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HomeMy WebLinkAbout34251-ZFORM NO. 4 TO,tN OF SOUTHOLD BUILDING DEP~TMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33668 Date: 04/23/09 THIS CERTIFIES that the building ADDITIONS/ALTERATIONS Location of Property: 2395 KING ST (HOUSE NO.) (STREET) County Tax Map No. 473889 Section 26 Block 2 Subdivision Filed Map No. __ Lot No. __ ORIENT Lot 44 (HAMLET) conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 16, 2008 pursuant to which Building Permit No. 34251-Z dated OCTOBER 24, 2008 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ADDITION WITH ATTACHED SHED TO AN EXISTING ONE F/~MILY DWELLING AS APPLIED FOR. The certificate is issued to ALAN & PATRICIA NORDEN (OWNER) of the aforesaid building. S~FOLKCO~3~l-fDEp~/~q~TOF}~ALTHAPPRO%5~L N/A ELECTRICAL c~KTIFICATE NO. 4022264 04/13/09 PL~MB~ ~KTIFICATION DA'£~U3 N/A gnature Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCC1 This application must be filled in by typewriter or ink and submitted to the Buildin For new building or new use: 1. Final survey of property with accurate location of all buildings, property 3. 4. 5. topographic features. Final Approval from Health Dept. of water supply and sewerage-disposal Approval of electrical installation from Board of Fire Underwritem. ~m;~t[~ wi~h~ ~o;~.' ~ BLDG. DEPI. _ ~ TOWN OF SOUTHOLD Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. Submit Planning Board Approval of completed site plan requirements. 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. Co New Construction: Location of Property: 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. (check one) Old or Pre-existing Building: Street Hamlet House No. Owner or Owners of Property: i~L-~ f4 Suffolk County Tax Map No 1000, Section db Block ~ Lot 4~' Subdivision Permit No. ,.~ Health Dept. Approval: Date of Permit. ]o/~ ~/o~ Filed Map. Applicant: ~ Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Final Certificate: (check one) Applicant Signature BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD Of FIRE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by DOROSKI ELEC. INC ALLAN NORDEN P.O. BOX 781 2395 KING ST CUTCHOGUE, NY 11935, ORIENT, NY 11957 Located at 2395 KING ST ORIENT, NY 11957 Application Number: 4022264 Certificate Number: 4022264 Section: Block: Lot: Building Permit: 34251 BDC: ns11 Described as a Residential 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 the13th Day of April, 2009. Name QTY Ra'e Rating Circuits Twe Wiring And Devices Dimmer 3 0 120 V Fixture 7 0 Incandescent Outlet 7 0 Fixture Outlet 17 0 Gan, Purpose Paddle Fan 1 0 Receptacle 1 0 20a-NC Appliance Receptacle 2 0 GFCI Receptacle 13 0 Gan, Purpose Switch I 0 Gan, Purpose seal I of l This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII~]ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34251 Z Date OCTOBER 24, 2008 Permission is hereby granted to: ALAN & PATRICIA NORDEN 2395 KING STREET, P.O. BOX 485 ORIENT,NY 11957 for : ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLINGAS APPLIED FOR. at premises located at 2395 KING ST County Tax Map No. 473889 Section 026 pursuant to application dated OCTOBER Building Inspector to expire on APRIL ORIENT Block 0002 Lot No. 044 16, 2008 and approved by the 24, 2010. Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ] ROUGH PLBG. [ ] ~JLATION [,,...,]"FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~ 0 ~ DATE INSPECTOR~~/~ TOWN OF SOUTHOLD BUILDING DEPT, 765-1802 [ ] FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION REMARKS: INSPECTION [ ] ROU/GH PLBG. [/_.,]~NSU LATION [ ] FINAL [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION DATE INSPECTOR~ ~~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~ ~ DATE INSPECTOR DEPT. INSPECTION [ ] FO~UNDATION 1ST [ ] ROUGH PLBG. [,~FOUNDATION 2ND [ ] INSULATION [ ]FRAMING / STRAPPING [ ]FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESI .SI'ANT C0~UCTION[/ ]FIRE RESISTANT PENETRATION REMARKS. ~~-~-- DATE INSPECTOR~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [~] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT C0NSTRUCT~0N REMARKS: [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENEI'RATION DATE INSPECTOR~~ ~TELD kN'SPECTION REPORT I DATE I COMiM[ENTS F OUqN:DATION (1ST) ROUGH FK~G & - PLL~-G LN S L~ATION PER STATE ENERGY CODE F~.~ ~DITION~ CO~NT8 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork. net Examined Approved Disapproved a/c Expiration toll ,2o0 PERMIT NO. Building Inspector BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Cheek Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Phone: _~_......-~.---'f~!~PLICATION FOR BUILDING PERMIT /~!~l ~~'/!t Date (JOT. I~ ,20 ~ a.~ ~plic~~mpl~mly fill~ in by W~ter or in ink ~d submi~ed to ~e Building Ins~ctor with 4 sets ofpl~ ~~~e~ing to schedule. b. P 9t pl~~ of buildin~ on p~ises, ~lmio~hip to adjoining premises or public s~em or ~, ~d v ~ys. c. The work cover~ by ~s application may not ~ comm~c~ ~fom iss~ce of Building P~it. d. Upon appmv~ offs ~plication, ~e Building Im~tor will issue a B~lding Pe~it to ~e ~pli~t. Such a ~it shall be kept on ~e premis~ available for ins~fion t~ou~om ~e wo~. e. No building shall be occupied or u~d in whole or in p~ for ~y pu~se what so ever until the Building l~tor issues a Ce~ficate of Occup~cy. f. Eve~ building ~it sh~l expire if~e work a~o~d h~ not ~en~ wi~in 12 monks ~er ~e ~ of iss~ce or ~ not ~en compla~ wi~ 18 monks ~m such ~. If no zoning ~dmen~ or o~ ~om ~fing ~e prope~ Mve ~n e~ in ~e in~ ~e Buil~g ~s~r may aurora, in ~ting, ~e e~ion of~e ~t for ~ ad.lion six monks. ~ter, a new ~it shall ~ ~. ~PLICATION IS ~REBY M~E to ~e Building Dep~ent for ~c issu~ce of a Building Pe~t p~t to ~e Building Zone ~m~ce of ~e Town of Sou~old, Suffolk Co.W, New York, ~d o~ applicable Mws, ~s or Re~la~o~, for ~e com~on of building, ~ff~tiom, or ~iom or for ~ov~ or d~olifion ~ h~in d~c~. ~e appli~t ~ ~ ~mply wi~ ~1 applicable laws, ordi~s, building ~de, ho~ing ~de, ~d ~lff~om, ~d to ~it au~o~ ~to~ on p~s~ ~d in bulldog for n~ss~ ins~ons. (Signature of applicant or name, ifa corporation) (Mailing address of applican0 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises }Jorcl (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. 1. Locatigp_ofJatl~d on which orpposed w_.ork will be done: q S i fn j House Number Street"' Hamlet County Tax Map No. 1000 Section 07(o Subdivision Block '~ ~ Lot ~ t~L/ Filed Map No. Lot 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost ~,~0.. ~ Fee construction: State existing use and occupancy of premises .and intended 9s.e and occupancy of proposed a. Existing use and occupancy ~r~[o.~ ~.~.t~cI y~¢~t'~e4rle~ b. Intended use and occupancy ~ilrl.5~.~ ,C,u i [c1 re~,d~,e~ 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. I f business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing stmgtures, if any: Front 070 '-/O * Rear .~/'-' ~" Depth Height o7o ~- q" +//- Number of Stories / Dimensions of same structure with alterations or additions: Front Depth. Height. 8. Dimensions of entire new conslmction: Front //-~/O t, Height //t Number of Stories 9. Size of lot: Front '7[- &''~ ' Rear Rear Number of Stories Rear Depth /~ '-g ~' Depth . / g ~- ~'~' ' 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 )<~ Will excess fill be removed from premises? YES 14. Names of Owner of premises ~lar~ gJard~ Name of Architect ~}l~ /~tO'JC.~,Jc-~' Name of Contractor ~t]c_~ ~>~t~t~ 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES__ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet ora tidal wetland? * YES__ NO )~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. NO X Address Oft ¢~.-~?* Phone No. Address ,/~ 7~'c~-~ Phone No Address~tt~4' /./~rt?/ct g Phone No. ~ NO )C 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. 9* __ 18. Are there any covenants and restrictions with respect to this property. YES NO /~ * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) ~t9.~ C~ ff~6f'g4~ being duly sworn, deposes and says that (s)he is the applicant (Name of indiqidual signMg contract) above named, CONNIE D. BUNCH (S)He is the (~ona'actor, AgeM, Corporate Officer, etc,) Qualified in Suffolk County Commission Expires April ]4, 20 1 3 of said owner or owners, and is duly authorized to perform or have performed the said work and to raBke and file th~s application; that all statements contained in this application am true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this -- I/,::r~ dayof O~ 20t~ Notary Public REScheck Software Version 3.7 Release lb Compliance Certificate Project Title: Norden Report Date: t0103/08 Energy Code: Location: Construction Type: Heating Type: Glazing Area Pementage: Heating Degree Days: Construction Site: 2395 King St. Orient, NY New York State Energy Conservation Construction Code / Suffolk County, New York// Detached t or 2 Family Non-Electric 14% 5750 Owner/Agent: Permit # Permit Date Ceiling 1: Cathedral Ceiling (no attic): Wall 1: Wood Frame, 16" o.c.: Window 1: Wood Frame:Double Pane with Low-E: Door 1: Glass: Floor 1: Ali-Wood Joist/Truss:Over Unconditioned Space: 394 30.0 0.0 13 616 19.0 0.0 32 19 0.350 7 66 0.340 22 394 19.0 0.0 19 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 Code requirements. When a Registered Design Professional has stamped and signed this page, they ara attesUng that to the best of his/her knowledge, belief, and professional judgment, such plans or specifications are in compliance with this Code. Builder/Designer Company Name Dat Norden Page 1 of 4 REScheck Software Version 3.7 Release lb Inspection Checklist Date: 10/03/08 Ceilings: [] Ceiling 1: Cathedral Ceiling (no attic), R-30.0 cavity insulation Comments: Above-Grade Walls: Wall 1: Wood Frame, 16" c.c., R-19.0 cavity insulation Comments: Windows: Window 1: Wood Frame:Double Pane with Low-E, U-factor: 0.350 For windows without labeled U-factors, describe features: #Panes Frame Type Thermal Break? Comments: Yes__ No Doors: [] Door 1: Glass, U-factor: 0.340 Comments: r~ Floors: Floor 1: All-Wood Joist/'rmss:Over Unconditioned Space, R-19.0 cavity insulation Comments: [] Air Leakage: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be 1) Type lC rated, or 2) installed inside an appropriate air-tight assembly with a 0.5" cJearance from combustible materials. If non-lC rated, the fixture must be installed with a 3" clearance from insulation. Vapor Retarder: [] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. Materials Identification: [] Materials and equipment must be installed in accordance with the manufacturer's installation instructions. I~ Materials and equipment must be identified so that compliance can be determined. [] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [] Insulation R-values and glazing U-factors must be cleaHy marked on the building plans or specifications. Duct Insulation: [] Supply ducts in unconditioned attics or outside the building must be insulated to R-8. [] Return ducts in unconditioned attics or outside the building must be insulated to R-4. E] Supply ducts in unconditioned spaces must be insulated to R-8. [] Retum ducts in unconditioned spaces (except basements) must be insulated to R- []Retum ducts in unconditioned spaces (except basements) must be insulated to R-2. . Insulation is not required on return ducts in basements. Duct Construction: [] All joints, seams, and connections must be securely fastened with welds, gaskets, mastics (adhesives), mastic-plus-embedded-fabric, or tapes. Tapes and mastics must be rated UL 181A or UL 181B. Norden Page 2 of 4 Exception: Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 [] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: Each dwelling unit has at lesat one thermostat capable of automatically adjusting the space temperature set point of the largest zone. Electric Systems: Separate electdc meters are required for each dwelling unit. Fireplaces: [] Fireplaces must be installed with tight fitting non-cembustible fireplace doors. E] Fireplaces must be provided with a source of combustion air, as required by the Fireplace construction provisions of the Building Code of New York State, the Residential Code of New York State or the New York City Building Code, as applicable. Sendce Water Heating: [] Water heaters with vertical pipe dsers must have a heat trap on both the inlet and outlet unless the water heater has an integral heat trap or is part of a circulating system. [] Insulate circulating hot water pipes to the levels in Table 1. Circulating Hot Water Systems: [] Insulate cimulating hot water pipes to the levels in Table 1, Swimming Pools: [] 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 clock. Heating and Cooling Piping Insulation: [] HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F must be insulated to the levels in Table 2. Norden Page 3 of 4 Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes Insulation Thickness in Inches by Pipe Sizes Non-Circulating Runouts Circulating Mains and Runouts Heated Water Temperature (°F) Up to 1" Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1,5 2.0 140-169 0.5 0.5 1.0 1,5 100-139 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes Fluid Temp. Piping System Types Range(°F) Insulation Thickness in Inches by Pipe Sizes 2" Runouts 1" and Less 1.25" to 2.0" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant and 40-55 0.5 0.5 0.75 1.0 Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD: (Building Department Use Only) Norden Page 4 of 4 TOWN OF SOUTHOLD PROPERTY RECORD CARD ~;? h/ OWNER STREET ~_~ ~< VILLAGE -DIST SUB.  TYPE OF BUILDING w '~X ~ES. ~; ! SEAS. VL. ,. FAR~ COMM. ~ ~'-~ --;~Value LAND IMP. TOTAL DATE REMARKS AG' BUILDING CONDITION N~ NORMAL BELOW ABOVE rilloble 1 ~ ) Fillable 3 ~oodland ~wampland FRONTAGE ON WATER ~rushland FRONTAGE ON ROAD 4ouse Plot DEPTH BULKH~D Fotaf r DOCK 26-2-44 necessary bld~ 10/01 Bldg. (j ~- / X ~, 6~ z ~f-~ ~ ~O ;¢ G ~6 Foundation BR c~< Bath ,, I Dinette ~,,, Is~ ~tensio 21/~ z 2&d ~,~. ua v, ?, ~ Basement ~, ~z~:,z, Fl~rs ~'~z /~ / ~,~' K. ~xtension Ext. Walls ~D B[~, ~,~ ,~,.: Interior Finish ~ ~tension Fire Place ,~_ ~v',:-' ~ ~, ~-': -- 'L&' /'t O · Heat ~ ~ ~ ~, DR. Type Roof R~ms Ist Floor BR. ~orch ~ ~ [ 7~ : /~_~ ~ /~ / Recreation Roo~ Rooms 2nd Floc FIN. B. ~orch Dormer 3reezewoy Driveway 3arage 4 M. Bldg. ~Extension 26-2-44 10/01 ~undotion Wolls ~oth Dinette i Interior Fin' I This certifies that the bearer is duly licene~l by the County of Suffolk SUFFOLK COUNTY EXECUTIVE'S OFFICE OF CONSUMER AFFAIRS HOME IMPROVEMENT CONTRACTOR LICENSE MICHAEL W DEGEN 35037-H (~0/18/2004 E~,~,.~, ~ 05/01/'2010 A~'~_ CERTIFICATE OF LIABILITY INRURANCE ___ .~:x~c~ CoR~n Coverage lnsuranc6 Agency, inc. 530 Horseblock Road P. 0 Box 557 .... _Fa~L"~9 J?,_NY_.:.t 79 _e. 49 Red Bridga Rd 11/1012008 THIS CERTIFICATE I~ ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'~ ~N THE CERTIFICA~ HOLDER, THIS CERTiFICA~E ~ES ~T A~[ND, EXTEND OE AL~ER THE C~VE~GE AFFO~D~O BY THE POLICIES BELOW, COVERAGES ALAN NORDEN 2395 KING STREET ORIENT, NY 11957 ACORD 25 ~ ACORD CORPORATION 1988 INew ork State Insurance Fund Worl~} ~o~'~ ~s-~fiili~ Be. efits~p~cialists Since 1914 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phone: (631) 7564300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE M DEGEN CORP 49REDBRIDGEROAD CENTER MORICHES NY 11934 POLICYHOLDER [CERTIFICATE HOLDER M DEGEN CORP ALAN NORDEN 49 REDBRIDGE ROAD 2395 KING STREET CENTER MORICHES NY 11934 ORIENT NY 11957 i POLICY NUMBER CERTIFICATE NUMBER i PERIOD COVERED BY THIS CERTIFICATE DATE 11370 301-2 430515 10/26/2008 TO 10/26/2009 11/24/2008 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1370 301-2 UNTIL 10/26/2009, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 10/26/2009 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRFCI'EN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE, NOTICE BY REGULAR MAIL SO ADDRESSED SHALL SE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLYANDCONFERS NO RIGHTS NOR iNSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. U-26.3 NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www, nysif, com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 350562252 Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. #: District Section Block THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PI.AH CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. Item Number: (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) Ye__.~s Nc, 1 2 3 4 5 6 7 8 9 Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? (This item will include all ran-off created by site clearing and/or construction activities as well as all Site improvements and the permanent creation of impervious surfaces.) Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Localion? This Item shall include all proposed Grade Changes and Slopes Controlling Surface WaterFIow! Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Matedal within any Parcel? Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000) Square Feet of Ground Surface? Is there a Natural Water Course Running through the Site? Is this Project within he Trus ees jur sd c on or with n One Hundred (100') feet of a Wetland or Beach? Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Ver(ical Rise to One Hundred (100') of Horizontal Distance? Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off into and/or in the direction of a Town right-of-way? Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any Item Within the Town Right-of-Way or Road Shoulder Area? (This item will NOT include the Installation of Driveway Aprons.) Will this Project Require Site Preparation w h n he One Hundred (100) Year Floodplain of any Watercourse? NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark in the Box, a Storm-Water, Grading, Drainage & Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Permitl EXEMPTION~ Ye..~s N...~o Does this project meet the minimum standards for classification as an Agricultural Project? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan is NOT Requiredt -- ~ COUNTY OF'"L)~ ......................................... SS That I ............... ../.t~...~....~:...].......~/~..._~... ................. being duly sworn, deposes and says that he/she is tim applicant for Permit, (Name of individfJal signing Documenl) AJ, d that he/she is thc ........................................ .'~'~:..~ ............................................................................................... (Owner, Contractor, Agent, Corporate O~cer, etc) Owner and/or representative o[ the Owner of Owner's, and is duly authorized to ped-orm or have perl~)rmed the said work and to make and file this application; that all statements contained in this application are ua~e to flze best of his knowledge and belief; and that the work will be performed in thc mmaner sel forth in the application filed herewith. CONNIE D BUNCH S'~ orn to before me this; ) b ~ ~.~ -'-f ~ 1^' ° * ~ Qualifled"U:m"uotll°uaUin Suffolk C0mlty ............................................... .......................... .......... FORM - 06/07 ~--7 *LC CONsmuC'rION SHALL"'"'X u~'~' CERTIFICATE , HE ~EOU ~E/fiENT8 OF THE Q)DES OF NEW YOF~K STATE  w C~IMN~; CONNECTION8 - REQUiREB. BATE:~t .... . FEE:.~ ~Y: -.~ COMPLY W~TH ALL FOLLOWING INSPECTK~NS: NEW PA~P~WALLA~UND I ,, ~ . COD~S O~ 1. FOURDAT~ON - TNO REQUtRED  ~oo~ A~ ~ E~ ~ DR < S~ A FE & TOWN CODEs FOR POURED CONCRETE AS REQU~REE AND CONDiTIONs OF 2. ROUGH ' FRAMING & PLUMBING 3. INSULATION ~'~ ~0~0LD ~0W~2~ 4, FINAL - CONSTRUCTION MUST BE COMPLETE FOR C,O. N~WCEDA~T~D ~'~O~OL~OW~G~O~~ ALL CONSTRUCTION SHALL ME~ ~ _ SO~OLD TOWN TRUSTEE~ REQUIREMENTS OF THE CODES OF NEW Z ~ JL ~ ~ JL JL L U ~ O~SJeNOR CONSTRUOTJON ERRORS. FRONT ELEVATION 5CALE~ ~"= ILO" TEEMITE MOD~T~ TO HEA~ L -- - J / JOIST5 ~EHrNB PA~P~ LAMENT REQUI~D SPECIFICATION5 / STATE CODE ~ ...... L ,, 50UT HOLD BUILDING D EFARTM'NT CRITERIA -: ~ ~ (~ ~ 7 ~ ~?~ ~ ~ J2 PIRE PROTECTION BEE PLO0, PLAN5 AND BECTION5 El G HT 51 DE ELEVATION 3E3E3E]E3E% $ i ]Z_ 3E ZE 3_ 2_ 3F II CLIMATIC AND GEOGRAPHIC DESIGN CRITERIA 50UTHOLD BUILDING DEFARTMENT CRITERIA DACE ELEVATION 51DE ELEVATION OUTLINE OF SECOND FLOOR W'A LL5 D(15TING PARAPET WALLD TO P~MAIN >o~ O0z , Zz~ PAGE: 2 } DADZM~NT 5~B ~N U~ A~II }, 2- ¢4 ~BA& IN FO~INGS, MINIMUM 3' 0" '~LOW G~D~ ~ ~ O~ f]}~/ ~PICAL~PICAL A~ N~ A~)ALL A~) S~]STING ~ALLTO -, ,. :"' POUNDATION WALL TO HOUDE FRAME WITH 5" II, USH DIN JO[DT5 NEW WALL ORENING; -- PROVIE CAP ~, 5 TO POSTS, TYPICAL EACH END WINDOW 4- DOOR SCHEDULE KITCHEN ?05T5, TYPICAL EACH END NEW P~NINSULA FAMILY ROOM CUDTOMWOOD CUDTOMWO©D JO 5 PROVIDE2 I$'X IJ~"LVL -- iflEADE&ABOVE FIRHPLACE WALL LEGEND; REMOVED PROVIDE 3- I~"'X 9 ½" LVL HEADHP,~ PROPOSED FLOOR PLAN SCALE: ¼"= ILO'' LU2 4 FOR F~T, ~-0 CBLING ~ .... t /W/C520 5T~FPING D°U~L~J°I~ 3- I?X II ~" LVLW/ ~z~ HDGHTWIT~IN EOOM ~POS~D3 XG .... ~oo~ 2- ~" FLITCH P~T~ ', ~ISTING F.J. TO ~ qAIN ~ GEl 40 9 ~" F.J. ~ I G" O,C. PROVIDE 51MESON C520 .................. ,N~¢r,~. WIND RESISTANT CONSTRUCTION CONNECTO~ ~T O~ W/ L~4 CONNE~O~ CONNECTION L~ATION PA~T NUMBER; NOT~ / · Z ~FOUNDATION WALL$ 1'4"NO"~, ~G.;PROV. DESIGN LOAD CALCULATION5 HEADE&TO JACKSTUD DUILDI N G 5ECTI ON "A" SRITERIA POP-. CALCULATION OF DEAD LOAD ACTUAL WEIGHT5 OF MATERIAL5 PJ!:FEP-.ENCED TO A,I,A, ARCHITECTURAL GRAPH lC 5TANDARD5 DESIGN LOAD CALCULATION5 MINIMUM UNIFOIP-ivlLy DISTRIBUTED LIVE LOAD5 (lb*f) J 0 ¢9 and J ¢~5 $BC High Wind ~dltlOn Wood Frame Construction IDESIGN cATEG°P''Y IB I'Ac°ntlnu°usl°ad?aOhbe~weenf°°tlngs, f°undatl°nswalls, fl°°rs, studsand WIND 2. Approved connectors, anchors and other fas~enmg STRU CTU RAL MEMBER ALLOWABLE DEFLECTION aiding, framing anchor* or connecbora shall be provld~ detached ee rafeer~ collar ~,es of I xG or 2x4 lumbe~ ,s located ,n TABLE P-.SO I ,G ALLOWABLE DEPLECTiON OF STRUCTURAL MEMEDEP.5 STRUCTURAL MEMBER ALLOWABLE DEELECTION NAILING SCHEDULE GENERAL NOTES: TABLE 3, I, INCLUDING 3,3 AND 3 B 1995 SBC HIGH WIND EDITION WOOD FRAME CONBTRUCTION MANUAL c PLUMBING ¢ HVAC NOTED: Intuition ra~nB~ aha m~s~alla~mon Iocabo~s as mal~ on f[oo~' pr~.~ t ~mo.~ Bd INTFRffb~ 70NE - I G" O/C - Q" AT PANEL EDGES AND I 2" AT tv' (,,D INTEP-JvlEDIATE 5U PEORT5 IN THE PANEL FIELD z FLOOR 5H EATM lNG STI~UCTU PAL PANELS - I" OR LESS ~d G" EDGE/ I 2" FIELD NAILING SCHEDULE 'ABLE 3. I, INCLUDING 3.3 AND 3 9 995 SBC HIGH WIND EDITION WOOD FRAME CONBTRUCTION MANUAL JOINT DESCRIPTION NAIL QUALITY NAIL SPACING ROOF FRAMING RAFTER TO TOP PLATE TOE NAILED ~5'-0" WALL: 3 Sd PER RAFTER J 0~ 0" WALL: 4-8d PER PAPTER CdlLiNG JOIST TO TOP PLATE TOE NAILED 8'-0" WALL' 3 &d DER JOIST J 0'-0" WALL: 4 ~d PER JOIST CEILING JOIST TO PARALLEL RAFTER FACE NAILED DEE TABLE 3.7 EACH LAP SELLING JOIBT LAPS OVER PARTITION5 PACE NAILED SEE TABLE 3,7 EACH LAP SOLLAR TIE TO RAFTER PACE NAILED SEE TABLE 3,4 PEP. TIE BLOCKING TO RAFTER TOE NAILED 2-8d EACH END RIM BOARD TO RAFTER END NAILED 2 I Gd EACH END WALL FRAMING TOP PLATE TO TOP PLATE FACE NAFL~D 2- I Gd · PER FOOT TOP FLAT~S AT INTERSECTIONS FACE NAILED 4 J Ga JOINT5 - EACH SIDE STUD TO STUD FACE NAILED 2 I Ga 24" O/C H~ADER TO H ~ADER FACE NAILED I Ga J ~" O/C ALONG EDGES TOP OR BOTTOM PLATE TO STUD END NAILED 2 I Gd PER 2X4 STUD 3-I Gd PER 2×G STUD 4- I Gd PER 2X~ STUD BOTTOM PLATE TO FLOOR JOIST, BANDJOrST, END JOIST, OR BLOCKING FACE NAILED 2~ I Gd ' ~ PER FOOT PAGE: NAILING REQUfREMENTD ARE BABED ON WALL SHEATHING NAILED G" O/C AT TME PANEL EDGE. IF WALL SHEATH lNG IS NAILED 3" O/C AT THE PANEL EDGE TO OBTAIN HIGHER St-lEAR CAPACITIES, NAILING R~QUIREMENTS FOR STRUCTURAL MEMBEP~5 SHALL SE DOUBLED, OR ALTERNATE CONN~ WHEN WALL SHEATHING I~ CONTINUOUS OVER CONNECTED MEM 5E~, THE TABU~TED NUMBER OF NAILS SHALL ~E PERMITTED TO DE ~DUCED TO O J Gd NAIL PE~ FOOT. ~