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HomeMy WebLinkAbout29014-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29712 Date: 09/16/03 THIS CERTIFIES that the building ADDITION & ALTERATIONS Location of Property: 1670 KING ST ORIENT (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 26 Block 2 Lot 42 .3 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 10, 2002 pursuant to which Building Permit No_ 29014-Z dated DECEMBER 17, 2002 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 AND ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOHN H & JOYCE A HOLZAPFEL (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1145509 07/03/03 PLUMBERS CERTIFICATION DATED 08/27/03 MATTITUCK PLUMBING & HEAT (:14 - - Authorized Signatur Rev. 1/81 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. 29014 Z Date DECEMBER 17, 2002 Permission is hereby granted to : JOHN H HOLZAPFEL PO BOX 193 ORIENT,NY 11957 for ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 1670 KING ST ORIENT County Tax Map No. 473889 Section 026 Block 0002 Lot No. 042 . 003 pursuant to application dated DECEMBER 10 , 2002 and approved by the Building Inspector to expire on JUNE 17, 2004 . Fee $ 172 . 50 Autho ized' Signat ORIGINAL Rev. 5/8/02 Form No. 6 rNnti,�,; ---rte TOWN OF SOUTHOLD V,�G,6gL Ar\ BUILDING DEPARTMENT l I t4 S nj TOWN HALL k 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to--the building inspector with the following: 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. 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 a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 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 Buildina - $100.00 3. Copy of Certificate of Occupancy - - .25C. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00/�C� , Commercial $15.00 Date . . . �2 .I.O7/ o erJ. . . . . � iew Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . /?�. . . . . . . . . ,ocation of Property. . . .&.�0. . . .. . . . K.� In)(a. Srpe�. . . . . . . . . . . . . . . . . . . . .Qk I erl7 . . . . . . . . . House No. Street Hamlet )nwer or Owners of Property.. Aohn. .�-)6 30yCe . . �101 � I��VIEI :ounty Tax Map No 1000, Section. . . .'��Q. . . . . .Block. . . . . .d. . . . . . . .Lot. . . . ')•. . . . . . subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . 'ermit No. CVP 1y .2-. . . . .Date Of Permit. . . . . . . . . . . . . . . .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . (ealth Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . 'lanning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . .X. . . . . . . gee Submi t d: $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . a DA-1 I;k- Ca- ( G' ` 0-, APPLICANT Town Hall, 51005 Mall$ nood .•i ?. i - " I m 1519) 745.1921 P. U. nox 1179 . . •, ', rnlnphono (515) 7115.1002 rinolhuld, Now York 11971 ',,� f:✓ �.i.)%• .1 OFFICE OF THE BUILDING INSPECTOfi TOWN Or SOUTI IOLD C R T x. F I C A T 1 O 14 Duild,ing Permit No. �qo�_ Owner; (ploaselIpr. int) Plumbor: (planes print• ) � ..�.—. f I certify that the soldor used in the wafer supply sy:,tem contains loss than 2/10 of J % lend . ( f' InmF�er.^1 G�aLu1:e1 Sworn to beforo me this L day of Notary Publics c*e _ Co11(1ly s"uve!noos NWary PuGl;c,Sate 0'New Yd¢ No.47.^9055 _ Oua!i0ed in Suffolk Count' E,#,,Jure 30.20 r�CPCPLI�LI�C.nC�LfLI�C.�LnCPC.I�C.�LnCPCPC�LI�LnC.fCPLl7LnC.�LI�LI�C.nLfLI�LI�CPCPC.fC�r�r�CPCPr�CPLI7Lnf�CPC�CnC�CPL�LfCPC�f�C�CPCPCPLl7C.nC.rr� 5 BY THIS CERTIFICATE OF COMPLIANCE THE I 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 SBUREAU OF ELECTRICITY 5 55 40 FULTON STREET — NEW YORK, NY 10038 r55j 5 CERTIFIES THAT 5 Upon the application of upon premises owned by i r5j JIM SAGE ELEC. INC. JOHN HOLZAPFEL 5 L� P.O. BOX 38 1760 KING STREET 5 7C7C7C5 GREENPORT, NY 11944-0038, ORIENT, NY 11957 5 Located at 1760 KING STREET ORIENT, NY 11957 55 Application Number: 1145509 Certificate Number: 1145509 5 5 Section: Block: Lot: Building Permit: BDC: NS11 �5 Described as a Residential occupancy,wherein the premises electrical system consisting of c1 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 First Floor, Second Floor, 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5 rj found to be in compliance therewith on the 3rd Day of July,2003. [r+j 5Name QTY Rate Ratinz Circuit Type 5 5 5 Wiring and Devices 5 Receptacle 15 0 General Purpose 5 5 Switch 8 0 General Purpose 5 Fixture 6 0 Incandescent 5 5 Receptacle 2 0 GFCI 5 5 5 5 5 5 5 5 5 seal 5 5 5 5 I of I 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 D rJrJ�rJ�r>�rJ�rJrJrrrJ arJ��nrJrJ�r�rJ�r�r�rnrnr�rJrTrnrJ cnrJ�rJrJ�rJ�rJ'r3PrjL73rJLffl3j �c rrJ�rJr�rJ�rrrJ acnrlrJ�rJrJ@nrJrJa�n�nrJ arJ�rJ�rJ arra o Permit Number MECcheck Compliance Report Checked By/Date New York State Energy Conservation Construction Code MECcheck Software Version 3.3 Release lc Data filename: C:\Program Files\Check\MECcheck\Holzapfel.cck TITLE: Renovations COUNTY: Suffolk STATE:New York HDD: 5750 CONSTRUCTION TYPE: Detached 1 or 2 Family HEATING TYPE:Non-Electric DATE: 11/26/02 DATE OF PLANS: 11/20/02 PROJECT INFORMATION: HOLZAPFEL RESIDENCE COMPANY INFORMATION: Samuels&Steelman Architects COMPLIANCE: Passes Maximum UA =242 Your Home=238 1.7%Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling l: Flat Ceiling or Scissor Truss 690 30.0 2.8 22 Wall 1: Wood Frame, 16" o.c. 457 15.0 2.5 20 Window 1: Wood Frame, Double Pane with Low-E 12 0.340 4 Window 2: Wood Frame, Double Pane with Low-E 95 0.340 32 Door l: Solid 60 0.170 10 Wall 2: Wood Frame, 16" o.c. 769 15.0 2.5 47 Window 3: Wood Frame, Double Pane with Low-E 90 0.340 31 Floor I: All-Wood Joist/Truss, Over Unconditioned Space 467 19.0 3.0 19 Floor 2: Unheated Slab-On-Grade,0.0'insul. 51 0.0 53 COMPLIANCE STATEMENT: The proposed building represented in this document is consistent with the building plans,specifications,and other calculations submitted with this permit application. The proposed systems have been designed to meet the New York State Energy Conservation Construction Code requirements. When a Regist Design Professional has stamped and signed this page,they are attesting that to the best of his/her knowl and professional judgment, such plans or specifications are in compliance with this Code. C. Builder/Designeryizs�wwrt(/u Date E MECcheck Inspection Checklist New York State Energy Conservation Construction Code MECcheck Software Version 3.3 Release lc DATE: 11/26/02 TITLE: Renovations Bldg. Dept. Use Ceilings: [ ] 1. Ceiling L Flat Ceiling or Scissor Truss, R-30.0 cavity+R-2.8 continuous insulation Comments: Above-Grade Walls: [ ] I. Wall 1: Wood Frame, 16"o.c.,R-15.0 cavity+R-2.5 continuous insulation Comments: [ ] 2. Wall 2: Wood Frame, 16" o.c., R-15.0 cavity+R-2.5 continuous insulation Comments: I Windows: [ ] I. Window I: Wood Frame, Double Pane with Low-E, U-factor: 0.340 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? [ ]Yes [ ]No Comments: [ ] 2. Window 2: Wood Frame, Double Pane with Low-E, U-factor: 0.340 For windows without labeled U-factors,describe features: # Panes Frame Type Thermal Break? [ ] Yes[ ]No Comments: [ ] 3. Window 3: Wood Frame,Double Pane with Low-E, U-factor:0.340 For windows without labeled U-factors, describe features: #Panes_Frame Type _Thermal Break? [ ] Yes[ ]No Comments: Doors: [ ] 1. Door 1: Solid, U-factor: 0.170 Comments: Floors: [ ] I. Floor 1: All-Wood Joist/Truss,Over Unconditioned Space, R-19.0 cavity+R-3.0 continuous insulation Comments: [ ] 2. Floor 2: Unheated Slab-On-Grade, R-0(uninsulated) Comments: Air Leakage: [ ] Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] Recessed lights must be 1)Type IC rated,or 2)installed inside an appropriate air-tight assembly with a 0.5" clearance from combustible materials. If non-IC rated,the fixture must be installed with a 3"clearance from insulation. Vapor Retarder: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls,and floors. Materials Identification: [ ] Materials and equipment must be installed in accordance with the manufacturer's installation instructions. [ ] Materials and equipment must be identified so that compliance can be determined. ( ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Supply ducts in unconditioned attics or outside the building must be insulated to R-8. [ ] Return ducts in unconditioned attics or outside the building must be insulated to R-4. [ ] Supply ducts in unconditioned spaces must be insulated to R-8. [ ] Return ducts in unconditioned spaces(except basements)must be insulated to R-2. Insulation is not required on return ducts in basements. I Duct Construction: [ ] I All joints,seams,and connections must be securely fastened with welds,gaskets,mastics (adhesives),mastic-plus-embedded-fabric,or tapes. Duct tape is not permitted. Exception: Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in.w.g. (500 Pa). [ ] Ducts shall be supported every 10 feet or in accordance with the manufacturer's instructions. [ ] Cooling ducts with exterior insulation must be covered with a vapor retarder. [ ] Air filters are required in the return air system. [ ] The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] Each dwelling unit has at lesat one thermostat capable of automatically adjusting the space temperature set point of the largest zone. Electric Systems: [ ] Separate electric meters are required for each dwelling unit. Fireplaces: [ ] Fireplaces must be installed with tight fitting non-combustible fireplace doors. [ ] Fireplaces must be provided with a source of combustion air, as required by the Fireplace construction provisions of the Building Code of New York Slate,the Residential Code of New York State or the New York City Building Code,as applicable. Service Water Heating: [ ] Water beaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of a circulating system. [ ] Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 105 °F or chilled fluids below 55 V must be insulated to the levels in Table 2. • Y L Table l: Minimum Insulation Thickness jar Circulating Hot Water Pipes. Insulation Thickness in Inches by Pine Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to I" Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2. Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pine Sizes Piping System Types Range F 2" Runouts I"and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD(Building Department Use Only) BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: 12 /x/02 APPLICANT: �lUHkd �u OLZf1pF�t DATE SUBMITTED: IZ /�/02 SCTM#DISTRICT: 1_,000, SECTION: -2-6 , BLOCK: —2 , LOT: STREET ADDRESS: 16 0 I -INc S-c CITY: _ SUBDIVISION: PROJECT DESCRIPTION: P 1-y- ESTIMATED PROJECT COST:f CQ ACT/ENGINEER `s FAST TRACK? Uu SINGLE & SEPARATE CERTIFICATION-REQUIRED? ,./e NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30, 1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at anytime after 7/1/8; ZONING DISTRICT: R-BU CONFORMING? YES REQ. LOT SIZE: ACT. LOT SIZE: LU REQ. LOT COV. ACT. LOT COV. ✓ REQ. FRONT 66 PROP. FRONT r REQ SIDE ao�ACT. SIDE REQ. REAR PROP. REAR REQ. HEIGHT PROP. HEIGHT WATER FRONT? vss DESCRIPTION: j>o.,a PANEL #: _6'EFLOOD ZONE:, APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or(ED (BED #):_DTE:—/ /_ PERMIT#:RI O- TOWN SEPTIC RECEIPT: Y or& NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or SOUTHOLD TOWN TRUSTEES: YES or TOWN ZONING BOARD APPROVAL: YES or TOWN PLAN. BOARD APPROVAL: YES or TOWN HISTORICAL PRE (SPLIA): YES o NYS ENERGY::OR NO : -+L715vs l� EGRESS (18 H min.? 4 sq total) ✓VENT (SQ. FT. x 41/o)____.w/ LIGHT (SQ. FT. x 8%) BUILDING PERMITS OPEN/EXPIRED: BP -Z/C/0 Z- HAVE PRE CO'S : Y OR N BP -Z/C/o Z- NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: „?3t SF SECOND FLOOR: 696 SF OTHER: SF INIT OTHER TOTAL TOTAL: 9. SF FEE FEE FEE 1. ( 6_ SF)- ( $`JD SF)=�2�' SF X $ ,30=$ ash' +$--1,50 +$ = $ 1-3a-_'�o 2. ( SF)- ( SF)= SF X $—=$—+$—+$—=$ M-1802 BUILDING DEPT. INSPECTION [ ] FOUND A N IST [ ] ROUGH PLBG. [ ] FO ATION 2ND ( ] INSULATION [ RAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ��/,� � 2rr.� r DAT INSPECTO �C/ Y- : � 765_1802 BUILDING DEPT. I NSPECTIO [ ] FOUNDATION IST ( OUGH PLBG. [ ] F NDATION 2ND [ ] INSULATION FRAMING C,G<:f- [ ] FINAL [ ] FIREPLACE CHIMNEY R R)KS. / L DATE O 3 INSPECTO 4 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [6<--INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: �� ow, DATE lam' is a3 INSPECTOR U Dt � a � 765_1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIO [ ] FRAMING [ If L [ ] FIREPLACE & CHIMNEY REMA S: DATE j �� INSPECT FIELD INSPECTION REPORT DATE COMMENTS d FOUNDATION(1ST) t x C FOUNDATION(2ND) M M 141 a� ROUGH FRAMING& PLUMBING -C ig INSULATION PER N.Y. 3 STATE ENERGY CODE } C G� Q�it� fief FINAL 121 ADDITIONAL COMhIENTS O m J �y O tv x Q '7 0 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 3 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631)765-9502 2 D Survey www. northfork.net/Southold/ PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees Examined 1247 20 2 Contact: Approved h 7 , 20 Z Mail to: Tf*12✓gfrel Disapproved a/c fo. 60)( / Y3f 6g1r1J7-,1V 1 J190 Phone: ,34?,3 Expiration ,20_$_ Building Inspector APPLICATION FOR BUILDING PERMIT i ' 202 Date 120 INSTRUCTIONS j a.This application N+1{ 91 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 waterways. 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 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 what so ever until the Building Inspector issues a Certificate 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 property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months. Thereafter, a new permit shall be required. 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. el (Signature of airicAWr name,if a corporation) fO, 6�-4 /f3 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises J-01yAl 4 Jo YC,6 PFEL (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and tftle of corporate officer) Builders License No. M06Y C30 FC ffM iJN Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: Ap 20 /l/NG ST o RiFNT House Number Street Hamlet County Tax Map No. 1000 Section of Block a Lot !a Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constrdction: a. Existing use and occupancy cS/•✓6 L 1 /--/;,""14 V /fd b. Intended use and occupancy S11m/C 3. Nature of work(check which applicable): New Building Addition Alteration ✓ Repair Removal Demolition Other Work (Description) 4. Estimated Cost Fee 1 (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 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. i 7. Dimensions of existing structures, if any: Front &I 8 Rear 8.1 i8 Depth y3� Height i17 y Number of Stories e? Dimensions of same structure with alterations or additions: Front S'jj Rear Depth S/3^16 Height S'f -xiri Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories i 9. Size of lot: Front '130 , a G Rear 't 'L' Depth 7 Gc2,s 10. Date of PurchaseN,,,49-,3 Name of Former Owner- /-�90M? /9SrcJc19TfJ 11. Zone or use district in which premises are situated I3 " deo 12. Does proposed construction violate any zoning law, ordinance or regulation? YES—NO 13. Will lot be re-graded? YES_NO /Will excess fill be removed from premises? YES_NO / ft7 Address Phone No. 7 y 14. Names of Owner of premises16 lT, !"NatY UQ�/93 aPilo+T. rr 3�J 1 7 Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO !' * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY ✓✓BF REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO — • IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF ) (Name of individual signing contract)above named,being duly sworn, deposes and says that (s)he is the applicant (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly 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. Swom to before me s , //day o 2p �tG Notary Public Signature of Applicant ELIZABETH A STATHIS NOTARY PUBLIC,State of New York No.01 ST6008173,Suffolk Courtity Term Expires June 8,20 car 5.40'0 .��. y ' L\ . STATEMENT OF INTENT y` ry�N y THE WATER SUPPLY AND SEWAGE DISPOSAI f SYSTEMS FOR :THIS RESIDENCE WILT I 'jh3 �• ��-.' '.\ b CONFORM,IO "THE STANDARDS OF THI SUFFOLK CO,DfvPT. OF HEALTH SERVICES StlFFmfJC¢OL .�4PINCA t 0VpffM ewdWaft SUF4OLK .„COUNTY DEPT. OF HEALTI H,&Hol NnIl° SIERVI+C�E�S�"'-fOR APPROVAL FOI a141d wd1Yr ply/eCDlies CONBTRUG7!ON ONLY . a ,S- 8 109"bwe baht Nlepadad>Ind/or DATE 0 OWMdh'1�pSpmmlwdaolherapMCwS H:�s,,BE* No RIo-95-d1 f•v SE P1-\•'� -, \.-U,�.�_--�ao. � ��8¢ � a11d1odMb �DSg�k/I�+o�Y• .,� 1�ITROVED - - j �- .-t=om � (5�` O �r.^rs� a -3_.-� ....G - �T�� $• ' . G .c - c� A.Cae1s,P.E,Chlsf ,SUFFOLK CO TAX MAP DESIGNATION: j 0 o ^�� I 2 i :� r OIRo�otwaw and Wyelmvrdlr N'aR •OUST �'"`SECT. BLOCK PCL. GPG. ; 1 r' � O; ADDRESS: QQ��`yVt�'jt tF?.-a�._ � v WmERS O 54:¢t/EY6D Ftd¢ z � ' 10 ar2low 0 =. 2 / o easerrtarrt Or2lErlr : :061D L- P. DEP1. S ca"00" atj0`" I.. o. TOWN 9P $Oc1::YOCO, lv'.Y. � p ~'27to e •„ \� �� �9.Ot QO 1 /bond ' ,., cm`.anr�wir..o�serb I \ s \\\ bWbrGM o ym't Z. Sud lo,'k. Go. rax Parcell: tans» 2A .x.'..42.1 ' tr \ !`�. Q. � • - _ <: y •ihphG�ez4.lpahow;. •d �p tiZ-.` a 4tnerraea a'ucj. !4,1945 -trrloy tl, 1996 - ---_ .• a w .' ,,,'�. 9�4 IQL � mwm�onsi ruumime a.+wninw `'3 `t ` 6ugrantssA to , SEAL f �-ulrtOerJ re{sr to rOmo-rA,irvwap , C*icayo Tlt/t _ ltjdur.,V,YGB 60. Yrt:scr subdivi3 drr Mdh - Of •• � A90or rel-pact" � and' �b tke 'oandrs i as surveyed "of 21 ,t ` ROS ICK VAN LIlVL, .C. `.' ," . hp AGtF o = ,bide LICENSED LAND SURVEYORS �\ o GREENPORT NEW YORK PROVIdY4 HR, FIRE . PROVIDE OPENINGS FOR UNDEr<,Ynl 'CERTIFIAT * RATED SEPARATION TO EMERGENCY-ESCAPE AS REQU RED C PART.`717 3 (f) (1) OF € I _ REQUIRED BY PART. 714.OF I� Y. STATE SOLDING CODE. OM PANtY a N Y�STI+TE,BUILDiNG CODE., •- 'u WITHOUT GES FCA `. .•e..,. ':I`7R+Li �'—� I „ �'. e•^ .,. I Cir• ,,. h � C NCY i . 0 C , _ �.� AO R y AS NOTED , { u 1 = �' ry s I I J2 �` / IZ SSA. I (yskb Bv RTMENT �IT --� NOTIFYUILDI G D 795-180 9 AM TO 4 PM FOR TOE ` "` • : zc F_ _ FOLLO No INSPECTIONS: TWO REOUIREQ — f•. - 1. FOUDATIO URED.. N�P � FOR MBiN ` 3. IWS��TI LU �Y A FINkL. -.-CONSTRUCT 10N MUST —"l 7 SE dbMP.LESE.F R C.O. c� aca �. — . r:;; I2•Z fF �" vI sl NSTR.�ICTION $HALL MEIN .� n� Boatubingi ALL>'V �I i' 4 `If cop Or ,is u$.ed -�,�'-'�� .. :THE * J r � P • OUIR1r1N1ENTS OF THE 11.E ----- s .Ira h i 1.$'EN = _r- — - Sy sty r��E°'ping sTA isibutli g 1 S ODE1, NO RESPONSIBLE �` f:� or 1 erlyg ,' 011 LF DESI OR E I x- UNDERWRITERS CERTIFICAIE �- F REQUIRED F _ Q. a PC4l11,10ER' TIFIC157,10 / � : 1r "��' _ _. ,�5''LF ® CC1lfIEIIfTFORE , .,._—_ •� _. ' rf.:: _ Nc....:�' F "' r.. 1 rrJ -yam s . - .. .:i - _ 'RTlFl�ATE _'0CCUP,4 /CYC; it - - o I�PiY ;a YS 7E-JV4 CAIJ1�aT C of I°Yo%LEAD NOW .. .. ..t-•�' .� .. -� rci.I ,, ,1,1A'L.L. fi.�M/rt�. .. r. "�'I... Y` . . e Pk t R cn(i(?K PRNENTV4G1 tl THER.�M X14 I gfS Ft RAL CoC6 , - DEWCES AS TO PART. 902.6(K) `�hET 1C)L - j PROV(.DE $"80KE .DETECTI & . . N.Y STA L , j ALARM•DEVICES t 9' TE BUp DING CODE c AS t0 RkRi: 721 1 r PL 1 j '�� }f . UN B NG . N,Y;S BUILflI,NG GODF , AL{,PLUMB(NG WASTE L. &bVATER NES y D CIA STING SEFOPE COMERIN6 �gtEREO Iq�' - _ — ---- it -+' I 11 , I I I I I k N4 - I I 14H, 1 r? {III I �Jr.�l t � �~j I -- —. r--(Tf— T —_ _ � I r h.l 't.� a y' 'o ,.�. :-I. r t•J'j _i ' �^ MCNIMI after — ,_� - •-�a' his„rq.iL��L�tst-�/ i I !^� f - o717,17- -'O" - ,., ' l I t � - -- 1 - - k : �,. ;✓ ' Ste;' P�:�r;,.i c r '�. �� I I /a:" 4 _• 'I leo T E RIO Q:) - DRI(' ,I. C • a - CfIPtt &9ZCo A7 HL..L Z : ZD Lu C LU �I - - _ i N tV �gS qq k COl 59�f II I,.j DQyJ. M I cam I I NEW kits Proj ct No: WA--- Li — -- -- - Drawn I � — L a —- --- ' y 1!YF> I � heck By: ed T� i C - --- _ '1 Date: 4 ' I Scale: T�10c0 Fi.�11�+-a Gy,q`----a. Sheet Title: ` t Bul yJaLL_ ELEVATtQNg - — . .d,.j Shut Na � If Ii� �^ II�r^^ cc�ITRGTbR, ER To OUPrGYTI F4 S'I d M a ae FLa 8 H rN U P2oVFnN�Yc+.liMh7GY ds Z . �citEEtii MTL F-UEb _— iN I ti oN ---- - ------ D — — — - -- -- _ - i II .I i I ti x c asi ;I Project Ho: Drawn By: Lj -t--k Checked r r+vJ C Date: t - j i f RS _. T .Scale: t14n i�I�o r�icN Lr p , w NJW-5 "�_ Sheet Title: -! , �U4NOt _ ELEV` � - T� tS. -46 _ ACHEEfi BARN E TERl�R _MOWWAL FIt SH I � I` - — - — - -- ---- i.e t Q w11t2" P�Ywogd sheafhirtg w/bust ' F I - - board siding w/ 1/2x1 rough WWI paper (Tyvek), w/ 1x12 rough sawn gh sawn cedar battens at joints. 2 1fi"`� Q . w/ I wood sheathin wj#I1 3Q # building Sheet No: I T �. ,.. Ares as a tdof Shingles. g g Paper wf BiRD; Inc., /1+ ,, n I"-a" F 1? rt2 Trfrri w/gutter (see elev.). i1i ' - o FASCIA - 1x6 Prime Trim vW gutter (see ePev.�. RAKE - 1x6 Prime Trim. FRIEZE BOARD - 1x12 SOFFIT - 2" insect screen. 9 9 c4a'oo. WINDOW & DOOR CASING - 5144 Prime Trim at sides & top, wl drip cap & flast COLI-^;L T,s,ft5 GUTTERS - prefab aluminum gutters and downspouts - white. CORNER BOARDS - 5!4x4 Prime Trim. EXTERIOR DECKING - 5!4x6 clear cedar decking, with CCA structure. L.IINI[70W nILL- (FX-rt✓r.POP2)- vale c�P op OF r'L.r TE AT !. I1 ,IT ;I Ij ! I �1 f-FLAL9I.JI�IC� }il ', 2x10 olfo° ZZ_- 7-- P OF $UP3M-OC9 AT G�.RgGrQ• _ _` R. sip N,O. CP OF PLAT E. I\T 11 ♦�?' Qlro°O.G G�^1.1L AZT 3' __. - _ 2. I act .;I I�i>w wu I- — — ' — o�,�+elrr 5/.'�• ,.� --- r. _ —_ - PMMZ"T �NDULGa0.tJLR �'.4RACgE � � cgYP.aO. SNiJ"TTERS f 2-19 ft�'rT4. 01.16 L NOR !.J A I4t=r r•bc ✓� 'l __ r ��LL i oP of FnU+,IooTlc+,l A r W/ A L-L- P OF p�1ov,DC -- --- L3✓s ...-Lv Gc�, i.JI�rPO� ! �iASE%AEj- tM i I' ' I1.r171N ��GTI ©tJ