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HomeMy WebLinkAbout29721-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31112 Date: 08/16/05 THIS CERTIFIES that the building INGROUND SWIMMING POOL Location of Property: 1970 VANSTON RD CUTCHOGUE (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 111 Block 3 Lot 12.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 8, 2003 pursuant to which Building Permit No. 29721-Z dated SEPTEMBER 10, 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 ACCESSORY INGROUND SWIMMING POOL IN THE FRONT YARD WITH FENCE TO CODE AS APPLIED FOR & AS PER CONDITIONS OF ZBA #5350 DATED 08/07/03 . The certificate is issued to PETER CROSS & ORS. (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 82130C 11/19/03 PLUMBERS CERTIFICATION DATED N/A Authorized Signature Rev. 1/81 -{,�, Vans,Tt-� Form No. 6 TORN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCI This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with 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 2r 10 of 1°,'o 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 surve} 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 tinting to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling$25.00, Additions to duelling $25.00, Alterations to dwelling$2.5.00, Swinuning 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, C'onumercial $15.00 i Dat/e. New Construction: Old or Pre-existing Building: _ �/^� (check one) rr,, -- l t \ 1 Location of Property: I q�C` V (Wh r% Y\d ►10< <1 l\ l House No. Street Hairdet Owner or Owners of Pro eery: /'`Q/' t.. JaMe] � rtti- t_ �S Suffolk County Tax Map No 1000, Section (A— Block— � _ Lot O�, O 0�- Subdivision Filed I tap. Lot: Pemtit No. c; 91.11 - 7--Date of Penrtit. __.applicant: Health Dept. Approval: _ Undencriters Appional: Planning Board Approval: Request for: Temporary Certificate !Final Certificate: 1/ _ (check one) Fee Submitted: $ el J .0 o U U )o�R Applicant Signature Co -? E .5 Electrical Inspection Certificate Issue Date Electrical Inspection Service, Inc. Application 11/19/03 375 Dunton Avenue 82130C East Patchogue, New York 11772 (631)288.6642 Issued To: James McKee Street: 1970 Vanston Road Village: Cutchogue Zip: 11935 Town: Southold Section: 111 Block: 03 Lot: 012.002 Contractor: Hanks Electric Inc. (L) Lic. # 2675-E Was examined and found to be in compliance with the National Electrical Code. ❑ Commercial ❑ NV Defects ❑X Pool ❑ 1st Floor ❑ Indoor ❑ Basement ❑ Hot Tub XCJ Residential ❑ Det.Garage ❑ Attic ❑ 2nd Floor X❑ Outdoor LJ Addition ❑ Survey Switches Receptacles Fixtures GFI Heaters A/C Fans 2 1 2 1 Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves Furnace oil Gas Circulators Smoke Detector Bell Transformer Meter Amps Phase UG/OH Jacuzz/ Television CO Detector i Bldg. Permit: Other Equipment 1-20A Time Clock 1-20A Spec Rec 1-Pool Heater Hugo S. Surdi President Rough Inspection: 11/18/2003 Inspector: Sean P. Hightower Final Inspection: 11118/2003 Inspector: Sean P.Hightower This certificate must not be altered in any manner. Inspectors may be identified by their credentials. 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. 29721 Z Date SEPTEMBER 10 , 2003 Permission is hereby granted to: PETER A & BARBARA CROSS 139 LONGVIEW AVENUE LEONIA,NJ 07605 for CONSTRUCTION OF AN IN GROUND SWIMMING POOL IN THE FRONT YARD WITH FENCE TO CODE AS PER ZBA #5350 at premises located at 1970 VANSTON RD CUTCHOGUE County Tax Map No. 473889 Section 111 Block 0003 Lot No. 012 . 002 pursuant to application dated SEPTEMBER 8 , 2003 and approved by the Building Inspector to expire on MARCH 10 , 2005 . Fee $ 150 . 00 u or ' ed Signat ORIGINAL Rev. 5/8/02 APPEALS BOARD MEMBERS ��gUFFO(�-c ��O Opy Southold Town Hall Lvdia A. Tortora, Chairwoman c � 53095 Main Road Gerard P. Goehringer ti Z P.O. Box 1179 George Horning O .le Southold, New York 11971-0959 Ruth D. Olivay�Jj O� ZBA Fax (631) 765-9064 Vincent Orlando �( �a Telephone (631) 765-1809 - http://southoldtown.northfork.net BOARD OF APPEALS i TOWN OF SOUTHOLD a BLDG.DEPT. FI DINGS, DELIBERATIONS AND DETERMINATION TOWN of souT►+o�� MEETING OF AUGUST 7, 2003 Appl. No. 5350 —JAMES and MARIA McKEE Property Location: 1970 Vanston Road, Cutchogue; CTM #111-3-12.2. SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without an adverse effect on the environment if the project is implemented as planned. PROPERTY FACTS/DESCRIPTION: The applicants' 26,767 sq. ft. parcel, shown on the filed map of Property of Alonso Jersey as Lot 5 and part of Lot 4, has 110 ft. frontage along the north side of West Cove Road and 172.20 feet along Vanston Road in Cutchogue. The property is improved with a 1-1/2 story frame dwelling which faces Vanston Road. The existing dwelling has the following setbacks: (a) 55 feet from the east front line, (b) 74 feet from the south front line, (c) 26.3 feet from the north side line, and (d) 35.6 feet from the west rear line as shown on the January 31, 2003 survey revised 7/25/2003, by Pat T. Seccafico, L.S. BASIS OF APPLICATION: Building Department's April 1, 2003 Notice of Disapproval, citing Section 100-33, in its denial of a building permit to construct an accessory swimming pool in a yard other than the code required rear yard. FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on July 24, 2003, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant: AREA VARIANCE RELIEF REQUESTED: Applicants wish to locate a 20' x 44' inground swimming pool in the southerly front yard area on an angle parallel with their home, as shown on the survey prepared by Pat T. Seccafico revised 7/25/2003, with setbacks: (a) 25 feet from the front line along West Cove Road, and (b) 20 feet at the closest comer with the westerly lot line. REASONS FOR BOARD ACTION: On the basis of testimony presented, materials submitted and personal inspections, the Board makes the following findings: Page 3—August 7, 2003 Appl. No. 5350—James and Maria McKee 111-3-12.2 at Cutchogue setbacks and other features as are expressly a dressed in this action. Vote of the Board: Ayes: Members Tortor, (C)Iairw ), oehr' ger, Orlando, and Oliva. (Absent was Member Horning.) Th' tie olu ' s my pled (4-0). Vig&nf Orla o, hairman Pro Tem 9/4/03 Approved for Filing 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL Cloa 0 LC [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: t ak-. n . DATE ��3 ~ ®� INSPECTOR "A 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL C1ooL [ ] FIREPLACE & C/HIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: due V DATE -� 7� INSPECTOR-"�- 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: c of C ��Rr�N� N1 c� of irkc cl r 4 - c�ro�I UT DATE 1° �� INSPECTOR 3_ z a TOWN OF SOUTHOLD PROPERTY., RECORD CARD w1 OWNER �p �_ /� STREET y VILLAGE DIST. SUB. LOT - bvtks O! ✓F is, Al LL/ FORMER.OWNER r N E ACR 1676 - K. Udwlf lir d S W TYPE OF BUILDING RES.�10 SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS INC. ZA Do w0,1 0 1 Zo,5- 5-00 5 5-00 n 11174 (z s/ s 3 r N6 SuUop. loon �c U 0 � y p /U C. I G(�� - jt Sf ��;'�:.L IV''. i ✓ I l l 0 - '°1 • 3 U.,18tn,rr�- T�u�i--.y,r�°C "illabie FRONTAGE ON WATER Voodland FRONTAGE ON ROADL �' a Aeadowland DEPTH Avr louse Plot BULKHEAD 'oral 09/09/2003 .15:04 6317448292 SWIM KING POOLS PAGE 02 LOT 6 CONI. 6N W. oN. S6¢30 S E' R.M. FIE t.r' LOT 5 1BS OO 1 ' O 1 17 2..7- clq I O urR.. off• �j'\ L TO G'Dt►! t7µ �eu3ta,� LOT RE;9v- a r �_ oN�'"i,1Nc1 Cpl CHORD—N79'55 3D"W 7 10.00 FENCE Ci 1 T.e• s. r 5G � 1 WEST COVE ROAD (NORTHWEST LOOP) = 0.6141 Ac. SURVEY OF FILE NO. 50710 CERT/PIED TO: OF LOTS 4 BC 5 . MAP NO. 763 REVISED SUBDIVISION OF F,- APRIL 26, 1930 rY OF ALONSO JERSEY REVISIONS: N)D PRaP. POO[ a]/?5/00.3 siruarE Ar PECON/C PAT T. SECCAFICO NN OF SOUTHOLD K COUNTY, NEW FORK DATE., JANL/ARY 31, 2003 PROFESSIONAL LAND SURVEYOR, p.( SEC. 1 7 7 BILK. 03 LOT 072.002 — SUCCESSOR TO — DONALD TASE, L.S. ACF STRUGTyRfS RECOpDEO OR UNRECORDED qRE —'�'-- RICHARD WILHELM AND ASSOCIATES ISICVIY EwOENT ON 1NC PRENiS'ES qT THE T/wE O£ ���' 'x'<:` PROFESSIONAL LAND SURVEYORS r • NORTHSTAR SURVEYING, P.C. N' ONte RVN OAkY 7b THE PERSON(5) £OR wNOM /�: .W� PAUL T. CANALIZO, a+ H1s sEHwrs m THE nn.E rowPgNr. - "- v L.S., ROBERT A. KART. L.S :ENallo INSf1IDI,pNS U4f(D HEREON, eN0 rD rNE +' / "`s. 1 GOOD GROUND SURVEYORS, P.C. NinTUTON. eU4RgNTEES ME NOT ]RwNSFERABLE TO 1 h 1 iue4E0UEM OWNERS. rHE iµRUOCT!H/REERS[Mio^RA REP Nor NTENom Tr LI-11 (rAOpR E cuMIT 1 107-5 WMon,tauk Hi9 hWOy J28A Moin INC ! Center Moriches, NY 1 f.Cl[ fwiZ.aP6m ><B -- PRE casT ALL CO STRU ION SHALL tT~ �� A COPING .I{F $IOLMERS �--- OF THE P I R�,Cf ANS Lp B.P. - 4 , N K ATE. FL 148E REIVEN rioN 4 pis a f i I sour _ E. �3- � 4MLMfDIoALTO olR BY: P r SLOPE O H BA UPOf ,C,OMPLETI TIFY BUILDING DEPARTM a Rom IMMERS BEFORE ATE " SIC C - �L CODES OF - o J OR Q� � � FILT=X.d PUMP OWNG INSPECTIONS: m EW Y R 11 OWN CODES RMr1Es ROM FILTER\AU FOUNDATION - TWO I ND G.ONDiT10NS OF L - S U IIF . :. FOR POURED CONCRETE Uf�DERWRITERSCERT�FI TD RET„RHS i roWNisa VVI. OU C� T) E �Eciu►�E� D , . ROLLED _ THCLDTOWN PLANWeMW ;E`wF--" GY . P1 PING ARRANGEMENT 4• L—CDNSTB[)(TKK�V ATFL. UNER T'cOHc ETE FOR C.O. SOUTW TOWN TRUSTEES as o D Ie UIRENB f SIDE - i. a-rw.c 5TH UCTKMV C THE REOfaENTS .Y16EG tic �DUAeD eONCR� r ezl. VINYL LINER YORK STATE. NOT RESPONSWE.FUR DESIGN OR CONSTRUCTION ERIROW. f e SEE TYPI :L' � -= - ' ^=:a - •'.'.. - ABERCLes' . _ WALL S=LTIDN ��"f'� n MDUI2FD c I PIECE ScCT10N . . m1 FORM TIE 13• �. . . . . L2- ;.SAND BOSTON - -'1 _ .. .. . _ i I i -D 2f" MAX _ 3z. BARS OPTIONAL : STEP SECTION B- B -- TYPE 1. - GRADE' fry_. .2 (y • .8�0•'��. G �La .. . i i 3 STEPS iP LAN nuz �—�•+ nl �{ I TY DI-CA' L ' VIA-LL .. ..`�;- I2 i. SECTION A- A , r OPTIONAL STEP -_'f 2. SIZE � A B I 'C , 0 I E 'F G '•'c`i !A � SE OF NEW TYPE:} FEETGE C�lr 1-C rt I R I rt I TL I rt I rt Isnrc I cat_ S -K� - - TES NO WAS S TO BE SMOOTH- NDN SKID TYPE. SLOPED 'GSDvL O'P- CONTRACTOR- ! AWAY FROM POOL ✓ WATER DISPOSAL SHALL HE LIMITcp TO owNERS I - c Sn'—TX+-3 PDDIS, IHC.. 16:''32 116 1321 H B 1 iZ ; 1 ; 5E 1Tc3DD PROPERTY TO SUR LOCAL RE6ULATID NS - ,: 1fi a 36: 116 136 T2 1 8 1 12 11 I 4 ST612C'ID - e O6 g n0�`� 2$A . 1 1 _ 056V• c7 RD= ?0131', Nz.i YDP_'L FIELD R SPECTION REPORT DATE cohn um 9 w FOUNDATION(1ST) at ct W FOUNDATION(2ND) z 0 _ O . ROUGH FRAMING& �3 PLUMBING INSULATION PER N.Y. STATE ENERGY CODE -Itkr Q ►� pf�,^ e WtA X, Y" FINAL 8- - O lt ADDITIONAL COMMENTS Ln O Z W a y � o z I � 0 M 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 sen of Building Plans Planning Board approval TEL: (631) 765-1802 FAX: (631) 765-9502 /��y n Survey PERMIT NO. -1�0�' Check Septic Form q N.Y.S.D.E.C. 1 Trustees Examined rd 2q-3 � Contact: Approved 20 3 Mail to: Disapproved c .3 � hof Phone: !�31 Tyr)- S!) 1 1177e Expiration 20_ qg ector APPLICATION FOR BUILDING PERMIT 12003 t p3 20 Date INSTRUCTIONS a. T-leis application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 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. (Signa of applicant or Ame, if a corporation) Ala �► , kIA121 (Mailing 40ress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder (7 1)A-)7 A(2 rot ,lame of owner of premises \, L4✓Y)F5 0l IQ 21/4 IVIP_<< l�L' (As on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) 3uilders License No. 'lumbers License No. electricians License No. to F Aber Trade's License No. Location of land on which proposed ork will be done: yrwi0i r:� ; 161v �ia��r�,� n _ _ u7`.r�e bu House Number Street Hamlet County Tax Map No. 1000 Section h Block 6,� Lot — Subdivision TQOP OF ALOA)t5o _)E,&F4 Filed Map No. 7&-i Lot C/o 494 --s– (Name) 4S(Name) titaat? pse ann occut)2rbeV pv nretT'l c� , � �n.c_aic�. t'.x a,:•. ..•._c ...,....... _ a. Existing use and occupancy 51 LUI,[c Ff-,09)4 y j2t�u b. Intended use and occupancy A-) - 6,V014Al b _W//1161/A j[ 4fLl)1 =. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work k 6 Lk&_VOD LL- �� X y�/ (Description) T. Estimated Cost /n non . — Fee (To be paid on filing this application) 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. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories S. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot:�t c7k 9&2 riQ FTRear Depth 10. Date of Purchase Name of Former Owner 1 1 Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation?YES_NO_ 13. Will lot be re-graded'' YES_NO—Will excess fill be removed from premises? YES—NO 139 I.0Nb0IEaJ A0,5 14. Names of Owner of premises�3lt}IYIES ft kEi5 Address hone No.4jj- Name of Architect 6engLne IY)lr.uo-5 Address.r LONb�Er`°' ` phone No i2e). q�79"-S��,3 ] Name of ContractorgAND Y T. )CO1?FGe£R Address °`- Phone No. i,v- 7ry'f- Sia o �cKy 7- 15 1i 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 kl/0b y T /` O D C6 Ar being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the Tp/r-- (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 lmowledge and belief, and that the work will be performed in the maturer set forth in the application filed therewith. Sv, "Al before me this 3I day of !i 206,5 � � c Notary PuNA Sig4&are of licant NOREEN L NAOER NOTARY FUSM./GROV1MWI[ OUALFIEO M KWM MAW MMOSS ON 03 BUILDING PiERMIT EXAMINER CHECK LIST DATE REVIEWED: c( / 10 /03 APPLICANT:?e-lEa ceor-s DATE SUBMITTED: 9 17 J03 SCTM# DISTRICT: 1,000, SECTION: I , BLOCK: _-�_, LOT: 12-2- SUBDIVISION: NIA ADDRESS: 19gp ��^5 11 2b, CITY: ('Ur, ZONING DISTRICT: " _CONFORMING? IJD BUILDING PERMITS OPEN/EXPIRED: BP$g� -Z/C/0 Z-04991 , INFO Mb —/BP -Z/C/0 Z- , INFO BP -Z/C/0 Z- , INFO /BP -Z/ C/0 Z- , INFO PRE CO: Y OR N BP -Z/ C/o Z- , SINGLE & SEPARATE CERTIFICATION-REQUIRED NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83) REQ. LOT SIZE: ACT. LOT SIZE REQ. LOT COV. ACT. LOT COV. REQ. FRONT ROP. FRO REQ SIDE l5 ACT. SIDE c�,� REQ. REAR ,/ 7 PROP. RE �/ REQ. HEIGHT a/ PROP. HEIGHT PROJECT DESCRIPTION: 9j 2-M ESTIMATED PROJECT COSTARCHITECT/ENGINEER: 01o, FAST TRACK WATERFRONT? A/0 DESCRIPTION: PANEL #: 4W FLOOD ZONE: , COMPLIANCE: `5L-a APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES ord)(BED M DTE: / / PERMIT#: TOWN SEPTIC RECEIPT: Y ol� NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or(K5 SOUTHOLD TOWN TRUSTEES: YES o TOWN ZONING BOARD APPROVA - TOWN PLAN. BOARD APPROVAL: YES o TOWN HISTORICAL PRE (SPLIA): YES o NEW YORK STATE CODE COMPLIANCE (SEE PA 2) YE NO NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: SF FEE FEE FEE 1. ( SF)- ( SF)= SF X$ =$ +$ +$ _ $ 2. ( SF)- (SF)= SFX$ =$ +$ +$ – 3. ( SF)- ( SF)= SFX$ =$ +$ +$ _ $ FINAL TOTAL: $ NEW YORK STATE CODE COMPLIANCE CHECKLIST USE/OCCUPANCY CLASSIFICATION: HEIGHT/FIRE AREA: TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEERED/PRESCRIPTIVE FULL FRAMING DESIGN ELEMENTS: 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: Y/N SHOULD INCLUDE LIVE,DEAD,SNOW,SEISMIC AND WIND(INCLUDING UPLIFT AND EXPOSURE) WINDOW AND DOOR SCHEDULE: MISSLE TEST REQUIREMENTS: Y/N EGRESS 5.7 S.F., LIGHT 8%, VENT 4%: Y/N LOAD PATHS: Y/N ROOF TO FOUNDATION NAILING/CONSTRUCTION SCHEDULE: Y/N MEANS OF EGRESS: Y/N PLUMBING RISER DIAGRAM: Y/N LOCATION OF FIRE PROTECTION EQUIPMENT: Y/N TRUSS DESIGN: Y/N CERTIFICATION: Y/N ENERGY CALCS: Y/N TOTAL COMPLIENCE? Y/N(RETURN TO PAGE ONE) ,