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Home My WebLink About30081-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31982 Date: 11/03/06 THIS CERTIFIES that the building ALTERATIONS Location of Property: 50965 CR 48 SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 51 Block 3 Lot 13.4 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 12, 2004 pursuant to which Building Permit No. 30081-Z dated FEBRUARY 12, 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 "AS BUILT" ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOHN G. MADSEN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2038211 12/25/06 PLUMBERS CERTIFICATION DATED 12/16/04 M.REED PLUMBING & HEATING /AIlhor' ed Si nature Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT e TOWN HALL 765-1802 ; J. , '=�'•'tAPPLICATION 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 2/10 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. New Construction: Old or Pre-existing Building: (check one) Location of Property: R(n j 77V+ 4-g sot A01 House No. Street Hamlet Owner or Owners of Property: . Q Suffolk County Tax Map No 1000, Section Block Lot s 4= Subdivision Filed Map. Lot: Permit No. Date of Permit. ZLApplicant: TQe;/rkpt- Ga- ` Q_ Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) ao Fee Submitted: $ �� /�/'/1,0 A,AA ffl/ adp� Applicant Signature fz �1a8 Com 31jC6k 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. 30081 Z Date FEBRUARY 12 , 2004 Permission is hereby granted to: REGINA L CARTSELOS 50965 CR 48 for "AS BUILT" ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. at premises located at 50965 CR 48 SOUTHOLD County Tax Map No. 473889 Section 051 Block 0003 Lot No. 013 . 004 pursuant to application dated FEBRUARY 12 , 2004 and approved by the Building Inspector to expire on AUGUST 12 , Fee $ 300 . 00 Au t or ' zed S nature ORIGINAL Rev. 5/8/02 a rJ�cPr�crcrcr� n�nnrrrr��nrr��rrr��n��nr��nr��n� MINI 15 n��.rLn co 5 BY THIS CERTIFICATE OF COMPLIANCE THE S 5 NEW YORK BOARD OF FIRE UNDERWRITE 5 5 RS S SBUREAU OF ELECTRICITY 5 5 40 FULTON STREET — NEW YORK, NY 10038 �r`f _ 3 5 CERTIFIES THAT 5 S S 5 Upon the application of upon premises owned by S 5 5 C-CAT CO. REGINA CARTSELOS S 5 X 27 50965 ROUTE 48 MATTITOUCK, NY 11952, SOUTHO D, NY 11971 5 S CS 5 Located at 50965 ROUTE 48 SOUTHOLD, NY 11971 5 S C 5 Application Number: 2038211 Certificate Number: 2038211 5 5 5 5 Section: Block: Lot: Building Permit:36og BDC: ns11 5 I 5 5 Described as a Residential 0-599 square ft. occupancy, wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 Basement,First Floor,Outside, 5 5 S 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 c5 5 authority having jurisdiction, and found to be in compliance therewith on the 25th Day of October,2006. S 5 Name QTY Rate Rating Circuit Tyne 5 Miscellaneous Cj 5 kitchen&bath renovation 5 Appliances and Accessories SDish Washer 1 0 1.2 KW 5 Exhaust Fan 1 0 F.H.P. 5 Wiring and Devices 5 5 Outlet 7 0 Fixture 5 SFixture 7 0 Incandescent 5 SOutlet 17 0 General Purpose 5 Receptacle 11 0 General Purpose SSwitch 14 0 General Purpose 5 5 Dimmers 1 0 5 SPaddle Fan 1 0 5 5 Lighting track 12 0 ft 5 5 Receptacle 4 0 GFCI 5 Service S 5 5 1 Phase 3W Service Rating 200 Amperes sea! 5 Service Disconnect: 1 200 cb 5 5 Continued on Next Page 1 of 2 S S5 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 o LPLPL�� o rl�n��n�n�nr.n�n�n� ��NONY, n�n�n�rr�, I�r�.n 5 BY THIS CERTIFICATE OF COMPLIANCE THE 5 S NEW YORK BOARD OF FIRE 5 5 UNDERWRITERS S S BUREAU OF ELECTRICITY 5 S40 FULTON STREET — NEW YORK, NY 10038 5 CERTIFIES THAT 5 5 5 SUpon the application of upon premises owned by 5 5 SC-CAT CO. REGINA CARTSELOS cS 5 Dj P.O. BOX 27 50965 ROUTE 48 5 MATTITUCK, NY 11952, SOUTHOLD, NY 11971 5 5 5 Located at 50965 ROUTE 48 SOUTHOLD, NY 11971 S 5 5 Application Number: 2038211 Certificate Number: 2038211 S 5 5 5 Section: Block: Lot: Building Permit: BDC: ns11 S 5 Residential 0-599 square ft. 5 5 Described as a q occupancy, wherein the premises electrical system consisting of 5 5 electrical devices and wiring, described below, located in/on the premises at: 5 SBasement,First Floor,Outside, 5 S 5 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 herein, 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 authority having jurisdiction, and found to be in compliance therewith on the 25th Day of October,2006. 5 Name OTY Rate Ra ine Circuit Tyne e 5 Meters: I S 5 5 S 5 5 5 5 5 5 S 5 5 5 S S S S 5 5 5 S S 5 Sea. 5 5 5 S2 of 2 CSS 5 S 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 _O$uFFo1,r�o �o � Town Hall,53095 Main Road O Fax(631)765-9502 P.O..Box 1179 y�o! �aO� Telephone(631) 765-1802 Southold,New York 11971-0959 .BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: 0 Building Permit No. Owner: (Please print) Plumber: Yn"c-/lt t-Z A"'31ml, (Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature) Sworn to before me this day of 20 Dy �. 41— Notary Public, 3aH-� County DIXON A.PAW–i Notary Public,State of Now York No.499591 a ified in Sutiolk County Commission Expires April 27.490— ?dd6 SOCAR Ur�o<o • yo TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN CATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: Ca zz DATE INSPECTOR 3oogi 2- 765-1802 BUILDING DEPT. INSPECTION . [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING - aND [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION rr REMARKS: DATE �°Z�l INSPECTOR 3flo � l � 768.1802 BUILDING DEPT. INSPECTION [FOUNDATION 7ST [ ROUGN PLBG. [FOUNDATION 2ND [ ] INSULATION [ vr"FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: 4 ol 3 „ DATE �� G �7 -INSPECTOR--��G �� 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 15T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & NIMNEY [ ] FIRE SAFETY INSPECTION IL REMARKS: Cp - DATE � INSPECTO 7ss.,soz BUILDING DEPT. 1 "PECTION [ IF NDATION 1ST [ ] ROUGH PLBG. [ OUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL ( ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION RE ARKS: AloD ao �3• �� I DATE �� INSPECTOR 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] R GH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: DATE ` � INSPECTOR- LAWRENCE M. TUTHILL PROFESSIONAL ENGINEER P.O. BOX 162 GREENPORT, N.Y. 11944 (631) 477-1652 December 14, 2004 Mr. Michael J. Verity, Department Head Southold Town Building Department Main Road Southold, NY 11971 Re: Residence Cartselos Route 48 Southold, NY 11971 Permit NO. 30081 Z To Whom It May Concern: I have inspected the above mentioned residence as to framing and strapping and found that they are in compliance with the floor plans, revision no. 1 ( stamped 12/14/04) showing headers over doors and being in accordance with the requirements of the New York State Building Code and the Southold Town Building Code. Sincerely, Lawrence M. Tuthill, P.E. - 1�r NEW)", f.1 W tc 0322541 ��FESSM JAMES J. DEERKOSKI, P.E. 260 Deer Drive Mattituck,N.Y. 11952 (631)298-5506 To: Town of Southold Re: Insulation Moutopoulus - 100 Oak St. East Marion,NY ? � Permit#30081 6j � 1 To whom it May Concern: After a inspection of the above mentioned house,the insulation was installed correctly and meets all state and local building codes. Any questions please feel free to call. OF NEIN yo S�.DEEq�, 9 0 cerely W r � N�� 9 . 07 P Junes J. o ' P.E. �FESSI�N 1 ' j FIELD INSPECTION REPORT -DAtE COMMENTS Ate /z FOUNDATION(1ST) ® GvO ------------------------------------- FOUNDATION(2ND) -- r ell G O ROUGH FRAMING& PLUMBING y v40 Vo .1r� INSULATION PER N.Y. y STATE ENERGY CODE c 0CIO � FINAL ADDITIONAL COMMENTS CD 0 z m - X _ >1 � b d U'� O x r r H x d r� b TOWN. OF SOUTHOLD PROPERTY—RECORD CARD - �� 3- /3. �/ OWNER STREET,5-0 VILLAGE DIST. SUB. LOT r L: f se o3 �S u o s" FORMER OWNER N T. C E U 4-F, C: ACR. L44ad-se o t4 , S W TYPE OF BUILDING RE�rj/4() SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS `,t p a R, `/ . — D 5,3 0 0 e 2— U► , 71 </6 —1- 17-2,q z —&j2 d sen c 3 j Co -7- 705 Tillable FRONTAGE ON WATER Woodland FRONTAGE ON ROAD Meadowland DEPTH �r ' House Plot BULKHEAD Total ■■■■■■■■■■■■ NOON■■NOON■ENEM a � NOON ■■■■■■■l��!■■NNOO ■■■ ■ CIO � ■■■■ ■■■■■■■IOM ■■■■■■■!O■■■■ fill-�� - `.,; ,.�_ , �, ■■■■■■■■■■■■■I!1!�''■!9■N■■ NOON■■ I� 'r -- �t ■■■■■■■■■■■■■I�iI■NOON■■e NOON■ ■■■■■■■■■■■■sI■■■NOON■■■O■■■■■ ■■■■■■■■■■■M■wN■'■■■■■■■■■■■■■ ■■■■■■■■■O■■■Erb■IIY■■■■■■■■■■■■ ■■■■■■■■■■■O RNO!YN■■■■■■■■■■■ ■■■�■ee■■e■e eeeee�e■e■■e■■■e■ ■■■■■■■■■■■■r��!!g3�J■'■■■■■■■■■■■ : .. � ■NOON■e■■■■■��1��l�■■■■■■■■■■■■ ■ ■■■■■■■■■■�i�t��:��;r�■■■ NOON■■ ,, ■CN■■■■■■!■ ►�� ll�t Ci■■■■■■■■■■ 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) 765-95027,(f Survey www. northfork.net/Southold/ PERMIT NO. f � Check �f Septic Form N.Y.S.D.E.C. 7 Trustees Examined �J ,20 Contact: Approved ,20 Mail to:1`�Q .A��Tt�� Disapproved a/c _X ✓13� ��t l,c�� l ►) Phone: 41? ( 14 Expiration 120_ Building Inspector K M APPLICATION FOR BUILDING PERMIT Date , 20 INSTRUCTIONS 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 sYFail 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) Gx S-31 6(Q nDO(�- (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder cwn I K Name of owner of premises�41/m C),94'sCJn_S_ (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. ow Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: -2K%6 �� House Number Street Hamlet County Tax Map No. 1000 Section 51 Block Lot 13-4— Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended rse and occupancy of proposed construction: a. Existing use and occupancy ( ' ).p b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition Alteration_�,�/ _ Repair Removal Demolition Other Work 7� (Description) 4. Estimated Cost �,ffl 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. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front mai 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 11. 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 �W"ill,_e-Ixcess fill be removed from premises? YES NO 14. Names of Owner of premises►�L,/af Y� ddress':22:/:- �-3 Phone No.,472,3966(0 2 1W) 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 9-&"S)- 0S being dilly sworn, deposes and says that(s)he is the applicant (Name individual signing contract) above named, (S)He is the O Wr-M-V (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 bgfore me this \ \ day of - 4_J6 20(5 ��N�Public Signature of Applicant BARBARA ANN RUDDER Notary Public,State of New York No.4855805 Qualified in Suffolk County Commission Expires April 14,0(0 J .�+ 3 7 Ca CA o paeoh (0 t 4 r rl> OA l `�• t JNAUTHORIEED ALTERATION OR ADDITION TO TO THIS SURVEY IS A VIOLATION OF SECTION 7709 OF THE NEW YORK STATE (DUCATION LAW.. 7, COPIES OF THIS SU".VEY MAP NOT 8EARING THE LAND SULVCY✓,- :A;OR FMROSSCD SERI _4A1: •�i�/�"-�'-. I-,V F-. I ,TO 8E A VALID T:UE C_F,: _ ', 4 _ - _'••' T.• 'GUAM NTELS InD;"ATED B�, rn, SHALL RUN ' •//�`� +► t •� ONLY TO tH:.+i S.:: t-+,, ,�.CM TH- SU.VEY EY �'OR Y, r •;IS PREFACED, A'S:7:U; L,111F I:) THE 1 TITLE COMPANY. A�,,r:CY AHG' }�—{/N /{� //,//,,,,,',�++t /"� ''_ `h ! ;•LENDING INIST TU 7014 L•STED H.TvG,�, AND ��" '!, ', _+�' V�4/ � ',, t' ,�� ,.J e •'` :TO THE ASS:GNUS OF THE LCT.DING INSTI- TUTION. GUARANTEES ARE NOT TRANSFERAllf �j TO ADDITIONAL INSTITUTIONS OR 5USSEOUEr'T., OWNERS SLUFF C'o., 7 ils70'. • ENERGY CODE CALCULATIONS CHAPTER.5 SECTION 501 Detached One and Two Family Design Criteria 5750 Degree Days (For Non-Electric Heat) Zone 11B For: Per: i?6�s•� (o�s S. b �'� .r o•f Rno _ Souf a // Dated: SUBSYSTEM, DESIGN CODE DESIGN CODE "U" "tI" UA UA Exterior Walls q7 ? o./Z/f 0.14 S 7. /4' e G6. o Ceiling Roof 31 p .O L13 0.031 Floor Over Unheated Space 31 �' a ,o 0.05 Heated Slab On Grade 6.5 Unheated Slab On Grade 4.5 Basement Wall 0.1 Crawl Space Wall 0.06 NOTES: Construction shall comply with 502.1.1 moisture control and 502.1.4 air leakage Building Envelope Systems to meet requirements of Section 501 The mechanical systems and equipment including: HVAC Equipment,HVAC Systems,Duct Systems,Ventilation Systems and Insulation of Piping Systems to meet requirements of Section 503 Service Water Heating Systems&Equipment to meet requirements of Section 504 Electrical&Lighting Systems&Equipment to meet requirements of Section 505 _- 4 ti. r,y To the best of my knowledge, , <<,r W VJ belief, &professional judgement, �, these plans are in compliance mop 032254-1 with,the code. 9°PrSS10% 2/3 ""LIJUNki 1 hIUV1I1 EXAIVIIINER U14EUKLIST DATE REVIEWED: 2. APPLICANT: �t � DATE SUBMITTED: 2/2/0? SCTM# DISTRICT: 1,000, SECTION: __.51 , BLOCK: _3 LOT: SUBDIVISION: ADDRESS: 1'0 6 S C.2* CITY:lz ZONING DISTRICT:... CONFO ING? BUILDING PERMITS OPEN/EXPI R N BP -Z/C/0 Z- , INFO /BP -Z/C/0 Z- , INFO BP --Z/C/o Z- INFO /BP -Z/C/o Z- , INFO SINGLE & SEPARATE CERTIFICATION-REQLUED 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 REQ. LOT SIZE: ACT. LOT SIZE:/ a'�REQ. LOT COV. 0 ACT. LOT COV. REQ. FRONT_ _3S" PROP. FRONT _REQ SIDE i p ACT. SIDE REQ. REAR e—PROP. REAR REQ.41EIGHT PROP. HEIGHT PROJECT DESCRIPTION: ` Ff ESTIMATED PROJECT COST: ARCHITECT4[ F$,,i 7njrh '`k L. WATER FRONT? W-0 DESCRIPTIOrT: PANEL # FLOOD ZON5X APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or 0, ED#): DTE: _/ /_ PERMIT#: TOWN SEPTIC RECEIPT: Y o NEW YORK STATE DEC: PRE DEC 9/1/75 YES DTE: / /_ PERMIT#: SOUTHOLD TOWN TRUSTEES: YES DTE _I I PERMIT #: TOWN ZONING BOARD APPROVAL: YES DTE: /_/_ PERMIT#: TOWN PLAN. BOARD APPROVAL: YES � DTE /_/_ PERMIT #: TOWN HISTORICAL PRF�(S'.'LIA): YES o �. NEW YORK STATE CODE COMPLIANCE (SEE PAG YES NO NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: S __--_— $—=$—+$—+$—= F FEE FEE FEE L CSF)- �___—_—SF)= SF X$ =$ +$ +$ = $ 2. ( SF)- (.___—SF)= SFX $ =$ +$ +$ _$ 3. (—_____,_SF)- (_SF)= SF X $—=$—+$—+$—= $ FINAL TOTAL: $_,3 � 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:Al-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:YIN SNOW: Y/N SEISMIC: Y/N WIND: Y/N WINDOW AND DOOR SCHEDULE: MISSLE TES-1 REQUIREMENTS: Y/N / EGRESS 5.7 S.F.: Y/N LIGHT 81/,: 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) M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: lool 11111P II 0I ''lealil 1/17 DATE 1 /4o// IN8P /Yap _-, Tj/ , y el tor M& -t L RQu ��, [? '' ' 4."( eaJ r,t /?>cis ctrt !► tR i- cc hecJ,xr ") UP �r4j t b 34. � e► k, f N,1 T' .. 3.� � 3 .D �c 3 - t S. t '-R 4.7) 10 � � � is. 2�. f 3,0 r.77 / -to 3 2, 00 1021 3 F NEW J' ?541 �V C F '� �OFESS1014 C�t- a ScAl, �V ° 300 _ �ZIA Y� - -1 ,t iAf� - 1 + WE �I -Vi ►►.�. . i� Q r- uj y UNDERWRITERS CERTIFICATE REQUIRED APPROVED AS NOTED DATE:aII� I B.P.# 30OFS 1-7- FEE' -b BY: -i NCTIFY BUILDING DEPARTMENT AT - 765.1802 E AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: L FOUNDATION - TWO REQUIRED FOR POUREDCONCRETE 2. ROUGH - FRAMING 6 PLUMBING j 1 INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. �X�ST�N -PLUM KATION e-TPL ,f ul E -- -- ---- - 7- ----- --- —�- --- ON LEAD, ONT VTBEFORE Hof To eaE AbIpHAI.'( 601 LEh / j CERTIFICA TEOF' CUPANCY Ili SOLDEA USED INWATER ESUPPLYXCEED YSTE CANNOT i' �� EXCEED 100 - 1%LEAD. � rwataxla i ra Tw zs3� - r ► " t.IavPEN �ILua T�E.'> W 6M ERgEHGY. f�Etfi,K : aYE 6uG;=-K --- ^— , � W -- FaU1Jl7/tly FffGb't7Eh) $T1Lcr>IPc'r�y%at " II 4KEME12ggtV,-' A zlk,b V'NI Y _ COMPLY WITH ALL CODES OF (ZFA� -� I, LVA ! IU{`-{JEWYORKSTATE &TOWN CODES -As REOUI ED AND CONDITIONS OF 1' 0p i� u,Vii_on q `I SOUTHOLDTONMZBA . SOUTHOLDTOWN PIANNINOBOARD •. SOUTHOLDTOWN TRUSTEES ':' N.Y,S.DEC OIL . . 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