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Home My WebLink About32464-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31993 Date: 11/17/06 THIS CERTIFIES that the building ALTERATIONS Location of Property: 500 MAPLE (HOUSE NO.) County Tax Map No. 473889 Section 64 LA (STREET) Block 1-- SOUTHOLD (HAMLET) Lot 20 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 30, 2006 pursuant to whicb Building Permit No. 32464-Z dated NOVEMBER 1, 2006 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 CONVERT GARAGE TO LIVING SPACE IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DOUGLAS F JR & AMY CROSE (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 3013444 11/09/06 PLUMBERS CERTIFICATION DATED 09/30/06 K & K PLUMBING Rev. 1/81 - -- jv~;> Lo<(s '::> '- Foe", No. .. ,. . TOlIN OF SOUTIIOLI) BUILDING OErARTMENT TOWN Il/\LL 765-1802 ,\. ,ThL:; apl'lication mulit bo fUled in by typ"writer OR 1nk an!! :;ubmitt,,!! to tho builai.nl: in:;Pl:Ctor wich chI: followinG: for n"w buil!!1ng or now u:;,,: 1. Fi,~~ :;urvey uf prop~ty With accuraco location ot al~ bUilding:;, propurty 11ne:;. :;creuts, Olnd unu"ullI natural or.. ,topocraphic featuros. 2. b'inal Approval trollllloa.l:ch OOI,:i:. of WOlcur ..upply an<l ,",,,w.:>raGe-!!1SpO"0l1(S_9 form). 3. AppcQva~ of uleccr1cal in"tallation iro~ BOllr!! of Firo Unllurwr1cors. 4. :;worn :icaco"'..nt fro,. plu"b..r c6r1:1lYinll thOlC th.. ,",ul!!..r u"<ld in ..yllC.... cORca1n:; luss chan 2/10 of 1% lOlld. 5. CU~rc~ buildinG, i.ncIu"crilll b..1ldi.ng, mulc1plu ro"idoncc" Olnd similar building:; Olnd 1n"callat1on", A CQrt1~icacQ of Cod.. Co"'plillncu from architecc,or ..nCin....r responllibl.. for the bUilding. '6. ~ubl.ic 1'lanninll Board Approval of compl"ced site plan requirementll. ' ~. For .:lxisting buildinGs (prior to April 9, 1957) non-conforminG "so", or bu11ainl::; ana "prc;-,,:x1~tint" l.and UI:i~U: 1. ACcUratll "urvuy oJ: propQrcy Showing 0111 proporcy lio':>li, streets, buildinl: and unusulll II01tural or topoGrapllic fllacures. 2. A properly compl<lced lIpplicaciun and a consent to inspecc signed by ehe 1I1'pl1canc. If a C"rtificato of OCcupancy is !!.:nil:d, the BUildinl; Inllpeccor shall :;taco eh" r"a:;on:; Chllrefor in writinG co ell.. 'applicant. Al'PLICATION FOR CEllTIFIc.\TE OF OCcur,\IICY ':"uney Tax IUI' 110 c. Fcc:s 1. C..rtifiCato of Occupancy - Now dwelling $25.00, Addicioil" to dwollinll ;25.00, Altcrationll to dweUill8 $25.00( Swiqinll poo! ;25.00, AccO'll:ory bui!!!iJlll $25.00, Addition:: CoaCCellsory bUlldillR $25.00. Bullinlls:;,,:: $~O. 00. 2. C...rtiiicate lit OCCUP4llCy on l'rll-wcisCinC auUl!inll _ $100.00 3. Cal'Y oi C<lrti!1c..ce of OCCllp..ncy _ $5.00 oVllr 5 year:; _ HO.OO t,. Up!!ac.:!!! Curc:l.iiclice ot Occupancy _ $50'.00 5. T.....por..ry Co:lri::I.fic:ate oC Occl>pancy - a..sidenC1al $15.00, Co_erc::t.11 $15.00 Date ...t9 ~J9~....~.............. ........ ':...w ConStruction........... Old Or l're-l:Xi:'t1~.. 1I1>11l!inl:. "~"''''':'1 r:' l ~ luc:ac1on of I'ropcny. .$~O... r.<:\~t~....,~~~...... ~.~~~................... 1I0u:;!: No. ~ :l~r~ "" f\. ~~lefu~ h""o:lr or Ownllr:; of rrol'orey~~\-,!-~~.,~.~.~".............~..................'" 1000, S..Ction. ....~~....1I10Ck. ..I........... .Lot...~. ............ ;ub<livi::10n................. ................ .:.Filcd IUp........... .Lut...................... .' ,'"r"1c NO~.'I.~ flz:. .DatQ OC P"rUli~..;:........... .Applicanc.........;............... .... '1""1 th Del' t. Approval..:...................... .Undorwriter:: AI'Jl roval. . . .. .. . . . . . . . . .. . . . . . . . . .'l~nriinc Bonrd Approv~l.........,............... 1"qul:St fur: TIIRlporary CcrtificOlte........... Fin ---...... ;' C't: $u.bmi"t t'~d: $. . . . . . .. . . . .. . .. . . .. " . . . . d'b20 31"7~ 3> ~~ 1)358 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. 32464 Z Date NOVEMBER 1, 2006 permission is hereby granted to: DOUGLAS F JR & AMY CROSE PO BOX 1331 SOUTHOLD,NY 11971 for : AS BUILT ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at SOUTHOLD 500 MAPLE LA County Tax Map No. 473889 Section 064 Block 0001 Lot No. 020 pursuant to application dated OCTOBER 30, 2006 and approved by the Building Inspector to expire on MAY 1, 2008. Fee $ 300.00 ~L' Authorized Signature ORIGINAL Rev. 5/8/02 lID.lID I BY THIS CERTIFICATE OF COMPLIANCE THE I i NEW YORK BOARD OF FIRE UNDERWRITERS i ~ BUREAU OF ELECTRICITY ~ ~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~ ~ CERTIFIES THAT ~ ~ ~ ~ Upon the application of upon premises owned by ~ ~ ~ ~ DOROSKI ELEC. INC DOUGLAS & AMIE ROSE ~ ~ P.O. BOX 781 500 MAPLE LANE ~ I CUTCHOGUE, NY 11935, SOUTHOLD, NY 11971 I ~ Located at 500 MAPLE LANE SOUTHOLD, NY 11971 ~ ~ ~ ~ Application Number: 3013444 Certificate Number: 3013444 ~ ~ Section: Block: Lot: Building Permit: BDC: n511 ~ ~ ~ ~ Described as a occupancy, wherein the premises electrical system consisting of ~ i electrical devices and wiring, described below, located in/on the premises at: i ~ First Floor, Outside, ~ ~ A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ~ ~ herein, was conducted in accordance with the requirements of the applicable code and/or standard ~ ~ 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 9th Day of November, 2006. ~ ~ Name OTY Rate Ratin" Circuit ~ ~ ~ Miscellaneous ~ ~ AS BUILT 2003 ~ ~ KITCHEN-BA TH-FAMIL Y ROOM ~ ii!I Alarm and Emergency Equipment ii!I ~ Sensor I 0 Smoke ~ ~ Appliances and Accessories ~ ~ Dish Washer I 0 1.2 KW ~ ~ Exhaust Fan 2 0 F.H.P. i!!I ~ Wiring and Devices ~ ~ Outlet 2 I 0 Fixture ~ ~ Fixture 21 0 Incandescent ~ ~ Outlet 17 0 General Purpose ~ ~ Receptacle 7 0 General Purpose ~ ~ Switch 13 0 General Purpose ~ ~ Receptacle 4 0 GFCI ~ ~ An as built inspection, of the delineated electrical installation, detennined that an obvious hazard is not present and the installation is believed to ~ ~ be in comformance with the applicable reference standard for the estimated period of construction ofthe premises wiring sy!lt9!J1. ~ I Continued on Next Page I of 2 I I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I lID.lID I!I.I!I ~ BY THIS CERTIFICATE OF COMPLIANCE THE ~ ~ NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~ BUREAU OF ELECTRICITY ~ ~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~ ~ CERTIFIES THAT ~ ~ ~ ~ Upon the application of upon premises owned by ~ ~ ~ ~ DOROSKI ELEC. INC DOUGLAS & AMIE ROSE ~ ~ P.O. BOX 781 500 MAPLE LANE ~ ~ CUTCHOGUE, NY 11935, SOUTHOLD, NY 11971 ~ ~ Located at 500 MAPLE LANE SOUTHOLD, NY 11971 ~ ~ ~ ~ Application Number: 3013444 Certificate Number: 3013444 ~ I Section: Block: Lot: Building Permit: BDC: ns11 I ~ Described as a occupancy, wherein the premises electrical system consisting of ~ ~ electrical devices and wiring, described below, located in/on the premises at: ~ ~ First Floor, Outside, ~ ~ A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ~ ~ herein, was conducted in accordance with the requirements of the applicable code and/or standard ~ ~ 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 9th Day of November, 2006. ~ iffi Name Ory Rate Ratinl! Circuit ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ seal ~ ~ ~ I 2 of 2 ~ ~ ~ I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I I!I.I!I lID.lID I BY THIS CERTIFICATE OF COMPLIANCE THE I ~ NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~ BUREAU OF ELECTRICITY ~ ~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~ ~ CERTIFIES THAT ~ ~ ~ ~ Upon the application of upon premises owned by ~ ~ ~ ~ CAROL & HOWARD SAFIR CAROL & HOWARD SAFIR ~ ~~ 215 EAST 68TH ST. APT 30E 215 EAST 68TH ST. APT 30E ~~ NEW YORK, NY 10021 NEW YORK NY 10021 ~ '~ ~ Located at 3121 OAKLAWN AVE. SOUTHOLD, NY 11971 ~ ~ ~ ~ Application Number: 3013612 Certificate Number: 3013612 ~ i Section: Block: Lot: Building Permit: 31515-Z BDC: ns11 i ~ Described as a occupancy, wherein the premises electrical system consisting of ~ ~ electrical devices and wiring, described below, located in/on the premises at: ~ ~ First Floor, ~ ~ A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ~ ~ herein, was conducted in accordance with the requirements of the applicable code and/or standard ~ ~ 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 9th Day of November, 2006. ~ ~ Name OTY Rate Ratio. Circuit ~ ~ ~ Miscellaneous ~ ~ AS BUILT200l ~ ~ BATHROOM ALTERATION ~ F.!I Wiring and Devices F.!I ~ Fixture 2 0 Incandescent ~ ~ Switch 1 0 General Purpose ~ ~ Receptacle 1 0 GFel ~ ~ An as built inspection, of the delineated electrical installation, determined that an obvious hazard is not present and the installation is believed to ~ Fa!] be in comfonnance with the applicable reference standard for the estimated period of construction of the premises wiring system. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ seal ~ ~ ~ ~ 1 of 1 ~ ~ ~ I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I lID.lID Town Hall, 53095 Main Road P.D.Box 1179 Southold, New York 11971..()9S9 Fax (631) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATJON Date: 9 / ~O/ () C Building Permit No. 3 2-y"G:, ~<t,- Owner: It('(\~ ~f)o~R~J( I (pI pont) #')..35/-P Plumber: ~/()"'" j, }\ ':'~ / floP ~j-,\ "'1 (Please pn I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. . Sworn to before me this ~/ eka{~ (plumbers Signature) dayof(JrK , 20.QL, ~ c-&-(j ~ Notary Public, County ~ DA J COOPER . UN State 0\ New Yo, NOTM\V 6~~~~~63, suHolk couW NO.01C . es December 31, 20 Term Expll MCJt,Dl-apCJ&. (.00[] -4 Date: November 13, 2006 To: Town of Southold JAMES]. DEERKOSKI, P.E. 260 Deer Drive Mattituck, N.Y. 11952 (631) 298-7116 c~ r rc [c ~ ,c ~ \ ~\ ! -_. 'Inv , 32U'. Re: Strapping/FraminglPlumbingllnsulation Inspections Rose 500 Maple Lane Southold, NY Permit# 32464Z To Whom It May Concern: This letter certifies that all wind strapping on the above mentioned project is in tact, and meets all state and local building codes. A Framing/Plumbing/Insulation Inspection was also Performed on this Structure, and all framing, Insulation, and Plumbing was done correctly and also meets all state and local building codes. A pressure test was also performed on the waste/water plumbing systems. Note that no Insulation is Needed below the concrete slab since the energy code was met without this being insulated. Any questions please feel free to call. 32-V&- y~ TOWN OF SOUTH OLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] INSULATION [ ] FRAMING/STRAPPING ~INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: ~~"' ~ ~ ~ f)~.r~ ~ Ev~ cJ"f- SA.A:i. /' tJ't:J:1)J~~~ e-f- ~ is u->0 71f1___ f ! ~ . DATE (f /rt!O~ ( I INSPECTOR o . .. FIELD INSPECTION REPORT DATE COMMENTS ~... ...ttrl . ~~ FOUNDATION (1ST) -t:.., 1\1-- ------------------------------------- -~ ~~ FOUNDATION (2ND) - V, z ti p - -- -- '---.- ~ on ---.--------.------ - ----'-.-....-------, ------------..._---- -- ------ " .., ROUGH FRAM1NG & 1---- - --------- ~ Gl .~,-- ~ ~!:l PLUMBING f--- '-t. ----- '"I f-- ~- ----- _._-----~- --...------ -I- ---------'-----.---- ----_.-------------. --- ~i - - - -- ---- -- -----,._-~- -.----.- -- i;~ INSULATION PERN. Y. ------ f--- - STATE ENERGY CODE ..... ~ \ /I ,. _or-/.' . -jf-:' /~ P~... . J ,..., _J I r 07t. 7:;.; ~_ iJ_ .-/ i ~ /'J >?h A.i? 7- L_ J (bIC. ,/jij . . ,.... rl.;t) 7&" ~J, " -"'- ,~ 7' . FINAL //h1h k' ~ A . f'/.J - /., ~ - .At::~...J ~ ~~I_- ~I / / //~~A ~_ ~ _ \~, .Y'. . / /...;;M / /. ../ / A ~_ ul.~ V '" / t:/ <::? ./ ---- -- - n _ -- ADDITIONAL COMMENTS /0 ~ -------------.. ~ L--... - - ~ ~ I- -- S n__ ..-----"---- , - ~ - ,g z -_._--,- - ~ --.------.--- --,._-----,,- = t"I -,-------,-- ~~ -'--- -.-.--- ... ~ Permit # Permit Date REScheck Software Version 3.7 Release 1b Compliance Certificate Project Tille: Amy and Doug Rose Report Date: 10/28/06 Energy Code: New York State Energy Conservation Construction Code Suffolk County, New York Detached 1 or 2 Family Non-Electric 10% 5750 Location: Construction Type: Heating Type: Glazing Area Percentage: Heating Degree Days: Construction Site: 500 Mapla La. Southold, NY 11971 Owner/Agent: Designer/Contractor: COmplldt1Ce Passes ~dclXllnlllll UA 96 Yel,l flame UA 94 "" 2.1%1 Better Than Code (UA) Assembly ..... Ceiling 1: Flat Ceiling or Scissor Truss: Ceiling 2: Cathedral Ceiling (no attic): Wall 1: Wood Frame, 16" o.c.: Window 1: Wood Frame:Double Pane with Low-E: Door 1: Glass: 320 0.0 30.0 10 160 0.0 30.0 5 648 0.0 13.0 56 18 0.340 6 50 0.340 17 Statement of Compliance: 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 Gode requirements. When a Registered Design Professional has stamped and signed this page, they are attesting that to the best of hislher knowledge, belief, and professional judgment, such plans or specifications are in compliance with this Code. ~-m~ jJ~Ei2-"VtJsll<JL Builder/Designer Company Name ~2'O1~ Dat , Amy and Doug Rose Page 1 of4 REScheck Software Version 3.7 Release 1 b Inspection Checklist Date: 10/28/06 Comngo: o Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 continuous insulation Comments: o Coiling 2: Cethedral Coiling <no oUlc), R-30.0 continuous insulation Comments: Abovo-Grade Walls: o Wall 1: Wood Frame. 16" D.C., R-13.0 continuous insulation Comments: Windows: o Window 1: Wood Frama:Double Pene with Low-E, U-factor: 0.340 For windows without labeled U-factOfS, describe features: #Panes _ Frame Type Thermal Break? _ Yes _ No Comments: Doors: o Door 1: Glass, U-factor: 0.340 Comments: Air Laoksge: D Joints, penetrations, and all other such openings In the building envelope that are sources of air leakage must be sealed. o Rooassed lights must bo 1) Type IC rated, or 2) installed Inside en appropriate eir-tight essembly with e 0.5" c1eerance from combustible materials. If non-Ie rated, the fixture must be installed with a 3" clearance from Insulation. Vapor Retarder: o Required on the warm-In-winter side of all non-vented framed ceilings, walls, and floors. Moterlals Identification: o Materials and equipment must be installed In accordance with the manufacturer's installation Instructions. o Materials and equipment must be Identified so that compliance can be determined. o Manufacturer manuals for all Installed heating and cooling equipment and service water heating equipment must be provided. o Insulation R..values and glazing U-factors must be c1earty marked on the building plans or specifications. Duct Insulation: o Supply ducts in unconditioned attics or outside the building must be Insulated to R-8. o Return ducts In unconditioned attics or outside the building must be Insulated to R-4. o Supply ducts in unconditioned spaces must be Insulated to R-8. o Return ducts in unconditioned spaces (except basements) must be insulated to R- D Return ducts In unconditioned spaces (except basements) must be Insulated to R-2. . Insulation is not required on return ducts In basements. Duct Construction: o All joints, seams, and connections must be securely fastened with welds, gaskets, mastics (adhesives), mestlc-plus-embedded-fabric, or tepes. Tapes end mestlcs must bo ratod UL 181A or UL 181B. Exception: Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 21n. w.g. (SOD Pal. o The HVAC system must provide a means for balancing air and water systems. Amy end Doug Rose Page 2 of 4 Temperature Controls: o Each dwelling unit has at lesat one thennostat capable of automatically adjusting the space temperature set point of the largest zone. Electric Systems: o Separate electric meters are required for each dwelling unit. Fireplaces: o Firepfaces must be installed with tight fitting non-combustible fireplace doors. o Fireplaces must be provided with a source of combustion air, as required by the Fireplace construction provisions of the Building Code of New Yarn stata, the Rasldential Code of Naw Yarn Stata or tha Naw Yarn City Building Code, as applicable. Service Watar Heating: o Water heaters with vertical pipe risers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of 8 circulating system. o Insulate circulating hot waler pipes to the levels In Tabla 1. Circulating Hot Waler Systems: o Insulate circulating hot water pipes to the levels in Table 1. SWimming Pools: o All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time ctock. Heating and Cooling Piping Insulation: o HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F must be insulated to the levels in Table 2. Amy and Doug Rose Page 3014 . Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes Heated Water Temperatura ("F) 170-180 140-169 100-139 Insulation Thickness in Inches by Pipe Sizes NonoClrculatlng Runouts Circulating Mains and Runouts Up to 1" 0.5 0.5 0.5 Up to 1.25" 1.0 0.5 0.5 1.5" to 2.0" 1.5 1.0 0.5 OVer 2" 2.0 1.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes PIping Systam Types Heating Systems Low PressurefTemperature Low Temperature Steam Condansate (tor teed water) Cooling Systems Chilled Weter, Refrigerant and Brine Fluid Temp. Range("F) Insulation Thickness In Inches by Pipe Sizes 2" Runouts 1" and Less 1.25" to 2.0" 2.5" to 4" 201-250 120-200 Any 1.0 1.5 1.5 2.0 0.5 1.0 1.0 1.5 1.0 1.0 1.5 2.0 0.5 0.5 0.75 1.0 1.0 1.0 1.5 1.5 40-55 Below 40 NOTES TO FIELD: (Building Department Use Only) Amy and Doug Rose Paga 4 of 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT ' TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST ',' " Do you have or need the following, before applying? Board ofHea1th 3 sets of Building Plans PI8IlDing Board approval 3;2- 'f6H ~ ~~ Septic Form N.Y.S.D.E.C. Trustees Contact: Examined Approved Disapproved ale I'~ II / r , 20 i- '- ,20--/L Expiration , 20'y::' Mail to: t......... :; ~---- 1-' i ri !. [,' ' Phone: Building Inspector '0 I I l._.I' APPLICATION FOR BUILDING PERMIT \11- Date lo \-a) ,200~ 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 ofIot and of buildings on premiaes;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 lnspC9tor 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 pait for any pUlJlose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorlzCd 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 rilIIy' authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICA nON 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 alt~onsor,for ~va1 or demolition herein described. The applicant agrees to comply with all applicable laws, ordinances, building code ing code, and , and to admit authorized inspectors on premises and in building for necessary in$pcCtio~. lure of applicant or name, if a corporation) &10 M 0t> \ A')( (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ( 0--~ \~ -\M..~ c...: ~~ Go-r- ~('S Nameofownerofpremises ~J \0":. ~~ s.~,~t. ~ t-\.\(V\..y c.~ (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. I. Location of land F!1 which proI{Osed work will be done: ~CO ,\~~\~ \..-6...~ House Number Street County Tax Map No. 1000 Section Subdivision b~ ~'). ~)\d. ~'!'\~J ' .. -" "0:3 j\T~ /".lSlJllY'1A''''~ Block 1,,,.,.,;,,',J;.,':., "" . Lot, ~ EilciI-MapN&.~.:v.lqj(.:JWl"~_,, , at (Name) 2. State existing use and occupancy of premises and intCl,l<lyd use)lpd 0 pancy of proposed construction: a. Existing use and occupancy ,,' _~ ~ \ '- ~ ~'- ...."""<- \ ,-( Wo;..C.(, ''-<'-t, b. Intendeduseandoccupancy cn~ u-,,<>--~ ',^-'-c::. ~. \ ". <=-c...-~~ \ M. OCJ V\.J"..-.. Alteration "'l,.. 3. Nature of work (check which applicable): New Buildin2 Repair Removal Demolition . Addition Other Work '-- 4. Estimated Cost (Description) 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 de ~QC,,-~ ......, c..c,..c- ~ ~9 ~ 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. Depth SY- 7. Dimensions of existing structures, if any: Front '1 0 Height Number of Stories Rear 5'1 Dimensions of same structure with alterations or additions: Front :'S.~'^'"-~ Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front J I ~ Rear Height Number of Stories 9. Size oflot: Front~ a-- D Rear--.J ti. n . Depth ~h "0- 10. Date of Purchase ~\3I'1S- Name of Fonner Owner ~,"'-~ o~ ~I<:'~ S.GrL..\.J.~~ Depth 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....::l::will excess .fill be remov~ from premises? YES_NO_ 14. Names of Owner of premises Name of Architect Name of Contractor Address Address . Address " ., Phone No. Phone No . Phone No. ';(,.',' 15 a. Is this propertywithp1100 feet ofa tidal wetland ora frcshwatcfwetland? .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) COUNTYOF~~l~ . u_ n \. .L/ - 1M '~- . u..:.~rY\"''f'\or- ~. ""~O l \I---- r ''<- ~ duly sworn, deposes and says that (s)he is thevapplicant (Name of individual signing contract) aOO cd, (S)He is the 0- \.-I..c~~~ (Con\ractor, 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 ofms knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me thiicd-i::lJe-r- ^I'I/ 4) day of 2~ Ifut/fFl(MI1~~ . Notary Public . . t.lNIMF.IlIOWAUIl<I -N'ttPU&lC. STATE OF NEW ....." NO 52-4824771 QUALIFIED IN SUFFOLK COlJt!!Y... j " COMMISSIONWlAESNOVao.~ Signature of Applicant ... .'. ... '- ~ CONSENT TO INSPECTION ~~c..S,c..s.~_ ~~'Q.~t-. if 4t'\\.v C '-J Owner(s) Name(s) T doleS) herebv state: , ' no. , . " c...\{Ot-r>>......y '" "'.- " , That the undersigned (is) (are) the ~wner(s) of the premises in the Town -Q~~.. . the undersigned, of Southold located at ~CX) ~~ ~k'-~\~ That the undersigned (has) (have) filed. or cau'sed to be filed, 'an applica- · ,', ~ . #1 tion in the Southold Town BUilding Inspector'S Office for the fOllOwing: 6S-~1 l{!l .b,-,-,-,~, ~ 00r- Co;\)o.,sl~~ ~ ~'" ~w/ \ <:'.0. It"- o...~Ci:""- ~ l ~~ \ N'- That the undersigned dotes) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem nec~ssary with respect to the aforesaid application. including inspections I to determine that said premises comply with 'all of the laws, ordinances. rules and regulations of the Town of Southold. The undersigned. in consenting to such inspections. dotes) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used as evidence in Subsequent prosecutions for vio- lations of the laws. ordinances. . ~\, L,- Dated: IO\~(C)0 (signature) (print name) " , ~,~ ~ 10/06/2006 09:21 FA~ lllo0: FA~ III 00 ~ : 1"<0/ F \~-',-1 ~/' , ROADZ5 1; oAAINJy~5.. R I~te. , IVI(~ I 1 ~ )> \l , m / / rJlOlf SMlTt'I W AR~a-l " ... '!!. .. , , ~ o ~ SURVEY OF PROPERTY A"r SOUTHOW TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000- 64 - 01-20 Scale, 1" = 30/ Jan. 11, 1995 z - Q. "1.\ o " o. '!" )> < ~ l" r- 'J> -I <.n <i r~ \\, \ % \ .~ \f'~i:~. \ \ CO~WIN RlqHMONO .1 I ! CERTIFED T{)f DOUGLAS ROSE. JR. AMY C. ROSE 1-I()IE S,4 V1N6S OF AMCRJCA ANTHONY J. CINCOTTA CONGRESSIONAL ABSTRACT. CO./Ne. .s. LIe. NO. ~9618 AREA = 31.486 sq.ft. 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