HomeMy WebLinkAbout29985-ZFORM NO. 4
T0~ OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPD3IC¥
No: Z-30384
Date: 08/27/04
T~IS CERTIFIES that the ~uildin9 ALTERATION
Location of Pzopez~¥: 22842 MAIN RD
(HOUSE NO.)
County Ta~Map No. 473889 Section 18
Subdivision Filed Map No. __
ORIENT
(STREET) (HAMLET)
Block 5 Lot 9.2
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed i~ this office dated DECEMBER 11, 2003 p%~rsuant to which
Building Permit No. 29985-Z dated J~LNUARY 2, 2004
was issued, and conforms to all of the requirements of the applicable
provisions of the law_ The occupancy for which this certificate is issued
iz ALTEP~ATION TO COI~VERT EXISTING ATTACHED GAP-AGE INTO A DEN IN SINGLE
FD~ILY DWELLING AS APPLIED FOR.
The certificate is issued to DAVID & GERALDINE CPIADICK
(OWNER)
of the aforesaid building.
SUFFOLK CO[~l~f DEP~%RT~ENT OF ~IEAL~ APPROV~_L N/A
ELEC~RICAL CERTIFICATE NO. 1192490 02/18/04
PLUMBERS ~ERTIFICATION DA'~mu
' ~/o rye d S~lg~/ature
Rev. 1/81
PORH NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTNFENT
Town Hall
Sounhold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
~~0. 29985 Z Date JANIIARY 2, 2004
Permission is hereby granted to:
JANET TABOR
PO BOX 22
ORIENT,NY 11957
for :
ALTERATION (GARAGE CON!VERSION TO DEN) TO AN EXISTING SINGLE PA/{ILY
DWELLING AS APPLIED FOR
at premises located at
County Tax Map No. 473889 Section 018
pursuant to application dated DECEMBER
Building Inspector to expire on JULY
Fee $ 150.00
22842 MAIN RD ORIENT
Block 0005 Lot No. 009.002
11, 2003 and approved by the
2, 2005.
ORIGINAL
Rev. 5/8/02
Fof~n No_ 6
t/~i -~,, · ' .'
TOWN OF SOUTHOLD / :; ~ --~
~D~G DEP~TMENT
"'~ 765-1802 / ~-.~_ ~ _
~P~CATION FOR CEK~FICATE OF OCC~CY
/
T~ applicafio~ must be fiH~ ~ by ts~exx~ter or ~ ~d submtted to ~e Bu~g Dep~ment wi~ the following:
For new building or new use:
1. Final survey ofpropetW '~Sth accurate location of all buildings, property lines, streets, and unusual natural or
topo~apltic featnses.
2. Final Approyal from Health Dept. of water supply and sewemge-disposal (S-9 form)._
3_ Approval of electrical installation from Board of Fire Undenvriters_
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead.
5_ Commemial build/rig, industrial build'rog, multiple residences and similar buildings and installations, a certificate
of Code Complhnce fiom architect or engineer responsible for the building.
6: Submit' PNn12ng Board~Appro'val o f con~pl-eted site plan rcqinrem~nrs.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
1. Accurate survey of propca'ty showing all property lines, streets, building and unusual natural or topo~aphic
features.
2_ A properly completed application ~nd consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor m writing to the apphcant.
1. Certificate of Occupancy - New dwelling $25.00, Additious to dwelling $25.00, Alterations to dwelling $25.00,
Swimming poo1.$25.00, Accessory building $25.00, Additiuns to accessory building $25.00, Businesses $50.00.
2. Certificate of Oceup'p"ancy on Pre-existing Building - $100.00
3 Copy of CertificateofOccupancy- $.25
4. Updated Certificate of Occupuncy- $50.00
5_ Temporary Certificate of Occapancy - Residential $15.00, Commercml $15_00
New Construction: '~ Old or Pre-existing Building:.
LocatiunofProperty: ~0q~ /~OI0 ~001~ 0CIP~'fI p}~,
Honse No. Street
Owner or Owners ofProperty: ~.ald,,q~ ~'_-b.~o01 C..[ctdtc~
Suffolk County Tax Map No 1000, Section [ ~ Block
(check one)
Hamlet
Subdivision
P uit No. fl, ct VS'-Z-
Health Dept. Approval:
Date of Permit.
Filed Map. Lot:
Applicant:
Undenwiters Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~ ~' 0_~,
Final Certificate:
(check one)
By THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
40 FULTON STREET - NEW YORK, NY 10038
CERTIFIES THAT
GOODALE ELECTRIC CONT INC TABOR
P. O. BOX 1190 22842 MAIN RD
MATTITUCK, NY 1 '1952. ORIENT, NY 11957
Loceted a~; a~84~ w!~, 4 RD ORr~NT, ~'~ 9,~,
APPlieatJoin Nwmber: 1192~90 Certificate Number: 1192490
Section: Block: Lot: Building Permit: BDC: ns11
Described as a Eesidetzda] occupancy, wherein the premises electrical system consisting
electrical devices and wiring, described below, located in/on the premises at:
FLrst Floor,
was inspected in accordance with the NaLional Electrical Code and the detail of the installation, as set for[h below, was
found to be in compliance therewith on the is[h Day of February, 2004.
Nttm~e 0'FY Rate Ra~lg Oil cult Type
Miscellaneous
convert garage ro livh~ space
Wiring and Devices
Receptacle '* 0 General Purpose
Swirci~ i 0 General Purpose
F~o:m,,-e. _ ~ i 0 - Incandeseeiit
Eecept~.cle 1 0 20 amp Appliance
sea/
[ of l
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
Permit Number
Checked By/Date
REScheck Compliance Certificate
New York State Energy Conservation Construction Code
REScheckSottware Version 3.5 Release ia
Data filaname: C:La~UTOCAD PROJECTS\energy talcs work pagas\CHADICICrck
TITLE: CHADICK RESIDENCE
COUNTY: Suffolk
STATE? New York
]tDD: 5,750'
CONSTRUCTION TYPE: Detached 1 or 2 Family
HEATING TYPE: Non-EleCtric
DATE: 1 U24/03
DATE OF PLANS: NOV. 21, 2003
PROJECT INEORMATION:
GARAGE CONVERSION
AT THE CltADICK RESIDANCE,
MAIN ROAD ORIZ~T, NY'
COMPANY I]qFORMATION:
ALLIED BUILDERS .
MAIN ROAD, ORIENT, NY
COMPLIANCE: Passes
Maximum UA = 75
Your Home UA -- 70
6.7% Betm' Than Code (UA)
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R-Value R-Value U-Factor UA
Ceiling 1: Flat Ceiling or Scissor Truss 266 19.0 0.0
Wall 1: Wood Frame, 16" o.c. 423 11.0 0.0
Window 1: Vinyl Frame:Double Pane with Low-E 22
Floor 1: All-Wood Joist/Truss:Over Unconditioned Space 266 19.0 0.0
0.320
14
36
7
13
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
New York State Energy Conservation Construction Code requirements. When a Registered
signed this page, they are attesting that to the best of his/her knowledge, belief~ and
specifications am in compliance with this Code.
Builder/Designer.
stamped and
or
proposed syst~,
gegistered.~
Insulation Thickness in Inches by Pipe Sizes
Heated Water Non-Cimulatlng Runouts
Temperature(F) Upto 1" Up ~o 12.5"
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
Cimulatin$ Mains and Ruuouts
1.5" to 2.0" Over 2"
Table 2: Mininmm Insulation ThicknessforHVACPipes.
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
piping Systcm Types Range(F) 2"Runouts l"andLess 1.25"to2" 2.5"to4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0
Low Temperatm~ 120-200 0.5 1.0 1.0 1.5
Steam Condensate (for feed water) Any 1.0 1.0 1_5 2.0
Coo~ing Systems
Chilled Water, Refrigerant, 40-55 0.5 0.5 0_75 1.0
and Brine Below40 1.0 1.0 l_q 1.5
NoTI~s TO FIEI. J) (Building Department Use Only)
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
operatin~ at less than2 in. w.g, (500 Pa).
Duets shall be supported evexy 10 feet or in accordance ~vith the manufacturer's instructions.
Cooling duets with exterior insulation must be covered with a vapor retarder.
Air filters are required in the relm'n air system.
The 1iVAC system must provide a means for balancing air and waler systems.
Temperature Controls:
Eack dwelling unit has at lesat one thermostat capable of amomafieelly adju.~ing the space
temperature set point of the largest zone,
Electric Systems;
Separate electric meters are required for each dwelling unit.
Fireplaces:
Fireplaces mus~ be installed with fight fitting non-eombusffble fireplace door~
Fireplaces must be provided with a source of combustion air, as required by the Fireplace constmc~inn
provisions of the BttiIding Code of flew I~ork State, the Residential Code of New York State or
the New York Cio' Building Code, as alyplieable.
Service Water Heating:
Water heatexs with vertical pipe risers must have a heat trap on both the inlet and outlet unless the
water heater has an integra] heat Irap or [; part of a circulating system.
Insulate circulating hot water pipes to the levels in Table 1.
Circulating Hot Water Systems:
Insulate circulating hot water pipes to the levels in Table 1.
Swimming Pools:
All heated swimming pools must have an oo/offheater switch and require a cover unless over 20%
of the heating energy is t~rom non-deplemble sources. Pool pumps require a time clock.
Heating and Cooling Piping Insulation:
I-IVAC piping conveyin~] fluids above 105 °F or chi]led fluids below 55 ~F must be insulated to the
levels in Table 2.
REScheck Inspection Checklist
New Yoek State Energy Conservation Construction Code
REScheckSoftware Version 3.5 Release la
DATE: 11/24/03
TITLE: CHADICK RESIDENCE
Bldg.
Dept.
Use
[ ]
[ ]
[ ]
[ ]
[ ]
[ I
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
Ceilings:
1. Ceiling 1: Fiat Ceiling or Scissor Truss, R-19.0 cavity insulation
Comments:
Above-Grade Walls:
1. Wall 1: Wood Frame, 16" o.c., R-11.0 cavity insulation
Cornrnell~S:
Windows:
1. Window 1: Vinyl Frame:Double Pane with Low-E, U-factor: 0.320
For windows without labeled U-factors, describe features:
# Panes Frame Type_ Thermal Break?. [ ] Yes [ ] No
1. Floor i: All-Wood Joist/Truss:Over Unconditioned Space, R-19.0 cavity insulation
Comments:
Air Leakage:
Joints, penetrations, and all other such openings Ia 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-fight assembly
with a 0.5" clearance from combusffble materials. If non-lC rated, the fixture must be installed with a
3" clearance from insulation.
Vapor Retarder:
Required on the warm-in-winter side of all non-vented flamed ceilings, walls, and floors.
Materials Identification:
Materials and equipment must be installed Ia accordance with the mantffacture~s installation Iast~uctious.
Materials and equipment must be identified so that compliance can be determined.
Manufacturer manuals for all installed heating and cooling equipment and service water heating
equipment must be provided.
Insulation R-values and glazing U-factors must be clearly marked on the building plan~ or specifications.
Duet Insnlatinn:
Supply ducts in unconditioned attics or outside the building must be insulated to R-8_
Return ducts in unconditioned attics or outside the building must be insulated to 1
Supply ducts in unconditioned spaces must be insulated to R-8.
Return ducts ia unconditioned spaces (except basements) must be insulated b
insulation is not required on return ducts in basements_
Duct Construction:
All joints, seams, and connections must be securely fastened with welds, gaskets, mastics
(adhesives), mastic-plus-embedded-fabric, ur tapes. Duct tape is not permitted_
Eacception: Continuously welded and locking-type longitudinal joints and seams on ducts
fi~PPLICATqT.'-~-~T=O~ (C~-oeStc~ DATE REVIE~rED: I.. / c~/0~
DATE SUBMITTED: ~/!! /03
SCTM# DISTRICT: 1,0'00, SECTION:: [~' , BLOCK: 5-' , LOT:. ~,~ SUBDIVISION:'~_._
AOr ss:oo& + . ZO OmSTmCT: .--_CONFOmWm ?.cO
BUILDING PERMITS .OPEN/EXTIRED: PRE CO: Y'OR N
BP II{DfiO -Z,'C,'OZ-iOr.~'o ,INFO .o[~ /Bp~&i~9 -Z/C/OZ-I~o,INFO Acc_,.)
BP -Z / C"'0 Z- __, ~O / BP -Z / C/0 Z- , ~O
SINGLE & SEPAK4TE CERTI~CATION-~.QL~D NOTE&
~ LOT S~E
~Q. LOT S~E: ACT. :~ (~ ~Q. LOT COV. ~% ~ ACT. LOT COV.
· ~Q,~ /~w~ PRO ~e~~'~ //~Q. ~r~T
EST=~TED PRO,CT COST:/ ~ ~C~E~'~
WATER FRO~? ~ DESC~TION:
SUFFOLK COUNTY HEALTH DEPT:
TOWN SEPTIC RECEIPT: Y ~
NE'W YORK STATE DEC: e~e-~c 9a.,~s YES o~
SOUTHOLD To~rN TRUSTEES: 5~S ~ N
TOWN ZONING BO~ APPROVAL: )~S or~
TOWN PL~. BO/i~ APPROV.~: 5~S or~ ~
TOS~ ~STO~C'AL P~ (SPLIA): X ES o~
~W YO~ STA'FE CODE COMPLIANCE (SEE PAGE
APPROVALS REQUIRED
YES ~ED #): __ DTE:
/ / PERMIT #:
DTE: / / PERMIT #:
DTE: .- / / PERMIT #:
DTE;' / / . PERMIT #:
D~PE: / .~/ PERMIT #:
or NO
NOTES:
FEESTRUCTURE:FOUNDATION:
FIRSTFLOOR:
SECOND FLOOR:
OTHER:
TOTAL:
c.(,/o
E ( SE)- (___ SE)= SF X $
2. (_ SF)- ( SF)= SF X $
3. ( SF)- ( __ SF)= SFX$__
SF
SF
SF
SF
__SF
INIT OTHER TOTAL
FEE FEE FEE
=$
=$
=$
+$ +$ = $
+$ -~$ = $
+$
FINAL TOTAE~S;' / ~%,~
765-1802
BUILDIN~EPT.
IN$ CTION
[ ] FOUNDATION IST [ ] ROUGHPLBG.
[ ] F~DATION2ND [ ] INSULATION
[~ FRAMING
[ ] FINAL
[ ] FIFIEPLACE & CHIMNL~(
DATE
76S-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ]../ROU/~GH PLBG.
[ ] FOUNDATION 2ND [ /_~INSULATION
[ ] FRAMING [ ]FINAL
[ ] ,'HIMNEY
REMARKS:
DATE
~6S-1802
B~UILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] RO~PLBG.
[ ] FOUNDATION 2ND [ ~NSULATION
[ ] FRAMING [ ] FINAL
] FIREPLACE & CHIMNEY
REMUS: .
DATE
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] ~J~ATION,
[ ~"FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE ~//~~/~F
INSPECTOR
FIELD INSPECTION REPORT D.kTE- I COMN[ENTS
FOUNDATION (1ST)
FOL~DATION (2ND)
ROUGH F[~I~G &
PLUMBING ~ ~,
.~D~ION_~ COM3~NTS
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
'TO~ HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
~. northfork.neffS ou~hold/
Examined I
Approved ' ! /
Disapproved a'~ -
,20 ~,
,20 __~
,20
' i :~' [ ' BUILDING PERMIT APPLICATION CHECKLIST '
PER3IIT NO. - q cT'-2
Do you have or need the follo,~qng, before applying'?
Beard of Health
3 sets of Building Plans
PJanning Board approval
Chebk
Septic Form
N.Y.S.D.E.C.
Tru~ees
Contact:
Mail to:
Phone:
PLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
I¢/! ,20
a. This application MUST be comp!etely filled in by typew~ter or in h~ and ~bm/tted to the Building Inspector with 3
sets ofplaus, accurate plot plan to scale. Fee,according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationskip to adjoining premises or public streets or
areas, and waterways.
c_ The work covered by this application may not be commenced before issuance of Buildh~g Permit_
d. Upon approval of this application,' the Building Inspector will isme a Building Perm/t to the applicant. Such a pexardt
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 Ibr any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy. .~.
f. Every building perrmt shall expire if the work autricnzed has not commenced w~thJn 12 months after the date of
issuance or has not been completed wittfin 18'months fi:om such date. If no zoning amendments or other regulations affecting the
property have been ~nacted in the interim, the Building Inspector ma), authorize, in ;~Titing, the extension of the pemah for an
addition slx moinhs..Thereafcer, a new permk shall be required.
.&PPLICATION IS I~REBY I~LkDE to the Builduig Department for the issuance of a Building Permit pursumat to the
Building Zone Ordinance o£the Tm;-n of Southold, Suffet~,Coumy, New York, and other hpplicable Laws, Ordinauces or
Regulations, for the construction of buildings, adtht~oas, or akerations or for removal or demolition as herein descr/bed. The
applicant agrees to comply witlx all apphcabl{l[aws, ofdiuances, Luildmg code, housingcode, and regulations, and to ad.~t
authorized inspectors an premises and in build/ing for necessary mspectious.
.
(Signature of applicam or name, ifa coIporation)
CMa~l~ng address of applicant)
.State whether applicant is owner,.lessee, agent, arckitect, engineer, general coutmctor, electrician, plumber or.builder
Nmne of owner of premises J~//,v/4
~/7/P/4/5 r ~ t t
(As on he ax roll or latest deed)
If applicant is a corporation, si~maature Of duly authorized officer
(Name and title of corporate officer)
Builders License No_
Plumbers License No.
Electricians License No_
Other Trade's License No.
1. Location of land on which proposed work will be done:
House Number r, '~treet
Hamlet ~
County Tax Map No. 1000
Subdivision
Sec on /
Filed Map No.
Lot t-..
._ Lot
2.,' ~tate ex~stmg use .and occupancy of premises and mteniled use and occupancy ofprop0sefi ~nstructlbn~, a_ Existing use and occupancy /
b. Intended use and occupancy
3_ Nature of work (check which applicable): New Building_ Addition Alteration
Repair Removal Demolition Other Work
4. Estimated Cost ~/vao Fee
5. If dwelling, number of dwelling uhits O/
If garage, number of cars
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each t32oe of use_
7. Dimensions of existing structures, if any: Front ~ ~ q~ ~ Rear__~/q' q _Depth
Height ir' ,¢7"' Number of Stories O,oC_-
Dimensions of same structure with alterations or additions: Front g/~- ~ i~¢ ~r
Depth. 2.~- r.' , .1.6 Height ~F ~-£ Number of Stories
8: D/mensions of entire new construction: Front ) e'tr- ~- Rear Depth
Height Number of Stories
9. Size oflot: Front iI~L ~'~ Rear /~£. a _Depth q,~, (i -~2~/,~¢
I 0. Date of Purchase ¢/~0/0~ Name of Former Owner
11. Zone or use district in which premises are situated / r~Tql/'//~,' ,Oa."f,{J.,)
1
12. Does proposed construction violate any zoning law, ordinance or regulation? 5'ES NO ~
13. Will lot be re-ga&d? YES NO '~Will excess fill be removed~fi:om vremises? ~'ES NO
, .. ii,!. .
14 Names of Owner of premises ,]~]RI4~--~['{~4ll.~ Address/t2 )/',,~, Phone No.
Name of .architect Address Phone No
Name of Contractor [~[Zt ed l.~-o,i~d ~, l Address i:~,,d~z .7¢'[ o/'a~'d'~ Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a fi-eshwater wetland? *YES NO __
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERIvlITS IVL, kY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES __ NO /
* 1F YES, D.E.C. PERMITS IVlAY'BE REQUIRED.
16. Proxdde surx'ey? to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on. property, is at I 0 feet or below, must proxSde topographical data on sunrey.
STATE OF NEW YORK)
ss:
COUNTY OF )
fi t/¢;,¢4,{ ~¢'~¢ilt¢,,J being d~y sworn, d~o;es ~d says that (s)he is the appiic~t
~e of indi~ddual sing contract) above nmned,
(~He is the
(Contractor, Agent, Corporate Officer, etc.)
of said owner or oxxmers, and is dui3, authozized to perfom~ or have performed the said work and to make and file tiffs application;
that all statements contained in this application are tree to the best of his knowledge and belief: and that the work \vill be
performed in the maimer set forth in the application filed therewith.
Sworu to before me tliis~
~ No{au' Public
LYNDA M. BOHN
NOTARY PUBLIC, State of New York
No. 0'~BO6020932
Oualified in Suffolk Coun~
Term Expires March 8,~'--