HomeMy WebLinkAbout26290-z 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. 26290 Z Date JANUARY 24 2000
Permission is hereby gran ed to: ► / /ry
BREN ICHANOWICZ
255 U NDIRVE
f3 CHOG £ NY 11935
for
CONSTRUCTION OF NEW TWO STORY SINGLE AMILY DWELLING WITH
COVERED PORC AND ATTACHED TWO CAR GARAGE S APPLIED FOR.
at prem ses located at 1570 INDIAN NECK LA PECONIC
County Tax Map No. 473889 Section 086 Block 00 4 Lot No. 006 .007
pursuant to application dated JANUARY 6, 2000 and a roved by the
Building Inspector.
Fee $ 919 . 80
"Authorized Signature
ORIGINAL
Rev. 2/19/98
o��gpFFOJ4-c
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JUDITH T. TERRY =� Gym Town Hall, 53095 Main Road
TOWN CLERKy '4 P.O. Box 1179
,i.
REGISTRAR OF VITAL STATISTICS O Southold, New York 11971
MARRIAGE OFFICERy 0� Fax(516) 765-1523
RECORDS MANAGEMENT OFFICER O,( �,`a Telephone (516) 765-1500
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3651-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BAGENSKI, CONRAD AND KATHRYN
------------------------------
Mailing Address 1 4 MEADOW STAR COURT
------------------------------
Mailing Address 2
------------------------------
City St Zip WOODLANDS TX 77381-0000
-------------------- -- ----------
Property Address 1 140 WAGON WHEEL LANE
------------------------------
Property Address 2
------------------------------
City St Zip CUTCHOCUE NY 11935-0000
-------------------- -- ----------
Owner Telephone No. 713-367-5358
Tax Map No. section 108.00 block 3 lot 9.002
Cross Street MAIN ROAD
------------------------------
--ff- ------------------------h=---
Issue Date: 6/26/97 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
FIEF) INSPECTION REPORT DATECOMMENTS
FOUNDATION 1ST)
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FOUNDATION (2N_D)
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INSULATION PER N. Y.
---------------
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STATE ENERGY it
CODE
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BOARD OF HEALTH . . . . . . . . . . . . . . .
FORM N0. I 3 SETS OF PLANS . . . . . . .
_�C3UI4aC,..... TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . .
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
TEL: 765-1802 NOTIFY:
U(Y'd
) P�/�1�� CALL . . . . . . . . . . . . . . . . . .
Examined..................., 2f0.... �/V G MAIL TO: . . . . . . . . . . . . . . . . . . . .
Approved.... "?CJ.......2000 Permit No ..... ..............
t��e2 cGQ
Disapproveda/c .................................. a �;>40 �.................................
(Building Inspector)
PLICATION FOR BUILDING PERMIT
Date. . 1.��. QIJ. . . . . , 20. . . .
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector vii
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 application.
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
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 BEb2EBY MAIL 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, bidinmx:es, building code, housing code, and
regulations, and to admit arthorized inspectors on premises and in building for neves in pections.
...� •... ........................
((Signature of./a icant�,, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plusher or builder
........... .......f/. .........,...j................................-......................................................
Nam of owner of premises / cl�C�{�` ¢.../,�tjTOGkI
..... . ........ ..............................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.........................................................
(Name and title of corporate officer)
BuildersLicense No. .........................
Plumbers License No. .........2.4 Z/..e..
Electricians License No. .......
Other Trade's License No. ....................
/Un9/A iYltl�� A/tlf.
1. Incation of land on which proposed work will be done.........�......tU.... .........................
Gov G
....... .......................................................................................................
House Number Street Hamlet
pp.// ��99,
County Tax Map No. 1000 Section .....O.tO....... Block .....&X.p..... Lot ..... {. ......
A)l c o/glis 3 / �/
Subdivision Filed Map No. ..6.. 3........ Int ....1..........
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 4/!¢...... � C/
......
°°ro'i 1.
5
� F/C,....t�. `Y / L
/ fitlC L
b. Intended use and occupancy ......... .. ? ...
. , . _
4 ti
3. KiLure of work (check which applicable): New Ifuilding ....Addition .......... Altera
Repair ............ Reamal . i......... Demolition ............ Other Work ..............Wf....: ... .:......
(Description)
4. Estimated Cost .......3Sb pOH.... fee ............................. ...............
(to be paid on filing this application)
5. If dwelling, rnniber of dwelling�units .....I...... Nnnber of dwelling units on each floor
................
Ifgarage, nnnber of cars ..,.. .......d......................
6. If, business, commercial or mixed occupancy, specify nature and extent of each type of use......................
7. Dimensions of existing structures, if any: Front................ Rear ............... Depth ..................
lleight ......................... Naber of Stories ......................
Dimensions of sane structure w4h alterations or additions: Front ............... Rear ...............
Depth .................... Ileight .................... Number of Stories ...............
8. Dimensions of entire new construction: Front ................ Rear ............... Depth ..............
Height ........................'i Naber of Stories ...Q..................
9. Size of lot: Front ....�Q.�........ Rear ...�ia.V........... Depth ...�.�p..........
10. Date of Purchase .............. ...... None of Former (loner ........................................
II. Zone or use district in which premises, are situated ..............................................................
12. Does proposed construction viol>!ate any zoning law, ordinance or regulation: .......TU(?............
14. Will
lot be Owneregraded
oaf premises ry,I ....•...' Will excess fill be removed from premises: YES
premi �..,.......F/(......... Address .............................. Phone No. .7...........
Name of Architect .............L...................... Address .............................. Phone No.
p ..............
Name . /r&MP191.............. Addre.4*414..T%Q,(.e6' at Phone No. 7aa-57W
I5 .is this grape ry within 300 feet of a tidal wetland? * YES .......... I10 ..........
*IF YES, SODTO(Hm TONN 'I w§Img Pmtrlrr MAY BE REQUIRED.
PLOT DIAGRAM
Iocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bwi dinepsions
from property lines. Give street andlblock amber or description according to deed, and show street rimes and indicate
whether interior or corner lot.
SUMS OF NW Y(A2K,
avatY or ..... sW o—K........ ss
(Nast of inlivi A(� gnimg caniract)•....................being duly sworn, deposes aril says that he is the applicant
above named, / /
fieis Lhe .........t.Vm?L C/fI.-e......,.......................................................................
(Contractor, agent, corporate officer, etc.)
of. said owner or owners, and is duly authorized to perform or have perforned the said work and to joke 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 perfoned in the manner set forth in the application filed therewith.
Sworn Lo �Cbef�ooj�e me this n
C..
L� 20 O,
Notary Public
' I (Si lvr�.• cant)
GERALYN NiM I CSC 2
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taryPubkc, E_.,, ofNewVork
No.4760631 Suffolk Cop ��'2:!r
Term Expires May 31 2:!r C) 1
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IN
MERGEW�AS OCCUPANCY O��R6p
�� REDUIRED SD USE IS UNLAWFUL
D�MR N.Y. STATE EfJMCODE WITHOUT CMiU-1CATE (�
OF OCCUPANCY y�
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EED0/1100f!liUM APPROVED AS NOTED IatMA
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TlENMKNR NO I QBUI DINGDEPARTMeNTA �b�P� s� s O
EEAMM I 765.1662 9 AM TO 6 PM FOR THE �+
ELL FOLLOWING INSPECnONS:
IMMM MIM DAft 1L FOR FOUNDATION
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E ROUGH - FRAMING A PLUMBIINI SPtsopFr 09 -.
S INSULATION y
Fl oopporlhIBMEB1F16N l FINAL • CO.MSTRUCTWM MUBT
` for water distdbu6ng BE COMPLRTE FOR C.O. w
S System;piping shall b6 ALL CONSfGi CT10N SHALL MEET
S of Types K or L only - RATED THE REQUIREMENTS OF THE N.Y. 41, 6525, 2
;i PART STATE CQNSI$UCTION A ENERGY O
CODES. NOT RESPONSIBLE FOR Op9pFE5St0NP�
tC SUTE DESIGN OA GONBTRUOTION ERRORB O N
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N0-74- VERIFY 1 r r usnyc ¢ p
NEW YORK STATE ENERGY
CONSERVATION CONSTRUCTION CODE
per; _North Fork Management
Building Address: Dated:_12-7-99�
Design Criteria: Non Electric Heat
6,000 Degree Days
O.A. 10 Degrees F
I.A. 70 Degrees F
One or two family dwelling
SUBSYSTEM AREA DESIGN THERMAL REMARKS
SS. "U" RATING
Exterior Walls
2304 .05 264 R- 19 Insulation
Glazing
350 .33 -53 Andersen HP or Equal
Doors
100 .40 -23 U 40 Rated Doors
1300 .05 0 R- 19 Insulation
Ceiling(flat)
R-
Insulation
Ceiling (Cathedral)
.33 Andersen HP or Equal
Skylights
FR- 19 Insulation
Floor 1300 .OS 0
R_ Insulation
Foundation Walls R-
Insulation
Slab Insulation
Total: _+188_
NOTES:
Building Envelope System to meet requirements of 7815.2 �0p NEW y
I-IVAC Equipment to meet requirements of 7815 11 y aptSOHF�,p9
HVAC Systems to meet requirements of 7815.12
r r
Duct Systems to meet requirements of 7815.13
mVentilation Systems to meet requirements of 7815.14 wa
Insulation on piping systems to meet requirements of 8715.15 2
Domestic water systems &Equipment to meet requirements of 78 21 No, 05y5,° �2
Electrical & Lighting Systems to meet requirements of 781531 OpR�FESSt�NPy
To the best of my knowledge, and belief
&professional judgement,these plans are in Signed
compliancecompliance with the code.