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Home My WebLink About29978-ZFORM I, IO. 4 TOWN OF SOUTROLD BUILDING DEPD~TMENT office of the Building Inspector Tow~ Ball Southold, N_Y. CERTIFICATE 0P OCCUPANCY No: Z-30475 Date: 10/01/04 T~IS CERTIFIES t~at the building ALTE~_ATIONS Location of Property: 3765 STILLWATER AVE CUTCROGUE (ROUSE NO.) (STREET) (~LA~{LET) County Tax Map No. 473889 Section 137 Block 1 Lot 1 Subdivision Filed Map No. Lot No. conforms substantially to Zhe Application for Building Permit heretofore filed in this office dated DECEMBER 29, 2003 pursuant to wluich Building Permit No. 29978-Z dated DECEMBER 30, 2003 was issued, and conforms to all of the requirements of the applicable provisions of the law_ The occupamcy for which this certificase is issued is INTERIOR ALTERATIONS TO A~I EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to EDGARD EL (OW~IER) of the aforesaid building- SI/FFOI~KCOI~gT~fDEPAR~4ENT ELEC~i~RICA/~ CERTIFIC-A~NO. PLUMBERS CERTIFICATION DATED 09/02/04 N/A 1192500 09/03/04 V & V PL~BING & ~EATING Rev_ 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII2DING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES LrNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~P-E"Pd~'~'~N~ 29978 Z Date DECEMBER 30, 2003 Pez~ission is hereby granted to: BRUCE R & ANN J JOHNSON 3765 STILLWATER AVENUE CUTCHOGUE,NY 11935 for : INTERIOR ALTERATIONS AND WINDOW REPLACEMENT AS APPLIED FOR WITH FLOOD PERMIT at premises located at 3765 STILLWATER AVE CUTCHOGUE County Tax Map No. 473889 Section 137 Block 0001 Lot No. 001 pursuant to application dated DECEMBER 29, 2003 and approved by the Building Inspector to expire on JUNE Fee $ 250.00 Aut hor/i z ed Si~a~ur~ / ORIGINAL Rev'. 5/8/02 Form No. 6 TO'MN OF SOUTHOLD ~ _---. BUII])ING DEPARTMENT , ~, 5 ,'?.~.-~ .... . .... TO$~ H.~L APPLICATION FOR CERT~ICATE OF OCCUP.~CY L ............. FlSs application m~t be fitted h~ by ts~ewrite~ or i~ m~d sub.trod to the Buildin~ Doping: For new bmldIn~ or new use: L Final ~un ey at propen5 ;x tth accurate locanon o2 all bm[drags, property lines, streets, ~n~s~ topo~ aphic features. 2. Final kpprov~ fi-om Health Dept. of water supply and sewerage-disposal (S-9 fo~). 3. ApproxM of electrical hlst~ladon ~om Board of Fke Undem'dteis. 4. Swo~ statement fi'om plumber certi~qng that the solder used m system contains less th~ 2'10 of 1 ~ [ lead. 5. Cmr~ercial building, iudustria[ building, ~nultip[e reside~ces ~d sSmil~ buildings and installations, a certificaIe of Code Comp[i~ce fi'om archit~t or engineer responsible for the braiding.. 6. Sub~t Pla~ing Board Approval of completed site plan ~equirements. For existing buildings (prior to April 9, 1957) non-confornting uses, or buildings and "pre-existiug" land nses: 1. Accurate snrvey of property showing alt property lines, streets building and unusual natural or topographic features. 2. A properi_x cam?lo,ed application and consent to inspec[ stgned 67 the npplicaut. Ifa Certificate of Occupant5 is domed, the Building Inspector shall st:tko the reasons [l-Lerefor itl writing to the applicant. C. Fees l. Ceni~Pcate of Occupancy, - ?.4e,v dy oiling 522.0,-,, Addition, to d~, oiling ~25.o0. Alterations to d'z'e~ling 325.0'), Swimming pool $25.00. Accessor5 buil,:ltng 52Z00. Addtd,:,u~ to accessc, o' buildiog 2. Certificate of Oceupancy on Pre-existing Bull&rig - 5100.00 3. Copy ofCe~ifica[e ofOccupanc/, - 5.25 4. Updated Certificate ofOccupaoc7 5 Temp,z)mtS' Cerdficaue ,',fOccup:[nc/ Residential SIS.(,0, C.z, nune~ciai Old c,r Pre e~:isdng Building: House No. Sneer Hamlet check one) Location of Piopert5: Owner or Owners of Property: E&a ~-~.~ IE/ ~.h~'P, ~' d ' Suffolk Count:,' 'Fax Map No 1C, O0, Section i 37 Subdivision Permit No. '~'~ ~"-] ~] Date ofmennit. Health Dept. Approxal: /3/}% Block ~1 Lot Ftled Map. Lot: AppIicant: h~v,~l ~ Plarming Board Approval: Request for: TemporaO' Certificate Fee Submitted: $ ~8 ~ Undenvriters Approval: Final Certificate: {'check one) pplic BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF 'ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by REP ELECTRIC P.O. BOX 635 MATTITUCK, NY 11952, BRUCE JOHNSON 3765 STILLWATER AVENUE CUTCHOGUE, NY 11935 Located at 3765 STILLWATER AVENUE CUTCHOGUE, NY 11935 AppEcation NumbeF.. 1192500- Certificate Number: 1192500 Section: Block: Lot: Building Permit: BDC: ns11 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: First Floor, 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 authority having jurisdiction, and found to be in compliance therewith on the 3rd Day of September, 2004. NarDe Alarm and Emergency Equipment Sensor Sensor Appliances and Accessories E,,chaust Fan Oven Dish Washer Wiring and Devices Outlet Fixture Outlet Receptacle S~itch Dimmers Lighting track Receptacle QTY Rate Rating Circuit Type I 0 2 0 Carbon Monoxide Smoke 3 0 lC.H.P. .1 0 50 Amps I 0 1.2 KW 12 0 12 0 24 0 11 0 14 0 2 0 8 0 7 0 'Fix'rare Incandescent General Purpose General Purpose General Purpose GFCI : seal I 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. To,xn Hail, 53095 Main Road P.O. Box 1179 .Somhold, New York 11971-0959 Fax (63 i) 765-9502 Telephone (631) 765-1802 BUILDING DEP:MR_TMENT TOWN OF SOUTHOLD CERTIFICATION Building Pemfit No. 0~ Owner: Z.J"~C, (Please print) (Please pnnt) Date:-,~¢~'= ~ .. ~C:O~ I certi~r that the solder used h~ the water supply system contains less than 2,10 of 1°.,6 lead. Swomto before me this ~ ~J~ day of~~ 20 g)~ Notary Public, County (Plumbers Signature) Permit Nttmber Checked By/Date · ~EC'check compliance RePort ~lew York State Energy Conservation Construction Code ~vlECcheck Soth,vare Version 3_3 Release lc ~am filaname: C:~cogram Filas\CheckLMECcheck~El Chain House. cck TITLE: E1 Chaar House COUNTY: Suffolk STATE: New York HDD: 5750 CONSTRUCTION TYPE: Detached l or 2 Family HEATING TYPE: Non-Electric DATE: 12/15/03 DATE OF PLANS: December 15, 2003 PROJECT INFORMATION: E1 Chant House 3765 Sfillwater Avenue Cmchogae, New York 11935 COMPANY INFORMATION: Mark K. Schwartz, AUk- Architec~ PLLC P.O. Box 933 Cutchogue, New York 11935 COMPLIANCE: Passes Maximum UA - 84 Yom: Home - 84 0.0% Better Than Code Gross Glazing Area or Cavity Cont_ or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 300 19_0 0.0 Wall l: Wood Frame, 16" o_c. 480 13.0 0.0 Window 1: Wood Frame, Double Pane 50 Floor 1: All-Wood JoistJTmss, Over Unconditioned Space 300 I9.0 0.0 0.400 15 35 20 14 COMPLIANCE STATEMENT: The proposed building represented in this document is consistent with the building plans, specifications, and other ealculatians submitted withthis permit applicafian. The proposed systems have been designed to meet the New York State Ener~, Conser~tian Construction Code requirements. When a Registered Design Professional has stamped and signed this page, they are attesting that to the best of his/her knowledge, belief, andp~fessionaI ju~,dgment, such plans or specifications are in compliance with this Code_ 'MECcheck Inspection Checklist iNew YOrk State Energy Conservation Construction Code MECcheck Software Version 3.3 Release lc DATE: 12/15/03 TITLE: El Chaar l-l~use Bldg_ DepL Use [ ] [ ] [ ] [ ] [ 1 [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] Cet~ings: 1. Ceiling 1: Flat Ceiling or Scissor Truss, R- 19.0 cavity insnlation Comments: Above-Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-13.0 cavity insulation Corem c'alts: Windows: 1. Window 1: Wood Frame, Double Pane, U-factor: 0.400 For windo~vs without labeled U-factors, describe features: # Panes Frame T3pE Thermal Break? [ Comments: ]Yes[ lNo 1. Floor l: All-Wood Joist/Truss, Over Unconditioned Space, R-19.0 cavity insulation Conm-tents: Air Leakage: Joints, penetxations, and all other such openings in the building e~velope that are sources of air leakage must be sealed_ Recessed lights must be 1) T3pe IC rated, or 2) instal/ed inside an appropriate air-tight assembly with a 0_5" clearance from combustible materials, lfnon-IC rated, the fixture must be installed with a 3" cIexrance from insulation. Vapor Retarder: Required oR the warm-in-winter side of all non-vented framed ce'dings, walls, and lloors. Materials Identification: Materials m~d equipment must be installed in accordance with the manufacturer's installation insu-uctions Materfals and equipment must be identified so that compliance can be determined_ Manufacturer manuals for all installed heating and cooling equlpmant and service water heating equipmem must be provided. h~sulation R-values and glazing U-f'aetom must be clearly marked on the bul/ding plans or specifications. Duct Insulation: Supply ducts in unconditioned attics or outside the building must be insulated to R-g_ Return ducts in tmcoacErfioned attics or outside the building must be insulated to R4. Supply ducts in tmconditioned sp'ac~ must be insulated to R-8 Return ducts in unconditioned spaces (except basements) must be insulated m R-2. Ir~sulatiun is not required on retura ducts in basements. Duct Construction: All joints, seams, ard connections must be securely fastea0,d with welds, gaskets, mastics (adhesives), mastic-plus-embedded-fabric, or tapes. Duct tape is not permitted. Exception: Continuottsly welded and locking-type longitudinal joints and seams on ducts operating at less [hun 2 in. w.g. (500 Pa). Ducts shall be supported every 10 feet or in accordance with the manufacturer's instructions. Cooling ducts with exterior insulation must be covered with a vapor retarder. Air filters arerequired ~n the return ah- systear_ The ErVAC system must provide a means [or baluncing air and water systems. Temperature Controls: Each dwelling unit has at lesat one thermostat capable of automatieafly adjust/rig the space temperature set point of the largest zone. Electric Systems: Separate electric meters are required for each dwelling unit. Fireplaces: F/a-eplaces must be installed with ti~t fitflng non-combustible fireplace doors. Fireplaces must be provided with a source of combustion air, as required by the Fireplace construction provisions of the Building Code of New York State, the Residential Code of Nmv York State or the Nm{, Vork CiO, Building Code, as applicable. Service Water Heating: Water heaters With ~ertical pipe risers must have a heat trap on both the irder and outlet unless the ~ater heater has an integral heat O'ap or is part of a circulating system. Instdete circulaling hot wmer pipes to the leveis in Table 1_ Circulating Hot Water Systems: In~late circulating hot water pipes to the levels in Table 1. Swimming Pools: All heated swimm big poois must have an on/offheater switch and require a cover unless over 20% of the heating energy is fi-om non-depletable sources. Pool pumps require a tune dock. Heating and Cooling Piping Insulation: HVAC piping conveying fluids above 105 °F or chilled fluids below 55 °F must be insulated to the levels in Table 2. Table I: ~§nimum lnstdation Tlticlotess for Circulating Hot ~Wat~r p~pe~ ]hsulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runotas Temperature (F) Up to 1" Up to 1.25" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-I30 0.5 0.5 0.5 1.0 Circulating Mains and Runouts 1.5" to 2.0" Over 2" Table 2: ]£tnimurn l~tsulation Thicl-ness for H[~AC Pipes. Fluid Temp_ Insulation Thickness in Inches by Pipe Sizes Piping System Types Range (F) 2" Ruuouts I" and Less 1.25" to 2" 2.5" ~o 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 Low Temperature 120-200 0.5 1.0 Steam Condensate (for feed ~vater) Any 1.0 1.0 coormg .Systems Ctdlled Water, Refrigerant, 40-55 0.5 0.5 and Brine Below 40 1.0 1.0 1.5 2.0 1.0 1.5 1.5 2.0 0 75 1.0 1.5 1.5 NOTES TO HELD (Building Department Use Only) Permit Number Checked By/Date tglECcheck Compliance RePort New York State Energy Conservation Construction Code ~MECcheck SoRware Version 3.3 Release lc Data filename: C:\Program Files\Chuek'aMECcheek~E1 Chaar House.cOx TITLE: E1 Chaar House COUNTY: Strl~lk STATE: New York IR)D: 5/750 CONSTRUCTION TYPE: Detached 1 or 2 Family I-IEATING TYPE: Non-Electric DATE: 83/30/04 DATE OF PLANS: 0%19-04 PROJECT INFORMATION: E1 Chcar House 3765 Stillwater Avenue Cutchogue,-New York 11935 COMPANY INFORMATION: Mark K. Schwartz, AIA - Architect, PLLC P.O. Box 933 Cutchogue, New York 11935 COMPLIANCE: Passes Maximum UA = 295 Your Home - 294 0.3% BeRet Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R_-Value R-Value U-Factor UA Ceding 1: Cathedral Ceiling (no attic) 704 30.0 0.0 Ceiling 2: Flat Ceiling or Scissor Tress 530 30.0 0.0 Wall 1: Wood Frame, 16" o.c. 630 13.0 0.0 Wall 2: Wood Frame, 16" o.e_ 694 13_0 0.0 Window 1: Wood Frame, Double Pane 119 Window2: Wood Frame, Double Pane 32 Door l: Solid 21 Floor 1: All-Wood Joist/Truss, Over Unconditioned Space 640 38.0 0.0 Floor 2: Unheated Slab-On-Grade, 0.0' insul. 73 0.0 0.340 0.340 0.500 24 19 52 42 40 13 ll 17 76 COMPLIANCE STATEMENT: The proposed building ~epresented in this document is consistent with ~e building plans, specifications, and other calculations submitted with this permit application_ The proposed systems MECcheck lnapectioa Checklist New York State Energy Conservation Construction Code MECcheckSoftware Version 3.3 Ralease lc DATE: 03/30/04 TITLE: E1 Chaar House Bldg. Dept. Use [ ] [ ] [ 1 [ 1 [ t [ ] [ ] [ ] [ ] [ 1 [1 [ ] Ceilings-. I. Cex~ing 1.:Ca~edralCeiling(noattic),R-30.0cavi~yinsutafioa Commerlts: 2. Ce'fling 2: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Cc~nments: Above-Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-13.0 cavity insulation 2. Wal12_W'oodFrame, 16 o.c.,R-13.0eavi.tyinsulafion Comments: Windows: 1. W'm, dow 1: Wood Frame, Double Pane, U-factor: 0.340 For windows without labeled U-factors, desoribe fealures: # Paves Frame Typ~ Thermal Break? [ Comments: ]Yes[ ]No Window 2: Wood Frame, DoubLe Pane, U-factor: 0.340 F6r ,~vindows wkthont labeled U-~ors, desert-be fcatores: # ]?an~s Frame Type Thermal Break?. [ Comments: ] Yes [ ] No l. Door l: Solid, U-factor: 0.500 Cmuments: 1. Floor l: All-Wood Joist/Truss, Over Unconditioned Space, R-3 8.0 cavity insulation Comments: 2. Floor 2: Unheated Slab-On-Grade, R-0 (oninsulated) Comments: Air Leakage: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed_ Recessed fights must be 1) Type IC rated, or 2) installed inside an appropriate ak-tight assembly with a 0.5- clearance fi:om combustible materials. If non-lC rated, the fixtxtre must be insmtled with a 3~ cle, a~uCe flom insulation_ Vapor Retarder: Required on the warm-in-winter side of all non-vented flamed eailktgs, walls, and floors. Materials Identification: Materials and equipment must be installed in accordance with the manufacturer's insmllafima instructions Materials and equipmenI must be identified so ilmt compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and servSce water heating equipment must be provided. Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. l)uct Ins~on: Sup~?ly duc~s in unconditioned attics or outside lite lmilding must be inanlaled to R-Il. Return ducts in unconditioned attics or outside the building must be insulated to S~rt0ply ducts in unconditioned spaces must be insulated to R-8. Return ducts th unconditioned spaces (except basements) must be insulated m R-2. insulation is not required on retrain ducts in basements. All. joints, seams, and coanectiom must be securely fastened with. welds, gaskets, m~cs (adl0esives); mastic-plus-embedded-fabric, or tapes. Duct tape is not pm-mitted. Exception: Cuntinuously walded mad locking-type lungitudinal joints and seams on duets operating at les[than 2 in w g. (500 Pa). ,Du~ts. shall'be se~p0rted every I0 feet or in aceordance with lhe manufactm'er's inslxuctio~s. Cunling du~mwith e~tedor hm.dalien must be cevered with a vapor re~arder. Air fitters are ~-equired in the remm ak system. Tbe HVAG system must provide a means for belancSng air and water systems. Temperatttre Controls: Each dwelling xmi~ has at lesat one thermostat capable of a~rtomat~eally adjusting the space teml~'aXure set point offlxe largest zene. Electric Systems: Separate electric meters are required for each dwelling anit. Fireplaces: F~reptacus must be inslatted with fight fitting non-combestibte fireplace doors. Fireplaces must be provided with a sunrce of co-mbustion air, as required by the Fireplace construction provisions of the Building Code of New York State, the Residential Code of New York State or the New York City Building Code, as applicable. Service Water ~Ieating: W~lx'r heaters 'Mth vertical pipe risers must have a heal hnlJ on both the inlet and outlet unless the water hea~er has an [utegrat heat Irap or is part ora cimulating system. Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: insulate circulating hot water pipes ~ the levels in Table 1. Swimming Pools: All heated swimming pools must have an on/offheater switch and require a cover ma[ess over 20% of the heating energy is fi'om non-depletable sources. Pool pumps requke a time dock. Heating and Cooling Piping Insulation: HVAC piping cunveyingfluids above 105 °F or chilled fluids below 55 °F must be insulated to the levels in Table 2_ Table 1: Minimum ~nsMalion Tldet~ess for Circula#~g ttot Water Pipes. /nsulation Thickness i~/aches by Pipe S~zes Heated Water lqon-Circulatine Runouts Temperature (F) Up to 1" Up to 1.25" 170-180 0.5 1.0 1.5 2.0 140-i60 0.5 0.5 1.0 1.5 100-130 0_5 0.5 0.5 1_0 Ch-culathag Mains and Runouts 1.5" m 2.0" Over 2" Table 2: Minimum Insulation TMckness for IIVAC Pipes. Fluid Temp. Insulation Thickness ha Inches by Pipe Sizes Piping System Types Range (F) 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" ltealing Systems Low PressareZremperal~re 201-250 1.0 1.5 t_5 2.0 Low Temperature 120-200 0.5 1_0 1.0 1.5 Steam Condensate (for feed water) An~ 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) muir SCTM# DISTRICT: 1,000, SECTION: [~ .~ B'I~,,~."..~, ~ , LOT: DATE REV[ESVED: 1~-/,_._~/03 DATE SUBMITTED: ~q /~h_/03 SUBDIVISION: SINGLE & SEPA1L4ffE CERTIFICATION-REQUI1LED ,ado NOTES: ~ LOTS 40,000SF -100-24. Lot recognition.(CKEATED before June 30, 1983), UNDERSIZED LOTS FRONt JXN,19~7 100~25. Merger..(A nonc. or~rming at any time ~'er REQ. LOT SIZE: / ACT. LOT SIZE~O[.(::)% REQ. LOT COV, c:~,~. ACT, LOT REQ. FRONT 4c~ PROP. FRONT ,,~._TQ SIDE ,5-~ ACT. SIDE REQ. REAR 5"fi PROP. RE~kl~ j,/,,t REQ.:.H~GHT -,' , PROP. [-I~GHT__ /. PROJECT DESCRIPTION: /tq~'- ,4t:7'S-. . EST~iATED PROJECT COS3~5'~/g---..-Ai~'Itrlt~T/ENGINEER:. ~-',.~:~,-,~,-e ,-v_...-- ~e.-s. DESCRIPTION: ~,~:..~oJ..~ ('~ ~-:_~_o_J~-- PANEL # __ FLOOD ZONE:_Acr--c~ WATER FRONT? APPROVALS REQUIRED sv~Fo~,~c COVNT~~ u~}I_~..~.~: YES o~0~Er~ #):__r~T~: / /__ P~m~ TO~,VN SEPTIC RECEIPT: 5 NEW YORK STATE DEC: ~,ar.vrc ~,75 YES of'g~ DTE: / / PERMIT #: SOUTItOLD TOWN TRUSTEES: YES o'g~ DTE: / /__ PERMIT #: ToV~rN ZONING. BO~XR1) APPROVAL: YES ot~' DTE:"__ / / PERMIT #: TOWN PLAN;/BO/,i-RD APPROVAL: YES or~j~. DTE: / t PERMIT #: TOWN HIS~ORIC:A_L PRE (SPLIA): YES o ~N'.~) NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2): ~or NO NOTES: FEE STRUCTUR]~: FOUNDATION: FII~ST FLOOR: SECOND FLOOR: OTHER: TOTAl_: 1. ( SE)- ( SF)--. 2. ( SE)- ( SF)= 3. ( SF)-( SFX$ SFX $ SF)= St; X $ SF SF SF SF INIT OTHER TOT.&L St: FEE FEE FEE =$ +$ +$ = $ =$ +$ +$ -- $ :$ +$ *$ -- $ FINAL TOTAL: ' · Lf~p~'~.i~I T. T~.I~RY TO Wl~/ CLEILK 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 2q, 1993: RESOLVED that the Town Board of the Town of Southold hereby adopks two (2) new forms to be used under t~e Flood Damage Prevent regulations of the Code of the Town of ~outhold: "Floodplain Development Permit Application" [FDP[93)]. and "Certificate of Compliance for Development in Special Flood Hazard Area [C/C(93)]. :--:, .. 8~Z.G. 6'2F~ TOWN OF SO"JD~OLD _ Terry Southold Town Clerk August 25, 1993 APPLICATION # PAGE I of ~ TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PER3vlFT A_PPLICAT~ON This form is to be filled out in duplicate. SE(TF[QN 1; GENERAL PRO~qSIONS (&PPLfC,UNT ~o rcad and 1.. No work may' st~t tm~ a permit is is~ueA. 2. The permit may be revoked ff ~ny false statements ~re made hr_rein_ 3. tf revoked, all work must ragase until permit is ce-is.sued_ 4. Development shall not b~ used or occupied until a Certificate of Comp[ia~ is Nsued. 5. The permit will ex-pig if h'o work is commencefl withi~ six montb~ of issuance_ 6. Applicant ix hereby [nlormed that other permits may be requh-e~ to [xfll-,ll local, stat= a~d federal regnlatory r e4ukementt 7. AppliFant h~reby give~ mnsem to the Local Admbi~trator. or h~/her reprezeatadv! to make ~:easonable inSl:~efion~ required to ',,erg'/¢ompliance. t T~-IE aVPLlCat4-r, C:E~Tn%, TH~T.~UL.~s'r}T~MF_/./crs/,~mV.~m~ a ~ ^-rr^cx-mmpTs. TO SECTION 2: PROPOSED DEVELOPMENT (-Fo be completed by APPLICAd',WI NA~i'E ADDRESS 'IT:LEP HQ NE .,~v p LI C.ad~FF B UILDE.R PROJECT LOCATION: To avoid delay in proce~zing thc apptication, pleaze pro~4de euouO ~omation to ~Hy identify thc project I~do~ Pr~de ~e ~eet addm-~ lot numar or le~ d~ption (aaa~) ~d, ou~[d: ~ ~, the dk(~ to ~c n~ ~t~se~g road or ~-~o'*~.~ Asket~ aria&ed to ~ apportion sho~g thc projc~ I~fiou wo~d bc hdp~. FDP(9]) APPLICATION # PAGE 2 OF ~ DESCRIPTION OF WORK (Check ~tl applicable boxes): A. STRUCTUI:C~L DEVELOPMENT ACTIVITY [] New Structttrc [] Addition ~.~ Alteration [] Relocation E] Dem6[idoo' ' [] Replacement ,.qTRUCTU RE 'fi'rTE J~Rcsid=odal (i-4 F~mily) [] Residential (Marc than 4 Fa.rally) [] Nou-residendal (Floodproofmg7 [] Yes) [] Combined Usc (K~ideatial & Counnerdxl) [] Manufactured (Mobile) Home (I~ Manu- factured Home Pazk?. [] Ye-s) COST OF PROJ'ECT $ B. OTHER DEVELOPMENT A~;[IVITIE. S: [] F'fll [] Mining [] Drilling [] Grading [] Excavation (00000~cept for Structural Development Checked Above) -- [] Watercourse Alteration (Including Dredging and Channel Modlficatior~) [] Drainage Improvements (Including Culverx Work) [] Road, Street or Bridge Construction [] Subdivision (New or Expamsioo) ,, [] [ncLbSdual Water or Sswcr S~tcm [] Other (Pleas= Specify). A1-ter compteting SECTION 2, A.PPL[CAfqT shotdd submit farm to Local Acknh~trator for r~q~ fiECFFION 3: FLOODPLAFN DETEPdd[N,h. TIOH [To be completed by LOCAL ADMtNI~iTRATOR) Thc propo.~cd development The Proposed Development: , Dated [] Ix NOT~ located in ~ Special Flood Hazaxd Area (Notify the applicant that thc applicatiou review i~ complete and NO FLOODPlaiN DEVELOPMENT PF. Rb,fiT IS REQUFRED). [] I~ located in a Special Flood H.7~rd Ad'U. FIR}.{ zone de.d~ation ix 100-Year flood elevation at the site Ls: ' Ft. NGVD (MSL) [] Uuavailablc Thc proposed development is located in a floodway.. Ff]FL'[ P~cl 1'4o. Da~cd DATE A~ PLICATION ~ PAGE 3 OF 4 SECTION 4: ADDfTIONAL [NFORJ'dATION REOUIRED (To hc completed by LOC,CL ADMINISTRATOR~ The_ app[ic2~t must submit thc documents checked below be[ore thc apphcado~ c2m bc processed: C]A SiLO plan showing thc [oca£iota of all cxzist~g structures, w~tcr bodies, adj~ccm roads, Iol dimcn~ioms amd proposed development. [] Development plans, cb-awn to scale, md specific,attOns, iachiding where appticablc: d cta.i, ls l'or amchor[ng structure, proposed elevation of lowest floor (indudbag basemeut), types of water resistant materials used below the £u-st floor, detain of floodproo£mg of utilities located below the first floor a~d detaZl.~ of cndosttres below the ftrxt floor_ ,adsoL [] Subdivision or other development plan~ (If thc subdivision or other development exceeds 50 lol.~ or ac acres, wb. ichever i~ the lesser, the appticzmt must provld= 100-year flood einvatinb, s if thcy ar~ not othenvis¢ available-)_ [] Pl~o_s showing the extent of watercourse relocation and/pr lancfform alteratioms. [] Top of new fill ¢levatioa Ft. NGVD [] Floodproo£mg protection level (non-residential only) Ft) HO'VD (M:SL), For floodproo[¢d strugtures, applicant must attach certification from registered ¢ugiaeer or architect. [] Certification -q/o~ a regi=tered engineer that thc proposed activity in a regulator)' floodway will not result in an2 increaze i~ the height of th= 100-yea~- flood. A copy o£ ail data amd calctdatio~ suppurtlng thi~ £mding must also be submitted. [] Othe~ ~E(7'l'IO[q S: PERMIT DETERJMINAT[ON I'To be. completed bY LOCAL, ADMINISTRA-TQR) I have determined that the proposed activity:. A. [] Is B. [] Is not in c:auformance with provixious of ~ Law ~ . 19 attached to and made part of ti:dx permit , D~ · The permit is issued subject to the conditious BOX A i~ checked, thc UocaJ Admin~trator may issue a Development Permit upon paymcnl of designated ~?< E il chm:ked, thc Local Adrnirdstrator v,'iJl pro;'idc a written surama~y of ,:leficinnclcs. ,Applicant may re',4se and resubmit ~ apphcatinn to the Local Administrator or may request a bearing from thc Boa_rd of A. PPF--¢~5: Appczted to Boazcl o[Appcals? [D Yes [] No HcazLag date: Appeals Bozrd Decision --- Approved7 [] Yes CoadJtior~ UI No APPLICATION PAGE q OF ~ SECTION 6: AS-gUILT ELEVATIONS (To bc submitted by APPLICA~IT be[ore Ccrtilicatc o[ Compliance b issu cd'} Thc following izd'ormadon must be prov;.ded for proje~ structurex_ TI~ section mctst be completed hy a reg/stescd profe-~ion, al engineer or a licensed land ~ttrveyor (or attach a c~rtLfication to tkis application). Complete 1 or 2 below_ Actual (As-Built) F~l¢~tioa of the top of thc low~t floor, including basement (in Coastal High Haza'rd AreaS, bottom of Iowesl structural member o(' the lowest floor, ezdudlng pillng and column) is: ~_ Actual (As-Built) Elevation of floodproo£mg protection ks Fr. I'tGVD (M. SL). · OIE: Any work performed prior to submktM of thc above u:fformation b at thc rLqk of the Applicator_ ,,~ECT[ON 7: COMPLIANCE ACTION [To be completed by LOCAL -kDMINIS'I'RATq)R'I Thc LOCAL AJ3hIINIS'I~a~TOR will complete this section as applicable based on iaspecziou of thc project to erasure compli~ce with the. COmmtmilry's local law [or flood damage prevention. INSPECTIONS: DATE BY DEFICIENCIES? [] YES [] NO DATE BY DEFICIENCIES? [~ YES [] NO DA?FE BY DEFICIENCIF~? [] YES [] NO SECTION 8: q~EIR. TIFII~ATE OF COMPLIAMCEI-FO be comalc~ed bY LQCAL ADMI1NISTRATOR). Certificate of Compljamce ksued: DAT~z: BY: Attachment B SAMPLE CERTIFICATE OF CO~PLI~[CE for Development in a Special Flood Hazsrd Area · TOWN OF SOUTHOLD CERTIFICATE, OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAi. FLOOD FLkZ. ktLD (O~rNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. p ERIvtlT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [] NEW BUILDING [] EXISTING- BUILD [] VACANT LA~D THE LOCAL ADMINISTRATOR IS TO COMPLETE 3- OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED 5~rlTH THE REQUIREMENTS LOCAL L~W # , 19 SIGNED: DATED: OF COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS LOCAL LAW #____, 19__, AS MODIFIED BY VARIANCE # DATED SIGNED: DATED: OF c/C(93) 765-1802 BUILDING DEPT. INSPECTION [] FOUNDATION 1ST ROUGH PLBG. ] F/01~DATION 2ND [ ]INSULATION FRAMING [ ] FINAL []FIREPLACE&CHIMNEY[ ] FIRE SAFETY INSPECTION REMARKS: ,~ ' '~~ DATE INSPECTOR ~'/'~/ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] RO~JGH. PLBG. [ ] FOUNDATION 2ND [,~/] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: ~-~_~2- ~J~~ ~ DATE INSPECTOR 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [~]~UGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ REMARKS: ] FIREPLACE & CHIMNEY DATE INSPECTOR 765-~802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG, [ ] F~DATION2ND [ ]INSULATION [~ FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ,~.~/a ~L~.~,~/~__~ // / / DATE INSPECTOR 765-1802 BUILDING DEPT. I'NSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [p~INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION R E MAR KS~_~,~~_ ~)~" ----~,~-,-~ .~ DATE :~:0: INSPECTOR J~~~'~ TO~ OF ~UT~OLD BUILDING DEPARTMENT TO~VN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 ~'w. northfork.net/Southold/ Examined 2_ / 't o .&pproved t 2-/7 o Disapproved a c ,20 ,20 3 BL)ILDING pERMIT APPLICATION · ~'~ildi[n~ insp~cto'~ r'~ Do you have or need the following, betbre applyi~g'~ Board of Health 3 sets of Building Plans planning Bo~pproval Stax,ey Septic Eonn N.Y.S.D.E.G Trustees Contact: b~to: Po t~.x 16~q Phone: APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. TbSs apphcation )~FU-ST be completely filled in by typewrker or in ink and submitted to the Bulldog 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, relatiousinp to adjoining premises or public s=eets or areas, and waterways. c. The work covered by this application may not be commenced betbre issuunce 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 throug, hout 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 permit shall expire if the work authorized has nor commenced wilhin 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other re=re.clarions affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition s£x months. Thereafter, a new perm/t shall be required. APPLICATION IS 1-~REBY MADE to the Buildthg Department for the issuance of a Builalng Permit pursuant to the Building Zone Ordinance of the Tox~m of Southold, Suftblk County, New York, and other applicable Laws, Ordinances or Regulatious, for the construction of buildings, add[tions, or alterations or for removal or demolition as herein described. The applicunt agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatious,/~.ud to aclmir authorized inspectors on premises and hz building for necessary inspections. ~~_~ (Stgnamre ot apphcant or name, ~t a corporauon) - ' - ~.lailing addres~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises E-da ~u'& ~-1 P---k~t~c · (As on the tax roll or latest deed) If applicant is a corporation, signature of dui), 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 Street Hamlet Comity Tax Map No. 1000 Subdivision (Name) Section IS7 Block ~ I Lot Filed Map No. Lot '~ 2,' · State exlstung use and ~cc~apancy, of prermses and intended use'and occupancy of proposed cons~'uction: ~ a. E~istiugusea~,liqec{~pancy ~,~lt ~'n,~ [,~ ~w-e/~l,~a b. Intended use and.occupancy_ ~rng ':':.,z. Nature of work (check/wider. applicable): New Building Addition Repair ' ' Removal Demolition Other Work Estimated Cost If dwellipg, number of dwelling units If garage, number of cars Fee ~'n4erlo~' Alteration (Description) (To be paid on filing this application) Number of dwelling units on each floor If business, commemial or mLxed occupancy, specify nature and extent of each type ofuse. Dimensions of existing structures, if any: Front Rear Depth. Height Number of Stories Dimensions of same structure with alterations or additions: Front $o,,~ t~a /~, ~} Roar Depth Height ,~ Number of Stories Dimensions of entire new construction: Front ~'3/Pl ' Rear Depth Height Number of Stodes Rear Depth Name of Former Owner 9. Size of tot: Front 10. Date of Purchase Zone or use district in which premises are situated ~g. 12_ Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO )~ l 3. Will lo~,be re-graded? YES NO /~ Will excess fill be removed fi:om premises? YES __ NO__ 14 Names 'ofOvmer of,,re,~io~o · · .. v ...... _~St_~.l~aaress . ,~,~L~k~Phone No. ~1~ c~ame of :~rctutect Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a t~dal wetland or a fi:eshwater wetland? *YES )~ * IF YES, SOUTHOLD TO\VN TRUSTEES & D.E_C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES ~ NO__ * 11c 5FES; D_E.C. PERIvlITS MAY BE REQUIRED. NO 16. Provide survey, to scale, xx4th accurate foundation plan and distances to property lines. l 7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF ) ~_ ~-~,cl ~-' ]~'~a-~ ~'l being duly sworn, deposes and says that (s)he is the apphcant (Name of individual signing contmcO above named, (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ',~ da3,~9 f v[~_,__ 20~ (~// ~t& ~blic L~DA M. BOHN NOTARY PUBLIC, State of New York No. 01 BO6020932 Qualifiec in Suffolk Tern Expr~- ' ........ Signature of Apphcant 0 0 Z 0 0 UJ ,,J ...i ~. LL LL ILl Z 03 '~, · 0 n~ m (.3 ~_. ILl RIS Ii II II ~. !1 Ii Ii II ti Ij~- i,I--' II II II II II .. II.;- II II N.T.$. ~ I~--' FOR PANEL SPANS: ~ I I 4' oR WIDER SPAN SHEATHING GRADE PLYWOOD OPENINGS 4') ,!2x4 STRONG-BACKS @ 24' OC STNNLEs,s STEEL WOOD SCREW ~. 1Z' O.C. 2). ATrAC~ING STRUCTURAL PANEl- FASTEN TO BUILDING wi ,', # 10x3' ,~,w/WASHERS) GALViNiZED oR STAINLESS sTEEL ~', i ,, wOOd"SCREW @ 16~ O C. , BUILDING: ~10 TEE ~IUTS ATFACHED TO BLDG wl#10x1-1/2 (W/WASHERS) .' MACHIUE, BOLT @ 12' O.C. - PREASi~EMBLE pLYWOOD TO 2x4'S: # 1Ox3' (wi WASHERS) GALVINIZED OR SECTION ASSEMBLY: 1/4' THICK BOLTS @ 2' OC Il Ii Il _ _ l i?. {I Il II Il Il II