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HomeMy WebLinkAbout31104-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30936 Date: 05/26/05 THIS CERTIFIES that the building ADDITION Location of Property: 4680 WUNNEWETA RD CUTCHOGUE (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 111 Block 14 Lot 36.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 3, 2005 pursuant to which Building Permit No. 31104-Z dated MAY 3, 2005 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 ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to RUST FAMILY PARTNERSHIP (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1097354 12/17/04 PLUMBERS CERTIFICATION DATED N/A Authorized Signature Rev. 1/81 l W &cW CAGY Form No.6 - -� TOWN OF SOUTHOLDnpn , r•_ BUILDING DEPARTMENT p}�---- -- - , TOWN HALL , 765-1802 F MAY Z 5 2005 ,{ APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Depl rtr�rit 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 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,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. 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, Commercial$15.00 Date. May 24, 2005 New Construction: X Old or Pre-existing Building: (check one) Location of Property: 4680 Wunneweta Road, Cutchogue, NY 11935 House No. Street Hamlet- Owner or Owners of Property: Rust Family Partnership Suffolk County Tax Map No 1000, Sectionl 11 Block 0 014 Lot 036.006 Subdivision Filed Map. Lot: Permit No. 31104—Z DateofPermit. 3/3/05 Applicant: Flower Hill Building Corp. Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: X (check one) Fee Submitted: $ 25 .00 Applicant Signature co 36 T ,3 6 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. 31104 Z Date MAY 3 , 2005 Permission is hereby granted to: FAMILY PARTNERSHIP RUST 2600 DOUGLAS RD #604 CORAL GABLES FL, 33134 for CONSTRUCT AN ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP 28873 . at premises located at 4680 WUNNEWETA RD CUTCHOGUE County Tax Map No. 473889 Section 111 Block 0014 Lot No. 036 . 006 pursuant to application dated MAY 3 , 2005 and approved by the Building Inspector to expire on NOVEMBER 3 , 2006 . Fee $ 150 . 00 Authorized Signature ORIGINAL Rev. 5/8/02 a[r���&L3]'] �n����n�n�����n�n���n�r�.n����n�n��n�nr�r�r�rr�r�����I-�n�n��n�n�n���l��n���n���n���n��n o 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 . 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 BUREAU OF ELECTRICITY cS 5 40 FULTON STREET - NEW' YORK, NY 10038 5 5 5 5 t CERTIFIS THAT 5 5 5 Upon the application of upon premises owned by 5 5 5 SABAT ELECTRIC HELEN RUST 5 5 50 PAT LANE 4680 WUNNEWETER ROAD 5 SMATTITUCK, NY 11952, CUTCHOGUE, NY 11,935 5 Located at 4680 WUNNEWETER ROAD CUTCHOGUE, NY 11935 5 5 5 SApplication,Number: 1097354 Certificate Number: 1097354 c5 5 Section: 111 ' Block: 14 Lot: 34 Building Permit: 28309 &2887 BDC: NS11 S 5 5 SDescribed as a Residential occupancy, wherein the premises electrical system consisting of 5 Selectrical devices and wiring, described below, located in/on the premises at: 5 5 5 5 Basement,First Floor,Attached Garage,Outside,Attic, 5 5 5 A visual inspection of the premise's electrical system, limited to electrical devices and wiring to the extent detailed 5 Sherein, was conducted in accordance with the requirements of the applicable code and/or standard 5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other 5 5 authority having jurisdiction, and found to be in compliance therewith on the 17th Day of December,2004.. S 5 Name QTY Rate Rating Circuit Type 5 5 Miscellaneous 5 4-elec sky lights rj 1-9 KW steam unit S CSS Alarm and Emergency Equipment 5 r5] Transfer Switch 1 0 400 amp 5 Sensor 2 0 Carbon Monoxide 5 Generator 1 0 10 kw 5 5 Appliances and Accessories 5 5 Exhaust Fan 1 0 F.H.P. Hydro Massage Tub,Residential 1 0 L� 5 Furnace 1 0 Oil 5 SAir Conditioner 1 0 36.000 BTU C5, 5 Wiring and Devices 5 5 Outlet 52 0 Fixture 5 5 Fixture 44 0 Incandescent C 5 Fixture 8 0 Fluorescent 5 Outlet 56 0 General Purpose seal 5 Receptacle 34 0 General Purpose �5 5 Continued on Next Page 1 of 2 5c 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. c 5 5 o J MCM 00 ��������������� o 7 a[�P[J�rJ�C.I�[1�r3rJ�[-9@1�CPry[J�[.n[.1[!r3j'L3 rL3rL3j rL3rL3 d-L3CJSL3pdM[1�[nCjiMi 1�[J�[J�MJ PCI[.frJ�[nrJ�[![J�GI�[J�CJ�rJ�[1�i!] mr,,J�r�C1�[.f[n[n�P[1� I� BY THIS CERTIFICATE OF COMPLIANCE THE 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 S BUREAU OF ELECTRICITY 5 40 FULTON STREET NEW YORK, NY 10038 5 5 5 CERTIFIES THAT rj 5 5 5 Upon the application of upon premises owned by 5 5 5 SSABAT ELECTRIC HELEN RUST 50 PAT LANE 4680 WUNNEWETER ROAD SMATTITUCK, NY 11952, CUTCHOGUE, NY 11935 5 5 Located at 468Q WUNNEWETER ROAD CUTCHOGUE, NY 1'1935 5 5 5 5 5 A lication Number: 5 PP 1097354 Certificate Number: 1097354 5 5 Section: 111 Block: 14 Lot: 34 Building Permit: 28309 &2887 BDC: S NS11 c� 5 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: 5 5 Basement,First Floor,Attached Garage,Outside,Attic, 5 5 5 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 5 herein, was ; conducted in accordance with the requirements of the applicable code and/or standard 5 5 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 17th Day of December,2004. . 5 5 Name QTY Rate Rating Circuit Type 5 5 5 Switch 26 0 General Purpose 5 Receptacle 1 0 20 amp Laundry - 5 nrj Receptacle 1 0 30 amp Dryer C� Paddle Fan 4 0 5 5 Dimmers 14 05 5 Receptacle 3 0 GFCI 5 Disconnect 1 0 60 amp Air Conditioner S 5�j Service L5'� 1 Phase 3W Service Rating 300 Amperes 5 Service Disconnect: 1 200 cb 5 5 Service Disconnect: 1 100 cb 5 Meters: 1 5 - S S 5 5 seal 5 5 5 5 5 5 2 of ? 5 5 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 5 5 a r ��LWI.: I��Ln�n�����n�n��nr��n�n���Ln�����n�.r�.rI�Wrry, a CHRISTIAN E. UHL TELEPHONE PRESIDENT 516 692-4545/6 Holl � egl J g p FACSIMILE ®V`1R�7�i� g � 1� ®� ®����®� 516367-7323 8243 JERICHO TURNPIKE, SUITE 010 WOODBURY, L.1., N.Y-. 1 1797 October 1,2002 Mr. John Boufis, Building Inspector � �� _ Town of Southold Building Dept. ��� OCT 4 2002 Main Road, P. O. Box 1179 �- Southold NY 11971 �� r C:'.PT. Dear Mr. Boufis: Enclosed please find the following enclosures for additional alteration for the Helen Rust Family Partnership located at 4680 Wunneweta Road,Nassau Point, Cutchogue,NY: 1. Three (3) sets of plans signed and sealed by John W. Olson,Engineer. 2. Application for Building Permit. 3. Blank check made out to the Town of Southold for the Building Application Fee. 4. Letter of Non-Jurisdiction from the DEC pertaining to this particular piece of property. 5. Fire Prevention and Building Code Affidavit. 6. Authorization from Robert Rust to Flower Hill Building Corp. 7. Certificate of Liability Insurance. Please note on the plot plan that the extension is more than 100 feet from the bulkhead and the elevation is above 10 feet. If any applications are missing that are required,please call my office at the above number at your earliest convenience. Sincerely, FLOWER L BUILDING CORP. Uhl TEU/cm Enclosures DN: Rust/BldgPrmt.gw OCT ?_ 8 2002 j' '' I Permit Number i' TMAJ.= ;r MECcheck Compliance Report Checked By/Date New York State Energy Conservation Construction Code MECcheck Software Version 3.3 Release lc Data filename:C:\Program Files\Check\MECcheck\rust.cck TITLE:Rust Existing Den and Den Extension COUNTY: Suffolk STATE:New York HDD: 5750 CONSTRUCTION TYPE:Detached 1 or 2 Family HEATING TYPE:Non-Electric DATE: 10/21/02 DATE OF PLANS: 10/10/2002 PROJECT INFORMATION: Addition of New Den to Existing Den COMPANY INFORMATION: Flower Hill Building Corp. 8243 Jericho Turnpike,suite 010 Woodbury N.Y. 11797 COMPLIANCE:Passes Maximum UA=242 Your Home=241 0.4%Better Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1: Cathedral Ceiling(no attic) 400 32.0 0.0 12 Skylight 1:Vinyl Frame,Double Pane with Low-E 6 0.500 3 Skylight 2:Vinyl Frame,Double Pane with Low-E 6 0.500 3 Ceiling 2:Flat Ceiling or Scissor Truss 240 32.0 0.0 8 Wall 1: Wood Frame, 16"o.c. 173 20.0 0.0 9 Window 1: Vinyl Frame,Double Pane with Low-E 6 0.500 3 Window 2:Vinyl Frame,Double Pane with Low-E 6 0.500 3 Window 3:Vinyl Frame,Double Pane 15 0.500 8 Wall 2: Wood Frame, 16"o.c. 158 20.0 0.0 8 Window 4:Vinyl Frame,Double Pane with Low-E 8 0.500 4 Window 5:Vinyl Frame,Double Pane with Low-E 8 0.500 4 Window 6:Vinyl Frame,Double Pane with Low-E 12 0.500 6 Wall 3: Wood Frame, 16"o.c. 144 20.0 0.0 5 Window 7:Vinyl Frame,Double Pane with Low-E 6 0.500 3 Window 8:Vinyl Frame,Double Pane with Low-E 6 0.500 3 Window 9:Vinyl Frame,Double Pane with Low-E 12 0.500 6 Door 1:Blass 32 0.550 18 Wall 4:Wood Frame, 16"o.c. 88 20.0 0.0 5 Window 10:Vinyl Frame,Double Pane with Low-E 6 0.500 3 Wall 5:Wood Frame, 16"o.c. 124 20.0 0.0 6 Door 2:Glass 28 0.550 15 Wall 6:Wood Frame, 16"o.c. 88 20.0 0.0 5 Window 11:Vinyl Frame,Double Pane with Low-E 6 0.500 3 Wall 7:Wood Frame, 16"o.c. 96 20.0 0.0 5 Window 12:Vinyl Frame,Double Pane 6 0.500 3 Wall 8:Wood Frame, 16"o.c. 102 20.0 0.0 6 Floor 1:Unheated Slab-On-Grade,3.0'insul. 120 11.0 84 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 to meet the New York State Energy Conservation 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, and professional judgment,such plans or specifications are in compliance with this Code. Builder/Designe Date 6 f/ O JOHN W. OLSON, PE. of NEW 1366 S.W.JASMINE TRACE P� W. Ot PALM CITY, FL 34990 0 Z O o, 33 AROFESSVOV P New York State Department of Environmental Conservation Building 40 -SUK..Y, Stony Brook, New York 11790-2356 Telephone (516) 444-0365 Facsimile (516) 444-0360 Erin.M.Crotty LETTER OF rOiNJURISDICTION -TIDAL WETLANDS Commissioner Date: August 1.7, 2001 Helen Rust Partnership RE: 1-4738-00860/00007 P.O. Box 7339 Helen Rust Partnership Property Breckenridge, CO 80424 Wunneweta & Bayberry Roads Nassau Point SCT:bI 1000-111-14-3.1 & 36.5 Dear Sir/Madam: Based on the information you have submitted, the New York State Department of Environmental Conservation has determined that the property landward of the functional bulkhead greater than 100 ft. in length and constructed prior to 8/20/77, as shown on Aerographics Aerial AGC 67075 71-2002. dated 4/6/76, is beyond Article 25 jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NI YCRRPart 661) no permit is required under the Tidal Wetlands Act. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands Jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary 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 wetland Jurisdictional boundary and your 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. Very truly yours, Permit Administrator cc: Christian E. Uhl, Flower Hill Building Corporati Woodbury, NY 11797 on, 8243 Jericho Turnpike, Suite 010, Bureau of Marine Habitat Protection, NYSDEC File DMG ACORD CERTIFICATE OF LIABILITY INSURANCE OPID C DATE(MM/DD/YY) LOWE-2 09/25/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JAQUILLARD & ZWIELICH, INC. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 409 LAKE AVE. ,P.O. BOX 2190 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ST. JAMES NY 11780 Phone: 631-862-1200 Fax:631-862-9222 INSURERS AFFORDING COVERAGE INSURED INSURER A: Ins Corp of New York INSURER B: Harleysville WO 'S "I Cp 1 Flower Hill Building Corp. s Chris Uhl INSURER C: ; r 8243 Jericho Turnpike INSURER D: Woodbury NY 11797 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDNY)E DATEYM / / Y EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY IRS100251 0301/02 03/01/03 FIRE DAMAGE(Any one fire) $ 50,000 CLAIMS MADE FX]OCCUR MED EXP(Anyone person) $'5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO LOC SECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO BA 6E. 26 89 03/01/02 03/01/03 (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 1,000,000 A X OCCUR F_� CLAIMSMADE IUS 300028 03/01/02 03/01/03 AGGREGATE $ 1,000,000 $ DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION AND Tj TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS -LOCATION: 4680 WUNNEWETA:ROAD, CUTCHOGUE, N.Y. : DESCRIPTION: EXPANDING EXISTING FAMILY ROOM. CERTIFICATE HOLDER N I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION HELEN01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL HELEN RUST FAMILY PARTNERSHIP 4680 WUNNEWETA ROAD IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR CUTCHOGUE, NY 11935 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Joseph A. Zwielich ACORD 25-S(7/97) A D dORPORATION 1988 ACORD� CERTIFICATE OF LIABILITY INSURANCE OPID C DATE(MM/DD/YY) LOWE-2 09/25/02 PRODUbER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JAQUILLARD & ZWIELICH, INC. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 409 LAKE AVE. ,P.O. BOX 2190 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ST. JAMES NY 11780 Phone: 631-862-1200 Fax:631-862-9222 INSURERS AFFORDING COVERAGE INSURED INSURER A: Ins Corp of New York Flower Hill Building Corp. INSURER B: Harleysville Worcester Ins Co Chris Uhl INSURER C: '8243 Jericho Turnpike INSURER D: Woodbury NY 11797 INSURER E: COVERAGES, THE POL'ICIES'OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE MMIDDIYY DATE MM/DDIYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY IRS100251 03/01/02 03/01/03 FIRE DAMAGE(Any one fire) $ 50,000 CLAIMS MADE FX]OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ 1;600,000 A ANY AUTO BA 6E "26 '89" . 03/01/02-' 03/01/03' (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ 1f000,000 A X OCCUR CLAIMS MADE IUS 300028 03/01/02 03/01/03 AGGREGATE $ 1,000,000 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS LOCATION: 4680 WUNNEWETA ROAD, CUTHCOGUE, N.Y. DESCRIPTION: EXPANDING EXISTING FAMILY ROOM. CERTIFICATE HOLDER N I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION TOWN00 9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF SOUTHOLD DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN BUILDING DEPARTMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL P.O. BOX 1179 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR MAIN ROAD SOUTHOLD, NY 11971 REPRESENTATIVES. �AUTHORIZED REPRESENTATIVE Joseph A. Zwielich ACORD 25-S(7/97) o A-dRD bORPORATION 1988 STATE OF NEW YORK ) ss: COUNTY OF SUFFOLK ) John W. Olson , being duly sworn, deposes and says: That deponent is over the age of 18 years and resides at 1366 S .W. Jasmine tTrace, - Pa1m City, Florida .34990 • That on the_� ay of ��mEE,t 2001 deponenfi architect/en ineer, . g licensed by the State of New York, hereby states that s/he accepts full responsibility for the accompanying plans compliance with the. New York State Fire Prevention and Building Code (9 NYCRR);:said plans pertain to property* located at SCTM# 1000- •111-14-34 and 36 . 5 ' street addr"esS 4680 Wunrieweta Road, Nassau ,Point, Cutchoc ue, NY 11935 12 Engineer Sworn to,be re me fihis .SLI.- 1 ay of , 2002, VIRGINIA W. UHL NOTARY PUBLIC, State of New York . No. 62UH475833 ualified in Nassau County N .otary REfflen xpires cc: applicant M-1802 BUILDING DEPT. INSPECTION �Q FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACES CHIMNEY REMARKS: ..''L-`may=��" ,�i!i��'.? .��'ti,.✓� r . ./� .- DATE 6 o -INSPECTOR 75� 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDAT IST [ ] ROUGH PLBG. [ ] FO ATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL [ ] FIREPLAC CHIMNEY REMAR S: DATE l � INSPECTO ' 'Peri 311D � 0 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] GH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: DATE INSPECTOR �cM 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: c p A2� ( D DATE � —� �� �� INSPECTOR -�6. TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET 416-r-) VILLAGE DIST. SUB. ✓ LOT #J O ® 9L 1 nus t 1rsh, dA n 1? We A a V C. v Xc- Q t! FORMF�R O W15R N E ACR. L�dDl / S W TYPE OF BUILDING RESAT SEAS. . VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKSfo 0g16,966 'I ��v e t'��/�.,�a 1 )4 �''� J / L �,� ¢ A 75b17!"": 4 �Cxb 19 2-12-% 2C0LF d. AGE BUILDING CONDITION - L- 1142-/j2 10� - ID u5+ ro IM r Po r frier ivL NEW NORMAL BELOW ABOVE /D a9 10,3L A P.#�8 815 p)ew odd i'-han FARM Acre Value Per Value Acre t 1)��- '2-83O h-Uy. r . Tillable 1 Tillable 2 92 Tillable 3 Woodland.. Swampland FRONTAGE ON WATER Brushland FRONTAGE ON ROAD o p i �.7 os House Plot DEPTH 2- BULKHEAD ULKHEAD notal DOCK v� -- ,isms-�==J ,:~_'.5. ..,. ..i Ho _ �■■i■■■■ ■■■■■■,,■■■■i��■■■■■■■ Y F!§+ re sz,._ yau- `"`"'_.--sem'-;. ■■�■■■■�■��■■■■■©�■■■■■■■■■■ L '� , - •• TOWN OF SOUTHOLD PROPERTY RECORD CARD J OWNI? STREET `�� VILLAGE -DIST. . . SUB. ✓ LOT #.2 k. 0eCSb'( !/h 4. e-tee./ad � � v 7`�.�a v� � a��d v �`� 7�L�/�d P� 12-it a. goRm R O R N E ACR. va—(7 f t / S W TYPE OF BUILDING ;ES:A10 SEAS. VL. FARM COMM. CB. MISC. Mkt.' Value LAND IMP. TOTAL DATE REMARKS g � 66Qan �+, 'U D �` CJ O EI-2 L �� �iE'IfO� �Q� �Yr�e"I Z G rI. —a — 3 ,12 - 4d o f-F G1 eca Cee-f. AGE BUILDING CONDITION - L//4 a./ LDS -faSf.Fa M I T" Y t��°tr N 1 -2117 19Z r I J' NEW NORMAL BELOW ABOVE L1 'ate Off- a 03� 1 FARM Acre Value Per Value ry Acre ;... "illable I 'illable 2 ilfable 3 ` Joodland wampl,and FRONTAGE ON WATER , rushland FRONTAGE ON ROAD o o /70 '4W Kb e"a 0- ' ;Y. S- 7 louse Plot DEPTH z , � BULKHEAD f offal ' ' DOCK 9 r _ i"OWN OF SOUTHOLD PROPERTY RECORD CAR® owa.._rc STREET 2 Oc~. VILLAGE DIST. SUB. LOT 02 ea*st ram, 7 tj lqi.- sus Iri t0Av i /z a—, FORM R OWNER N E ACR. S W TYPE OF BUILDING _ RES. - o SEAS. VL. FARM COMM. CB. MISC. Mkt. Value ---°�- -- ✓ t. LAND IMP. TOTAL DATE REMARKS J�6/0/ z ea U L� d d I 0 ,0 q Z"vp 3 11617 3 s 2- c r! a s-e - df egt aff_r 7 a� +S z-�- ! l /bf� - 106YI& e_ z �a �w B ��-gl e COND T FARM Acre Value Per Value Acre Tillable 1 Tillable 2 r' Tillable 3 Woodland O. s Woo d Swam lanFRONTAGE ON W��ER Sa P Brushland FRONTAGE ON ROAD 4_0 House Plot DEPTH d ®.o BULKHEAD Total' DOCK I_ _ TOWN OF SOUTHOLD PROPERTY RECORD CARD - 01Nt1E'R STREET VILLAGE DIST. SUB. ✓ LOT viflei` h t !/h A titre 1�� d a� G.. I/ 1 L.�i d Ud; 6p d 4-(r4 V 000e, f JLi_AlG i r!- .��a. FORM R O R NE ACR. 7L 1z 1.21 JW// / �t S W TYPE OF BUILDING I z Y::� ES;A10 SEAS. VL. FARM COMM. CB. MISC. Mkt: Value LAND IMP. TOTAL DATE REMARKS 0 ,6 b i *1214 Z '46, o b 43 r_'-• - �(/Bt tj cS�iJ•�'c S/i,N�1.r �<7 f 3 X12- 4d o l-F d.eco tp rf. AGE BUILDING CONDITION • L 1142/ !06 = u f -fa �",�vs�r' p rf'i7er /v J= NEW NORMAL BELOW ABOVE . �� a%3o l FARM Acre Value Per Value Acre 7 7 'illabie 1 illable 2 ilfable 3 foodland. -C Narrmpl,and FRONTAGE ON WATER rushland FRONTAGE ON ROAD 3o o s ,f v 9 .7 ouse Plot DEPTH z &� 14ae; v BULKHEAD oto I DOCK 9 "OWN OF SOUTHOLD -PiOPERTY RECORD CARD ^ ,/'j OYI z.._rt STREET -Z_ VILLAGE DIST. SUB.t-1 LOT 0C_..= Eist r d af4 1�I'S r t3 - FORM R 9WNER N E ACR. S W TYPE OF BUILDING RES. •�to SEAS. VL. FARM COMM. CB. MISC. Mkt. Value � LAND IMP. TOTAL DATE REMARKS�� fi,���, �1« / I 01, o 3116/7Z 3 — q Z I ' S.e - d eeHA ae - ` f T a� 5�� Z v v 5/a . . a 2-L -4l 16b_w. f 7:� ' �Ca M-V B ,L I CONY FARM Acre Value Per Value Acre Tillable 1 Tillable 2 ' Tillable 3 Woodland v' ..r Woo Swampland FRONTAGE ON WATER Ss " �� h �' � 3 0 `•. Brushland .FRONTAGE ON ROAD House Plot DEPTH ( j ®,.� •.a BULKHEAD _ Tota' DOCK a ... TOWN OF SOUTHOLD. PROPERTAF RECOR -=.:_^rKfi - OWNERSTREET VILLAGE- DIST. SUB. LOT �. FORMER OWNER N E ACR. S W TYPE OF BUILDING RES. SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP, TOTAL DATE REMARKS Titlabie FRONTAGE ON WATER ' Woodland . FRONTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Total = �e [ 9 "ja JdaY rrrrrrr rrrrrr Rxrrrrrrrrrrrrr � � iay'1p V'4I ,^�Y{ f• yq, i , _i int .` • •• rrrrrrr rrrrrrrrrrrrrrrrrrr rrrrr rrrrrrrrrrrrrrrrrrr i, rrrrrr rrrr�� P- �rrrerr l qt I r _ : rrrrrr rrri� �rrr� room t ° rrrrrrr rrrrwrr� rrrrrrr z# } rrrI rrrrrrr rrrrrrrrrrrrv �rr�r rrrrrrr ti rrrrrrrrirrrr..n�.�rr� �rr ; rrrrrrrrrrrr � �rrrrrrrr rrrrrrr ism MINIMUM rrr�rrrrrrrrrrrrrrrrrrrr : R rME rrrrrrrrrrrrrrrrrrrrrrrrrrr rrrrrrrrrrrrrrrrrrrrr : - - rrrrrrrrrrrrrrrr ation :. ent 1=0 M. Ext. Walls Interior Fin ish., Fire • • .- Roof. Room DriveW(• 71v �09, k_ llilil�lilliiilililil foundation Interior Finish Fire Place Room . st Flo r Roo ms 2nd Floor -- = - w �' ��_{ ilii!■ s��liliiilil!! W y FIELD-INSPECTION REPORT DATE COMMENTS . b /41 FOUNDATION(1ST) ©l� 211.4 -------------------------------- C ro FOUNDATION(2ND) • �r z � , ,s y ROUGH FRAMING& y PLUMBING C� y INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS O Z. m Vi H y x � e c 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy on?, F ami l y Private -R F s l•rl P n P b. Intended use and occupancy done Family Private Residence 3. Nature of work(check which applicable): New Building Addition rx Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost $80, 000 -00 Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units 1 Number of dwelling units on each floor 1 If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front J. 0 ' +/-- Rear 134.41 Depth 9 0 ' +/= Height 27 Number of Stories 1 Dimensions of same structure with alterations or additions: Front 1301 +/= Rear 134.4 ' Depth 90 ' +/= Height 27 Number of Stories 1 8. Dimensions of entire new construction: Front 19..6" Rear 19.,6" - Depth 151 211 Height 21 '+/=. Number of Stories 1 9. Size of lot: Front 326.681 Rear 19. 1 ' Depth 4.13 . h 2 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated Residential 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO x 13. Will lot be re-graded? YES NO__X__Will excess fill be removed from premises? YES NOS_ Helen Rust Familv 4680 Wunneweta Rd. 14. Names of Owner of premises Partnershi Address Cutchogue,NY Phone No. Name of Architect John W. Olson Address P�—Jam z n e PPalm City., Ff3 onecRo Name of Contractor Flower Hill Bldg . Q }Bess H243 7 e r c-ho ftQ1w No. (51 h ) 692-4545 Woodbury, NY 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES x 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 . x 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 N a s s a g Thomas E. Uhl being duly sworn, deposes and says that Ohe is the applicant (Name of individual signing contract)above named, (S)He is the Corporate Officer (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 t s5 f da. f u, 20`� Notary ublic r , ojo saaldxg uoissiwuta: Signature of App icant OE 4 W �/EE€GSK� W. �. ! �C}uno� nossoN ui pzq oi}liana A90TARY PUBLIC,Stace of 1A@\W V%t� E o8a }S oriiond�.adlON No. 02UH475833 *oA A4aN} Qualified in Nassau county. - iNn .M I'INI912IA ieommission Expires � I TOWN OF S-OUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL oard of Health SOUTHOLD,NY 11971 n_ ^ ets of Building Plans TEL: (631) 765-1802 \� �1, Tanning Board approval FAX: (631) 765-9502 .7 � ,®'C Survey www. northfork.net/Southold/ PERMIT NO. ZfrS7_2 Check Septic Form N.Y.S.D.E.C. Trustees Examined '/8 1/6 ,20a Contact: Approvedt of�� ,20_q2 Mail to: Disapproved a/c Phone: Expiration C� y ,206-4 Building Spector . APPLICATION FOR BUILDING PERMIT 4 2002 Date October 1 , 2002 �-� --- INSTRUCTIONS TOWN 1-"F ow a. This app4. icHion 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. Flower Hill Building Corp. (Signature of applicant or name,if a corporation) 8243 Jericho Tpke . , Suite 010 (Mailing address of applicant) .Woodbury, New York 11797 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Genera.t, Contractor Name of owner of premises Helen Rust Family Partnership (As on the t ro r latest deed) If applicant is a corporation, signature of duly authorized office Thomas E. Uhl , V. Pres,. (Name and title of corporate officer) Builders License No. 13.18 5 H z Plumbers License No. 28,77-D ,' Electricians License No. 4204-E . Other Trade's License No. 1. Location of land on which proposed work will be done: 4680 Wunneweta Road, Nassau Pt . , Cutchogue, NY 11935 House Number Street Hamlet County Tax Map No. 1000 Section 11.1 Block i 1.4 Lot 34 Subdivision Nassau Point Filed Map No. Lot (Name) LOT LINE CHANGE FO/x, s HEL ESV RUS T FA MIL Y PA R TINIERSHIP AT NASSAU POINT TOWN OF SO UTHOLD SUFFOLK FFOLK C0UNTY Nl=/ W YORK 1 1000-111-14-34 & 36.5 SCALE: 1 "=40'=40 68. �� SEP T. 23, 2002 00 0 MAR. /0, 2003 ( re v,scion �F _ t F April /0, 2003 (revision) 1 . F9 AUGUS i 5, 2004(final) !�, c2 �F, 2b • May 3, 2005 (revision) 6 v `� ��`,� � �.. ,�G '•>. ,cam Ste- -=- --_ —_- d�ivewaY___- - __` •:J \\` \ Qi stone F �T�F J �o 007°� \ \ \�� ht i s�° ?m C9'P ��r t n Q L 4 i 5' ✓ U fF IE 10CINE k Iz- o l 1 1 � • • dock a I i l 111 ��`� `� Fixed wood k ; ' 1000- -14-3 , � \ �✓_ Floating doc ) ov,� lip O CL t Y4v z o i q SED ? 00 t i 66 s -` EXISTING. — _ 10 oT 1 - y 3 D 5 e o 22o AREAL. 4 ,825SI ES �3 (A z LOT Tp TIE L Z o G � m d ��r E X t31. Ino 0t�s ` R/ N' 1C ZQNEEL 8) ,� ZONE j 40,00,• a Y�` �a AE ( �` N. 81°01 50 5to�e 36, f ti OPOSEO 1 � wood (n ; PR �T 2 9 /' p0 wood boats L .'J,T�9J�" $•F �� TAX MAP 100E - ll1 '4 34 a ramp AREA (IE LINES / ,' AREA - S3,8O sq. /�. or C! tp1\0° TO Ct�j� �tN 1.23`2 acre- to !,e line Z ! T 19 5 1°Ll j1 ' 2 DOu 02, a i �° 1000-111-14-36, 5 6 � T_1 '; tea P.• /r r� C o / UNDEFINED ss walk r-LINE 168,8 ,, C-.`l ,;URIV 1;'e s. .c; lie ;in e; �' --TIE <v a S 8 15 401 W _ --------- --- -------- b. ' 30 -— -- --- - — - - - 0 O� 17,5' 12.0' ro Q • N Q �� 1 lr� a FR. SHED Zlg ,�0 ■ =MONUMENT m �' PSD °T �ti�•rZti ( - - - - -=SPLIT R FENCE 17.5' 11BY FIRE DISTRICT. CUTCHOGUE �oF NEWy 8U,76 ' C-1 r-tk �A�E' SCHOOL DISTRICT- CUTCHOGUE 60,00' � S •21'20 / , ZDNING DISTRICT: R-40 6�•� oma' i N 89'38'20' W 78 T FLOOD ZONES FROM FIRM 36103CO50EG ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION IbECL7NIC RVEY NOTE, MAY 4, 1998 AND ACTUAL CONTOURS OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, (631) 765 - 5020 765-1797 LOT NUMBERS REFER TO 'AMENDED MAP 'A' OF EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS P, Q, BQX 909 NASSAU POINT' FILED AUG. 16, 1922 IN THE ELEVATIONS REFERENCED TO N•G•V.D. HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF 1230 TRAVELER STREET A // OFFICE OF THE SUFFOLK COUNTY CLERK AS SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR O O — 1 ? V Q MAP NO. 156, WHOSE'- SIGNATURE APPEARS HEREON, SOUTHOLD, N.Y. 11971 P 2 2•-- : IF ID �Ep� sem° SURVEY OF PROPERTY AT NA SSA U POINT � . . .; TOWN OF SO UTHOLD i SUFFOLK K COUNTY NEW YORK �T 1000-111 -14-34 & 36.5 1310- ?� SCALE: 1 "'=40' , =40 SEPT. 11, 2000 MARCH 29, 2001 (partial topo) APRIL 16, 2001 (PROP, NEW ADDITION) s a w le �i J� � \ OCT 3, 2001 (ADDITIONS) 0 LO o° s �s _ __ JUNE 13, 2001 (FNDTN. LOCATION) �� stone JUNE 20, 2002 (additions) CJs 3 b° h >> y`rt� \:' = -.___ oe i�ret \�T1F Jan. 3, 2002 (foundation) [? -�� �2 C ro s� UpVf wood dock Ir it f �n• Flxed ( t dock I ! Not,) lD r Y` N��2� �O floating 1 m ( I wets ' 34 S LINES <1\ AREA 3 ACRE r T(7' TIE E j \ GD ! l0 1 2411 41362 Y 3 3 \ 6 a o LOPRO 15E baD � � T O o tT a X 13.1 70 r P °115 N c ZONEEL 8) `,z ZONE N� ret � AE rn � O W � 1�.� b Noo0,ao N �'S 81°01 5 000-111-14-365 F pr TIE LINES v c'F wood boat 1 Q AREA:300,96 5 ACRES TE oromp � 0 b % LOT -019 Ri ... �� UNDE�Ih D CURD= 168,89' 3 SIN E w a S 8115'40 �✓.. ------- - `O� 30 y 1715' F d 4o Q N FR. SHED T Zlg p ,D0 ■ =MNNUMEI�IT rL2 � �17.s• PCO LO ti !,/ RY F.-�(Ew y0�PLIT RAIL FENCE - / yBER `R` S. METZ" _ 80,76' S B� 5 �a F� N 6 v'� 60,00' 7g°21'ZO -:::. sa 8�`' -N 89 38 20 W S Y 1 '`- 10• PCO LOT 2 ,o .• '�°- 49 yw S. LIC, NO, 4961 8 FLOOD ZONES FROM FIRM 36103CO50EG ANY AL :-E'RATION OR ADDITION TO THIS SURVEY IS A VIOLATION EC RS, P.C. ND TE: MAY 4, 1998 AND ACTUAL CONTOURS OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. (631) S — 020 FAX,-(631) 765-1797 LOT NUMBERS REFER TO 'AMENDED MAP 'A' OF EXCEPT AS PER SECTION 7209-SUBDIVISION 2 ALL CERTIFICATIONS P. O. BOX 909 NASSAU POINT' FILED AUG. 16, 1922 IN THE ELEVATIONS REFERENCED TO N,G.V,D, HEREON ARE VALID FOR 'THIS MAP AND COPIES THEREOF ONLY IF • 1230 TRAVELER STREET OFFICE OF THE SUFFOLK COUNTY CLERK AS SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR SOUTHOLD, ,N,Y, 11971 O O — 7 't 8 MAP NO, 156 WHOSE SIGNATURE APPEARS HEREON. I ' \ .e�r� a.Gl' .+YS3C,Ta.�+-•r (�,�([o; NYSDfL'� \�\ PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE q� CERTIFICATE OF OCCUPANCY APPROVED AS NOTED x .. SOLDER USED IN WATER DATE: /o a g,p g 2R&73� l SUPPLY SYSTEM CANNOT FEE: -0v/_<'q BY EXCEED 2110 OF 1%LEAD. NOTIFY BUILDING DEPARTMENT AT FOLLOWING 9 AM EC 4 S: FOR THE FOLLOWING INSPECTIONS: UNDERWRITERS CERTIFICATE 1 FOUNDATION - TWO REQUIRED REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. If C°pper tuting is Used ALL CONSTRUCTION SHALL MEET for water distributing THE REQUIREMENTS OF THE N.Y. /o f �''• system;piping shell be STATE CONSTRUCTION & ENERGY r of types K or L only CODES. NOT RESPONSIBLE FOR V DESIGN OR CONSTRUCTION ERRORS L !1 IA-,34 PROVIDE ANTI-SCALD AND/OR OCCUPANCY OR i l , !q[eEq'546� 5' rF 2 X134.2 THERMAL SHOCK PREVENTING USE IS UNLAWFUL ht \ DEVICES AS TO PART 902.6(K) WITHOUT CERTIFICATE pj;20 �a a x I N.Y. STATE BUILDING CODE. OF OCCUPANCY PLUMBING ALL PLUMBING WASTE + &WATER LINES NEED 2 [po399b9LGr 41GD, TESTING BEFORE COVERING PROVIDE OPENINGS FOR EMERGENC 4*5� , • ,/ REQUIRED BYYESCAPE AS PARi. 714 OF , DO NOT PROCEED WITH N.Y. STATE BUILDING CODE. 'a FRAMING UNTIL SURVEY -tom uT OF FOUNDATION LOCATION I�a$9 HAS BEEN APPROVED. PROVIDE SMOKE-DETECTING ALARM DEVICES r6t AS TO PART. 721.1 N.Y.S BUILDING CODE #0�4 p7 2/9 -'!'__I TO ATHIS RIZED ALTERATION OR ADDITION DOCUMENT IS A VIOLATION OF SECTION 7209 OF THE NEW YORI, STAT EDUCATION LAW. STATE Y OF N Wy 0410 tifS �W. STRUCTURAL ENGINEER °a * I107 JOHN W. OLSON, P.E. * 1 r------'`� 1366 S.W.JASMINE TRACE I , PALM CITY, FL 34890 Ey3°NFL` (T,/ L OP No. ROF /1Ys-f � THIS ENGINEER ACCEPTS NO /� fGso U 1 fif es ��1rl.7� '.!b RESPONSIBILITY FOR THE ,[ PV /9� 5 ��}c c PRESUMPTION OF GOOD SOIL /!+ BEARING AND STABLE SOILS VITHOUT PROPER TEST BORINGS -' �i�< . 10 C•a! ,tl«� Fair ey" It ' The draRemen and/or"erehdbct shall not be Hil la for any errors or omissions on plans. - - — - AU "ions must be rar�eo on job site. I -.-amn, . -^m o-pr".o v'...,:;r W .-v ..r„ - - - `T' "Y"aM 4 i ; Y +.. F. 7'.' ` ,f? ,y'°e r..:, ll In '„^c -' T .r h 6$ ..,rt. . R” , ^, . .. � .x�� c't,lf', .t. -S.,.x ..- .. .v,_ . -q --'v t ....�_. '" • ;i: + JV`,S.rs y1�4 9s _ 5: .FyY as r", sd a. -Y r. - - c ;r' v r -+n'i`WSf7�._ ..p`4' r F� o':. �,.�. .' r ", ,?� ._'-;,: f i i.' ,.,+ ;.., ., J 'a:: .'• �• + .. � _ f _ ,� b� ':�'TY �71I:,8 '"' � X 5"e, r4 4 ,a .'� . �'r , r ' ! !� Na'lnxr'.; V I , vi. + ''01':' - _ t - ,1x+ .,>4 , r�"��1 !�f y�5a €'C oa x✓y: '',�aie. a p ,, s ! y y TEE '.1. S r +7 i '� �M.� 4M!�1 14, `-'r,a iC' Y�: nr }} f l4' vY... F •V ..d Y,(vr! +- ,"`1n r }I� %�P•,� 4- "ral -Yyy+'t ,y CG•` ' < .�.� i" - �� a_n�rx: x � k 'xir'.'lnY� ''P'E' �,7.C. r, �" •,4I f 1 r '"'fin;' rv� t+N mi- "fpySAM �dk'k+T 'nv5y .r�Y tfr, I, t PS I S �. yr r ° 1 . of r i. -v - _ i• y -d d d,u' tK' isti>rs �`' .S �`` 7 5 x7 +, r ':n.+ r N y r v X'w5I c3o aaT'� +Jf4k"s"!`3: y I,d n ' ff,i r rys4�"ya•6 11 a ; 4'11 It 4r 4,f t y If ! Y r ....a me rl + f n - ' X26 -yGosF ai . 'it �7 —_—J.:. . - I — ._ —._.' VNAUTIIORIZU'O'ALTERA 16N OTC ADDITIO!T . ...,- ..•r—, —� — -- — -- SLCPION 7209;OF`T[1E �rAbW�,f P:PO THIS DOCyoRK STATE - .. OF STRUCTURALENGINEER " ' JOHN W'OLSON;,P.E. � . .,. - 1366 LM JASMINE TRACE ns Aqa PALM CITY, FL 349910 - eQ No s3 PROFESSIO�P Y • � ., � � . ', � �r4�pW1A �.7� �f6hrT'y'nr^"P^�M vl 11 } , Y±,ru,r .f r Yat It 2r m` s`� F �� Ai 'i E Jt 9GiGiR:ka 4toan hw;'PIb an �r f �asr5 ' � � - � INY 114RNIP�M 1♦iY7It YWG �'� f + wi �:ty n rw a ,- tF .-{�. � w �r '" x r , f- 4 _ _ . _ _ . _ ,_... J._ _� y_. _..�. ....n-+..•,,..�.i„�.I...a±.�•.w.taa+. ';iBT. .=-.-. :5}Enu 1i,c a I �,/ s .� ' � 3• �'�� --t�r✓ert.. / - -- / J .� :.4r�L-I 40 p _ .�. ✓ • . � xS � Per, r"' 7'"✓.:_ / � ,�a;, fo �� �rs+ - �7XW<Jtx �n ..y eill " CCd�rariJf{4.�va A�{ .� Cr 22o.vScr ✓rip�f � � ry . . - •1, .- weOil /�ecpc. tid . �.,w det 7A y*�?o��e . eft _ " . , /y Tic- dv /ev wye %c�9,a /i G coY � 7. ! 4/y.S . uc.2A,d•J 4wr # raa =8� / UNAUTHODOCU ALTERATION OR ADDITION TO THIS DOCUMENT IS A PIOLA'T1ON OS SECTION N09 OF THE NEIL YORK' STATE LLUCATION LAW. Of NEW y.-h •'. � o�N W. OL STRUCTURAL ENGINEER + �"�' * �1 67 JOHN W. OLSON, P.E. 9�; �iy 1366 S.W.JASMINE TRACE PALM CITY, FL 34990 y rN�xA 9 c ' FkUFE 5510NP CU - - 8243 ARIC40 TPKE., WOODNAY, N. Y. Il/':➢ -The Emmen and/or architect sheE not M liable for spry errors nr omissions on nl-ns. W1A iY ,., -' - - W dlm.n,,! ,, „ llled on Ing r'- I R I411t�ri t ; E Z L UNAUTHORIZED ALTERATION OR ADDITION TO THIS DOCUMENT IS A VIOLATION 'I '� SECTION 7209 OF THE NEW PORI: STATE I `<•lf/F/,� EDUCATION LAW. /� ok' I T 5 X00 oy STRUCTURAL ENGINEER f �•, I JOHN W. OLSON P.E. a o. : ulr � 1 a • _ I - - I - 1386 S.W.JASMINE TRACE PALM CITY, FL 3499044 �, ' .�.. --�-. -••-` ,+�,- - �.- _ _ � L ZS`O h'o. 33a�9 '� I N'YOFESS�ONPV , Ilia �rjlC - - - _ B243 }EiIC.iD TP.- E, WOO'DA RY, N• Y. li7 i - ' DA FE _ ¢6' - 7 The drallsman and/or architect shMnot M SCAR '�^' 6''� •�� - Ir Ilable for nrry errors or omissions on parts. DQAiY YY ;fir AN dunanarns must be verified an lob site. i -� L L la I I- 77 4 77y— �� � t I UN:�UTHGh�GSD ai.i_:xxiWiJ �.. yLL.l3Y1'lON TO THIS DOCUMENT IS A VIOLATION OF r! SECTION 729 OF THE NEW YORK STATE f r I I EDUCATION LAW. Oz E �g I f"moi * `L6/bC, I I I STRUCTURAL ENGINEER JOHN W. OLSON, P.E. 1366 S.W.JASMINE TRACE PALM CITY, FL 34990 mea G O 40. 33419 !"c �kOEESSIW4 f p2nJ JE:ICHO TPKE, WWj,1k )r, N• Y. Ll;d UA fE The d0tsman and/or architect 41111111 hot b4 DOWU CY 140 r- or omissions on plans. r" "� veitied on fob one. I f i w• r . y����tl�� y 4� X; I I I - JY.2 � - ✓C*�0'- ' � _ '+S"`7,�t � w., �r�' � rSC+S�51': , ' • ` h " PAF, OF W Y ` f�U'TNEE yti�o�N ---JOHN,W. OLSON, P.E. n �J III T - 1366 S.W.JASMINE T13ACE PALM erry. FL 34990 TO TITIS RIZEDDOCUMENT E TERi1i"A O$ ADDITION ON �^ -"` A f• '.4G' __._._� EE ON 7209 O L+ T ISE VIOLATION Gr q TO THIS _ SECTION' 7269 OF THE NEW YORK STATE - '- ' ON'LAW, _ ✓ ' r.wd�yt r41. i�•! Pip� � a I3E �- tt r fb �_ IbN {I _ ' %1➢t` -lK3n�FsA:--fai���'«'� fne�' / � - v�'�,�`,-}:- .��- -. iL-�iS -/�i4so l^�i�eL w ..--^- -- i 14 UNAIMORI�p AI•TEl=A ON OR A-noT4 Of wdKi�' : N W ypn TO TFuB OF NTM :C1FON MT3yq NBW XOR& � . .�" Si , p� + ��n/�C IIHMF T N X * A i _ - , • .. n FW WE i1pp STRUCTURAL p & L STRUCTURALbe ",So"S9 & JOHNW: OS011 P.E. s MyWM ,' - :.. -�`w�✓ •I"^" c�a' '` "`�" " Y •j� , - - 1" �h'4fk PAIM,CfTKFL3099 _ gpf[ssry - Alld{k(ynahnerist-8everAlxlSoA ar'#d4elp u - ' �,;�I, d `per' '�1C�,��dY y' �'t3,°fir l :v ' A,��y ir.,. •n; .K nd Y - -_,.�.�.,4. ..,. .. __ "--` _ _ _. _ _ _