HomeMy WebLinkAbout28991-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30029 Date: 02./18/04
I
i
- THIS CERTIFIES. that the building ADDITIONS
;'Lo'cation of Property:. ., 1395 AUGUST LA GREENPORT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No_ 473889 Section 53 Block 4 Lot 44.22
`-Sub'diivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
-filed in this office dated DECEMBER 9, 2002 pursuant to which
`Building Permit No. 28991-Z dated DECEMBER 9, 2002
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 DECK ADDITION, ENTRY DECK ADDITION, . UNHEATED SUNROOM ADDITION AND
ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to STEPHEN D & HELEN F RYAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A.
ELECTRICAL CERTIFICATE NO. 77239C 08/13/03
PLUMBERS CERTIFICATION DATED 02/13/04 ROBERT VAN ETTEN
j4a�
t
/ x-�
AuozAized Kignature
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'_ 28991 Z Date DECEMBER 9, 2002
Permission is hereby granted to:
STEPHEN D & HELEN F RYAN
1395 AUGUST LANE
GREENPORT,NY 11944
for
ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR
at premises located at 1395 AUGUST LA GREENPORT
County Tax Map No. 473889 Section 053 Block 0004 Lot No. 044 . 022
pursuant to application dated DECEMBER 9, 2002 and approved by the
Building Inspector to expire on JUNE 9, 2004
Fee $ 384 . 30
uthor ' z Signature
J
ORIGINAL
Rev. 5/8/02
,p Form No.6
TOWN OF SOUTHOLD ' t
BUILDING DEPARTMENT
TOWN HALL
765-1%02
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following.
C
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines, streets,an and a ual net
topographic features- _ y
2. Final Approval from Health Dept,of water supply and sewerage-disposal(S-9 form). d
3. Approval of electrical installation from Board of Fire Underwriters. j rt-B I!jl I
04
4. Sworn statement from plumber certifying that the solder used in system contains less i 'X2/10 of I%lead_
5. Commercial building,industrial building,multiple residences and similar buildings anti installations a certrffcate
y 3 C
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. Accuratel survey of property showing all property lines,streets,building and unusual natural or topographic
features.',
2. A properly completed application and 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,�O,
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- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00; Commercial$15,00
Date. C'j l�lC f
New Construction: Old or Pre-existing Building: (check one)
Location of Property: 1,3qS� &r ee n ff 1
House No. 0 Street Hamlet
Owner or Owners of Property: 5+e-P k-e + ge— e F R�A Cc Y�
Suffolk County Tax
/f�lap No 1000, Sectio, � �' Block b� Lot f� 2 ?i
Subdivision �a'lii -i /Tch4 C Filed Map. Lot:
Permit No. d 8 0,q 1 � Date of Permit. z 9 0`✓ Applicant: ^ l� 'r A Rtf tL h,
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
�F
Request for: Temporary Certificate Final Certificate:--- check o )
Fee Submitted: $ dJ t tf
P �/(GJ JAS Applicant SignatuVe
O���11FF0�,�cQ
0
co
Town Hall;53095 Main Road Fax(631)765-182
P.O.Box 1179 �i + t� Telephone(631)765-
Southold,New York 11971-0959 (
,m
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
1
J
!i
CERTIFICATION.
Date:
Building Permit No. 0 q
Owner: 'R y a-p
n (please print)
q� /
Plumber: 'er
(please print)
I certify that the solder used in the water supply system contains less than,2l10 of 1%
lead..
(Plumbers*SignaI
Sworn to before me this
day of V eQr 204
LYNDA M. BORN
NOTARY PUBLIC,State 3 New York
Qua rf ed n Suffolk County
Term Expires March 8,20
Notary Public.� County
. n :. i ✓: .r' �n •m` \ ° r. t\ � r" � '." S n \ r",T1 / ��'*.—.��P�`gs'11... � .
AI
Electricallnspectian Certificate
Issue Date Electrical Inspection Service,Inc. Application Number
03/13/2003 375.Dunton.Avenue 77239C
East Patchogue,New York 11772
c
' (634)288.6842
1
I; Issued To: Steven & Helen Ryan
Street: 1395 August Lane
Village: Greenport Zip: 11944 Town: Southold
Section: Block: Lot:
Contractor: Lademann Electric Inc. Lie. # 4141-E
Was examined and found to be in compliance with the National Electrical Code.
i ❑ Commercial ❑ NV Defects ❑ Pool X❑ 1st Floor ❑X Indoor ❑ Basement ❑ Hot Tub
(� ] Residential ❑ Det. Garage ❑ Attic ❑ 2nd Floor X❑ Outdoor EX Addition ❑ Survey
I Switches Receptacles Fixtures GFl Heaters A/C Fans
14 20 13 6 4
Dishwasher Washer/Amps DryerlAmps Oven Range/Amps Microwaves
Furnace Oil Gas Circulators Smoke Detector Bell Transformer
2
Meter Amps Phase UG/OH Jacuzzi Television CO Detector
1
Bldg. Permit:
Other Equipment
i
1 Hugo S. Surcli
President
i
Rough Inspection: 06/24/2003
Inspector: Ed Scavelli
Final Inspection: 06/12/2003
Inspector: EdScavelli
This certificate must not be altered in any manner. Inspectors may be identified by their credentials. .N
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BAY5�� �y2 lb ( H.5.055..-NO:.
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"ArnENOEO MPP FILE I l2 -MAP OF P c�PE2TY -
�UFF Gam,- Ill `r>D` WLR �
log I o I �µ�SE� STEPHEN Q * NELEN F, ( YQN S'
AT 0
(HOUSE) ''� AQSHAMOMAQUE
TowN aF 5afTHOLO,MY
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"AUGUST Ac2E5� Al CHCx15E SCALE:
N UNO. caysT,) A1A-41,63 sq.FT:
N SUFF.CO.FILE.MAP A0.9/07 (0,956 Ac) z . .
N O> MONUMENT 5
CO.TAX MAP DESICNAMON:
O
[9 i - 12 x 'ly H.�r OtST. 1000,SEC7:O53,BLK.4,FCL.44.22
(ROUSE) _ 26 IIit - owuE¢s 400eEss:
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ELEVATION OKNM'
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N43'09'40 W. - 150.0 "' 212.05 "�
�� LJLJ$ ae SI D TO 541441EN D,E HELEN F.RYAN, tj. N ev
-1�• $"1YATElZ MAIN UL5TEe SAVINSS BR1dK�CCM40NVWALTH LAND �� 1 W.LEW,�y
b� AUGUST by
LANE TITLE IN
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UND, CONST: -ACE CHCUSEJ CVACAN7) 4 33696 P
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a
1 Permit Number
MECekeck"Compliance Report Checked By/Date
New York State Energy Conservation Construction Code
MECcheck Software Version 3.3 Release le
Data filename:C:\Program Files\Check\MECchecklryan.eck
TITLE:Ryan
COUNTY: Suffolk
STATE:New York
HDD:5750
CONSTRUCTION TYPE:Detached 1 or 2 Family
HEATING TYPE:Non-Electric '
r
DATE: 12/05/02
DATE OF PLANS: 11/18/02
PROJECT INFORMATION: 1
Greenport ? :'
COMPLIANCE:Passes
Maximum UA=98 `
Your Home=68
30.6%Better Than Code
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R-Value R-Value -Factor UA
Ceiling 1:Flat Ceiling or Scissor Truss 589 30.0 0.0 21
Wall 1:Wood Frame, 16"o.c. 640 19.0 0.0 36
Window 1: Wood Frame,Double Pane with Low-E 32 0.340 11
COMPLIANCE STATEMENT: The proposed building represented in this document is consistent with the
building plans,specifications,and other calculations submitted with this permit application. The proposed systems
have been designed to meet the New York State Energy Conservation Construction Code requirements. When a
Registered Design Professional has stamped and signed this page,they are attesting that to the best of his/her
knowledge,befie�and pr onai judgment,such plans or specifications are in compliance with this Code.
Builder/Designer Date III LA "d2
i
I
MECcheck Inspection Checklist
New York State Energy Conservation Construction Code
MECcheck Software Version 3.3 Release lc
DATE:12105/02
TITLE:Ryan
Bldg.
Dept.
Use
I
Ceilings:
1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation
Comments:
i Above-Grade Walls:
[ ] J 1. Walll:Wood Frame, 16"o.c.,R-19.0 cavity insulation
J Comments:
J
Windows:
[ ] 1. Window 1:Wood Frame,Double Pane with Low-E,U-factor:0.340
J For windows without labeled U-factors,describe features:
J #Panes_Frame Type Thermal Break?[ ]Yes[ ]No
Comments:
Air Leakage:
[ ] J Joints;penetrations,and all other such openings in the building envelope that are sources of air
J leakage must be sealed.
[ ] Recessed lights must be 1)Type IC rated,or 2)installed inside an appropriate air-tight assembly
with a 0.5":clearance from combustible materials.If non-IC rated,the fixture must be installed with a
3"clearance from insulation.
J Vapor Retarder:
] J Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors.
Materials Identification:
[ ] J Materials and equipment must be installed in accordance with the manufacturer's installation instructions
[ ] { Materials and equipment must be identified so that compliance can be determined.
[ ] J Manufacturer manuals for all installed heating and cooling equipment and service water heating
(iJ equipment must be provided.
[ ] J Insulation R values and glazing U-factors must be clearly marked on the building plans or specifications.
J Duct Insulation:
Supply ducts in unconditioned attics or outside the building must be insulated to R-8.
f [ ] Return ducts in unconditioned attics or outside the building must be insulated to R-4.
Supply ducts in unconditioned spaces must be insulated to R-8.
[ ] J Return ducts in unconditioned spaces(except basements)must be insulated to R-2.
Insulation is not required on return ducts in basements.
J
Duct Construction:
[ ] I All joints,seams,and connections must be securely fastened with welds,gaskets,mastics
(adhesives),mastic-plus-embedded-fabric,or tapes. Duct tape is not permitted.
Exception: Continuously welded and locking-type longitudinal joints and seams on ducts
operating at less than 2 in.w.g. (500 Pa).
Ducts shall be supported every 10 feet or in accordance with the manufacturer's instructions.
{ ] Cooling ducts with exterior insulation must be covered with a vapor retarder.
[ l f All'filters are required in the return air system.
] The HVAC system must provide a means for balancing air and water systems.
Temperature Controls:
{ J Each dwelling unit has at lesat one thermostat capable of automatically adjusting the space
temperature set point of the largest zone.
s
Electric Systems:
{ ] Separate electric meters are required for each dwelling unit.
pppp ' Fireplaces:
Fireplaces must be installed with tight fitting non-combustible fireplace doors.
[ ] Fireplaces must beprovided with a source of combustion air,as required by the Fireplace construction
provisions ofthe Building Code ofNew York State,the Residential Code ofNew York State or
the New York City Suing Cade,as applicable-
Service Water Heating:
f ] I Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the
water heater has an integral heat trap or is part of a circulating system.
[ } Insulate circulating hot water pipes to the levels in Table 1.
I
Circulating Hot Water Systems:
{ ] Insulate circulating hot water pipes to the levels in Table 1.
Swimming Pools:
{ ] All heated swimming pools must have an on/offheater switch and require a cover unless over 20°/a
of the heating energy is from non-depletable sources. Pool pumps require a time clock.
Heating and Cooling Piping Insulation:
[ ] HVAC piping conveying fluids above 105 V or chilled fluids below 55°F must be insulated to the
levels in Table 2.
ill
,II
i
Table 1: Minimum Insuiation Thickness forCirculating Rot Water Pipes.
Insulation Thickness in Inches by Pike Sizes
Heated Water Non-Circulating Runouts Circulating Mains and Runouts
Temperature(F) U_ to o 1„ Up to 1.25" 1.5"to 2.0" Over 2"
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
Table 2: AfinimuminsulationThicknessforHVACPipes.
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
Pining System Types Range(F) 2"ltunouts 1 and Less 1.25 to 2" 2.5"to 4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0
Low Temperature 120-200 0.5 1.0 1-0 1.5
Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0
Cooling Systems
' Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0
?I
and Brine Below 40 1.0 1.0 1.5 1.5
f'
NOTES TO FIELD(Building Department Use Only)
I
it
III
„x
�r ✓ 41
44
TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET r VILLAGE bIST. SUB LOT
U_SA Lit } t( .
C'w't-I-) r � .
ACR. RE AR s
TYPE OF BLD._ pp pp 1 /
1�L' .z�wac
PROP ASS
LAND IMP. TOTAL DATE
>® c ->'o lot
k tr.7
1P v 759o1$td 4 000 2
,bo® --
T—
e� 8�O 2Fa
FRONTAGE ON WATER TILLABLE
FRONTAGE ON ROAD WOODLAND
DEPTH MEADOWLAND t�®
BULKHEAD HOUSE/LOT
TOTAL
i 6z_q 2/��n
I
I
7 i I
r
�jtII x �r �l I I COLOR
t
�tl �ISiIjTIlhi�uJ
�iwg- w
1
iY I . . 6F ..a.' f � TRIM
L J ter L"'A
6 Foundation as Bath Dinette
M. BId r tit{ t��i� I25C�
FO
Extension Basement Aw Floors Kit.
BLAB
Extension
Ext. Walls �, le cCa Interior Finish L.R. t/
Extension Fire Place Y� Heat eid D.R. /
Patio Woodstove BR. g /
Porch Dormer
_ Attic �o..J�../.
V
Deck
Breezeway Rooms tst Floor
Driveway Rooms 2nd Q- 2
Floor u-
arage qG Ea
O.B.-
Pool e(OB c�c.e..'�-':... . :)•c bpot!�t#
BUILDING PEWMT EXAN HNER CHECK LIST
y DATE REVIEWED: /L/_/02
APPLICANT: / E's DATE SUBMITTED: / /02
SCTM#DISTRICT: 1000, SECTION: BLOCK: ~ ' , LOT: 2
STREET ADDRESS: CITY: SUBDIVISION: Aedw
PROJECT DESCRIPTION: yj
k
ESTIMATED PROJECT COST: —!�ARCHITE %NGI t"" FAST TRACK?,Ao�
SINGLE & SEPARATE CERTIFICATION-REQUIRED?�NOTES: �—
� LOTS 40,OOOSF-100-24- copitron.(CRE D.bcfore lun1UNDER=LOTS
i- MJAN.1997100-25..Merger,(A nonconforming at any time after 7/i/8:
ZONING DISTRICT CONFORMING?
REQ_ LOT SIZE: i ° ACT. LOT SIZE:OWREQ. LOT COV. ACT. LOT COV.
REQ. FRONT 556 PROP. FRONT ✓RE SIDEcp7� ,/
ACT. SIDE
REQ. REAR-----60—PROP. REAR REQ. 11 GHT PROP. HEIGHT
WATER FRONT? /k/d DESCRIPTION:
PANEL #:/ FLOOD ZONE
APPROVALSREOUIRED
SUFFOLK COUNTY HEALTH D : YES or O ED# : DTE: / PERMIT#:R10-
TOWN SEPTIC RECEIPT:Y AJ
NEW YORK STATE DEC. P - Ec 9ny75 YES o
SOUTHOLD TOWN TRUSTEES: YES o
TOWN:ZONINGBOARD APPROVAL: YES or
TOWN PLAN. BOARD APPROVAL: YES o
TOWN HISTORICAL PRE (SPLIA): YES o
NYS ENERGOR NO
EGRESS (18 mm.? 4 sq total) VENT(SQ. FT. x 4%) – LIGHT (SQ.FT. x 8%)�
BUILDING PERMITS OPEN/EXPIRED: BP -Z/C/0 Z-
HAVE PRE CO'S: Y OR N BP -Z/C/o Z-
NOTES:
FEE STRUCTURE:FOUNDATION: coo SF
FIRST FLOOR: 10,31 SF
SECOND FLOOR: SF
OTHER: SF INIT OTHER
TOTAL: F FEE E
i. ( / SF)- SFr 5F X $ I +$
2. (-SF)-( SF)= SF X
i
Permit Number
j
SV�Ch
. ,
Compliance Report Checked By/Date
New York State Energy Conservation Construction Code
=MECcheck Software Version;3.3 Release le
Data filename.C:1Program FileslkChecktMECcheckkyan.cck
TITLE:Ryan
i
COUNTY:Suffolk
f STATE:New York
OD:5750
CONSTRQCTION TYPE:Detached l or 2 Family
HEATING TYPE:Non-Electric
DATE; 12/05/02 X r t OFr
DATE OFPLANS: 11/19/02
PROJECT INFORMATION: '
Greenport N 1 ZZ,
COMPLIANCE:Passes �
Maximum UA=98
Your Home=68
30.6%Better Than Code
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R Value R Value U-Factor UA
Ceiling l:Flat Ceiling or Scissor Truss 589 30.0 0.0 21
Wall 1:Wood Frame, 16"o c. 640 19.0 0.0 36
Window 1:Wood Frame,Double Pane with Low-E 32 0.340 11
COMPLIANCE STATEMENT: The proposed building represented in this document is consistent with the
building plans,'specifications,and other calculations submitted with this permit application. The proposed systems
have been designed to meet the New York State Energy Conservation Construction Code requirements. When a
Registered Design Professional has stamped and signed this page,they are attesting that to the best ofhis/her
knowledge,belied and prosaianal judgment,such plans or specifications are in compliance with this Code.
' Butlder/Designer Date V1 ^C%�
9
MECeheck Inspection Checklist
New York State Energy Conservation Construction Code
MECcheek Software Version 3.3 Release Ic
DATE: 12/05/02
i
TITLE:Ryan
i
Bldg. I
Dept.
Use {
l
I Ceilings:
[ ] I 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation
I Comments:
I
{ Above-Grade Walls:
j ] ( 1. Wall 1:Wood Frame, 16"o.e.,R.19.0 cavity insulation
{ Comments:
I
I Windows:
t ] f 1. Window I:Wood Frame,Double Pane with Low-F,U-factor:0.340
{ For Windows without labeled U-factors,describe features:
#Panes_Frame Type Thermal Break?[ ]Yes[ ]No
{ Comments
j
j Air Leakage:
[ ] { Joints,penetrations,and all other such openingss in the building envelope that are sources of air
leakage must be sealed.
Recessed lights must be,1)Type IC rated,or 2)installed inside an appropriate air-tight assembly
i with a 0.5"clearance from combustible materials.If non-IC rated,the fixture must be installed with a
I 3"clearance from insulation.
I Vapor Retarder:
t ] I Required on the warm-hr-winter side of all non-vented framed ceilings,walls,and floors.
I
I Materials Identification:
[ ] I Materials and equipment must be installed in accordance with the manufacturer's installation instructions
t ] I Materials and;equipment must be identified so that compliance can be determined.
t ] I Manufacpzrermanuals for all installed heating and cooling equipment and service water heating
I equipment must beprovided-
Insulation R-values and glazing LT-factors must be clearly marked on the building plans or specifications.
I
I Duct Insulation:
t } I Supply ducts in unconditioned attics or outside the building must be insulated to R-8.
[ ] I Return ducts in unconditioned attics or outside the building must be insulated to R-4.
] { Supply ducts in unconditioned spaces most be insulated to R S.
t ] J Return ducts in unconditioned spaces(except basements)must be insulated to R-2.
I Insulation is not required on return ducts in basements.
I
Duct Construction:
[ ] { All joints,seams,and connections must be securely fastened with welds,gaskets,mastics
j (adhesives),mastic-plus-embedded-fabric,or tapes. Duct tape is not permitted.
j Exception:Continuously welded and locking-type longitudinal joints and seams on ducts
operating at less than 2 in.w.g.(500 Pa).
i
Ducts shall be supported every 10 feet or in accordance with themamifactutel s instradions.
( j Cooling ducts with exterior insulation must be coined with a vapor retarder.
Air filters are required in the return air system.
( ] The HVAC system must provide a means for balancing air and water systems
Temperature Controls:
{ ] l Each dwetling unit hasatq Iesat one thermostat capable of automatically adjusting the space
{ tempetatura seE point ofthe largest zone.
Oectric Systems.
] ( Separate'electric meters are required for each dwelling unit
( Fireplaces:
Flan mpst be installed with right fitting non com�ustible fireplace doozs.
V± enlaces must he provided with a source ofcombustion air,as required by the Pireplaceceonstraction
provisions-,of the Building Code oj'1Vew York State,the ResikvlialCode ofNew lr64 State pr
{ the Nein Ynrk City Building Code,as applicable
C. Service•Water Heating:
[ j ( Water heaters with vertical,pipe risers must have a heat trap ort both the inlet and outlet unless the
{ water heater has,an integral heat trap or is part of a circulating system.
[ ] [ Insulate circrdatmghot water pipes to the levels in Table 1.
E
Circulating Hot Water Systems:
] k Insulate,circulating hot water pipes to the levels in Table 1.
Swimming Pools:
] All heated swimming pools must have an on/offheater switch and require a cover unless over 20%
ofthe heating energy is from non-depletable sources. Pool pumps require a time clock.
Heating and Cooling Piping Insulation:
] HVAC piping conveying fluids above 105 T or chilled fluids below 55°F must be insulated to the
levels in Table 2.
t
t
Table 1 Minimum Insulation Thicknessfor Circulating Hot Water Pipes.
Insulation Thickness in Inches by Pipe Sizes
Heated Water Non-Circulative Runouts Circulating Mains and Runouts
Temperature(F) Up to l" Uo to 1.2511 1.5"to 2.0" Over 2"
170-180 0.5 1.0 1.5 2.0
140150 0.5 0.5 LO 15
100-130 05 05 0.5 1.0
Table 2. Mmimuminsulation ThicknessforHVACPipes.
Fluid Temp. Insulation Thickness in Inches by Pine Sizes
Piping System Tvnes Range(F) 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 L5 1.5 2.0
LowTemperature 120-200 0.5 1.0 1.0 1.5
Steam Condensate(for feed water) Any 1.0 10 15 2b
Cooling Systems
Chilled Water;Kefrigerant, 40-55 0.5 M 0.75 1.0
and Brine Below 40 1.0 1.0 1.5 1.5
NOTES TO FIELD(Building Department Use Only)
M-1802
BUILDING DEPT.
SPE+CTION
[ FOUNDATION 1ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: / '/yY �-
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DATE ` INSP O
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I
M-1802
BUILDING DEPT.
I #SECTION
[ ] F NDATION IST [ ] ROUGH PLOD.
I �
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMI [ ] FINAL
j ] FIRE LACE CHIMNEY
RKS:
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765-1802
BUILDING DEPT.
INSPECTION
'
] FOUNDATION IST ] ROUGH PLBG.
7FNDATION 2ND [ ], INSULATION
MING E ] FINAL
] FIREPLACE S CHIMNEY
RE S:
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DATEINSPECTO
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765-1802
BUILDING DEPT.
t
INSPECTION
] FOUNDATION IST [ ] ROUG BG.
] FOUNDATION 2ND [ SULATION
[ ] FRAMI G [ ] FINAL
] FIREPLA CHIMNEY
f `
REMAR - �
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DATE INSPE
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765-1802
BUILDING DEPT.
INSPECTION
FOUNDATION IST ROUGH PLBG.
[ l f ]
[ j FOUNDATION 2ND: [ j IN TION
I
[ j FRAMING [ - FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
' DATE INSPECTOR 1'
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ROUGH11 &
PLUMBING ®' �..
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STATE ENERGY CODE
_ . el .
TOWN"O ;SOt7THOLD BUILDLVG PERMIT APPLICATION CHECKLIST
BUIL#MC;DEPARTMENT Do you have or need the following,before applying?
TOWN HAIL Board of Health.
SOUTHOLD�NY 11971 3 sets of Building Plans J
TEL: (01) 765-1802 Planning Board approval
FAX (631)765-9502 �J�� Survey
www. northforknet/Southold/ PERMIT NO. C— Check, 3 <oY .2
Septic,Frtii-
N.Y.S.D.E.C. ,
Trustees
Examined T2. 20 Contact: s ,� -f r
Approved: � `j ,20 Y Mail to:
Disapproved We
Phone: G/ 7 7 - 3(1'03
Expiration 201: 1
r, Builth gInspeotor
i�
E, APPLICATION FOR BUILDING PERMIT
Date A 20 0 v
t F •- 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. Feeaccordingto schedule.
b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas, and waterways:
c. The work covered by this application may not be commenced before issuance of Building Permit.
C d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a 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 what so ever until the Building Inspector
issues a Certificate of Occupancy.
ff.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months.Thereafter,a new,permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
1 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,iordinances,building code,housing code,and regulations,and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant or name,if Y corporation)
i3a5 AUc At - ( 0- A-e t9- C� — 0-14
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder.
Name of owner of premises She PIgCto l��
i
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
n
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which roposed work will be done:
i31� TuAt( S+ QnP Gr2e 0 0-y—�-
House Number Stre t Hamlet
County Tax MapANo. 1000 Se tion d ') 3 Block Ll Lot. m il. 0'-V
Subdivision ✓}a 44/1/ Ch Filed Map No. ; 738$�153.� y r t 2y
(Mme)
2. State existing use'a t Occupancy of premises and intended use and occupancy of prop'osed'construction: Y
a. Existing use and occupancy
b. Intended use and occupancy + Q
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Otber Work
(Description)
4. Estimated Cost tri 0 D p, Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling 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.
R r" GR
7. Dimensions of existing structures, if any:Front '70 Rear 10 Depths) Z(, ' Zy
Height ak_� 1'tu " Number of Stories " 02
Dimensions of same structure with alterations or additions Front U Rear 000 "
Depth s r ,n tom,;, Height �L" 'a 'Lo. Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height j t wo Number of Stories 1
9. Size of lot:Front Rear f5y, Depth N 3o 3" 6 r.
g10. Date of Purchase `1 i `, (o Name of Former Owner Pb<.i* f r( i o s h-�C,( c rn' �r
11, Zone or use district in which premises are situated C, rce ry
12. Does proposed construction violate any zoning law, ordinance or regulation?YES—NO
13.Will lot be re-graded? YES J NO Will qxcess fill be removed from premises? YES NO
14.Names of Owner ofpremises SAPge d h " W-P",Address f�kihone No. V-7-7 - :3 10. 3
Name of Architect �zn lv�m.L-�y Address 1 CLQ moi) 'd ayrtPhone No, 4 > -fo o
Name of Contractor Address Phone No. 1
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? *YES NO .f
* IF YES; D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
I COUNTY OFc's%�-_.)
fle l2/i E Ra n being duly sworn,deposes and says that(s)he is the applicant
(Name of individual si(paing contract)above named,
(S e is the
(Contractor,Agent, Corporate Officer,etc.)
of 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
C�} day f 4m ( 20 0 2—
otary Pu7ROSERT
Signature of Applic t
L
SCOTT:JR.
tate of New.York
Qualified in Suffolk County
No.
01SC4725089
Term Expires May 3t,. ��" � -
Vv
�/ �0r NUMBER
REFER ro "AuctsT ac , SEC7TgN. ONE"' 72 IN
TME U FgLK Od�WTY CLER'K'S OFFICE ON 3, 104'
A5 ME NO, 9109
SURVEY E,
WOPERT�Y '
AT : Al? mo
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F, �f�
TOWN OF S UTHOLD
I SUFFOLK GO U11FT
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AP R ED AS NOTED
DATTTE• O B.P.# 2699 1
NOTIFY BUILDING DEPART
765.1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS: '
- - - 1. FOUNDATION - TWO REQUIRED x
FOR GH - F AMINGCONCRTE
- 2 ROUGH - FRAMING 6 PLUMBING v
3. INSULATION -
\�\ 0. FINAL - CONST.RUCTION MUST
BE COMPLETE FOR C.O. o o m
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION 6 ENERGY
- CODES. NOT RESPONSIBLE FOR
\ DESIGN OR CONSTRUCTION ERRORS
6JL741FE3 CERTIFICATION
ON LEAD CONTENT BEFORE
C. RT{,r1d Ae_ GC1c.8"L/PANCY
i �\ IT
ADDr�T� tr=-_ �
OLDER L le i�l.- 3TER
C , T 1� _ a �a , .,v, ' ivNOT
�� sir r ' FAD.
_ 1 m
_ —
PROVIDE SMOKE-DETECTING °
DO NOT P CEED WITH ALARM DEVICES
FRAMING NTIL S RVEY AS TO PART. 721.1 PR
OF FOUNDA ION L CATION N.Y.S BUILDING CODE.
- ^_------_ T l—�--_ - - ---
HAS BEE; APPROVED.
W r
cc x
UNDERWRIiQERSCERi1FICATE m
RE UIRED " a
I 1 PL BIN(3
A L PLU BING WASTE O
WATER LINES NEED O >-
ORB NG BE ORE COVERING
Q 3
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- If Copper 8l bInq is used G
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a cuPA cv
_ US IS U LA sy �
— - — -- - ITR'. . TIFI ATE Of types I: L+vijy
OF OCCUPANCY UNDERWRITERS CERTIFICATE
REQUIRED
PROVIDE ANTI�SCALD AND/OR PROVIDE OPENINGS FOR
TNERMALSROCKPREVENTING GENCYESCgpE
AS
DEVICES AS TO PART.902.6(x) REQUIRED BY PART. 714 OF
N.Y. STATE BUILDING CODE. R.Y. STATE BUILDING CODE.
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