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Home My WebLink About26472-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27063 Date: 05/04/00 THIS CERTIFIES that the building HEATING SYSTEM Location of Property: 9955 SOUNDVIEW AVE SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 59 Block 2 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 7, 1999 pursuant to which Building Permit No. 26472-Z dated APRIL 26, 2000 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 INSTALLATION OF HEATING SYSTEM TO CONVERT SEASONAL DWELLING TO YEAR ROUND ONE FAMILY DWELLING AS APPLIED FOR "AS BUILT" The certificate is issued to RICHARD & MIRIAM KLEIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N-474830 12/21/98 PLUMBERS CERTIFICATION DATED 11/12/99 BURTS RELIABLE ..tG . A horized Signature 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. 26472 Z Date APRIL 26 , 2000 Permission is hereby granted to: RICHARD & MIRIAM KLEIN 9955 SOUND VIEW AVE. SOUTHOLD,NY 11971 for INSTALLATION OF HEATING SYSTEM TO CONVERT SEASONAL DWELLING TO YEAR ROUND SINGLE FAMILY DWELLING AS APPLIED FOR "AS BUILT" at premises located at 9955 SOUNDVIEW AVE SOUTHOLD County Tax Map No. 473889 Section 059 Block 0002 Lot No. 005 pursuant to application dated DECEMBER 7 , 1999 and approved by the Building Inspector. Fee $ 75 . 00 Authorizdq_5,1gnature ORIGINAL Rev. 2/19/98 pnim N,•. ( V MAY TOWN a� TOWN Or SOUTHOLD `'bx BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OF. 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-dishos:il (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. B. 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. C. 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 Buildin¢ - $100.00 3. Copy of Certificate of Occupancy - .25V 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . . . . . . . ./�. . . . . . . . . . . . . . . . . . . New Construction. . . . . . 1�Qr Pre-existing Building. 77 Location of Property. .! !. . . . . . . . UC9.LaU/f_u�. .hU(°. . . ,�j,O�tYVj_.Q. . . . . . . . . . . . . . . . . . . . . '. . House No. Street Hamlet Onwer or Owners of Property. �.V` � . , ! .�.�? 4 ��.�. V. . . . . . . . . . . . . . . . . . gag County Tax Map No 1000, Section. . 0 . . .Block. . . . . . . . . . . . .Lot . . . . . . . . . . . . . . . . . Subdivision. . . .��. . . . . . . . . . . . . . . . . . . . . . . . . .``��.qq�.��. . . Fi e Map. . . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . Permit Nob 1.W 77�.' Date Of Permit. .:! . -111 64 .Applicant. . . . . . . . . . . . . . . . . . . . . . . . . . . HealthDept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . � . . . . . Fee Submitted: $. . . . �. . APPLICANT ccs a �o63 g-aFFO(kcoGz Town Hall,53095 Main Road y Z Fax (516)765-1823 P. O. Box 1179 ' Telephone (516)765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE:Nov. 12, 1999 Building Permit No. 26472_7 Owner: RICHARD & MIRIAM KLEIN (please print) Plumber: BURTS RELIABLE (please print) I certify that the solder used in the wate supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this ' / ',;L- day o , tn-0'""�`� 19 g p Notary Public, County JOYCS M.WILKINS Notary Public,State of New York No.4962248,Suffolk County Term Expires June 12, Zoo 7 NEW YORK STATE ENERGY CONSERVATION CONSTRUCTION CODE Building Address: II Per: �3fx'r�l q95-s- SOvnCl/ 7 Dated: 2/ cd Design Criteria: Non Electric Heat 6,000 Degree Days I 5 O.A. 10 Degrees F "` ' I.A. 70 Degrees F One or two family dwelling ^ SUBSYSTEM AREA DESIGN THERMAL REMARKS s.f. "U" RATING Exterior Walls 99' Z 4 t S9 R- // Insulation Glazing 2 O 7 .33 fi Z 9 Andersen HP or Equal Doors 4 Z .40 4 3 U 40 Rated Doors Ceiling(flat) 8 97 / DS 3 Z{ R- 1 q Insulation Ceiling(Cathedral) R- Insulation Skylights .33 Andersen HP or Equal Floor 897 ,OS.3 — 4 R- q Insulation Foundation Walls R- Insulation Slab Insulation R- Insulation Total: 8 3 NOTES: Building Envelope System to meet requirements of 7815.2 HVAC Equipment to meet requirements of 7815.11 SOF NErryY HVAC Systems to meet requirements of 7815.12 �Q� �FtSCyO Duct Systems to meet requirements of 7815.13 Gj Q Ventilation Systems to meet requirements of 7815.14 * o Y� • Insulation on piping systems to meet requirements of 8715.15 Domestic water systems & Equipment to meet requirements of 7 .2Z Electrical & Lighting Systems to meet requirements of 7815.31 CoA N° 052b�� v To the best of my]mowledge, and belief & professional judgement, these plans are in Signed compliance with the code. Date 21 NEW YORK STATE ENERGY CONSERVATION CONSTRUCTION CODE Building Address: cy I Per: t443 9 j J`�J� rJDUnGuu�? Dated: Design Criteria: Non Electric Heat 6,000 Degree Days „n,; 2'5 L��1 O.A. 10 Degrees F I.A. 70 Degrees F One or two family dwelling SUBSYSTEM AREA DESIGN THERMAL REMARKS s.L °°U" RATING Exterior Walls Cid/ Z. . 9 1- 59 R- // Insulation Glazing 20 7 .33 * Z 9 Andersen HP or Equal Doors 4 Z .40 4 3 U 40 Rated Doors Ceiling(flat) 8 17 0 053 -- 4 R- 19 Insulation Ceiling(Cathedral) R- Insulation Skylights 33 Andersen HP or Equal Floor 8g� .OS�3 — 4 R- 1 q Insulation Foundation Walls R- Insulation Slab Insulation R- Insulation Total: 7t 83 NOTES: Building Envelope System to meet requirements of 7815.2 HVAC Equipment to meet requirements of 7815.11 OF NEyi HVAC Systems to meet requirements of 7815.12 �P �FIgCE,y0 Duct Systems to meet requirements of 7815.13 g Ventilation Systems to meet requirements of 7815.14 Insulation on piping systems to meet requirements of 8715.15 C Domestic water systems &Equipment to meet requirements of 7 .2Zv, Electrical & Lighting Systems to meet requirements of 7815.31 A '10. 0502. RIFE SIO�� To the best of my knowledge, and belief &professional judgement, these plans are in Signed compliance with the code. Date 2f THE NEIN YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1195099 BUREAU OF ELECTRICITY F 40 FULTON STREET, NEW YORK, NY 10030 Date DECEMBER 21 ,1998 Application No. on file 17369698/98 N 474830 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of RICHAD KLEIN, 9955 SOUNDVIEW AVENUE, SOUTHOLD, NY in the following location; ❑ Basement ® 1st FL ❑ 2nd Fl,i OUT Section Block Loi t DECEMBER 07,1998 and was examined on foundto be in compliance with the National Electrical Code. r FIXTURE RECEPTACLES SWITCHES FIXTURES (RANGES 7.kmPs, OVENS DISH WASHERS EXHAUST FANS r. OUTLETS INCANDESCEN FLUORESCENT OTHER AN. K.W. . K.W. AMT. K.W. 4 4 5 4 ALF DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SFCIAL REC'PT. UNIT HEATERS M LTI-OUTLET DIMMERS E AMT. K.W. OIL H.P. GAS HIP, AMT, NO. A,W.G. MT. AMP. AMT. H,P. MS NS TE FEET AMT. WA778 1 F SERVICE DISCONNECT NO.OF S E R V I C E P METER NO.Of CC CCD. A.W.O. A,W.O, A. AMT. AMP. TYPE EQUIP. 1 0 26V 1 0 SW S 6 SW J 6 IW 01PIR OF ND. NO,OF xldFO F NO.OF NEUTRAL! F UL L 1 100 CB 1 X 1 4 1 4 OTHER APPARATUS: I` PADDLE FANS-F-5 G,F,C.It-1 JIM SAGE ELEC. INC. LIC.#385- L PO BOX 38 GREENPORT, NY, 11944-0038 GENERAL MANAGER 11 Per Thts certificate mutt not be altered in any manner,return to the office of theard If Incorrect.Inspectors may be identified by their credentials. Shannon Barry 698-2114 298-5451 NORTH FORK •DRYWALL P.O. BOX 1230 •INSULATION MATTITUCK, N.Y. 11952 •PAINTING •STEEL STUDS Fax:516-298-1897 •ACCOUSTICAL CEILINGS 19 77 M Alf Ate j 2/w-C cow w cwt 2 WAYNES%1NSUiG'�iMY 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ SULATION [ ] FRAMING [ ]] 1FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE _ / INSPECTOR PEERLESS Series WBV/WV ❑ Residential Oil • Packaged or Knockdown ❑ Natural Draft Venting ❑ Flame Retention Burner CAST IRON BOILERS ❑ Steam or Hot Water Boilers ❑ Optional Tankless Coils ❑ Rear or Top Flue - rr Convertibility ❑ This compact, low-profile residential oil boiler is economically priced with AFUE ranges from 81.9%to 86.1%, significantly exceeding the federal energy standards for residential boiler efficiency. ❑ The 3-and 4-section boilers can be converted from back to top venting for ease of installation. ❑ Top clean out is provided for annual maintenance and cleaning to insure the Series WBV-Water U .! highest operating efficiencies. ❑ The large water content of these boilers 0 reduces on/off cycles thus providing more • consistent and efficient home heating comfort. I ❑ Optional high output tankless domestic hot water coils are also available on most models, insuring ample domestic hot water M production. t� ❑ The entire burner mounting plate operates as a swing out door providing easy access to the combustion chamber thus making boiler cleaning quick and easy. ❑ Circulator can be converted from return to Series WOV-Steam supply. L � • i i � ► DOE Heating Seasonal Efficiency Water Content Boiler Burner Input Capacity Net 1=B=R Ratings (AFUE) (Gal.) Min. Model Steam Steam Water Draft Req. Number GPH MBH Water Steam Sq.Ft. MBH MBH Water Steam Water Steam _Stack W.C. WBV-03 0.60+ 84 74 N/A N/A N/A 64 86.1 N/A 11.75 N/A -.03 WBV-03 0.85 119 102 101 317 76 89 83.8 83.1 11.75 _12.00 -.04 WBV-03 1.10 154 129 129 404 97 112 81.9 82.0 11.75 12.00 I_ -.05 WBV-04 0.95+ 133 116 WA N/A N/A 101 86.1 N/A 14.75 NIA -.03 WBV-04 1.25 175 150 149 467 112 130 83.9 83.0 14.75 14.87 -.04 WBV-04 1.50 210 178 177 554_ 133 155 82.8 82.2 14.75 14.87 1 -.05 • WV-05• 1.75 245 209 1 N/A I N/AN/A 182 84.0 N/A 1 17.75 1 N/A -.05 WV-05 a 2.00 280 237 NIA N/A NIA1 206 1 83.1 j N/A 1 17.75 N/A 1 -.06 +Noules for these firing rates not provided as standard equipment.Consult factory for price and awdlabtiity. aTopvamingonly. ith Burner firing rate is based on a fuel oil wa heating value of 140,000 BTU per gallon.Burner input based on maximum altitudes of 2,000 P.-far other aftilWes wnsutt factory, Nesting capacity based on D.O.E.Testing procedure with 13.0%COs and-.OT water column draft in firebox. The Net 1=8=R Ratings shown include allowance for normal piping and pick-up load.Water ratings are owed on an allowance of 1,15.Steam ratings are based on an allowance of 1.33. SERIES WBV/WV BOILER SPECS e • • • • Top Flue Outlet Rear Flue Outlet Cast Iron Section •Cast Iron Sections—Factory Tested Steam --� .-__� / and Assembled with Steel Push Nipples • 15 PSI Pressure — _,•, •- •Deluxe Insulated Enameled Steel Jacket Relief Valve --ix'•.-rr •Drain Cock •Gauge Glass •Target Wall •Probe LWCOf/'•" •Top Cleanout (SP&SPT ; {C:iltiti:`v. • Built-In Air Elimination Baffle Models) •Swing Out Door •Pressure Gauge (Packaged Boilers) •Pressuretrol •Rear Flue or Top Flue (SU,SP&SPT Convertible(WBV-03-04, package only) Models) `kF (WV-05-Top Flue Outlet ONLY) Water • • • •30 PSI Pressure Relief Valve • NOTE:WBVAW-WPC boiler designations do not allow for a tankless coil opening which •Aquastat(WU Models) • Draft Regulator makes it ideal for cold start applications and applications using an indirect water heater, •Theraltimeter •Two-Stage Pump WPC Models include Circulator and Aquastat Relay •Circulator(WPCNJPCT Models) "Tankless Water Heater WPCO Models include Circulator Less Tankless Cal •Aquastat Relay or Triple Aquastat .Swing Out Door WPCT Models include Circulator,Triple Aquastat Relay and Tankless Water Relay(WPC/WPCT Models) (KD Models Only) Heater wIRm Control valve . . , "Insillim 1,TION GUIDE THE PEERLESS WARRANTY SUMMARY* Example: s=steam Knockdown This warranty covers: WBV - 03 - WPCT SP=steam Package -the entire boiler, one year from date of installation. SU=steam w/Burner -cast iron sections,lifetime for water; 10 yrs for steam. T T T— SPT=Steam Package w/Burner&Tankless specseries sects. w=water Less Sumer Coil Optional 5 and 10 year extended warranties are also WSVorWV WU=Water w/Burner available. WBV oWPC=Water Package w/Burner&Circulator WPCT=Water Package w,lBurner,Circulator&Tankless Coil -Before purchase contact your installing contractor for WPCO=Water Package w/Burner and Circulator Less Tankless Coil complete warranty Information. Jacket Rear Flue Outlet Top Flue Outlet _ Burner Depth Right of Right of Rear of Jacket to Boller Firing "B" Top to Jacket to Floor to Jacket to cA of Flue "E" Flue Model Rate WidthFloor cA of Flue cA of Flue cA of Flue Size Chimney Number GPH "A" Water Steam "C" "D" "E" "D" Water Steam "F' Size WBV-03 0.60/0.85/1.10 2211" 1411" 150/4" 35" 7" 2971" 85/16" 7Vie• 871" 6" B"X 84 x 15' WBV-04 0.95/1.25/1.50 2211" 181/6" lave 35" 7" 297/8" 85/18" 91/16" 107/8• 6' 8'x 8"X 15' WV-05 1.75/2,00 2211• 2211" - 35" - - 85/18" 111/16" - 7' 8"x 8'x 15' "AR noF OP7 ,a I.IFN . WBV Vqy� ING� , EL FFyA � \Ll T 2'S.F4L ' A YY Steam L I-, /I r' ,NI �� Boiler j21 GEE 1, l, 0E- 2. » - ` 2r' �Q A �r '.aR. zZRF,"FN L J FR ORµ'JA iN TAPPo^X =-oP,.o"A o'o—oi�a L P 1 ,�PPo —i�z� rnrx �yR .??€�RN�T�Y— L_.e.� s9s _P LEF, ,SDE -- FnCNT WBV/WV— Water Boiler @CAUTION: Pipe, .di.cinwgeofreliorva .topmentinjury inlite event ofpressurereliel. THE PEERLESS HEATER CO. Suggeet disonwee to be piped to dmn.Pipe fill mm or outIa Spring&Schaeffer Streets Boyertown,PA 19512 CARTON DIMENSIONS AND SHIPPING WEIGHTS Phone:610-367-2153•FAX:610-369.3284 Length Width Height Approz.Shipping Weight Qbs.) A PEERLESS INDUSTRIES COMPANY WPC_ WPC- Knockdown Package Boller WPCT, WPCT, Model WPC- SP- SP- SR Number WPCT SPT SPT SPT W WU S SU WPC*:757'0 member WBV-03 35" 40" 2811" 40'1" 470 485 535 550 560Cstings CeBoetl by F?FCO,Inc. WBV-04 43" 40' 28'1" 40'1" 590 605 650 665 665Boyenavn,PA 19512 wvA5 43" — 2811" 401" 710 725 — — 770Form No.WBV-R-e(1 QW) 40�SERIES OIL IRE1 illia ll e RIELLO 40 SERIES OILFIRED BURNER PAELLO f EXTRAORDINARY BURNER PERFORMANCE " Put Riello 40"up front"to power your heating system. Each Riello 40 oil burner ^ r^ is a completely integrated package.All components are designed to work together for BURNERS I IK�C KC reliable,fuel-efficient heating with low maintenance requirements. Every burner is V V FYI V p' thoroughly tested to verify the highest level of quality and performance. Available ADVANCED BURNER TECHNOLOGY ""` in five models,the Riello 40 burner can accommodate heat outputs ranging from 70,000 to 896,000 Btus per hour.These features maintain Riello's leadership in high -- Now technology oil heating and ensure years of reliable service. Nlg15f�1�rrIG11L1�� HIGH-PERFORMANCE FEATURES -High efficiency,for fuel savings -Safe,dependable performance -Extremely quiet operation -Worry-free heating _ =: •Safety solenoid valve -Reliable, low maintenance requirements -Low energy consumption -Smoke free starts and positive shutoff F 3PJEL AUTOMATIC AIR SHUTTER ACOUSTIC INSULATION ELECTRONIC CONTROL BOX up IBURN Our heat-saving air shutter automati All Riello 40 series burners include a The Riello all-in-one control box tally closes the air intake when the heavy gauge metal cover with sound combines interrupted ignition, a ADVANCED BU: burner is not operating.This unique attenuating acoustic insulation for 5-second safety shutoff and a MCHNOLOG feature virtually eliminates heat loss quiet operation. 10-second prepurge cycle through the burner and enhances controlling the solenoid valve. burner efficiency. Model F3 F5 1 F15 F20 h m Firing Rate-gph 0,50 to 0.95 to 2.95 2.55 to 5.75 3.50 to 6.40 Output-Btu/h x 1,000 70 to 133 203 to 413 357 to 805 490 to 896 Output-kW/h x 1,000 20 to 39 30 to 62 59 to 121 104 to 236 143 to 263 a Usable Heating Oil #2 #2 #2 #2 #2 Power Supply 120v 6OHz 120v 6OHz 120v 6OHz 120v 6OHz 120v 6OHz _ Motor Load(Raledl 1.6 A 1.7 A 2.2 A 4.0 A 4.3 A Mstar rpm(Rated) 3250 3250 3250 3250 3250 _- "' Pump Pressure-Max. 200 psi 200 psi 200 psi 200 psi 200 psi h Power Consumption 155 W 175 W 230 W 450 W 465 W A inch 8'5/32 9"/64 105/'6 110/4 11'/4 Him 215 233 262 298 298 - B inch 91/53 1011A6 12 1325/, 13 /62 mm 252 272 305 350 15n z C Inch 615/32 72/32 81/32 91/'6 91/u _ mm 164 180 204 230 230 rn D inch 35A 35fs 3151's 411fIs 41Rs mm 92 92 100 119 119 f E inch 6 6 5 5 5 ' — mm 152 152 127 127 127 F inch 8 29112 91'/32 10'116 1121/x2 112'/62 mm 226 239 265 301 301 - ...OTHER HIGH-PERFORMANCE FEATURES •User-friendly -High static pressure -Burner cover with acoustic insulation -Easy to install and service •Interrupted ignition -Motor with automatic thermal overload reset -Factory pre-wired -Automatic air shutter -Precise combustion adjustment •Pump with integrated solenoid valve •Integrated electronic control box •10-second prepurge,5 second safety shutoff RIELLO 40 SERVICE KIT ` 1en, VAVAILABLE ON REQUESTThe Riello 40 SeriesA Service Kit comes c1 complete with all _ service parts Specify tube length when ordering burner, needed during E1:10-inch long(254mm)tubes are available for each model,on request, a no heat situation. All burners in the above range are C.S.A.Approved and U.L.Listed. a r CALL THE RIELLO HOTLINE COMBUSTION CHAMBER 1-800.4-RIELLO.1-800-474.3556 - - - int OPERATING PRESSURE RANGE Monday through Friday•8:00 a.m.to 5:00 p.m.•Eastern time 1, RIELLO CORPORATION OF AMERICA RIELLO CANADA INC. 35 Pond Park Rd. 2165 Meadowpine Boulevard c a F2 Hingham,MA 02043 Mississauga,Ontario LSN 6H6 �EEI Phone:(791)749-8292•(800)992.7637 Phone:(905)542-0303•(800)3873698 � 10 �Bt1RNE Fin Fax;(781)740-2069 Fax:(905)542-1525 3 o s up front/ 0 3; 0 m a5 RIELLONJ ce ADVANCED BURI ca FLS TECHNOLOGI a=F3 5 Fin 5 1 15 2 25 6 x5 . 16 E 55 a 65 BURNER(' FIRING RATE(USgph) ADVANCED BURNER TECHNOLOGY BOARD OF HEALTH . .. . . . . . . . . . . . FORM NO. 1 /3 SETS OF PLANS . . . . . . . . . . . . . . TOWN OF souniow SURVEY . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CNECIG�.%X l . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TET.: 765-1802 NOTIFY: CALL . . . . . . . . . . . . . . . . . . -W... � MAIL T0: . . . . . . . . . . . . . . . . . Aliproved...x� 5..1�Q.., ... Permit No. W.1./.�.:G... ............................... Disapproveda/c .................... ............................... ........................................ .. .......... J' r. 2't ( f', V,7 ,, (Building Ills 6 r) _ y �� i l 1 APPLICATION FOR BUTI,DTNC PRRmT'P i .. ._,, INSTRUCTIONS n. Ild s application most 6e.na_ letely filled in by Lypewriter or in ink nix) submitted to the Building Tospeclr 3 seta of plans, accurate plot plan to scale. Fee according to schedule. b. Piot plan showing location of lot and of buildings on premises, relntionship to adjoining premises or pu8nlir streets or areas, and giving a detailed description of layout of: property mist be drawn on the dingran which in part this application. c. Ibe work covered by this application my riot be, commenced before issuance of Building Permit. it. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. B permit shall be kept on the premises available for inspection througinant the work. e. tWb uilding shall be occupied or used in whole or in part for any purpose wiatever until a Certificate of Occupancy Shall have been granted by tine I*rilding Inspector. APPLICNria4 IS IEREBY MWE to the Building Department for Lite issuance of a Building Permit pursrnnt to 'the Building Tone Ordinance of the Taim of Southold, Suffolk County, New York, and other applicable laws, Ordinances or Regulations, for Che construction of buildings, additions or alterations, or forn.-eso a] or memo ttion, as herein described. The applicant agrees to comply with all applicable laws, ordinances, it c housing code, ml regulations,mnd to admit suthorited inspectors on premises and in building fo san i tions. �� (Si ture tic r name, If•a. ..po.stio .996.,, c (Mailing address of applic, State wliether a cant is owneir essee, agent, architect, engineer,'general contractor, electrician, plul)er or bu {trtlec &v t-aR2 ivur,16Py ......................... ......................... ................................................................ Name of owner of premises ... .e//in1 CL./.tf .............io6 vk.1 ?�3[tS1Y{fi.. ...... (as on Lbe tax roll or latest deed) t�'11S1193A If applicant is a *Milo am IN dhdully�auLborized officer. ............ � MII.IYIIwItMT!'."!!r!........ (Name and tIFAil�11 1� ITpI N tf� & OT IRA i ljOtlf.11)T Builder t PlumbersLicense ElectriLran48 ��!. �IWra i1GltJW2iit 0... Other 1at� I. locatio� MIwiil be done........................................................... i.iR JJ4 t� . [louse ;' W� '-t!a..!:':�e-.C....�u.�C(�.....l' " 4ffiIRO l4 To" HamiVO cantyINTiN Block .... ......... int .... ...... Subdivision ...................................... Filed Map No. ......... ..... int ............... (Name) 2. Stale existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .y�'f'�L' ................. .......................................................... /�w� � Cl se ad occupancy ...... �.. Y ...... ..�...b. Intended u . . G r 7� .:1............................ ,16%.bitty v% x'4. 3 d IAT I. Nature of wick Week LAlidl applicable); tau Iktilding .......... AdWition .......... Alteration .......... Ite;a1r ............ Pemoval ............. Demlition ............ Other Wrk .................................. (D //��//33// l escription) 4. eatiulated Cost .��:4'Y.................. fee ..............-..•..-..---.- ............... 1 (to be paid on filing this application) 5. if rkaellh/g, 1xsAler of duelling emits ............ Rider of dkelling twits on each floor ................ Itgarage, otnher of cars ...................................... G. If business, eomiercial or mbxed`occupancy, specify nature stud extent of eadl type of use...................... 7. Ditoerainls of existing strucLti res, if ally: From................ Rear ............... Depth ................. 11eiglut ......................... Mziler of Stories ...................... Dimensions of aline structure with alterations or adklitions: Front ............... Rear ............... lleptll .................... !eight .................... Nadler of Stories ............... g. Dimensions of entire new construction: Croup ................ Rear ....... ........ Depth .............. Ileigllt ......................... Umber of Stories ..................... 'J. Site of lot: FrCAIL .................... Rear .................... Depth ................... Ill. Dale of Purdllase ..................... Have of Former Owner ........................................ II. Zone or use district in whidl premises are situated .............................................................. 12. Does proposed rixatructionvv�I/q�late any zoning eau, ordinance or regulation: ......lLt il............. 1:3. Will lot be regrcded .....P'. .......... will elweas fill be r iuxv Gfl1tsMT«1 'r��,�, ND YAC.(!/IIF[36 14. Nanes of Omer of premises ........................... lxkireas LT 01V-L.E`,AD-C'GM-f Er'i+-T-"r�r°la filo; ....... .... Name of Architect °rI e!i- �+/y` ,`,. r .: V .................................... Ackireap,�;�ET3Y'F�'Tcl x.�-�,IC.�....._ Musa-No; ......... .. Nape of Contractor ......................... ........ Mlreas ,� ¢•,,-'- , " 'Nlone No. ........... 15. Is (itis property within 300 feet,of a tidal wetland? * YES .... *IF YES, SODntllill, lull 7FOSf1'dms l'4RMIT MAY Be Ret)111RSDElc. e�/Cr� LiFL� MOT DIAGRAM locate clearly and distinctly all buildings, rdled er existing or proposed, and indicate all set-back dimensions frnn property (has. Give street aid block nudger or description according to deed, and allow street nares and inlicat'e ldlle(Iter interior or corner lot. � VCLDS"—a : inl9vd!a �icN fC't !1%dv+' it- tk'Ox.� ,llOr # ,ce'i4e Ili Lie cec�erra� J� � �reaR1fer Call ��rfh 1+= /f�� }�Ludry 13 eeee GC'A4) /�cc 0e'e- CC,,J/, 3rf7k TOkl CC-'�i S C S D Al deal Av✓,d&e ...Fl9`� f, lro,tl 6y MDER"I)V?S CER14cicATE REQUIRED an SI'A'IE (A' N•ll YlN2K./ �� I SrJ /y t6i-110! i AN T4 4 PM FOR <XJIIN IY 010 ......}.......... ..... / POLLMM },�/ u�Jj ,1••/ �� Y..R'ld.`:...."....��{yJ/ /.'Uf...................11eily; duly i �QK til' he is the a1lpl.io:rult (N•rr of itzlividual. signing contract) a, nlxrve olited, $ IIdBIH.ATIOK 4 FINAL • COttlllRtwiCwYlOKutR lie is .... the ........................ . .................................AE(DQE lTffQalfetee (Canriractor, agent,-corporate officer, etc.) ALL OONSTRuMak of said nutu.r or wtiers, mini is duly authorized Co ixxrfons or have iuerf IA /II�R61'/file this applicatidat; that all staLetnents uxltained in Chia application are Ln t� All,a'^`a`lief; still that the milk will lux perfonned in the manner set forth in lite appl.ica' SMlro to before ere this ... ....i2;!.t':.....clay of .. ... ...... ,. i .�.f.... / Notary Public ... ... . .. ... .............. - ......u. .... 1 ........... (Si vu:ure of t,li ant) ROBERT 1.S T.JR. Notary Public,Sta of New York Cluelitied in Suffolk County No.Ot SC472508�ma?n Term Expires May 31, BUILDING PERMIT REVIEW CHECK LIST Appli `cant/ pp (� /` Date Owners Name: i C.t1 t `"2-�� ` Reviewed: 1- 7,0-00 Architect/ Date Engineer: Submitted: SCTM #: (�� District: 1.000 Section: 551 Block: Lot: Project (� Subdivision Location: 1�� uLCAJt V " -A Name: Single&separate Requertification: Yes Co) tN5 DcoF- Req. Zoning District: [Lot size. Actual: ] [Lot coverage Proposed: ] Req [Front Yard Proposed: ] (Side Yard Proposed: 1 [Rear Yard Proposed ] ProjJ ect DescriptiIon: tw bCALd- - puveoes rpv fa [ �Je- �� e•�c� AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: 6 AKQ� ��) N0 Al ECF3 S Ce8n l0�J � e, CO 0-01 ��LL ST R u c+, i a� S �u�L'f e,2'�S NY,5 ape—