HomeMy WebLinkAbout29688-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30368 Date: 08/06/04
THIS CERTIFIES that the building ADDITIONS & ALTERATIONS
Location of Property: 695 BAYVIEW AVE GREENPORT
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 52 Block 5 Lot 20
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 29, 2003 pursuant to which
Building Permit No. 29688-Z dated SEPTEMBER 2, 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 JAMES M & MARGARET FLANAGAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1193366 07/02/04
PLUMBERS CERTIFICATION DATED 07/06/04 PECONIC PLUMB.&HEATING
r
A7uKaorized Signature
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N-Y.
CERTIFICATE OF OCCUPANCY
NO: Z-30368 Date: 08/06/04
THIS CERTIFIES that the building ADDITIONS & ALTERATIONS
Location of Property: 695 BAYVIEW AVE GREENPORT
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No_ 473889 Section 52 Block 5 Lot 20
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 29, 2003 pursuant to which
Building Permit No_ 29688-Z dated SEPTEMBER 2, 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 JAMES M & MARGARET FLANAGAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1193366 07/02/04
PLUMBERS CERTIFICATION DATED 07/06/04 PECONIC PLUMB)&HEATING
A7uKiorized 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)
PERMIT ISO'. 29688 Z Date SEPTEMBER 2 , 2003
Permission is hereby granted to :
JAMES M FLANAGAN
7 YOUNG STREET
CORTLANDT MP.NOR,NY 10567
for
ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR; FLOOD PERMIT INCLUDED
at premises located at 695 BAYVIEW AVE GREENPORT
County Tax Map No. 473889 Section 052 Block 0005 Lot No. 020
pursuant to application dated JULY 29, 2003 and approved by the
Building Inspector to expire on MARCH 2 , 2005 .
Fee $ 707 . 80
i
Authorized Signature
ORIGINAL
Rev. 5/8/02
Form
No.6
- TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAIL
765-1802
i._ AML F1LIIl 'QafERTMCATE 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:
1. Final survey of property with acctuate location of all buildings,property lines,streets, and unusual natural or
topograpltic 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 Undenvriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead_
5. Commercial; uilding,industrial building,multiple residences and similar buildings and installations,a certificate
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. Accurate survey of property showing all property lines, streets,budding 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 dwellina$25.00, Additions to dwelling$25.00,Alterations to dwelling$25.00,
Swimming pool$25.00,Accessory building$25.00,Additions to accessory building$25.00,Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building- S100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00
Date. A/0
New Construction: / ��jj Old dor Pre-existing Building: (check one)
6
Location of Property: 9:s— SgyU1&-o AUS c,-0C,7 01-b. 11f 71
House No. ff Street Hamlet
�J
Owner or Owners of Property: -4o-' j )'56'41J-464"j
Suffolk County Tax Map No 1000, Section �� Block Lot Oo
Subdivision Filed Map. Lot-.
Permit No. C
�.�\p O Date of Permit. Applicant.
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request fon Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicanj� a e
c C'
SsS F014,
Albert J. Krupski, President QUO BOG .Town Hall
- James King, Vice-President h� S _ 53095 Route 25
Artie Foster O - P.O.Box 1179
Ken Poliwoda as x Southold. New York 11971-0959
Peggy A. Dickerson
Telephone(631) 765-1892
•l a ' Fax(631) 765-1366
2 9 ?vJu
f BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0005C Date 8/23/04
THIS CERTHIES that the second-story addition to dwelling and new garage
At 695 Bayview Ave. , Southold
Suffolk County Tai Map # 52-5-20
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 3/31/03 pursuant to which Trustees Permit# 5742 Dated 4/30/03
Was issued, and conforms to all of the requirements and conditions of the applicable
provisions of law. The project for which this certificate is being issued
is a second-story addition to dwelling and new garage
The certificate is issued to James & Margaret Flanagan owner of the
aforesaid property.
Authorized Signature
Albert J.•Krupski,President g % Town Hall
James King,Vice-President t � FFU(,�c ` -� 53095 Route 25
Artie Fosteri" P-O.Box 1179
Ken Poliwoda yJ� Southold,New York 11971-0959
Peggy A. Dickerson
G Telephone (631) 765-1892
y ��' Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN
APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO
SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE
PERMIT.
INSPECTION SCHEDULE
Pre-construction, hay bale line
1st day of construction
% constructed
Project complete, compliance inspection.
��O�pS�FFOIx�o�
a �
G7 �
Town Hall,53095 Main Road p • Fax(631)765-9502
P.O-Box 1179 �'�O aft` Telephone(631)765-1802
S'onthold,New York 11971-0959 1 ,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD20
5 t
0`14 1
k
CERTIFICATION � F"°`
Date:_ //�
Building Permit No. { r)e"
Owner: p V'1 = S F L"4 N
(please print)
per,/ j
Plumber: ?e-co Y\ [ P A JVi
i
(please print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
lumbers Sign
Sworn to before me this
day of I 20
1
Notary Public, County
VUi L.tr�'R
Notary Pubfrc.State DfNaw aw York
No.01106070081
Qualified in Suffol Coun
Cmnmissm UIres U(p
EMU
OF
SCr�st�rLata
MIN
5 BY THIS CERTIFICATE OF COMPLIANCE THE
5 NEW YORK BOARD OF FIRE UNDERWRITERS
5 BUREAU OF ELECTRICITY 5
5 40 FULTON STREET — NEW YORK, NY 10038 5
CERTIFIES THAT
5 Upon the application of upon premises owned by
' 55
5 PAUL R. BURNS JAMES FLANAGAN
P.O. BOX 1061 695 BAYVIEW AVE
SOUTHOLD, NY 11971-0932, SOUTHOLD, NY 11971
5 Located at 695 BAYVIEW AVE SOUTHOLD. NY 11971
Application Number: 1193366 Certificate Number: 1193366
e
Section: Block: Lot: Building Permit: BDC: ns11
Described as a Residential occupancy, wherein the premises electrical system consisting of C
LU electrical devices and wiring, described below, located in/on the premises at: 7
Basement,First Floor, Second Floor,Attached Garage, Outside,
A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed v
S herein, was conducted in accordance with the requirements of the applicable code and/or standard
promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
authority having jurisdiction, and found to be in compliance therewith on the 2nd Day of July, 2004.
5 Name QTY Rate Ratine Circuit Tvpe
Alarm and Emergency Equipment
Sensor 2 0 Carbon Monoxide
—u Sensor 4 0 Smoke
Appliances and Accessories
Exhaust Fan 2 0 E.H.P.
Hydro Massage Tub.Residential 1 0
S
Dish Washer 1 0 1.2 KW
Range 1 0 12.1 KVV
Air Conditioner 1 0 24.000 BTU
5 Air Conditioner 1 0 30.000 BTU
5 Furnace 1 0 Oil
5 Pump'Motor 1 0 1 H.P.
Wiring and Devices
5 Outlet 39 0 Fixture
Fixture 38 0 Incandescent
Fixture 1 0 Fluorescent -_
Outlet 73 0 General Purpose seal -
Receptacle 39 0 General Purpose -
Continued ou Next Page 1 of 2 -
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
B rJ�cl acJrJ@PrJ�rJ�cf�Pc fcJcJ a�J acJ�fact acJ arJ�rJ�r�rJ�rJ�cfacJrUrJ@JcJcP[PrJ�rJ�rJi JrJ�rJ�rJcJ Ili: fdPi JcJ 111Cr�rJ�cicJr PL.PrJ-d3 @rr�rPcJarJ��JcJa
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BY THIS CERTIFICATE OF COMPLIANCE THE
5 NEW YORK BOARD OF FIRE UNDERWRITERS
5 BUREAU OF ELECTRICITY 5
5 40 FULTON STREET — NEW YORK, NY 10038
5 CERTIFIES THAT
5 Upon the application of upon premises owned by 5
5
PAUL R. BURNS JAMES FLANAGAN
P.O. BOX 1061 695 BAYVIEW AVE
SOUTHOLD, NY 11971-0932, SOUTHOLD, NY 11971
Located at 695 BAYVIEW AVE SOUTHOLD, NY 11971
C5 Application Number: 1193366 Certificate Number: 1193366
SSection: Block: Lot: Building Permit: BDC: ns11
r�I Described as a Residential occupancy, wherein the premises electrical system consisting of 5
5 electrical devices and wiring, described below, located in/on the premises at:
Basement, First Floor, Second Floor,Attached Garage, Outside,.,
A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed
herein, was conducted in accordance with the requirements of the applicable code and/or standard
�± promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
5 authority having jurisdiction, and found to be in compliance therewith on the 2nd Day of July, 2004. 5
5 Name Q'1Y Rate Rana Circuit Type
5 Switch 34 0 General Purpose
5 Paddle Fan 1 0
5 Receptacle 1 0 20 amp Laundry
5 Receptacle 1 0 30 amp Dryer
L+ Dimmers 4 0
5 Disconnect 2 0 60 amp Air Conditioner C
Receptacle 11 0 GFci
Service 5
5 1 Phase 3W Service Rarin.g200.amperes
11 Service Disconnect 1 200 cb
5 Meters: I C
5
5 seal
5 2 of 2
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
5
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Jul 26 04 11:06a DIC III EHAMPTON 631 329 7159 p.2
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Product Data Sheet
FSK-25
General Description
FSK-25 is a 0amexretardant insulation facing vaporbarner made from lightweight a"- mim idl,fiberglass yam
rsttfrrara en"e"kat pepw1amiriafed tmjetherwiA,aflame retardant adhesve-FSG25 is designed to be
usEU over unfecedfiberglass Insulation m applicaliorfsivch regtare faced insultilmto comply with ASTM E-84-
Tegfor Surface BIRni The%&tg is aCedvd to the wall or cei§P.g wM
staples or mechanical fasteners
FSK-2[facing Is s ,,gied in 50"(127 cm)wide X 6DE (183m)long rolls to provide convenient job ste appticatior,
Other roll sizes are available an regL*M
FSK-25 when installed fail sde exposed meets the follow.ing speMeations:
1. ASTM E q4-TEST for Stxiece EaA.ning( tsacieristics of Binding Materials
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Flame Spread>25
Smoke Developed>50
2.Federal Specifications r�U-Ii790.Vapor Banner Requirements
T,^-. 1,Grade n.
3.ASTM E9SPermeance(Pror edL4e A)
Maxim=permeancia-0.05 grainihr.fftzNn.Hg(0.03 grarns24 hr/m2hnm Hg)
Thephvjail rarr wuflprmarlfes of John Marwile prodwxs repro senttypical averwevalues obtairoed in accordancemth
aCCep[ablat65[Iflefhe(IS'a 11G are 911lfapl tO nef11181p8nUFdLFllfnp VBl'IaLOnS. VxduesdR suppled F¢a leGIN®l s&-Ace end due
suLjeR to change wehnut non.
Hamilton Technologies, A Business of Johns Manville Corporation
74x0 Franco Road Corp.Headglrrrtare 717 17TH Street;
Richmond,VA 23228 Denver,CO 90202
(804)2617400 1 FA.Tr(8041261-74 05 (M3)9786000
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;RR. . Board Of Southold Town Trustees k`
SOUTHOLD, NEW YORK .-
5 PERMIT NO. 375 ..... DATE: ... April 30, ?003 s= I
ix •.
ISSUED TO JAMES MARGARET FLANAGAN
._.._.._ _ .
�_ .�lutl�nrt�tttinn '�
Pursuant to the provisions of Chapter 615 of the Laws of F
the State of New York, 1893; and Chapter 404 of the Laws of fhe
- State of New York 1952; and the Southold Town Ordinance en-
` titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;:-. and in accordance with the
Resolution of The Board adopted at a meeting held on .. `.P.z'il. 30-,__
` $ paid by
2003 and in consideration of the sum of ! 0u
Y Jade Margaret Flan. ...1
...
. Y. and subject to the rs 1
of Southold N.
Terms and Conditions listed on the reverse side hereof, f I
of Southold Town Trustees authorizes and permits the following:
Wetland Permit to construct a second-stor on the existing
drelling and to expand the house b-,_ constructing a garage
s .
to-ward the road •:•dth the condition that dr-, ells and gutters
on the h-us p ar a e , d ,as. 'de icted o the
azll insa le t pp
a �or`�lance with t�e �etaiC s eci ications as resente in
'r the originating application. site plan prepared by Donald Feiler, ` \
i' Architect last dated June 26, 2003.
IN WITNESS WHEREOF, The said Board of Trustees Mere-
j by causes its Corporate Seal to be affixed, and these presents to 1,
be subscribed by a majority of the said Board as of this date.
Trustees _ ,r
I
e 1.,
TERMS and CONDITIONS
The Permittee James & Margaret Flanagan
residing at 695 Bayview Ave. , Southold N Y as
Y
part of .the consideration for the issuance of the Permit does understand and•prescribe to the fol-
lowing:
L Thu the said Board of Trustees and the Town of Southold are released from any and I
all damages, or claims for damages, of suits arising directly or indirectly as a result of any opet-
ation performed pursuant to this permit, and the said Permits..- will, at his or her own expense,
defend any and all such suits initiated by third parties, and the said Permittee aca+mes fall liability
with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold
2. That this Permit is valid for a period of 24 mm which is considered to be the 4
estimated time required to complete the work involved, but should circumstances warrent, request
for an extension may be made to the Board at a later date
3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes
to maintain the structure or project involved, to provide evidence to anyone concerned that auth-
orization was originally obtained
4. That the work involved will be subject to the inspection and approval of the Board or
its agents, and non-compliance with the provisions of the originating,application, may he cause for
revocation of this Permit by resolution of the said Board-
5. That there will be no unreasonable interference with navigation as a result of the work
herein authorized.
G. That there shall be no interference with the right of the public to pass and repass along
the beach between high and low water marks.
7. That if future operations of the Town of Southold require the removal and/or alterations
in the location of the work herein authorized, or if; in the opinion of the Board of Trustees, the
work shall cause unreasonable obstruction to free navigation, the said Permittee will be requited,
i
upon due notice, to remove or alter this work or project herein stated without expenses to the Town
of Southold_
8. That the said Board will be notified by the Permittee of the,compledom of the work auth-
orized.
9_ That the Permittee will obtain all other permits and consents drat may be required stip-
plemental to this permit which may be subject to revoke upon failure to obtain same
New York State Department of Environmental Conservation
Division of Environmental Permits, Region One V
Building 40-SUNY,Stony Brook, New York 11790-2356
Phone: (631)444-0365 • FAX: (631)444-0360
Website: www.dec,state.ny.us Erin M.Crotty
Commissioner
I
Letter of Non-Jurisdiction -Tidal Wetlands Act
James and Margaret Flanagan February 28, 2003
7 Young Street
Cortlandt Manor,NY 10567
Re: Flanagan Property, BayvieXv Avenue, Southold
SCTN I-4 1000-052-5-20
Application 4 1-4738-03136.100001
Dear Mr. and Mrs. Flanagan-
Based on the information you hay e submitted. the Nen' York- State Department of Environmental
Consen-ation has determined that:
The property that is Landv;and of the pre-existing prior to Si20 7 7) bulkhead which is more than
100 feet in length. as seen on in-house infrared aeriat photograph �1 684 is beyond the jurisdiction
of Article 25 (Tidal �A,'etlands).
` Therefore, in accordance with the current Tidal W etlands Land Use Regulations (6NYCRR Part
661) no pcnuit is required under the Tidal Rredands Act. Please be advised, however, that no
construction, sedimentation, or disturbance of any kind may take place seaward of the tidal
Nvetlands jurisdictional boundary, as indicated above, .vithout a permit. It is your responsibility
to ensure that all necessar,precautions are taken to prevent any sedimentation or other alteration
or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may
result from your project. Such precautions may include maintaining adequate work area between
the tidal wetlandjunsdictional boundar;and -,our project (i.e. a 15' to 20' wide construction area)
or erecting a temporary fence, barrier, or hay bale berm.
Please be further advised that this Letter does not relieve you of the responsibility of obtaining
any necessary permits or approvals from other agencies.
Sincerely,
Mark C. Carrara
Permit Administrator
cc: 1\IHP
File
PROFESSIONAL ENGINEER
1725 HOBART ROAD/PO Box 616, SOUTHOLD. NEW YORK 11971 '
TEL631-765-2954 • FAX631-614-3516 • eanall: joseph@HscheW.com - -
Date: August 8, 2003
Reference: 695 BayvieNv Avenue
Southold Building Dept
ID lain Road
Southold,NY 11971
1
i
i
Dear Sir.
I inspected the subsurface sanitary system at the above referenced property owned by Mr. Flanagan. I
certify that the system contairLs a 1000 gallon septic tank and a 10 foot diameter leaching pool 8 foot
deep and is in harking order and is adequate for a three (3) bedroom home.
�\
f.� OF iVa;�:1 �
a525�n
�SSIO�`
Joseph Fischetti, P.E.
Fl.0✓..E.'�-+unlvJ'srw:�tion.lor:
_ FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
f ELEVATION CERTIFICATE
important: Read the instructions on pages 1 -7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use-
,� BUILDING OVINER'S NAMEr ---- -- // Pehoy Number
1 _ <Jrairle� �
BUILDING STREET-/ ESSJncluding ApL,Unit, ite',and/or Bldg.No.)OR P.O.R E AND BOX N0. CompanyNAIC Number^ -•
rc� �tJei9✓�
CITY �O v /; o/�/ STATE j ZIP CODE 1(f
71
PROPERry DESCRIPTION3
/(Lot aF4Blo Nu bers,TaxL parcel Number gal Desc" lion,etc.)
fu• ' � �cG r9TZ Ilea fCl7P. to T4K �I�a/� A� rlsG�T /000— Zia
C'
BUILDING USE(e.g.,Resid fiat, Yon-re dentia,Additio Accessory,etc. e a Comments area,if necessary.)
)2e Si drrl [[
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: 1-1 GPS(Type):
or ##. ') 1-1 NAD 1927 1_I NAD 1983 LI USGS Quad Map LI Other:
SECTION B-FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
I
B1 NFIP��OMMUNITY NAME&COMMUNITY NUMBER B2.COU NAME B3.ST TE
O]E
#e 1V1f-L4J
B4. MAP AND PANEL B5.SUFFIX BS.FIRMINDEX B7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATIONS)
NUMBER DATE EFF GTIVE/REVISED DATE ZONES) _ (Zone AO,use depth of Flooding)
B10. Indicate the source of the Base Flood Elevation (BFE)data orb se flood depth entered in 139.
I I FIS Profile JA FIRM 1_J Community Determined 1_1 Other(Describe):
311. Indicate the elevation datum used for the BFE in B9: 1�NGVD 1929 1_1 NAVD 1988 1_1 Other(Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS)area or Otherwise Protected Area(OPA)? 11 Yes No
Designation Date:
SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 1-1Construction Drawings' 1-113uilding Under Construction' 1 Finished Construction
`A new Elevation Certificate will be required when construction of the building is complete.
C2.Building Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed-see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
I C3. Elevations—Zones Al-A30.AE, AH,A(with BFE), VE,V1-V30,V(with BFE), AR,AR/A, ARAE,AR/A.1-A30,AR/AH, AR/AO
Complete Items C3.a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Llse the space provided or the Comments area of Section D or Section G, as appropriate,to document the datum conversion.
Datum Conversion Conversion/Comments
Elevation reference mark used 13 ✓oto �P.52 Does the elevation reference mark used appear on the FIRM? 1J Yes �. o
❑ a)Top of bottom floor(including basement or enclosure) 6 (m)
❑ b)Top of next higher Floor .'5R ft m)
❑ c) Bottom of lowest horizontal structural member(V zones only) —R(m)
❑ d)Attached garage (top of slab) _ /U /a ._ft.(m) E a
Li e)Lowest elevation Of machinery and/or equipment ur v
servicing the building Describe in a Comments area. o� m a ` a
❑ f) Lowest adjacent(finished)grade(LAG) /o�'�ft.(m) i y
❑ g) Highest adjacent(finished)grade(HAG) ft-(m)
❑ h) No.of permanent openings (flood vents)within 1 ft. above adjacent grade 400
❑ Total area of all permanent openings (flood vents)In C3.h sq. in. (sq.cm
) -
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
This certificafion is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify that the information in Sections A, B,and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. _
CERTIFIER'S NAMES��rl/P, TDp1. LICENSE NUMBER y/�
J. 1 ,7- N p Lfc o 73
TITLE oUlH--6S lop e- y4'r- COMPANY NAME r / ' �
/ /' 7 J r9 �Y � 15a ase n, �Tr.
ADDRESS '
� v— , I CITY L IL' STATE ) ZIP CODE 11956
SIGNATURE ' `7 DATE/ �Jv U5 I_/� LEPHONE / 7
5--33 5-
FEMA
FEMA Form -31,JUL 0 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
i
TOWN OF SOWHOLD PROPERTYCARD
OWNER — STREET (1 ,, ., VILLAGE DISTRICT SUB. LOTS 3 c�
!`la/
�RME1j OWNER N \ E ACREAGE / 6
S W TYPE OF: BUILDING
RES.
SEAS. VL. FARM COMM. IND. CB. MISC.
LAND IMP. TOTAL DATE REMARKS��i,J
x t� rJi 0 4x70 '3o, ?Cl
---
L 117h r i 283- Ln
�n)C �r7c, h) F71 Qn
j I.1 i s i.! (;r , { i �!� r !Ur ✓,r•i ',i + Y ! Z
AGE BUILDING CONDITION
NEW NORMAL BELOW ADOVE
OG)
Farm Acre Value Per Acre Value —
Tillable 1
Tillable 2 - - - - -- �- -
Tillable 3
Swampl°nLa - - � - - - -
Drushlarid �-
i
/yyr.rs !J rr15xii 'r C
y��i���irlle��� � � �* 'i��i�V "7'
t$'S'p*l�Fk Itve Vie,. 4 r+1 � C Arrrj" yV�9 iYS,yte.M y Ni
m W�
T 9
M. Sldg. I —, � 1302
Foundation C Bath
Extension Basement Floors 7—fbe
Extension Ext, Walls Interior Finish
�
Extension Fire Place Heat ?sj
Porch Attic
Porch Rooms 1st Floor
Breezeway Patio Rooms 2nd Floor
Garage Driveway
• • ,j}"j-14 T. T.CRAY I _ Trri•n Hall. S lllyC t,1am I
TOWN CLERK X ^ P O_ nn.c 117a
A
I LECI SFRlJ7 OF%ILU"SEATISn'_S , ;.. ;• I I'
MARRIAGE-. OFFICER J JbOTclq�hanc 15161 7G5. IF
f1ECG RUS hL'W AG EM ENT OI'FICEII 1`
FREEDOM OF tr4FORMAT10N OFFICER '4
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 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
Ppplic3tion" [ FDP(93) ] , and "Certificate of Compliance for Development in
Special Flood Hazard Area [C/C(93) ] .
t
TOWN OF SOUPIOL]
s� Judith T . Terry �
Southold Town Clerk
August 25 , 1993
APPLICATION b
PACE I of a
TOWN OF SOUTHOLD
FLOODPLAIN DEVELOPMENT PFHIMIT APPLICATION
This form is to be filled out in duplicate_
• SECTTON I: GENERAL PROVISIONS (APPL1Ce.IVT fo read and signl:
1. No work may start until a permit is issued-
2- The permit may be revoked if any false statements are made hcrein-
3. If revoked, all work must cease until permit is re-issued.
4. Development shall not be used or occupied until a Certificate of Compliance is issued.
5_ The permit will expire if no work is commenced witbin six months of issuance.
6_ Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory
requirements.
7_ Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable
inspections required to verify compliance.
8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHME_N'CS TO
THIS APPLICATION ARE,TO THE BUT OF MZOE
GE,TRUE AND ACGC�U TE.
(APPLICANTS SIGNATURE) — DATE / e3
SECTION 2: PROPOSED DEVELOPMENT (To be completed by APPLICP.I�'n
NAME AD D R ESS TELEPHONE
APPLICANT -
BUILDER lY3E .>
A?
"��Br� . � iii?1,6 �� zz n:e A i=
ENGIITEER
PROJECT LOCATION:
To avoid delay in Processing the appbcadoq please provide enough information to easily identify the project
location_ Provide the street address, lot number or legal description (attach) and, outside urban areas, the
distance to the nearest intersecting road or vre.11-k.nown.land=k. A sketch attached to this application showing
(he projcd location would be helpful.
I
AA'; em sk caw 41 �� Je T eity -v Wille
4251 ♦f
f
FDP(93)
APPLICATION
PAGE 2OFd
1
DESCRIPTION OF WORK (Check all appbublc boxes)
A. STRUCTURAL DEVELOPMENT
ACT(VTTY STRUCTURE TYPE
❑ New Structure 14 Residential (1-4 Family)
fidAddilion O Residential (?,fare than 4 Family)
KAlteratioo ❑ Noo-residcutiaJ (Floodproofmg? ❑ Yes)
❑ Relocation, ❑ Combined Use (Residential ,& Commcraal)
Demolition R ❑ Manufactured (Mobile) Home (In Manu-
0 Replacement facturcel Home Park? ❑ Yes)
=IvfATED COST OF PROJECT S
B. OTHER DEVELOPMENT ACTIVITIES:
❑ Fill ❑ Mining ❑ Drilling ❑ Grading
❑ Excavation (Except for Structural Development Checked Above)
❑ Watercourse Alteration (Including Dredging and Channel Modifications)
❑ Drainage Improvements (Including Culvert Work)
❑ Road, Street or Bridge Coastructiou
❑ Subdivision (New or Ezpausion) .
❑ Individual Water or Sewer System
❑ Other (Please Specify) J)1(�
After completing SECTION Z APPLICANT should submit form to Local Administrator for rcvio -
SEMON 3: FLOODPLAIN DECERP INNTION CTo be completed by LOCAL 4DMINISTRATOR)
The proposed development is lo�-t,ted on FIRM Pancl No. Dated -
The Proposed Development-
0
evelopment❑ Is NOT located in a Special Flood Hazard Area (Notify the applicant that the application -
review is complete and NO FLOODPLAIN DEVELOPMENT PERMITIS REQUIRED)_
❑ Is located in a Special Flood Hazard Arca.
FIRM zone designation is
L00'i ear Hood elevation at the site E:- Ft. NGVD (PdSL)
CI Unavailable
❑ The proposed development is located in a Goodway.
FBRet Pancl No. Dated
❑ See Section 4 fer additional iavrucncns.
SIGNED DATE
. r
- . APPLICATION #
PP.GE 3 OF 4
.SECTION 4. 4DDITIONAL INFORLt.4TfON REQUIRED (To he comnlc(cd by LQCAL ADM INISTRATORI
The appfi=L mus( submit the documents checked below before (be application reser be processed:
O A site plan sboo,ing Lbc location of all exiriing structures, water bodice, adjaccoi roads, lot
dimensions and proposed development-
C1 Development plans, drawn to scale, and spcciGcatipm, including where applicable: details for
anchoring structures, proposed elevation of lowest floor (including basemcot), types of water
resisLant materials used below the firs[ floor, details of floodprootrng of udEties located below
the fust floor and details of enclosures below Lhc first floor-
Also
❑ Subdivision or other development plans(If the subdivision or other developmentexceeds50
lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations
if they are not otherwise available)-
❑ Plans showing the extent of watercourse relocation and/or landform alterations_
❑ Top of new fill elevation Ft. NGVD (MSL).
❑ Floodproofing protection level (non-residential only) Ft:NGVD (MSL). For
Iloodproofcd structures, applicant must attach rrrtification from registered engineer or
' _ architect- -
❑ Certification from a registered engineer that the proposed activity in a regulatory floodway
will no( rcmoult in any increase in the height of Lhe 100-year flood- A copy of all data and
calculations supporting this finding must also be submitted-
0 Other-
SECTION 5: PERMIT DETERMINATION fTo be completed by LOCAL 4DMINTSfRATORI
I have determined that the proposed activity A_ ❑ Is
• B. ❑ Is not
in conformance with provisions of Loral law f 19 - The permit is issued subject to the conditions
attached to and made part of tbis permit-
SIGNED
If BOX A is checked, the U;cal Administrator may issue a Devclopmeu( Permit upon paymeui of designated
tee_
If BOT; B i; checked, (he Local Administrator will prnvide a v.Tiaen summary of do Gcicncics. Applicant may
revise and resubmit an application to the Local Administrator or may request a hearing from the Board of
Appeals.
APPLICATION a _
FADE a OF a
?.PPE�IS. Appealed l0 Board of ?.ppcals? 0 `rcz 0 No
t
Hearing data
i ,4ppeaL Board Deci-sio❑ --- Approved? ❑ 1'cs ❑ No
1
Conditions
iSECTION 6: AS-QUILT ELEVATION (To be submitted by APPLICANT before Certficate of LOMOiance
I is issued
The following information must be provided for project structures. This sec600 must be completed by a
registered professional engineer or a licensed land surveyor (or attach a certific fion to this application).
Complete f or 2 below_
L Actual (As-Built) Elevation of the top of the lowest Boor, including basement(in Coastal High Hazard
Areas bottom of lowest structural member of the lowest Boor, excluding pdiag and columns) is
Fr. NGVD (MSL).
? - Actual (As-Built) Elevation of floodproofmg protection is Fr. NGVD (MSL)_
NOTE: Any work performed prior to submittal of Lbc above iaformatioa is at the risk of the Applir, L.
SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADhIINISTRATOR)
The LOCAL ADMINISTRATOR will complete this section as applicable based on iaspc lion of the project to
ensure compliance with the communitys local taw for flood damage prevention_
INSPECIZONS: DATE BY DEFICIENCIES? 0 YES 0 NO
DATE BY DEFICIENCIES? 0 YES 0 NO
DATE BY DEFICIENCIES? 0 YES 0 NO
SECTION 8: CERTIFICATE OF OMPLIAN Eflo be comnlctcd by C AL ADM[PfI RATORI
Certificate of Compliance issued= DATE BY:
III
I
i
Attachment B ,
6AXPLE
CERTIFICATE OF COKPLIAIICE
for Development in a Special Flood Hazard Area
t
P i
e ,
1� 1
TOWN OF SOUTHOLD
j CC,RTIFICATE OF CON[PLL4NCE
FOR DEVELOPMENT IN A SPECLAL FLOOD RAZARD AREA
(O" ER MUST RETAIN THIS CERTIFICATE)
PREMISES LOCATED AT: PERMIT NO.
PERMIT DATE
i
OWNERS NAME AND ADDRESS: CHECK ONE:
❑ NEW BUILDING
❑ EXIS'T'ING BUILDING
❑ VACANT LAND
i
THE LOCAL ADMINISTRATOR IS TO COMPLETE A OR B. BELOW:
a. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF
LO CAL LAPP # 119 .
SIGNED: DATED:
B. COMPLIANCE IS HEREBY CERTIFIED NVITH THE REQUIRETAENTS OF
LOCAL LANV # , 19AS MODIFIED BY VARIANCE #
DATED
SIGNED: DATED:
C/C (93 )
PROFESSIONAL ENGINEER
Z 8 Mn
1725 HOBART ROAD I PO Box 616, SOUTHOLD, NEW YORK 11971
TEL 631-765-2954 • FAX 631-614-3516 - e-mail: jmeph@Fjschetb.com
Date: August 8, 2001
Reference: 695 Bayview Avenue
Southold Building Dept
Main Road
Southold,NY 11971
Dear Sir,
I inspected the subsurface sanitary system at the above referenced property owned by Mr. Flanagan. T
certify that the system contains a 1000 gallon septic tank and a 10 foot diameter leaching pool 8 foot
deep and is in working order and is adequate for a three (3) bedroom home.
01F NE
V, 1r'F%SC 0
C')
0- 052
-PSSIOiA
Joseph Fischetti, P.E.
c FEDERAL EMERGENCY MANAGEMENT AGENCY Y-4-34�' '7
'NATIONAL
„- INSURANCE POOTvI B 1'o aD67 DI3T
: TAL• FLOODRGRAM � r A
... E3tplYesrSuly 31,20Q2''
ELEVATION CERTIFICATE - - - - -
Important: Road the instructions on pages 1 -7.
i SECTION A.PROPERTY OWNER INFORMATION -or:--siumv, 1ro
riL V;:+.:V' I'.a"JAVI:-..=:--_..-. /' �/ ILI: r\ nhrr ,
ii!'_."'.',SI�'_F'r:•.;111;-�5�'+':c .r.'rtr Ap',Uni.S_11' /'rdo: 91:ir..`I�.);,,t.'U ZLI:. EAt."I 9U\:ICI 1. r ,5ai!rl:.i::`lu ,bus••
CITY sO /�7 ` A 7 Oe/k /-';I 02 I f / 7
0
PROPER DESCRIPTION(Lot a Bio N hers,Taxp;mel Number L gal Des tion,etc.)
f� k I/_'r-,«,IfA ' � ��o�-fz/,...T4-Y . dl.� A�aovb 1�o dS� rQ 5' Zo
BUILDING USE e.g ,Resj'd tial,NNon-r :(dentia,Addib Accessory,etc. a-a Comments area,if necessary.)
LATITUDE/LONGITUDE-(OPTIONAL) HORIZONTAL DATUM: SOURCE 1 1 GPS'. ypery -
( ##°-##'-#iF.##" or ##.###N#°) L_l NAD 1927 . 1_1 NAD 1983 I_j l'1SGS'Ouad.Map •�__1 Other._ _.
SECTION IS FLOOD tNSURANCE'RATE MAP(FIRMj,INFORMATIO_ N _
Bt.NFIP COMMUNITY NAME&COMMUNITY NUMBER - B2.COU rJ Y NAME
�ov�holc�., /ccilvf of 3�oFl ri dj.
B4.MAP AND PANEL B5.SUFFIX 06.FIRM INDEX 487:FIRM PANEL BN
8.FLOOD B9.BASE FLOOD ELEVATIOS)
NUMBER ,� DATE. EFF CTIVE/REVISED DATE ZONE(S). (Zone AO,use depth of Flooding)
-810 Inifirok+-t� sou ce""nf(he Paso Flnod FlP ra!ion (RFE)data nee sc flood depth entered in 139
11 IRim � .. I C'cmmunll Dotnimincd l—1 Other(Describe);
cvqtion r.,llu•r used lur:Ila 617 in 114: 1/',L-N , U 1!'29. 1 1 NAVI7 1988 lJ;,dthar(Describe):
B12 I:• ho!•.:iIJ n' lor.�.rer,l III ':Coaslrl rlf:rrr•.r R;si: ircos S)sl_:u (CIiIZS)area or Otherwise Pmtectedkea'(OPA)? Ll Yes ONo,
Designabori,Date: - - -
i
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are basedon: lPoristr4don Drawings* 1_1Building Under Construction* l lVnished Construction
*A new Eleva{ion Certificate will be required when construction of the building is complete.
C2. Building,Diagram Number_LT L(Select the building diagram most similar to the building for which this certificate is being completed.-see
pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.)
C3. Elevations=Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARAE,AR/A1-A30,AR/AH,AR/AO
Cnmr"o!c items C3.a 1 b^low according to tho building dingmm specified.in Item C2.State the datum used.If the datum is different from-.
t:c dal.rm LFCJ Icr Ilio rii t in Sec'ion n.cbnvortlho dalunl :n shat used for the BFE Show field measurements and,datum conversion
c a'::uI-Ak; '. Uso Ibu spice provid-d o' LPr.Con mrnts I:rF-i BI Section 0 o Section G,as,apprepriate,:to document the datum"conversion.
C rl :n )� Zg Crnac•Fic•i:f:ur.rnrn's _ .. '
Fl ,v..ic,•rakn•-rc:.rnr.rk usuJ�. �c. :/<<�'� Uoos:he elevation reference mark used appear on the FIRM? Ll Yes' l . o-
❑- a)'Top ofbottom floor(including basement orenclosure) o` m) a
❑ b)Top of next higher floor .zf3 ft m) 9 �i
❑ c)Bottom of lowest horizontal structural member(V zones only) --—ft.(m)
❑ d)Attached garage(top of slab) /U /� ._ft.(m) -� -. ---
❑ e) Lowest elevation of machinery and/or equipment
servicing the building,(Describe'in a-Comments'area.)
❑ f Lowest adjacent(finished)grade(LAG).y h>�'�ft.(m)
❑ g) Highest adjacent(finished)grade-(HAG): - _,. _ /D. r�ft.(m)
❑ h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade-401 e El i)i)Total area of permanent openings(hoo'd vents)in C3.h sq.in.(sq.cm)
SECTION b-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by;a land surveyor,engineer,or architect authorized bylaw to certify elevation information.
I certify that the information in Secffons A,-B,and C'on this certirrcate represents my best efforts to interpret the data available.
I understand the[`any false statEment 2lay be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
S wyilP� � ,_rff) e.?mss. �1� 973
TITLE oU/fe! So/ . COMPANY NAME r
f/' o'fJi'/�fo/ �f 11/ty .J- 15a k52n, Tr.
ADDRESS /� / �dX - CITY, eaj c/-r STATE ZIP CODE 9S�
SIGNATURE if DATE/V� p-U Ul`T/cf( LEPHONE / / 7 (-75Y-35 z r5
FEMA Form -31,JUL 00' I.:� SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
Permit Number
t
REScheck Compliance Certificate Cbm.ked By/Date
New York State Energy Conservation Construction Code
REScheckSoftware Version 3.5 Release 1
Data filename_Untitled rck
TITLE:Flanagan Residence
COUNTY:Suffolk
STATE:New York
HDD: 5750
CONSTRUCTION TYPE:Detached 1 or 2 Family
HEATING TYPE_Non-M=ric
DATE:06/17/03
DATE OF PLANTS:June 18,2003
PROJECT INFORMATION:
Additions&Renovations to E)dsting Residence
COMPANY INFORMATION;
Donald G_Feller
COMPLIANCE:Passes
Maxim un UA=292
Your Home UA=225
22.9%Better Than Code(UA) .
Gross Glazing
Area or Cavity COOL orpoor
Perimeter R Value R-Vahm U-Factor UA
Ceiling 1: Fiat Ceiling or Scissor Tross 92.8 30.0 0.0 32
Ceiling 2: Cathedral Ceiling(no attic) 392 30,0 00 13
Wall 1: Wood Frame, 16"o_c. 1598 21.0 0,0 S1
Window 1: Vinyl Frame:Double Pane with Low-E 172 0320 55
Floor 1:All-Wood Joisr/frnss:Over Unconditioned Space 1008 21.0 0.0 44
Furnace 1:Forced Not Air, 78 AFUE
Air Conditioner 1:Electric Central Air, 10 SEER
COMPLIANCE STATEMENT: The proposed building represented in tivs document 1s con�ee r with the��g pt
specifirarions,and other calculations submined with tlris permit application. The proposed systems have been desgned to meet the
New York State Energy Conservation Construction Code rcgwrements_ When a Registered Design Pro&=onal has
Mmped and
signed this page,they are attesting that!that!oAhe best of his/her knowledge,belief,andofm6onal'
specifications are in liattee with a J �k such Plass or
Bmlder/DesignerA2 Date 712&10",
Applicant/ Date. .
Owners Name: Reviewed: ja
Architect/ Dale
'Engirieer: Submitted:
SCTM #:
District: 1000 Scaion: 5 Block _ � Lol. -'7
Project Subdivision
Loealion - -
--- — Name-
i SmLlc k, separalc Required ,
e certification:
Fcy �� ,l lid
_ 7ouiu�Oisuie,� fL_ ILGEsiu: i�n'�T -_A.cn nal:10 YUI ILof euvcra&c
S
7,� r Req
Ili onl 'r'-v1 J � Prorc.c]' —I IS iac-i_rd� �Iri2'P.�.�� I lP.ar'r�r.. I'ro�.c.cl
Project Description: - CW .t
A,–ENC?'fsRAfIT5 Permit .
RECIUIRED FOR P-EKMGTr N.A.} / NO IrES Number
Suffolk CourltyHealth Deet
?dev: Yorl; State D. E.. C. _—
Town Trustees _ _ _—
Tov,n Zoulag Doard approval: mss✓'– _--
Trlv,rn Pbtntiae PD-,aid appro.'al —
Flood Plane Elevation?:? %" r
Flood Zoa!e: 1 +✓ — — tr ��C� ,`J
—C
Notes: l� ax P/] ♦ /JjJ��
e .e.Sm"'>d"�irh s'Yrt'riYS
;rte s
v
NEW YORK STATE CODE COMPLIANCE CHECKLIST
CIMATIC'GEOGRAPHIC DESIGN CRITERIA:
Ground Snow Load: 45 Wind Speed: 120MPH_f Seismic Design Category: B /
Weathering: Severe Frost Depth: 36"_Termite: NI-H Decay: S-DI
Design Temp: 11 Iee Shield Underlay:FES Flood Hazards: Y;A
USE/OCCUPANCY'CLASSIFICATION:
HEIGHT/FIRE AREA:
TYPE OF CONSTRUCTION
DESIGN CRITERIA: ENGINEE SCRIPT '
FULL.FRA vTING DESIGN ELEMENTS: Y,N
HEADERS: Y/N WALL STUDS: Y/N ✓ GIRDERS: Y/N
CEILING JOISTS: Y/N FLOOR JOISTS: YiN ROOF RAFTERS: Y/N
LUMBER SPECIES AND GRADE: YIN
DESIGN LOAD CALCULATIONS: Y/N
LIVE: YIN DEAD: Y/N SNONV: Y/N SEISM1HC: Y/N «IND: Y/N
WINDOW AND DOOR SCHEDULE:
MISSLE TEST REQUIREMENTS: Y/N
EGRESS 5.7 S.F.: Y/N
LIGHT S°/b: Y/N
FENT 4%: Y/N
NAILING.%CONSTRUCTION SCHEDULE: Y/N
MEANS OF EGRESS: Y;N f
PLUMBING RISER DLAGRAM: Y,N
LOCATION OF FIRE PROTECTION EQUIPMENT: A"N
TRUSS DESIGN: Y;N
CERTIFICATION: Y;N
r
ENERGY CALCS:YN � ..
v ;
TOTAL COMPETENCE? Y/N (RETURN TO PAGE ONE)
V
.IdNPIEC ImON
[ ] FOUNDATION i ST [ ] ROUGH`PLOG.
7
] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
a
REMARKS:
DATE C c INSPI'9
765-1802
BUILDING DEPT.
i
INSPECTION
[ ] FOUNDATION 1ST [ ROUGH PLBd
[ ] FOU ATION 2ND [ ] INSULATION
[ RAMING [ ] FINAL
[ ] FIREPLACE A CHIMNEY y
J
RfMARKS: il��j494
r, �
f
J -"'--
DATE INSPECTO '., 1_
J /{
d '
�m
k'
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] R H PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
f
[ ] FIREPLACE A CHIMNEY
REMARKS: 7 /
DATE L = INSPECTOR
I
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I ULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DAT -2 *a'INSPECTOR
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ Vf FINA
i [ ] FIREPLACE & CHIMNEY [ ] FIRE-SAFETY INSPECTION
REMARKS:
DATE .2-8 Zvu INSPECTOR v
FIELD]NS$ECTION REPORT DATE COh
olm
FOUNDATION( �r
m
- t+1
FOUNDATION ) h
z
- o
z.
ROUGH FR4h3II?G& -3
PLUMBING
4 �
_ J
G
INSULATION PER N.Y.
STATE ENERGY CODE
96FAWAV, OZ
<r
FINAL 71.8 d
d Q
ADDITIONAL C MMMiTS
.a� a
n
z
m
z
_ W
y
O
i 2
l �
C
My
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN WALL Board of Health
SOUTHOLD, NY 11971 3 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 A� Sunley
vvww. northfork.net/Southold/ PERMIT NO. Check
Septic Fonn
N.Y.S.D.E.C.
` Trusties
Examined pIif ,?0&5 Contact:
Approved // �- , ?0 613 Mail to:
Disapproved A.
Phone:
Expiration -
6'
Building Inspector
{I YAP�LICATION FOR BUILDING PERAHT
9VQ �1
Date 20
INSTRUCTIONS
a. Tnb STN 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. Few 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 pemut
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.
f. Every building pern it shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within I8,montns 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.
APPLIC kTION IS HEREBY N1_-kDEjto the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Townof 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, ordinances, building code, housing code, and re lations, and to admit
authorized inspectors on premises arid in building for necessary inspections.
/ (Biwa rz of applicant or uame,if a orporation)
/C/ � —
(Mailing address of applicant) T
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
6)WA45e
Name of owner of premises Jd M&t ;. A,6 Al,,WG A.PJ=T /—L/NAC-Jn.)
(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. 1'17�
Plumbers License No. j g 7
Electricians License No. 7-6
Other Trade's License No.
1. Location of land on which proposed work will be done:
.69� z✓/,dyyrgtt) /d
House Number Street Hamlet
t -.
County Tax Map No. 1000 Section 7 J Block r•„_ : - Lot^<
Subdivision Filed Map No.
(Name)
2. Stateietcisting use and occupancy of premises and intended use and occupancy of proposed construction: ~
a, Existing use and occupancy
b. Intended use and occupancy 6,
-;3. Nature of work(check which applicable): Next Building_ Addition Z-'� Alteration
Repair Removal Demolition Other Work
g"/ (Description)
4. Estimated Cost l( �o 0 e6o Fee
To be paid on filiug this application)
5. If dwellingnumber of dwelling units / Number of dwelling units on each floor
If�garage,`numberofcars
6. If business, commercial or mixcd occupancy, specify nature and extent of each type of use-
r2-,9 Jj 5
se.PLNJj5
7. Dimensions of existing structures,_ if am': Front Rear Depth
Height Number of Stories /
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories ;2-
8.
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories ;Z
' r ,
9- Size of lot: Front S%i. Y Rear o, G Depth 215 . O
10. Date of Purchase per /yy.j Name of Former Owner
11. Zone or use district in which premises are situated /1 U
12. Does proposed construction Violate any zoning law, ordinance or regulation' YES NO r/
i
13. Will lot be re-waded' YES NO ✓ Will excess fill be removed from premises? YES NO
14. Names of Owner of premises � h_ 4ddress7 Yo c d.-yi; hone No. y r,�Ld 32-
Name
2-Name of architect J)OtJ r=f/G;Ej _,address iaLz- M1ft 4 4AFrtt hone No
Name of Contractor ft?4 Fri ItALLoc&' address N36d- i Pp e'9P one No. 3/- 7eS
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland *YES ANO
* IF YES, SOUTHOLD TOWN TRUSTEES R D.E.C. PERMITS NLNY BE REQUIRED.
b. Is this property within 300 feet of a tidal vvetlandl r YES NO— ,x-
IF
O ,/IF YES, D.E.C. PERMITS NLNY BE REQUIRED.
16. Provide survey, to.scale, with accurate foundation plan and distances to prcperty 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:
COUNZ'y OF )
being dul}sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named.
(S)He 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.
Sue om to before me this;' ))
day of l`' t .1)41 02)
JNotary Public "Signa ure of_applicant v
LYNDA M. BOHN
NOTARY PUBLIC, State of New York
No.01 B06020932
Oualified in Suffolk County
Term Expires March 8, 20 C ,
-
D �� t
PROP.
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:)PVGKCRITERiA Pr,d**Iv4 Design 20"P_
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4 'ToRE COMPLY WITH ALLCODFSOF
kd pH, vw '_._ / q . gA To ESN-'JNO „ 'I NEW YORK STATE & TO'NN ODES
�CtY+ p�•W.""4� .-._... NS OF
- { op 5 tf YFVz4' t0 ' +� ' (1 1?k `}c " TW&9Ip AS REQUIRED AND CONDITIO ,.
Q '0 DIJ J I Tt , °YVEHT ;#� ,�1"U!.{ fit LrT(C14 O'.DTOWN ZBA
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OUTHOLD OLDTOVWN LANNINGSOARD T,
Tw 3b r2 i 2 5 TRUSTEES
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f /o 4mt 3?.SP < 55G 4 sF 35 sl= �k (aRC(275�D. cOe SYRa Pro ^' - "^ CERTIFICATE OF OCCUPANCY,
5P C '�A a,3(¢ (v 6F < n•G SF _ _
M . 4a�5F z7sor - MA`s ' ppp ''' — bPtL$TI� -,TomFEMtCN� PLUMBING ^nLDEF ""D IN WATER
/,SIT 2' {•q sP-!L SF < I & 5p - G 5F t 2; SP r fi )', RT' — - ALL PLUMBING - PL` ;EM CANNOTryry--
�j(y: p ( - 8 WATER DINES NEED L, .EF' _ CI OF 1 q LEAD
ftE55 1a.11T �2. •' k,'
1 G7 - TESTING.BEFORE COVERING
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k I ciZ �� o t LS, APPROVED AS NOTED
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" + " OUNAbTJfx.7 1^14).1•'- '1-• •. ' - ..r a 1 i- ,.' +c" NOTIFY BUILDING DEPARTMENT T (Q
U _ � OCCUPANCY OR Tssaeoz SAM To IPM FOR t� J
USE IS UNLAWFUL FOLLOWING ON - TWO
�p - * - 2 0 N 1. FOUNDATION • TWO REOUBIED —
Iy I _ C�e✓tt-Zf.�-�-e9 WITHOUT CERTIFICATE
FOR POURED coNCRETE .Q
(� dp t 4 DO NOT PROCEED WITH 2. ROUGH • FRAMING 6 PLUMBIN
Al K - : n y'' � u -� g Sry ley � d' I+ FRAMING UNTiLSURVEY OF OCCUPA Y 4. FINAL3. INSULATION
MUST
a
OF FOUNDATION LOCATION BE COBIPLETE FOR C.O.
` I HAS BEEN APPROVED.ri ALL COITION SHALL MEET TH�
REOUIREME OF THE CODES OF
K STATE, NOT RESPONSIBLE v
w E*A'bT • Cgt6W L PIxCE _ G wt 1 Pte E I . t 1 r-� �c5�✓ r T E U t7 M r��IU�
u _ 'y. p PLV VD[A/l9GxA "'°a nG-' OR CONSTRUCTION ER
30`poCOMPLY - ►L7 T'—
LLO OD DAMAGE PAPT ION
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ZLD'•y.q'.a° / �T 2k�aREmM+-- 46 UNDERWRITERS.7ERTIFICATE
FSP F+ FTT-
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2 • +t E- RennRs — —
REQUIRED I`
�., Ihr• grr �.� �r fir, �, 2„ 3'_,I" 61. �� — __ � �' � � ° — — _—
NOTE-
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G ( ! c�� ) L 1� 1 J/¢' /� r ) 1 I L �� t/¢" CERTIFICATION TOF
I
0 U IL-1 A ` ALL CONSTRUCTION SHALL NAICER I CONNECTIONS
MEET THE REQUIREMENTS OF THE
Cwb.awawrdrrwdka wwWtMtlwt Th.ConbadwrliowN 1. FRAMING LUMBER: DOWNS Fit No,l a No.2.1400 Ib#*Pwi").
E•I.WrIM Double Soarjort under par"perNbrn.d evourb �.
thbArchked Merry 001111101 Or drorapantlse M ete Orawkw ad amopa*mw et O ^
SpacMalWns. 2 ENGINEERED LUMBER: ParaAem PSL eM MWd[am LVL, `tE 4
aM
EXISTING CONDITIONS: rwe
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Vepw bertr,htlepdMda m � o � Q
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- 7. ROOFSHINGLEB: IifGGNr•doAaWrw,Chateau 5hatbwSaltd, �' !�
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12 Con .to toerer to bar on unamurwd.oll,min.baerkp s ton Pat. 11. EXTERIORWOODTRIM: Prtnd FmpanJdM CrerWfdbPM ,
vAUt1wo56 alal rokltrldnp Mrs. 12 SOFFITS: Sir Plywood,AC,wmoth sm. \ 1
g Conaw.Mll not be placwwnw.bwnpw.W e r below dwla F. 1a PORCH CEILING 1.Sc.np wd 5wua.trwue s p dow V 1 �.1
orrA=WW4OWnpw•WokrIae1Mr150de5ne.F. , It PECgNG: wMS
xol Phh"Ing Mc •wser,wnSw
iolow MM
V**"depth OffootinpSbbe W-W below gads. �imkp
FOOWV Mepe a be 14 rM rdiubd. - 10.' T7@RS F1 (�
('^�P ROKE .�O 1v F.%Wldroltundetlon WlAl.a dMnWdoEdwIlhirthkka5PkM1 LENTERS:SaWdwMU Mum41um,5'%b1/T yuMr., VFW
1111 Now turldsuortvnllr a be e' r%r rdya.
u
While Plog,
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o u edwwofo orwt� de5dnww.wMwuow+Iedon+Wan+kW. &Wnd aI,14' llilir 1MrxWKdo* toimv#nowdro
no 'pOwwcfoo { Tnr� .WaoaUoraNofPoWYM'drNn,marble dualfwtrrpooftapwt WOOD OOR: NIU 1nUhRad1rr:wi .25Waw,UC, WoI ' 1'
ChWuuv bA sr■.••r•,+..W^''^'^ r 17. WDQDFLQOR: 5Y eprrdnOlr Red Oak amP.4YJ7tr 5.1lr. V
-v d j�- Tc.kT SoFt°Ir ewsr-� .ye. STAIRS: SOAR w5irw PGNWara
15. GYPSUMBOARIk f/3't■p.rsdadaa;mdiatides) nlftnj mRaome.
set Q TY i'ICf�I, --- Y. CIO.1 town; 6 wtlFl µllydwddd Dth. I fJYa� ver-Ar ,
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� dETERIC ft 00"a mrAtIMfmeson 1�PN �
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Ofi06li SECTION F11D VIEW CROSS SECTION' EN01YIBVII
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p5Dp�ee Ylkrrpr0ullld . water5nas eMy4
MW srddpl aelvke tdMed Ow"o, :2 WATER HEATER: So&.d*md,50 gallons,plow Bl4*110rrd, r rrrrrrw •. rr•er. �" ,�O>) !!
Y. LIGHTINGSURURfi& aaeMNddby Oa Ua,. 1+re..lrew ?Ir w 'pr,.wn.,� w r•w r rlrw .. ,_ . _ - _ 1.L'
-�.r ry,�.�..,, ",A DOMESTIC WATER wm+rA,a 8CVW5w7hr 5nea47UMt. nrreY ywWlr.pwNyj «r 1w.,.�+e
8• �_^'r'N 14. SANITARYSVSrfyr 'oWlm.d pblpaMlrNpNdgeUlil,Npf 'Ww rw N. r MYpiwirLn� ar1Y r,� .Yyi a1 (1
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S. BATH EXHAUST S. .-,HOSEBIBS: Fratfise:aalleM a wain on-DmlWps, tw•■isnsrW OWToq s1u wrrri - ' '1I ww+w w
5. BATH EgerW. FANILIGHTI Nina»0T100F4 aw5dr aapelaM�y,
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