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29596-Z
FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30129 Date: 04/08/04 THIS CERTIFIES that the building ADDITIONS & ALTERATIONS Location of Property: 1225 ARROWHEAD LA PECONIC (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 98 Block 3 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 9, 2023 pursuant to which Building Permit No. 29596-Z dated JULY 23, 2003 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 ADDITIONS & ALTERATIONS TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DAVID C. & PATRICIA O'DAY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1176302 02/09/04 PLUMBERS CERTIFICATION DATED 03/28/04 MIKE JACOBI PLUMBING c th ized Signature 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) PRIi1Df�; 29596 Z Date JULY 23, 2003 Perm-' ssion is hereby granted to: DAVID C O 'DAY 1730 ROOSEVELT STREET WANTAGH,NY 11793 for I: ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 1225 ARROWHEAD LA PECONIC County Tax Map No. 473889 Section 098 Block 0003 Lot No. 008 pursuant to application dated JULY 9, 2023 and approved by the Building Inspector to expire on JANW25 Fee �$ 253 . 80 re ORIGINAL Rev.il 5/8/02 I � fir--- - Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: [A. For new building or new use: s I. 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 I%lead. h 5. Commercial building,industrial building,multiple residences and similar buildings and installations,a certificate d of Code Compliance from architect or engineer responsible for the building. i 6. SubmitVlazmmg_lioard 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 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. Fees / 1. Certificate of Occupancy-New dwelling$25.00,Additions to dwelling$25.00,Alterations to dwelling$2540, Swimming pool$25.00,Accessory building$25.00,Additions to accessory building$25.00,Businesses S50.00. 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. 3/ 2 i/5�i New Construction: Old or Pre-existing Building: (check one) Location of Property: 122,r Lrowilead Lana Pe tonin House No. Street Hamlet Owner or Owners of Property: _Day,d O'0aU Ia )Yi - ©`dui Suffolk County Tax Map No 1000, Section 0q? Block 03 Lot U000 Subdivision Filed Map. Lot: Permit No. 2 q rq 4 - i Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Bee Submitted: $ tt q fXpplicant Signature 2Z. N Sd CO 301 � ea/1012001 17:37 6317342276 'PAGE 81 PertaitNarxiller RE*Awk COMPI mce Certf'%sate Cb DdBrum New Work State Energy Cousemat m Conatruction Code 'RES aiecckSoltwareVemion 3.5 Release 1 tleYeame C: Sch254-EseFggiats s.*ck TrJ7LE:May Residence GOUN'"Mt olk STATE:New'Yotk S 57511 Ct7N5TAx rYON TSS$ 1 at Uamily ';1;EATING'TYPE:Non-Electric rDATE:93/VUU DATE OF PI-AaN&May 13,2003 P> QIECT:IbWGRMATIOM ODay Residence 1225•A Lane Feconic;NY 11958 COWANX 1NFORb1ATION: Boulevard Planning]East,,RC. AR$irs 32645 Nfa v Rbad O=bogoe„NY11435 COMPLIANCE: Passes 182 Your Home UA- 123 32-4°/&R4 tee IhaiLCmk(UA) Gsem &ata S Area oz Cavity Cont. 0=1` Painteter R R Yah -I�,=m UA Ceiling 1:Flat Ceiling or Scissor Truss. 1130 30.0 0.0 40 4daU 1; Wood usownk,_L6"oz- L169 L4 0. 011 60 Window 1: Vinyl Frame:Double Pane with Low-E 174 0.130 23 twi 1 s TA NT' Tbe• lnaildi tediatltis dccruaentis consisten th tke,bw dtag,phut , CQOdPk,IANCE STE>y!E . .. 1n � esea spe this mut lication. The sed stems have been designed to meet'ons sial other aal -tied wale sys �catt Free° > Pe aPP " Code. "rerttents. ivlten a " 1?cofta`gsionel has slaart and New X S &egister�Destg<t ask, ta� � ,� signedads theyo1 htsr=knowledge,belief,and prefessaonal Judgment, such plaits or SiQPS BYe.tn , .�' Buiiderl9es igprs r t ! MAR 2 9' T1 Town Hall, 53095 am Road C H � o W � Fax(631)765-9502 P.O. Tx 1179 cLnIC LEFT Oy • �` Telephone(631) 765-1802 Southold,New"4,Zj 1 -D BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: [2- /to) I � � Building Permit No. ? 9 j�9 G — Z ba d 1 Owner: q v i . Gl (Please print) ISL Plumber: ika ae®b o Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ers Signature) Sworn to before me this c�,'? day of Y17 ; 20 d c' i n � n I Notary Public, County p NDAJ COOPER Notary�Utonic state 01 NOW York No. 633,Su fGlk W±jp6 Torrz lra�Dacewber 3 rL=' rM910 -11211 IE91 121 R110�MilimaapLPLJ'iapL r-PL LrrrJpLrJ2frJ�cPrJ�r PrJ�i J�rJ�rJ�rJ@Pr�frJ�rSu�cJ�rJ�rJ���r18PrJ�rJ�rJ�rJ�rJ�rJ7rJ���rJ��frJ�rJ�rJ�rJ� , i BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITER � BUREAU OF ELECTRICITY 40 FULTON STREET — NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by KFC ELEC_CQNTR. DAVID O'DAY 1977 MAIN ROAD 1225 ARROWHEAD LN. LAUREL, NY 11948, PECONIC, NY 11998 IL �' Located at 1225 ARROWHEAD LN. PECONIC, NY 11958 Application Number: 1176302 Certificate Numbers 1176302 Section:� .098 Block: 03 Lot 008 Building Permitt�9596Z BDC: NS11, 2e� Described as a Residential occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below, located in/on the premises at: �'. Second Floor, I was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below,was. fo hind to be in compliance therewith on the 9th Day of February,2004. Name QTY Rate Rat�ina Circuit Type Miscellaneous 2nd'floor addition Alarm and Emergency Equipment Sensor 1 0 Carbon Monoxide Sensor 5 0 Smoke Appliances and Accessories Exhaust Fan 1 0 F.H.P. Witi�ing and Devices Receptacle. 24 0 General Purpose Switch 11 0 General.Purpose Fixture 16 0 Incandescent Fixture 2 0 Fluorescent Dimmers 4 0 Paddle Fan 3 0 `. Receptacle 1 0 GFCI lil seal � 1 of 1 This certificate may not be altered in an way and is validated only b the presence of a raised seal at the location indicated. I 9 y Y y Y rIx a Equi rrluriu JmejutPrl[n[.nrP[P[P[J�[J7[J�[J�[J@farJ�rJ�rJ�[n[1r�r�r�9091J�cfrJ�rJ�cPcfacfrJ1.1 E rr. tt c11:1P[1�[J�cJ 1 rE1Ef[PRPrr PRI PRI f-0INENE-00[n EI I Boulevard Planning East, PC. rchitects•Engineers•Construction Management Internet:www.blvdplan.com 32645 Main Road Cutchogue,N.Y. lJ935 HONE 631.73420 11 a - July 23, 2003 E� I Southold Building Department L111 JUL Town Hall S�3095MainRoad outhold,N.Y. 11971 - 0959 e: Proposed Additions &Alterations,O'Day Residence,Peconic,N.Y. SCTM# 1000-98-3-8 To Whom It May Concern, This letter is to certify that the materials, design,and methods of construction used in the above referenced project are based on the prescriptive method of design,as stated in the Residential Code of the State of New York. If you have any further questions,please feel free to call me at any time. Respe v rs, oert I, TOWN OF SOUTHOLD PROPERTY ttECOit CAR® ` OWNER STREET " F ' VILLAGE DIST. SUB. LOT. �l�Al �_ ��. �•�` X141 ?,.4�r1'� �' e u , � , . � - C�°�.r u r� �3 r> �+ c� �r FORMER OW ER N E ACR. iF 4 fa , 0 �Y 1,I i fel t C.r1 A- S W TYPE OF BUILDING 1 p j ... pa r _y tES. ��� SEAS. VL FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS 1 ) Too 3 6 Ya v r 5 is2,01 Q . . .. IP1teY^t': P IY? 4e6'�G'm+6in eDrnrncrn A//C:- . ca �—� � / b'Ir; fir , to /;Z, 0 0 a 6 *oys 4D 0, 6ay c3 0310t� /3 o '. NEW NORMAL BELOW ABOVE 7 �U FARM Acre Value Per Value r Acre l23� t a tillable 1 Fillable 2 "illable 3 Voodland swampland FRONTAGE ON WATER 1rushland FRONTAGE ON ROAD € louse Plot DEPTH BULKHEAD 'atal DOCK Will . r 1 { V. 3 x, y� p } V. a yy ) ! M. Bldg. �(� /036_ L g� �? � Foundation Both Both Dinette Extension 3 ( 7 f f_ Basement floors � K. Extension Ext. Walls '� .interior Finish- Extension inishExtension Fire Place Heat � A . DR. Type Root ' u Rooms Ist Floor BR. Porch - a–!J ,2�0 7p Recreation Room Rooms 2nd Floor FIN. B. Porch Dormer Breezeway - Driveway Garage i Patio i O. B. Tota! _ — naJ1b/,G17H1 11::i! 631 fa4'L'1 fb rcaut ni i RIERIteck CoMP&nce Cerate New Fork State Energy Consenrxtinn Comtructiton Code REScheckSoltware Version 3.5 Release I Daf&fiUxaUW-Q $cher 4254->3&ergg gpv.rck TITLE:O'Day Residence �F7FlP1- S�fvdk STt1.f:`Newyork 9750 T T Lzr Detadied.1 to 2 Family dA7INC TYi Ion-Electric D#�i,8,3{1-3103; DA1J'E�t P!'I-ANS:May 13.2003 k1d;0IFf.1'12�E£3RMATdON: O'17aylirisideuce 12id�, ,Large Peconie,A13G 11 938 CQUIRANY INFORt41AT1ON: 13o-�ie�ardP.tanming East,P.C. AIslttt�tS`-EP4iiteers 3245 Road Cott h4de.w$1935 CONOLIA.NCE: Passes QUA-- 182 Your Home UA= 123 32AQ/&B eT1mnC (UA) faese rng Area or Cavity Cont. of boar Perime- R_3VafiR-baiacr UA Ceiling 1:Flat Ceiling or Scissor Truss 1130 30.0 0.0 40 W aU L. we Rro rLfi'.°o c 1.169 L2-a. 04 60 Window 1: Vinyl Frame:Doable Pathe with Low-E 114 0.130 23 CtJAdI',I,IAtaFCE_�TATEDSENT: 'I7td propc�.hutlt}ing,Iepre�ated.in this derccterzeitt is c�sistent�Yith the-btailding..platts= specifications,and other calcata tied with this permit application. The proposed systems have been designed to nxxt-the New Yo9LStMEnugk W$en a Ragistered Desi;p Professional has stashed and signed this page,they of Mather knowledge,belief and professional judgment, such plaits or $tnlder,Aesiga+ec_ 68/10/2001 17:37 6317342276 PAGE 02 REScfiee*Inspection Checklist New York State Energy Conservation Constttletilow Code REScheckSoftware Version 3.5 Release I F?PtTE:@SLY3f03 TITLE: O'Day Residence !, Bldg. Dept. Use �i Ceilin s: f [ 3 I I. Ceiling 1:Flat Ceiling or Scissor Taus;R-N-0 cavity,insulation Comments: I I Above-Grade Walls., [ ) I 1. Walt 1: Wood Frame, 16"ox-,R-19.0 cavity insulation I Comments: I wiadows.. 1 Window.1: Vinyl Framce Double Pane with Low-E,U-factor:0.130 I For windows without labeled U-factors,describe features: #?Panes—Frame Type 'Thermal Break?t J Yes ( )No I Couunenw _ Air Leakage: [ J ( Joints,penetrations,and all other such openings in the building envelope that are souro s of air 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,time fixture must be installed with a 3"cic rnnce Emir-insulation. t f Vapor Retarder: ( } I Required;ostgscwanw-ie•wotsssiieefaiSnoa-vw"fifiandceikRMwall&an{lloocs. I Materials Idendfwation- Materials aud?gipmen,mid be insiall€td iaaccoWasice wsitktbe izutActsons. ] I lvlaterials and equipment most be iderifted so that compliance can be detemned ( ] { lluAmU hirer swumalc tag ali iocwlted L ung sail owlia&eyuipmeat&YA wxciee watu-4eating equipment must be provided. F. k I »R valtrecaad.8ga�ing U factors must be clearly marked on the building plans or specifications. I I Duct Ins4ation: [ l i Supply ducts is union boned attics or outside the building must be insulaued,to R-B. { ] I Return ducts in unconditioned,attics or outside the building must be insulaW.to R4. f 1 I Supply ducts in uncoamditioned spaces mistbs.imsuiwAw&swL [ ] Return ducts in unconditioned 3psices(except basements)must be insulated to R-2. I hisulaiioa is.Put regm»3 ontetaracducts inbaKpeots. I I Dact.Conotruction: } All joimts,;seamg:and onaiWtfts twill[be securely,fastened with welAs s>wasti s I (adhedves1, masta�phxs�mtbeddand iabiit,or tapes..U 10 tapFts W- �gftad:. I Fx vaon:Coptmnummisly Welded sial ybdml IlRe,lort�mdt shl joaatts,and s opooking at len tha n 2 in.w.g. (' W'P ). 4 1 I Dwtas M*be supportO every io feet$1.ih Awoi�with the zaariufaeKktr's 4 68110/2001 17,37 6317342276 PAGE 03 [ j ( Cooling;ducts with exterior insolation armt be covered with a vapor retarder, 1 ( Awfihecs;are uquitedSn tkiotim air system. ( d TZe HVAC system ttiust providea means for balancing air and water systems. I ( m C4"e: dwelling bas at lesat one thermostat capable of automatically adjusting that space I temperature act point of the largest zoite. I i Macuftsystefim ( ] ! Separate electric meters arc reituired for each dwelling unit. 1. I kn daces: 4 7 I Fi�piat ea mtiecbe a ria. top I I Fireplaces must be provided with a source of combustion air,as required by the Fireplace construction j provisions of the Buildsng Code of New Yark&-at&, the.. Yaak ire oz I the New York City Building Code,asapplicable. I F 9e wai= tipg: 2 i° tVater the I water heater has ata integral beat trap or is part of a circulating sfstem ( ] I lasulate circulating bol water pipes to the levels m Table 1. I Circulating Hot Plater Systeam: ( l ( Insulate circulating hot water pipes to the levels in Table 1. i I Swimming Poole: 0 x.11 bested swimming pools must Rave sat os/off beater switch and a cover erseiesa over 2(}/o j of the heating energy is from non depletable sources. Pool pumps require a time clock. i I j Heating and Cooling Piping Inia:ladon. HVAC piping conveying fluids above 105 OF or chilled fluids below 55 OF must be insulated to the I levels in Table 2. i 08/10/2001 17.37 6317342276 PAGE 04 Table 1. ;Wmim mrfnsKlatidek 7lh*ugfor Ctreut ting Hot Woaet Pipe& �r�;,�yp�y��� 1aaStflatlnn�l`bidmess til Inches by Pipe Sizes A,�6PWYt'rrater Nom-Citctil dml thmou s Circl618d M bkos and Runouts feirtivec2tas F1 USO 1" 1.25°' 1.5"to 2.0" Over 2" 170-,'150 0.5 1.0 1.5 2.0 140-160 015, 04 1-8 1.5 1100-130 0.5 0.5 0.5 1.0 Tablt 2:. lfi sixaum Imsutmiam-?9Yichvmfs tVC?PO" plaid-.Temp; Insulatlna. iudncltesltacSiaes Ektin--System Tvm Rance(F) 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4" { �`e'aiing-S�etems lL4Wpze&sum(Csm;W+n,re 201..25o LO L5 1..5 2.0 ii Leova Teitipetatiue 120-200 0.5 1.0 1.0 15 ?team Cnn�ie =a(far fmi, g1. Any LO LD 1.5.. 2.0 Cooling Systems +I Cli WatOr BeMge®nt 40-55 O.S U 0-75 1.0 ( and Brine Below 40 1.0 1.0 1,5 1.5 i i 1 Boulevard Planning East, PC. Architects• Engineers•Construction Management Internet: www.blvdplan.com 32645 Main Road Cutchogue,N.Y. 11935 PHONE., 631.734.2011 July 23, 2003 Southold Building Department >s Town Hall 53095 Main Road Southold,N.Y. 11971 -0959 -- Re: Proposed Additions&Alterations, O'Day Residence,Peconic,N.Y. I, SCTM#k 1000-98-3-8 To Whom It May Concern, This letter is to certify that the materials, design, and methods of construction used in the above referenced project are based on the prescriptive method of design, as stated in the Residential Code of the State of New York. If you have.any further questions, please feel free to call me at any time. 'I f• ' Respe > > s, it hH ert H I' J C F r x i' -- E M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ OUGHf PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ - RAMING [ ] FINAL { ] FIREPLACE & CHIMNEY REMARKS: ` DATE / E/ INSPECTOR f M-1842 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ;G DATE l4 .Q 3 INSPECTOR it IIS s 765.1802 BUILDING DEPT. INSPECTICIV i [ ] FOUNDATION IST [ ] ROUGH P [ ] FOUNDATION 2ND [ ] INATION [ FRAMING [ INAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS I� -01 j - I' DATE -AKIC P17 INSPEC 'I I v . .. coxrns . FIELD INSW. TI0 12EPOR R� i FOUNDATION(IST) J �' --- ----- ---------.-- a FOUNDATION(2ND) r s ROUGH FRARDNG 8z PI,UNISING a r IlVSULA7TON PER.N.Y_ H STATE ENERGY CODE 3 i L i FINAL r ADDITIONAL COMMENTS 1 T O m t i W i °z 4 TCiWN'OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets of Building Plans TEL. (631) 765-1802 Planning Board approval FAX: (631) 765-9502 {/ Survey www. northfork.net/Southold/ PERMIT NO. Check I',.. ... Septic Form /// N.Y,S.D:E C Trustees � Examined ,20 tact. Approved 20 Mail to: .3,9645- M.v4a 14i :Disapproved J1 49 'a GUtiIZ uC �y�l�93s Phone: Expiration '205 r r g inspector JUL 92003 4 2x03 APPLICATION FOR BUILDING PERMIT Q Date. tom...... 200„3 INS`T'RUCTIONS j a This application MUST lie_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 waterways. 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 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, " £ 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 Building Zone Ordinance of the Town of Southold, Suffolk County,New York,4and 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 comgly with all applicable laws,.ordinances,building code, housing code,and regal "_lins, and to admit authorized inspectors on premises and in building for;necessaryinspections. (Sig e of app at r name;if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, chitect, engineer, general contractor, electrician,plumber or builder t'/ Name of owner of premises 06LV h7(, VT Am "/G/G O lya,� (As on the tax roll or latestdeed) If applicant is a corporation, signature of duly authorized offieer, (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. I. Location of land on which proposed work will be done: iAod Gane Poon/ ArropvhG House Number Street Hamlet County Tax Map No. 1000 Section 8 Block 3 Lot Subdivision Gov e. Filed Map No. 3010 Lot 8 (Name) 2. State.existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and"occupancy _51-n4f jc:km I /X G-L b. Intended use and occupancylYrsL C �mi �v Re Sf�Er!G C I 3. Nature of work(check which applicable:New Building Addition X Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost (DD , flfJ'O Fee (To be paid on filing this application) $ ,If dwelling,'numlier"ofdwelling units__/ Number of dwelling units on each floor !V/,09' If garage, "number of cars N/4 6. If business, commercial or,mixed occupancy, specify nature and extent of each type of use. N14 7. Dimensions of existing structures, if any:Front 53 Rear 5- 3 Depth iq 7 Height 12 Number of Stories Dimensions of same structure With alterations or additions: Front 5- 3 Rear 5- 3 Depth_ 4-7 Height a .2.3- Number of Stories 2 & •Dimensions of entire new construction: Front Rear Depth "Height" Number of Stories 9. Size of lot: Front 135- Rear 3 S Depth (�2 ii 10. Date of Purchase Name of Former Owner I, 11. Zone or use district in which premises are situated �— t 12. Does proposed construction violate any zoning law, ordinance or regulation? YES—No .� 13.Will lot be re-graded?YES NO X Will,excess fill be removed from premises? YES NO 14.Names of Owner of premises Pr vjeA (J 'Da✓ Address I X2,6- 4rliw�vtoa 46&No. 73 ' 9 Je Name of Architect$!✓r,( P/ana6ft EaS;Address 32605' Merin RgL Phone No 73_f—20 I Name of Contractor T Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES,SOUTROLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a,ddal wetland? * YES NO * 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: COUNTY OF ) // p �Oj Ii�flrifir T '-. being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)abovee��named,' (S)He is the /7Sfi/1 (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 b ore me this f d 206 JOHNE.S7UIMPF s PUBLIC.SBate M NeW Vak Otaty PUbhe No. d856t 96 ouaNied in Nassau County Signah pph1c'ant y Term EXCrr s Jura zs, 3 BUILDING PERMIT EXAMINER CHECKLIST DATE REVIEWED: /0Z/03 APPLICANT: �� �[ _ DATE SUBMITTED: /�/03 SCTM#DISTRICT: 1,000, SECTION_: BLOCK: , LOT: _SUBDIVISION: ADDRESS: 12�fCsr1V�,�dl( CITY: ZONING DISTRICT:4U CONFORMING? BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N BP 9—,060-Z/C/0 Z- A-GC;�J , INFO /BP, 6 �7 z/C/0 z- ,92co INFO N b BF&j:�_L-4-Z/C/o Z-Pp , INFO KMO&y BP -Z/C/o Z- , INFO SINGLE & SEPARATE CERTIFICATION-REQUIRED _NOTES: �— LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1n997 100-25.Merger.(A nonconforming at an7ift 7/1/82 REQ. LOT SIZE: ACT. LOT SIZE, OT E REQ. LOT COV. `0 ACT. LOT COV REQ. FRONT !TD PROP. FRONT_ REQ SPE 1,5-J ACT. SIDE REQ. REAR DROP. REAR REQ. T PROP. HEIGHT PROJECT DESCRIPTION: ESTIMATED PROJECT COST: 661 CH CT/ENGINEER: _'Z_- w A4q - WATER FRONT? Ky DESCRIPTION: PANEL # J6 FLOOD ZONE: APPROVALS REQUIRED SUFFOLK COUNTY HEALTH D PT: YES or O, BED ft DTE: _/_/ PERMIT#: TOWN SEPTIC RECEIPT: Y o1& NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or IV DTE: PERMIT#: SOUTHOLD TOWN TRUSTEES: YES o DTE__/ / PERMIT#: TOWN ZONING BOARD APPROVAL: YES or DTE: /_/_ PERMIT#: TOWN PLAN. BOARD APPROVAL: YES or DTE_ /_/ PERMIT#: TOWN HISTORICAL PRE (SPLIA):" YES o NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2)�'YE$ or NO NOTES: ��/� FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: -,r-19- SF SECOND FLOOR: l/0 K SF OTHER: SF INIT OTHER TOTAL TOTAL: 1411,15' { SF FEE FEE FEE SF)- ( PSro SF)= SF X $< 3C) $ /a 3 t�+$ 6) +$ _$ o9s3 2. ( SF)- ( SF)= SFX $ =$ +$ +$ _ $ 3. ( SF)- ( SF)= SFX $ =$ +$ +$ _$ FINAL TOTAL: $ cl:: 3 - NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGRAP DESIGN CRITERIA: 5 Ground Snow Load:45 Wind Speed: 120MP smic Desi Category:B Weathering: Severe rost Depth:36" Ter :M-H ✓ Decay: S-M Design Temp: 11 Ice Shield Underlay:YES Flood Hazards: 12C Z USE/OCCUPANCY CLASSIFICATION: HEIGHT/FIRE AREA: Q ' TYPE OF CONSTRUCTION: w DESIGN CRITERIA: ENGINEERE SCRIPTIV W � � FULL FRAMING DESIGN ELEMENTS hEADERS: Y/N WALL STUDS: Y/N GIRDERS: Y/N CEILING JOISTS: Y/N FLOOR JOISTS: Y/N ROOF RAFTERS:Y/N LUMBER SPECIES AND GRADE:Y/N DESIGN LOAD CALCULATIONS: LIVE:Y/N DEAD:Y/N SNOW:Y/N SEISMIC: Y/N WIND: Y/N WINDOW AND DOOR SCHEDULE: MISSLE TEST RE UIREMENTS�N EGRESS 5.7 F.: N LIGHT 8%: /N VENT 4%: /N NAILING/CONSTRUCTION SCHEDULE /N MEANS OF EGRESS /N PLUMBING RISER DIAGRAM-�'/N LOCATION OF FIRE PROTECTION EQUIPMENO/N TRUSS DESIGN: Y/f lit CERTIFICATION: Yo ENERGY CALCS:VN TOTAL COMPLIENCE? 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T 1'i l S.C.T.M. # 1000-98-03-08 II I CLIMATIC GEOGRAPFIIC DESIGN CRITERIA As PEKN.Ys. CODE -- TA6LF R30 2( I ) I '' - ' `_ I }++ GROUND SNOW LOAD =I5 PSE 1Nl;Vit101y� L1.1"['.� 1 �, _7&J I ISM n - - o ,rl, -- - - AS I1I3R BUILDING'' IIEPAR1lMENT _ --- _ -- -. _ �--- - '- --- - - - ---- - -Y, WIND LOAD �. - : _ 1 � . _� � -- - -- - - - -- - - _"-���- - - ---- TI ' - -- - - - - I , ,r- fl ILr 91 „nP11 or :mn i ,.,1 73 CP c.,OMFE SEISMIC CATEGORY 5 1r I', I�r .I MING ----- - - - '- -- ---- - -- - --- -- - -- - -- - r,n l r 1F:ooN wEAT17eRING 5FVEKE _ FROSTLINE DEPTH 36 IN If L U I D TERMIFL MODERATE TO HEAVY � n O o w L_ II DECAY SLIGHTTO MODCKAIE If Exl"Fl INC, I KO(�fvl CIIfRYN/P'( - - - - - - - .. . -- - - - WINTER DESIGN TEMP E. I I - F 131 F S��� . __ �_ . I TANIIY FLOOD HALARIP5 7-25-78 - - 1XISTING a - � � ICC SHIELD UNDCKLAYMCNT YFS --- - - - - - NAILING SCHEDULE 995 s6c r1 n w1II e,�ntMranuai ABLE s. l 1� . . - - - - - - - - - ___ - - - _— --_ - - - �I I❑ - __ _ _ Joint Dc, Ilpil011 Nuu,bcr of M1is Rad SP acing I 1 - ROOF FRAMING - — - - - � 't.lr 6r ` fl ',I ON ll Mt,nllrl ELC'W - IIII — i 1 I �o;., f I IL;��fI II'iGU ,1P � _I .— L — 1 1 ^' - _ _ n , I ��II„ WALL FRAMING „rl I� , - -� I I I .I 11 I -I T- 1-;,,III I I � 11- w w11-� a �o r' �Inn - 1� 'i � ? 1 �7 I '� •I1 , � _ 1 =1 ' - MA, I �� r 6 ,C -I LfF , .a.lILI if I !I FLOOR FRAMING - - IF"”,, 11, T1r... PLANNING - NING EAST, P . C . ARCHITECTS ENGINEERS FIRST FLOOR PLAN - - bVAIL"10 T FrmJIOVEE, (, !., II Iin� I. — --- - N/ALLTO EfC P.fl'NIAIN SCALE 1/4" = I'_0" NewI - � wnlLa�N�sTRu�nonl - - -i ROOF PdOlf 1 I �Ir1 I I III r Is., I ) ALL AEPE(--LED WILIDOWS MCFT IJIIN GIYS CGRTI55 REOUIR,FMLN TS 1 — L) ALL AFI1CI LD 7 ,o PACLMELT MIDI INY`�, VI NTII LATION RLQUIKCMEM-S _ I � �I,� � - - - C�ALL 5r1E_ATIIINGLINIG ShEATi11NG WIND BOf_NED�31-,15 P' C�ICC7101J FPSIfNIIJT `�CtiEDULE � 1 i ' _ I 1 - - - - - - - I FOR WOOD SIf UC TUBAL PANE _. ✓ —_! F__ ---- -- DATE: 4- 29-6',f I iliul41=t (r11 X11 = rrll - r . rl II _1 .IJ _ DR. I3?': P lo IOf F rl "j, i I % -- - NC I , FLOOR SrIEATl11 - -- 1 , 1, I,11. 111 I I PLUMBING SCPIEMA'TIC Pa�a��'d` vuhi����� -- - III , , 1 10. ' II 11 Ie1 - a, fht l" e• C.g f.,,11 ., L•ral B• I - - ---- -- - - --- - -- I 1 �/ij asl - I ( LI - - _11 '11 ! FI- , ¢ , le ,�n II _. III , I , ni n 0254 IL 1 - — WI I [M1 i.,q ,, eo - i - J "..Li ll.l _ L< I_ fill I , _ I e �d J I I�.f. I c � I WINI)0Vv / EXI LTIOR [)OW S( 11FDULI'. NOCI'S 6 NEW NYS('ODE REQUIREMENT G WINDOW No of - ADDITIONS DEXPJPTION P,OUGH OPENING NIANUFACI'UP,EE P.EMAP.Y,S C INDOWS pp__ 6 & A --- -- - LTERATIONS - - I 3 I ; N! '3,- ?' I i ;�,' . .: ' � 11.1"--- r,PJf)FI�SL)hJ -- ---- TO THE ! � , 5 rI111 >CN O' DAY _ ! 4 , , " 1 ul �t -- RESIDENCE - - _ - - - ,- I 8 1 / 11 IL)'1 P":)OtJ i /' -" — — - — ARROWHEAD LANE /1',° ;' 3� i' 1rI� l 11 L. ,0 � 'II-1 1...it - - - - - - - -- --- --- - - -- �- PECONIC, N.Y. 3/4" OSB ONE 8d NAIL EACH SHEATHING I (D"II ,�, :r. .:, l,� . .I SIDE AT BEARING r':,.. S.C.T.M. # 1000-98-03-08 r� �, h RII ,1. I rtDrs fAl, UIF HInIII M1IICft ! ncPUtP tll as - o +tl,�, 1! SQUASH BLOCKS V ��� orGAT H R000M ( Zi;,,I°itONS — nlU � � (2x4 minimum I ) DAER BUILDING DEPARTMENTl?: rill O - - � m ' P t I nw,,.hu� I 1 I I � I P� n5 �' �� 7 I , ItF-INIDLC - Ip 7 -21 03 Iu _IUDY U n � oc U DCDP,OOb9 O u — 1 3/4' minimum �I ) IINR 'II'LII svc v. 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