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Home My WebLink About36946-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 11/7/2012 CERTIFICATE OF OCCUPANCY No: 36034 Date: 11/7/2012 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 4370 New Suffolk Rd, New Suffolk, SCTM #: 473889 Sec/Block/Lot: 110.-8-29 Subdivision: Filed Map No. conforms substantially to the Application for Building Permit heretofore 1/26/2012 pursuant to which Building Permit No. 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: garage altered to living space including living room, fireplace, washer/dryer room, pantry and interior staircase in an existing one family dwelling as applied for. Lot No. filed in this officed dated 36946 dated 1/26/2012 Pantry, Interior Staircase, as applied for, The certificate is issued to Burns, Roseann (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 11/7/12 36946 9/24/12 t Plumbing A/,klS~ed ~~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 36946 Date: 1/26/2012 Permission is hereby granted to: Burns, Roseann PO BOX 261 New Suffolk, NY 11956 To: Additions & Alterations to a Single Family Dwelling (Garage Conversion to Living Space); Living Room, Fireplace, Washer/Dryer Room, Pantry, Interior Staircase, as applied for, At premises located at: 4370 New Suffolk Rd SCTM # 473889 Sec/Block/Lot # 110.-8-29 Pursuant to application dated To expire on 7/27/2013. Fees: 1/2612012 and approved by the Building Inspector. CO - ADDITION TO DWELLING SINGLE FAMILY DWELLING - ADDITION OR ALTERATION Total: $50.00 $360.00 $410.00 Inspector Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 2/10 of 1% lead. 5. Commercial building, industrial building, ~nultiple 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. New Construction: ~ . Old or Preyexisting Building! X Location of Property: H-~oou?e "~ l~) ~ ~ 5 k) ~-';l-~tS>.C2/(_.Z /~6 ~3.t~ No. Street OWner or Owners of PropertY: ~:>t;:~ ~O t0 ~l~ c) i~k.[~ Suffolk Couuty Tax Map No 1000, Section i I CO ' Block SulSdivision~ ~" Permit No. ~bc~ ~'b B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. 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. Ifa Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees t. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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 ofOccupancy - Residential $15:00, Commercial$15.10/ ~?/~), Date. I ~' (check one) Health Dept. Approval: Filed Map. Date of Permit. Applicant: "'-- Underwriters Approval: Planning Board Approval: Lot '~-~ Lot: Request for: Temporary Certificate Fee Submitted¢$~ ~' Final Certificate: .. (check ort~) ~ -- Applicant Signature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765-1802 Fax (63 l) 765~9502 ro.qer, richert~,town.southold.ny, us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Burns Address: 4370 New Suffolk Rd City: New Suffolk St: NY Zip: 11946 E~uilding Permit #: 36946 Section: 1 1 0 Block: 8 Lot: 29 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Platinum East Electric Inc License No: 34091-me SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only ~ Commerical Outdoor 1 st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Servicelph ~ Heat ~ DuplecRecpt ~ CeilingFixtures ~ HIDFixtures ~ Service 3 ph Hot Water GFCI Recpt Wall Fixtures ~.~ Smoke Detectors Main Panel NC Condenser Single Recpt Recessed Fixtures ~ CO Detectors Sub Panel NC Blower Range Recpt Fluorescent Fixture ~ Pumps Transformer Appliances Dryer Recpt Emergency Fixtures~___.~ Time Clocks Disconnect Switches Twist Lock Exit Fixtures I I TVSS Other Equipment: 200a service Notes: Inspector Signature: Date: Sept 24 2012 81-Cert Electrical Compliance Form.xls Town Hall Annex 54375 Mai.n Road P.O. Box 1179 Southoid, New York 11971-0959 Telephone (631). 765,1802 Fax (63 l). 765-9502 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Building Permit No. Owner: __ ,...(f;lease~pr~t) Plumber: ~ 6~0~ (JE- ~(Ple~e prat) I certify that the solder used in the water supply system contains less than 2/10 of 1% Sworn to before me this ~-2M~ . day of ~-b~~, 20 · ~/~ ~ (Plumber~-FfSigtmture) CONNIE D. BUNC Notary Public, State of ~\ No. 01BU618505 Qualified in Suffolk Commission Expires April Notary Public,&Ow~ County TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ [ ] ELECTRICAL (ROUGH) [ ] ROUGH PLBG. [ ]INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (FINAL) REMARKS: 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 ~i~LECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE INSPECTO~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 IN PECT/JON [ ] FOUNDATION 1ST [~"]'~ROUGH PLBG. REMARKS: FOUNDATION 2ND [ ] INSULATION FRAMING/STRAPPING [ ] FINAL FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION . / [ ] FOUNDATION 1ST [~]/R~GH PLBG. [ ] FOUNDATION 2ND [~'INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT C0NSTR~ DATE ~--~/~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] ROUGH PLBG. [ ] I~U~ATION [~FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRI~ (ROUGH) [ ] ELECTRICAL (~FINAL) REMARKS: ~ DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INS~~TiON [ ] FRAMING / STRAPPING [ ~I:INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: ~ ~ ? DATE TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION ] FOUNDATION 1ST ] FOUNDATION 2ND ] FRAMING / STRAPPING ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ] ELECTRICAL (ROUGN) [~] ELECTRICAL (FINAL) REMARKS: TOWN OF,SOUTHOLD BUILDING 'DEPARTMENT TOWIq HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.nct PERMIT NO. Examined Approved Expiration 7 ~- ~7 ,20 /.~ ~ ./,- / ;,. ,-- Building Inspector TION Date I/{I ,20 I Z FOR BUILDING PERMIT INSTRUCTIONS a. Thi : completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the ~vork authorized has not commenced within 12 months after lhe 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. ~mre o~f ap I or'name. iS~ggna ic ifa corporation) 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 Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: Paq _ Ico't z, M .qq"tToc4 . Phone: ( ailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises "~o% ~...p,q,6 b..I ::~O~ ~ (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. u Electricians License No. k Other Trade's License No. ', Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section Subdivision filosk 'O6' ' Filed Map No. Lot Lot State existing use and occupancy of pr~mises and' intended use and occupancy of proposed construction: a. Existing use and occupancy ~ [ ~ ~ ~ I b-~'2 ~ ~ t 1,3 C~ b. Intended use and occupancy Nature of work (check which applicable): New Building Repair Removal Demolition Estimated Cost ~0 6EYD Fee If dwelling, number of dwelling units If garage, number of cars Addition v/ Alteration Other Work ~ ~i~ezr9 (Description) (To be paid on filing this application) Number of dwelling units on each floor o If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front Height ~'~" Number of Stories Rear Depth ~-"~ Depth '~D"~ ~ Height t 5 8. Dimensions of entire new construction: Front ' Rear Height \ ~ Number of Stories I00 Rear [0 ~" Dimensions of same structure with alterations or additions: Front ~ ~ Number of Stories Depth ~O O'z[- Name of Former Owner 7~ 1 1. Zone or use district in which premises are situated ~',,~ 9. Size of lot: Front 10. Date of Purchase Rear Depth 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 7,, NO 14. Names of Owner of premisest2o-a¢ kto~;~% Name of Architect ~ ~ ~ Name of Contractor Address ~'~-D Address Address Phone No. Phone No Phone No. 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 cfa tidal wetland? * YES__ NO X * IF YES, D.E.C. PERMITS MAY BE REQUIRED. NO X 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. 18. Are there any covenants and restrictions with respect to this property? * YES · IF YES, PROVIDE A COPY. NO ~< STATE OF NEW YORK) SS: COUNTY OF ) 315) ~ (',,3 ~ ~ C.- ~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ~Z~,~--Ir t ~"~ (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 before me this C'//2 cJey oJ~ ~"Ot~"t V~, ,CCt~ 20j_~ ~ ! / -., . ~ '~',./,. CYNTHIA J. KESSLER / rqorary ~1/[D1112 Notary Public, State of New York Signature of Applicant -- ~' No. 01KE5006684 Qualified in Suffolk GountFc'~/q/ Commission Expires January 4, Town of Southold I Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM LOCATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A PROPERTY~ jD ? ~ STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN District ~ Block CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. CONSTRUCTION ITEM # / WORK ASSESSMENT [ Yes No SCOPE OF WORK PROPOSED a. What is the Total Ama of the Project Parcels? Total Area of all Parcels located within ~ ~. ~'(~O z~z~- 1 Will this Project Retain All Storm-Water Run-Off (Include Generated by a Two (2') Inch Rainfall on Site? the Scope of Work for Proposed Construction)-~ (This item will include all run-off created by site I-I (S.F. I Acres) b, What is the Total Ama of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed ' ~' ~ ,~ '~' Site Improvements and the permanent creation of construction activity? impervious surfaces.) - (S.F.,'~r--) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEI? PROJECT DESCRIPTION (~.~,,~.~F,~....~) DmlnageStructureslndicatingSize&Location?Thls Item.shall include all Proposed Grade Changes and - Slopes Controlling Surface Water Flow. I '~~~T~C)~ T~ 3 D°es the Site Plan and/°r Survey describe the er°si°n r'~ and sediment control practices that will be used to , conb'ol site erosion and storm water discharges. This [ ~---~ ~ ~ [ ~ ~ item must be maintained throughout the Entire · ~ ~ Construction Period. 4 W/il 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 Material within any Parcel? 5 Will this ApPlication Require Land Disturbing Activities Encompassing an Area in Excess of Five ThousandI I (5,000 S.F.) Square Feet of Ground Surface? 6 is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction U General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or. Submission of a SWPPP is required for all Construction activities involving soil Beach? fisturbances of one (1) or more acres; including disturbances of less than one acre that 7Will there be Site preparation on Existing Grade Slopes am part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen (15) feet of Vertical Rise toI I including Construction activities involving sea disturbances of less than one (1) acm where One Hundred (100') of Horizontal Distance? the DEC has determined that a SPDES permit is requlmd for storm water discharges. ( SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways, Parking Areas or other Impervious r--'l for Storm Water Discharges from Construction activity - Permit No. GP.0-10-001.) Surfaces be Sloped to Direct Storm-Water RumOffI--I 1. The SWPPP shall be prepared prior to the submittal of the NOI. The NOl shall be into and/or in the direction of a Town right-of-way? submitted to the Department prior to the commencement of construction actMty. 2. The SWPPP shall describe the erosion and sediment control practices and where 9Will this Project Require the Placement of Material, required, post-construction storm water management practices that ~n'll be used and/or Removal of Vegetation and/or the ConstnJction of any ~ ~ constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder~ ' compliance with the terms and conditions of this permit. In addition, the SWPPP shall ' Area? (rh~ ~ wi, NOT Include the Installation of ~ Apron~.) Identify potential sources of pollution which may reasonably be expected to affect the quality of storm water discharges. NOTE: If Any Answer to Questions one through Nine Is Answered with a Check Mark ~. All SWPPPs that require the post-construction stom~ water management practice in a Box and the construction site disturbance is between 5,000.$.F. & t Acre In area, component shall be prepared by a qualified Design Professional Licensed in New York a Storm-Water, Grading, Drainage & Erosion Control Plan Is Required by the Town of Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. that is knowledgeable in the I~inciples and practices of Storm Water Management. (NOTE: A Chad< Ma~ (~) and/or Ansv,~er~...~.r.e.a~.._Question is Required fora Complete Application) ,-,~n~m D, UUNCH Notary Public, State of New Yo~ STATE OF NEW YORK, No. 01BU6185050 COUNTY OF ........................................... SS Qualified in Suffolk County Comrnleaion Expires April 14, That I, ....~,,,~O...~...~...7. L'.':~,.[.~ ....... being duly swom, deposes and says that he/she is the applicant fOY'Pe~g (Name of individual signing Document) And that he/she is the ......... ~.':~.~ ................................... :' ........................................................................... (Owner, Co~tract~. Agent. Corporate Officer. etc.) Owner and/Or'representative o£ the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and fde 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 herewith. Sworn to before me this; ~ (Signature of Applicant) FORM - 06/10 Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 ax (631) 7 -5 roRer, richert~,~own.so~J~oq~.ny., us BUILDING DEPARTMENT TOWN OF $OUTHOI.I~ APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name-: License No.: Address: Phone No.: Date: K. mT~ voO~ t~~ 3~oq~ -rt(~~ ; ,..goo JOBSITE INFORMATION: (*Indicates required information) *Name: ~/L~ ~ U£~'J ~: *Cross Street: /~, ~ ~ ~ *Phone No.: ~ - '~- ~2~ Pe~it NO.: ~~ ~ ~ Tax Map Distdm: 1000 Se~ion: ) l 0 Block: Lot: *BRIEF DESCRIPTION OF WORK (Please Pdnt Clearly) 6J~q~~ T~ Lt~,~.~ ff~¢c- ~ (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: Temp Information (/~D~eded] *service Size: ~ 3Phase *New Service: ~ Underground Additional Information: . ~ Final 100 150 (200 ~,J 300 350 400 Other Number of Meters Change of Service ~--verhead-'~'~,,) PAYMENT DUE WITH APPLICATION --- 82-Request for Inspection Form Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 October 22, 2012 BUILDING DEPARTMENT TOWN OF SOUTHOLD Roseann Burns PO Box 261 New Suffolk, NY 11956 Re: 4370 New Suffolk Rd TO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy: __ Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. (contact your electrician) A fee of $50.00. __ Final Health Department Approval. v'~Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84) __ Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Planning # 765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. BUILDING PERMIT: 36341 - Alterations to existing Barn TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER FORMER OWNER VILLAGE DIST. SUB. !STRE~r LOT LAND AGE NEW FARM Tillable Woodland Meadowland House Plot Total SEAS. NORMAL Acre is p¥ ' IVL. :ARM COMM. CB. MICS. BUILDING CONDITION BELOW ABOVE Value Per Acre Value TYPE/~',.,LOF BUILDI~/~/~ ,..,,~r ~ ~ .. ,~ '"~. FRONTAGE ON WATER/o~-_J" :RONTAGE ON ROAD DEPTH ~/~ /.~ 1.~,~ DOCK COLOR QM. Bldg. ~ ?X/ri -- Y.?,,~/ ~,, Extension 5 ~/~ Extension · ~- Foundation Porch Ext Walls~"~- Breez~ay I Fire Place Patio ~~ Recreation Room Bath Floors Interior'Finish -lear Rooms 1st ·Floor Rooms 2nd Floor Dinette K. ' LR. DR. BR. Driveway FIN. B BUILDING PERMIT EXAMINER CHECKLIST Applicant: Architect/~: SCTM# 000 - tlr Property Address: +3'7o ~ Date Submitted: Owner: Subdivision: City: I ~- /~k. Date Reviewed: Estimated Cost: "f-5'-0 Zone: f-~a Conforming? A/o ~4/-~~ Pre C0s? .. Building Permits (Open/Expired): BP -Z / C/0 Z- ., Info: BP__-Z / C/0 Z-__, Info: · BP__-Z / C/0 z- Single & Separate Search Required? Y o~ Determination: REQ. Lot Size: ACT. Lot Size: 0 , Info: BP__-Z / C/O Z- , Info: BP -Z / C/O Z- , Info: REQ. LOt Coy. ao% ACT: LotCov. REQ. Front ACT. Front REQ Side ACT. Side REQ. Rear" PROP. Rear REQ. Height. 3~I ACT. Height Rl~tt, I~oTH Stb~$__~ CT ~ /~,~ ~ Project Oescriptio~~ '~: ~ ~ ~. ~ ~~ ~ t~~ ~. Waterfront~o~' ~~ ' ~ jo/~/~/ Ify~, water noay: Panelg ~ Flood Zone: ~ ~Ul~ead/BluffDistance: ADDITIONAL APPROVALS REQUIRED ?L~/S (q-) $1~nE:l)., S~'S/_[b O~.~a~¥,~/.-~ 511'6 Pt-AN Suffolk County Health: Y or N- If yes, *Bed#: __ *Date: / / *Permit#: Town Septic: Y- - If no, certification required: Y or N Received: Y or N By: NYS DEC: ea~-~zc~a/T5 Y or N - Date: / / Permit #: , or NJ Letter- Notes: Sonthold Trustees: Y or N - Date: / / Permit #: or NJ Letter - Notes: Southold ZBA: Y or N - Date: / / Permit #: - Notes: Southold Planning: Y or N - Date: ::'1 /__ Permit #: - Notes: Town Landmark C of A: Y or N DTE: / Co~4TKII-c't-oR klc~-at_~ ff DI.~ABILI'rY Notes: / *NYS CODE.~_ompliance (page 2): Y or N L~t~BILI TY .Vdot?.&~/~.N~ ComP~At$4WlOA/ , Fee Structure: Foundation: SF Floor: ~ 0 SF First Second Floor: SF Other: SF Total: t~ 0 SF Calculation: c oF o __q-o, oo X ,~$ BUILT FEE I~0,, OO (~ ~c-£t-/t/C9)+ Initial Fee: $ + Additional Fee ( ): $ , SFX$. :$',' qF, oo (~~) + Initial Fee: $ ] ~o, ~ NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOG~HIC DESIGN CRITERIA: .Ground Snow Load: g0~ Wind Speed; 120MPII~ Weathering: Severe__ -Frost Depth: 36"__ Termite: M-II' Decay: S-M Design Temp: 11 .-- 'Ice Shield Underlay: YES ~ Flood IIazards: USE/OCCUPANCY CLASSIFICATION: HEIGHT/FIRE AREA: TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENG1NEERED/pREscILIPTIVE Seismic Design Category." B . FULL FRAMING DESIGN ELEMENTS: Y/N HEADERS: Y/N WALL STUDS: Y/N CEILING JOISTS: Y/N FLOOR JOISTS: Y/iN LU1V[BER SPECIES AND GRADE: Y/N GIRDERS: Y/N ROOF ILAFTERS: YfN WINDOW AND DOOR SCHEDULE: .MISSLE TEST REQUIREh{ENTS: Y/lq EGRESS 5.7 S.F.: Y/N LIGHT 8%: Y/N ~rENT 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 (Re$¢}IECK) TOTAL COMPLIENCE? Y/N (RETURN TO PAGE ONE) I]L L PO0 r'q D~T O~ -1' '1 --r 2 PL~OI COMPLY WiTH ALL CODES OF NEW YORK STATE & TOWN CODES rR,: ;lNG ELECTRICAL & CAULKING 3, 'iS r_ANON 4 r IN;,L. CONSTRUCTION & ELECTRICAL ,IUS Y BE COMPLETE FOR C,O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE, NOT RESPONSIBLE FOR DES GN.OR CONET,RUCTION ERRORS, PLU~4 ~lr-lA ELECTRICAL INS%~.PECTION REQUIRED :.i i'~ [ :r_~::___ - - - ~NeBEFO~E'd~hING ' ~ { ~ ' ~ 15 --~ WITHOUT CERTIRCA OF OCCUPANCY' ~b~PT P--L-F