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Home My WebLink About29893-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30746 Date: 02/04/05 THIS CERTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 435 GLENN RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 78 Block 2 Lot 9 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 19, 2003 pursuant to which Building Permit No. 29893-Z dated DECEMBER 1, 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 VINCENT A RICCIARDI & JAMIE HARTMAN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2378-H 01/12/04 PLUMBERS CERTIFICATION DATED 12/03/04 H2M LABS, INC. ut 6rized 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 NO. 29893 Z Date DECEMBER 1, 2003 Permission is hereby granted to: VINCENT A RICCIARDI 60 SHEPARD DRIVE SOUTHOLD,NY 11971 for ADDITIONS/ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 435 GLENN RD SOUTHOLD County Tax Map No. 473889 Section 078 Block 0002 Lot No. 009 pursuant to application dated NOVEMBER 19, 2003 and approved by the Building Inspector to expire on JUNE 1, 2005 . Fee $ 169 . 20 4 th izeSi ature ORIGINAL Rev. 5/8/02 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL _D 3 765-1802 A. PLICATION FOR CERTIFICATE OF OCCUPANCY T14-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 accurate location of all buildings,property lines,streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters- 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building,industrial building, multiple residences and similar buildings and installations, a certifica 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,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy i denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1- Certificate of Occupancy-New dwelling$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- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commerciaj$141'5L.00 Date. � New Construction: \ Old or Pr xisting Building: check o e Location of Property.• ,� 1 ,tr House No. StreetA Owner or Owners of Property: ! �" VM Suffolk County Tax Map No 1000,Section Block Lot Subdivision Filed Ma . t: Permit No. �'x.- Date of Permit.l L�� Applicant. c�,. ►� l car Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate c eck o f f� Fee Submitted: $ � licant Com 3o?y� JH2M l U%o INC. 575 Broad Hdlow Road,Melvis NY 11747 (631)69OM.FAX(631)42M436 NYSDOHID#10478 LABORATORY RESULTS HARRY GOLDMAN WATER TESTING MAIN ROAD Lab No. : 0411774-001A Sample Information... Type : Solder MATTITUCK,NY 11952 Origin: Distribution Attn To 631-298-4640 Routine Federal ID Client ID.: JAMIE HARTMAN Collected : 11/30/2004 8:25:00 AM Point No: #3 60 SHEPARD DR,SOUTHOLD SOURCE(CWL- Received : 11/30/200411:13:00 AM Location: BS)(29893-Z)ADD.DOWNSTAIRS Collected By JD99 Copy : Original CC Parameter(s) Results Units Limit Method Number Analyzed Lead 0.04 % 0.2 SW6010A 12/02/2004 2:48 PM Result(s)reported meet(s)Regulatory Limit(s). . Result(s)flagged with * Exceed Regulatory Limit(s). Limit noted. Date Reported: 12/3/2004 Page 1 of 1 Laboratory Manager 04/14/2004 09:52 7227865 CHRIS STRESS AIA PAGE 01 CHRISTOPHER R. STRESS, A.I.A. ARCHITECTURE AND PLANNING P.O.BOX 821 JAMESPORT,NY 11947 PHONE/FAX(631)722-7865 Town of Southold I I Building Department 'R f 4 M Mak Rona Southold-,N.Y. i RE :Vince Riccardi addition P6rmit#29893-Z Dear Sirs, Pleaso be advised that the Mowing revisions have been implemented on the above noted prof These revisions have been reviewed md approved by this office. Specifically the revisions are as follows 1. 9 %"TR's at 12"o.c.have been installed in fico of T%s ones as specified. 2. A double 1 %"x 9 %"w/%"ply-word flitch header has been installed in lieu of the 7 inch LVL's between the new addition and the existing room. 3. A double 2x8 header was installed over the door and whx ow in the new addition on the west side of the first floor. This was in lieu of the(2)2x12 `s. The above items are in conformance with the building code for this work and are approved by this office . Show there be any n*.:estions on the above,kindly contact me directly. ds PEDAAER p�,�� Christopher P NYS Lic.No.' AR53�`a0Q OF SFW Nassau Suffolk Electrical Inspections, Inc. 5A Canal Street • Center Moriches,New York 11934 • Tel:631-878-3500 • Fax: 631-878-3764 Application: 2378-H Date:1/12/04 Issued to: Ricciardi Address: 60 Shepard Dr Village: Southold By: 1-1/0 License#:N/A was examined and approved up to the above date and was in compliance with the NEC Attic 1st Floors Residerttial❑x Pool Det Garage Basement 2nd floor Carrrordal Hat Tub AdAmIR] Switches Receptacles Fixtures G.F.I. Range Hood Whirlpool 17 23 20 2 Fans Dishwasher Washer/Amps Dryer/Amps Oven Carbon Range/Amps Monoxide 1-Ex Bath Furnace Oil Gas Heat Zones Smoke Bell Detectors Transformers 2 Meter Amps Phase Motors 1 1200A OH I1 ther Equipment: 1st Floor Addition ut,Res This certificate must not be altered in any manner a TOWN OF SOUTHOLD PROPERTY RECORD CARD - z J NER'� r STREET VILLAGE DIST. SUB. I/ LOTr/� 9 FOER OWNER or % N E ACR. �..'" r.2 -�/ S W TYPE OF BUILDING ' ES. SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS ,0O D 7,0,9 5-7-v as �` s Ll V15-3 - IZ - o ..4e, 22 X5'0 '� �s �� - p 2 P - .2. S C P a- 'v - o sem' AGE BUILDING CONDITION t�al -8P017713 - �o►�sfr. ss P �t,�.� . foo, NEW NORMAL BELOW ABOVE g 9g,L q _ C r o FARM Acre .Value Per Value Acre 'illable 1 'illable 2 illable 3 ✓oodland wompland FRONTAGE ON WATER rushlond FRONTAGE ON ROAD louse Plot DEPTH BULKHEAD 'otal ,..� A ,� r DOCK M— -- -------------- ■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■� ■■■■■■■■■■■■■■■■■■■■ _ ■■■■■■ �_-`-�_■_�_�_■■■■■■■■■■■■■■ ■■■■■■■M■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■No■■■■■■■■■■■■■■■■■■ BasementFire Place •• ,, • • Rooms 2nd Floo� •• -_ - . .• ■■E■E■■ E■EE■E■NO■■■■■■■■■■■ ■■■E ■E■E■EEEEONEE■E■■EN NOON■■ ■EE■■■■■■■E■■■■E■E■ ° ■■■■i ■?■■iN■i■■■i■■i■■i■■ NonniNONE■■i owN�iii■■■■■■■■■■■■■■ j - r ■■ENE■■ •��■■s■■■E■■■■■■ ■E■E■11 �i■■O■■■■■■■E■■■■O f" � ■■■■■■��■■■■!1`■NOON■■■■OO■■■■ - __ _ �t. . _ , _�� - s y �...� NOON■■■ ■■■■■■■■■■■■■■E■■EN■ ■■E■■■■ ■■■■■E■■■■■■■N■EE■■■ ■ PlaceBasement Ext. Walls Fire .• o a o _ 7,f-2 - TOWN OF SOUTHOLD PROPERTY RECORD CARD ! O NE R`�ro r STREET x= VILLAGE DIST. SUB. LOT . ,a F O ER OWNt N E ACR. S W TYPE OF BUILDING ' :ES. _216 SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS aooDo � 7o a 3 � ,� s ��f � o c> -466c> 35 �' � i- _54 c) ��11 - 203 2 S rn a ,� +v ` 4 o SS AGE BUILDING CONDITION 1; ,Al fT,"8P*017`713 - coosf r. ei ss y e � , � , 4100. NEW NORMAL BELOW ABOVELv r 29 Isv"94m FARM Acre Value Per Value Acre Tillable 1 tillable 2 Fillable 3 Noodland swampland FRONTAGE ON WATER 3rushland FRONTAGE ON ROAD -louse Plot DEPTH BULKHEAD dotal ,.� a A 0"%� DOCK Permit Number MECcheck Compliance Report Checked By/Date New York State Energy Conservation Construction Code MECcheck Software Version 3.3 Release lc Data filename:Untitled TITLE: Ricciardi/Hartman Residence COUNTY:Nassau STATE:New York HDD:4910 CONSTRUCTION TYPE:Detached 1 or 2 Family HEATING TYPE:Non-Electric DATE: 10/29/03 DATE OF PLANS: 2003 PROJECT INFORMATION: Vince Ricciardi/Jamie Hartman Residence 60 Sheppard Drive Southold,N.Y. 11971 COMPANY INFORMATION: Unknown at this time COMPLIANCE:Passes Maximum UA= 173 Your Home= 158 8.7%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 656 30.0 0.0 23 Wall 1:Wood Frame, 16"o.c. 640 19.0 0.0 29 Window 1:Wood Frame,Double Pane with Low-E 163 0.320 52 Floor 1:Unheated Slab-On-Grade,6.0'insul. 76 7.5 54 Furnace 1:Forced Hot Air,78 AFUE Air Conditioner 1:Electric Central Air, 10 SEER 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 proposed systems have been designed t e ew York State Energy Conservation Construction Code requirements. When a Registered Design ofessio 1 s s id signed this.page,they are attesting that to the best of his/her knowledge,belief, d profe 'o al ju such plans or specifications are in compl' nce w' h this Code. tt) Builder/Designer Date 2 3 MECcheck Inspection Checklist New York State Energy Conservation Construction Code MECcheck Software Version 3.3 Release lc DATE: 10/29/03 TITLE:Ricciardi/Hartman Residence Bldg. Dept. Use I Ceilings: [ ] I 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: I Above-Grade Walls: [ ] I 1. Wall 1:Wood Frame, 16"o.c.,R-19.0 cavity insulation Comments: I Windows: [ ] ( 1. Window 1:Wood Frame,Double Pane with Low-E,U-factor: 0.320 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ J Yes [ J No Comments: I Floors: [ ] I 1. Floor 1:Unheated Slab-On-Grade,6.0'insulation depth,R-7.5 continuous insulation Comments: Slab insulation to extend down from the top of the slab to at least 6.0 ft. OR down to at least the bottom of the slab then horizontally for a total distance of 6.0 ft. Exterior insulation must have a rigid,opaque,weather-resistant protective covering that covers the exposed(above-grade)insulation and extends at least 6 in.below grade. I Heating and Cooling Equipment: [ ] I 1. Furnace l: Forced Hot Air, 78 AFUE or higher Make and Model Number [ ] I 2. Air Conditioner l:Electric Central Air, 10 SEER or higher Make and Model Number I Air Leakage: [ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] I Recessed lights must be 1)Type IC rated,or 2)installed inside an appropriate air-tight assembly with a 0.5"clearance from combustible materials.If non-IC rated,the fixture must be installed with a 3"clearance from insulation. I Vapor Retarder: [ ] I Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: [ ] I Materials and equipment must be installed in accordance with the manufacturer's installation instructions. [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] I Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications. I Duct Insulation: [ ] I Supply ducts in unconditioned attics or outside the building must be insulated to R-8. [ ] I Return ducts in unconditioned attics or outside the building must be insulated to R-4. [ ] I Supply ducts in unconditioned spaces must be insulated to R-8. [ J I Return ducts in unconditioned spaces(except basements)must be insulated to R-2. Insulation is not required on return ducts in basements. I Duct Construction: [ ] I All joints,seams,and connections must be securely fastened with welds,gaskets,mastics (adhesives),mastic-plus-embedded-fabric,or tapes. Duct tape is not permitted. Exception: Continuously welded and locking-type longitudinal joints and seams on ducts I operating at less than 2 in.w.g.(500 Pa). [ ] I Ducts shall be supported every 10 feet or in accordance with the manufacturer's instructions. [ ] I Cooling ducts with exterior insulation must be covered with a vapor retarder. [ ] I Air filters are required in the return air system. [ ] I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] I Each dwelling unit has at lesat one thermostat capable of automatically adjusting the space I temperature set point of the largest zone. I Electric Systems: [ ] ( Separate electric meters are required for each dwelling unit. I Fireplaces: [ ] I Fireplaces must be installed with tight fitting non-combustible fireplace doors. [ ] I 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 New York State or the New York City Building Code,as applicable. I Service Water Heating: [ ] I Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the I water heater has an integral heat trap or is part of a circulating system. [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Circulating Hot Water Systems: [ ] I Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% I of the heating energy is from non-depletable sources. Pool pumps require a time clock. I Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 105 OF or chilled fluids below 55 OF must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating_Mains and Runouts Temperature(F) Up to 1„ Up to 1.25" 1.5"to 2.0" Over 2" 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 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2"Runouts 1"and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 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) NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGRAPHIC DESIGN CRITERIA: Ground Snow Load:45 Wind Speed: 120MPH Seismic Design Category: B Weathering: Severe `� Frost Depth:36" " Termite: M-H V/ Decay: S-M Design Temp: 11 V Ice Shield Underlay: YES ,../ Flood Hazards: USE/OCCUPANCY CLASSIFICATION: ✓ HEIGHT/FIRE AREA: / TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEERED SCRIPTIVE- ,,, �.c e✓t FULL FRAMING DESIGN ELEMENT8'0/N HEADERS: Y/N WALL STUDS:Y/N GIRDERS: Y/N CEILING JOISTS: Y/N FLOOR JOISTS:Y/N ROOF RAFTERS:Y/N LUMBER SPECIES AND GRADE:Y/N DESIGN LOAD CALCULATIONS:VN LIVE: Y/N DEAD:Y/N SNOW:Y/N SEISMIC:Y/N WIND: Y/N WINDOW AND DOOR SCHEDULE: l/ ISSLE TEST REQUIREMENTS:('/N l EGRESS 5.7 S.F.: Y/N LIGHT 8%: Y/N VENT 4%: Y/N NAILING/CONSTRUCTION SCHEDULEZ MEANS OF EGRESS: Y/N PLUMBING RISER DIAGRAICV//EQUIPMIEN�/N LOCATION OF FIRE PROTECTI TRUSS DESIGN: Y/N CERTIFICATION:,Y/N ENERGY CALCPIENCE? N TOTAL COMP N (RETURN TO PAGE ONE) BUILDING PERMIT EXAMINER CHECKLIST DATE REVIEWED: (2 /x/03 APPLICANT: l« a( DATE SUBMITTED: I 1 /!: /03 SCTM#DISTRICT: 1,000, SECTION: , BLOCK: 02 , LOT: _ SUBDIVISION: Oesr Cmelc-. ADDRESS: z-In Garv, k d • CITY: ZONING DISTRICT: CONFORMING? No BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N BP.� -Z/C/0 Z-yr 6,3 INFO , ,�r� /BP 19 9C -Z/C/0 Z- /*26 3B , INFO BP -Z/C/0 Z- , INFO /BP -Z/C/0 Z- , INFO SINGLE & SEPARATE CERTIFICATION-REQUIRED NOTES: LATS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LATS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7i REQ. LOT SIZE: — ACT. LOT SIZE: f REQ. LOT COV. x ACT. LOT COV. REQ. FRONT 3," PROP. FRONT REQ SIDE ACT. SIDE REQREAR t :; PROP. REAR REQ. H IGHT PROP. HEIGHT PROJECT DESCRIPTION: r ; t A-,,-r5 ESTIMATED PROJECT COST: 5"C- /ENGINEER: Brat ss WATER FRONT? Xo DESCRIPTION: PANEL # FLOOD ZONE: APPROVALS REQUIRED SUFFOLK COUNTY HEALTHD PT: YES orS(BED#): DTE: /_/_ PERMIT#: TOWN SEPTIC RECEIPT: Y oc) NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or DTE: / / PERMIT#: SOUTHOLD TOWN TRUSTEES: YES or DTE _/_/_ PERMIT#: TOWN ZONING BOARD APPROVAL: YES o DTE _/ /_ PERMIT#: TOWN PLAN. BOARD APPROVAL: YES o DT8: _/_/ PERMIT#: TOWN HISTORICAL PRE (SPLIA): YES NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2): or NO NOTES: v FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SL j_ SF SECOND FLOOR: 3 f L SF OTHER: SF INIT OTHER TOTAL TOTAL: 9 ! SF FEE FEE FEE ?� I. f j, SF)- iia SF)= SF X $ �o=$ I�1 +$ i J +$ =$ ( (,` 2. ( SF)- _SF)= SF X $ =$ +$ +$ _ $ 3. (_SF)- _SF)= SF X $ _$ +$ +$ _ $ FINAL TOTAL: $ G� 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH G. [ ] FOUNDATION 2ND CATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE EY FIRE SAFETY INSPECTION REMARKS: DATE � INSPECTO BUILDING oar. INSPECTION [ OUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: F-�1�1i� � �� Com✓' JAA4 DATE INSPECTOR, �c.v� M-ieoz suiwINc DE". INSPECTION [ FOUNDATION IST [ ] ROUGH PLBG. [ „}}'FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY REMARKS: DATE INSPECTO 765-1802 BUILDING DEPT. INSPECTIO [ ] FOUND ION IST OUCH PLBG. [ ] FO DATION 2ND [ ] INSULATION RAMING [ ] FINAL [ ] FIREPLACE 8 CHIMNEY [ ] FIRE SAFETY INSPECTION EMARKS• DATE � INSPECTO 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS ON [ ] FRAMING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: oeV DATE !� � INSPECTOR 14 151 ' • . -UON(2ND) r\ r flims! � ,�i! �_ __, ■ TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 �._3 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. d / Q ( Check Septic Form N.Y.S.D.E.C. Trustees Examined / ,20 Contact: Approved �� 20__3 Mail to: Disapproved a/c / ' ' Phone: -7&5-L eSe Expiration ,20_,j t Building Inspector APPLICATION FOR BUILDING PERMIT Date N�� , 20 _"3 INSTRUCTI ONS a.This application MUST 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. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, 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 regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder 0 W Nom. Name of owner of premisesy I m C o l , (Z m A at i V Al l E 144 V-Wt\J (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. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which roposed work will be done: (PC) S CPA V-6 b L S U l i imc_6 House Number Street Hamlet County Tax Map No. 1000 Section Block 2— Subdivision Subdivision Filed Map No. ' (Name) iQ#-1 WIT 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy CAUL-1 b. Intended use and occupanci 11 -A K)J 7t t l tj 3. Nature of work(check which applicable): New Building Addition ✓ Alteration Repair Removal Demolition Other Work ce- &167,Nc,�— (Description) 4. Estimated Cost tow,(10 Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. i 1 t` t l< 7. Dimensions of existing structures, if any: Front 31. 2 Rear. 37L Depth 28 Height Number of Stories 2— Dimensions Dimensions of same structure with alterations or additions: Front 3-7 L tt Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 7O ItdS G0 11. Zone or use district in which premises are situated 12. Does proposed construction violate anyzoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO \//Will excess fill be removed from premises? YES NO 14.Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF C�►Jti 'Ci l.�Q�i being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the ul�K)6� (Contractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said wor d to make an file this application; that all statements contained in this application are true to the best of his knowledge and elief, and that t work will be performed in the manner set forth in the application filed therewith. Swo t before me thiI day of W1�k{/ 20b _&"a;:�U4 . No Public Si a of A pli nt ft"poWN601111w'111A No.01WA5328, Term Expos 1rb�. SURVEY OF LOT 26 MAP OF WEST CREEK ESTATES S 7.2-.5.9, FILE No. 3848 FILED AUGUST 19, 1963 SIT UA TED A T SOUTHOLD TOWN zoT� TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-78-02-09 'q ~/ 14.x.47. SCALE 1 to =20' ,� \ / °s OCTOBER 24, 2003 ��„ AREA c 18,647 sq. ft. 0.428 ac. -p�q.�, J "T v Aj LOT 2S r •� �.s ? r. :. ... 040, 0 ryry ff / SPREPORED IN ACCORDANCE WTH 7W Dom?" b� emir �.s. AND APPF40VW AND O ETON THE NI° YORK STATE LM ry y 130, ? � ��CA0, � 0, W " 046 N.Y.S. Lk. No. 7 Q IN�IMlTFIORIZED ALTERATKIN OR ADDITION G SECTION �TO THIS SURWY �1HE NEW YORK STATE EDUCATM COMS F � SURM IAAF NOT BEAMW Nathan Taft Corwin 9 N THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHAM NOT BE CONSIDERED TIDBEL Surveyor O TO 8E A V" TRUE COPY. SO ONLY M THE P8VSON FOR WHOM THE SLWEY 00. IS PREPARED. AND ON HIS BEHALF TO THE TITLE OOAPANY. 004ERNMENTAL AGENCY AND LENDNG INS ITWON LISTED I OREON. AND TO TME A °""� `NOT I OFE 992 Roanoke Avenue TLRION. CEIMN'ICATKlNS ARE NOT SLE. THE EXMnVM of 1 " WAY Riverhead, New York 11901 AND/'DR ANTS A ° W=ft. PHONE FAX (631)369-54733 ANY. NOT SHOMIN RE NOT GUMMED. A QFF'ICri opt L R �`. 'w SIF YII .+ll., •�' � '�' "Q4 '�12+ v � .�. ��,_ AP OVEDAS NOTED pp DATE: B.P.2.�??2 r It - FEE: BY: NOT BUILDING DEPARTMENT AT 765.1802 SAM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1011, 1. . . 4 1. FOUNDATION - TWO REOMED FOR POURED CONCRETE i- - - - ------ —�� --`— ~, - 2. ROUGH - FRAMING & PLUMBING -. . S. INSULATION _ - 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE ... REQUIREMENTS OF THE CODES OF NEW T"W30. -2 - YORK STATE. NOT RESPONSIBLE FOR }' - DESIGN OR CONSTRUCTION ERRORS w y1cIL ALL coNsrRlwnDN seALL MEET THE R EOUIREMENTS,OFTflE CODES OF NEW YORf�STA - Ylk .; I #, FLOOD ZONE COMPLY WITH CHA R`O FLOO6:DAMAGE PRE ENTIC7N SOUTHOLD TOWN CODE. p �phoy 4Q�I Dli CAtZD�1" I 1 NAILING & CONNEbggpp6uawa4�' CERTIFICATION Of 'b REQUIRE[Tifi"- UNDERWRITERS CERTIFICATE REQUIRED to — I ;I COMPLY W Uvl. PITH ALL CODES OF Y 6 — _ N. CONDITIONS OF t ' r ' ULVF1� - I J NEW YORK STATE & TOWN CODES n Pw* twp • SOUTNgDTOWNISA ��( yyC� Wkus ,�Pwa + �A ^- t � _ -,_ i ,, SOURIOLDTOWN RANNINGBOARD W�. SOUrNMD'I MTRUMES NTS. PLUMBING ALL PLUMBING WASTE 8 WATER LINES NEED M1 � r - _ TESTING BEFORE COVERING �'� � > � ``- _ _ OCCUPANCY OR USE IS UNLAWFUL ,. : WITHOUT CERTIFICATE e OF OCCUPANCY I I PLUMBERCERTIFICdTlON k"ft* lv ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN (NATER ( OP &044N6 UNq(TD SUPPLY SYSTEM CANNOT `rid* EXCEED 7110 OFf%LEAD, " � —I l _ I 0 9J+ + T:_ 17 Ire .H. m C f d . . .. ,. . -.Y' u-,y,�..lc I ' � • � � _ _�. ,w__.� _—_ WI[vE'e, sa l Stfi IiY '; � �� w T..' �T "". .- -' .l :,.." _�_ ', ��, �.r � fS �N '. � .�.:�'�-�•��C�SY L��'eL _ .. ., �_ . yrt�l _ 1 �r - _ -., ... � ., AT"E R"L:] 5 +-- "' .. _ .. R/ 1_�.QY.J -F• �yw,' 3 O- m a� 7X24" ,2 tvrwt:. r manp. e/. ' J^.�dC; MWneA ex x y�y Ff 1 � , , ,Q s-x a i i j � .�3tlt'i'Ycrc*] �— �kdFrTlNIS rw-'rte. 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