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Home My WebLink About34579-ZFORM NO. 4 TOWN OF SOLV~HOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34235 I~te: 03/19/10 THIS CEI(TIFIES that the building ALTEP~ATIONS Location of Property: 680 ACKERLY POND LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) Cotulty Tax I~ap NO. 473889 Section 69 Block 3 Lot 12 Su]~division Filed Map NO. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 24, 2009 pursuant to w~ich Building Permit No. 34579-Z dated APRIL 1, 2009 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 FOUNDATION REPLACEMENT, STOOP REPLACEMENT AND ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DOUGLAS & DEANNA TIKKANEN (OWNER) of the aforesaid building. SD-FI~LKCODIq~fDEpAR~qTOF}~LTHAPPRO~ N/A ELE~-rKICAL CERTIFICATE NO. 10711 11/06/09 CERTIFICATION DA'£~ 01/23/10 CUTCHOGUE EAST PLUMBING Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUI NC~k BLDG. DEH. / This application must be filled in by typewriter or ink and submitted to the Building I 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 thc applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy- $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: Date. Old or Pre-existing Building: 5// (check one) House No. / Street / Hamlet Owner or Owners of Property: ~'~ O O q / el 5 ~';, ~e&O 1'3 0,~ '"'~\ ~' Suffolk County Tax Map No l000, Section'q'r~B~'$x? ~q'~ ]Y-Block ~c/_ Subdivision Filed Map. mermitNo..~isr](~ DateofPermit. ~11/O~ Applicant: Health Dept. Approval: Lot Lot: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~'~, OO Final Certificate: e/ (check one) + SUFFOLK BUREAUo~ ELECTRICAL 1N$ P E C TORS,;nc, 40 Nottingham Drive. Middle Is;a.d, NY 11953 Telephone: 631 495 8136 · Fax: 631 980 6455 · E-Mail: SBEIGS~grnail.com CERTIFICATE OF ELECTRICAL COMPLIANCE Applicant: Rough In Inspection Date: Application No.: Daniel Wilcenski Elect Cont July 22,200g 10711 Certificate No.: Final Inspection Date: Building Permit No.: 10711 November6,2009 34579 County Tax Map No.: This Certificate of Electrical Compliance is limited to the inspection and compliance of electrical equipment and/or work described below, installed by the applicant named above, located at the premise of and not after the final inspection date above: Owner: Mr Tikkanen Site Location: 680, Aekerly Pond Lane, Southold, NY 11971 Owner's Address (if different): [] Residential [] Indoor [] Bassment [] ~ndca [] Shed [] Commercial [] Outdoor ~] Fimt Floor [] Pool [] Hottub [] New [] Renovation [] Second Floor [] AUJc [] Garage [] Addition [] Suwey Other: INVENTORY Single Phase 200 Heat t~as Duplex Recpt 36 Ce~ng Rxtupe 5 HID Fud~res T~o~ner ~ dish Dryer Rec~ 1-30a ~ T~ne Cleck Other Equipment 2(]Oa ug sewice, 1 arc fatdt circut Ixeaker The electrical work and/or equipment described above were inspected and appear to be in compliance with local, state and national electrical code requirements and this office. Applicant Daniel Wilcenski Elect Cont Inspected By: Roger Richert License No.: 4723-ME Date Of Cedificate: Nov 13,2009 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUI'HOLD CE R~ I F 1C AT I 0 N ~ ~- f_N ~'~c certify that the solder used in the water suppl'; system contains less than 2/10 of !% lead. Qualified ~ Suffolk Coun~ Commission Expires Jan. 4, 2014 Sw~=-n to before me this NOtary Pubi £c,. Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town HallAnnex 54375MainRoad P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0528C Date: February 24, 2010 THIS CERTIFIES that the raising the existing dwelling, installation of new foundation, new roof, new windows and new siding with the removal of the brick patio on north side, and maintaining the Non-Disturbance buffer from along the top of the bank northward At 680 Ackerly Pond Road, Southold, New York Suffolk County Tax Map # 69-3-12 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 11/18/08 pursuant to which Trustees Wetland Permit # 7029 Dated 1/21/09 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the raising the existing dwelling, installation of new foundation, new roof, new windows and new siding with the removal of the brick patio on north side, and maintaining the Non-Disturbance buffer from along the top of the bank northward The certificate is issued to DOUGLAS TIKKANEN owner of the aforesaid property. (/ Authorized gig~ure CHRISTOPHER R. STRESS, R.A. ARCHITECTURE AND PLANNING A Main Road Southold, N.Y. 4 February2010 P.O. BOX 821 JAMESPORT, NY 11947 PHONE/FAX(631) 722-7865 mnbout~optonline.net ~[I]G. DEP]. ~OW'~ OF SOUTHOLD RE: Tikkanen Residence 680 Ackerly Pond Rd. Permit # 345792 Z Please be advised: This office has made inspection of the above noted residence and find the following: The construction completed substantially conforms to the requirements of the New York State Building Code and code of fire underwriters. In addition the plumbing pressure test completed meets or exceeds the code. Attached is the Fire underwriters certificate and plumbing certification required to close out the project and issue the certificate of occupancy. Should you have any questions on the above or attached kindly contact this office. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERi, IT NO. 34579 Z Date APRIL 1, 2009 Permission is hereby granted to: DOUGLAS & DEANNA TIKKANEN 129 HARBOR BLVD EAST HAMPTON,NY 11937 for : REPLACEMENT OF EXISTING FOUNDATION, PER TRUSTEES,NYSDEC AND APPROVED PLANS AS APPLIED FOR. at premises located at 680 ACKERLY POND LA County Tax Map No. 473889 Section 069 Block pursuant to application dated FEBRUARY 24, 2009 Building Inspector to expire on OCTOBER 1, SOUTHOLD 0003 Lot No. 012 and approved by the 2010. Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 + SUFFOLK I N S P E L' I 0 R S. ~ n c 40 Nottingham Drive, Middle Island, NY 11953 Telephone: 631 495 8136 · Fao(: 631 980 6455 · E-Mail: SBEIGS~gmail.com CERTIFICATE OF ELECTRICAL COMPLIANCE Applicant: Rough In [nspection Date: Application No.: Daniel Wilcenski Elect Cont July 22,2009 10711 Certificate No.: Final Inspection Date: Building Permit No.: 10711 November6,2009 34579 County Tax Hap No.: This Certificate of Electrical Compliance is limited to the inspection and compliance of electrical equipment and/or work described below, installed by the applicant named above, located at the premise of and not a~er the final ?~i inspection date above: Owner: Mr Tikkanen Site Location: 680, Ackerly Pond Lane, Southold, NY 11971 Owner's Address (if different): ~ Residential ~ Indoor [] Basement [] Service ~ Shed i Commercial ~' Outdoor [] First Floor [] Pool ~ Hottub New [~ Renovation [] 8eoond Floor ~ Attic ~ Garage Add,ion []su y INVENTORY single Phase 200 Heat 1-gas Duplex Recpt 36 Ceiling F~ure 5 HID Fixates Tr~ree Phase Hot Wate~ GFCl Recpt 5 Wall Fixture 14 Smoke 4 Main Panel 20Ga AC Cond 2 Single Recpt Rece~l~d Fixture CO Dele~ 1 Trar~ormef ~ dish Dryer R:ecpt 1-30a Emeq~ncy Time Clock Other Equipmef~ 20oa ~g sewlce, 1 arc fault cin:~t bmaKer The electrical work and/or equipment described above were inspected and appear to be in compliance ii!.'L with local, state and national electrical code requirements and this office. Applmant: Daniel Wilceneki Elect Cont License No.: 4723-ME Inspected By: Roger Richert Date Of Certificate: Nov 13,2009 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34579 Z Date APRIL 1, 2009 Permission is hereby granted to: .DOUGLAS & DEAATNA TIKKA/NEN 129 HARBOR BLVD EAST HAMPTON,NY 11937 for : REPLACEMENT OF EXISTING FOUNDATION, PER TRUSTEES,NYSDEC AATD APPROVED PLANS AS APPLIED FOR. at premises located at County Tax Map NO. 473889 Section 069 pursuant to application dated FEBRUARY Building Inspector to expire on OCTOBER 680 ACKERLY POND LA SOUTHOLD Block 0003 Lot No. 012 24, 2009 and approved by the 1, 2010. Fee $ 200.00 Authorized Signature COPY Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ~x~ FOUNDATION 1ST ROUGH PLBG. INSULATION FINAL FIRE SAFETY INSPECTION FIRE RESISTANT PENETRATION [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION REMARKS: DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ J~FOUNDATION 2ND [ [ ] FRAMING / STRAPPING [ [ ] FIREPLACE & CHIMNEY [ [ ] FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION REMARKS: TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN~,~ULATION [ ] FRAMING / STRAPPING [,~J~ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION / DATE INSPECTOR COMMENTS FTE!,I~ INSPECTION REPORT I DATE I FOUNDATION (2ND) ROUGH FRAMING & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE ~DITION~ CO~ENTS TOWN OF SOUTHOLD BI~LDING DEPARTMENT 'Town HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SouthoidTowmNorthFork.net BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Bo~l of Health 4 sets of Building Plans Plashing Board approval Septic Form Trustees Flood Permit Storm*Water Assessmem Form Mail m: Building Inspector PPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ,20 mpletely filled in by typewriter or in ink and submitted ~o the Building Inspector with 4 Fee according to schedule. int and of buildings on premises, relationship to adjoining premises or public streets or 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 issue a Building Permit to the applicant. Such a pemait 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 ptu3~se what so ever until the Buildthg Inspector issues a Cenifica~ of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the properly have been enacied in the interim, the Building Inspector may authorize, in writing, the extension of the Perlmt for an addition six months. Thereafter, a new pertmt shall be required_ APPLICATION IS HEREBY MADE to the Building D eparimem/for'fl~4.~n c e of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, NeJ¢ York, an~ ~er a~p FLc~al~ Laws, Ordinances or Regulations, for the cons~u~don of haildmgs, additions, or alterations ~r for remol~al o1~ dal~5~ herein described. The applicant a .grees to comply wi, all applicable laws, ordimmees, buildi~ code, ho~mff~od~re~ _fions, ~d~ admit authorized inspectors on prcm~s and in bullthng for necez~y (As on the tax roll or latest deed) If applicant is a corporation, signa~ of duly authorized officer (Name ~ot!~orat~ officer) Builders License No. Plumbers License No. Elecfficians License No. Other Trade's License No. House Number Street I Hamlet County Tax Map No. 1000 Section~',Lg_~]~Bloek '~ Lot Subdivision .--.---1 Filed Map No. -------- Lot State existing use and occupancy of premises ~dff~j~efl~u~t occupancy of proposed eons~cfioo: a. Existing use and occupancy .~t~l~/.,l[~&J~ b. Intended use and occupancy ~~ 3. Natuse of work (check which applicable): New Binldthg Repair Removal Demolition 4. Estimated Cost gq ~ 5. If dwelling, number of dwelling units If garage, numt~r o~ mrs Fee Addition Alteration (Desoription) (To be paid on filing this application) Number of dweging units oo each floor 0- 6. If business, coramerciai or mixed occupancy, specify natuse and extent of each type o f use. 7. Dimcusions of~x~, ting dmctures, if any: Front ~, 4 ,..,~. Rear Heqght t']~g/)4'~ Number of Stories ' ~. Dimensions of same structure with alterations or additions: Front Depth Height . Numb~t60~s Dimeusious ofent' ewe traction' Front gt~, ~, Rear 8. Ho/ght n~,~e_.~ ~s Number of~ 9. Size oflot: Front ~.~-~~ Rear -+ Rear 10. Date of Purchase 11. Zone or use district in winch prelmse-s ale situated ~ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO,~. 13. Will lot be re~gxaded? YES NQ~ Will excess fill be removed from premaSes? YES __ NO__ 4. NamesofOwnerllf~p[emit~ ~.~ddress ~ ~ooeNo.~ N amc of Archit~'~'~'~Addred~l~:~-M' ~ Phone No 7~Z · 7[[~llb~ e me 15 a. Is ~ 100 feet of a ti~flweiland or a fxeshwater w~and? *YES ~ NO · IF YE~,iO._UTHOLD TOWN TRUSTF~I~ & D.E.C. PERM,S MAY BE REQUIRED. b. IsthislLr. gEort~w]-- -~"~mmSaS[~,matldal~v' 'wetland?* YES ~NO~ 16. Provide survey, to scale, with accurate foundation plan and distances to prop~ty lin~. ~/~ 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property. YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY o~5 CONNIE D. BUNCI~ being duly sworn, deposes and says that (s)be is ~e NatJitaJu~blic, State of New York (Name of individual signing contract) above named. NO. 01BIJ6185050 ~ualifi~d in Suffolk County , (S)tle is the Commission Expires fil~fi114, 20 (Contra~orate Officer, et~.) of said owner or owners, and is duly authorized to perform or hav~qJ~,ffll~ ~1~ said wo~lI~ to make~and file this application; that all smtsmeats contained in this application are tree to the)~t ofhts Imo~l~ and be~; ~ tl~ work will he /hi Swom to before me this~ ~ \ [ afl] f ~'N,.Iw"~,~ ),) q-~ day of ~-4z~2v~ ~-~ 20 0 q Xx I]~ ~ Nota~ Publk Signature of Applicant ISSU~I~ TO,': ~ iGLAS~TJ/~L~gN PROPERTY oREss: .... ~t to *~ ~ro~sio~ of C~pter 275 =oumo~a ~ m accor~ee ~ ~o~pe~t~ the ~ Wet~and PermR to raise ghe existing dwelling, install now f.,,.aa~. · ~ .. ' roof, windows aii~ si~;ilo- .~.,~.n~.~ .~,,~ .~ ,~.~,. ,~,~ ~..~ ~-, ~: ~ · ~"b~ --aa tang ~OaUIUO~I~ Oi a i~e OlSta~d hao' hnl~a with eflf enemg Is Installed prmr to eonstrueaon, the removal of the b~c~~ ~d~g the 'nor~ the ba~ nor+~, -- ~ · .... ' -' -'g " '. ~ ~'''q:qL ag ~ mwa~ the restrain o~ e'r~ch ~ins, e~.g~; lead. s ~:d~eHs to con~ roof runoff and ~ a~dnnce wRh Chapter 236 of ~e Town Cod~Storm ~d ~e p~nm to be Subse~b~ by a ~o~W of ~e said B~ ~ ~ ~ NEVV YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION DEC PERMIT'~I'UMBER 1-4738-03880/00001 FACILITY/PROGRAM NUMBER(S) · PERMI Under the Envlronmentat Conserva~on La~ TYPE OF PERMIT · New D Renewal [] Modification [] Permit to Construct EFFECTIVE DATE Janua~23,2009 EXPIRATION DATE(S) Jaguary 22, 2014 [] Permit to Operate [] Article 15, Title 5: Protection of Waters El Article 15, 'rifle 15: Water Supply n Article 15, Title 15: Water Transport [] Article 15, Title 15: Long Island Wells E].Adlcle 15, Title 27: Wild, Scenic and Recreational Rivers D Article 17, Titles 7, 8: SPDES [] Article 19: Air Pollution Control [] Article 23, Title 27: Mined Land Reclamation · Article 24: Freshwater Wetlands [] Article 25: Tidal Wetlands [] Article 27., Title 9; 6NYCRR 373: Hazardous Waste Management [] Adicle 34: Coastal Erosion Management [] Article 36: Floodplain Management [] Adicles I, 3, 17, 19, 27, 37; 6NYCRR 380: Radiation Control El 6NYCRR 608: Water Quality Certification PERMIT ISSUED TO Dou~llas Tikkanen ADDRESS OF PERMITTEE [] Article 27, Tit~ 7; '6NYCRR 360: Solid Waste Management ITELEPHONE NUMBER (631) 324-5027 129 Harbor Blvd, .East Hampton, N.Y. 11937 CONTACT PERSON FOR PERMITTED WORK Christopher Stress R.A.P.O. Box 821, Jamesport, N.Y. tt947-0821 NAME AND ADDRESS OF PROJECT/FACILITY ITELEPHONE NUMBER (631) 722-7865 Tlkkanen Property Ackerl¥ Pond Road, Southold COUNTY TOWN Suffolk · I Southold:..... DESCRIPTION OF AUTHORIZED ACTIVITY: IWETLAND # JNYTM COORDINATES E: N: Raise existing single family dwelling and install a new fo[Jrldafion,. All work is to be done in accordance with the attached plans prepared by John T, Metzger on 5/t5/06 and last re.vised on 1/6/09 and stamped NYSDEC approved on t/23/09. 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 and any Special Conditions included as part of this ~ermit. DEPUTY PERMIT ADMINISTRATOR: I ADDRESS Region 1 Headquarters George W. Hammarth (DM, G) SUNY ~ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 AUTHORIZED SIGNATURE _ IDATE I ~~ I January26,2009 ' I Page lof4 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION SPECIAL CONDITIONS 1 ~Any ~vork, disturbance, and or storage of~constrqction materials shall be confined to within the limit of clearihg alqd ground disturbance shown~oh the approved ~lafi." '~- %. 2. Any demolition debris, includingexcess construction materials'and Or (~ess. excavated materials, shall be disposed of on an approved upland site more than 100 feet from any regulated freshwater wetland by the close of business on the day such material was generated. 3. Prior to commencement of any construction activities, a continuous row of strawbales shall be staked end to end along the "Limits of Grading a~qd Ground Disturbance" line as 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. Sediments trapped by the bales shall be removed to an approved upland location before the bales themselves are remoVed. 4. Straw bales shall be recessed tWo to four Inches Into the ground at all times. 5. All equipment and machinery shall be stored and safely coatained greater than 100' landward of the regulated wetland or waterbody at the end of each 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 in an area greater than 100 feet landward of the regulated wetlarld or Waterbody at all times. If equipment cannot be Stored and safely contained .100 feet lattdward of the wetland or waterbody at the end of each day, then an absorbent tarp/mat system must be used,' The absorbent tarplmat system must ensure that inadvertent leakage of deleterious substances I~ever reaches the ground or into the regulated wetland or waterbody. The tarp/mat must be large enough So that ni)'part of the equipment over hangs the edge of the tarp/mat at any point. 6. 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 date of this permit, whlcheveHs first, Mulch shall be maintained until a suitable vegetative cover is established. If seeding is impractical due to the season, a temporary mulch shall be applied and final seeding shall be performed as soon as weather conditioils favor germination and growth. 7, Suitable vegetative cover is defined as a minimum of 85% area vegetatively covered and no unvegetated areas larger than one [1) square foot in size, 8. The permittee shall incorporate the attached Covenant (or similar langUagel to the deed for the property where the project will be conducted and file it With the Clerk of Suffolk County within 30 days of the effective date of this permit. This deed covenant shall run With the land into perpetuity. A copy of the covenanted deed or other acceptable prOof of record, along,with the number assigned to this permit, shall be submitted within 90 days of the effective date of this permit to: NYSDEC, Bureau of Habitat Regional Manager, SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790-3409 DEC PERMIT NUMBER 1-4738-03880/00001 PAGE 2 of 4 NEW YORK STATE DEPARTMENT OF ENVII~ONMENTAE CONSERVATION 1'; ADDITIONAL GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5), 24, 25, 34 AND 6NYCRR PART 608 - ( ERESHWATER WETLANDS) If'futur~ operations by the State of New. York require an al{~ra[i6n ih-thT~position of the structure or work herein authorized, or if, in the opinion of the~-Department of Environmental Conse~vation it shall cause unreasonable obstruction to the free navigation of Said waters or flood flows Or endanger the'health~ safety or welfare of the people of the State; or cause loss or destruction of the natural resources of the State, the'owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modiflcaflon of the watercourse hereby author[zed shall not be completed, the owners, shall, Without exped~e to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to Its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration, The State of NeW York shall in no case be liable for any damage or injury to the structure or Work herein authorized which may be caiJsed by or result from future operations undertaken b~y the State for the conservation or Improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. Ail necessary precaUtionS shall be taken to preclude contamination of anywefland or Waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated With the project, Any material dredged in the conduct o~ the work herein permitted shall be removed evenly, withoUt leaving large refuse piles, ridges across or along the bed of a waterway or floodplain, deposits Within any regulatory floodway, or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterWay. There shall be no unreasonable interference with navigation by the work herein authorized. If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall Without expense to the ~tate, and to such extent and in such time and manner as.the Department of Environmental Conservation mayrequ~re, remove all or any portion of the uncompleted structure or flllanc~ restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration, If granted Under 6NYCRR Part 608, the NYS Department of Environmental Conservation hereby certifies that the subject prpject will not contravene effluent limitations or other limitations or standards under Sections 30t 302,303, 306 and307 of the Clean Water Act of t 977 (PL 95-2'17) ~provided that all of the conditions listed herein are met. At least 48 hours prior to commencement of the project, the permiffee and contrector shall sign and return the top portion of the enclosed notification fot'm certifying that they are fully aware of and Understand all terms and conditions of this permit. Within 30 days of completion Of project, the bottom portion of the form must also be signed and returned, along With photographs of.the completed Work and, if required, a survey. All activities author[zed by this permit must be in strict conformance with the approved plans submitted by the applicant or his agent as part of the permit application. Such approved plans were prepared by John T. Metzqer on 5/15/06 and last revised on 1/6/09. DEC PERMIT NUMSER PAGE 3 of 4 1-4738-03880/00001 FOR LPC USE ONLY I have rew,'e~.,ed the enclosed application and determined the following action to be taken: Exempt Administrative Permit ~Req~/ ) ~ ' ~ ~ Date~~ TOWN OF SOUTHOLD HISTORIC PRESERVATION APPLICATION Meetings are on the third Tuesday of the month at 3:00 pm in Town Hall, 53095 Main Road, Southold, NY. All applications must have a representative at the hearing in order to be re- viewed. Questions? Call Historic Preservation Commission (631) 765-1800. Date: Property Address: Owners Name: ~/_..~ Sections of local laws authorizing review by the Historic Preservation Commis- sion of proposed work on designated town landmark properties are in Chapter 56 of the Southold Town Code. Categories of Proposed Work ,,~,Repair [] Storm Windows & Doors D Alteration El Additions D Painting new construction ~l~Rooflng [] Signs Please attach a detailed description of the proposed work to the application. At the eadiest stage of planning of the proposed work, the applicant should contact the Chairman or Secretary of the Commission in order to establish a dialogue of the proposed work. I understand az~l-agree that no w..oLk on this request shall commence until written approval h~een ~e~y the~.~.il~'~ Inspector if a Building Permit is required. Note: Applicants should review Commission Standards before planning work to insure that the application conforms to these requirements. 1. APPLICANT Name: Telephone/~mail/$ax.~. _ 2. PROPERTY Owner's Name: Address?~'7 /'"~-1~ Z~:~5~.~,~-~~~ Tele~ail/f~: phone/e-~aHn~: - T~ Map Number:ff~. ~ . ~ ~/~ Date Acquired by Curre0t Owner: Status: Local Landmark~.~ In Local Landma{k ~)istrict/~ On Register or in NHR Disc ( ) Use: Current: National Historic Proposed: 3. PROPOSED WORK Reason for Work: Architect/Enginee~,x,J~'/~/-~'g~ ,~ ~,Contracto~/~ ,~ Construction Schedule: r..~/o/~,,,,,//~ ~ , APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orehibits conflicts of interest on ilte nmi of town officers and emolovees. The ournose Of this form is to nmvide information which can alert the town of oessiblc cenfli~s of in~re, at and allow ii to take what~ver action is (Last name, first name, middle initial, unless you are a'!~li, i~ inihe name of someone else or other catity, such as a company. If so, indicate the oiher person's or company's name.) NAME OF APPLICATION: (Check all &at apply.) Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", name thc activity.) Building Tms~ Coastal Erosion Moiling P~m~n~ Do you pelsonally (or through your company, spouse, sibling, paren~ or child) have a relatiollship with any officer or employee of the Town of S0uthold? "Relationship" includes by blnod, mamage, or bnsi~ess ime~st. 'Busincsz interczt" means a business, in~iodlng a partnership, in which the town officer or cmplnyee has even a partial ownership of (or employment by) a co~poralion in which lhe town officer or employ ee owns more ~an 5,% of the sha~s. YES NO ~Z~ ffyou answered "YES", complete fl~e balance of this form and date and sign where indicated. Name of p~rson employed by the Town of Southold ~ Title or position of that person · D el~n'b~ the relationship beiw~,n yourseff (the applicam/agen~/repreeemative) and the town officer or employee. Either check the apprepfiate line A) through D) and/or descfib~ in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): A) the owner of greater than 5% of&a shares of the cerporate stock of the applicant (when the applicant is a corporation); B) tho legal or beneffkial owner of any imcrest in a non-coq}orate entity (when the applicant is not a corpomiion); __.C) an officer, director, panner, or employee of the applicant or __D) the actual applicanL DESCRIPTION OF RELATIONSHIP Form TS 1 Signature Print Name Town of $outhold Erosion, Sedimentation & Storm-Water Run-off A6SE~SMENT FORM PRO~EKTY LOCATIOn, A.C.T.M.~ THE FOLLOWING AGTiOKll M~Y WIRE ~ ~um~__L~_KNI OF d~ item Numbe~: (NOTE: A Cheek M,e,'k (~') for eadt Oue~lJoo ts Required ~r a Compline Ar~Memlon) Y~ No 1 3 4 5 6 ? 9 {This Item will inctude all nx',-off ofea(ed by alta deadn0 end~a-,~ondnJ~lon a~,dti~s as weg a~ ai~ ~le ImL~ovemems a~l the pemm~ent ;reatlm dlm~ s~.) Do-- '. ~lta PIm a~.r 8unmy ~ltow ,MI Propo~d Dmim~g~ 5'~uct~el In~ca~ Size & Lo~tfo~? ~ ~'~ ]his Item $hail I~dude ali ~ Gmcle Cllsflg~ and 81opes Cordrd~g 8ffr~ce Wa(e~lowl E)ds~f~g Grade Involv~g mom than 200 Ca,bio Yam~ o! Matmtal ~ithfn any Will this App~on Require Land Oi~tulblOg A~ Enomlvpassln9 an Are~ In Excess Five Ti~ousarld (5,(~0) ~iquare Fast of GI~0U~I Is there · "-- Water Course Ruling (llr~ 61e 8.? Is tJ~$ Projo~ w~h]n I~e Trustees ~urisdro~io~ or w~hln O~e Hu~md (1 ~ ~ee~ of a EXEMPTION: Y_~ g__o Does this pmj~d meet the mi~mum ~md~ls for daadl~oaaon ~Srm ~ ~? ~ No[ary Public.State of New York ~U~ O~~ ...................... ~.~ .......... ~ No. 01BU6185050 ~~ ~' / -- ~/~ Qualified in Suffo k ~tl~' '~ ~/~ ~ ..... .................................................... ~ ........................ ~ d~ ~m, ~ ~~~r~ pang And that heffshc is the ......................................... ........................................................... Owner and/or mprescab~vc of ~ Owner or' Ow~r's, ~d b duly au~orized to ped'orm or have pcdormed the said work and to m~tke and file d..fi..s, application; .t~a. t all s~atemems cont~tinccl in ~his applkalkm a~ii~lx~.the best ¢~'his Imowtcdge and belie~ ami that thc work will be penMnm~ ,n the manner set forth in ~he application flc~rewirh. ~ .......... .................... ,,, -_ FORM - 06~07 CONSENT TO INSPECTION the undersigned, do(es) hereby state: Owner(s) Name(s) That the undersi,~d~is) (arff,~ ~e~o~5~nff_r(~f ~e p~p~ses in ~e Tom of Southold, located at ~ ~~ · ~ r~ , which is shorn and desi~a~on ~e Suff~Co~W T~ Map as Dis~ict 1000, Section ~, Block ~ , Lot [~ . ~at ~e ~demi~ed ~) (have) filed, or cause to be fil~, ~ a~licafion in ~e Southol¢ Tom Buil~ng hspgctor's Office [o~the fglloMng: That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessmy with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, roles and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: (Print Name)' (Signature) (Print Name) FORM NO. 3 NOTICE OF DISAPPROVAL DATE: March 8, 2009 TO: Doug Tikkanen 127 Harbor Blvd. East Hampton, NY 11937 Please take notice that your application dated February 24, 2009 For permit to make additions and alterations to an existing single family dwelling at Location of property: 680 Ackerly Pond Lane, Southold, NY County Tax Map No. 1000- Section 69 Block3 Lot 1~2 Is returned herewith and disapproved on the following grounds: The proposed construction, on this nonconforming 23,985 square foot parcel in the R-40 District, is not permitted without review and approval by the Southold Town Landmarks Preservation Commission, because the property is listed on either the Southold Town, New York State and/or the National Registers of Historic Places and requires review by the Southold Town Landmarks Preservation Commission. If the requirements of the town code, pertaining to Landmarks (Local Law No. 22) are met, a Certificate of Appropriateness (C of A) will be issued. The C of A is required before a Building Permit will be approved. Information about the requirements for applying for a C of A is available at the information counter in the Building Department. ~thoriz~ S~ CC: file, Z.B.A. Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. /~-~-'L~-.f-~/~-" TOWN OF SOUTHOLD PROPERTY RECORD OWNER STREET :VILLAGE LAND AGE NEW Farm Tillable 1 Tillable 2 Tillable 3 Woodland Swampland Brushlan~l House Plot I VL IMP. TOTAL DATE ~-/~. NOR~AAL BUILDING CONDITION BELOW CARD REMARKS Value' Per Acre '"bfS~CT SUB: ACREA6E I CB; TYPE OF BUILDING LOT MISC. Est..Mkt. Value FRONTAGEONWATER FRONTAGE ON ROAD BUL.~HEAD ABOVE Value Total J <tension B~sement .p~ Floors Interior Finish ~tension " Fire Place ~ ~ , Haat Porch R~f T~e reezeway Patio R~s 2nd Flor a~age Driveway D~mer TOWN OF SOUTHOLD PROPERTY RECORD CARD STRE. OWNER F~Uv~E R OW, NER,~ ' RES. S~S..Z~<~ LAND MP. VL C:ONb% TOTAL DATE I ~'~ VILLAGE '" '""Df'S~RICT SUB. LOT ACREAGE REMARKS 1.2._ BUILDING CONDITIOI' AGE TYPE OF BUILDING BUL~HEAD ~ ~ .~""---.~ Total Swampland Brushland Houee Plot Tillable 2 Tillable, 3 Woodland NEW NORAAAL BELOW ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 JlND. JCB. J MISC. J Est. Mkt. Value xtension Basement ?~r Floors Interior Finish Xtension Fire Place ~ ~ , Heat Porch R~f T~e ~ :: Porch Roo~ 1st Flor ,reezeway Patio Rooms 2nd Floor iarage Driveway Dormer 'l'o~n 1 lall Annex .5/375 Main Road ILO. Box 117!( Sottdlold, NY 11971 0959 Tclcphonc ((;3 I) 765-1802 Fax (631) 7(3,541502 I3UILI)IN(; 1)EPARTMENT TOWN OF SOUTHOLD February 9, 2010 Douglas Tikkanen 129 Harbor Boulevard East Hampton, New York 11937 gq - 5o q ~11~0 Ackedy Pond Lane, Southold Your architect or engineer must certify the plumbing and pressure '-"~ per the Building Inspector's request on 214110. TO WHOM IT MAY CONCERN: The following items are needed to complete your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of $25.00. ~" ' ' ' '~ ' ' Final Health Department approval. ~ f ~-~ Plumbers solder certificate (all permits involvin/plumbing a~/~¢~ -- lmstees Certificate of Gompliance. Final Planning Board Approval. Final Fire Inspection from Fire Marshal. Final inspection from the Building Department. Final Landmark Preservation approval. Building Permit: 34579-Z N SURVEY OF PROPERTY AT SOUTHOLD TO'tN OF SOUTHOLD SUFFOLK COUNTY, N.Y. I000--$9--05--I2 SCALE: 1~$0' MA Y 15, 2006 JAN. 6, 2009 (ADDITIONS) MARCH ,~$~ 2009 (FLOOD ZONES) APRIL I, 2009 ,'ELEVATIONS~ HOUSE TO BE RAISED AND NEW FOUND TION INSTALLED EXISTING SEPTIC SYSTEM TO REMAIN IN USE FLOOD ZONE LINES FROM FIRM 56103C0162 G 5/4/..08 ELEVATIONS ARE REFERENCED TO NGVD AREA=23,985 SO. FT. N/O/~ LoU~S 5/._ VAC.4NT N.. · . v i ~t ' ~ow ~o ~ ~ ~ " ....... . ~ ~~ oo~ ~o~ ~ ZONE AE(EL 8) Y~LLOWFLA~ "/ _V- V '_V_ -% .~'A"''~~0'~¥ v o~ ,~-~s .,. ..... ::2 ;~u,~'r~° F_~"~,,,s ~,~ YEU. OW FLAG EOGE ......... ...~.um N~.~ ,'-- .~ ~ MAt~r', '"' *'.A.~. .............__.~: .""'v~.~$~FIE~ O-," =_ _ E,,~,,~--'" -ZZONE x CESSPoot r*°~*~r z~,v~ ROAD O~LING k ~ CON~-~E/ORs, P.C. O~LLI~ ANY AL~RA~bN OR ADDI~ON TO ~IS SURLY IS A ~OLA~ON CP EXCEPT AS P~R SEO~ON 7209-SUBDI~SI~ 2. ALL OER~OA~S' SAID ~P ~ COPIES BEAR ~E I~PRESSED SEAL OF ~E SUR~Y~ 12~ ,~,, ~ TREET I=~ONU~ENT ~OSE $~RE APPEARS HERE~. SOUTHOLO, N,X 11971 I :' COMPLY WITH CHAPTER "46" FLOOD DAMAGE PREVENTION SOUTHOLD TOWN CODE, UND~RWRffEflS CERTFICAT[ REQUIRED COMPLY WrFH ALL CODFS OF NEW YORK STA'i d & TOWN CODES AS REQUIREB AND COND"TiONS OF - , ~uu, ha. ln',,N r ~NNJNG BOARD · , -~L, I';~ ~LL' Tu'A'I~ TRLJSi EES ~ N.Y.& OEO CERTIFICATION OF NAILING & CONNECTIONS REQUIRED; OC U8 WI' ,OF APPROVED AS NOTED .~UPANCY OR BATE: ~(( (Oq B,P# J/J-'/?? ~ IS UNLAWFUL FEE'JO0-0O % ~rC% O/I:IFY BUILOIN~' GEr-ARTM~NT AT )CCUPANCY FOLLOWING INSPECTIONS: ~, FOUNDATfON - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4, FINAL - CONSTRUCTION MUST BE COMPL~E FOR C,O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTLON ERRORS. ,,,~ ~'-~ L RETAIN STO&k~, .'~%~r%; ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. ,9, r_ L,~A9 e 16" 0£, ZON~ I ZON~ 2 ZO~ ~ I PI~LP 4" O,C, I B" O,C, 12" O,C; ~p~I~ ~" O,C, 4" O,C, 6" O,C, with 6d Cawr,~ Nab F'at/~m m Indlat,~ ,q~,~, . ~L.AZlN~ PROl~CllON PA,.~I~/6 NOrgl2 N Provide I/2" CPX ~t p~l~, NCaxlrrum ~l::,an ~8'-0" l/2" ~ x 16" I., ~.. ~,:Bd b~ l','~' 16-10~ · ~2" ?8-IOd