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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Nc Z-22547 Date AUGUST 25, 1993
THIS CERTIFIES that the building ADDITION
Location of Property 625 WOOD LANE PECONIC, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 86 Block 6 Lot 7
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 11, 1993 pursuant to which
Building Permit No. 21615-Z dated AUGUST 20, 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 INSTALLATION OF HEATING SYSTEM TO CONVERT EXISTING SEASONAL
ONE FAMILY DWELLING TO YEAR ROUND OCCUPANCY & ADDITION TO SAME.
The certificate is issued to THE NATURE CONSERVANCY
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - 9/2193
PLUMBERS CERTIFICATION DATED N/A
ui ding Inspector
Rev. 1/81
I
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) ~j
Date 19../..-.~,..
N2 21615 Z
Permisslon Is hereby granted too:
N?CICF .....P~/F_/.lft`?C
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to Y}GC..................sr1~1~9..//......~ ~?....:T
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1 ~ ......~.G...............r~~'~C
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at premises located at .:'TZCl2~ ?/!7~G
L( ......G//LPC..... , ......................~Q /
County Tax Map No. 1000 Sectlon tCI,P/.............. Block .........A// Lot No.
pursuant to application dated ...............A. 19.../.q .x°....., and approved by the
Bullding~Innspector.
FeeS•.`... .
.~~••••..:..N
Bullding Inspector
Rev. 6/30/80
i
Form No. 6
y
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
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 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 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, Commercial $15.00
Date AIIG: 24: 193
New Construction........... Old Or Pre-existing Building
Location of Property...,, 625 WOOD LANE PECONIC: N Y,
House No. Street Hamlet
Onwer or Owners of Property ......,~,NATURE CONSERVANCY
County Tax Map No 1000, Section.....86....... Block 6.......... Lot 7
Subdivision ....................................Filed Map............ Lot......................
Permit No...2~615-Z...... Date Of Permit., 8/20/93 Applicant RAPELL REAL ESTATE: INC.,
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $,,,,.?5.00
DAVID RAPELL, AGENT
APPLICANT
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Fairweather • Brown
Architects • Designers
Box 521, 122 Front Street Garden
Greenport, New York 11944
(516) 477.9752
August 10, 1993
ENE.RG.Y.......AL.CULA.T.IONS.
F.QR..._G52R~L~ANCE._..ki~TH
NEF1.-.YQRN.....STATE .....ENE . QY
GQN.SERY.A.TL.QN.....CQ~E
SHAPIRO RESIDENCE
Indian Neck Road
Peconic New York
SCTM No. 1000-86-6-7
On August 9, 1993, this structure was inspected and measured in
order to complete an calculation to determine compliance with the
New York State Energy Conservation Code,effective March 1, 1991.
I have found the structure to be in compliance with Part
4,section 7813, specifically Paragraph 2(b), which allows for
non-conforming components provided the total heat-loss for the
structure does not exceed the total heat loss for a structure in
which all components comply.
The calculations follow:; `r
xt;
Page - 1
Fairweather • Brown
Architects • Designers
Box 521, 122 Front Street Garden
Greenport, New York 11944
(516) 477.9752
1,245 SF
Net wall area 954 SF U=.078
Single glass w/ storm 100 SF U=.50
Insulated glazing 123 SF U=.48
Wood door 20 SF U=.36
1/2 Glass door 17 SF U=.67
Single glazed door 32 SF U=.83
NET WALL CALCULATIONS:
Insulation R-13 Studs R=3.5
1/2" Gyp Bd 0.45 0.45
1/2" Sheathing 0.62 0.62
Cedar Shingles 0.87 0.87
TOTAL R=14.94 R=5.44
U=0.067 U=0.184
U (net wall) _ (.906 x .067)+(.094 x .184) _ .078
U (total wall) _
1245 SF
U=.183 (wall)
to
(U=.20 maximum per Table 4-1)
n
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Page - 2
Fairweather • Brown
Architects . Designers
Box 521, 122 Front Street Garden
Greenport, New York 11944
(516) 477-9752
Ceiling area - 1239 SF
Insulation R=22 Joists R=5.5
1/2" Gyp Bd 0.45 0.45
1/2" Sheathing 0.62 0.62
Asph. Shingles 0.44 0.44
TOTAL R=12.51 R=7.01
U=0.043 U=0.143
U(ceiling) _ (.906 x .043) + (.094 x .143) _ .052
(U=.05 maximum per Table 4-1)
Floor aalp
Original floor area = 727 SF:
Insulation R-19 Joists R=5.5
3/4"subfloor 0.94 0.94
Hardwood floor 0.68 0.68
TOTAL R=20.62 R=7.12
U=0.048 U=0.14
U(orig floor) _ (.906 x .048) + (.094 x .14) _ .056
Added floor area = 512 SF
Insulation R=22 Joists R=7.5
3/4"subfloor 0.94 0.94
Hardwood floor 0.68 0.68
TOTAL R=23.62 R=9.12
U=0.042 U=0.11
U(add. floor) _ (.906 x .048) + (.094 x .14) _ .048
U (tota 1 floor)- Q5.,§x7,7.)_+,,,(,,,,Q~#8x5,2,)„ _ .052
1239
(U=.05 maximum per Table 4-1)
Page - 3
Fairweather • Brown
Architects • Designers
Box 521, 122 Front Street Garden
Greenport, New York 11944
(516)477-9752
Total heat loss allowed per Table 4-1, NYSECC:
Walls: 1245 SF x 0.20 x 65(deg.) = 16,185 BTUH
Ceiling 1239 SF x 0.05 x 65 = 4,027
Floor 1239 SF x 0.05 x 65 =
Total 24,239 BTUH
Actual heat loss:
Walls: 1245 SF x 0.18 x 65(deg.) = 14,567 BTUH
Ceiling 1239 SF x 0.052 x 65 s 4,188
Floor 1239 SF x 0.052 x 65 = ....4..,.,i,.
Total 22,943 BTUH
Since the actual heat loss is less than the maximum allowed heat
loss per Table 4-1, the house is in compliance with the New York
State Energy Conservation Code.
3 4
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Page - 4 ,
BOARD OF HEALTH
FORM NO, 1 J SETS OF PL.,aiS .
TOWN OF SOUTHOLD SURVEY
BUILDING DEPARTMENT CHECK
TOWN HALL SEPTIC FORK
SOUTHOLD, N.Y. 17971
TEL.: 765.1802 Ii OT I FY ;
p
Examined CALL 19C11J). MA> L TO:.. . .
Approved 19, ll. Permit No. I .
Disapproved, a/c . .....I....................... _ .
w.
0-1
rr :1
IF)
t ` (Buildain~nspec" tor)
k
3 ~Jd I APPLICATION FOR BUILDING PERMIT
o'
.f17 • E
Date 1
ETO.W,NOF 9~-
r. SOO-A L0 g'! INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
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 street
or areas, and giving 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 permi'
shall be kept on the premises avallab;le 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 hou in code, and regulations, and to
admit authorized inspectors on premises and in building for necessary i ions.~`~~°~i
(Sign ure of applicant, or name, if a corporation)
(Mailing address of applicant) ~%C to qq
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises 1. ~ . CC?1 - ex Qrsyt.~
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. j . . .
Plumber's License No. .
i
Electrician's License No, , , , , , , , , , ,
Other Trade's License No. ....i, , , , , , ,
0 ~
Location of ]and on which ProP0;;ed work will be done.
~r~S, „ll~~~~c~~~~~~l.~.Y:~~.E3F`~? C;
House Number
Street Hamlet
County Tax Map No. 1000 Section Block G:2 Lot .
Subdivision . ...........1 Filed Map No. Lot , , .
Name)
1 State existing use and occupancy of premises and intended use and occupancy of proposed con ction:
a. Existing use and occupancy
~v \ S~~yZSe,R t
b. Intended use and occupancy
Q... art4
-3. Nature of work (check which applicable): New Budding
Repair Removal . , , , , , , , ' ' • Addition Alteration
.
Demolition
• Other work
4. Estimated Cost (Description)
+vv`~ Fee
S. If dwelling, number of dwelling (to be paid on filing this application)
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 .
7. Dimensions of existing structures, if any: Front .
Height Rear Depth
........Number of Stories .
Dimensions of same structure with alterations or additions: Front
Depth Rear
Height , , Number of Stories
8. Dimensions of entire new construction: Front .
.
Height Rear ...............Depth
Number of Stories
y. Size of lot: front Rear
.
10. Date of Purchase Depth
••••••••••••..........Name ofFormer Owner
11. Zone or use district in which premises are situated ' ' ' • • • • • • •
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded • • • .
14. Name of Owner of premises , Will excess fill be removed from premises: Yes N(
Name of Architect ' ' ' ' ' ' • • Address . Phone Nq.
. . Address .
, Phone No.
Name of Contractor '
15. Is this property within 300 feet of a tidal dwetland? Phone No.
*If yes, Southold Town Trustees Permit may be required No.........
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 number or description according to deed, and show street names and indicate whether
interior or corner lot.
. 0-7
STATE OF N YO ~.yN
COUNTY OM~ X S'S
• being duly sworn, deposes and says that he is the applicant
(Nam eofindividual lssigning contract)
above named.
He is the .
(Contractor, agent, corporate officer, etc.)
Df 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.
Sworn to before me this
da o v6 19
:otary Public,
.County
County
aoTavuauc, otHw cA'`~' ~
pa 4725089, Coin c3iA e Ei (Signature of applicant)
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1 AUG 1 2 1993 ;11
N O UOUAT. BL" N OF S7HOLD
SIG"OG f
e%IV P/ATT II4'pJ4AVOO - CGDPS 5 4KF/ n
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=APAI
NUh S. c*o B1M1
765-FY BUILDING DEPARTMENT AT
785-1802 S AM TG 4 PM FOR THE FOLLOWING INSPECTIONS:
GJl-1/~Vl~~ __.~fj+~%}i _•4r,"~_,_~ - I. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
~u'r-,.,~ I p1 E? ~NiC / 1,4 3. INSULATION
4. FINAL - CONSTRUCTION MUST ~fM hl° IEY7C~"Sla-67 BE COMPLETE FOR C. O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N V
STATE CONSTRUCTION & ENERGY _ 3CT N T~j F-tU~71r~0(~ CODES. NOT RESPONSIBLE FOR
(G-xrvnrk:I t;ONl71'(IChI~,~ DESIGN OR CONSTRUCTION ERRORS
1'~ 1
2"~°b° FI.ooR ,701~~ OCCUPANCY OR
m Itdbl.
i.
USE IS UNLAWFUL
--PJ''CONG, P.l,.LLrK FLUNDA?147N ' WITHOUT CERTIFICATE
OF OCCUPANCY
KNOW