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
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FEW
ICI �ALL- I M Yd;AAWWWi
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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
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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-
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----------� Ok =-- - - - _ - -- - _ -- -- -- ,�
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tills
' 1 vVELL i Ha. AMENDC-D APR. 12,
1t-I Fa'/Z a, t r7 � l.,_
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' SEAL
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i -� - _- - r_t''y c. �, r� ter: lE� r ��loJ_i0 i c� ��
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" - 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.
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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:
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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
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saPJ steal1 notbe cormidef
ed
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a pezr_ra for whom tY�5z;r
eta his b-.h�i to ine
HCJ. AMENC>ED AP12 12,_1944 Lu_
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7 0
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SEAL
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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.
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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
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' . 1990.
LICENSED LAND SURVEYORS
OT
S:G. D . OF .
:. '..
TH SERUICE�� CREENFORT NEW YORK
i EDY4 6ST, N81329. . ;
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i 02. BASEMENT/CELLAR WALLS �'. . ,
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V al I J-V&IU* �ic , I , .
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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
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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
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T ~ W %
- ~ z~ !tee 3
' 0
UNDERWRITERS CERTIFICATE 4 v, Mm
REQUIRED 1D W
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7l ZSc I"9 - - - N
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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
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a 16" O.C. a z
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8'-8" 6'-8- (4) 2X10 HDR
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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
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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
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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