HomeMy WebLinkAbout21288-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARI~ENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22318
Date MAY 12~ 1993
THIS CERTIFIES that the building.
Location of Property 695 YOUNGS ROAD
House No.
County Tax Map No. 1000 Section 18
Subdivision
ADDITION
ORIENT~ N.Y.
Street Hamlet
Block 1 Lot 5
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 19, 1993 pursuant to which
Building Permit No. 21288-Z dated MARCH 25, 1993
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 CHIMNEY ADDITION & HEATING SYSTEM INSTALLED IN EXISTING
ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to
of the aforesaid building.
TOBA LAJA ORRO
(owner)
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-268527 - MARCH 5~ 1993
PLUMBERS CERTIFICATION DATED N/A
i Inspector
Rev. 1/81
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PEPu~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N-eNo. 21288Z
Permission is hereby g,r~nted
.....................
~..~/~..~./~......~.~.~. ......... ~..=.....~~~ ..............
at premises I~ated at ..~ ......................... ~ ...................................................................
................................................ ..................................................................................
County Tax Map No. 1000 Section ....... .?., .~... ........ Block .......... ./.. ........ Lot No ......~....."~... .......
pursuant to application dated ....... .~/./~../..~.. ................................... , 19../...'~..,
/
Building Inspector.
Fee $..~
approved by the
Rev. 6/30/80
Form No. 6
TOWN OF SOUTIIOLD
BUILDING DEPARTMENT
TOWN I~LL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by ~ypewriter 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).
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 Approvai of completed site plan requirements.
For existiog huildings (prior to April 9, 1957) nou-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 applicatiou and a conseat 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 Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Con~nercial $15.00
Date ....... ~ ...............................
New Construction ........... Old Or Pre-existing Building .................
Location of Prone~tv ~f fO~]~ ~)~p
tlouse No. Street Hamlet
~nwer or Owners of Property '. .......................................................
~ ~ax Map N 1000 S cti /.~. /
~ounty o , e on ........... · Block ................ Lot.
;ubdivision .................................... Filed Map ............ Lot ......................
'ermit oN ............... Z tZ ~ · Date Of Permit. .?./..~./?.~. Applicanto .~..C.O0.~/~'
lealth Dept. Approval ......................... · Underwriters Approval...~.. .....
~lanning Board Approval ........................
lequest for: Temporary Certificate ....... · .. · Final Cert[cate: .......... .
'ee Submitted: $ ...........
f .... . ..............
~O ~ 1~ ^PPLICANT
OUNOA~ION
OUNDATION
(1st)
(2nd~
0UGH FRAME &
.PLUMBING
:NSULATION PER N.
STATE ENERGY
CODE
FI:IAL
ADDITIONA'L COMMENTS:
THE NEW YORK BOARD OF FIRE UNDERWRITERS
[~)0012[ BUREAU OF ELECTRICITY
V 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date H/'iRC {] ~lJ~ , 'J ~) 9 ~ Application No. onfile 04i~5593/~3 }~ ~'
THIS CERTIFIES THAT
o~]y the electrical equipment ~ ~scribed be~w and introduced by t~ ~ppJicant ~med o~ the a~ve appBcat~on number in the prem~es of
Fl. [] 2nd Fl. Section Block
and found to be in contpllance with the requirements qf this Board.
Lot
FIXTURE FIXTURES RANGES
OUTLETS SWITCHES FtUORESCENT OTHER
OVENS DISH WASHERS EXHAUST FANS
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS
UNIT HEATERS MULTI.OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
SERVICE DISCONNECT $ E R V I C
)THER APPARATUS:
NO. O E COND. OF CC, COND
NO OF NEUTRALS
OF NEUTRAL
P~IlI', R. BURl, IS
275 'l'O~l',l lt~RBOR LM'll~
SOU'I'HOf, D, NY~ 11971
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by the
C I DN DE R E .THS OPY F ERTIFICATE MUST NOT BE ALTERED
/~ 765-~,802
~ INSPEI~IION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
FRAMING [;/j/~INAL
REMARKS:
!'-1lAP OF pPOPERTY
SUI2'VEYEP
ANNE F !,.xE.ATI NO
AT
ORIENT
'ro,~N oF ~OUTNOLP
-
LJC, L./'JqP .-..;',cV EY-, I?. -, __
~ ~ c H I ,~'--£ C 'T'"'~L~L~
610 ¥o15. Memorlll Hilihw~
Hauppaull, New York 11768
(51~) 5 4 3 * 1 3 0 0
OF
J
A a C U I T t C T
IH I 14J
610 Vols. Memorial Highway
Hauppauge, New York 117,88
(,5Il) 54 3 · 1 3 0 0
61p Vets. Memorial Highway .
Hauppauge, New York 11788
(~11) 5 4 3 1 3 0 0 OF~ .~/×
SUMMARY OF TOTAL THERMAL RATING.
If the Total Thermal RaCing is zero (0) or greater, the proposed
design for the building envelope complies with the Energy Code.
THERMAL TABLE
AREA , U-VALUE RATING USED
A, ROOF/CEILING ~.. ,o67_ _
B. NET WALLS I I~... .07~ ~ 7~ ~-~
C.
o~,, ~ ,7
Skylights H/~ N/&...
D~. BASEMENT/CELLAR WALLS
Wall Perimeter Feet
Exposure Above Grade Feet
W~ll U-Value
Depth of Wall U-Value
Below G,ade ... lnches
D3. SLAB INSULATION
Slab Perimeter Feet
Insulation R-Value .... N/A _ H/A
E, INFILTRATION CONIROL
Conditioned Floor Are~ Sq. FE.
F. SOUTH FA~ING GLAZING
South Glass/Total Glass Percent
Gl. Area/Gross Wall Area Percen:
Conditioned Floor Area Sq. Ft.
TOTAL THERMAL RATING
.Phi. lip C. iPaTndOill ~ SHEF. T #!
'l ii 0 H E C T ',~
610 Vets, Memorial Hi!lhwiy
Hauppaug;, New y~rk 11.788
~ '(ill) ,8 4 3 ' 1 3 0 0
A # C '1t I T E C
610 Vets. Memorial Hiihwlly
Hauppauje, New York llTII
(Ill) § i ~ · I ] 0 0
SHEET N~,
OF '~t¥.
N.Y.S. ENERGY CONSERVATION CONSTRUCTION CODE REQUIREMENT~
E 1- All work shall conform to N.Y.S. Energy Conservation Construction Code
effective March 1, 1991 and shall meet but not be limited to the following
minimum requirements.
E 2- Design values: 6000 degree days
10 degrees F to 72 degrees F design dry bulb temperature
87 degrees F to 78 degrees F design dry bulb temperature
E 3- Windows and Door manufacturers shall certify that their products meet
mihimum U values indicated and air infiltration rates as per code.
E 4- Fireplace shall be equipped with the following:
a. Damper with air leakage of 20 cfm max.
b. Dampered combustion air vents ducted from the outdoors with total
capacity of sufficient quantity to support combustion located in
hearth or at sides of firebox Damper shall be capable of being
fully closed.
c. Non-combustible glass fireplace doors.
E 5- Hot water heater shall comply with requirements of Section 7813.31 thru
7813.34 of the code.
E 6- HVAC equipment shall meet the following requirements:
a. Minimum combustion efficiency shall conform to Section 7813.21 of the
code.
b. HVAC equipment performance shall be certified by the manufacturer for
conformance with Section 7813.21 of N.Y.S Energy Conservation
Construction Code.
c. Each thermostat shall have a minimum range of temperature settings
from 45 degrees F to 85 degrees F and shall be capable of 6perating
the system heating and cooling in sequence. All thermostats shall be
capable of providing a deadband of 5 degrees F between full heating
and cooling.
d. All heating piping'shall be insulated in conformance with Section
7813.18 of the code.
E 7- All electrical equipment and lighting shall conform to Section 7813.52
thru 7813.54 of the code.
E 8- These drawings andispecifications have been prepared by or under the
direction of the u~dersigned and to the best of the undersigned's
knowledge, information and belief meet the requirements of the N.Y.S.
Energy Conservation Construction Code.
Phil!PA r C ,C'" Pa"d°lfll ' t [ c t
$1o Vets. Memorial Highway
Hauppauge,, Naw York
,(t 16) 6 4 3 · 1 3.0 0
$1t£ET
OF ,'~IX
55 Northern Boulevard
Great Neck, NY 11021
Telephone (516) 482-5237
FAX (516) 482-5291
RICHARD M. ADLER
PRESIDENT
RONALD D. GOODMAN
EXECUTIVE V~CE PRESIDEN~T
BARBARA S. KA~.ISH
SECRETARY
Members:
American Institute of Architects
REGISTERED IN:
NEW JERSEY
CONNECTICUT
MASSACHUSETTS
PENNSYLVANIA
VIRGINIA
LOUISIANA
TEXAS
FLORIDA
CERTIFIED:
.NATIONAL COUNCIL OF
ARCHITECTURAL
REGISTRATION BOARDS
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TE£.: 765-1802
Disapproved a/c .....................................
APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH .........
3 SETS OF PLANS ..........
SURVEY ...................
SEPTIC FORH ..............
CALL ...................
HAIL TO:
INSTRUCTIONs
a. This application must 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
br areas, and gi~ing a detailed description of layout of property must be drawn on the diagram which.is part of this appli-
cation.
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 issued a Building Permit to the applicant Such permit
shall be kept on the premises available fbr 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 ~he Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of. ~e.. Town of Scuthold, Suffolk County,' New York, and other applicable Laws, Ordinances or
Regulations, for the constl~lch~n 6f buildings, additions or alterations, or for removal or demolition, as herein described.
~F{I'e--a-ppli~.an~ a~e~a ~:,~ly wi~h all appl/oablc lawa, uxdhtancuS~, b-uildillg coa--~7~gi~'~ode;~afid rdguiations; and to
admit authorized insp.~ctors ~n pr!raises and in building for necessary in.sp .~n~q/.~
(SiTn: u~re of aplSlicl}nt, or nanle, if a corporation)
(Mailing address of applicant)
State whether applicant is p. wrm~-, [~;.~, aj~rr, arj;hi{~t, e~-kr~r, g?.ge, ma-l-~ontractor, ele_oh'q~an, pl~u. ml,'~ or baiter.
:,. ..4 .........................
', 7'0 ITA o
Name of owner of premises . .
. . (as on the tax roll or latest deed)
If applicaht is a corporatlbn~ ,signature of duly authorized officer.
(Name and title of.corporate officer)
Builder's License No ..........................
Electriqian's License No. g.
Orner lraae s License jwo ..................
1. Location ofland on which proposed work will be~done. ~f41.~ ~6~J ~A~ ~ ~lM ~.
House Number Street Hamlet
Subdivision .................. . ................... Filed Map No., .... : :..... =... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exhtin~ use and occupancy ...................................................................
3. Nature of work (check whxch applicable): New Building .......... Addition .......... Alteration
Repai?..... :.....~.~... ~. Removal .............. Demolition .............. Other Work ...............
4. Estimated Cost ....... /. .... . .................. Fee ........... .~.. 7C ...............
· ¢ / (to be paid on filing this application)
5. If dwelling, number of dwelling nits ................ Number of dwelling units on each floor..../~'/.~. ........
· If garage, number of cars ..... "' '; ...................... ' ....; .................. .t ................ ..
6. If business, commercial or mixe4 occupancy, specify nature find extent of each type of use . .~/~..
7. Dimensions of existing structure~ if an,,' Front ~ ~ --dc ~oo, ~/Jr t_ ~r- n,.a. ~/15'-4; ct ....
Height .... ~.. ~.~;.t.. Number of Stories ...... l!g .... ' ........
Depth ' Height .... ..... Numberof Stories
8. Dimensions of entire new construction: Front .... N./../~. ...... Rear ............... Depth ...............
Height ............... Number of Stories '
10. Date of Purchase ........ ,..[q~.?. ......... Name of Former Owner ...~?./.~..t'f;..~. ..... 'i'" .'"
1 I. Zone or use district in which premises are situated ..... /'~/~.d .......................
12. Does proposed construction viol te any zoning law, ordinance or regulation: .../~..O. .........................
13. ,W, il)lot ?e..regraded ....'' '/~-/~--' '-:' '~'' ':'-'~5.~' '~-:': ..Will excess fill be removed from .2remises: Yes No
Nmne of Architect . ~ ./~.b./~.~0 ~ ~.l hI~. ......... Address ~/~. i/.~.rJ. ~..~.,9../(/~./~.~1 Phone No . ~'~ 7. 17 O. 0 ....
Nm-ne of COntractor
........ ~ ................... ~ ......... ' .......... Phone No ................
15. Is th±s property w±th±n 300 feet of a t±dal wetland? ayes ........ No .........
~If yes, 8outhold T~wn Trustees Perratt may be requ±red.
.. I PLOT DIAGRAM.
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block n'umber or description according to deed, and show street names and indicate wh~ther
interior or corner lot. ~E' 5 0 gu ~"7'
STATE OF NEW YORK, ..
C'OUNTY OF ......
Alg II D AS NOT£D .,
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FouNDA?ION ~ TWO REQUIRED
FOR POI. J~ED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSUI~TION ,
4. FINAL CONSTRUCTION MUST
BE cOMPLETE FOR C,O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
........................................... being duly sworn, deposes and says that he is the applicant
~Name of indiv!dual signin~ contract)
above named.
He is the .: ..............
(Contractor, agent, corporate officer, etc.)
*f said owner or owners, and is duly ~uthorized to perform or have performed the said work and to make and file this
~pplication; that all statements containbd in this application are true to the best of his knowledge and belief; and that the
a, ork will be performed in the manner s~t forth in the application filed therewith.
gworn to before me this
.............. .~ ...... aay o~~. ............... ,19..
BA~BI~ 8,R, ~LISH
NOTARYFUBLIO, lak of New Y~ I
No. 4~o3t I (Signature of applicant)