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Home My WebLink About30647-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31167 Date: 09/23/05 THIS CERTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 495 TUCKER LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Nap No. 473889 Section 59 Block 11 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 10, 2004 pursuant to which Building Permit No. 30647-Z dated SEPTEMBER 20, 2004 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 LINDA G. METZ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2010295 09/20/05 PLUILIBERS CERTIFICATION DATED 09/20/05 RBT VANETTEN PLUMBING Authorized Signature Rev. 1/81 _- -- —_-- ,7 � e^ N 3�3 � 31 � y Form No.6 Z Z TOWN OF SOUTHOLD ( ,� �/� - 3 yS- 5 6� BUILDING DEPARTMENT j TOWN HALL _ t 765-1802 ID APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with 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 2110 of I% 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. jeP1". i8. 2005 New Construction: Old or Pre-existing Building: (check one) Location of Property: _�3 5; House No. Street T Hatnlet Owner or Owners of Property: eiiiol M Ef'L Suffolk County Tax Map No 1000, Section ✓=q Block___[L__-__ Lot_0 Lj Subdivision Filed Map. Lot: Permit No. p Co y 7 Date of Pemtit. 2.w.� Applicant:_- _ bU y�J f It-1`L Health Dept. Approval: I.-,/A< Underwriters Approval T Planning Board Approval: Request for: Temporary Certificate Final Certificate: /� _ (check one) Fee Submitted: $ �, plicanignature 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. 30647 Z Date SEPTEMBER 20, 2004 Permission is hereby granted to : ARNOLD MENGEWEIT 495 TUCKERS LA SOUTHOLD,NY 11971 for ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 495 TUCKER LA SOUTHOLD County Tax Map No. 473889 Section 059 Block 0011 Lot No. 005 pursuant to application dated SEPTEMBER 10 , 2004 and approved by the Building Inspector to expire on MARCH 20 , 2006 . Fee $ 150 . 00 oriz d Signature ORIGINAL Rev. 5/8/02 OrJrJdJdJr fr1 rJ�Pr�r�rJr Pr frgfcPrJ�rJrJ rrJ�PrJ�rJrJrJ�rJ�rJrJrJr�cP rJ rrJ�Pr2ffl 3rJL3L3jj! rJ�rJ rJ�rJ rJ�P �PcP f5, BY THIS CERTIFICATE OF COMPLIANCE THE 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 BUREAU OF ELECTRICITY c5 5 40 FULTON STREET — NEW YORK, NY 10038 5 5 CERTIFIES THAT 5 5 Upon the application of upon premises owned by 5 5 5 BRIAN BROOKS ELEC. INC. GWYNN METZBOX 1001, 455 BEEBE �5 NE CUTCHOGUE, NY 119 5, SOUTHO D, N495 TUCKERS Y11971 S 55 Located at 495 TUCKERS LANE SOUTHOLD, NY 11971 5 55 55 5 Application Number: 2010295 Certificate Number: 2010295 Section: Block: Lot: Building Permit: BDC:ns11 5 �c Described as a Residential 1200-1799 square ft. occupancy,wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 Basement,First Floor, Second Floor,total renovation,Outside,Attic, 5 5 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5 5 found to be in compliance therewith on the Day of 5 20th September,2005. Name OTY Rate Rating Circuit Tvoe 5 5 Alarm and Emergency Equipment 5 Sensor l 0 Carbon Monoxide 5 5 Sensor S 0 Smoke 5 5 Appliances and Accessories 5 5 Furnace 1 0 Gas 5 Future Appliance Feeder 1 0 20 Amps 5 5 Wiring and Devices 5 5 Outlet 36 0 Fixture 5 5 Fixture 30 0 Incandescent 5 5 Fixture 6 0 Flourescent 5 5 Outlet 72 0 General Purpose 5 5 Receptacle 40 0 General Purpose 5 5 Switch 25 0 General Purpose 5 5 Dimmers 20 0 5 5 Receptacle 2 0 20 amp Laundry 5 L5rj Receptacle 1 0 30 amp Range 5 'J Receptacle 7 0 GFCI seal 5 5 Service rrr5 5 Continued on Next Page l of 2 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 IN rJrJ cP rJrJrJrJrP rJr�nrJr�rJPL o Or3rJL3rL3rJ�r3Pffl ri cn rJrJ rJ 2rnr1r PrP�PrJ�r rr�nrJ�rJ�rJrJ�cn�nrJ�rJ�rJ�rJ�rJ�r��P cn�rr�ncP cn rJ�rJ�rJ� �PcPrJ�c n o 5 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 rj BUREAU OF ELECTRICITY C5 5 40 FULTON STREET — NEW YORK, NY 10038 5 5 CERTIFIES THAT 5 5 Upon the application of upon premises owned by 5 5 5 BRIAN BROOKS ELEC. INC. GWYNN METZ 5 5 5 BOX 1001, 455 BEEBE DR. 495 TUCKERS LANE 5 CUTCHOGUE, NY 11935, SOUTHOLD, NY 11971 5 Located at 495 TUCKERS LANE SOUTHOLD, NY 11971 Application Number: 2010295 Certificate Number: 2010295 5 SSection: Block: Lot: Building Permit: BDC:ns11 Described as a Residential 1200-1799 square ft. occupancy,wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 Basement,First Floor, Second Floor,total renovation,Outside,Attic, 5 5 5 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below,was C5 5 found to be in compliance therewith on the Day of 20th September,2005. 5 Name QTY Rate Raine Circuit Tie 5 1 Phase 3W Service Rating 200 Amperes 5 5 Service Disconnect: 1 200 cb 5 Meters: 1 5 5 5 5 5 5 5 5 5 5 5 sea. S 5 z or z 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 Town Hall, 53095 Main Road Fax(631) 765-9502 P.O. Box 1179Telephone (631) 765-180 Southold, New York 11971-0959 C*04 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: �5y ate_�5y • a Building Permit No._3 0 (A / . _ Owner: GTS.-M&7, _ (Please pr nt) /.- Plumber: _ KQ b +. Viu F tP.n F I"ease pr.nt) I certify that the solder us:d in the water supply system contains less than 2/10 of I% lead. (Plumbers~S ii Signature) Sworn to before me this , / dayof�,��—Q ;_ , 200.5 Notary Publ C aunty Oe�n�irb aiBE> q� E I York _ - �1aN'31.20 Q� TOWN OF SOUTHOLD PROPERTY RE 1a CORD CARD rj-zs� OWNER STREET 5 VILLf,GE DIST. SUB. LOT FORMER OWNER N� E ACR. �I� y� / d G G' C4C ./ S Id TYPE OF BUILDING S � W , C 4 �9 RES. SEAS, VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS ° o X600 00 � '7y ' ' a - qi3 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value " Acre Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD t%o 0 Meadowland DEPTH House Plot BULKHEAD Total DOCK PAGE 01 NYBFU NYC 09:26 2123853740 09!23/2005 � ILL NEW YORK BOARD OF FIRE UNDERWRITERS INCORPORATED 1867 FACSIMILL Tk.A_NSM1TTAL SHLET TO (u�►� • t DATE: q � �31aS co' 707AL `p OF P. RUIIBER co"lK 3 F A?• - �-M$ER: SE�TDER'S REFEFEI C£ ��1�nJMBER FEgENf�'`'LDISLR PHO. YpL'RRE gE' PLY�PLEASE RECy0-lE �rJ []PLEAS£ RE fl GEntI OFOTLFEvZE any ASE res: ?.TO'Ik5/CONS x FL ORS E ,kX 2'-2•:IT 2703716 T 5 R T FqX 3740 F 40 PFiO�E X12.227.3700' FROM FAX NO. -- Jan. 09 2004 04:26PM Pl 23 201 L . SUFFOLK COUNTY DEPARTMY NT"+`HEALTI+SERVICES CERTIFICATE Of..CARBON MONOXIDE ALARM INSTALLATION �— E� ltcrrii•o7fns telionA enc /MownBfscrritalf,:t ector � 13u,iness name Addrisr. Na Inspec-or- ~i .Telephone: __ ...� I I2 iSl_ l (IhIPLt I C.D A!:TtilllilLEU A(,Eiv 1 Health Department ltcCerem a Numb+r: Tax Map Numl:et: !])strict Section / Bigc�!(s) / I oils) Uwrlling L.ot:tu:,•:t:1.L�ress: �.>�- 5*u l �IC�--Y-- - ie^ ! Vr,ter%AgW.i`S7=tl9t[tre-dt l�:S"`.' 1. VO.Of Allan%tmtat:'eC: ROagll m Pass (Daterl,ti6): Rail Psis D.at90it.1: bJ I CETIFY THAT ALL ON THE FOL;S.O WINO ARE TRUE: S • Carbon Morwxide Alarms have bi installed on each levee where sleepigg quaatrs arc luzaled,AND • All alarnta ha:c Ix:en installed in!accordance with Article 10 of the Suffoli County Sanitary Codo and the Carbon Mawxn:e Alarm Sta!!dards,inciudino: •r Ali u:arms are UL2034]id(Late)! Edition), have a dig:til Display, have a resci but;or,,and have a feature to.lisphuy the maximum carbon momxitc corworeation recorded since the feature was last reset, AND 4, All alarms have been di4etly,cormecwd to the ligbnng cl.t uit with no intervening swii(•hcs,.4.ND All:warms have been tesod and found to be operational.AND 1 am etaaloyed by an agency that is curremly approved to perform electrical inspections in the iown/Village hviag jurisumiun. i • li this certificate i:: -or a MULr1P DWIiLI.LVO,Carbon Monoxide Alarms have been in•tallcd: • in all slocring rooms ser ed by a coruraliaed 9y3;em supplying air fbr cooling.he;mng.;x ventilatic ii.AND •} In eah sleeping room cc wining a fuel fired appliance,AND S In u' dwelling units alto sleeping units sharing a common wall with, or located directly above or below• a rnon t omaning a centralized lye'-fired applisoca.AND G Ir, a,wrid u serving dw ling a„rs or sleepintJ;taax within Ibrty(40) feet of all ci.,o,s to those units and the corridor also ser e,::r nnr.coutainingcontaining fuei•firr�je!J/,,/poliance. iattature of hispcclor) (Da 1 (Pruned Nama) (Llcerue Number) Falr su ,#I.t%made heroin are able err o(:leu A trdsdameamrc tures t to Stction 210.415 of the New York State Penal Law I CF RTIFY THAT TRIS DN•1:FLING IS EXI-M!'f FROM THE 14EQVIREAIENT TO INSTALL CARBON MONOXIDE ALARMS BEUSE ALL OF THE FOLLOWING ARE TRUL: • Tacre are r:- t,a. bt.rning app]iarwfn installed,AND • Tnvre ate tat. ar:.ges atutched to it�c dwelling,AND • ]':t.dwelling uses an electrical hin.ting system. [Signature of 1r;pcetor ) (Date) (Primed!Name) (License Number) Fairs atatemaut:mads bcnin are u nishable an a Clan A mixdemonur oris to Section 210.45•,f the New York Stats renal Lew THE OWGINAL SIGNED COPY OF THIS FORIYI rv1US'r 116 MITTF•D TO>1Y1E SUFFOLJI►COUNTY DEPARTMENT.OF HEA LTH SERVICES IN ORDER TO It£CES V E F INAL APPRO VA L ww w:07 5"Ltd.. I tw1; o OF SOU)y�6 TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: 'cA 12k Af� DATE ( ��- b S INSPECTOR 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ V]'INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: '�'�""'�� = ' s T' Lam / O-i .etc ///J-OXo '/��f/�..�r.4.' , DATE i S ° S INSPECTOR '" - 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ VrROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [+]'FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: � /- . .•�P�.� DATE �� INSPECTOR / 3 0 6 7 2 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND \(�J INSULATION [ ] FRAMING /[ ] FINAL [ ] FIREPLACE\& CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: `-/ 2� -bT DATE �T �s INSPECTOR�� 134 366f9z� 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ � KOUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ V(FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: Q DAT E�� INSPECTOWY-.Z��/L� 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ,, NSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION 1 REMARKS: ' DATE 0 INSPECTOR `"'� COMPLAINT REPORT NAME: DATE ADDRESS: PHONE # / HOW RECEIVED: - TEL. -MAIL- IN PERSON LOCATION OF COMPLAINT: SUFF. CO. TAX MAP # ;ot , p OWNERS NAME : NATURE OF COMPLAINT: —P1_� ASSIGNED TO: INSPECTION DATE: REMARKS: C` J-m—".2L ACTION TAKEN: i FILE # IF APPLICABLE RE-INSPECTION DATE: • TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Baud of Hmkh SOUT{iOLD,NY 11971 3 sets of Building Plans TEL:7651802 Survey PERMIT NO. 3064---7-k— Check Septic Form N.Y.S.D.E.C.__ Tnutees Exammed ,20_ Contact: Approved 0_ Mail to: Disapproved a/c Phone: Buildi 4 2004 APPLICATION FOR B PERMIT - Date 20Q+ INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submittal 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 prcmisw,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- ever until a Certificate of Occupancy is issued by the Building Inspector. APPLICATION 1S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Lone 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 barrio described.The a 1 al &:: applicable laws,ordinances,building code,housing code,and regulations,and to admit r�authorized itf9pe 091t'6n&tem in building for necessary inspections. To,corporation) [[�r7t 10 �/rpra�a � `�^ _. I .fSr applieantmname, SEP 3« . al��r � 14sj (Mailing address of applicen[)—T �Wpphcaffl-� lessee,agent,architect,engineer,general contractor,electrician,plumber or builder 6 W oem Name of owner of premises irlw yt-I Herz- (as on the tax roll or latest deed) If applicant is a corporation,signs=of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. 3410 R - P Electricians License No. Other Trades License No. Z 1. Location of land on which proposed work will be done: All Ag;,--)7JJ1D �D, AJ� Horse Number Street Hamlet County Tax Map No. 1000 Section 59 Block I l Lot Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Qw fling b. Intended use andoccupanty Dwelling 3. Nature of work(check which applicable):New Building Addition Alteration_ Repair__X _Removal Demolition Other Work 4. Estimated Cost "` � app Fee (Description) (to be paid on filing this application) 5. If dwelling,number of dwelling units__L_Number of dwelling units on each floor If garage, number of cars 7 A 6. If business,commercial or[nixed occupancy,specify nature and extent of each type of use. I 7. Dimensions of existing structures,if any:Front 3, -4 11 Rear 2(0,O u Depth 3/Q Height Zg D4 Number of Stories Tura t Dimensions of same structure with alterations or additions: Front h t/rA _Rear DFcK 10,K 131 Depth Height Number of Stories 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot:Front fob Rear ko' Depth 1440 10.Date of Purchase • (g' D-I' Name of Former Owner O?�E ri- 11.Zone or use district in which premises are situated 12.Does proposed construction violate any zoning law,ordinance or regulation: no 13.Will tot be re-graded N0 Will excess fill be removed from premises: M NO 14.Names of Owner of premisesMe'rZgddreef0434012.1ets.Phone No. Z)31323341(6r Name of Architect Address Phone No Name of Contractor SC-LE Address Phone No. 15. Is this property within 100 feet of a tidal wetland?'YES NO X — a IF YES,SOUTHOLD TOWN TRUSTEES PERMITS MAYBE 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 being duly mom,deposes and says that(s)he is the applicant rattle opldlvidual signing c ttrra'ct)above/named,, - S)He is the OTL.J"7LC�/ /A-raJYlf>� (90etractor,Agent,Corporate Officer,etc.) rf said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; :hat all statements contained in this application are true to the best of his knowledge and belief;and that the work will be 3erformed in the manner set forth in the application filed therewith. iw m to f*meos Signange of Appl cent Mstary li �OfNewroei No.0I 11852 aud!dled in Sufi* ...ssrnrrolrcsSaptl3, FIELD INSPECTION REPORT DATE COMMENTS ^o FOUNDATION(1ST) u ---------------------------' - - - FOUNDATION(2ND) z - o ROUGH FRAMING& ~ a PLUMBING Y /-►� ter- 3 c INSULATION PER N.Y. /� STATE ENERGY CODE k .�- dft d D � FINAL b ADDITIONAL COMMENTS Z _5 Q� Z ci � a �Z o z m v m b a N SURVEY OF PROPERTY P&O AT SOUTHOLD s* TOWN OF SOUTHOLD v` ¢S°o-F l g�,�, SUFFOLK COUNTY, N. Y, 1000-59-11-05 sOoo• SCALE. 1'=20' ✓UNE 9, 2004 d C3' N All AV S 2\ - D �ry 'Js /yam,y y '�J O O 'rry "f CER77F►ED 70. N/O� N6j's(S LINDA & ME77 AIX/A GWYN METZ 77COR 7171E INSURANCE COMPANY TITLE rd Y P. ��A.b sQ00• ag g�� aI.me it Y.S. LIC. N0. 49618 ANY ALTERATION OR ADDITION TO THIS SURVEY ISA NOLATION S, P.C. OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW. 4�5 AX (631) 765-1797 EXCEPT AS PER SECTION 7209—S'UBDIWSION 2 ALL CER77RCA77ONS N @ ■=GRANITE MONUMENT HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY /F SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR F)T AREA=8,400 SQ. FT 12 STREET 04-179 WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y. 11971 _ COMPLY WITH ALL CODES OF UNDERWRITERS CEATIFICAT NEW YORK STATE & TOWN CODES REQUIRED ED AS REQU D AND CONDITIONS OF SOUTHOLD TOWN ZBA EBUI'LDII'�G ED AS NOTED SOUTHOLD TOWN PLANNING BOARD DATB,P,p SOUTHOLD TOWN TRUSTEES FEE: svy.��y� � N.Y.S.DEC NO FY DEPARTMENT AT {.s •.rmj 1`!�/D 4+ &Za� WlL1pa5{Aa5 p � „ 765-1862 8A TO 4P FOR THE . ' V!7�^NFI/ 'Cb MkrGH- �1' - —_..-_ _— FOLLOWING INSPECTIONS: _ 1. FOUNDATION - TWO REQUIRED FOR RETE If _- 2. ROUGH POURED FRAMING 8, PLUMBING j� VOTE' -elz LIT 3. INSULATION t _ �,..' G+A'YLB�S -�D15GL5$� -. _--_ PLUMBINBING TE - CONSTRUCTION MUST ALL --- - _ - - - „ - &WAXER LINES NEED - 4 FINAL COMPLETE FOR C O. .I,._,_.-._,_._•____ ...._-_- - " , „j __ k. A , ,TESTING BEFORE COVERING = L CONSTRUCTION SHALL MEET THE 'T' G - � �:� q : - �R QUIREMENTS OFTHE CODES OF NEW q ' ii �` T- -,.--- - -- - � RK STATE. NOT RESPONSIBLE FOR ( , I ,-�k"" I,� _ �,- I " DESIGN OR CONSTRUCTION ERRORS. ALL CONSTRUCTION E THE REQUIREMENTS OF �Olt> II110� HALL � C DES OF NEW YORK STA„TEHE x % p New Dry P �MpI4 Wr, HRt j - 0 ! CUPANCY OR wr �' �� ' % �;E1't U E IS UNLAWFUL �- ATE � ERTIF THOU WI �✓ _ ' � ;Q OCCUPANCY W,Ipef 32 W DOINEtU*v' -� 5(fawNJ' w 1 l` ! 8" Glwt -tiro r -17) �.fd(' W u,. ,5 -y�i '� 1 Q -�. _ .:� iV ASH' Pte'}' - (`Ft ZONE ¢ , Gn �' - N -1J.m/.I I't ipGt ; �' - W.P• n.F>!'..S c'N Z n Z X l' 1 1' OOD ZONE` IU14 •, f 1 ,. , _ . - ._ - G.r,:,..ILS .. ��'� - r FLOOD DAWITH CHAPTEREPREVENTION i SO � 4 � - . �; 1 � t _ w _-,�- _ [¢�(e� - 1 k '.._� I I FLOOD DAMAGE PREVENTION k 9 n d8N'f I SOUTHOLD TOWN CODE. --- i — — it - -�— I ce tt �• Til 6LOE� Ut�cFl Y� MATrr2rA15. y RETAIN STORM WATER RUNOFF wI eLgRSI✓ANT TO SECTION 45-1 OC Mill $h OF THE TOWN CODE. V. LLS T i y ti z asw• L S= CERTIFICATION OF 1 NAILING & CONNECTIONS I a I I —_Y. �I REQUIRED. 6 1 o i a dGL` 1 T IT 1 AMBER �}.. PCIIMBERCERTIFICATION �A7.1['�:�� r, � .. 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Al.{4• O2e° ,Z SCALE: ID) BUILDING PERMIT EXAMINER CHECKLIST DATE REVIEWED: '9/ /04 APPLICANT: PAW - DATE SUBMITTED: ./Q/04 SCTM#DISTRICT: 1,000, SECTION: QBLOCK: LOT: S SUBDIVISION: AA- ADDRESS: 4E CITY: ZONING DISTRICT: CONFORMING? BUILDING PERMITS OPEN/EXPIRED: PRE CO: Y OR N BP /" -Z/ C/0 Z- , INFO BP -Z/C/0 Z- , INFO BP �`-Z/ C/0 Z- , INFO SINGLE & SEPARATE CERTIFICATION-REQUIRED NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83) REQ. LOT SIZE: ACT. LOT SIZE oa REQ. LOT COV. 02A?. ACT. LOT COV. REQ. FRONT f—PROP. FRONT REQ SIDE ACT. SIDE REQ. REAR !2f —PROP. REAR REQ. EIGHT PROP. HEIGHT PROJECT DESCRIPTION(:/ ESTIMATED PROJECT COST: ARCHITECTER: Fsc WATER FRONT? No DESCRIPTION: PANEL # FLOOD ZONE: BULKHEAD? DISTANCE? APPROVAL REQUIRED SUFFOLK COUNTY HEALTH D PT: YES o ; ( ED #): DTE: _/_/_ PERMIT#: - TOWN SEPTIC RECEIPT: Y or SEPTIC CE CATION: Y or N NEW YORK STATE DEC: PRE-D 9nn5 YES o1>(s) DTE: _/_/_ PERMIT#: SOUTHOLD TOWN TRU�'I'EES: YES o DTE:— /_ PERMIT#: TOWN ZONING BOARD APPROVAL: YES o� DTE: PERMIT#: TOWN PLAN. BOARD APPROVAL: YES or DTE__/_/_ PERMIT#: TOWN HISTORICAL PRE (SPLIA): YES or O 5 NEW YORK STATE CODE COMPLIANCE (SEE PAGE 2) E or NO NOTES: 44 FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: 11SO SF SECOND FLOOR: c;I�`� SF OTHER: SF INIT OTHER TOTAL TOTAL: �' _SF FEE FEE FEE 1. SF)- ( SF)= SFX$ -=$-+$-+$-=$ 2. ( SF)- ( _SF)= SFX$ _$ +$ +$ =$ 3. ( SF)- (SF)= SFX$ _$ +$ +$_ FINAL T TAL: $ /ST-� { 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 Decay: S-M Design Temp: 11 Ice Shield Underlay:YES . Flood Hazards: USE/OCCUPANCY CLASSIFICATION: HEIGHT/FIRE AREA: TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEERED/PRESCRIPTIVE FULL FRAMING DESIGN ELEMENTS: Y/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: Y/N LIVE: Y/N DEAD:Y/N SNOW:Y/N SEISMIC:Y/N WIND:Y/N WINDOW AND DOOR SCHEDULE: MISSLE TEST REQUIREMENTS: Y/N EGRESS 5.7 S.F.: Y/N LIGHT 8%: Y/N VENT 4%: Y/N 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)