HomeMy WebLinkAbout16797-zFORM NO. 4
TOM/q. OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southo~d, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-18345
Date AUGUST 31, 1989 ....
THIS CERTIFIES that the buildin9
Location of Property 3210 ~LLS ROAD
House No.
County Tax Map No. 1000 Section 086
Subdivision
ONE FAMILY DWELLING
PECONIC, N.Y.
Street Hamlet
.Block 1 Lot 10.2
Filed Map No. Lot No.
conforms substantially to the Application for Building Perrait heretofore
filed in this office dated MARCH 11, 1958 pursuant to which
Building Permit No. 16797-Z dated Vd~RCH 11¢ 1988
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 D~ELLING WITH ATTACHED GARAGE AS APPLIED FOR.
The certificate is issued to
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. H-009128 - APRIL 19~ 1989
PLUMBERS CERTIFICATION DATED APRIL 27, 1989-JOHN R. MEHRMAN
JOHN R. & NORMAJEAN MEHRMAN
Rev. 1/81
Inspector
TOWN OF Sou'rHOLD
BUILDING DEPAR'rMtEN'r
TOWN HALL
SOU?HOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NO
- 16797/ Z ~,. .... ~..'. ............................................ ,
Permission is hereby granted tO: .9
...gi.~. ................ ~,....?,,~.., ...............................
. ....~,,d~..,..~/...,~.~ ........... y.7./3 ......
...~....~. '....~.. '.~.....M., , . ~P' ~' ._ ,. '--,,.- _.,,!_//', / .~..~../..~./..~'-
__ . . .. ........ .................................
~, ,~,,,, ~=ed ~, ....~..~./..o......~;..~I~......~ ..................................................................
o ../.o, ~--
County Tax Map No. 1000 Section ........... ~s~.. ..... Block .............. ~ ./..... Lot No ......................
pursuant to application dated '"i.~/~//PO/~'~'~j~ ............... , 19 ........ , and approved by the
Building Inspector.
Rev. 6/30/80
I~OB, M NO. ~
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)
14911 Z
Permission is hereb/granted to:
............
........ .~.~..~.....~.~.....~ .....................
'~" '~~"""~';~":~ .~ ~, n.,' ~-..
~(~ , , .r~o~ ~_ .-.ll_d~- - · ~.--~...~ I L)~ U
..~.....,~,~.~.....~ ............ L~,.~..~..._ .~~ .....................................................
ot premises lo, cited~ at ,..l~.~....l~. ...... . ..~....~......,~.,~...~.'~....~Z .......................
pursuant
Building Inspector.
Building Inspector
Rev. 6/30/80
Ir'OB. BI NO, S
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)
N? 1316t Z
County Tax Mop No. 1000 Section .... ..(~..~...~. ....... Block .......... I ........... Lot No. C~ ,~-~
pursuant to application dated ......... ..~..~....~:....~:'.. .................. , 19.~].~..,- and approved by the
Building Inspector.
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDINC DEPARTHENT
TOWN HALL
SOUTROLD, NEW YORK
765 - 1802
11971
APPLICATION FOR CERTIFICATE OF OCCUPANCy
NEW COHSTRUCTION -- ~...OLD OR PRE-EXISTING BUILDING ...... VACANT LAND
Location of Property..~.'~ ........ ..~0.~5~.%~~ ........ .~.~ ............
~OHSS ~o. STREET UA~L~Z
Owner or Owners of Property.~p~..~.~e~.~.Q~.rfx.%.x~ ..................
County Tax Hap No. 1000 Section ~. Block ..~ .... Lot' ..~..
Subdivision .......................
Permit No. ~
.......... Date of Permit
Health Dept. Approval ./.~;~.~- ~V ·
Planuing Board Approval ................
Filed Map ........ Lot ..........
Underwriters Approval ...........
Request for Temporary,'Certificate ....... Final Certificate
Fee Submitted' $
rev. 10/14/88
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
TEMPORARY
CERTIFICATE OF OCCUPANCY
No Z17967
Date APRIL 25, 1989
THIS CERTIFIES that the building
Location of Property 3210 WELLS ROAD
House No.
County Tax Map No. 1000 Section 86
Subdivision
ONE FAMILY DWELLING
PECONIC
Street Hamlet
Block 01 Lot 10.2
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 11~ 1988 pursuant to which
Building Permit No. 16797Z dated MARCH 1t, 1988
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, ATTACHED GARAGE.
REPLACES B.P. #14911Z
The certificate is issued to
JOHN R. MEHRMAN
(owner, X~)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 14-SO-97
UNDERWRITERS CERTIFICATE NO. PENDING SLIP 3/27/89
PLUMBERS CERTIFICATION DATED PENDING
Building Inspector
Rev. 1/81
THE NEW YORK BOARD OF FIRE UNDERWRITERS 1
R~'JOJ~9~ BUREAU OF ELECTRICITY
eS JOHN STREET, NEW YORK, NEW YORK 10038
O. te APRIL 19,1989 ,4ppli~ation~%~.onfile 49794287/87 ~ 009128
THIS CE~IFIE~ THAT
~y [~ e~t~ ~uipme~ ~ ~d~ ~w a~ intr~ by t~ ap~i~nt ~m~ on the ~ appllcat~o~ num~r in ~he p~m~ of
JOHN R. EEHRMAN, 32i0 WELLS RD~ POLE ~22, PECONiC, N.Y.
~s ex. ml.~ on F~RC~ 27,19 8 9 and.found to be in compliance with the req,tirernentn of this Board.
lot
FIXTUI~ ~ [ t FIXTURES j RANGES ICOOKING DECKS ! OVENS ]DISH WASHERSi EXHAUST ~ANS
OUTLETS ~EC~PTACLESt ~NITO4ES ~N~E~ Ft~E~E~ ~ OTHER ~Z ~ K W ~T. ~ K W ~ ~T J K w ~t- g W ~T' H p'
63 ~7 74 62 i ! 1 7.3 I t.2 10 ~
OTHER APPARATUS:
MOTORS:i-i/3 H.P.
PANELBOARDS:I-36 CIR. 200,1-5 CiR. 100
G.F.C.I:-14
SMOKE DETECTOR:-3
TRACK LIGHTING:-32
JOHN R. MEHRMAN
83 CIRCUIT RD.
BELLPORT, NY, 11713
GENERAL MANAGER
This certificate must not be altered in ony manner; return to the office of the Boord if incorrect. Inspectors may be identified by their credgntlals.
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL. 765-1802
CERTIFICATION
Building Permit NO. /~ 7q'77-
Owner ~/~
(please prin~)/ '
(please print)
I certify that the solder used
contains less than 2/10 of 1% lead.
in the water supply system
~ ~plumbe~'s signature)
Sworn to before me ~his
Notary ,ublic,,~---~ (~ County ELFF~4BETHANN.E~LL~
Term ~ir~ ~ 3L 1 ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NE~ YORK
765 - 1802
11971
APPLICATION FOR CEKTIFICATE OF OCCUPANCY
HEW CONSTRUCTION
....... OLD OR
Location of Property .....................................
HOHSE NO. STREET HAMLET
O.ner or Owaers of Property..~n ¢.~.
Coonty Tax ~ap No. 1000 Section Xk.. Block .aL .... Lot .15.'~ ....
Subdivision ....................... Filed Map ........ Loc ..........
Health Dept. Approval ..I.~ 23.O.~.~.~ ...... Underwriters Approval.~¢U.~.~.3.
Plaanlng Board Approval ................
Requesc for Temporary Certificate ...~.... Final Certificate ................
Fee Submitted-
APPLICANT ............
c o £ I' '7% 7
rev. 10114/88
~' I E [,O [iL~;FECTION
1.
t~ OU:J DA'r I Oil ( 1 s t', )
COi'I 'lkN r~
FOUIID A'I' IOfl ( 2nd )
?LUMBING
3.
'IIlSUt, ATION IPER N.
~';T A'r E EI~ EP, G Y
C,ODE
AI)DITIO~IAL COMMENTS:
83 Circuit Road
Bellpont, New YonK 11713
November 4, 1987
Town o~ Southold
Building Department
Town Hall
Southold, New York
Dear Sirs;
I am writing to request a six month extension on my
bui]din9 permit ~149tl Z. The location o~ the property is
3210 We]is Road in Peconic.
ThanR-you for your attention in this matter-.
Sincerely,
.John R. ~ehrman
BLDG. DEPT.
83 Circuit Road ~ 7',V~qOFSOUTHOLD
Bellport, New Yorl( 11713
October 21, 19B5
Town of Southold
Building Department
Town Hall
Southold, New York
Dear Sirs:
I am writing to request a six month extension on my building
permit ~13164 Z. The location of the property is 3210 ~ells Road in
Peconic.
Than~-you for your attention in this matter.
~,, ~PPROVED AS NOTED
IqOT[~ BUILDING ~PA~TMENT AT
~65-1802 9 AM TO 4 PM FOR TH[
FOLLOWING iNSPECTIONS:
~]. FOUNDATION - ~O REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING &
~3. INSULATION
4. FINAL - CONSTRUCTION
BE COMPL~E FOR C. O.
'ALL CON~RU~ION 5HALL
~E REOUIREMEN~S OF THE N.Y.
~ATE CON~R~tON & ENERGY
CODES. NOT RESPONSIBLE FOR
D~IGN OR CoN~RU~ION ERRORS,
Sincerely,
John R.,Hehrman
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST []ROUGH PLBG.
FOUNDATION 2ND []INSULATION
[~FRAMING []FINAL
INSPECTOR
/67,°7
7GS-ZS02
BUILDING DEPT.
INSPECTION
FOUNDATION IST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ~/~SULATION
FRAMING
[ ] FINAL
76S-~02
BUILDING DEPT,
INSPECTION
REMARKS:
FINAL
INSPECTOR
[ ] FRAMING
FOUNDATION 1ST [//] RO~JGH PLBG.
FOUNDATION ZN. []~L~g~iN/~JLA~
76S.1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION ~,ST [ ] ROUGH PI~BG.
[//']/'FOUNDATION 2:ND [ ]INSULATION
[ ] FRAMING
FINAL
REMARKS:
DATE
765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION ZST
FOUNDATION ZND
FRAMING
REMARKS:
ROUGH PLBG.
INSULATION
r~FINAL
INSPECTOR~
THE NEW YORK BOARD OF FIRE UNDERWRITERS
80]0899 BUREAU OF ELECTRICITY
~-- 85 JOHN STREET. NEW YORK. NBW YORK 10038
/~t. APR]is 19,1989 J~l~ti~No.~file 49794287/87 ~ 009128
~1~ ~IPIE~ THAT
~, HE{iREA#, 3210 W{':hLS RI)., POLE I 22, P~:C(~C, N.Y,
in t~/~ti~; ~ ~nt ~ I,~ Fl. ~ ~ FL GAR ,~*io. ~k
~ ezeml~ ~ HARCH ~7,1989 a~ fou~ to be ln com~iance with the requi~n~s ~ th~ ~d.
I~11~11 RXTWWS OVENS
OO~'~qS SWtTCHIS FL~SC~4T OTHEm
63 ~7 34 62
OIMMBIS
~%1~1 ~ONI4ICT S E R V I
MOTORS: 1- 1/3 H.P.
PANEl,,BOARDS:I:-36 C~. 200,1 5 CJIR. 300
G.F.C.I;-14
SMOKE DETECTOR :- 3
TRACK IJ. GHT [NC,: -' 32
600 ~
2/0
JOHN }{. MEHRMAW
{'I3 C1RCUIT RD.
BE1,L, PORT, }4Y. 11713
office of the Board if incorrect.
II
Per.
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y, 11971
TEL,: 765-1802
Examined..1{/1...0~...~..c~..., 19
Approved . .~..0~ .~.~..., 19~. Permit No../..~./.b. ~..~..
Disapproved a/c .....................................
Received ........... ,19...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ................... 19...
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
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 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 remogal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building cod/,/housing code, )ff~ regulations, and to
admit authorized inspectors on premises and in building for necessary inspec~nyJ/7~/~//7//~4///
~nature of applicant;j~)r name, if a corporation)
L 9
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builder.
............ ...........................................................................
Name of owner of premises . .d.~.~.~....~...~..~..~./~d'at/%/ ...................
(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 ..........................
Plumber's LicenSe No../4t...~..~.~4 .~. ·
Electrician's License No.// /~ (~
Other Trade's License No ......................
I. Location of land on which proposed work will be done. ~.].~..~..t.~..O~1~..~.~.. · .~...~..~.. '~' ./~. ..... -~..~. .........
............................ ,g..0.,4..Z:? .................. ....................
House Number Street Hamlet
County Tax Map No. 1000 Section ..... ....... Block.../. ............. Lot~~..
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n:~ '3' t
a. Existing use and occupancy ..... E~'~. [. ...................................................... ~
b. Intended use and occupancy ............................................ ~
J. Natureofwork (check which applicable): NewBuilding,~....' ..... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition~ .............. Other g/ork ...............
i "- (Description)
4. Estimated Cost ~../.0..O(,d, ......................... Fee ......................................
~" (to be paid on filing this application)
5. If dwelling, number of dwellinglunits ._.... / ........ Number of dwelling units on each floor ................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing stmctur6s, if any: Front.../~/.A~. ...... Rear .............. Depth ............
Height Numbar of Stories
Dimensions of same structure w~th alterations or additions: Front ................. Rear ..................
Depth ................... ~.. Height ...... : ............... Number of Stories · · · ~ v ......
8. Dimensions of entire new construction: Front . ~.O. ......... Rear .
11. Zone or use district in which premises are situated ............. .'~ .......................................
12. Does proposed constructio, n,~o~ate any zoning law, ordinance or regulation: ~.O. ...........................
13. Will lot be regraded ... d~.~. i ................... Will excess fill be removed from plq~mises: Yes (~
Name of Contractor .... .~.IiV.~.~$~ ............. Address ................... Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly al!' 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 comer lot.
A
STATE OF NEW Y)O~I~K,
· · · ~(~a.m/~e ;~! .' .'~..//~~. .~. .~. · - .-~. ............... being duly sworn, deposes and says that he is the applicant
/ (Name ofindiviflual signing contract)
abov~ named.
(Contractor, agent, corporate officer, etc.)
of said owner or ownem, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this
application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the
work will be perfomed in the m~ne set forth ~ the application filed therewith.
Sworn to before me this
........ ~. ~ ..... ..~ .day
' ) [ X No.[ 476/93~/ j
Com;~~'~'j~ (Signature of applic~t)
· I ...JO/_~r,~..,/. "~/. (~.~t-~t~-?( ~.J' ~, SUFFOLK COUNTY DEPA~MENT OF
: ~._)~;.,, ~ ~j. ~v/[A~ ~,~.,,~ SINGLE FAMILY D~LLING ONLY
Th~ s~'a~ dis9o:;~ and w~t~r
~11~, ~. ,': l f~!~_~.,:~ "SG- ~t~) ~c~tio~ i~ve bean i~so~cted by this D~partment and/or
- other.a~nc;~ ~nd found to be satisfac~ry.
W~w~
~ .
-
t
~ ~ ~, ~.Y. ~ .' ,~.~ .~, ~ ,
,OWN~[~: . SUFF. cO. HEALTH DEPT. APPROVAL { H. $. NO..
~ ~ U Y~. ~0~ . .oreo. the possibility ,x,sts t~t the
m~nts of ~st~c~e~ ~/ er
~O~/C RODERICK VAN TUYL, P. C.
~ SUFF. CO. DEPT. OF HEALTH $I~RVIOI~i , STATEMENT Off I~NT
8INGLE F~ILY DWELLING ONLY
O'
' DATE: ~ ~ ' DI~PO~L SY~EM~ FOR THI~ R;g{-
[ /~' DgNC~ WILL CONFORM TO TH~
Examined . 'fl/: .......... 19 .~.ff~
Approved .~?/ ......... 19oC~.~. Permit No./~..?.~..7.
Disapproved a/c .....................................
BOARD OF HEALTH ......
3 SETS OF PLANS .......
FORM NO.,1 SURVEY ..........
TOWN OF SOUTHOLD CHECK ......... /
BUILDING DEPARTMENT SEPTIC FORM ............. :
TOWN HALL NOTIFY
°,,OUTHOLD, N.¥. 11971
TEL.: 785-1802 CALL ................
MAIL TO:
(Builflin~ ~pector)
APPLICATION FOR BUILDING PERMIT
Date .................. , 19...
INSTRUCTIONS
a. This application must be completely filled in by Wpewriter 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
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 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 cfa Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New Y6rk hnd' other, app!igable Laws Ordinances or
Regulations, for the constructmn of buildings, additions or alteratmns, o~ fo~ removhl or d,emohtion, as hereto desert ed.
The applicant agrees to comply with all applicable laws, ordinances, buflgiflg,~'od~; housing co_de, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspe~ti~s~//~
(Signa~fim of app'lic~ttlt, or' name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
....... .C;.~ ??.,.rT ...............................................................................
Name of owner of premises . ?.~.o..~...'~.: .~.,¢~?.~. ~ .~. ...............................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer) .
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ..........................
Plumber's License No... T.</~:~.~..~.L.~,c~.<~..~ .....
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done .... /~. ~.~./... ~ 0~.k....c~..£~.,~.~ .~.,~...¢v~ .........
......... d. ............... , .............
House Number Street Hamlet
County Tax Map No. 1000 Section ....C?.~...~ .......... Block / Lot. Z(? ~ ~
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........ .~. {: .~.q~g~- .....................................................
b. Intendeduseandoccupancy .~ d.n.~.j.o~ .~. .,~,d~ :~ ~'.~-I1~ .~
ture of work (check which appiicable): New Building . ~ .' ..... Addition .......... Alteration ..........
pair .............. Removal .............. Demolition ............ Other Work ...............
. (D ip~ti )
4. Estimated Cost ....... .~..~ ~..rt)'Z.? ........................ Fee ......................................
· (to be paid on filing this application)
5. If dwelling, number of dwelling u~its .... ./ .......... Number o,qdwelling units on each floor ................
If garage, number of cars ......
6. If business commercial or mixed occupancy 's~pecif~nature and extent of each type of use ....................
7. Dimensions of existing structures,! if any: Front.. &/.,~ ......... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions'of same structure with alterations or additions: Front ................. Rear ..................
Depth ..................... ]. Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front .... 6~.... ..... Rear ... (>.9 ......... Depth . .~ .7. ?. .......
Height ...q,n~ ......... Numb:er of Stories ....... ./~_ ..............................................
9. Size of lot: Front ...... /~c. Tf.i .......... Rear ...... /.6X..~.7 ........ Depth .'.&?fl2 ff...,,Y?? ............
10. Date of Purchase .... .cr.//&//.g. oM ·... ............ Name of Former Owner .... ._v.% .~.....B??.~.~.(~. .........
11. Zone or use district in which premises are situated .......... .A. .........................................
Does proposed construction violate any zoning law, ordinance or regulation: ...~.. c.?. ........................
13.12. Will lot be regraded ....... ./~,(~ .................. Will excess fill be removed from premises} Yes
Name of Contractor ...C~..cC..n~. :~ ......... Address .... : .............. Phone No ..............
15. Is this property located w~thin 300 feet of a tidal wetland? *Yes ..... /'No .....
· If yes, Southold Town Trus!tees Permit maybe required.
- i PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimenmons from
property lines. Give street and block n~mber or description according to deed, and show street names and indicate whether
interior or corner lot.
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
A~RO~DASNO~D
NOTIFY B[flLDII~G DEPARJ'I~I~NT AT
~65~1802 ~ AM TO 4 PM ~R ~E
FOLLOWING INSPECTIONS:
FOUN~A'f!OM ~VO R~XIUIRED
FOR POU~,O
ROUGH
4. FINAL CO~gY'[~[~C"fK)N MUST
ALL COM~T(:~OC'[*Oh~ gHALL ~EET
STATE OF NEW YORK, S.S
COUNTY OF ................. ~
............ ~ .................................... being duly sworn, deposes and says that he is the applicant
(Name of individual ' "
mgmng contract)
above named.
He is the . . .C.~X~.w?.,~<.. ....... , ..................................................................
i (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dul~ 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
.............. // ...... , .day of. .... 79¢~ .... , 19 ff~. "
HELEN & I)E VOE i' ...
NOTARY PUBLIC, Stale of New YoLk .........................
. Ne,370787B, Suffolk County~'~] applicant)
~e~m ~pires M~rch 30,
AREA INSULATION SUBSYSTEM CODE ALLOWABLE DESIGN
~UBSYSTEM FT~ "R" VALUE "U" VALUE "U"OR R BTUH BTU"
EXTERIOR WALL (GROSS)
EXTERIOR WAlL (OPAQUE)
TOTAL DOORS (TO UNHEATED SPACES)
FLOORS (OVER AMBIENT CONDITIONS)
HEATED BASEMENT WALLS (TOP TO GRADE)
HEATED BASEMENT WALLS (DOWN 24" FROM GRADE) ,
HEATED SLABS (DOWN 24" FROM TOP OF SLAB)
UNHEATED SLABS (DOWN 24" FROM TOP OF SLAB)
PERCENT DOOR AREA
DESIGN INSIDE WINTER TEMP,
DESIGN OUTSIDE WINTER TEMP.
DESIGN DEGREE DAYS
MAXIMUM ALLOWABLE BTUH
TOTAL DESIGN BTUH
* Insulation may be omitted over unheated spaces when
foundation walls are insulated as required by code.
ENERGY CONSERVATION SPECIFICATIONS (DESIGN BY ACC£PTABLE PRACTICE)
GLAZING
Maximum glass area sh~ll not exceed 23% of the total exterior wall area.
All operable windows must be weatherstripped.
All windows must be double glazed or provided with storm sash.
DOORS
All exterior doors opening on unheated areas must be insulated and weather-
stripped or be accompanied by a weatherstripped storm door.
AIR LEAKAGE
a, Window & Door Infiltration
Windows
Swinging door
Slidin§ glass doors
(25 mph wind)
0.5 cfm maximum per linear foot of sash crack
1.0 cfm maximum per sq.ft, of door area
0.5 cfm maximum per sq.ft, of door area
b. Exterior joints and cracks around windows, doors, openings between walls
and roofs, walls and foundations, penetrations, etc. shall be caulked,
gasketed, weatherstripped or otherwise sealed.
c. Residential fireplaces shall have losses with damper closed not to exceed
20 cfm. Fireplaces shall be provided with dampered outside combustion air
vent each side or in hearth wi th a total capacity of 150-200 cfm, and a
maximum leakage rate of 20 cfm when closed.
MECHANICAL SYSTEM CONTROL
a. Thermostat shall be provided for each dwelling unit or separate HVAC system.
A readily accessible manual or automatic means to partially restrict or shut-
off heating and cooling to each zone or story shall be providsd. Wh~re used
for heating, thermostat shall be capable of being set from 45 t~ 7§~; ~or
heating and cooling, it shall be capable of being set between 45
TM to 85 F.
* MECHANICAL SYSTEM INSULATION
a. Air handling duct system
All ducts, plenums and enclosures in unheated basements shall be insulated
with duct insulation having an R value not less than R:5.
b. Piping, Heating system (120° - 200° F)
Runouts up to 2" dia. 1/2" (R-4 per inch or greater)
1" or less in diam. 3/4" (R-4 per inch or greater)
* In one and two family dwellings which have insulated walls in basement/cella~
and unventilated crawl spaces, insulation in those spaces may be exempt.
ENERGY CONSERVATION SPECIFICATIONS - Cont'd
HEATING EQUIPMENT PERFORMANCE
Combustion efficiency of gas and oil comfort heating equipment shall be no less
than 75% at maximum rated output.
SERVICE WATER HEATING
All Class One oil fired water heater~ shall have a minimum combustion efficiency
of 80%; gas water heaters shall have a recovery efficiency of 75%. All heaters
shall not exceed allowable standby losses.
Water temperature settings shall not exceed 140°F maximum.
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SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT
EXCEED (2/10 of 1% LEAD. ,
PLUMBER CERTIFICATION'
ON LEAD CONTENT BEFORE'
CERTIFICATE OF OCCUPANCY
OCCU, ^ Y I]R
(iF OCCPJ?, N ¥
NOTIFY BUILDING DEPARTMENT
765-]802 9 AM TO 4 PM FOR
FOLLOWING INSPECTIONg:
]. FOUNDATION - TWO
FOR POURED CONCRetE
2 ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CON'STRUCTIQN MUST
BE COMPLFTF FOR C O
ALL CONSTRUCTIONF SFIALL MEET
THE REQUIREMENTS OF THE N.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
~ESIGN OR CONSTRUCTION ERRORS
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