HomeMy WebLinkAbout15995-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin§ Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No ,Z,-16578 Date .J·a..n.ua.r.y .1.2:1988
THIS CERTIFIES that the bmldmg Construct One Famzly Dwellzng wzth attached
gki:a~ &' bokeh.' ..............
Locatxon of Property 2000 Fa.zrway Drive .... Cutchogue, New York
Street
House No ............... Hamle~
County Tax Map No 1000 Sechon 109 .Block 05 ...... Lot 14. I 0
Subdtvtmon M/o Fazrway Farms Fried Map No 6066 Lot No. I0
conforms substantmlly to the Apphcatton for Burid~ng Permtt heretofore filed tn th~s office dated
Aprzl 28, 1987 pursuant to wl~ch Buridmg Permit No 15995 z
dated May I 9, I 987 was tssued, and conforms to all of the reqmrements
of the apphcable prowmons of the law The occupancy for Much thxs certfficate m msued ts . .
ONE FAMILY DWELLING WITH ATTACHED GARAGE & PORCH AS APPLIED FOR
HENRY
The cemhcate m msued to ...
of the aforesaid budding.
Suffolk County Department of Health Approval
UNDERWRITERS CERTIFICATE NO
P. & MARTHA A. POPE
· [dwo'er,'~Ig'Jox~'lf~,~tfx
87-S0-95 Dec. I 1 , I987
N847870 Dec. 23, 1987
PLUMBERS CERTIFICATION DATED: Dec. 14, 1987 - John Deacy
Rev 1/81
1~O~ NO. ~
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)
N~ 15995
Z
Permission is hereby granted to:
.~.~.~.~~..~ ...........
..............
.~.~ ...... .,...:~..:. ...... ~.l.~.~.~ ....... . .
., .............................................. ,.~ ........ ., ........... ~ .................................. ......~ ......................
~ ,
o,~m,,,,~a,~ ~.~.~. ....... ~.'.~~.~.~ .......... ~~~ ....
to application dated ..... ~.....~.....~.. ............ , 19.~.~.., and approved by the
pursuant
Building Inspector.
Fee $ a~. I ...~.,~....~...~....
Building I~ector
Rev 6130/80
FORM NO 6
TOWN OF SOUTHOLD
Buddm~ Department
Town Hall
Southold, N.Y. 11971
765- 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A, Th~s application must be filled In typewriter OR ink, and submitted II to the Building Inspec-
tor w~th the following, for new buddings or new use'
I Final survey of property w~th accurate [ocaUon of ail buildings, property lines, streets, and unusual
natural or topoqraphlc 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 buddings, Industrial buddings, Multiple Remdences and similar buddings and mstalIa-
t~ons, a cert~hcate of Code comphance from the Architect or Engineer responsible for the budding.
5, Submit Planmng Board approval of completed site plan requirements where applicable.
B For ex~st~ng buildings (pr=or to Aprd 1957), Non-conforming uses, or buddings and "pre-ex~sting"
land uses'
1 Accurate survey of property showing all property lines, streets, buddings and unusual natural or
topographm features
2Sworn statement of owner or prewous owner as to use, occupancy and condition of buddings.
3 Date of any housing code or safety inspection of buddings or premises, or other pertinent informa-
t~on required to prepare a certificate.
C Fees Additions $25 00 ?OOLS $25.00
1 Cerhflcate of occupancy New Dwe]l,ng $25.00, Accessory ,$10 00 Bus,ness $50.00
2 Certificate of occupancy on pre-ex~st~ng dwelhng $ 50 00
3 Copy of certlflcate of occupancy $ 5 00, over 5 years $10.00
4.Vacant Land C.O. $ 20 00
5.Updated C.O. $ 50 00 Date .....................
NewCong" t'uc L ~ on Old or Pre-existing Building
Location of Property 2..o,~o. Hou.~ No.
Owner or Owners of Property
.. . Vacant Land ...........
. ................
Street ftarn/et
¢. 4 ...........
CountyTax MapNo 1000Section . /0.~ ....... Block ....~' .......... Lot..),~,~..Q .......
Subd~wslon ~-~'Jt'z-W'~."~' F',~...~z-C-./t,~, FIledMapNo.~'.(~d~,~., LotNo..\O .....
Permit No /~'~¢2'" '~ Date of Perm,t~'4A~l% l~$TApphcant . .J~ ,.'~.°..l~..~.~' ................
Health Dept Approval
.... Labor Dept Approval .....................
Unde~vnters Approval
........ Planning Board Approval ..................
Ruquest for Temporary Certificate
Final Certificate ..............
Fee Submitted $
Construction on above described bulldmq and ~able codes and regulat,ons.
Rev 10 10 78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[]9'~0~ '~ BUREAU OF ELECTRICITY
Decaaber 25, [YS/85 JOHN ETREET, NEW YORK, NEW ~ORK 10038
~97690/87
THI~ CE~IFIE5 THAT
o~y the el~tr~ ~mpment ~ ~scri~ ~ ~ mt~uc~ by ~ ~wont ~ on the a~ ap~t~ numar m t~ prem~s of
Pope, 2000 Fa$~ay Dr~ve~ C~r~og~, N.Y.
t~ follow~ng Iocat~on. ~ B~e~t~ Ist ~t ~ 2nd ~3 ~iC, O~aide ~t,o. Bilk ~t
FIXTURE
OUTLETS EC-CEPTACt~S SWITCHES
26 66 38
DRYERS
FIXTURES RANGES OVENS
KW
Motos~: l-lhp
3-C.F.C.I. 2-S~oke Detecto~
2/0
R V
NO OF HI [EG
AWG
~NEUTRAL
C.C. Electric Inc.
Williams Street
Centereach, N.¥ 11720
Lic. 2909E
.Per
Th~s certificate must not be altered {n any manner, return to f4e office of tfle ~oord {4 incorrect inspectors may be ~denhfled by thetr credenttoJs
COPY FOR BUILDING DEPARTMEHT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER
STATE OF NEW YORK)
)
COUNTY OF SUFFOLK)
ss.:
I, JOHN DEACY, being duly sworn, depose and say that I
am licensed as a MASTER PLUMBER in accordance with the
Occupational Licensing Law of Suffolk County, New York, and
have been issued License Number 2501-P, having an expiration
date of January, 1987.
That the material and work installed in conjuncition
with Building Permit Number ~~z- issued by the Town of
Building Department for the structure located at
Number '~c~cO N-~S--E-W-~ ~%~/%.~ ~ ~
Village ~-{3-~o~(3~ , State of New York, is in
full compliance with the State Building Construction Code
and all other applicable laws.
That this affidavit is made pursuant to the
requirements of the Town
Building Department
in connection with the issuance of a Certificate of
Occupancy/Compliance for this structure.
HN DEACY
Sworn to before me this
day of
NOTARY PUBLIC
DEBRA ANNE DEACY
NOTARY PUBLIC, State of New York
fie 48186211 Suffolk C°u~tY91
Commmston Expires March-3O,
OUNDATION (1st)
OUNDATIO~! (~2 n d )
OUGH FRAME &
PLUMBING
NSULATION FERN. Y.
STATE ENERGY
CODE
FINAL
ADDITI AL C0:~HENTS:
NELSON & POPE
Robert G Nelson, P E, L S
Henry P Pope, P.E, L S
Victor Bert, P E.
Robert G Nelson, Jr, P E
Harry Spitzer, P E., L S 1904 1979
CONSULTING ENGINEERS
LAND SURVEYORS
May 11, 1987
572 WALT WHITMAN RD
MELVILLE, N Y 11747
(516) 427 5665
(516) 735-2844
Town of Southold
Building Department
Town Hall
53095 Main Road
Post Office Box #1179
Southold, New York 11971
Attention: Mr. V. Lessard
Re: Pope Building Permit
Lot 10 Fairway Farms
Sec. 109, Block 5,
Lot 14.10.
Dear Mr. Lessard.
Enclosed herewith are N.Y.S. Energy Code Workbook Thermal Rating Method
Energy Sheets for the subject home.
If there are any questions on them I will be pleased to go over them with
you.
HPP/kz
Enclosures:
Henry P. Pope
NEW YORK STATE
ENERGY CONSERVATION CONSTRUCTION CODE
PART 6 WORKSHEET
THERMAL RATING METHOD
ONE- AND TWO-FAMILY BUILDINGS
BUILDING
ADDRESS
CONTRACTOR,
ARCHITECT OR ENGINEER
GROSS FLOOR AREA 7_..1~'~,
~'~NUMBER OF STORIES
DEGREE DAYS . ~,
TELEPHONE
If the building does not meet the following pr~-qualafylng
conditions, Part 6 of the Energy Code may not be used.
YES
NO
Building ~s one- or two-family residential.
Building is detached.
Building ~s less than 5,000 gross square feet.
Building ~s three stories or less un height.
Entrance doors have a storm door
or certlfled U value of .40 or less.
Glazing area/gross w~ll area ~s equal to or
less than:
24% if 5,000 degree days
-- 23% if 6,000 degree days
20% if 7,000 degree days
18% ~f 8,000 degree days
16% if 9,000 degree days
If all of the above conditions are not met, either PART 3,
PART 4 or PART 5 of the Energy Code must be used.
41
DIRECTIONS: For each component of the proposed building design enter the
design ~nformatlon requested such as Areas, "U" or "R~'' Values,
Additional lines are prowded for designs with more than one component
construction type. Obtain thermal ratings for each item by consulting
the appropriate Tables.
A. ROOF/CEILING
Area: ~.~/~
Square ~t.
Area:
Square Ft.
Obtain Thermal Ratings from Table 6-1,
6-2, 6-1E or 6-2E depending upon degree
days and heating type.
U-Value: (9.o~ ThermaOatlnglR
U-Value:
T'hermal Rating
B. NET WALLS
Area:
Square Ft.
Obtain Thermal Ratings from Table 6-1 or
6-1E depending upon heating type.
U-Value: ,~"'~'"' ""~'" ~'~"'
%hermal Rating
Area: U-Value:
Square Ft.
Thermal Rating
Note: Net Wall Area ~ Gross Wall Area minus Basement/Cellar
Walls, Glazing Areas and Door Areas.
C. GLAZING
Obtain Thermal Ratings from Table 6-3 or
6-3E depending upon heating type.
WINDOWS
Area of Glazing:
u-Value:
Thermal Rating
Area of Glazing:
SKYLIGHTS
Area of Glazing:
Square
U-Value:
U-Val ue:
Thermal Rating
Thermal Rating
O1. FLOORS
F oor Area?j,
Obtain Thermal Ratings from T&ble 6-1,
6-1E or 6-4E depending upon degree days
and heating type.
U-Value:
Thermal Rating
D2. ,BASEMENT/CELLAR WALLS
Wall Perimeter:
Exposure Above Grade:
U-Value of Wall:
Obtain Thermal Ratings from
Table 6-4, 6-5, 6-6 or 6-5E
depending upon degree days
and heating type,
Linear F'eet
I 0
Feet
Inches Thermal Rating
Depth of Wall U-Value
Below Grade:
Note: Use the above grade U-Value of the wall. The Thermal
Rating Tables have been designed to take Into account the
~nsulat~ng effect of the earth.
D3. SLAB INSULATION Obtain Thermal Ratings from Table 6-7
or 6-6E depending upon heating type.
Slab Per~meter: ~L~near Feet
Insulation R-Value:
The'rmal Rating
43
£. INFILTRATION CONTROL
Obtain Thermal Ratings from Table 6-8
or 6-7E depending upon heating type.
If the building does not meet the follow~ng conditions,
enter NA (Not Applicable) for Thermal Rating.
YES NO
All w~ndows have an air leakage rate of 0.35 cfm
or less per l~near foot of operable sash crack;
All net wall areas have an ~nf~ltratlon barrier;
and
A heat recovery ventilator, which transfers heat
between the outgoing airstream and the a~rstream
entenng from the outside, is ~nstalled.
Condltloned Floor Area:
(Shall not ~nclude
basement/cellar floor area)
Square Ft.
Thermal Rating
F. SOUTH FACING GLAZING
Obtain Thermal Ratings from Table 6-9
or 6-8E depending upon heating type.
If the building does not meet the follow3ng cond~t3ons,
enter NA (Not Applicable) for Thermal Rat3ng.
YES NO
The building is no less than 1,250 square feet in
conditioned floor area;
At least 45 percent of all glazing faces w~th]n
30 degrees of true south;
All glazed areas In buildings are no more than
U(glazlng) = 0.58;
South facing glazed areas are free of any s~te
obstructions during the heating season; and
An area of four-~nch thick concrete or masonry
is exposed to direct sunlight from south facing
glazing. The area of this concrete or masonry
shall be no less than three times the area of
south facing glazing.
Conditioned
South Glass/Total Glass: % Floor Area:
(See Above)
Glass Area/Gross Wall Area: %
Square Ft.
Thermal Rating
SUMMARY OF TOTAL THERMAL RATING
If the Total Thermal Rating is zero (0) or greater, the proposed
design for the building envelope complies w~th the Energy Code.
THERMAL TABLE
AREA U-VALUE RATING USED
A. ROOF/CEILING
C. GLAZING
Window
Window
Skylights
Wa~ Per~meter
Exposure Above Grade
Wall U-Value
Depth of Wall U-Value
Below Grade
D3.
SLAB INSULATION
Slab Per,meter
Insulation R-Value
~ Feet
'"-'372~¢ 10
-7).~ r~ Inches
Feet
E. INFILTRATION CONTROL
Conditioned Floor Area Sq. Ft. ~
F. SOUTH FACING GLAZING
South Glass/Total Glass
Gl. Area/Gross Wall Area
Conditioned Floor Area
Percent
Percent
TOTAL THERMAL RATING
45
NEW YORK STATE
ENERGY CONSERVATION CONSTRUCTION CODE
PART 6 COMPLIANCE FORM
THERMAL RATING METHOD
ONE- AND TWO-FAMILY BUILDINGS
BUILDING L~-~ Io'~=,q.E~,.x~jA~ p ~
ADDRESS t
CONTRACTOR, ARCHITECT OR ENGINEER
GROSS FLOOR AREA
NUMBER OF STORIES
DEGREE DAYS
PRE-QUALIFYING CONDITIONS
All pre-qualifying conditions for use of Part'6 have been met.
Yes ~No
TOTAL THERMAL RATING
The total Thermal Rating for th~s building design is 43[~) . The
Worksheets that developed th~s Thermal Rating are attached. A ~ermal
Rating of zero or greater lnd~cates that the building envelope complies
w~th the Energy Code.
PRESCRIPTIVE REQUIREMENTS
INSULATION: 7815.5
Element
Vapor Barrier - where capable of
absorbing moisture
Continuity - at plate lines, sill
l~nes and corners
Required Specified
Yes ~/
Yes ~/
47
AIR LEAKAGE: 7813.5
INFILTRATION RATE
Element
W~ndows
Sliding Glass Doors
Swinging Doors
Required
.5 cfm/linear foot
.5 cfm/square foot
1.0 cfm/square foot
Spec ~ f t ed
CAULKING, WEATHERSTRIPPING AND SEALANTS
Location Required
Exterior Je~ts - W~dows Yes
Exterior Jo~nt~ - Doors Yes
Openings at Walls - ~oof/Ce~l~ng Yes
Openings at Wall Panels Yes
Utility Service Protectors Yes
Spec'~f'~ed
FIREPLACE
Element
Outside Combustion A~r
Infiltration Control:
20 cfm flue damper, or
non-combustible doors
Required
Yes
Yes
Specified
or
t Type
~He~ting Only
iCool~ng Only
iHeating and Cooling
Type
Add Moisture
Remove Moisture
Type
Thermostat
Thermostat
Shut-off
Shut-off
,Sw~tch, or Clock,
HVAC CONTROLS:, ,, 7813.13
THERMO~TAI: ...... ' '~J
Required Range
Specified
,45 - 75 degrees min.
70 - 85 degrees min.
45 - 85 degrees
HU~IDISTAT ' '~
Required Specified
Relative Humidity R.H.
30% maximum
60% minimum
TEMPERATURE ZONING
Required
Each System
Each Dwelling Unit
Each Zone
Each Floor ~ ~
CONTROL SETBACK
Required
or Manual Yes
,49
Specified
Specified
c-,.-o j
NVAC EQUIPMENT PERFORMANCE REQUIREMENTS: 7813.23
Equipment
Gas Boiler
{Oil/Furnace
~?eat Pump - Air Source
High temp (47 deg.)
Low temp (37 deg.)
Cooling
M~nimum , Spectfied'~~t'
Performance Performance
70%'AFUE'
.......2.6 COP~' 1.8 COP
8.5 SEER
Heat Pump Water Source
Cooling '~ 8.5.'SEER
Central Air Conditioner
MECHANICAL SYSTEM, INSULATION:~7813.19 and 7813.20~ t.~ ~ '
Hydronic Low Temp. Required Thickness Specified
Pipe Size at 1" = R4 - R4.6 Thickness'~
~." and less , u~ ' N~p~- ' _~1==~.--..-.':
1 1/4" to 2" ' 1" ' '
~ Forced A~r' .r Required Speci,fie6
Duct Temperature ~ ~-va~ue ' R-Value
~'T of 52.5 ~eg.',,F. or less ' ' (M~n.)
~T of more'than 52.5 Deg. F. ~T(De~.F.)(sq. ft.) '~ ~'
' 15 btu/hr
WATER HEATERS: 7813,33
Type
Minimum Energy
Factor Required
Electric Storage
Gas
0~1
· 93 - .O013V
Specified
Energy Factor
Maximum13.3 pmdn Standby+ 400 Loss Specified I
CONSERVATION OF HOT WATER: 78~3,38
Maximum Specl fled
Fixture GPM GPM
Lavatories ~ __~
Showers
ELECTRICAL POWER: 7813,52
Does building comply with National .~:Yes
Electric Code
51
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST []ROUGH PLBG.
[/-~]~FOUNDATION 2ND I* ]INSULATION
[]FINAL
[ ] FRAMING
REMARKS:
I NSPECTOR~~
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [~ROUGH PLBG.
FOUNDATION 2ND [ I~NSULATION
FRAMING
FINAL
DATE
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING
[ ] FINAL
REMARKS:
INSPECTOR~--~/.~~~
DATE
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ R~OUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
REMARKS:
DATE INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[~]~OUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING
[ ] FINAL
DATE
8OUTHOLD, N,Y 11971
TEL,. 765-1802
BOARD OF HEALTH ..~...,.-~.
SETS OF..- LANS .......
FO,M NO. SOKVEY
TOWN OF SOUTHOLD CHECK : 1~1~9~1~/=9 ~
BUILDING DEPARTMENT S[~[C Y0~H ............. :
Examined
Approved ... "~
Disapproved a/c ...................
(Budding Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
CALL
MAIL TO:
BLDG. DEl'T,
TOWN OF SOUTHOLD
a. This apphcatlon must be completely filled m by typewriter or an ink and submitted to the Budding Inspector, wit
sets of plans, accurate plot plan to scale. Fee according to schedule
b. Plot plan showing locanon of lot and of bmldmgs on premises, relationship to adjoining premises or pubhc str.
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this al:
cation.
c. The work covered by this application may not be commenced before ~ssuance of Budding Permit.
d Upon approval of this application, the Budding Inspector will issued a Budding Permit to the apphcant Such pe~
.shall be kept on the premises available for mspectaon throughout the work
~s e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupa
hall have been granted by the Budding Inspector
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bml&ng Permit pursuant to
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance
Regulations, for the construction of buildings, ad&tlons or alterations, or for removal or demolition, as hereto descnl
The apphcant agrees to comply with all apphcable laws, ordinances, budding code, housing code, and regulations, an,
admit authorized inspectors on premises and m budding for necessary~
Name of owner of premises
(as on the tax roll or {at;~t ~leed)
If apphcant m a corporation, signature of duly authomzed officer
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Bmlder's License No ...........
Plumber's License No
Electrician s License No
Other Trade's License No . .
Location of land on which proposed work will be done
House Number Street
C..
Hamlet
2
County Tax Map No I000 Section l O.~ Block ~:~ ..... Lot I ~4, t. {.,9 .
Subdwmon '[=:,a-I.O_.~V,,,~,"-~ ~=:P'.0.4'4~ FiledMapNo ~,O,~(~.. Lot
(Name)
State ex~shng use and occupancy of premises and intended use and occupancy of proposed construchon
a. Exmtmg use and occupancy '~/~-~-~-~.~"~ ....
b Intended use and occupancy ,.~ I.~ L~' . ~-~ ~..19~..t?.~ . ~. ~ .~.1~.
3 Nature of work (check which applicable) New Budding ...... Addition ...... Alteration
Repmr ....... Removal ...... Demohtlon ....... Other Work .......
~[ (Descnphon)
4. Estimated Cost .. .[O.~_1 Om o .......... Fee
· (to be paid on fihng this application)
5. If dwelling, number of dwelhng umts . . .~ ....... Number of dwelling umts on each floor ~ ...........
If garage, number of cars .O,~' ............................................
6. If bumness, commercial or mixed occupancy, specify nature and extent of each type of use ..............
7 Dmaenmons of existing structures, ff any Front Rear ............ Depth .....
Height ...... Number of Stones ........................
Dmtenmons of same structure with alterations or additions Front .......... Rear ........
Depth ............ Hmght ........ Number of Stones ...................
8. Dm~enmons of enhre new construction Front .. ~/.i-t~ ~': . Rear .............. Depth .-~q~.',7~.°! ....
Height I .t~ . Number of Stones . ~ ......................
9. Size of lot Front .. 1'~'0' ..... Rear.. ~i~'i~if. ....... Depth ...................
10. Date of Purchase ....~..~ ~,~,"/ ....... Name of Former Owner .~...[::~711,.~.'7[ ........
1 1 Zone or use dmtnct ~n which premises are situated.. ~ ~- ~ .C~.~,~ ........................
12 Does proposed constructmn wolate any zoning law, ordinance or regulahon . ~[~1. O .................
13. Will lot be regraded . ~O. ............ Will excess fill be removed from premmes: Yes
14 Name of Owner of premises ~f,[q/:to~5~2~t,l'td..A~'l~l~.~l~l[~dress ~l~*~-~oo.~."l',.Z:~. ~.o.~.Dl~lh-one No..qtL,~ .~Z.Y]O.'~
Name of Architect ............... Address ............... Phone No ............
Name of Contractor ................... Address ................. Phone No ............
15. Is this property located withzn 300 feet of a tidal wetland? *Yes ..... No .~..
*If yes, Southold Town Trustees Permit maybe required.
PLOT DIAGRAM
Locate clearly and dmhnctly all bmldmgs, whether existing or proposed, and xndlcate all set-back dwnensxons from
oroperty hnes Give street and block number or description according to deed, and show street names and indicate whether
ntenor or corner lot.
3TATE OF NEW YORK, S S
2OUNTY OF..
~t'~.'~. ~. '.' ~> -. C~ V ~'-. being aulk sworn, deposes and says that he Is the apphcant
(Name of ~nd~wdual mgnlng contract)
,bo~ namcd.
~s the .. ~.~ - ~ .V~O~ ................................
(Contractor, agent, co,orate officer, etc.)
smd owner or owne~, ~d m duly authored to perfom or have perfo~ed the said work~d~e and file ~s
tpphcat~on; that all statements contmed m thru apphcahon a~ tree to the best of ~s ~owledge and behef, and that the
york will be performed in the manner set forth m the apphcatmn filed therewith.
;worn to before me this
(Signature of applicant)
G
G
LOT lO
L o
UO0 O
TE CK'D REVISION
7S-~[x' ~W'H ~Y
£HK D BY
DATE
'~ ~-~O,
JOB NO
EIL[ HO
SCALE
SHEET
I OF I
NELSON & POPE
CONSULTING ENGINEERS
572 WALT WHITMAN RD.'
MELVILLE. L I N Y HA 7-5665
516
11747
~__ ' VN OF SOUTHOLD
,.3
4'Z, ¢q'1 ~ F
0
L
NO PHYSICAL EASEMENTS ON PROPERTY UNL,SS NOTED
..~,
MOkl
u ~ __
~ 7~o' ~/ ~.o~ ~ ,,.
~ ~/,
~ DWN 8Y
DATE
108 ~0
SHEET
NELSON & POPE
CONSULTING ENGINEERS
572 WALT WHITMAN RD.'
MELVILLE, L, I, N.Y, HA 7-~665
1 1747
SU,FFOLK COUNTY DEPARTM]~I' 0¢ HEAL~ ~
~ ~;~% o / ~J~ L~ - ~IIL.~~ ~o~T~
· ~ ~ ~. ~ o
~ ~ % ~ . ~ DWN. 8Y
~..~~.~.~.~.~ J ~1 ~ ,~ .,.~ s~t~ MAP ~
TOTHiS~RVEY~AVlO~TIOHOF ~ ] / / '~' ~''0~~ CHKD BY ' --.._t J ' ''~'T%'/ ' ~'-~
NEW ~o.~ ~E % ~ ~ / / ~ ~ ~ ~T r~:
"~ "~H'LF TO THE 1% / __ ~ ONSULTING ENGINEERS
,a~ ~ ~E~ ~Wh ~OT CERTI¢,[O -- -- . :_' _ - _ -_ ~ ~ ~] S~ET m~vl~E, L I.N.Y. HA 7-5665
, ~up~ ~NTy TAx MA~. P[~.[~ ~lO~ ~-~l~ [][1[ ~ [~ 11747 516
I1
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF, OCCUPANCY
APPROVED Ail NOTED
NOTIFY BUILDING DEPARTMENT AT
766-1802 9 AM TO .~ PM FOR THE
FOLLOWING INSPECTIONS:
FOUNDATIOi~ 'tWO REQUIRED
FOR POURED CONCRETE
ROUGH FRAMING & PLUMBIN~
4 FINA~ CO~ISTRLICTION MUST
~']'T~*-r[- CONSTRUCTION & ENIER~'Y
CODE~ l,t~T i~tE,'~PON6tEILE FOR
r~l~:~l~'~ 0,~ COI~iSTRUCTION ERRORS,
si.-
- C)
'1
DATE
JOB NO.
FILE NO
SCALE
SHEU
REVISION
'~)
NELSON & POPE
CONSULTING ENGINEERS
572 WALT WHITMAN RD.'
q
ri -
I
tt
~-oF5
'-%
L~,t lo
WOO p
DATE
JOB NO.
FILE NO
SCALE
Topo ~ ul~'v~y ~ '
L ~ ~ . I
NELSON &~"POPE' '
CONSULTING E.NGINEERS
572 WALT WHITMAN,'. R~.~