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Home My WebLink About28853-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30041 Date: 02/23/04 T~IS CEP~TIFIES that the building ALTERATION & ADDITION Location of Property: 580 WIGGINS LA (HOUSE NO.. (STREET) County Ta_XF~p No. 473989 Section 35 Block GREENPORT (HAMLET) Lot 28.30 S%~bdivision Filed Map No. Lot No. conforms substantially ~o the Application for Building Permmt heretofore filed in tluis office dated OCTOBER 23, 2002 pursu~uqt to wtu~ch Building Permit No. 28853-Z dated OCTOBER 23, 2002 was issued, and conforms ~o all of the requirements of the applicable provismons of the law. The occupancy for which this certificate ms mssued is ADDITION & ALTERATION TO EXISTING SINGLE FAMILY DWELLING WITH GAS FIREPLACE AS APPLIED FOR. Re certificate is issued to SALVATORE & FRANCINE PRATO (OWNER~ the aforesaid building. SUFFOLK COU1Fi~i DEP~RTMENT OF~ALT~APPROVAL ELEC~fRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION D~rmu Rev. 1/81 N/A 1190725 10/25/02 10/25/02 MIKE JACOBI PLUMB.&HEAT. Authorized ~ign~r e 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~ 28853 Z Date OCTOBER 23, 2002 Permission zs hereby granted ~o: SALVATORE PRATO & WF 580 WIGGINS LANE GREENPORT,NY 11944 for : ALTERATION AND ADDITION TO AN EXISTING ONE FAMILY DWELLING WITH GAS FIREPLACE AS AFPLIED FOR. THIS PERMIT REPLACES BP~26624 at premises located at County Tax Map No. 473889 Section 035 pursuant to application dated OCTOBER Building Inspector to expire on APRIL 580 WIGGINS LA GREENPORT Block 0004 Lot No. 028.030 23, 2002 and approved by the 23, 2004. Fee $ 244.90 ORIGINAL Rev. 5/8/02 FORM NO. 3 Town OF SobTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS PERI~iT' NO. BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 26624 Z Date JUNE 28, 2000 Permission is hereby granted to: SALVATORE PRATO & WF. 580 WIGGINS LANE GREENPORT~NY 11944 for : ALTERATION AND ADDITION TO AN EXISTING ONE FAMILY DWELLING WITH GAS FIREPLACE AS APPLIED FOR. FLOOD PERMIT FEE OF $100.00 INCLUDED. at premises located at 580 WIGGINS LA County Tax Map No. 473889 Section 035 pursuant to application dated APRIL Building Inspector. GREENPORT Block 0004 Lot No. 028.030 17, 2000 and approved by the Fee $ 244.90 Authorized Signature ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUTItOLD BUILDING DE]PARTMIgNT TOWN l~3J ,L 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to tl~o Building Deparunent with the folloxving: For new building or new use: 1. Final survey of proper~y with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. F/ual ApprovaI from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board o f Fire Underwriters. 4_ Sworn statement ~rom plumber certifying that the solder used in'system contains less than 2/10 of 1% lea& 5. ¢onm~erci~l buildipg, industrial building, multiple residences and similar buildings and iustaL[afioas, a certificate of Code Oor~pli ,ance from architect or engineer responsible for the baildh~g. 6. Submit Phmfing Board Approval of completed site plan requirements. Bo For existing buiIdings (prior to April 9, 1957) non-conforming uses. or buildings and "pre-existing" land uses: l. Accurate su~ey of property sho a?ing ali property lines, streets, buildivg and unusual natural or topographic features. 2. A properly completed application and cansent to inspect signed by the applicant. Ifa Certificate of Occupancy ~s denied, the Building Inspector shall state the reasons therefor in writing ro the applicant Fees [. Certif/cate of'Occupancy - New dwelling $25.00, Additions to dwelling $25.00. Alterations to dwelling $25.00. Swirrm~ing pool $25.00. Accessory building $25.00. Additions to accessory building $25.00. Businesses ~5C 00. Certificate of Occupancy on Pre~existing Building - $100.00 Copy of Cernficate of Occupancy- $.25 4 Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00. Commercial $15.00 ' 0 7' _ (check one) Hamlet Underwriters Approval: Final Certificate: New Construction: Old or Pre-existing Building: LocationofProperty: ~'~O dc.Y?~--~-/,~iY-f ~/4t~L~- House No. Street Owner or Owners of Property: Suffolk Cou~ty Tax Map No 1000, Section ,~ ~'- Block Sub divi s ion _/~//Z ))/,/.d-$r~ ~r.- ~d£~ q Filed Map. Permit No.~~==~ Date of Permit. _ Applicant: Health Dept Approval: Plarming Board Approvai:5~t 1~/ 7~_~,7~ 7~,~9 Request for: Temporary Certificate Dg o Lot ~J~..~ ~' Lot: Fee Submitted: $ (check one) ~ibplic~ant Signature BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 1OO38 CERTIFIES THAT Upon the application of upon premises owned by Q.C. ELECTRIC NC, P.O. BOX 518 LAUREL. NY 11948-0518, SAL PRATO 580 WIGGINS LA GREENPORT, NY 11944 Located at Application Number: 1190725 Section: Block: Described as a Residential :580 WIC-:-:-:-:-:-:-:-:-~G[NSJ~A GREENPORT. NY ! !944 Lot: Certificate Number: 1190725 Building Permit: BDC: NS37 occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: First Floor, Outside, Attic, was ~nspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was found to be in compliance therewith on the 19th Dayof January, 2004. Name QTY Rate Rafin~ Circuit Type Appliances and Accessories Air Conditioner [ 0 12.000 BTU Panels I 50 6 Wiring and Devices Receptacle 22 0 General Pm-pose Sw~tch .... ~ -0 General Purpose Fixture 12 0 Incandescent Paddle Fan 2 0 Receptacle I. 0 GFCI Invoice Total $5.5( seal I of 1 lhis certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. · ' · ' FEDERAL EMER'GENCY MANAGEMENT AGENCY · r '-~ Z3'20 , NAT ONAL FLOOD NSURANCEPROGRAM "| .... U~ ' ' [ ' Road th'o ins(h~tion~ 0~ ~a~bs 1 - 7. ' -.,' SECTION A - PROPERTY OWNER INFORMATION =- .... ' PR~ER~ O~S~PTION (Lo[ a~d B~ N~ T~ P~ Numbs, L~al ~p~on etc.) BUI~IN~pSE (e.g.~ ~iCen~al, Nco~dential, Ad.tiaa, A~ etc. U~e a ~mmen~ area, ~ E~-. MAP AND PANEL NUMBER I-..iI ~S Profile ' ' ~ FIR~ B11. IndJ~e ~e eIbvat/o~' datum used B12. Is the buil~ lo~d'in a C6asta D~afi~' Date: · I~l Otl~ (Dasccibe): area or Othefw~e Protectad A~Lea (~)PA)?, I I Yes :l'~No .; : . ~, .- , , SECT[ON C - BUIkDIN~ ELEV,~TION~dN, FORMAq'ION ~OR~EY'REQO1RED~,' Cl. Building elevations are based on: Construction Drawings* ;Building,Undat.Ooinstr, uction* [_](~,lFinished Construction *A new'Elevation Cerbficate will be required when construction of the building is complete. C2. Building,Diagram Number ~Z. (Select theqbuildlngrdiagram most similar to the bu~did§ far whicfi this certificate is being completed -,see pages 6 and 7. if no diagram accurately represents thee building pro,4de a sketch or photograph.) C3. Etev~tions -Zones Al-A30, AE, AH, A (w~b BFE), VE, Vl-V30, V (w~th BFE), AR, AR/A, APJAE, AR/Al-A30, AR/AH, AR/Aa QompI~te ita~ns C3.a-i below according to the,bullS'ag d'agram spe~,~ied 'n tern C2 State:the datum used f the datum s d fferent from the d~rg used for the BFE iB Section 6..c&)'veft the datum to that u:sed for the BFE. Show field measurements and datum cunvehaion caio~atioe. ,Us6the space provided Or the CommAnts~r~a of SectiOn D or Section G, as apprept~te, to document the datum conyersion, Datum Conversion/Comm6dt¢' ' , ' Elevation,reference mark used :~.,,Iv~'~._Q~ , __ Does the elevation reference'mark used appear on the FIRM? ~z¢~l Yes L_l No Q a) Top,of bottbcn fioor ![including basemenf~or efic ost~re) ..... ~. a b)Topefnext higherfloor ___ _-i~_~_ Q c) Bo~om~ af !oweet'ha,'+-L'oA~at ~tn~c~rai m~m bar (V zoaes oeb'~ ...... _/~'__/_~ __ [I d) Attached garage {top of slab) ...... N//i~_. / Q e) Lowest elevation of machiner~ and/or equiprsent esrvici~ag the building {Describe in a Comments area.) ~ Q fJ Lowest adjacent (finished) grade (LAG} ..... 4~ Q g) Ftlghbst adjacent (finish~d~ gracfe (HAGJ _~_. _~__ ft.(m) El h) No. of permanent openings (flood veq~s) within I ft. above adjacent grade El i) Tots[ area of all permanent openings (flood vents} in C3.h ___ sq. in. (sq. cra) SECTION D - SURVEYOR, ENGINEER, OR ARCHI'rECT CERTIFICATION This'certificationisrto be sig~ne d and sealed by ~ ihnd ~urveyor, engineer, or architect authorized by I~w to certify elevation information. i ceRiCy that the,information in Sections A, B, and C on thi~ certificate represents my best efforts to interpret the data, available. l underatand that ~ny false statement maybe punishable by fine or impriaonment under f S U. S. Code. Section ?'OOf. CERTIF1ER'Sd O~"~ ~t.~ NAME(~ ' Ib~[t~ \~-~.~-- __, LICENSE,NUMBER T TLE COMPANY NAME I~.PO~TA.,N~: In theAe,spacna,=copy the cerrnsponding information,from Secttan A. ~ ~ :~e~uracc~ ~c~:[:y b?' . . ~. V~, ,,.,O~, ~ .~ ~.,.,.4 ~C I I · SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION {CONTINUED} ' ~--~ Check here ~ a~achments ~.SEC~ON E - BUI~ING;~A~ON [N~ORMATION.(S~R~Y~OT P~QgI~D).FOR Z~EAO ~D Z~E A ~ITHOU~ ForZoneAOandZ~eA(w~outBFE) ~m~etaltemsEl.thmughE4. [theEevation Ce~cataisintendedfor~e~supp~ in~fioo.~o~ a LQ~'o~ ~0MR:F, Section C must be ~pletad. El. Bu~g D}agmm,~,u~r ~ [~e~e ~ild}~ d~mm m~t s mflar to ~e building ~r whf~ th s ~ ~ ~ing comple~d - see.~ 6 a~Z. ~ n~ dia~m a~ mtaly repmse~the buB~ing, :pmvJ~e~ ske~.~hot~raph.~ SECT ON F - PROPERTY OWNER (OR OWNER'S REF'~SENTATIV~) CERTIFICA'FiON COMMEh'TS L1 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or, ordinanca to administer the community's floodpJain management o~inance can comclete Sections A. B,'C (er E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Gl. ~__~ The information in Section C wes taken fram qther documentation [hat has been signed and embossed by a licensed surveyer, engineer, or arch[tact who is authorized by state or, local law to certif~ elevation information. (indicate the source and date of the elevation data in the Comments arAa below.} G2. [__[A;osmrnugity ~fflcfal csmpietad SeqCoR E for a building L~ted in Z~e ,~c(vy2,~. qu[ a FBMA-issued or communit,/-iseosd EFE) or Zone AC. G3. I__]'The following information (items G4~Gg} is provide~ ~0~ community floodplain managemen[ purposes. GT. This permit.has been issued for:. I--[ ~New Construction LJ Substantial Improvement G8. Elevation,of, as-built lowest floor (includihg basement) of th~ bud no s: ___ ff.(m) Datu m: __. Gg. BFE or (in Zone AC) depth of flooding a~ the building site is: ° ~. ft.(m) Datu m: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE ' SIGNATURE DA'RE COMMENTS L-I Check here if attachments Town Hall. 53095 Main Road P.O. Box 1179 Southotd~ New York 11971-0959 Fax (631) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTItOLD CERTIFICATION (Please pri~t) Sworn to before me this._.~ [ dayof OC~ , 2005 Notary Public,~ Countg I certify that the solder used in the water supply system contains less than 2/10 o£ 1% 1.YNDA M. BOHN NOTARY PUBLIC, SYate of New York No. 01BO6020932 Qualified in Suffolk County '~rerm Expires March 8, 20 ~ MARRIAGE OFFICI~R ~a~....~, ~ ~-~~' AY Tctcphonc (51 (,~ 765- I H() I OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD THIS IS TO, CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOAR~ AT A REGULAR MEETING HELD ON AUGUST 2t;. 1993: RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent regulations of the Code of the Town of Southold: "Floodplain Development Permit Application" [FDP(93)], and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)]. BLDG. DEFT., TOWN OF SO,UTNOLD~, ~ Southold Town Clerk August 25, 1993 TOWN OF SOUTHOLD APPLICATION # PAGE I of 4 FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. _SECTION 1: GENERAL PROVISIONS (APPLICANT to read and L No work may stm-t tmtil a pcrmu is issucd. 2. The pemit may be revoked if any false statements are made herein_ 5- If rexrot<ed, all work must cease tmtll pemit is m-issued. et. De~[0pment skall got be uscc[ o? occupied until a,CcrtixScate of Compliance i~ issued 5. T~e permit will expireff, no W(~:k.is commenced within six m0n[hs of issuan~. 6, ~pt~caat is hereby inf6rmed, th~ other permit~ may be reitulred to fulfill local, state and federal regulatory 7. Applicant laexeby gives consent to, the Local Administrator or la.is/her representative to make reasonable insp~miorm reqCired to verify compliance. 8. ~:TIG, E At>PLICANT,.C~ THAT ALL STATEMENTS HEt:LEIN AND IN ATTACHaMENTS TO - THIS APPLICA,TION ARE,, T0 TH~EST O Z~/0 WLEDGE, TRUE AND ACCUR.ATE. ' SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICAI~mF} N,,~ME BUILDER ADDRESS TI~!.EPHQNE ENGINEER PR- SE L_ - h,N: To avoid delay m proe~sing thc application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban area~ the distance to the nearest intersecting road or v~il-known landmark. A sketch attached to this application showing the project location would be helpful. FDP(931 APPLICATION PAGE 2 OF ¢ DESCRIPTION OF WORK fCheck all applicable boxes/: A. STRUCTURAL DEVJELOPMENT ACTIVITY ~TRUCTLIRE TYPE [] New Structure [] Addkion ID Alteration [] Relocation [] Demolition El Replacement [] Residential (1-4 Family) [] Residential (More than 4 Family) [] Non-residenti~ (Floodproo£mg7 [~ Yes) [21 Combined Use (P, egidential & Commerdxt) [] Manufactured (Mobile) Home (Ia Manu- fact'U~ed Home Park2 [] Yes) ESTIMATED COST OF PROJECT B. OTHER DEVELOPMENT ACTIVITIES: [] Fill i2 Mining [] Drilling El Grading [] Excavation (Except'for Structural Development Checked Above) ID Watercourse Alteration (Indudlng Dredging and Charmel Modifications) El Drainage Improvements (Including Culvert Work} E] Road, Street or Bridge Construction 12] Subdivision (New or Expansion) [] Individual Water or Sewer System ID Other (Please Specify) After completing SECTION Z APPLICANT should submit form to Local Administrator for re~aew. SEC-gl'ION 3: FLOODPLAIN DETERMINATION {To be completed by LOCAL ADMINISTRATOR) The proposed development is located ou ~ Panel No. , Dated The Proposed Developmem: [] Iz NQT located in a Special Flood Hazard Area (Notify the applica, nt that the application review is complete and NO FLOODPLAIN DEVELOPMENT PERMIT IS REQUIRED). [] Is located in a Special Flood Hazard Area. PIRM zone designation is 100-Year flood elevation at thc site is: Ft. NGVD (MSL) [] Unavailable ID The proposed development is located in a floodway. FBlVM Panel No, Dated O See Section 4 for additional instructions. SIGNED DATE APPLICATION PAGE 3 OF 4 SECTION 4: ADDITIQNAL INFORaMATION REQUIRED (To be completed by LOCAL ADMINISTRATOR) The appl/cam must submit the documents checked below before the application can be processed: [3 A site plan showing the location of all existhag structures, water 15odies, adj3cent roads, lot dimensions and proposed development. [] Development plans, drawn to scaDe, and spedflcations, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the £~st floor, d~taiI~ of floodproo£mg of utilities located below the f'n-st floor and details of enclosures below the gu:st floor. Also, Subdivision or other development plan~ (If the subdivision or other development exceeds 50 lots or 5 acre.& whichever ~ the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). [] Plans showing thc extent of watercourse relocation and/or land[om alterations. lei Top of new Fill elevation Ft. NGVD (MSL). [] Ftoodproo£mg protection level (non-residential only) Ft. NGVD (MSL). For floodproofed structures, applicant must attach certification from registered engineer ov architect. Certification from a registered engineer that the proposed activity in a regulatory floodway wilt not result in any increase in the helgh? of the 100-year flood. A copy of all data and calculations supporting this £mding must al~o be submitted. [] Other: SECTION 5: PERMIT DETERMINATION (To be comnleted bv LOCAL ADMINU!iTRATOR) I have determined that the proposed activity:. A. [] Is B. CI Is not in conformance with provisions of Local Law # , 19 attached to and made part of ~ permit. · The permit is issued subject to the conditions SIGNED . DATE If BOX A i~ checked the Local Administrator may tssue a Development Permit upon payment of designated If BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a hearing from the Board of Appeals. APPEALS: Appealed to Board of Appeals? [D Yes [] No Hearing date: Appeals Board Decision --- Approved? [] Yes Coaditions_ 0 No APPLICATI DN = PAGE 4 OF ': SECWtON 6: AS-BUILT ELEVATIONS (To be submitted by APPLICANT before Certilicate of Compliance i.s -issued) The following information must be pro-tided for project structures. This section must be completed bY a registered professional engineer or a Ecensed land surveyor [or attach a certification to this appEcation)_ Complete 1 or 2 below. Actual (As-Built) Elevation of the top of the lowest floor. Lnduding basement (in Coastal High Hazard Areas, bottom of lowest structural member of the lowest floor, excluding piling mad columns) is: FT. NGVD (MSL). 2. Actual {]As-Built) Elevation of floodproo£mg protection is FT. NGVI) (MSL). NOTE: Any work performed prior to submittal of th-* above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be completed bv LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR wiB complele this section as applicable based on inspection of the projgct to ensure compliance with the commtmity's local taw for flood damage prevention. INSP-ECq~IONS: DATE BY DEFICYENCIF-.S? [] YE~ [] NO DATE B'Y DEFICIENCIF~? [] ~ 12 NO DATE BY DEFICIENCIES7 [] YES [] NO SECTION 8: CERTIFICATE OF GQMPLIANCE(To be completed by LOCAL ADMINISTRATOR) Certificate of Compliance bsued: DATE: BY:. for Attachmen~ B SAMPLE CERTIFICATE OF COMPLIA/~CE Developmen~ in a Special Flood Hazard Area TOWN OF $OUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZAJLD AREA (OWNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [2] NEW BUILDING [] EXISTING BUILDING [] VACANT LAND THE LOCAL ADMINISTIL4~TOR IS TO COMPLETE A. OR B. BELOW: COMPLIANCE I$ HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # ., 19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH. THE REQUIREMENTS OF LOCAL LAW # ,19_~_, AS MODIFIED BY VARIANCE # _., DATED SIGNED: DATED: C/C(93) Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Potlwod~ Town Hall 53095 Main Road P.O~ ~ox1179 Southold, New York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February ~7, 2000 Fairweather-Brown Amy Mart~n P.O. Box 521 Greenport NY 11944 RE: SALVATORE & FRANCINE PRATO SCTM #35-4-22 Dear Ms. Mart~n, The Southold Town Board of Trustees reviewed the survey dated and received in our office on February 14, 2000, and determined that the construction of an addition to the family room to an existing ~ouse to be out of the Wetland jurisdiction, under Chapter 97 of the Town Wetland Code. However, any activity within 75' of the Wetland line would require permits from this office. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. ' Project Description: AGENCY PE~ITS ~JI~D FO~ Suffolk Co~.~ Heal~ Dept New York State D.E.C. Tovm T~t~s Tox~ ~qg Bo~d approval: To~ Plmqi~ Bo~d approval: Permit NO YES Number Flood Plane Elevation 277 Notes: (where. applicant is not the owner) '(mailing address~ do hereby authorize ~ or other of l*airweather- Brown Design Associates Inc. to act as my agent to apply for al! permits necessm-y for the proposed work to be .2. 4,4 Energy Calculations New Room GROUND FLOOR SQUARE FOOTAGE GROUND FLOOR WALLS DOOR (112 GLASS) WINDOWS NET WALL FIRST FLOOR ROOF Garage Conversion GROUND FLOOR SQUARE FOOTAGE GROUND FLOOR WALLS DOOR (1/2 GLASS) WINDOWS NET WALL FIRST FLOOR ROOF Prato gross SO' 191 395.14 77.84 58.4 259 191 420 307.5 20.25 44,58 243 420 FIRST FLOOR SF U" RATING 6~3 FLOOR R10 6-1 NET WALL R15 6-1 GL 6-1 DOOR 6-3 ROOF R30 6-3 FLOOR R30 6-1 NET WALL R15 6-1 GL 6-1 DOOR 6-3 ROOF R30 191 0.1 -11 259 0.066 27 58 0.3 -13 78 0.19 -2 191 0.033 3 220 0.033 3 243 0.066 20 45 0.3 -4 20 0.19 -1 220 0.033 3 TOTAL 25 76,5-1802 BUILDING DEPT. INSPECTION FOUNDATION l~r [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] F~NAL [ ] FIREPLACE & CHIMNEY INSPECTOR ~~ 765-1802 BUll. DING DEPT. / INSPECTION [ }/J=O"NDATION 1ST [ I ROUGH PLBG. [,~FQUNDATION2ND"/* ~ [ ] INSULATION ],'FRAMING [ ]FINAL [ ~ F!I:iEPL~ CHIMNEY I NSPECT~~~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUN~D~TIONIST[ ] ROUGH PLBG, [/] FRA~iNGM ON 2ND [ ] INSULATION [ [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS:/~~//~'~ D~ATE~/~' ,NSPECT~~ / B~UILDING DEPT. INSPECTION FOUNDATION 1ST [ ~] ROUG~.H.~G. FOUNDATION 2ND [ ~iI~ULATION FRAMI~ [ ]FINAL REMAR~ 765-1802 BUILDING DEPT. iNSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ]INSULATION FRAMING [~ FINAL [ ] FIREPLACE & CHIMNEY REMARKS; ~/~'/~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] ROUG~BG. [ ~]/FINAL ¥I~D INSPECT: DATE COMME~S FOUBIDAT%ON / (~) PLI~BING -FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD~ N,~,,Y, , 1197 TEL:.,'. 76~1802 (Bu~Tding~ L'~fpecrgr) APPLICATIOH FOR BUILDING PERttIT INSTRUCTIONS EOARD OF 'HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK .......... r; .............. SEPTIC FORM ................... NOTIFY:, ~.~ M~IL TO:,. ................... % 4z // .- - a. Tflis applicatici{'mmt be a~pletely f~lled in'~ ~iter or in i~ ~ ~itt~ to ~ hildi~ In~tor 3 ~ts of pI~, ~a~e plot p~ ~ ~le. ~ ~i~ m ~le. b. Plot pla ~ l=tim of lot a of Mild~ m ~s, ~lation~ip to ~joinin~ pr~s or ~lic st~ts or ~e~, ~ ~ a ~tail~ &mripCim of lst of p~ ~t ~ ~ ~ ~e di~ ~i~ is ~r~ of ais c. ~ ~ ~ ~ ais ~liatim ~ mi ~ ~m~ ~fore isae~o[ ~ildi~ d. ~ ~ of ~is ~li~cim, ~ ~ild~ I~ctor, i~ll is~ a ~ildi~ Pe~t to the ~li~t. ~t ~1I ~.~ ~ ~ ~s ~l~le for i~ti~ ~t t~ ~rk. e; ~ ~il~ ~11 ~ ~i~ or ~ in ~le or in ~ for ~ ~ ~t~er ~til a ~ificate of ~m~ ~1 ~ ~n ~t~ ~ ~ ~ldi~ ~tor. ~I~ IS ~ ~ ~ ~ ~ildi~ ~t for ~e isle of a ~ildi~ Pe~t ~t to ~e ~iP~di~ ~ ~f~ of ~ T~ of ~ld. ~o~ ~, ~ Yo~. ~ o~er ~li~le ~, ~i~es' or ~ati~, f~ t~ ~ti~ of ~ild~, ~i[i~ or alterati~s, or for r~ or ~liti~. ~ri~. ~ ~li~t ~s to ~ly ~ all ~li~le 1~, ordi~s. ~ild~ ~, ~i~ c~e. ~lati~, ~ to ~t ~ri~ i~t~s ~ ~ ~ (Si~f ~li~t, or ~. if a co. ratio) ........... ......................... .......................... ...... :, ........................ (~ m ~ t~ mi1 or latest ~) If ~li~t is a ~rati~, s~ of ~y ~t~]~ of~cer. · (1/are a~d title of corporate officer) Repair .......... ~.. Rain,al ............. l~molitl°ix-. ..... [ ..... Offer 14~rk ...(~.*;.:..~.~;*:..~ f. ......... ~ (~rip~) (to ~ ~id ~ fili~ als 5. Ii ~ll i~, ~ of ~lli~-lmlts ...~...;~..' ~r of ~lql~g' ~lts' ' ~e~ fl~r ................ If ~r~e, ~r of ~r~ ...................................... ~. I f ~imss, mrcial or ~ ~; ~i~ ~a' ~ atmt of e~ ~ of m ...................... ~. ~ ~s~.~ ~ st~s, ~f . ~ ............... ~ .~ ......... ~ ~ ............. ...... ng ~ p .~., ............ ~r of ~ ......... ,...~.,. ~..., .... :Z ..... ......... I0. ~te of ~d~a~ ..................... ~ of ~o~r ~r .;..: .... ~2 .............................. 12. ~s ~o~ ~t~ti~ violate a~i~ 1~ o~i~e or ~l~i~: ...~ ................. ~ill lot ~ ~ ~ ~ill mss ~ill ~ a ~ ~s: ................. . ~ o~ ~tr~tor ................................... ~ress .............................. ~LOT I~ate clearl7 ~ distantly ail ~ildi~s, ~flmr ~sti~ or p~, ~ i~i~te ali ~t-~ d~nsi~s ~ pr~r~ llms. ¢~ sr~t ~ ~1~ ~ 6r ~mrlpti~ ~i~ to ~, ~ ~O~r ~nterior or m~r ; .....~.).y..~..:. ~...~...7-/../~.. ...................... being duly ~m, ~s a~ ~ys ~t he is ~ a~li~t ,t~ of i~fvia s~iug ~trat) ,,,, ................ ___ _.._. _ ............................ (~t;acto , ~ t, co~ ~e o[ficer, e c.) ~licati~; ~at all stat~n~s c~ai~ in ~is a~lica~i~ are t~ ~o ~ ~sC of his ~1~ ~ .~lie[i a~ a~at ~e ~ ~ill ~ ~r[o~ in tI~ ~r ~t ~orth ~ the a~li~i~ ~i1~ ~. ~m to ~fo~ ~ ~is ' - SHI,,'OE]D BTOUE ~- F/P CO Stove & cc~ [~ U~j~nt [] For Review ri ~ Repiy B p|e.s~ Recycle FR[~4 : ASHW[]OD STOVE ~ F×P CO .cq__~ NO: Nov. ~o ~ .... 1. POSITIONING THE FIREBOX on e me~[ ~ 9 FROMm: AS~OD STOVE ~ F/P CO FA ....... ~ D~C42