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Home My WebLink About12249-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi[icate O[ Occupancy No..Z.~.l.9. q0. .......... Date ........ 5..ep.t.e. mbe? 23 19 83 THIS CERTIFIES that tbe building ': 7, .n.e?...d?.e. 1..1 .~.n.~. .............................. Location of Property 570 Jernick Lane Southold House No. Street Hamlet County Tax Map No, 1000 Section . .0.7. 0. ....... Block ...0.3. .......... Lot ...0.1. 9. ..... Subdivision..H.a?.v..e.s.t..H. 9.m.e.s' . .E.s.~.a.g..e.s ..... Filed Map No..6.3.7.9....Lot No..2..5 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .~.a?.c.h...2 ~ .......... , 19 .8.3. pursuant to which Building Permit No... ~..2 .23.9...g ........... dated .... .Ap. pti: .~..1.2. .............. 19 .8.3., 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 private one-family dwelling. The certificate is issued to HENRY B. & ANNE WASBMER ..................... ¥'r'tii a ............ ' .......... of the aforesaid building· Suffolk County Department of Health Approval 13-S0-37 ~ 9/23/83, Robt, A. Villa, UNDERWRITERS CERTIFICATE NO. P e nfl ing Building Inspector Rev. 1/81 TOWN OF tlUlLDING DEpARTMi~N~ TOWN HALL SOUTHOLD, N. Y. BUILDING PEmiT (THIS PEP, M T MUST BE KEPT ON THE PRE~IS~S UNTIL ~ULL coMPLETION OF THE WORK AuTHOp, izEDi i PenJnissior~ is hereby granted to~ . ,~/;~,/ , at p~emlse~ located at Builalng I~spector. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing'~ land uses: 1, Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph ic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings, 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion requ ired to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / ! 2. Certificate of occupancy on pre-existing dwelling q'r land use 3/S-/$5.00 3. Copy of certificate of occupancy $1,00 Date ~ gB New Building ............. Old or Pre-existin uilding ............ Vacant Land ............. Location of Property .............. .~-.~.~..~./..6./'.~...A'. ~ .<~, .~. .... ~.. House No, Street Hamlet Owner or Owners of Property ...~.~.~.~. ?'.~..~..'../.'.../~..z~..x~-. ?.-~. ?,...~'../~. ~,.~ ................. County Tax Map No. 1000 Section .. ?. ~ o Block ~ LOt .... Subdivision .~.~.~..°.5..//..~..d.~ .°.~..~?..~?.F.c~.?.~..edMap No. ~,3 ? ? .Lot No. Permit No./..2 ?. ~.~.~..Z,. Date of Permit ..... ,~..Applicant ............ ¢ ..... ~-'?. ;. Health Dept Approval /?. ~ J~o ~ .2 ~ L pt App ...................... abor De . roval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ,.~. ................... '7 Submitted $ el Fee ..,.......................... Construction on above described building and permit meets all applicable codes~'nd regulations. ^,,,,..t. ............... Rev, 10-10-78 FIELD INS~I~N COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING ~so 0 INSULATION PER N. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT ~ry 'W~r, J~ick I~e off Wells Ave., ~ld, N.Y. ~n the foltowing location; ~ Base,nen~ ~ 1st FI. ~ 2nd FI. Section Block Lot was examined on Sepz~r ~9 ~ ~ 983 and found to be in ~ompliance with the ~equirements of this Board. 26 DRYERS rECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS NCANDESCENT FLUORESCENT 37 27 26 SYSTEMS E OTHER AIPPARAIUS: 1-G.F~i. t~Sm~ge De~ector f~or. ors: 1-F. E R V I C NO' O ~[ C~.COND' l A' W. G, NO OF HI-LEG NO'~NEUTRALS AW, G Dick~rsOn Elect. Co. Inc. ~ ~~ 13 '£arkegtle Rd. Shelter Island, N.Y., 11964 LIC,~291 GENERAl1]. MANAGER;~r~% i~" ~ This certificate must not be altered in any manner return to the off ce of the Board f, nco~rect nspect6rs may be dent f ed by the r cre~enf a s /~ ~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERIIFICATE MUST{NQ~r BE ALTERED IN ANY MANNER. PROJECT LOC~?ION ,,, PROJECT I hereby certify that I have prepared the plans and specifications for the abo~e referenced project and~ together with the following information~ they are.~ to the best of my knowledge and belief~ in compliance with the New York State ENRRG¥ CONS~,RV~TION CONST~JCTION CO~ printed January 1~ 1~79 by the acceptable practice me~hod (E500) ~ART 5. tl . / I ~l~ichal s~' lr~tlitect Date ' Oil _ , Elect~ic' DXSTRIBUTION~ ~" ~ater ~ Heating Only ,. ~ir Steam Cooling Only H~g. & Coolin~ Split Co Eo Fo The ,contractor shall furnish and install construction ~aterials such that the follo~in~ *~" values are not exceeded~ 1° Roofs 2° Floor over Unheated Basement 3. E~terior ~alls ·~ 4. Glazing .,g ~ 5. Entrance Doors . ~ 6° Perimeter Slab ' ~ :?. Floor over Crawl Space ~ Heating- Design INDOOR Air Temperature shall be Cooling- Design INDOOR Air Temperature shall be -- Heating- Desisn OUTDOOR Air Temperature shall be Cooling- Design OUTDO0~ ~ir Temperature shall be Desi. gn heat loss/heat gain through each exterior facade in B~J/IIR. - ~~ ATTACHED SII~7~T "R" Values of Insulating )~aterials- As indicated on the Drawings. NU~BER OF ZONES~ / THERFOS?AT ~6E ,,7~, ?,~f ~th automatic controls- Range; ~o 140 F ins%all ~th shut off swi~ch~ Electrical llgh~ing ~nd power design da~a are in ~ccord~nce with Section E40~.~ of ~he CO~. ~G~ DAYS~ ~0 sheet No. 1 1. The contractor shall furnish to the o~ner written maintenance instructions for all equipment which requires preventative maintenance for efficient operation. 2o The contractor shall furnish and install adequate ventilation in accordance with NoYo State Building Construction Code and NoY. State Building Construction Code ~'anual, latest edit&ens. AIR LEAKIGE~ Exterior joints around window and door frames; openings between walls and roof/ceilings and between wall panels; openings at penetrations of utility services through walls, floors, & roofs; and all other such openings shall be caulked~ gasketed, weather- stripped or otherwise sealed. Th9 contractor shall furnish and install manufactured doors and windows which have infiltration loss rates ( at 25mph ~ind velocity equal to or less than those listed below; I~INI~ 0.5 cfm per lin. ft. of operable sash crack .S~INGING ~ORgt 1.0 c~ per sq. ft. of doer area SLIDING GL~S ~0~ 0.5 cfm per sq. ft. of door area ~A~ D~R~ 20 cfm Furnish and install tight fitting, non combustible fireplace doors. Furnish and install ~ dampered duct in fireplace sides or in hearth ducted from the outdoors. 5o Insulate supply ductwork in unheated basement or crawl space with insulation with vapor barrier ~ith R= 5.0 or greater. 6. Insulate piping in all unheated spaces and slabs with 3/4~ thick suitable insulation for all pipes 1~' and less in diameter. sheet No. 2 of ~ 'ROOF SUB TOT,~ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Approved ............ (/ ....19 ::. Permit No../"~.'~...~...~: Disapproved a/c .... ~ . . :~ ....... .,~ .... .. APPLICATION FOR BUILDING PERMIT Date 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 inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises filet..d.~g,a:., ff..*-.~..dty..~...:, r.~.(l',.~.'.to.*.~ .................................. (as on the tax roll or latest deed) If applicant is a corporation, sig~ure of duly authorized officer. ... :,....,:.4 .... (Name and title of corporate officer) Builder's License No .......................... Plumber's License No...~.]..~. :.~. .............. Electrician's License No...~..~./.~ .~."~ ............ Other Trade's License No ...................... ~ r) O 1. Location of land on which proposed work will be done ....... .'YT.~.'-.~/.~? .e.d~.. 4.d..a:'.~. ~,..~fi. ~.. ................ ......................................... House Nmnber Street Hamlet County Tax Map No. 1000 Section . ?.a..~ ............. Block ....~. ............. Lot.../. ~. ............. Subdivision/~/~.P. .er-.-. ?g. tt4.~/P::,~..t./(.o.ta.a.-~.'. >.27.T..~[(.,$'... Filed Map No...ff.~.?.~ ....... Lot . .~..~.'.~. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . ~.Z~. .e'..~ff ~...~.?. (~..~. .............................................. b. Intended use and occupancy .... J...(;.~.m. ( .~X'../9.~.'.~: ~ ~./:~.' · .&: ....................................... 3. Nature of work (check which applicable): New Building ~ Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ... ~,. ~ ~ ~:~ ..................... Fee ............................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars . ',g ~'.rF~ ~.T/',q. 6. If business, commarciai or mixed occupancy, specify nature and extent of each type of use ..................... 7 Dimensions Of existing structures if any: Front Rear Depth Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... ... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ... ~fi...8.: ...... Rear ...?.(*..3: ....... Depth .-~ .~., ?.* ......... Height /.X. ' N b f Stories ./ ............. um er o ....................................................... 9. Size of lot: Front . ./.3..0.:4/.:..: ........... Rear ../~-,&.~?':: ............ Depth . !.2..a~,..~. ~ ............ 10. Date of Purchase ........... .................. Name of Former Owner ............................. 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed constru~tion viol3te any zoning law, ordinance or regulation: . . .~..o.,. ............. 13. Will lot be regraded . .~.~.3 .... ................... Will excess fill be removed from premises: "'~;i .... ~) 14. Name is /-/~ ~ ~o,~,c,**, ~ ,,,~.~f~,,~.::.~., ~,:~ ~7.,*.~// of Owner ofprem es ... ~.. ~.ff ....... .~Y... Address 'g,)~,~¢;.5,~t,~'; ..... Phone No ................ Name of Architect ~t¢. frt? ~?~,~.~-.~:~. .......... Address ...~.~.~,~ .......... Phone No.. g '.~.~-'~.~..~ .~... '&~O ~tt~t/"o,v~ ~-*,t# ~' . .......... Name of Contractor ~. ......................... · ~ t~ Address . [~.q~.ff.'2'.~!..., ...... Phone No. PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all Bet-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. STATE OF NEW,.'YO~, . ,~ S.S ............... - .... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. is the ...................... i.~~"i~'~'~":'~. :~. ~.~N ...................................... He ! --,,,~ontractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorize~fl~trr-pcrfornim~'tiave performed the said work and to m~e and file this application; that ail statements contained ~ this application are true to the best of his ~owledge and belief; ~d that the work will be perfomed in the m~ne~ set forth in the application filed therewith. Sworn to before me this ......... 5 [ NOTARY PUBLIC, State~f New Y~ [~]gnature ot appncant) : ~ ~o. 52-8125850, Suffolk / DATUM APPROXIMATE LOT AREA 22,080 S~.FT. TAX MAP DISTRICT 1000 SECTIf%N 700 FSLOCK 3 LOT 19 WATER MAIN IN STREET DWELLINGS - PUFSLIC WATER (21.7) JERNICK rd. N. 65° IB'OO"E. (20,0) I30.61 0.1'N. 25,00 ~or'ch LANE -30.0 -- -- gar. [ prop, dwell. 76.: area used as storage for ~t and trailors '~26.~) w NOW OR FORMERLY GRIGONIS VACANT The existence of right of ways ani~ or easements of record, if any¢ not shown are not guaranteed, SUFFOLK COUNTY DEPT. OF HEALTH SERVICES FOR APPROVAL OF CON~;T. ,ONLY H.s. REF. NO. 7 APPROVED ,Y - THE WATER SUPPLY & SEWAGE DISPOSAL FOR THIS RESIDENCE WILL CONFORM TO THE STAND- ARDS OF THE SUFFOLK cO!JNTY DEPT. OF HEALTH SERVICES. O~THEIHI! LANDSURVEYs~dRY~eYOR,IBMAP NOT GUARANTEED ONLY TO ~ ~ '~l~' .~(~J'" ' R N.Y. LIC. NO. 04899Z NAME READ CUSTOM HOMES ADDRESS PO. ~OX 990 SHELTER ISLAND N.Y. JOB NO.' 83-43 SURVEYED'FOR LOT NQ 25 MAP OF HARVEST~HOMES SITUATE~D ~T SOUT~OLD ;TELEPHONE 749- 2333 FILE NO. HARVEST HOMES EST. ESTATES TOWN oF ;SOUTHOLD - SUFFOLK COUNTY N Y. SCALE I" = 40' DATE 2- 28 ~ 1983 ~FILED M;AP NO. 637:9 DATE 7- 18- ~969 I~BOOK NO. ;L. L. PAGE HAROLD F. TRANCHON JR. P.C LAND SURVEYOR SUCESSOR ~0 WILLIAM G. MEIER NORTH COUNTRY ROAD - WADING RIVER NEW YORK 11792 , ~. (~[6);;92i9;-~I~95 .~LT. 473-3626 DATUM APPROXIMATE LOT AREA 22,080 SQ..FT. TAX MAP DISTRICT 1000 SECTION 700 FSLOCK 3 DWELLINGS - PUBLIC WATER LO T lg WATER MAIN IN STREET 0 (20.o) LANE d (27.7) JERNICK rd. pip¢ rd, N, 65' 1S'O0"E. 130.61 -. 0,1'N, '~ -m°n';'(21'9)~,,\" Cesspool ii (20'c~r 2500I ~ ~ ~, / ..X ~ ~ ~ ~ u ' x ~i- I I 23.9 ~ 1 sty fr / '. ' ~ ~ · z ¢ - ' 76.5 198r z . o ~ /~ ii ~ (26.8~ ' ~- " 0.8'N. mort. S. 66'36'10'W. 123,00 p~p~ NOW OR FORMERLY GRIGONI~e Gewa~e. d..~po~.-~,,] VACANT facllttle~ for :.~ '_~ ]or:~t ~on have bee~ ~e exi~en~ of right of ways and or easements to be sattstac~.~. M ~, ~ ~, not s~wn ~e not guarantY. ~r~.~---~ FINAL SURVEY 9- 19- 1983 ~erv~ces SEPTIC TANK, CESSPOOL & WATER SERVICE LOCATIONS ~Y OTHERS SUFFOLK COUNTY DEPT. OF THE WATER SUPPLY & SEWAGE NAME HEALTH SERVI~S~OR DISPOSAL FOR THIS RESIDENCE READ CUSTOM HOMES APPROVAL OF CONST. ONLY WILL CONFORM TO THE STAND- ADDRESS ' SHELTER ISLAND N.Y. H.S. R EF. NO DEPT. APPROVED BY TELEPHONE 749- 2333 ;:~%%,~ ~ ~ ~, I JO~ ~o. ~3-43 F~L~ NO.'A"V~ST HO~S ~ST ~,E~S. A~mo, TO SWLOm~ I~l~l~. C,~w. rnF~S ~[ J MAP OF HARVEST HOMES ESTATES I . m~ o~ suBs~m TED AT SOUTHOLD ~'~~,~,- I TOW, o~ SOUT,OL~ I ~E~l~me~ I SCALE 1" '= 40' DATE 2- 28 ~ 19~3 GUARANTEED ONLY TO FILED ~AP NO. 6379 DATE 7- 18 - 1969 HENRY ~. & ANNE WASSMER j BOOK NO. L.L PAGE USLIFE TITLE INSURANCE C0.~82-52- 40953 J HAROLD F. TRANCHON JR. I LA~D SURVEYOR I suc~sso~~. ~R . ~ ~~ I,NORTH COUNTRY ROAD - WADING RIVER H~ROLD ~ TRA~CHON JR ~NLI~jcN~'o0~ [ , (~'6)929;~695 ALT, 473-36Z6 NOTI~ BUILDING DEPARTMENT AT 765-18~2 9 AM TO 4 PM FOR THE FOLLOWING NS2ECTIONS: '1. FOUNDATION - ~O REQUIRED FOR POURED CONCRETE 2.,ROUGH - FRAMING & PLUMBINGs. 3. iNSULATION 4. FINAL - COnSTrUCT ON MUST BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL ME~z THE REOUIREMENTS ~ THE N.Y w' ~ATE CONSTRUCTION & ENERGY C~ES. NOT RESPONSIBLE' FOR~' DESIGN OR CONSTROCTION ERRORS. 6-4 r IVI' tq .- _.m'. 0" 15'-0" , ¢.&¢o _t OWNERSHIP OF DOCUMENTS THESE DRAWINGS AND SPECII=~CATiONS ARE INSTRUMENTS OF SERVICE FO~ PROJECT !40. ~. :~/..~ AND SHALL REMAIN '~HE PROF2 T¥ OF THE ARCHITECT WH':THER THE PROJECt .[OR W;~,l H IHE¥ ARE MADE I$ EXECUTED OR NOT. THEY ARE NO'[ $,3 BE USED IN ANY OTHER PROJECT EXCEPT BY WRITTEN AIJ'T~ORIZATiON OF THE ARCHITECT. . .I '1 L L-LJ IF--II I IF coppeF tubing is used for water di.~tributing system; piping shai{ be of types K or L copper tubing is used for water di;,tributing syslem; piping sha~ be of types K or L only