: o Ij r \ y, �C1UTHl` Y. i 1 ,'i i I ��,1 t^ t ,� 1 T�,!Ch` ° �� �° S.�. �t TEL•�765 3lZl �/ p DEED: L.N/P. P. j -m------�►"q� {.----I n ! ,. � �;=I i-� � TEST HOLE _ STAMP ., Ft?OI_ 1 F ' o this ,•vny cc:'o i85- ol i ! � `rtELL \ r� Yorestate ----------� Ok =-- - - - _ - -- - _ -- -- -- ,� IJ s�v;Pid Au' only 3u `E•a Ir,�,�:�::or•N,:,- . . . - F" 5 SN IZEAP 4v'EIrL tills ' 1 vVELL i Ha. AMENDC-D APR. 12, 1t-I Fa'/Z a, t r7 � l.,_ �IZEs.I 16 u . ' SEAL 4 POOL p r � i Q7 IN .. I i�.,., L •I i'v 0'5. f<:E F L,l"! 0 h✓t/` P r,F. ` �'-`"`' e � _ �" .. 1 �j',%sq�/�.;s i -� - _- - r_t''y c. �, r� ter: lE� r ��loJ_i0 i c� �� i Fi 4� 'li_y�.—r�'-L'?_f _✓M14� �.1f1✓ '. ` �`f ,f -rr � �'r�l l F+�f�:iy --- 1 ^ r " - RODERICK VAN TUYL, R.C. S NO.1.52-° , LICENSED LAND SURVEYORS r ro 1,A..,,,,.. , GREENPORT NEW YORK TELEDYNE POST N81329 vJEtrf_ i. �1 n E� SUFFOLK CO. HEALTH DEPT. APPROVAL 't� I`r�!LO{' R 3 Y H. S. -NO. ---- --- _ �._ --- - -. - _, -I - - - --- -- _ •- - -. Pl:•�'f< " -fir hti'�,r�r tNp � ` VACAFJT STATEMENT OF INTENT a v f THE WATER SUPPLY AND SEWAGE DISPOSAL Qa /� , `- SYSTEMS FOR THIS RESIDENCE WILL 72 nGjl, S 12s:(J £`•J'E. rOO / V� .O I _. +T t('�+ •^ CONFORM TO THE STANDARDS OF THE �, �; t 1 1 �' .�7 w j\� P20P. ,' I �.WELL � - _ SUFFOLK DEPT SERVICES. C3 ( SEPTtG +o' of �ij ! �(���` ��� L> _ v ?'� _` Iit t`ai C7 li , I� I f 1 11 0 (S w - i ♦ 0 k, t \ . I APPL 1 35 ' t f.t J % i` `� C' SUFFOLK COUNTY DEPT. -OF HEALTH SERVICES - FOR APPROVAL FOR '`-�rdEL.� / � 4, — __•_ _j—n� 1 Ci � •� � CONSTRUCTION ONLY , DfLrVE I d v t, ` \- J i r DATE: ��>✓5sr---: s , n - - - - - ,- _ __ _ n�� ` .NON-TURF60 A2� 0 I a H. S. REF. NO.: ✓ct114?. ;fit<`a:' SHL.OW iS CQN70C_1CZ APPROVED: / 7 (j 1 _ ( r SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. II� �� �nT rr. I\:Mr� +� 1Gp�l�r' , "�1 '.� I�r' O79 '= C'POOL(2EPUTEe) ;;,{4, �_ =r� 5:,,•';=; f. n l4 0 , Z OWNERS ADDRESS: 111 � 3GG?V�. r`-lu'''i .°�, r'i:.. t'.1�:t°t T•i:. :: ry � .a In \ - - -- - {5a}. � t `t?t 9�►t•2 f311S ..is 7� ' _ �55 !_-525 S1CJC.JA N!T»J COVE Lu C _ TEL._765 DEED: L.N/A, P. i- F `r TEST HOLE STAMP IN Y 3 D E C U�tiau'-� afELL ere ncra:r I APPROVED AS PER TERMS 2ostrs orizsda,r. sqY415, o - - — -- ---- - V- - -- PERMIT NO -�%3 -��0 la 0 PEu�tot 7�C&at ti a�dsty Y4�$ ---- ------� AND CONDITIONS sEh4� W f�r1sI of f, 1 l t1 a ler du &urry, ��oot hs^ 1 6�zd �� 1 rb s s Sea G)t<![r. oT 0'�1 ` DATE --C'PL�LS 1N REFtZ � WELL � i qua r @ tcopr. I ca only rxa+r is Y to Ehs person tw.hom tks �8� Hp, AMENC�EC' Ant 12 1�( �4 FrPFar�d.ano `NEB.L F f--- — Fide ert his beh"— -- , .. - .,-. nPsr1 o u:a ((.2 0� Zt'i A`( ��U, 9.4 Iy Fsndin�to i'gcvsrn j a,3t !� - i—___ .__..-_ _ .--_--- ._.._ _._ 1'Ott r-�� �0 ahQ�cS Siih.i^li; �?•:,:GYi�ft� 9. .CRES.) (55 _ W Oft.� ;.. i•l �'.i�n^ tl- C'PaJC SEAL~ �'d> � 1 L0I g` O'S. F F_r4 T z v F rTrr:E .'tc LiGH1 _ 'EC, fw. J� �'..;�.',/EYt:.i; i=I L E t- {N' -I"+-?E U ;-F '"' C L f= <'C' '}r l t�',5 1�) ? n 1 I .__. '� '' ;� � f RODERICK VAN TUYL. PtiC. LICENSED LAND SURVEYORS S�ooLAN SJ�J�i ! GREENPORT NEW YORK TELEDYNE POST N81329 SUFFOLK CO. HEALTH DEPT. APPROVAL 0�� MAP _,DF P�Ci�E r,?T H - -- 1✓Ei-�I NG� >•-Its,.��-,' � � 11- s i- -- 1?�-;7.. _ \ , `.fAChN i t l- n i r'1•. rrT,1 _ LDG.DEPT. a THE WATER SUPPLY AND SEWAGE DISPOSAL `_ fop, SYSTEMS FOR THIS RESIDENCE WILL '•72a-8 10 E. ^� a, ��'C �� J j- CONFORM TO THE STANDARDS OF THE SEPTIC, `ti J� PtZop• ` It C� _ SUFFOLK CO. DEPT. OF HEALTH SERVICES. } � ' uj , r-t � IJ , \ t _ rty�. ) C_j — --- --- APPLICANT �' CONC2. J^� C� 5O7oExRN o SUFFOLK COUNTY DEPT. OF HEALTH ELEV,TOP - "ram y SERVICES — FOR APPROVAL FOR 43= -- - J4 � CONSTRUCTION ONLY e. I d a DATE: �tiELI l DfItVE '/ _ WON! AREA t U H. S. REF. NO. gEt_o�/ f5 cot-r70ut2 Lt)/ 21994 }99 I APPROVED: (� - /! BLDG.DEPT. SUFFOLK CO. TAX MAP DESIGNATION: TOWN OF SOUTHOLD I DIST. SECT. BLOCK PCL. LD 1 VJEI_L';% >�' i.n.�/. / `+7 i_..Cd:,, �7'7 O Q I G C'POOL ",cEPUTEDI !'. � :` C �.._=a:,,:.;a'i`.:;L, C: �'. OWNERS ADDRESS: • .�- ,`. i...:C. .. i i ti E�ins,`; '_ :i �j'•( p C W —_ _.__ - , P.:4 1 's - ai ` r '�"� _�_____ __ __.._ l 197 DEED: L. , P. TEST HOLE STAMP IO+S t_ fi d a!tar�a;aa cr adji111'q ? ` f iris survey is a v 7"'On of of the New York$tom `n/ELL u ��on liar. rL' Asa° rob ng -------- � tr` -— -- _•C1 ulvcYora Inked cew or saPJ steal1 notbe cormidef ed i l 1 1i GG a va,;d&V@ Cppr. ! i_u _ a s indltct g 6 aMan shgJ9 run --C'PC�C'LS (N 12Et,Q. WEL eY a pezr_ra for whom tY�5z;r eta his b-.h�i to ine HCJ. AMENC>ED AP12 12,_1944 Lu_ � \^JEL 7 0 { , t was an3 l6 " Lu \UG,22,1994 w SEAL C'POQ L 0) =--� { INC (c`F- i% MA `iF i-{P.I��v�.� LK--,H ", F3EC. a PC -1j.Z'lE`'/raj J r E_ .15_f_•_,"P-._N.._0_.-51�_��Lk N : , rLCic ' 0 ROD-E R ICK VAN_TUYL. P.C. ;� t LICENSED LAND SURVEYORS �SF� GREENPORT NEW YORK TELEDYNE POST N81329 !!!' � r n• c SUFFOLK CO. HEALTH DEPT. APPROVAL ` AP ,.1F F . D^t -OPER:FY H.'S. NO. 210.�%'' 00(67 N. iQ� - W - t . VACAWT) `t STATEMENT OF INTENT ­�-- ---- -- THE WATER SUPPLY AND SEWAGE DISPOSAL — Co C .; 1 AC SYSTEMS FOR THIS RESIDENCE WILL, Z F 1' ry. •GJ,r �J. l8`..7C7'1QL � i �a� L�.O � - - �_ - CONFORM TO THE STANDARDS OF THE t J�;3' f, ! i + +1+� TELL ti►,y v� `—�; b SUFFOLK CO. DEPT. OF HEALTH SERVICES. �= din,. .. / I F:= _ PizNGwAY Isl L? APPLICANT 00 o`` t" SUFFOLK COUNTY DEPT. OF HEALTH '` SERVICES — FOR APPROVAL FOR I w �� `° L„ ? 11§ r;7 r CONSTRUCTION ONLY WELL DATE: Ul H. S. REF. NO.: 210:r94-OOG7 CC .. ! APPROVED: —7 I .a � Z o 7 / r.it � @'L. '1 •�J _ SUFFOLK CO. TAX MAP D SIGNATt {tiN E ON•. 1 DIST. SECT. 'BLOCK PCL. I WELL L:;�/..t. :� � �!,t2- �8 tC>�trJ._ 1 � ��.a� i 1000 079 C�. � C`?QQC (2�PUTEt7�. I;f",' 'C �',12M�Ii;^JfaT'Ef�. n(c€'L.Aititt7` OWNERS ADDRESS. '' - .r: - � .. . . , .. �vt�.��3A.�.`r" A"S C�.t�4;t••d�t.�'�' _;� �Y .." .. F:iZt M-4tl �s .3--- —9,j �, �52 ` S'; i I�!Tih�E PP VE . �, � �`ee; . . i P •' ) usc _ l =G :; TEL.76.5--31%1 BU5ci :?_, _ MO if I DEED: L. P. I S7 ifs k:S . -' SupF �i�Csl uMy bWARTmwT� ALTH ` PIPE TEST HOLE STAMP: 0 C'PC?DL �' , SIN FAWLY DM ,`� �C3Af P"Id 7. Sect ci ug. :cf 011 72c8 !,,. - �,,�,,�� Ed>JpV�P�vr �+ o�x SlLq The 1 �{�p'tf�$�pL'+iap �y3�x3g �} 7 •T.7±8_RLAl1C I t �fAI-G L�: dfie!by�R.�r.'���'.��Sa 9`.`�Si@4 Sr'1 S.Oii a .r 1 o be 1, r °6a err '� _ -, _ ra➢�Y�[Ge?.�I$a�o�i;?�`17:L`niiViJ�tatiii�i nar ! 4-tD. 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BASEMENT/CELLAR WALLS �'. . , Wall Parteater fiat 12' ON Ir-0a , , ,Expoiura Above6rodo Foot .I1 V al I J-V&IU* �ic , I , . D*Oth of Wall 11441,,r, below Grade lohs I, - .:* I . , 1A 93. StMUSULATIM .. . I � 9 Slab wrletter Foot � . Intu i tion A-vilv - t0 k, ' ., . . , j �- ,i. I 2X10 jOIST W O-C. �V? - k J .t. *111"I"mto M� , I . , 9 . ! . K,• ft - = , , i C*iti*(",fjo* Aft* %. mk : q � � I w I" iIi � , AC1wkAZIk I , . � .ti 4 .-, wA j .I , _ -` ' ,U 1 i I � I "' .R ,S6uth:Gla%s/Tot&) slats Iorcont . =x, 1 , - � -, ." V 9 ," " � F* I(,�- - ; , ', ?-; , 1e el. Ama/SrI W*11'Aros Tercont � 9& - . 4C4"ItlftA F lo�w,Afts 'Sq. ft. - 2 I-- ,;; 'w c in t ' � �.� ,VIMI zI ,I� 16 M FW DR. 0 - �"M AL -WERMAL RAT ING+ , a 9 1w- . I U 4 . ..-% I" � -t s IP ' p ----a ;' : vI- .� - �' I ,-� - �-- -- - � , , - 1 �I -' ----- 10I ' - -. , i -V : , .. - .' . I .I . t f , 1IZ N, I , A, - 0 -* . ", V A- i /, - A "MT- HI NOT P� F-P-fNe r-40 I . 81-0 i , �° a ^ a P-- ;10N ,,.� ? 2M 12'Ia 11'-I I 9 . ,K, >I, , U4— � .. 13 R a CAN rC" FOCM"(.I , - ,- - 12T V fA .i :1 ! . lw , " 1 ; Z O -L,# " 0 . I xI "m� i 1 cw �11 11 1 :` , I ; , pojrq2 � . ,0� � ,I �4 /- I . , 6 . ,. 'I. ecL-Tp " romMA15z 16L- N =09m N & 1 . .1 , v .: . . I/ -- M, I H r TV IP 0-925M DF IF4� bb 4:s ',term "am I �I MP � r 0 VAP FZ5 MLD-rP— UE > I, . ;-x :i . c- v / a I > . II. -J, -- -- j� .- I : - . -- I . - I -. �� - T --.;- .1 . . ," �! . 0 4L t- 1CW 'M MQST N lye , JW#at_.IIw . 1. OI r I 11 � I � 'Pis.# 60N 0) W . *- ,-- + *,j6,� ' 'CaAa" CN uw -�r * m& Altm,- q!�,�_'_ •. . ` t, 1 7 . - *,'A6+it --;r. ,H AI mr ,) rz Tw -+ T IIi _, �-FINIw1 - - .� 4. I jc-4N. —A .lt*A-I- I . . -' . - . . I fi .mot: It I 7! - 1 I ro ., cA 0, I b I t �' - -b 1, r � � 11 I 11 11 i I I � . I r . ; -I- I- 11-I-o. .,: I - i r rn r Z r OD W Lu aLu a V/ e FPAGE DESCRIPTION )N z 1 OF 9 FOUNDATIN PLAI PLAN co o 20F9 FIRST FLOOR PL, ?R PLAN ~ _ a 30F9 SECOND FLOOR OOR PLAN w cn O 40F9 CROSS SECTION MON O w 5 OF 9 FRONT (WEST) El ST) ELEVATION Y oc c D ITH) ELEVATION DONOTPROCEED wI7d F2Aml J O Cc Lu 60F9 RIGHT (SOUTH) E UNTIL M SURVEY OF FOUNDATION LOCATION z ~d F. r) ELEVATION HAS BEEN APPROVED NONE 70F9 BACK (EAST) ELI `n a 80F9 LEFT (NORTH) EL 'H) ELEVATION OCCqU~+PANCY OR J ~ [ISE IS UMA~~IFUL WITHOUT CERTIFICATE w ~ 90F9 WINDOW AND DC 4D DOOR LEDGER OF OCCUPANCY M M A M? WA AS WOM cm o,Q-E: v L.p.4 223/9 a, 2Eu°i._ DE I . i n r ; In-i" b-r_cY- I 'JF+1~i.! .1 "-7J kFF`^ IMP IR TLS/I~li tJ ----Y s~e~,9 ~3¢:11.1.n-.1-.L- I :c:.-so ue.:x n,rviv -c nvi mom one ~I~I-~ c1Jr-!~?~-L.i'~"fl2_"~,1 7"~ ~~IIF~1'" l-~Yya.U Ts.r;'~ F0LLOMNG, INS PECiTIONS. 7 FOUNDATION TWOREQUIRED FOR POURED CONCRETE I ROUGH . FRANNNC e, PLUIN6VNc WISPJLATION I L'ONSTRUCTION IUIUST TE FOR c.O, R RCW ALL CONSTRUCTION $HALL V'+1EET v h~~p THE REQUIREMENTS OF THE N.W. I STATE CONSTRUCTION & ENERGY C:;rS;ES. NOT~h, RESPONSIBLE FOR r` i. r• ,y c, r GEgGN OR CO~ICIST'RUCTION ERRORS OF NE'N i ~ SUMMARY OF TOTAL THERMAL RATING O I\\~ I J o If the Total Thermal Rating is zero (0) or greater, the proposed design for the building envelope complies with the Energy Code, 0~2~3~ aos~ ~1 F6S ~ n co '~7 LL co THERMAL TABLE '1 ry AREA U-VALUE RATING USED _ co A. ROOF/CEILING 1440 .Om. I¢ 6"3- - ~ W W B. NET WALLS _ .060 24s b-I i,.O 11 ' 0 a F 24'-0• ti r a N D C. GLAZING 24'-0' Window 29(a 11~9_ 3V !e - I Window _ Skylights _ Ill. FLOORS 200 .047 0 Ir3._ 12'-0' 12'-0e 02. BASEMENT/CELLAR WALLS Well Perimeter Feet 00 Exposure Above Grade _ feet Wall U-Value _ 1r-a• 1r-0• _ Depth of Wall U-Value Below Grade Inches 03. SLAB INSULATION Slab Perimeter Feet Insulation R-Value . ~z z ~ o E. INFILTRATION CONTROL 4 2X10 JOIST 16' O.C. Conditioned Floor Area _ Sq. Ft. NL tr F. SOUTH FACING GLAZING q - South Glass/Total Glass Percent G1. Area/Gres. Well Area Percent K Conditioned floor Area Sq. F0. 1 2820 4 WIND, l 0 6068 FWDA. a q u TOTAL THERMAL RATING +292 -o n ~ I / OTL ~.[IVC Fl.Dr LAL.v-I fol... `c~ .O 7 y _ O K 1 ON nJW ~J&I X12k C1.Yt4c" O ~ . ~ 11'-0' fgC1'fiWl cr C.'ITN•) tiR'. . • o 0 I 0 N 7,-4e - 8,-0. . W Ox2 WIOx2.:- WioKn~2 i V~ m P1 -01 2820 .0 12'-9' `W AQi WIND, L tr-9' 11'-3• -o~' 3 ifl O 0 v 11'-4' - UP 13 R cnLon. 'JU °x ylbnx lti~ T 12T W Y 9/ rJ O I cri m Z 0 a T ~ W % - ~ z~ !tee 3 ' 0 UNDERWRITERS CERTIFICATE 4 v, Mm REQUIRED 1D W J C 7l ZSc I"9 - - - N • ALA Cc7~I°s1Y.t Y~I'Cy~d "iLh 1A~~ ~ N'Y.s, p.Lb ~EY77v $icY~-x.,, Cri~S . ~ioo P~~S,I, coNG 4 3 Z 4uVriATq-k"'F 4 . Aw CcYVC, ~v ~!N 1~151i7~P-r~P a"7~. f,~' ~ 7^~I P.Y-5 ~siur~i~ f Nam VIM ~a~~?{llsl ory A/F ?C 30 sLr1o I ~'Nf~ ~PF4Y'~ I~-~'- ~E•tQ. Fa€x_~a~~ H,=.i., -~Fr~ca.~ ;I.T.wr~ F-It~aNY6 c~ ~ze~y°Z r42T -7Iw l~,y,5'fA~~° Lb K!ITl' tPtr_RW nc a'9~,LT1~V • £b'x <<~' G[x~2rs~ Ccvvc , =nom ~4/ # 4 F_:rARS 1 PLUMBING s4P or ALL PLUMBING WASTE b WATER LINES NEED PLUMBER CERTIFICATIONi 97' O I TESTING SEFORE COVERING ON LEAD CONTENT BEFORE OFtNE'Ny CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER Iyl. kr~ SUPPLY SYSTEM CANNOT ~i~ s, c • r, j EXCEED 2110 OF 1% LEAD. copper tubing i f s used water distributing a> em; Piping shall be types K or L only 48'-0" U. N T- of 0 -e r. W 2a'-0" J W 24'-0" /Q? a V a IL N C 12'-0" 12'-0" 3'-71/2" 14'-101/2• 5'-6- Of ol A-4 z " a 'v 1O ' 2X10 JOIST a 16" O.C. a z 7 O ~ o a 1 LL O X1 O . 1 H v16" O.C.T M io ' 23'-0" 9'-0 1/2" 9'-0 1/q• 4° 14'-1 1/2• O 8'-8" 6'-8- (4) 2X10 HDR _.L.._... W W 9 r Cl) I I.V EDGE OF B CONY ABOVE U O 13-R 8.1 Y 4 12-T 10" J d er = W p 3'- S° 4 i J o-0, ~u 9'-2• v z 0 ( H io F F 0 Q Y 0 19'-7" 3'-5" 4 1o m 6' 5• s-T J F e- 10 ol CO) W ef) ~ N 4~pfiD ARo T-0" 81-0" 8'-0" 8'-0" a v y~ ao .0 -1 A-4 aN~ ~ uu n7 1,1 A, co ('7 r \ 48'.0" 24'-0" M N o za'-o• 3'-0" V-D" 5'-0" V-0" 3'-0" 3'-7" 11'-0" 5'-6' 3'-0" 10 10 a A n A~ A li U U /mm-~ U e J Z LL w n Fir. U U Z J E ° ' O a E ~ 27-0" 1Z-2" W v ~ Q w 3'-0" ti O O Q N ~ _ W c W t _ > > -----t------------- ~ ~ I N O OC Q ~ N i ~ ~ Y W N ~iF'h1L~R61~_,i - .4 D w/ n n p z OPEN TO BELOW DN 13R 'k- Y 12T rn_ ~ 3'-71/2" 5'-4 1/2 5'-41/2" 6'-0" 5'-0• T-6" M / or J O V V V V SIN Y M CV) N PORCH BELOW i ED q R ~ Rpy~, F OF NE'N nnmimlus~`° VEWED RIDOE 0112 RIDGE SID. N ASPHALT SHINGLE ROOF 1w COX PLY. 2Xi 2 RAFTER 16' O.C. W / R-30 INS. 9115 COLLAR TIE S' O C. a 'Q VENTED SOFFIT T CEDAR SNINOLES OVER 7116" OSR W / TTVEK 2xmi STUDS 16" O.C. W / 141 S INS. 4 ~ ZXi RAFTER l COLLAR TIE _ r A 2ND FLR. w T T M ¦ T SXS SUPPORT COL SOLID FIR GXS SUPPORT COL. 4 F/ S V L ~4'T~ , ro 2XI O CCA .10157 & SN1• TAO DECK 1 BT FLR ( SEE PAGE 1ST FLR JOIST) W / R•11 d1 Io°/a (2) 2XS CCA SILL PLATE W / TERMITE SHIELD ORADE - ..,7,j LAl-L-y Crx_ I 'F j OXi CCA COL..' O.C. W C /R=LL W / REDAN S' O.C. NOR. 2. O.C. VER. Z7C1'X2' FOOTING ~ RN - 1 L'"XS° FOOTING W 12 REIr c~N 2 oNrv~BP ~aryL TRF') 9411 T FOOTINGS W / RESAR MESH KELLY SIKORSKI HOUSE CROS: :ROSS SECTION eD'A PAGE 4 OF: 9 XCALE 1/411=1' 2330 BRIGANTINE DRIVE SOUTH DUTHOLD, N.Y. N9 131 io~rE DATE r 18/94 F OF NEB mmmu i - TOP OF CHI NEY 4 a PEAK OF ROOF TIMBERLINE SHINGLES N iF SOT. OF COLLAR TIES RED BRICK CHIMNEY 1X6 CEDAR FASCIA 1X4 CORNER BRDS. RED CEDAR SHINGLES 6' EXPOSURE TOP OF 2ND rLR. BOT. OF 1ST FLR CEIL 7X6 FASCIA - 6X6 PORCH COLUMN 4 m 0 0 0 PORCH RAIL WITH 7 1/2' X 1 9/2' _ BALISTERS TOP OF 1 ST FLR 7X8 PINE RISERS - u. PAINTED WHITE - - GRADE I ED Aq KELLY SIKORSKI HOUSE FRONT (WE T (WEST) ELEVATION-~ PAGE 5 OF 9 CALE 1/4" = 1' 2330 BRIGANTINE DRIVE SOUTI- OUTHOLD, N.Y. CP a Foy; DA"iE 8/18/94 qrF 02 OF NE y~`` nwmnno i I } ~ BRICK CHIMNEY 12 12 99 TIMBERLINE ROOF 4 Iy`1 1 X6 CEDAR FASCIA I i 1X4 CONER BRDS RED CEDAR SHINGLES 6' EXP. Il~ D I (I 1 X6 CEDAR RAKE BRD 6X6 FIR HDR. 6X6 FIR COL -r PINE RISERS -r GRADE Ul- RADE i FOOTING EXTENDED T L~ KELLY SIKORSKI HOUSE RIGHT (SOU1 . gCF' OH~.°D ;SOUTH) ELEVATION ~EDlint PAGE 6 OF 9 ALE 1/4" .1' 2330 BRIGANTINE DRIVE SOUTHI )UTHOLD, N.Y. ,roes` DATE 8/16/94 211 1 IF OF HS: "fill I i D 0 m El V GRADE GRADE STONE STEPS TO GRADE EXPOSED FOUNDATION TO BE VENEERED WITH THIN BRICK -co GRADE FOOTING EXTENDED T TO BE BELOW MOST KELLY SIKORSKI HOUSE BACK (EAS (EAST) ELEVATION PAGE 7 OF 9 v (f ALE 1/4" -1' 2330 BRIGANTINE DRIVE SOUTI- OUTHOLD, N.Y. fry DATE 8 / 18 / 94 g1iF OF NEB R`° 12 ~9 0 N CO 12 ~4 UFTi GRADE (NORTH) ELEVATION Ail PAGE 8 OF 9 KELLY SIKORSKII HOUSE LEFT (NOR E 1/4" = 1' SOUTHOLD, N.Y. .p„ o~ DATE S/ 18 / 94 2330 BRIGANTINE DRIVE SOUT ~TF OF ll N N ROUGH OPENING WINDOWS DESCRIPTION VG 2/2 T2 3/8" X 5'9 9/16" VG 2/2 6'3 3/4" X 5'9 9/16" i F D MARVIN WDH 3230 DOUBLE HUNG 2/j D MARVIN WDH 3230-2 DOUBLE HUNG 2/. 6'1 1/8" X 6'1 1/8" D ANDERSEN A21-32 AWNING TO 5/8" X 2'0 5/8" s D ANDERSEN A21 AWNING TO 5/8" X 6'l 1/8" D ANDERSEN A21-3 AWNING a DOORS DESCRIPTION N ROUGH OPENING 34" X 83" z O MORGAN 2868 6 PANEL EXT. T. ~ . z • 0 72" X 80" O ANDERSEN 6068 FRENCH PA Q 37" X 80" O ANDERSEN 3068 FRENCH ST MORGAN 2668 RIGHT SWING G 32" X 83" 0 62" X 83" 0 MORGAN 2668 POCKET )OW & DOOR LEDGER D ARO PACE 9 OF 9 ~pE KELLY SIKORSK:1 HOUSE WINDOW 2330 BRIGANTINE DRIVE SOU SCALE 1/4" = it SOUTHOLD, N.Y. ATE 8 / 18 / 94 y''0m 0 F NEo