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HomeMy WebLinkAbout25962-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27886 Date: 08/23/01 THIS CERTIFIES that the building NEW DWELLING Location of Property: 1655 EVERGREEN DR CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 102 Block 1 Lot 4.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 24, 1999 pursuant to which Building Permit No. 25962-Z dated AUGUST 17, 1999 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 ONE FAMILY DWELLING WITH COVERED FRONT PORCH AND ATTACHED TWO CAR ` GARAGE AS APPLIED FOR. The certificate is issued to BEN & DIANE BENEDIKTSSON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL R10-99-0083 07/26/01 ELECTRICAL CERTIFICATE NO. 42992 05/24/01 PLUMBERS CERTIFICATION DATED 07/31/0 BEN BENEDIKTSSON A14 ri d Sig ature 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. 25962 Z Date AUGUST 17, 1999 Permission is hereby granted to: BEN & DIANE BENEDIKTSSON BAY SHORE,NY 11706 for CONSTRUCTION OF A NEW SINGLE FAMILY DWELLING WITH ATTACHED 2 CAR GARAGE AND COVERED FRONT PORCH AS APPLIED FOR. at premises located at 1655 EVERGREEN DR CUTCHOGUE County Tax Map No. 473889 Section 102 Block 0001 Lot No. 004 . 005 pursuant to application dated JUNE 24 1999 and approved by the Building Inspector. Fee $ 910 . 60 Authot '.zed Sig ure ORIGINAL Rev. 2/19/98 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. 25962 Z Date AUGUST 17, 1999 Permission is hereby granted to: BEN & DIANE BENEDIKTSSON BAY SHORE,NY 11706 for CONSTRUCTION OF A NEW SINGLE FAMILY DWELLING WITH ATTACHED 2 CAR GARAGE AND COVERED FRONT PORCH AS APPLIED FOR. at premises located at 1655 EVERGREEN DR CUTCHOGUE County Tax Map No. 473889 Section 102 Block 0001 Lot No. 004 . 005 pursuant to application dated JUNE 24 99 and approved by the Building Inspector. Fee $ 910 . 60 c � H Authorize Signat e COPY Rev. 2/19/98 93K - Fo rm No. 6 � . ' JUL, TOWN OF 5OUTHOLD �' 'i BUILDING DEPARTMENT L...___.._ _...... _, TOWN HALL FLOG. ��� 41 765-1802 - APPLICATION FOR CERTIFICATE OF OCCUPANCY A. 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 or 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 building; 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. j 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 a unusual natural or topographic features. ' 2. A-properly completed application and a,consent to inspect signed by the applicant. If a Certificate of Occgpaucy 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 Buildine - $100.00 3. Copy of Certificate of Occupancy - : .2Sv 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 -Date . . . . .. ... . 0` �. . . . .. . New Construction. . . . :. . Old Or Pre-existing uilding. . . . . . i `r Location of Property. .)�? . Vacgr.�*n. . ,r►.v,-Z hsqu e- n� House No. Street Hamlet Onwar ox. Owners of Property. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 4 County Tax Map No ;10 0, Section. 1Pd1.v �5 ' ' l , .. .Block. . . . . . . . . . . . . . .Lot. . l. . . . . .. . . . . . . . . . . . Subdivisim.—t q�..'W o Q 5. . . . . .. . . . . . . . . Filed Map. . . . . . . . . . . .Lot. . . .. . . . . . . . . . . a1�.4�. . . . . .Date Of Permit. ✓, . .Applicant /� Permit No. . . . .. l;,K'-n d-Aa)V_.i8 !9��o Health Dept. Approval. . . . . . . . . . . . . . . . . .. . . . . . . .Underwriters Approval. . . . . . . . . .. .. . . . . . . . . . . . Planning Board Approval. . . . . . .. . . . . . . . .. .. . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. .✓. . . . . . . . Fee Su matted: $. .. a :0 0. . . . . . .. . . . . � -ul 01'1 r?k'L ,.�l I�M.S � 115x. ♦TTT T/1 A 11f,1 ear"'. a Town Hall,53095 Main Road y Z Fax(516)765-1823 P. O. Box 1179 .F Telephone (516)765-1802 Southold,New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: 3 U� Buildin Permit No. — (P Owner: 1Ct(>2 f� )JC ► 1 t�C t 06SDj (please print)X Plumber: C7Lf� I. nenM5UIV (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this day of 1 � o; Notary Public, County SI;SAN d IM"&Y NotaryPubllo State of Bew'FQh! No 4896735 QNal6d in Sullank County CommisSlnoFxdw�ugy$R 20,x,3 /: v'Vf•':{v�'�.•�rC� � t�•01,.1.:�,.'rV4"�_' r . Yi'p�°.•.Sir.s1rr?M1a v•6 .0�':l �r s .'e. •^.. q� 1410 p144h � 1 � • �i00 v '''• 10'f •11' 'if'•'' n rP 0 � 1 1 1 11111 1 , 1111 1 Y 1 1 0 r1f f 1 fl 111 1 1 1 11 � °••• V t {f i1 t N I i t � 1 1 0 < ' C,,, Electrical Inspection Certificate = h ,.. Electrical Inspection Service, Inc. 375 Dunton Avenue @EEast Patchogue, New York 11772 s hl .••> � �� � � r � (631)286.6642 Date: 5/24/01 Application No. : 42992 Issued to: Ben Benediktsson Street: 1655 Evergreen Dnve_"� � __ _ • ,{ a Village: Cutchogue Zip: 11971 Town:Southold Section: Block: Lot: Introduced by: Ice Electric (L) Lic.# 4586-E was examined and found to be in compliance with the National Electrical Code ❑ Commercial ❑NVDefects ❑ Pool ®1st Floor ❑Indoor ©Basement ❑ Hot Tub © Residential ❑ Det. Garage ❑Attic ®2nd Floor ❑Outdoor ❑ Addition ❑Survey '{ Switches Receptacles Fixtures GFI Heaters A/C Fans 41 93 51 6 5 Dishwasher Washer/Amp Dryer/Amp Oven Range/Amp Garbage Disposal 1 1 20 1 30 1 gas _ Furnace Oil Gas Circulator Smoke Detector Bell Transformer 1 X 7 1 Meter Amps—Phase UGtOH Telephone -Television-- Carbon-Monoxide 1 200 ❑ / ❑ 1 2 Other Equipment. 210 AMP dedicated receptacles/4 zone oil heat/2-30 r AMP A/C disconnects/1-20 AMP air handlers/10 AMP r� retridgerator/20 AMP central vacuum system/10 AMP Hugo S. Surdi jacuzz "'CUSTOMER REQUESP'NO ISLAND ; n, RECEPTACLES President , Building Permit No. This certificate must not be altered in any manner a<• Inspectors may be identified by their credentials 511 w,• Final Inspection: 5/24/01 Rough Inspection: 5116100 Inspector: Quentin Reynolds goivvm� vi 1P111 1�� 11 ,'0 4 e .. 1 l�Vn1.a3 ✓e° >'1 _ sss1= sy •>r_'6„'� 3 v�1 r 1 ^ ' 1 ' i • 1 it r I 6 A y J/�. ���_ / � /t. �l. � '� �l/ / 1. ,"�v�• ff � �/� v 6 �oS11FF0(,f opo Gyp Town Hall,53095 Main Road y Z' Fax(631)765-1823 P.O.Box 1179 O Telephone(631)765-1802 Southold,New York 11971-0959 T BUILDING DEPARTMENT TOWN OF SOUTHOLD June 27, 2001 Ben & Diane Benediktsson 50 Mystic Circle Bay Shore, NY 11706 Re: 1655 Evergreen Drive, Cutchogue To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: xx An application for Certificate of Occupancy is not on file. (Enclosed) xx No Underwriters Certificate on file. xx The check is (not on file. )$25.00 xx No Health Department Approval on file. No final inspection has been made. xx No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT a 25962-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. MAY-24-00 03 :54 PM ALL. SEASONS. GALLERY 5169244248 P. 02 I SEL 1% ALBF.$TOS Model SSll. at 1000°F nuc gilt icnipctauire at two The ruggedallstaiNess inchc�clearance t I :ndosing tombuslib(e hi "- test sirticturewithou:txceedingtemperature steel C mney thatmakes limits.AddhionRIN. tTIC chimney is tested at every installation simple 1400"1'fur a one hour period.'fhC important 'type 11'I'test~consul of three fit ings at nor• fastand sound. r•; mal 1000'1; long,eny ugh to obtain steady k conditions. Cach0Owse1000"Ffirings isFol- SClkirkMetalbeStosChimney lowed immediately by len minutes at 2100°F. Systems Meet All UL These rusts help ro luccntat prtxlurr damage or y su'uCluralhwarddurin�,bncl'periodsofcxccs- ;fi.' Requirements sive chimney wnipernuic. This catalog includes both the " ;... Model Ss11 T6nlperat:lue Tests Model sSli Ty x HT (6" 7"&8" "' ;., '1' The Model Sslt Ghinuney in 10". Size) and Mt ICI SSII (10",12"&14" •• ,�cr' 12"and 14 Sizes is also intended size)chimneys.Model SSI)Type HT �' ': '.: -;, for nonnal;continurus use at not has been tested to 2100°E This is y ovci IOJOyI 'I he tail+ratory tests tine high lenipt"rature test option or fur thctic laver sizes involve a Underwriters'Laboratories Safety 7Y n.'- total of fou(ten-n,iniute linings at Standard forFactory-Bulb Chimneys, ;•: 1 WIT*. UL-103 Sixth Edition.The Model SSII Chimney sizae 6, 7 and 8 Itch is not ,r,,,^r x model SSl1— only UL Ustud as a"Type HT Chinuuy", The Multi-1;Uel 1.111 m ne� bill these sizes have passed additional Model SS1I and Mod+1 SSII'rypc fr Chilli- exhaustive and stringent laboratory ncys are designed li+r 5ravlty vcnl ui� only. tests called for in She sizes 1 Edition d They are usable on any'11) lance having a UL-103.Model SSII sins 10, i2 and 14 power burner(such as ,II-Furnace) if that ap- inch have been tested to UL-103 max pilancC operates with cutral or negative draft !mum temperature of 1700017 and also at its outlet, Non residntlal appliances which Comply with all UL-103 Sixth Edition re- may cause positive{{Pressure in the chimney qu{rements,installation and maitlte- slnauid use a Selkirk MetalGesws Model nonce hlslnictions for Model SSI1 F'S system. Chimneys provide Installers and users 1'hc jll l ssyl Chimney,sizes 10", r. with detaiiedandacetiratc lnfomtaUon 12", 14 arc i(lcal for venom} as on imlxvtant aspects oroi>eratingsafety (natural and;LP), #2 oil,an open andperfomtance• front woodh�I ning a9l) a0ces.For coal-fired ap(,liances.both the Model IMPORTANT Type INs cau clog references Model SSII SSII 1 IT and MotlCl DSII are available with chimney systems with two maximum test tem- Type 316 Stainless Steel. Appliances burning coal 1x raaues under Underwriters'Labomtorles Safety require chimneys with tttdiu0nal resistance to staudanl for Faciory•auRt chhnueys(UL-103). corrosion to cope with the sulphur and chloride MODELSSII-TYPE IIT found in many coals. Nameter Sizes: 6".7"&S" Part ldentlikation: Letter"T" Model SSU l'ype rl'—DeSlj;tled Clearances: 2"to Combustibles f 71:mperatureRatings! 2100"F(Maximum l st) Specifically or",airtight"stoves MODEL SSII ritC MJdCI SSII l;t•pe H r Chimney;sizes 6". 7" DlatnelerSizes; 10, 12"&14" &8" Is ideal I'or venting r�sidcntial heating ap• Part Identillcatlow Letter"s" t ptianccs bunnhng niuural�and LI"gas,#2 cul,and. Clearances: L"to contbuslibles woai, it has been sipcciftyally designed for today's 1W Pcralure Ratings: 1700°F(Maximum TWO niodenu,high-elTciency +'alit!•int"wood stoves, T rpeHTTelnperaturCTests or as they are tcrnicd:s0iid I'ut woad burning �rrff 1I'r rircplares. It is also suita4de for uvaod burning to Model SSit ype HT Chln,Zn is heatem,and Ie r conillinalion fuel centratlieat- intended for normal continuous operation big furnaces, 2 MAY-24-00 03 :55 PM ALL. SEASONS. GALLERY 5169244248 P. 03 Roof Brace Kit Wall Band A Rnnf Mare Kit can he used whenever there IS a necJ to 1'heWall9puu.lisuccdalengwalitostrcrc�idcf0r2 inchekar- stalrili'ie the chinulcy ahove the roof level.'1'he puriwsc of the ince and assure stabilil>:Aisu eine IiIsus�taldin};oll'scls. bracing is it)hold the chimney against wind load;and to pre. Required at H foot or closer inlertals to siabt ze the chimney: , vein danuli a I•rvul slatfr and sliding snow,Up to 4'above the wherever It Is supporicd along avertitaliwall. V napf rrgniroa no ln'acing. Rom S'10 10'above the roof one r ItRK should be used,at a midpoint on the chhlincy.over to'use one RRK 4'front 111e rood'and one R5K every 5' •>• I -+� Ihrn',Ifu'r.Adjusts from 4'l0 6'. "` h ; Pill Pari No. A i B C Wit 6.. ,. 4MODEL ggSll TYPE IITT1' ten eT wit 7"MODELSSIIp'I} 9" 1 I" 7" I-IS Wn I01 I1 b,. ♦aW.i.er.rw..� 04 w,�elunnuep.., Anchor Plate 11te Anchor Plate provides a secure a utvhmem.ler chimney to smoke chaultkv ouUrl on nnsnnry rite>laces. "oar Stainless steel and heavy�'gauge:ACCT cc nstnlCtion lip(10"9 life.Retains chinmey wish a twirl lock I:annection, Allows the use of a lightweight Model 5511 Type I IT or M%xlcl 0511 Chimney on standard masonry ftrcplac .reducing footing loads and speeding construction. I �.. Iwo Part No. •I . r 6T-RnK { —tt MODEL 15511 TI'-R0K i ..-•, •"TYPE irr •' I •�,,,,3 8'I'ARK F •t Wn ._ ..---.. .. Fire Stop/Wall Spacer _____... ..._ ''a"" " ° - i'hedtshcJ, nlvauli7sdd'IreSlop/WdlSpacer Isre tilted fill MODELSSII 71'.11' wherever the C linutey passes through combustible cors or TYPE HT „ I 1 , redil>,es.It Is also used nn outside calls where a Wall Suppol I P I' ,1p ' ” Kit and Invulated 11C is used without an enclosure.The fire I h;,np a?" 13%.11 141 op Willi Spacer closes the f ap mound bile chimney pipe and 12c.AP 12" I bi," IIIc iltuned opcnhtg. MODEL 5511 Pnfi NA, A B C (Pra111C) (IT-Ws WiR, w' 12"x12" Chimney Pipe Adapter MOL31>11$511 7•r WS e';r' 15" Is"x I'" To simplify chirnney to sing;lu Wally connections. 1'VPEIt'f RY'.W5 101 Q, 16" 14"r,14" .........__... ...... _... _,..__ .,_,;--.......-- 10S-WS 121e kIW" 16"x 16" 10%-WS 144^ 0 18,x l a^ MIIE Ot.ssll 14S-WS 161,." 22" 20^x20•' i; ' Pa No. _ A 10,, 12 -t.PA II.9b" t41.ti'A 13.03^ w ' (,Ill.;.(TA 5.Co."" . "Noun:defer W I'+s Smoke I'ipr0. HC!S i;l'A' i roc product nun boR and pricin}S ._..__._,._.—_ ...,_ ._.._.... u I 'r SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES WASTEWATER MANAGEMENT COUNTY CENTER RIVERHEAD, N.Y. 11901-3397 852-2100 BEN BENEDIKTSSON 50 MYSTIC CIRCLE ' BAY SHORE NY 11706 CASH RECEIPT Date Processed: 04/19/99 Receipt #: 55481-P-34573-11432 RESIDENTIAL WELL & LP'S Hdref No: R10-99-0083 Fee: $330.00 Received From: WILLIAM D. MOORE, ESQ. Amount Paid: $330.00 Check Number: 5807 s Project Name: RESIDENCE @ THE WOODS AT CUTCHOGUE LOT 5 Location: THE WOODS AT CUTCHOGUE Lot 5 GE0155 a f I COUNTY AF SUFFOLK ROBERT_ J. GAFFNEY SUFFOLK COUNTY EXECUTIVE - - DEPARTMENT OF HEALTH SERVICES - - MARY E. HISSERD. M,D., M.P.H. , t - COMM15510NER PERMIT k THE ATTACHED PLAN, WHEN DULY SIGNED° BY A REPRESENTATIVE.OF THE DEPARTMENT, CONSTITUTES A, PERMIT TO CONSTRUCT A 'WATER SUPPLY AND/OR A SEWAGE DISPOSAL SYSTEM - FOR THE PROPERTY AS DEPICTED. CONSTRUCTION :MUST CONFORM WITH -APPLICABLE STANDARDS INCLUDING " `. THE STANDARDS FOR CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES AND-STANDARDS AND PROCEDURES FOR PRIVATE WATER SYSTEMS. THE PERMIT (PLAN) EXPIRES THREE (3) YEARS AFTER THE APPROVAL DATE. ANY MODIFICATIONS WHICH MAY AFFECT`f'HE .PROPOSED SEWAGE DISPOSAL SYSTEM OR WATER SUPPLY REQUIRE"SUBIAISSION'OF A REVISED PLAN AND ANY ADDITIONAL FEES, PRIOR TO CONSTRUCTION. NO INSPECTIONS WILL BE PERFORMED BY THE DEPARTMENT ON EXPIRED PERMITS- " PERMITS MAY BE REISSUED UPON . THE SUBMISSION OF NECESSARY APPLICATIONS, PLANS AND FEES', AND WILL BE REQUIRED TO MEET THE STANDARDS IN EFFECT AT THE TIME OF REISSUANCE. A PERMIT"MAY BE TRANSFERRF'D"INTO ANOTHER PAIRTY'S NAME UPON RECEIPT " OF WRITTEN PERMISSION FROM'THE_ORIGINAL APPLICANT AND THE RECEIPT OF ANYREQUIREDTRANSFER` FEES: . IN THIS CASE,'THE PARTY PAYING:THE ORIGINAL APPLICATION FEE_ WILL BE CONSIDERED TO BE THE ORIGINAL APPLICANT. WWM-058 PAGE 1 OF 2 DIVISION OF ENVIRONMENTAL QUALITY ' COUNTY CENTER ,RIVERHEAD. N.V. 11901-3397 - B52-2100 " - - 18480;.72/42 i INSTRUCTIONS FOR FINAL APPROVAL OF CONSTRUCTED SYSTEM'S It is the applicant's responsibility to call the Department to arrange inspections of the sewage disposal system and water supply facilities prior to backfilling.'' These include inspections of the soil excavation for the sewage disposal system . and inspections of the water supply well, well lateral,public water supply line, disposal system,piping and final grading. Other inspections may be 7quired. Following satisfactory construction and inspections: L The applicant must submit 4 pr its of an as-built plan(tip to and including 11"x17"), by a licensed design professional, of the subject prop'erty showing the following: a. the lot location and dimensions; b. the lot number(s) and the name of the subdivision, if applicable; C. permanent structures (i.e., buildntgs, driveways,walkways, swimming pools, decks, etc.); d. the exact location of the private well, if applicable (give at least 2 dimensions measured from the comers of the building); e. the exact location of the publ�c water line, if applicable; £. the exact location of the septi tank and leaching pool(s), if applicable. Give 2 dimensions from the building corners to the covers of the ser tic tank and each leaching pool; g. the exact location of the sewer line from the dwelling to the street; if applicable; and h. have a clear area at least 3' x5" for the Department's approval stamp. 2. The applicant must submit a certificate from the sewage disposal installer attesting that the system has been installed according to the criteria la of the Suffolk County Department of Health Services, when applicable. 3. If a well has been installed as t e potable water supply, the applicant must submit a current well water analysis (within one year) and a well dr' ler's certificate. If the well or water quality does not confonn to standards,proof of corrective measures will be required. Refer to "Standards and Procedures for Private Water Systems." 1 4. In those cases where public sewers are utilized for the dwelling, the applicant is also to submit one (1) copy of the sewer line inspection approval From the public sewer district. In districts operated by Suffolk County, two (2) copies of Form S-9, duly execued by the Suffolk County Department of Public Works, are required. 5. In those cases in which the installation and connection of the public water service line has not been inspected by the Department of Health Servil es, a tap letter from the appropriate water company is required. HEALTH DEPARTMENT REFERENCE NUMBER MUST BE ON ALL CORRESPONDENCE OR DOCUMENTS SUBMITTED. SUBMIT ALL ECESSARY FINAL PAPERS AT THE SAME TIME. PHOTOCOPIES OF DOCUMENTS WILL NOT BE ACCEPTED. WWM-058 PAGE 2 OF 2 1&388.A 2192 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS TION [ ] FRAMING [ FINAL [ ) FIREPLACE & CHIMNEY REMARKS: 1-2e ,DATE_����INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. { ] FOUNDATION 2ND [ ] IINN ATION [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY MARKS: 2�a� izk a--'r r 3 I. 1 6 / 0974 DATE 01 INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. ( ] FOUNDATION 2ND [ SULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR 5 M-1802 s mar" �"- INSPECTION [ FOUNDATION IST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: DATEfliq q9 INSP OR A-4-� M-1802 BUILDING DEPT. INSPECTION [ ] F NDATION IST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE A CHIMNEY REMARKS: ' DATE 1 INSPECTOR ` i M-1002 BUILDING DEPT. INSPECTION [ ) FOUNDATION 1ST [ ] ROUGH PLBG. [ ) FOUNDATION 2ND [ ] INSULATION VrFRAMING = [ ] FINAL [ ] FIREPLACE A CHIMNEY C < REMARKS: _ c -76 X ` y DATE d O INSPECTOR I M-1802 r /� BUILDING DEPT. � . INSPECTION d , [ ] FOUNDATION IST [ OUGH PLO [ ]�ATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL �IPL ECA & CHIMNE REMARKS: ' c — DATE INSPECTO REF, # RIO — 0083 sGAigl as FOR.i1PP1�9 m ` � SURVEY OF PROPERTY to OaiPMt�ligt FAltY a�ad CA Pry tr aardo- art ft% ow& lb. ate , AT CUTCHOGUE &W .�, Fay 4. T O WN OF SO UTHOLD >t, . SUFFOLK COUNTY , NeY. t 000-102-0 t—4.5 I 5,0s 4 P". 0.2, togs l Nov. 1 1999 lfoundaflonl N. JAl7,, 2001 ! final J ✓�a-r 20 200�(�evisie»a ? --� R-25-E - low ,3pN . tl i , lea k 4 II` JUL 4 2"MI .-J 3C:' F : �uD k , , Cr'erF1 ai H Y� N �� �♦ The aeuP2do- vo r.;a.^rd srRtzr� r cQ �Y �� � .� �� � ��:,.. a 7*xat9"CdCu '1Q Ly KSb�9C'�f1� +°ti2�`»„P ,,,,'T��• ac ���"4°5T�ikME�YCrtA Qtv YE; / Ucv A fE� ,��"cEtCa[ 'r e` cmwm o� NEWk, okxwS�P \It\1. MEr"O so swodktosw o £!F a TO *1W t a 4 Amt" tion sa JC- Z2504 Ccuwl! CLOW Is \ 1 . 1 23, IMW AS e 496 � \ L-> o 10 Ito *'Ak. 2 % t��bd �31:it+31S'J+317�IJ�C' lad F SSR S33if,u35i,ltw`� ld?"w N. Y.S. L Pv'0. 49 '3 To rArM I LO _ w . J5 Y 765 0 SE H Pt4F + � (F; tL30 TPAV' LE� jjns 0"111977)o ;GPq � ' GX 903f tLT 2-5 62- . �Q.�i" ;ay. 07 ICES � M p- alid In byr the O011ANRM ed t@0� V SUR ."di3 OLD - 'V PE T I ` Wd as tbt.p o to =Dora& me,wwm of "Mww �;� AT CUTC OG l ' fho�n A�� ss fwn Ard �pl4a s°'� � SUFFOLK COUNTY , N., Y. SCAM' t" ' At 1 $> � * j � Nov. 19, 1'999 ff"ndaffon) Fd=25.00' l �a �,• t�-39.27' pp a o Py y+i e h «ewe bt 0 5 AlWA AVB , l t t"m / ' � BeF+se�e#ascn aT 1K! 'f)E ® At Land Abstmd Corporation CI4� kt t�!'PCiipaw JC- 225" I 1w suff"_� '`s 0. ti MM Ifft AS � S aN n+rap AP i� lCXt7 Y.S. ,LIC. PN) 486;8 Kf A[�V AL*ERdT,7N OP- AIDE-I-i 70 TNfS SURVEY IS A +irOLAL'G,'V C L SECT,ON 7209 ^r itiE ' r„ W STATE -EDuCA T4N° LAW ,may ExCEPT AS DER SEC C+h' 7frllll,�FRF.,')tj SUBDI0 0,!v 2 ALL CEPTIFtCATtCHdS - �1 HEREIN ARE VAL Q FOR THAP AND COPIES THEREOF ONLY iF SAID ,ArtAP OR COPES SEAP;' E ,M€'PtSSED SEAL OF THE SUPVEvOR t23fl' , t °$. ST E I oGn,a Trerr6 APPEAR - '. 5t7UPt�F i t * wft the STANDARDS FOR APPROVAL � VmO � Y� SURVEY OF PR OPER T Y of KaM � . .� > DEPZ /j� /`� �r �j �r j OFFICU �s v� A l l� UT l.�ll 0V V E 7M IoeaRon d was and o.avoob - � - »° TOWN OF SO UTHOLD SUFFOLK COUNT' , No Y. ti°' F ♦d 1000—MZ-0-4.5 SCALL: q�!" 50' ,. AID. K. R=25.00' L=39.2T pP MFTOIX COUMULA''aARTE'LMVZOINlwulssm2m;:,e^ra O p `a6 / 1 j� PEYtC�"'Y'ia 'FOR r� , 0^°+1A.L ON n?�¢`???7�.'7°°Dia�OR A,A� �. A r 1 S�dO F V OT-lei' A � d'• APPROVED �'' �O � . .• FO"�Wm:sfu m,OF EES OIvs Y PMES TERM Yi. & RS MOM D:AIFE OF APPROVAL ; . g a o. per/ Lao f° sol �L� •p � . ,,y` 1000 °o. _ '` ®� ^�"�� t PLEASE NOTE h h� �� (/ Minimum distance between well and cesspool is to be 150 feet. CERTIFIED TO: Diane BsnedlctmM d�> Beh BwwNlktsson e J.C. Land Abstract COr 0rOt1On �OE N n�eri j 0" .o NUMBERS AO �CUTCHOGW FLEDl \ <�^!� � dc- 22504WOODS c, ��N s. vlw N"THE SUFFOLK COUNTY CLERK'S S PnCE ON kfAIM 23. 1989 AS AAP NO. 8717. lanit \ ll�� x o C L':: NC 4901& 3EVATiQ15 - �N XSSDYED DA117f1 -Ev4'.�� aEC ':? + �_°._ S E'�Gfh Celan P _ ra_ 76� a AM = 44sON 9q, fL -rEQE:r. Pr va -- S vAF 13n 7R,6 «ELFP C7;EE 199- 129 197 BOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TET.: 765-1802 NOTIFY. { )� CALL N7mnined .:<��.., 19.,( . MAIL TO• . . . . . . . . . . . . . . . . . . . . C� ................................... Approved .. . - �� , 19 / PermitNo. ` �°�•.� Disapproved a/c 30 Oft AL2 RrPiG .a.,,l�. �......... ........... ................................... 11 �q_•_, .-� (Building Ins Cor) .JUN ? 4 X999 'sID APPLICATION FOR BUILDING PERMIT DEPT• INSTRUCTIONS T V N FS J!.Intn a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wi 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. 1 c. 'IIme work covered by this application my 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 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. (Signature of applicant, or nam, if a corporation) ) 5v m y"57 1C CI SIIA/1 .... ................... (Mailing address of applicant) 7L-q /!7by, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ..............0. W.nf� ...... .......... ........ .................................................... ...... .... ....( '�p . Name of owner of premises .......... e �. :n L . �l en.... b tctYt (as on tree tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (Name and title of corporate officer) Builders License No. U. Plumbers License No. ......................... Electricians License No. k14... .... Other Trade's License No. .................. / I. Location of land on which proposed work will be done....) .. �... / ............ I. pati_ ................ ...... ............... House Nmber Street Hammet County Tec Map yNo. 1000 Section I...��. ....... Block ...(�.I......... Lot ....: `�.�...... Subdivision ..�" �.. Y. l� CJO .......... Filed Map Ho. ............... Lot ....:. ..... (Name) 2. State existing use and occupancy of premises and inte9ded use and occupancy of proposed construction: a. Existing use and occupancy ✓ �Q GCII ...................... ...; ,.,,, .,................... b. Intended use and occupancy ..... ���( rne( n El ... ... Fltivll ...... 1 3. N•ilure of cork (check which appli able): New Building .k'�7.... Addition .......... Alteration ......... Repair Nmnval DOW)ition ............ Other Work ........ ............ ..... ....... ....................... U U �'1v (Description) r. Estimated Cost .........4(�......,�...... fee ............... (to be paid on filing this application) g, ng u i. If ckaellin nudher of dwelling nits .....I...... Harker of dwelling units on each Floor ................ Ifgarage, Winker of care ....... , ........................... i. If business, eomnercial or mixed occupancy, specify nature and extent of each type of use.... ............... 1. Dimensions of existing !! structures, rf any: Front................ Rear ........... Depth ................. Height iNurker of Stories ...................... Dimensions of sere structure with 'lalterations or additions: Front ............... Rear ............... Depth gF I.................... Nunker of Stories ............... 3. Dimensions of entire new construct1ion: Front ......... ..... Reat................. Depth ............ Height ......................... lnber of Stories ...�................ 5 d. Size of lot: Front �w. ....... Rear ...I•` Q........... DeLpth/ �5,�(��/,r�J�,..... 10. Date of Rirchase ...!....., .•.... Nam of Rimer Owner II. Zone or use district in which prem+ises are situs ed ... ................................................. 13. Will lot os pled ..ion vi latII arty zoning law, ordinance or regulation: .../V..(2............... 12. Ibex proposed construction violate regraded ....... Wil ess fill be removed from premises: YES NO 3 14M ..'.....�d k it ..?�U I .y �.4.Cca- ...... Phone No.q. 14. Nares of Owner of per' s .�[1..�....I.,....,......... Address Nave of Architect ....J.�(�V�l A.kfl v Address (!� 5 /�(xJYPttwne No. .............. of Contractor I5. idUus property rot300 feet of ... eet o .. . gess ........ ....................Phone No. .............. a tidal wetl nd? * YES .......... N0 .. ... *IF YES, SOUd JOID TOM TkaJMP-113 ]TWIT MAY BC W!k7ffRMi . IPIAT DIAGRAM locate clearly and distinctly all )nrildings, ube her existing or. proposed, and indicate all set-back dimensions from property lines. Give street and bll-- rusher or Jescription according to deed, and show street names and indicate clhether interior or corner lot, TME OR MW YO[W SS U1NIT U' ....................... �► 2 �e(,�di` K�ssoN •••••••••�••••••-••••••••••••••••.....................being (July swvrtb, deposes and says that lie is the applicant Now of individual signing contract) Ime n.-rbed, e is theD ................................................................................................... (Contractor, agent, corporate officer, etc.) I said owner or owners, and is duly authorized to perfonn or have performed Ube said work and to make and file this pplication; that: all statements contained in this application are true to the best of his knowledge and bcl.ief; and hal the work will he performed in the broIriner set forth in the application filed therewith. worn before me this c .... .......day of .... .. �.. 19./..�.. I Notary 13bblic JOYCE M.WILKINS (Signature of Applicant) Notary public,State of New Yak No.4952246,Suffolk Co(14Y TermE> lmjun$12. 3pp� H copper tuIS bused DO NOT PROCEED WITH {or water diat9 ributin A►PROVED AS NOTED FRAMING UNTIL SURVEY system; piping shell be �� g 1 `1` §jp s a5gba � OF FOUNDATION LOCATION of types K or L only FM 1� 'bZ HAS BEEN APPROVED. UNDERWRITERS CERTIFICATE NOM BUILDING DEW ENT T REQUIRED 7WIS02 a AM TD 4 PM FOR THE - _ FOLLOWING INSPECTIONS: " OCCUPANCY OR 1 FOUNDATION - CRE REQUIRED LL 'ld°y�! Y LJ FOR POURED CONCRETE USE3I� UNLAWFUL2. ROUGH - FRAMING PLUMBING . INSULATION I 4. FINAL - CONSTRUCTION MUST PLUMBER CERTIFICATION BE COMPLETE FOR C.O. °z I „1THOUT CERTIFICATE ON I EAD CONTENT BEFORE ALL CONST9UCTION SHALL MEET o m �. � �I'AI�CY THE REQUIREMENTS OF THE N.Y. m CERT/F/GATE OF OCCUPANCY STATE CONSTRUCTION a ENERGY OL, ' NSIBLE FOR SOLDER USED IN WATER DESIGN ON .:ONS RCODES KinT OUCTION ERRORS SUPPLY SYS TEM CANNOT ELEVATE HEATING EXCEED 2/10 of 1% LEAD. APPLIANCES IS"AS PROVIDE ANTI-SCALD AND/OR REQUIRED BY PART. PLUMBING THERMAL SHOCK PREVENTING `r 717.3 (e)(4) OF N.Y. STATE BUILDING CODE ALL PLUMBING WASTE DEVICES AS TOPART.902.G(K) a NATER ONES NEED D.L STATE BUILDING CODE. i TESTING BEFORE COVERING MIt-1, gyp" T2 PROVIDE% HR. FIRE hPf CDrr PROVIDE OPENINGS FOR RATED SEPARATION TO EMERGENCY ESCAPE AS PART.717.3 (f) (1)OF REQUIRED BY PART. 714 OF N.Y. STATE BUILDING CODE. \ I � N.Y. 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Glazing (n t.S� 1- 9,far l7igc I7 a 3S 3 � b ur ept, rl Doors s6 D - z3 Ccil.iuy/Ruof (Opaque) lef. �'� , OS p Se Skyligh Ls • 8 6 3L� / C), ¢w t) Floor - / L) S Cj Foundation Walls Slab Insulation TO'T'AL 4h Notes: Building Envelope Systems to meet requirements of 5.2 BVAC Equipement to meet requirements of 7915.11 11VAC Systems to meet requirements of 7015. x2 Duct Systems to meet requirements of 7015.13 Ventilations Sys Lems to meet requiremellLs of 7015. 14 Insulation of Piping Sys Lems to meet requiremen Ls of 7815. 15 Service Water heating Systems 6 Equipment to meet- requirements of '7815 . 21 Electrical s LighLing Systems 6 Equipment to meet requirements of 7915. 31 To the best of my knowledge, <E0F NEiyp belief, s professional - 54P¢NGE judyemen L, these plans are in cunipllance with the code. y r .0 { - - F Q5225Qt aySS Q O' - � r l i � \y O • MItJ, ZVI NYS coop 2" cLU o CL — - --- --- — Z m cc 1 w 4 EQ El I I C n I � DE-- a 17 p O ,of NEW �y GE T�b�- W W V e'gNFES510NP�2 i w 1I - — i 3 � w C N O e�C �If Cl nr m 0 H N ' Q O W 5 x� Q 19 LL I Q I Q. d TOEL -0 I _ 19- 1 HL ,`PS NOF�NL'M��9,�. 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' • R. . _.' _tau_.i4f , z i a s C-, L, _. 7x12 Ooc,P � I Y I ~ 4i . - - X12 RIDGC. - I OAl . - i OL Ip"� a + I2 \ a o 4 LU cc i U I � o 0 WO 1 _ __ _.- ---_--• 4�2`�`'c",�'AD_1i�"Qc4,_.__ �IC�IX� pall ill ++ �R etcs�ll rk V/ a 4Gi1— (/ }iii � V l �r�'v -a^/�a4)tip dc:' WH�'"' a uNe ' Of NEW P Cf . _ • _ y n _W - � � � °FessPOW� ITD < -- ti � BUILDING PERMIT REVIEW CHECK LIST Applicant/ Date Owners Name: rel Reviewed: • f(� �f Architect/ Date Engineer: Submitted: SCTM M District: 1,000 Section: Y—OFBlock: ! Lot: 7•S- Project /_ �/f Subdivisionm `-� Location: (� 6Lf Nae: ✓ Gr/ Single& 401, separate Required certification: Req. / Req. Zoning District: (Lot size: Actual: Ov [Lot coverage Proposed: Rey. A5' Rey /S X37 Rey [Front Yard Proposed: [Side Yard ♦ Propos [Rear Yard c50 Proposed: Project Description: ' AGENCY PERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. '0(9/1) 00 83 New York State D. E. C. V ✓� - -�r�+�G� Town Trustees _ 000, Town Zoning PP Board approval: . / Town Planning Board approval: Flood Plaits Elevation ??? /3 Flood Zone: / Notes: 1�� Oak- -