HomeMy WebLinkAbout12214-zFORM NO. 4
TOWN OF SOUTHOLp
BUILDING DEPARTMENT
Office of thc Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No..Zl 1B.I, 2 ......... Date .......... JuLy..27 ............... 19 83.
THIS CERTIFIES that the building ... ad~itio~ ...................................
Location of Property .... 895 ............. tlighlzmd. Raad ........... Cut:chog~.e .....
House No. Street Ham/et
County Tax Map No. 1000 Section . , 113.2 ...... Block . .. 0.8, ......... Lot ..... (Iff2 .........
Subdivision... Hi.qhlar~d. Em.takes ......... Filed Map No.. 653.7...Lot No .... 5 .........
conforms substantially to the Application for Building permit heretofore filed in this office dated
..... I~Iar.ch. id ....... ,1983. pursuant to which Building Permit No... ,1,221&g ...........
dated ... 3tarc~, · 28 ............... 1983., 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 .........
...... addition · to..oxis.t;ing, clwe 1.Li. ng .......................................
The certificate is issued to ............. D..r:..~..~..r.c..I~.e..v?.7...a..~.f.: ......................
(owner, lee~'~"~O
of the aforesaid building.
Suffolk County Department of Health Approval ........ N../.A. ..............................
UNDERWRITERS CERTIFICATE NO ................ ~ .e.n.d.J:..nit ..........................
~ Building Inspector
Rev. 1/81
BUILDING
(THIS PERAAIT MUST BE KEPT ON ~HE pR'E!
COMPLETION OF THE WORK AUTHORIZED)
:N~.o 12214 Z
Per nisslon is hereby granted~."
~ Tax Map No: lO00
I lng Ihspector.
~ ? ........ ;. ....
end. ~3pproved by the
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold. N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instruotions
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
nam ral or topographic featu res.
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. Su bm it Plann lng Board app royal of comp leted site p lan requirements where app licable.
For existing buildings (prior to April 1957), Non-conform!ng uses, or buildings and "pre-existing"
land uses:
1. Accurate 'survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occUpa,ncy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate,
C, Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
Date ~?./.~.... '(~.~.../~ .~.~. .......
New Building ..... ~ ..... Old or Pre-existing Building ............Vacant Land .............
Location of Property... ?~, ?. ,~,-' .............. ,~, ~.¢/~,, ~,¢~..~..~-~. · ......... House No. Street
Owner or Owners of Property .~...~7~...~...~..c~..~. ~.~. .............................
County Tax Map No. 1000 Section .... ./.~.~'. ....... Block ...(-.)~. ......... Lot .... ~ ....
Subdivision .............. Filed Map No. .Lot No.
Permit No../.'~. ~-/../.. Date of Permit .~.~.Applicant..~,,.~.
Health Dept. Approval ..... .~./~. ............... Labor Dept. Approval ..... ¢~J./~. ..............
Underwriters Approval ........................ Planning Board i~,pproval .... ~ .., ............
Request for Temporary Certificate ..................... FinalC rtificate .......................
Fee Submitted $. ~..~'"./. ~. .....................
Construction on above described building and per, mit meets all ap_plica, ble codes and regulations.
Applicant...%~------~..~.. '~'"~''' "~''")~"'"''"~'(i'
FIELD IN~FEC~ION
FOUNDATION (1st)
COMMENTS
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
qODE
FINAL
ADDITIONAL COMMENTS:
SPBCI
cutchog~e,
General Cons~t~u¢fi J
Plumbt~ng
B eetr al
Renovai: :[ on s
Dr. & Mrs, M~rc
Righlands~K~ad ~
DO.AL~ A.
Aqwebogue, Ni'w ~
.
RENOVATIONS & ADDITION
For
Dr. & Mrs. Marc Levey
Highlands Road
Cutchogue, Town of Southold, New
York
SECTION
3
5
6
7
8
9
10
INDEX
TITLE
General Conditions
Excavating, Grading, Site Work
Sanitary System
Concrete and Masonry~
Cabinet Work
Rough and Finish Carpentry
Windows and Doors
Ceramic Tile, Resilient Flooring
Bathroom Accessories
Painting
Plumbing
Heating
Electrical
PAGE
GC-01 - GC-03
1-01
2-01
3-01
4-01 - 4-03
5-01
6-01
7-01 - 7-02
8-01 - 8-02
9-01
10-01 -10-02
GENERAL CONDITIONS
The STANDARD FORM OF GENERAL CONDITIONs of the A.I.A. will be
part of this' Contract and are on file at the Architect,s
office.
Extracts of major clauses of the STANDARD FORM OF GENERAL
CONDITIONS are as follows:
The Contract Documents are complimentary and what is called
for by one shall be as binding as if called for by all. The
intention of the documents is to include all labor and mater-
ials, equipment and transportation necessary for the proper
execution of the work.
Unless otherwise specified, all materials shall be new, and
both materials and workmanship shall be of good quality. All
workmen and subcontractors shall be skilled in their trades.
All work is to be done in strict conformity with applicable
local, state and national codes.
SURVEYS~ PERMITS & REGULATIONS: The OWNER shall furnish
all surveys unless"otherwise specified. Permits of a temporary
nature necessary for the prosecution Of the work shall be
secured and paid for by the CONTRACTOR. The Contractor shall
comply with all laws and regulations bearing on the conduct of
the work and shall notify the ArchiteCt if the Drawings and
Specifications are at variance therewith.
PROTECTION OF WORK~,.PROPERTY & PERSONS': The Contractor shall
adequately protect the work, adjacent property and the public
and shall be responsible for any damage or injury due to his
act or negligence.
EXAMINATION OF JOB SITE: Examine the site and all conditions
~hereon, since your proposal must take into account all such
conditions as may affect the work.
~RANGES IN THE WORK: No extra work or changes will be valid
unless performed by a written order s{gned by the Owner.
CORRECTION OF WORK: The Contractor shall re-execute any work
that ~alls to conform to the requirements of the Contract and
that appears during the progress of the work, and shall remedy
any defects due to faulty materials Dr workmanship which appear
within a period of one (1) year from the date of completion of
the Contract. The provisions of this article apply to work
done by subcontractors as well as to Work done by direct em-
ployees of the Contractor.
GC-01
GENERAL CONDITION:;
~ONTRACTOR'S LIABILITY INSURANCE: The Contractor shall main-
tain Such insurance as will protect him from claims under
Workmen's Compensation Acts and from Such claims for damages
because of bodily injury, including death, which may arise
from and during operations under this Contract, whether such
operations be by himself or by any subcontractor or anyone
directly or indirectly employed by either of them. The Con-
tractor shall carry not less than $500,000 for injury and
death to any one or each person, and $1,000,000 for all.
Property damage not less than $200,000 on account of damages
to others.
OWNER'S LIABILITY INSURANCE: The Owner shall be responsible
~o,r, and at his option, may obtain such insurance as will
protect him from his contingent liability to others for damages
because of bodily injury, including death, which may arise
from operations under this Contract, and any other liability
for damages which the Contractor is required to insure under
any provision of this Contract.
FIRE INSURANCE: The Owner shall effect and maintain fire in-
surance upon .the entire structure on which the work of the
Contract Is to be done to one hundred Percent (100%) of the
insurable value thereof, including items of labor and materials
connected therewith whether in or adjacent to the structure
insured, materials in place or to be used as part of the per-
manent construction.
LIENS: The final payment shall not be due until the Contractor
h-~elivered to the Owner a complete release of all liens
arising out of this Contract or receipts in full covering
all labor and materials for which a lien could be filed, or a
bond satisfactory to the Owner indemnifying him against any
lien.
,~EQUIS!TIONS: The Architect shall review and approve all req-'
uisitions for payment.
CLEANING UP: The Contractor shall keep the premises free from
accumulation of waste materials and rubbish. Upon completion
of construction, the Contractor shall thoroughly clean the
building for all trades as follows:
1. Masonry: Clean with a stiff brush, removing all mortar
stains, dirt and other objectionable discoloration.
2. Glass:
Remove
stains
Out.
putty stains from all glass, remove all paint
from glass, wash and polish same inside and
OC-02
OENERAL CONDITIONS
3. Hardware and other unpainted metal surfaces: Clean and
polish for all trades. Thisi~shall include removal of
all stains, dust, dirt, paint and the like.
4. ~ixtures and all equipment~ including plumbinE fixture~:
' Clean,' removing all stains, Paint, labels, dirt and
dust.
~loors: Remove all temporary floor protections and clean.
Dust and clean.
All interior space~:
~,11 exterior spaces:
Remove all surplus materials, scraps
and debris From the premises and
rake the site cleah.
TEMPORARY POWER & WATER: The OWNER shall provide and pay
~or all b'~mporary water and power for the Prosecution of the
work, as necessary.
LAYOUT OF WORK: The OWNER will provide and pay for all surveys,
The CONTRACTOR will perform and pay for all layout work includ-
ing the services of a licensed surveyor, if required.
00-03
LEVEY
SECTION NO. 1
EXCAVATING, GRADING, SITE WORK AND SANITARY SYSTEI!
1-01 EXCAVATION
Excavate to dimensions one foot greater than outside dimensions
of the masonry, slope to prevent cave-in and to the depth re-
quired or to solid formation suitable for the foundation.
The Contractor shall bring the grade up to the necessary level
to receive 6" topsoil. Machine spread 6" of salvaged topsoil
balance of required topsoil by Owner. '
Excavation shall be kept free from standing water at all times.
Excess fill shall be removed from the site and legally disposed
of.
1-02 FINISH GRADING, LAWNS
1-03
1-04
Finish grading, topsoil, walks, lawns and landscaping are not
in the Contract and will be performed by the Owner.
EXISTING FACILITIES
The Contractor will protect all existing facilities which are
to remain. The Contractor will protec't the existing house from
the weather and keep the structure secure from unauthorized
entry. Owner will provide required electricity.
SANITARY SYSTEM
No change use existing.
1-01
SECTION NO. 2
CONCRETE AND MASONRY
LEVEY
2-01 FOUNDATIONS
Foundations shall be constructed of hollow concrete block of
height shown on Drawings. All blocks shall be well cured of
stone aggregate concrete, meeting A.S.T.M. specifications.
Provide corner and solid blocks as shown or required. Mortar
for Joints shall be one part Portland cement, two parts sand to
which 10% (by volume) lime shall be added. Blocks shall be
laid in full buttered Joints and shall be set in straight hori-
zontal and vertical courses. Joints shall 'be staggered. The
top course shall be of solid concrete block units. Concrete
shall be ready mixed to a design of 3000 p.s.i, strength.
Forms shall be in good condition, forms shall be set even and
true. Any honeycombing shall be patched. Furnish and install
1/2" diameter by 18" long anchor bolts for sill at mioimum
6'-0" on centers, 4t-O'' from corners.
The exterior of the foundation walls shall be
grade with one coat of asphalt emulsion (1/8"
2-02 FOOTINGS
damproofed below
minimum thickness).
Footings shall be of size shown on thee Drawings, of
1-2-4 mix, resting on undisturbed soil, formed with
true, level and braced.
concrete
2" X 8"s,
2-03 CONCRETE SLABS
Slabs shall be p%aced over well tamped fill, slabs shall be uni-
form thickness, screed smooth, float and then trowel smooth with
a steel trowel. Design mix shall be 3000 p.s.i.
2-06 VAPOR BARRIER
Install a 6 mil. thick vapor barrier under all concrete slabs.
2-01
SECTION NO. 3
CABINET WORK
3-01 DRESSING ROOM & BATH VANITY CABINETS
3-02
3-03
3-04
Reuse the existing cabinets.
MILLWORK
Provide other millwork as required.
CLOSET SHELVES
Shelves 3/4" thick, plywood, A-A, INT-APA,
edges.
a. Dressing Roo'm Cabinet: (9) shelves -
b. Coat/Clothes: Pole, chrome, k. & v.
12" shelf above.
MIRROR
Relocate existing mirror where
indicated
LEVEY
painted with hardwood
adjustable.
with support brackets.
on Drawings.
3-01
SECTION NO. 4
ROUGH AND FINISH CARPENTRy
LEVEY
4-01 MATERIALS
Materials shall be the best obt'ainable of the respective kinds,
grade marked with the grade stamp of the association from which
it is produced, of sizes shown, well seasoned, square, sound,
clear, free from sap, shale, large and loose knots, wet and dry
rot and other imperfections injuring the quality and strength.
1. Framin~ Lumber
Light Framing:
Douglas Fir, 75% "Construction Grade", 25% "Standard".
No hemlock, spruce or balsam-fir will be acceptable for
framing.
b. Structural Joists & Planks:
No. 2 Douglas Fir, 1400
Exterior Steps:
CCA treated lumber.
fb (repetitive), E= 1,300,000.
2. plywood
a. Sub-Flooring: TYPICAL
b. Underlayment:
C-D, INT-APA, exterior
glue, 5/8" thick, glue
to top of floor Joists.
Underlayment INT-APA, exterior
glue under tile work and carpet,
3/8" thick.
3. Building PAper
15 lb. saturated felt.
4. Bart Insulation
a. Johns-Manville or equal, aluminum faced, fiberglass in
bart form.
b. All insulation in side walls and ceilings exposed to cold
shall have a vapor barrier on one side. Vapor barrier
4-01
LEVEY
shall slways be installed against the heated surface.
Generally insulate as follows:
1. Ceiling below unheated spaces: R-19
2. Exterior stud walls: R-il
3. Floors over crawl: R-11
6. Interior walls (sound deadening): R-11,
barrier. Insulate
bath.
no vapor
around
All insulation to comply with New York' State Energy Con-
servation Construction Code effective January 1st, 1979.
Framin~
Sills to be halved at corners, CCA treated. Studs for walls
and partitions 16" on center, plat~form type, as shown on
the Drawings. Double studs at all openings and tripled at
all corners. Double all floor joists under walls running
parallel to Joists and around all floor openings.
6. Wall Shingles
Shingles shall be cedar shingles; length, type and exposure
to match existing.
Exterior Wood Trim (Soffits, Fascias, etc.)
Clear white pine to match existing; back paint before in-
stalling.
Nails
Stronghold steel underlay floor nails on all interior
wood flooring·
Stonghold coated screw steel drywall nails for interior
sheetrock wall surfaces.
Wood siding - 8d, galvanized·
Galvanized steel casing nails for fastening of all mill-
work.
Galvanized steel framing nails for all framing.
4-02
LEVEY
9. ~h,eetrock
Tapered edge, 1/2" thick on all walls and ceilings except
where indicated; 1/2" vinyl coated backer board behind cer-
amic tile. Use galvanized metal beads at all exposed edges
and external corners.
10. Interior Wood Trim
Clear white pine; to match existing,
11 . Flashing
a. All doors, windows, openings, sills,'~finish walls:
16 gauge aluminum.
b. Pipes:
Extend flashing out onto roof not less than 6",
extend up on the outside of the pipe over the
top of the pipe; use lead coated copper.
12. Caulkin~
All joints to be.water-, wind- and light-tight. Use non-
hardening sag- and stain-proof caulking compound. "Tremco"
Lasto Meric. Use non-absorbent, nOn-staining close cell
Joint backings.
13. Roof Shingles
Asphalt, 235# per square, color, exposure and manufacturer
to match existing.
1~. Gutters & Leaders (TO MATCH EXISTING)
a. Gutters: 5", O.G.
b. Leaders.: 2" X 3", corrugated, std. gauge.
c. Materials: Aluminum, baked white finish, seamless,
standard gauge.
Installation: As per manufacturer's instructions.
e. Splash:
Provide each leader with a precast concrete
splash.
4-03
SECTION NO. 5
WINDOWS AND DOORS
LEVEY
5-01
WINDOWS
Pella, doubl~ glazing, clad (Dark Brown), factory installed
weatherstripping, flashing and insect screens. Sizes as shown
on Drawings. NOTE: Pella "CD" windows are special factor~
order and require 6 to 7 weeks delivery time.
5-02 INSULATED METAL FRONT DOOR
Benchmark, insulated steel door in wood [ramc, f;~ct.ry weather-
stripped, prepped for lockset and deadbolt. Style sclectJon
by Owner.
5-03 INTERIOR DOORS
Morgan, flush hollow core doors, 1-3/8'~ thick, to match existing.
Reuse existing doors where possible.
5-04 HARDWARE SCHEDULE
1. Exterior Door:
--Hinges - solid brass, 1-1/2 pr.
--Lock - Schlage "A" Series, key alike w/deadholt; finish
and design to match existing.
--Deadbolt - Schlage, A53PD.
--Threshold & W~therstripping - factory applied w/[rame.
2. Bedroom and Bath:
--Privacy Lock; I pair butts, brass plated, ~chl ~c "A";
match existing design.
NOTE: Reuse existing hardware where possible. New hardware to
match existing.
5-01'
LEVEY
SECTION NO. 6
CERAMIC TILE, RESILIENT FLOORING & BATHROOM ACCESSORIES
6-01 VINYL FLOORING
Vinyl flooring shall be Designer Solarian by Armstrong. Cnlor,
pattern, as selected by Owner. Installation and underlayment as
per manufacturer's instructions.
6-02 ACCESSORIES
Provide paper holders, two (2) 24" towel bars, soap dishes,
toothbrush holders, etc. in bath; instaIlation' by Contractor.
6-03 MEDICINE CABINETS
Allow the sum of ONE HUNDRED ($100.00) DOLLARS for EACH medicine
cabinet; selection by Owner, installation by Contractor.
6-04 SHOWER ENCLOSURE
~'6-05
Existing showe~ enclosure to be relocated.
CARPET FLOORING
Carpet flooring by the Owner.
6-06 CERAMIC TILE
New shower base and walls to be ceramic tile. Shower base mem-
brane to be lead pan over sloped fill; slope 1/4" per foot to
drain; membrane to turn up wall minimum 5" above shower curb.
Reinforced setting'bed to be min. 3/4" thick. Wall tile by
adhesive method; full height up to 7'-0" dropped ceiling. The
Contractor shall guarantee all tile work against defective work
and/or materials for a period of two {2) years.
a. Manufacturer: All tile to be from A~erican Olean Tile Co.
Ail colors as selected by Owner.
b. Tile to be 4-1/4" X 4-1/4" crystalline; wall tiles scored
vertical SD-4.
6-01
SECTION NO.
PAINTING
7
LEVEY
7-01 PREPARATION
The Painting Contractor shall not commence work until surfaces
are in proper condition. He shall protect adjacent work from
soiling or damage, as well as his own work. All surfaces to be
painted must be sanded smooth~ clean and dry.
Ail knots or sap streaks shall be given one (1) coat of shellac
before painting. Ail necessary puttying of ha.il holes, cracks
and blemishes shall be done after priming coat'has become dry
and hard before second coat is applied.
All mixing required shall be done on the premises and no materials
shall be reduced or changed in any way except as specified.
NOTE: All paints are to be of the color selected by the Owner.
7-02 MATERIALS (EXTERIOR)
a. Exterior Wood Shingles : Finish to
match existing.
Wood Trim, Fascia,
S6ffits, Screen Door
(BACK PRIME ALL TRIM)
ONE (1),coat Pittsburg Sun-Proof
Primer;~*ONE (1) coat Pittsburg
Sun-Proof Exterior Oil Paint.
c. Windows
: Prefinished,
d. Exterior Door (Metal) :
Prime factory applied; TWO (2)
coats PPG Speed-Hide Exterior
Enamel.
7-03 MATERIALS (INTERIOR, ONLY NEW WORK).
a. Interior Trim :
ONE (1) coat primer; ONE (1)
coat Eggshell Oil Enamel.
b. Ail Sheetrock :
Tape and THREE (3) coats spackle;
ONE (1) coat primer and ONE (1)
coat latex.
c. Bathrooms (Ceiling
& Walls)
ONE (1) coat primer; ONE (1)
coat Eggshell Oil Enamel.
7-01
d, Interior Doors
LEVEY
Stain to match existing as
required: TWO (2) coat of
Polyurethane.
7-02
1~1 W!Ork and~r ~h~ Sectioh
.~ ~ ~ orth calla r ,;, ~d c mmon goo a
V~nt ~nd ~aste piping PVC ~o~
.~ all, be hard copper
~,~ere~er~ ~ecesSat~ ~o p~o~
~em~n~ provide
:~ , ~ ~nt~ Provide shu~ o~f
~' ~en~ Vent pipes to roof
~l p~p~S f~rmly Zup~por~ed
~l p~pee throuzh roof
~th ~ead coated Copp~r~
: ter~Cioset, (2) laVatOry~
the execut!on'and comp!et
LEVEY
;bneral and
!
' required
ntS,,~raps and
;licable codes
~a~er
lines. Slope
a~k to the
:er at low
*;aE!'fix~ures.
~ies.
roof
L~'v'Ey
9-01
9-02
9-03
SECTION NO.
HEATIiNG
HEATIN~,,SYSTEM
provide a baseboard perimeter
to existing system.
DESIGN
9
LEVE¥
hot wate!r iheating, system;
Heating system shall be designed and g~a~anteed to maintain
the inside temperature at 70°F. when the~:outsi,dE temperature
is -10°F. and the wind is at 15 mph.
,EQ~.IPHENT
The existing boiler is to be used to h~a~ all zones.
New baseboard radiation shall be manu:f~c~ured b~ Slantfin,
primed for painting. Insulate hot Wat~r~piping;! both new and
eaisting~ in Basement with R-4 ineUlatio~. Existing baseboard
in renovated areas to be reused where ~ogsible.
9-01
are
~n
it~Pe
tp Ovt~ch
receptacles
at
are not
by, the
electrt-
~ncl ara not
fan by,
wALL
an £iorced wall heater by.Nu~
all ,~in new Bath.:
x~s~$ng to be,reioca~d.
LEVEY
Connect
~cate' on east
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined~.~.~..~.. Z~..., 19.~..~
Approved/~.~.~.c..~...~.?..., 19~..~Permit No./t~.../.~./
Application No. / rid./..~. .......
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by Wpewriter 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary insp~gections.
(Signature of applicant, or name, if a corporation)
.~z~Z, cw~.c~... ~.~..,.. _Ca~. ~.c.,~ .....
(Mailing address df applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.....fl. ~'..2.,?,,. ~ ...............................................................................
Name of owner of premises . .~. e~/. 9(:...g~.~.lg .... ,d~...d~./M. ~;~. ...............................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corpOrate officer)
Builder's License No... ~..../t:~../ .............
License No.. ~._._~..~ .~.~/ ......
Plumber's
Electrician's License No. ~.~:~.
No ..... Id./.~.
Other
Trade's
License
1. Location of land on which proposed work will be done ..................................................
House/q~'~er ....... ~., ~ ~[ L~/dvfo .~.Street .... ---~t~Y~'"~'--Hamlet ~' O' '~'"~'1:1'0~'J''~' .....
County Tax Map No. 11300 Section /.~..~..~. ........ Block .... .6)~.. Lot t~67t:~7 ,.
..... ..... .........
Subdi ision ./_ ', ........ · ......... iled Map No
-~'~J (Name) ..................
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... {D,~..~..~.---~.lt~l~,~.L {~....'~..*OO.~.o..~ ...........................
b. Intended use and occupancy ~' I, ~ ·
3. Nature 0fwork (check which applicable): New Building .......... Addition....~..... Alteration ..........
Repair .............. RemoVal .............. Demolition .............. Other Work ...............
(Description)
4.
Estimated Cost .... J .[./. O')).'t~, ........................ Fee ......................................
(to be paid on filing this application)
5. If dwelling, number of dwelling qnits ............... Ntanber of dwelling units on each floor ........ ........
If garage, number of cars ..... [ ..................................................................
6, If business, commercial or mixedi occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structurei, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ..................................... ~ ...................
Dimensions of same structure wilh alterations or additions: Front ................. Rear ..................
Depth ......... :.. Height . . ~ ........ Number of Stories ........... ~ ....
· · · : , _ ~, £ t , z~ .....
8. D~mensmns of~ant~re new constructmn: Front .... ~ .~.. ~,/ .... Rear .... [5.. ~. ..... Depth . I .............
Height .. [ ~.-./~? ....... Number of Stories ...... .~--. ................................ r ..............
9. Size of lot: Front . I.~?.' I.~.j .......... Rear... I.~.7,{~. .......... Depth . .~..~..: .............
10. Date of Purchase ........... : .................. Name of Former Owner .............................
11. Zone or use district in which pre?nises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ..... /~. O .......................
13. Will lot be regraded ...... /,~D..; ................ Will excess fill be removed from premises: ,~k~Yes _ No
14. Name of Owner of premises .~, ~..~ ........ Address . .[~t~[~...~'0... Phone No. 7~ '.~L ~..[~.7....
Name of Architect .D~.D_~ .............. Address .. ~[~.~.&~.~ U.g'. .... Phone No. '~..~Z..-/5..57.1.1..,.
Name of Contractor ~.O~eJ..B.e,~'T'~,~q ......... Address ................... Phone No..~¢, .-C7.-..L,~.~..
PLOT DIAGRAM
Locate clearly and distinctly all ibuildings, 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.
STATE OF NEW YQRK~..
COUNTY OF .... ~O.~ .~.~.
....... .~gl ~.' .... .~. ~-f2~"[-..tq:/~OJ ................ being duly sworn, deposes and says that he is the applicant
(Name of individual signling contract)
above named.
He is the i .~,/)~l~r~'~ .... ~...~;(-,-~..'('d-, .........................................................
(Contractor, agent, corporate officer, etc.)
of said owner or Owners, and is duiy 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 b0fore me this
..................... day of ............
~0~}; ;-~' ~'~ ¥or~ (Signature of applicant)
No. 5~-8125850, Surf0 k ColJt~ty,
Term ,:E~:lires March 30,
}~ll~[~l E~TIFICATE ·
OF OCCUPANCY
765-1802 9 AM TO, 4 PM FOR. THE
J;OLLOWJ NG
INSPECTIONS:
, ~ "~ ~i~:OUNDATION ' TWO REQUIRED
· ' . ~ '.; ~DR: POURED cONCRETE
2. ROUGH - FRAMING & pLUMBiNG
3. INSULATION
4. FINAL - CONSTRUCTION MUST
~E COMPL~E FOR C, O.,
~LL CONSTRUCTION SHALL MEE~
~ REQUIREMENTS OF THE N. Y,
~ATE CONSTRUCTIO~ & ENERGY
CODES. , NOT RESPONSIBLE FOR
12
I~ copper tu~ing is used
for water distributing
syslem; piping shall be
of types K or L onl~
i
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