HomeMy WebLinkAbout16428-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y,
Certificate Of Occupancy
No Z 16978 Date June I3, 1988
THIS CERTIFIES that the bmldmg One f a?.i.z y...a?.e ! ~. i.n.g.: ............
245 Kimberly Lane Southold
Location of Property House No ...............................
Street Ham/et
County Tax Map No ! 000 S¢cnon 0 7 0 B]ock 13 ....... Lot .2.0 ..2. ......
Subdlv,slon.P. ar.adi.se, by t.h.e.Ba.y .... FdedMapNo 6.4.6.3... LotNo .2. ......
conforms substantmlly to the Apphcation for Braiding Permit heretofore filed m this office dated
· S.ept.. 1, 1987 pursuant to which Bmld~ng Perm~t No. . 1642.8Z ..........
dated . .S.e ? t. 4: .1987 was issued, and conforms to all of the requirements
of the apphcable provmlons of the law The occupancy for wtuch tlus certificate ~s zssued ~s ....
One fam:tl'y dwellJ, ng, with attached 2 car garage and decks.
The cerUficate ~s ~ssued to , AL.~X.A.NpER. G....&. RYCK A. KOKE
~ownec:X&~,~y2~f&lxkk ........
of the aforesaid building
Suffolk County Department of Health Approval
UNDERWRITERS CERTIFICATE NO
87-S0-I48 6/7/88
PENDING 6/13/88
PLUMBERS
CERTIFICATION DATEB:
ROGER MC CARVILL 5/23/88
Rev 1/81
FOR~ NO. S
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
f'I'HIS PERJ~41T MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORI(AUTHORIZED)
Perm,ssron is hereby granted rD:
~.~..~.....~~...~.~.,. ........
o~.~.~...~:~..,...u..~ ........
.......... ............
at p~m,ses ro=~,,d ot ....... .~. .......... ~'~~.~ ..... .0~.....~ .........
Co.n~y To× Mop No 7000 Sect~o,, ....,~.. .... Bt~:k ....... 1..~ ....... U~ No....~...O..,.~,..
Building Inspector.
Fee $. ~ .......
Rev &/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Buildmg Department
Town Hall
Southold, N.Y. 11971
765 - 1802
PL,CAT,O. FO. OE.TIF,OATE OF OCCUP*.CV
,.struct,ons
A Thru apphcat~on must be filled ~n typewmter OR mk, and submitted mllmmm~ to the Buildmg Inspec-
tor with the following; for new buddmgs or new use:
1. F~nal survey of property w~th accurate location of all buddings, propertV lines, streets, and unusual
natural or topographic features.
2. Fma[ approval of Health Dept. of water supply and sewerage dlsposal-(S-9 form or equal).
3. Approval of electrical ~nstallat~on from Board of F~re Underwmters.
4. Commercial buildings, Industrml buildings, Multiple Remdences and simdar buildings and instaila-
tions, a certificate of Code compUance from the Architect or Engmeer responsible for the bullring.
5. Submit Planning Board approval of completed rote plan requirements where apphcable.
B. For ex,sting buildings (pmor to Aprd 1957), Non-conforming uses, or buildings and "pre-ex~sting"
land uses:
1. Accurate survey of p~operty showing all property hnes, streets, buddmgs and unusual natural or
topographic features.
2.Sworn statement of owner or previous owner as to use, occapancy and condition of buddings.
3. Date of any housmg code or safety inspection of buildings or premmes, or other pertinent informa-
tion required to prepare a certificate.
C Fees' Addztzons $25 .00 POOLS $25.00 ALTERATION $25 .00
1.Cert~ficateofoceupanc¥ New Dwellzng $25.00, Accessory ,$]0.00 Buszness $50.00
2. Certificate of occupancy on pre-ex~stmg dwelling $ 50.00
3. Copy of certlf~cate of occupancy $ 5.00, over 5 years $]0.00
4.Vacant Land C.O. $ 20.00
5.Updated C.O. $ 50.00 Date ........................
NewConst~uc%~on .... O~d or Pre-exlstmg Buddmg ........... Vacant Land ............
Location of Property ..............................................................
House No Street Ham/et
Owner or Owners of Property KOKE, ALEkANDER & RYCK
County Tax Map No 1000 Section 70 ...... Block . .[3. .......... Lot 20.2
Subdivision ...................... Fded Map No ....... Lot No .............
Permit No. /.~. ~/~¢.?.. Date of Perm,t ........ Applicant ................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ................... Planmng Board Approval .....................
Request for Temporary Certificate ............... Final Certificate .....................
Fee Submitted $ ...............
Construct,on on above ~~ ~.~ 14~'~
descmbed buddmg and permit meets all apphcable codes and regulations
Apphcant ....................................
Rev 10 10-78 /,',~
· ~ ~-, ~ew YOrK btate Depa~rtm~ent of Environ~enta nservat~on .... ~ . ~,~ ~ ~. ~, ~
-- ~ Regulatory Affairs Unit ~ ~ "~-~ ~
~BId~. ~0,.S~,' ~. 219~
~ Stony Brook, ~11794
(516)' 751-7900~
A review has b~n made of your proposal to: O01'~)~-¥VC'~--
Based on the infor '~tion you have submitted, the New York State Departmen~ of Envi~on-
mental Conservatiof~][a& dete~ined that the ~_ parcel ~ project is:
Greater than 300' from inventoried tidal wetlands.
Landward of a substantial man-made structure ~U ~CI?~[~
greater than 100' zn length which was constructed prior to September 20, 1977·
__Landward of the 10' above mean sea level eleYatmon contour on a gradual,
natural slope.
__Landward of the topographic crest of a bluff, cliff or dune which is greater
than 10' in elevation above mean sea level.
__Listed in Part 661.5 of 6NYCRR (Tidal Wetlands Land Use Regulations) as a use
not requiring a permit or notification letter approval.
Therefore, no permit is required u~der the Tidal Wetl~nds~ct_(B~ticle 25-of the
Environmental Conservation~ Law)z~lease~ be~ advis~d,~ho~e?~r, that no construction,
sedimentatio~ or disturbance of any kind may take place seaward of the 10' contour or
topographic crest without a permit. It is your responsibility to ensure that all
necessary precautions are taken to prevent any sedimentation or other alteration or
disturbance to the ground surface or vegetation in this area as a result of your pro-
ject. Such precautions may include providing adequate work area between the 10~ con-
tour or topographic crest and the project (i.e. a 15' to 20' wide construction area)
or erection of a temporary fence, barrier, or hay bale berra.
Please note that any additional work, or modification to the project as described,
may require authorization by this Department. Please contact this office if such
are contemplated.
Please be further advised that this letter does not relieve you of the responsibility
of obtaining eny necessary permits or approvals from other agencies.
Very truly yours,
Deputy Regional Permit Administrator '
FOU~DATION
FOUNDATION
2.
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
TO~VN OF SOUTttOLD
OFFICE OF BUILDING INSPECTOR
P O BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Date
Building Permit No.
Owner /~t
(please print)
I
contains less than 2/10 of 1%
certxfy that the solder used in the water supply system
lead. ~
Sworn to before me this
05 day of
Notary Publxc,~~__County
Notary
Nots UpuN~DAJ' COOPER
- No. 4822563, Suffo{;,
765-180~'
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST []ROUGH PLBG.
FOUNDATION 2ND []INSULATION
FRAMING ~r ]FINAL
765-1802
BUILDING DEPT.
INSPECTION
FRAMING
FOUNDATION 1ST
FOUNDATION 2ND
REMARKS:
ROUGH PLBG.
INSULATION
FINAL
Zm ~/c
DATE
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [,~INSULATION
[ ] FRAMING
REMARKS:
FINAL
DATE
BUILDING DEPT.
INSPECTION
['~ FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING
FINAL
DATE~?~/~
INSPECTION
FOUNDATION 2ND L ] INSULATION
[~'~RAMING [ ] FINAL
765-1802
BUILDING DEPT.
INSPECTION
[ ]/~OUNDATION 1ST [ ] ROUGH PLBG.
[~/] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING
REMARKS:
FINAL
DATE / ? INSPECTO
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
/
[4FOUNDATION 2ND [ ] INSULATION
FRAMING
FINAL
REMARKS:
DATE
765-180Z
BUILDING DEPT.
INSPECTION
[ ]~FOUNDATION 1ST [ ]
ROUGH PLBG.
INSULATION
FINAL
FOUNDATION 2ND [
FRAMING [
/,/// /
~_~./. ~,'/
~/-
~,oo~.o73, THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~-- (7t~(],¥ 08,. 1988 85 JOHN STREET, NEW YO~, ~ORK ~OO38
~te ~pplicafion No. on file
THIS CE~IFIES THAT
KI~IBKRLY LANK, $OUTHO/,D, N.V.
a~ found to be Jn compliance with the requi~ments of th~s ~.
FIXTURES
Lot
RANGES OVENS IXHAUST FANS
84 [05 83
~Y~
TMM CLOCKS MUtTI-OUTUIT
MRS
e. JRVICE {XSCONNlCT S E R V I C E
2OO
G & $ CONTI~AC'I'OR
BOX 235
$OUYHOi,I), NY, 11,9~']
Th{~ certificate mu~t n~t be altered {n *ny monner; return to thelb~{i~N4~{~{~cmr~correct.
2 ~4/0
P#r. 'J l
b~ idm~tifi~ , {f~w credmeie~.
TOWN OF $OUTHOLD
BOARD OF SOUTHOLD TOWN TRUSTEES
$OUTHOLD, NEW YORK
WETLANDS P£RMIT
This Wetlands Permit No ...... .~.~..6. .......... has been granted by the Town Trustees according to
No 531 .... ~z~-Consultants.
information furnished in Apphcauon ..................... Tlleo by ApFlicant .........................
..~.o.~....A..1.e..~.a.~.d..?.....~..o..~..~.. on ....~F..~%...Z.?.; .......... 19...8..?..... A map of the proposed work will be kept
on file m the Trustee Office under the apphcat[on number given.
Permit granted to do the following work ~.C~'~.~.~.'s'~t.~'~'~..c''t.~.~.~h.~9~u'.s''e~P~'°~.~'~]~s~.~E~¢~ ............
(see reverse szde of permzt for pro~ect descrzptzon)
Locat,on of property on which work to be done ...~.z..~.e.....~..e..c..k...~F...d...~..°.¥.t..]7
Creek. Bay or Harbor fronting property .....m.~.~....m..a..ci...e...c...~..~..aJ....°..~..9.¢..f.°..c...~..e.x..~E~ ......................
Size of wor~: Leng[n 4', 16', (3)
4', 3', (3) 6'
Width ........................................
Height Above H~gh Water ...........................................................................................
Depth Below Low Water ..........................................................................................
Yards to be Excavated ...................................................................................................
Yards to be Filled 3500 cu. yds.
Manner in which material is to be removed or deposited ................................................................
Intended use of property ....... R...e.s..z..c];..e.,z}.t.z~.l ..........................................................................................
Conditions if any .................................
Expiration Date July 27, 1989 zf work has not commenced by sa~d date
Number of Inspect,ohs Requ,red ~.~.~.~?~.s.t..e..e..s.~z~`e.~..t~.b..e.~.g~°.'t.z~.~¢.¢.~t~$~g~ .o.,f,...t,,b..e. ....
InspecUon Fees $:LO.O0 pazd ..................................................
L~abdity Pohmes ~n the Amount of ...................................................................................................
The vahd~ty of th~s permit is or may be sublect to the approval of other governmental or mummpal
authorities. The Town accepts no respons~bdlty m applying for or obta~mng such approval. In the
event that such approval ~s necessary, the holder of th~s permit sha~l not commence operations here-
under untd such approval has been obtained m writing. TI3e fadure to obtain such other approval when
required shall subject th~s permit to ~mmedlate revocation by the Trustees upon recerpt by the
Trustees of written notice from such other governmental or mumc~palauthor~tlesofits refusal or
disapproval.
The applicant does by the acceptance of this permit, assume all respons~blhty for operations under-
taken pursuant to this permit, and shall take all precautions for the prevention of injuries to persons
and property resulting from such operations. By such acceptance, the applicant aisc agrees to indemni-
fy and save harmless the Town, and ~ts officers, agents and employees from any and ali claims arising
from operations under this permit and any and all acts or omissions of applicant, his agent and
employees.
The applicant and the owner and occupants of the premises upon which the operations authorized by
mis permit are being conducted, do, by the acceptance of this permit, qive consent to the Town, and
ItS officers ano employees to enter upon the premises where such operations are being conduc~eo ~o
moke such inspections as the Town may deem necessary to insure that such operations are being con-
This. operation will not substantially.
A, Adversely affect the wetlands of the town,
B. Cause damage from erosion, turbidity or siltation.
C. Cause saltwater intrusion into the fresh water resources of the town.
D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife and vege-
ration or the natural habitat thereof.
E. Increase the danger of flood and storm-tide damage.
Adversely affect navigation on tidal waters or the tidal flow of the tidal waters of the town.
G. Change the course of any channel or the natural movement or flow of any waters.
H. Weaken or undermine the lateral support of other lands in the wcm~ty.
Otherwise adversely affect the health, safety a,nd general welfare of the people of the town.
PreCdent
Board of $outho]d Town Trustees
ate ..............
Exalmned ~~ q , 19 .~.'~
Disapproved a/c ....................
FORM NO 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT SEPTIC
TOWN HALL
NOTIFY
$OUTHOLD, N.Y. 11971
TEL.: 765-1803 CALL
MAIL
(Building Inspector)
BOARD OF HEALTH
3 SETS 0Fx/PLANS
SURVEY
FORM
APPLICA'rION FOR BUILDING PERMIT
INSTRUCTIONS
a. Ttus application must be completely filled in by typewriter or In Ink and submitted to the Building Inspector, w
sets of plans, accurate plot plan to scale Fee according to schedule
b. Plot plan showmg location of lot and of buildings on premises, relationship to adjomlng premises or pubhc
or areas, and glvmg a detailed description of layout of property must be drawn on the dmgmm whxch is part of thxs
cation.
c. The work covered by flus application may not be commenced before issuance of Building Permtt
d Upon approval of this application, the Building Inspector will issued a Bufldmg Permit to the apphcant Such p
shall be kept on the premises available for mspechon throughout the work
e. No building shall be occupied or used ~n whole or in part for any .purpose whatever untd a Certfficate of Occui:
shall have been granted by the Bmldmg Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bmldmg Permtt pursuant t
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordman,
Regulations, for the construction of buildings, addmons or alterations, or for removal or demolition, as hereto desc~
The applicant agrees to comply with all apphcable laws, ordmances, building code, housing code, and regulations, at
admit authorized ~nspectors on premises and m building for necessary inspections
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)t
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bm
z ............
Name of owner of premises ./c~/'~ ./ ~.lt~$ . ~~ff ~ ......
(as on the tax roll or latest deed)
If apphcant ~s a co~orahon, mgnature of duly authorized officer
f~ (Name and t~tle of co,orate officer)
AL~ ~p~T~ACTOR'S MUST BE SUF~LK COUNTY LICENSED
Bmlder s License No 4~ ¢¢~ ~ . .
Electnman's License No ~4 7 .~Zr~
No
1. Location of land on which proposed work will be done ..........
ltouse Number Street Hamlet
County Tax Map No I000 Section 1970 Block [~ .. Lot 20, 2.-
Subdivision ~t/.~D£5;~ (~ ~m ~.e~t~' FdedMapNo ~,gtl~,~.. Lot ..~. ....
State ex]sting use and occupancy of premises and intended use and occupancy of proposed construct]on
a. Existing use and occupancy . {,/1~(.~'- ..........
b. Intended use and occupancy ().~.~..~(~fl,]~ D~fl,~'~.~.~ .................
3 Nature of work (check which apphcable) New Building /.. Ad&tmn ........ AlteraUon
Repmr ....... Removal .......... Demolmon ........ Other Work ........
4 Estimated Cost .............. Fee ........................
" (to be paid on fihng th~s apphcation)
5 If dwelhng, number of dwelhng units ....... Number of dwelling umts on each floor ........
If garage, hum her of cars .............................................
6. If business, commercml or mixed occupancy, specify nature and extent of each type of use .................
7. Drmenslons of ex,sUng structures, ~f any Front ............... Rear ............ Depth
Height ............... Number of Stones ..........................................
Drmensmns of same structure w~th alterattons or ad&ttons Front ............ Rear
Depth ...................... Helgb. t ...... ''' -t ..... Number of Stones ............. ~, ......
8. Dtmenaonsof_en$~renewconstructmn Front . .-.~,~t...~t.~... Rear .q'~d {:6,~. . .. Depth ...7'/. ........
Hetght .... ~t~. ....... Numbet of Stones ...... ? ~..~.. . ~. ................ ~, .......
9. S~ze of lot. Front . /'.,-~-~;: . Rear . . ./.~ .,~" .... Devth : ~g? ........
I0 Date of eu~ft~'~ .. (2)~ .../~d- ........ Name of Former Owner .rff. e:x,f~t..~..a~-~.~je=~..
11 Zone or use &strict tn which prenuses are s~tuated .. Z"~. ~ ......................
12. Does proposed constructmn vmlate any zomng law, ordinance or regulation ...................
13. Wdl lot be regraded ~'.~:;~. ((. ~.~'.~,~. . ~, .... Will excess fill be removed from prenuses. Yes
14 NameofOwnerofp~remme~s~.f~.~/ff~e~ald.~e..~./ff-o~Address.~'d~,c~t~.~a'~:__ ,~at.4~,t~neNo
Name o f Architect 6/~'a~ .~/~'g_q/~
........ Ad dress ~?d~: ~,,~. .
Name of Contractor 4~/~.. ~a.~ .,~O) ..... Address/.~$O tO~./~...c~. ~)r/¢~Plrone No.F~ 4~ ./-~..~.~( .
15. Is this property located within 300 feet o~ a t~dal wetland? *Yes ..... No
*If yes, Southold Town Trustees Permzt maybe required.
PLOW DIAGRAM
Locate clearly and dlstmctly all bufidmgs, whether existing or proposed, and red,cate ail set-back dxmenslons fro
property hnes G~ve street and block number or description according to deed, and show street names and red,cate wheth
interior or comer lot
STATE OF NEW YORK._ ._
COUNTY OF . .~.(..dt~/z 0 ~.. S S
....... lil '.
..... being duly sworn, deposes and says that he ~s the apphcan
(Name of mdlwdual s~gmng contract)
above named
He is the
(Contractor, agent, corporate officer, etc )
of smd owner or ownem, m~d ~s duly authomed to perform or have perfo~ed ~e sad work and to m~e ~d file t~
apphcatmn, that all statements contmned m th~s apphcat~on are true to the best ofh~s ~owledge and behef, and that th
work w~l be perfomed ~n the m~ner set forth m the apphcat~on filed ~erew~th.
Sworn to before me th~s
..... ~ ....... day o~ . ...... ,
v ] N~ Pu~ S~ of NeW Yo~ (Si~ature of applic~
Z
Y.S. LIC. NO.
ENGINEERS ~
{516~ 765 - 5020.__
P.O. BOX 909
MAIN ROAD
SOUTHOLD N Y, 11971
PINE
NECK
ROAD
LOT
N
I
86 06 50 E.
S, 69° 52 50"W~
LOT 2
49618
AREA
= 4.8,6'
'6 SQ. FT.
¼
_o
LOT
$02'
114.60
288.8~
97
275. 81 '
v
LU
bJ
LU
0
TOPOGRAPHICAL SURVEY OF
LOT 2
" MAP OF PARADISE BY THE BAY
FILED NOV. 4 ,1976 FILE NO 6463
AT SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
I000 070 13 20 2
SCALE I" 20'
JULY 28 ,1987
SEPT. 29 ~ 19 87
TO
86 - 752 B
Z
J
PI NE NECK
J
- g
/
N 86° 06'50''E'
48,676 sq. ft. :,.
...... j B.O.H. #87-S0-14R
CERTIFIED TO,
TICOR TITLE ~.IARAIvleE CO.
SOUTHOI. DS,4VIN~BAI~
ALF_XAND~R ~ K~
RY~ K~
tandards for title surveya m mtablid'~d by
fhe L.I.A.L,S. and appro,md and adopte,~
ROAD
LOT
LOT 2
8,2
LOT 3
DETA/L OF
MAr
$OUTHOL D ,
N.Y S. LIC. NO. 49618
2O
ENGINEERS , P C.
N,Y. 11971
3O
~ '/~ sw. FR.
HOUSE
288.82 '
60'
/
/
275.
n-
SERVICE LINE
TOPOGRAPHICAL SURVEY OF
LOT 2
MAP OF PARADISE 8Y THE BAY
FILED NOV, 4 ,1976 FILE NO. 6463
AT SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
I000 070 13 20 2
SCALE I" 20'
JULY 28 ,1987
SEPT. 29 , 19 87
APRIL 14 , 1988 (FIN^L)
MA Y 12, 1988
86 - 752 B
PINE NECK
ROAD
lOT I
S. 89°52 50"W~
;'88.62 '
114 60'
///
/
- /
LOT 3
AREA = 4.8,676 SQ.FT.
P.O. BOX 909
MAIN ROAD
N Y $ LIC.
~// ' . .
NO. 4961S
'~f~ORS 81 ENGINEERS ~
2O
SOUTHOLD ~ N,¥. H97~
CERTIFIED TO:
'?ICOR TITLE GUARANTEE
~;OUTHOLD SAVINGS .BANK
I[LEXANDER G. KOKE
RYCK KOKE'
CO.
ELEVATIONS ARE REFERENCED
N.G.V. DATUM OF 1929 ,
TO
275, SI '
o
o
o
t
)-
0
TOWN OF SOU~HOLD
TOPOGRAPHICAL SURVEY OF
LOT 2
MAP OF PARADISE BY THE BAY
FILED NOV. 4 ,1976 FILE NO. 6463
AT SOUTHOLD
'TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
I000 070 13 20 2
SCALE l" = 20'
JULY 28 ,f987
SEPT. 29 , 19 87
86 752 B
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