HomeMy WebLinkAbout37919-Z Town of Southold Annex 8/27/2013
A P.O. Box 1179
54375 Main Road
'ffi Southold, New York 11971
} ~Q,s
CERTIFICATE OF OCCUPANCY
No: 36438 Date: 8/7/2013
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 525 Deerfoot Path, Cutchogue,
SCTM 473889 SecBlock/Lot: 97.-7-20.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this otficed dated
3/28/2013 pursuant to which Building Permit No. 37919 dated 4/8/2013
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 and alterations to an existing one family dwelling as applied for.
The certificate is issued to Gary & Randy Ackerman
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37919 8/6/13
PLUMBERS CERTIFICATION DATED 8/2/16 Cut ogue East Plumbing
Auth ' ed Si atur
rte` TOWN OF SOUTHOLD
BUILDING DEPARTMENT
~a' TOWN CLERK'S OFFICE
SOUTHOLD, NY
~b! .tsdfi
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 37919 Date: 4/812013
Permission is hereby granted to:
Fahrbach, George & Fahrbach, Christine _
525 Deerfoot Path
Cutchogue, NY 11935
To: construct addition & alterations to an existing single family dwelling as applied for
At premises located at:
525 Deerfoot Path, Cutchogue
SCTM # 473889
Sec/Block/Lot # 97.-7-20.1
Pursuant to application dated 312812013 and approved by the Building Inspector.
To expire on 10/8/2014.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $532.00
CO -ADDITION TO DWELLING $50.00
Total: $582.00
Building 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 iocatioa 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 fnan).
3. Approval of electrical irtgtallation from Board of Fire Underwriters.
4. Sworn statemenE from plumber certifying that the solder used in system contains less than 7110 of I % lead. .
5. Commercial building, industrial building, mdltiple residences and similar buildings and installations, a certificate
of Code Compliance'from architect or engineer responsible for the buildings
6. Submit Planning Board tlpprcval of completed site plan requirements.
B. For existing buildings (prior to April 4, 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 $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 $SO.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 $1 5.00
New Construction: V Old or Pre-e/xisting Building: (check one)
Location of Property: J`Z~ ~E'P~2t-~'/~ /'fITI{ ~UTGKOGGc
House No. Street \I Ha le
Owner or Owners of Property ~ 1 ~ ~r 7 ~ ~ ~y~
Suffolk County Tax Map No 1000, Section ~ Block .7 Lot ZD .
Subdivision Filed Map. Lot:
Permit No. ~ 7~/ ~ Date of Perutit. 2/- g- / ~ Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate _ _ Final Certificate: ? (check one)
Fee Subniitted_ ~ _~0,~~2ey
- 't-~`-~-
Applican Si nature
~~~aQf SO(/r~o~
Town HaII Annex ~ ~ Telephone (63 O 763-1$02
34373 Main Road Fax (631) 7G5-9302
P:O. Box f t79 G Q - _
Southold, New York (1971-0939
`~Vv~~
BUII.DING bEPARTMENI'
TOWN OF sOUTHOLD
CERTIFICATION
Date: b
Building Pertnit ,NQo.
Owner: i / Ci f-Fr f~~AU
(Please print) II t
~ c~tC 6~~t ve Lr l`~ ~
Plumber: r~-G~L ~1 ~p~( J
(Please print) Z ~ ( / - P
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
dayof~ 203 _
~C
~ ~ ~~rar~~t tt. euNC,H
- /t ~P ~ p ~IOte f r'uhfia. State of SVew.!`ori~
(~~~L~)n1it.`„`~pc-'~\ P~o.016U6185(~°.i~7
' '1~w^d in SraCfolk Qc~ rr 3~
CC r m E t Ires A(J~ii +~„i - - -
Notary Public, SU L County
T~
511fF0(K
Town Hall Annex ~~0~ COGy Telephone (631) 765-1802
54375 Main Road _ Fax (631) 765-9502
P.O. Box 1179 0 •
Southold, NY 11971-0959 y~y~! _ ~.~4~'ty~ roger.richert(a~town.southold.nv.us
BUILDING~D~E°P;"`rAj'RTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Ackerman
Address: 525 Deerfoot Path City: Cutchogue St: NY Zip: 11935
Building Permit#: 37919 Section: g7 Block: 7 Lot: 20.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
contractor: DBA: Triangle Electric License No: 4468-e
SITE DETAILS
Office Use Only
Residemial X Indoor X Basement Service Only
Commerical Outdoor X 1st Floor X Pool
New Renovation 2nd Floor X Hot Tub
Add'Rion X Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 9 Ceiling Fixtures 2 HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall FiMUres 3 Smoke Detectors 2
Main Panel A/C Condenser Single Recpt Recessed Fixures 11 CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent FiMure Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 3 Twist Lock Exit Fixures TVSS
Other Equipment:
Notes:
Inspector Signature: ~2.c~,f,~ Date: Aug 6 2013
Electrical Certrficate.xls
9~ ho~v,OF SOUlyo6
TOW OF SOUTHOLD BUILDING DEPT.
765-1802
1 NSPECTION
[ ]FOUNDATION i ST [ ]ROUGH PLBG.
( ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING /STRAPPING [ ]FINAL
[ ] FIREPLACE A CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FI
REMARKS:
l
DATE INSPECTOR
*
~OF SOUTy
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] UNDATION 1ST [ ]ROUGH PLBG.
[ FOUNDATION 2ND [ ]INSULATION
[ ] FRAMING I STRAPPING [ ]FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ J FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (RO GN) [ ] ELECTRI INAL)
REMARKS:
DATE INSPECTOR
3 L ~ l q ~o~~OF SOUTHOIo
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ] F NDATION 2ND [ ]INSULATION
[ FRAMING /STRAPPING [ ]FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
( ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL)
REMARKS:
DATE INSPECTOR
*
MoF soulyo6#
TOWN OF SOUTNOLD BUILDING DEPT.
765.1802
1 NSPECTION
[ ]FOUNDATION 1ST (UGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING /STRAPPING [ ]FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (R,OUG~H) ~ [ ]ELECTRICAL (FINAL)
REMARKS: ~
DATE D~ i3 INSPECTOR ~
3~ 5 ~ ~ ~o~.1,OF SO4lyo6
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ]FOUNDATION 1ST [ ] R UGH PLBG.
[ ]FOUNDATION 2ND [ INSULATION
[ ]FRAMING /STRAPPING [ ]FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROU H) [ ]ELECTRICAL (FINAL)
REMARKS: C,~
DATE ~Z ~3 INSPECTOR ~ v~
o~,~,OF 80GT,y_
f®~'#
TOWN OF SOUTNOLD BUILDING DEPT.
765.1802
1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING /STRAPPING [ ]FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL)
REMARKS:
DATE G lG ~ ~ INSPECTORS
_ _ _ _
/ ~
~OF SOUTy~#
c/
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
1 NSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH P BG.
[ ]FOUNDATION 2ND [ ]INS TION
[ ]FRAMING /STRAPPING [ FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL)
REMARKS: C.O
_
i
7
DATE ~ INSPECTOR
o~,~OF SO4Ty~
TOWN OF SOUTNOLD BUILDING DEPT.
/ ass-~ sot
1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING /STRAPPING [ ]FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
REMARKS:
DATE ~ L /3 INSPECTOR
FIELD Il~TSPECI~ N REPiDRT DAT$ CO
, ro
~ r~ 3 ~
FOUNDA~TON (1ST) ~
p
y
FOUNDATION (2ND) 1
~ O
~ .
d
ROUGH FRAMING & ~ ~ o ~ y
PLUMBIIVG \
\
T
f2 ~""~"`ti' ~ ~ ~
H
IN,4ULATION PER N. Y.
STATE ENERGY CODE
r
FINAL
ADDITIONAL CONIMT;NTS
~ 5 ~s G I S
~ r ~ ~ ~ ~3 y 6 ~
B -1 ~ ~ ~ 5 a~. d.~.t ce.~- C•g -
c
" ~
0
z
e
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 4 sets of Building Plans
TEL: (631) 765-1802 ~ Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTowu.NorthFork.net PERMIT NO. 7~(~ ~ Check _
Septic Form
N.Y.S.D.E.C.
Trustees
CO. Applicatioq_
Flood Permit
Eramined_ 20~.'{_ Single & Separate_ _
v StomrWater Assessment Form
Contact:
Approved_ ____~l Q~. 30 Mail to: ~Z
Disapproved ale l
Phone:
F,kpiration 1~~.~~20~
~,1 _
__-,~~~`1 Buildinglnspector
~~i '
~ f,~ LIGATION FOR BUILDING PERMIT
MAR ~ R 2013
Date , 20
INSTRUCTIONS
a. This application MUST be 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 Ocdupancy.
f. Every building permit shall expire if the work authorized has nol 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, dhe 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 Dcparhnent 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 I'or removal or demolition as herein described. 'T'he
applicant agrees to comply widh 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)
(Mailing address of applicant)
State whether applicant is owner, lessee, agen , archit ,engineer. general contractor, electrician, plumber or builder
Name of owner of premises C/ ~ ~~~2~ ~~'~~~Ai?~l
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized otticer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
I. Location of land on which proposed work wtl be done:
5L Y D~~T ~~~y~-~
fD~ l.~
House Number Street Hamlet
County Tax Map No. 1000 Section~Block 7 Lot
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .S/~1/ ~ (~~L- r~~/Lf(L 4 /~E S'.
b. Intended use and occupancy f.~ M
3. Nature of work (check which applicable): New Building Addition~Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost 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
o~cy, specify nature and extent of each type of use.
7. Dimensions of exis i g structures, ~f any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height~Number of Stories
9. Size of lot: Front ' " - ~~~eai' Depth
10. Date of Purchase Name of Former9Owner
11. Zone or use district in which premises are situated ~ ~ G
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO~
13. Will lot be re-graded? YES NO~ill excess fill be removed from premises? YES NO
14. Names of Owner of pr ises ~ ~ / Address Phone No.
Name of Architect ~ ~i?601'Z/TZ- Address Phone No
Name of Contractor ~ Address Phone No.
I S a. Is this property within 100 feet of a tidal wetland or a fi-eshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWN TRUS"FEES & D.E.C. PERMITS MAY B,~rREQUIRED.
b. [s 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 accm-ate foundation plan and distances to property lines.
17. If elevation at any point on property is at ] 0 feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? *YES NO~
* IF YES, PROVIDE A COPY. NotayCF~,~iNi,
~DtBoNNewYark
n~~,. ~1at1e1aseso
S"I A 1 E OF NF W YORK] i'icd in Ssffolk County
SS: Comna~ssivn Expires April 14, 2~j[~
COUNTY OF V~ U
being duly sworn, deposes and says that (s)he is the applicant
(Name
of individual signing contract) above named,
(S)He is the X1V~~ C
(Contractor. Agent, Corpor to Offic ,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
day of 20 ~ ~ -
NotaYyPublic r. ~ Signature of pplicant
Town of Southold -Chapter 236 - Stormwater Management
~ SWPPP -Storm Water Pollution Prevention Plan Assessment Form
GF.NF:RAi. TNFpRMATION: (All Requested Information is Required for a Complete Application)
APPIJCANr NAME: Oagr-Aare-ComrNard •Conpcbr or Otbr (CkCla Orel p '
S ~ dr OWNER: (rDllhront Nan Appllp
(N b 2~t
Adds.. ,r ~ ~ ~ vl t. ~J ~ na i
TaNphanas: V l F..~ L~ 2lto Tx.vnon.~ ~ F,.a: CV
E-MaL
~rb ~I L lP 0 I ~ E-Mae:
PraPard AdOua:
e.C.T.M. e: hafiatioa OtCoaNrecdoe Atbaay, Apposed SOaclmalBMPs, $aT
1000 O j/, BMPs, Aotrx Snipe aadlor Sequarca of Activi
wwr a.rr. nr w N„ Irrwa.MrmWFprrNrml
Naroa of earrtracfx andrw CoraaetPraon Reprrible PorYrrplsmand0on naWPPP: ~~1
~_c.. i
E • YaL•
Naar of Praaro Reaponalela far Mahaatloaa MFMmrunanCroabn Control Pnctlra: I.
I-
TaNptrrn e: Fart
E-Yaa:
p cleerrp _
Protad Parcae: O GLf Ta1M Aroeniarw
/ anwor Gnnnd Clstr.ba~ea: _ _ ,
F.rary
ryF.l.er)
ProJa40arWOn: Sbrt End ~
tA~wavalad~ ~ Lo wa: 04 f !J on.: O~
d~~ ~ I
t
W111 thB Pro Dkturbe flue
1~ (31 or Mors Acres. et 0
Arty fAle Time DUrl the Pro
ng Posed Development 7 Yes No
tlYEB: Plaaw Arrrartlw FolleMnq
a. Does the ApplManl haves DuaAlled lnapecbr On
slap ro Conduct the RequYed IrYpectlone ~ ~ 0
b. Does the SWPPP Indfcat9 HaW Fregllemgr tle Sde O O Llat Ma NANE9 adaariptlM atop Pa4nady eapayd WnrbodlaaaamarWa4rna;
InspectlOrls vrR OecIN and for Whet Perbd of Thee 7 Yes No
c. Does the SWPPP u i:..
Adeq eEsly MarrtlhrAO Temporary Q ~
i
and/a Permanent 5011 SYebalfzabn Measures? Yes No
d. Doec dle SWPPP Adequatery ldent7ya Corwlete
i
Proiecl Phadn9 Plan 1 Yw O BYas or trn - _ _
e. Doe6 itle SWPPP hNmle Adtli0mel Sita Spedac qa.d waln4ody: Nc. TMO~, 7nldl ubh4 tranaiM-J ~
Preukee that Ww Ee tlpllzed ro Protect Water twaiay 7
f. Nes Ole Applcant SubmaYda CO -----------------------ry---------------
Of Inhrlt and SWPPP Aae mpl8ted DEC NoOCe TrF• or Mpamb was . _ _
parrs Fern for Review ~ Q ~adY- ta& tetra. Creek, ww.,d,.t
by the town o1 SouMdd a ye, Ne Nota Public, State of New Yolk i
- ._---No.01$1~6
'A1'F. OF NFW YORK, f ~ ours
_CQUNTYOF. ~ Commission Expires Ar ril 14, 2
,~1_/l/ P I
~,~p ~ . J ~
That I, `~N..n.~.~..... ..~l.~f~ z being duly swum, deposes ar~says.that heJshe is the applimnt for Permit,
u ooa.n.+l
Aud thaz he/she u the . ~ .
. cSrradcr
Owner and/or representative of the Owner or Owners, and is dul au prized w ' ~ i.
make and File this Y~ perform or have perfofined the said work and to
application: that all sfatemenls contained in this a lication are true [o the best of his knowledge and belief; and
that the work will be rfornxd in the manner set forth in the application filed herewith.
Sworn to before me this; ~ ~y, ` 'y I
.-di'~
NotaryPublic• ~~~f~"",, ,_._,~~;L,{_~.,
l AFPkr+dl
SWPPP Assessment FORM: 03-12 ~
~O~~Of SUl/lyo~
Town Hall Annez 1~f Telephone (631) 765-1862
54375 Main Road
r.o. soX u7s ~ ~ ~ roger.t9chertCa~fowris7ou~t~io9d.nv.us
Southold, NY 11971-0959 ~ lyC
OUNi`I,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTF;ICAL INSPECTION ~
J
REQUESTED BY: ~1~1~~I~~/_- CC-C~/L Date:_ ~
Company Name: ~ , f~
Name:
License No.: I;
Address: ~ 3 f , j - ~ 31P L I
Phone No.: ~ ~
JOBSITE INFORMATION: (*indicates rEa~7,aa ~:7 formation}
nn
'Name: /T,~~ °r iC ~ ~C _•C~~f~~C./ ;
'Address: ~ ~ ~ ~~9.~
*Cross Street: ~C'7/)')'~f' Sr'73
*Phone No.: ~--~p
Tax Map District: 1000 Section: Block: ~ Lot:
*BRIEF DESCRIPTION OF WORK (Please Prnt ',:4 ;i~r`
ra,~s,~~~-:~o~~o~
Ac~-~,4~icws ~ acv ~x~sT~,v~ sraQlE - i -
{Please Cirrle Alt That Apply)
'Is job ready for inspection: .YES NO ough In ina
'Do-you need a Temp Cert~cate: YES NC
Temp Information (If needed) I `
*Service Size: 'I Phase 3Phase ^G~ 7.00 300 350 ,400 Other
i
"New Service: Re-connect Underground Nurlb<~•.:i Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLIC (a I, ~~9
~~~~~D
JUN - 13
~~G 3 I
82=Request for Inspection Form / ` 3 BLDG. DEPT.
~~J /1~~ TO~ND Of SODIHDLD
O _ ~`1i''
_ ,
(
- ' ~ Y ~ 'TOWN OF SOUTHOLD WKOPERTY RECORD CARD ~
OWNER STREETS VILLAGE DISTRICT SUB. LOT !
FORly//1ER OWNER DL N E ACREAGE y~,~
S W TYPE OF BUILDING
'lLLip~ l3EEr3E
ES~~ SEAS. VL. FARM COMM. I IND. I CB. MISC. Est. Mkt. Value
LAND IMP. TOTAL DATE REMARKS - ,f wiyiar
n ero+ road v
~ C) / ^2 Af~ S/a ~ %7.spp, 2•NC./~Na, Pn,rcc w•M.f3EEa ,-o ~,s.ChA.~,-cis ~
~ ~ 6 3 d 0 ` ,566 3/aY/31 3ca PvX ~9i~y z ~En N~
w ?'~P 7tw. ['c '~~i apo
6 0 ~ ~G 0 ,f" 7Q G 1y/9~ ~F~~+~~-, ~ , C - pia ~ C N~,r-:'~s ~ wF ~ sy}
~ 0 O 0 G b ~ 7 o ~ 7 7 3~Z/P ~</p/'~/(o pd"oo Cr~i ~~e rs ~p //i s ,C ~ 9 7a
A E U~.. ING CO ~ 49 / SGT/ Z -
L EL ~7 l7~~OVE FRONTAGE ON WATER
Farm ` Acre lue Per Acr Value FRONTAGE ON ROAD f r '
Ilabie 1 BULKHEAD
fable 2 DOCK
fable 3 ~e f~ _
~odland
ampland
ash land
use Plot
'a I
i
i a `F a ~ ~
I
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F; ~ ro r2 X 6 ~ I
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L ~ T ~
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I ~ I I I
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I ~ I I -i
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Foundation ~ Bath 2
P y
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M Bld a
i u - o La
9 B S
~ ~3 _ .to 3
y _ 7
Extensio
Q ~ ~ ~C {l a 3. 2~ 93 Basement /~v Floors ~u¢(
Extension Ext. Walls - (,c,, Sfr,x. Interior Finish sjZ-
Fire Place ~ Heat Q
Extension _
7e c!C / ~ X ~ ~ = .Z , 2 !r- 7~ / Porch _ Roof Type
Porch Rooms lst Floor
Breezeway ! Patio Rooms 2nd Floor
Garage ~ a. I( 2,1~ - ,5','j~ ~ v D 5 yd ~ Driveway Dormer
O. B.
~/3
OWNER (STREET I VILLAGE I DIST i SUB 10T
_ _ - i
V 7 T"'1P' 1lCG-VR~ ri.7~G7iii
OVGNER STREET ~ VILLAGE DIST. SUB. LOT
Johns J, ChAR'TE~s Dr
ERl=eat P-f/ ~uTe.6~ u~ 1~es~,PiBr
FORMER OWNER N E ACR
Moose CavE S, 0/% ~ J. Vtiv~ ciJpES .072
S W TYPE OF BUILDING
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IT .I.a A~MJCANT
REScheck Software Version 4.4.3
Compliance Certificate
Project Title: GEPPEL &SESTA RESIDENCE
Energy code: 2010 New York Energy Conservation Construction Code
Location: Suffolk County, New York
Construc8on Type: Single Family
Glazing Area Percentage: 14%
Heating Degree Days: 5750
Climate Zone: 4
Construction Site: Owner/Agent: Designer/Contractor.
y~35 6888 Cox Lane Mark Schwarz, Archkea
Cutchogue, NY 11935 28495 Main Road
Cutchogue, NY 11935
831-734185
Compliance: 7.79E Better Than Code Mawimum UA: 426 Your UA: 393
The %aeCer a Wane Than Cade index redeca how dose b aortpAetrce the hang b bead an mde tradeaR Mos.
tt OOES NOT poNde en ewNnab d eaxgy use ar wet Metlve b a ngiaxncotle hate.
e
• e..
Ceiling 1: Flat Ceiling or Sdssor Truss 1400 30.0 0.0 a 4g
Ceiling 2: Flat Ceiling or SGSSOr Truss 700 30.0 0.0 25
Wall 1: Wood Frame, 16' o.c. 1488 21.0 0.0 67
Wall 2: Wood Frame, 16' o.c. 728 21.0 0.0 39
Window 1: Wood Frame:Double Pane 282 0.330 86
Window 2: Wood Freme:Double Pane 48 0.330 i6
Door 1: Solid 35 0.330 12
Floor 1: All-Wood Jdst/Truss:OVer Urtconditloned Space 1400 19.0 0.0 ~
Fbor 2: All-Wood Jdst/Truss:Over Unoonditloned Space 700 19.0 0.0 33
Compliance Statement The proposed building design described here is consistent with the building plans, specifications, and other
calculations submitted with the pam9t applicetbn. The proposed building has been designed to meet the 2010 New York Energy Conservation
Constructlon Code requirements in REScheck Verson 4.4.3 and to comply with the mandatory requi fs listed in the REScheck Insperd;ort
Checldist. n ate,,,,
~
d',~ J CHc.iA~ T~ A~ .b 4
Name -Title ~ /-i/! S.. - D O /
lye .
.~J ~
l D u
faAY -9 2013 4~~~;.`~~
BLDG. DEPT.
TOWN OP SOUTHOLD
Project Title: GEPPEL 8 SESTA RESIDENCE Report date: 04/17/13
- _ Data filename: Untitled.rGc Page 1 of 4
REScheck Software Version 4.4.3
Inspection Checklist
Energy Code: 2010 New York Energy Conservation Constructbn Code
Location: Suffolk County, New Yor1t
Construdion Typo: Single Family
Glazing Area Percentage: tq^/,
Heating Degree Days: 5750
Climate Zone: 4
Ceilings:
? Ceiling 1: Flat Ceiling or Sdssor Truss, R-30.0 cavity insulation
Comments:
? Ceiling 2: Flat Ceiling or Sdssor Truss, R-30.0 cavity Insulation
Comments:
Above-Grade Walls:
? Wall 1: Wood Frame, 16" o.c., R-21.0 cavity insulator
Comments:
? Wa112: Wood Frame, 16" o.c., R-21.0 cevtty insulation
Comments:
Windows:
? Window 1: Wood Frame:Double Pane, U-fador: 0.330
For windows wtlhout labeled U-fadors, describe features:
#Panes _ Frame Type Thermal Break? _ Yes _ No
Comments:
? Window 2: Wood Freme:Double Pane, U-fador: 0.330
For windows without labeled U-factors, describe features:
#Panes _ Frame Type Thermal Break? _ Yes _ No
Comments:
Doors:
? Door t: Slid, U-factor: 0.330
Comments:
This door is exempt from the U-factor requirement.
Floors:
? Floor 1: All-Wood Jdst/Tmss:Over Unconditoned Space, R-19.0 cavity insulation
Comments:
Floor insulatlon is installed in pertnenent tooted with the underside of the subfloor dedctng.
? Fbor 2: All-Wood Joisf/Truss:Over Unconditioned Space, R-19.0 cavity Insulation
Comments:
Floor insulator is installed in permanent tooted with the underside of the subfloor deddng.
Air Leakage:
? Jdnts (irxiuding rim jdst Junctions), attlc access openings, penetrations, and all dher such openings in the bulMing envelope that are
sources of air leakage are seakid with caulk, gasketed, weatherstrippad or otherwise sealed with an air barrier material, suitable film or
sdid material.
? Air bartier and sealing exists on common walls between dwelling units, on exterior walls behirxj tubs/stwwers, and in openings between
window/door jambs and framing.
? Recessed lights in the building thertnel envelope are 1) type IC rated and ASTM E283 labeled and 2) sealed with a gasket or caulk
between the housing and the interior wall or ceiling wvering.
Project Title: GEPPEL & SESTA RESIDENCE Report date: 04!17/13
Data filename: Untitled.rck Page 2 of 4
• ~ Access doors separetlng wnditloned from unconditioned space are weather-stripped and insulated (without insulation compression or
damage) to at least the level of insulation on the surrounding surtaces. Where loose fill insulation exists, a baffle a retainer is installed
` to maintain insulation application.
~ Wood-burning fireplaces have gasketed doors and outdoor combustion air.
~ Automatic or gravity dampers are installed on all outdoor air intakes and exhausts.
Alr Sealing and Insulation:
~ Building ernelope air tlghtness and insulaton installatlon complies by either 1) a post rough-in blower door test result of less than 7
ACH et 50 pascals OR 2) the following items have been satisfied:
(a) Air barriers and thermal banter. Installed on outside of air-pemteable Insulatlon and breaks or jdms in lfte air barrier are fNled or
repaired.
(b) Ceilinglatfic: Air banter in any dropped ceiling/soffit is substantially aligned wtth Insula8on and any gaps are sealed.
(c) Above-grede walls: Insulafion is installed in substantial tooted and continuous alignment with the building envelope air barrier.
(d) Floors: Air bartier Is installed at any exposed edge of insulation.
(e) plumbing and wiring: Insulation is placed between outside and pipes. Batt insulation is cut to tit around wiring and plumbing, or
spreyedlblown insulation extends behind piping and wiring.
(f) Comers, headers, nenow framing cevities, and dm joists are insulated.
(g) Showerltub on anterior wall: Insulation exists between stxtwers/tubs and exterior wall.
Sunrooms:
~ Sunrooms that are thermally Isolated from the building envelope have a maximum fenestratlon U-(odor of 0.50 and the maximum
skylight U-factor of 0.75. New windows and doors separa8ng the sunroan from conditioned space meet the building themtal envelope
requirements.
Materials Identitication and Installation:
~ Materials arxf equpment are installed in accordance with the manufacturer's installation instnrrxions.
~ Materials and equipment are identlfied so that compliance can be determined.
~ Manufacturer manuals for all Installed healing and cooling equipment and service water hea8rg equipment have been provided.
~ Insulatlon R-values and glazing U-factors are deady marked on the buckling plans or spedflcatlons.
Duct Insulation:
~ Supply duds in attics are insulated to a minimum of R-8. All other duds in uncendifioned spaces or outside the building envelope are
insulated to at least Rte.
Duct Construction and Testing:
~ Building freming cavities are not used as supply duds.
~ All jdnts and seams of air duds, air handlers, filter boxes, and building cavi8es used as return duds are substantially airBgM by means
of tapes, mestlcs, liqukl sealants, gasketlng or other approved closure systems. Tapes, mastlcs, and fasteners are rated UL 181A or
UL f 81 B and are labeled according to the dud constmdion. Metal dud connections with equipment andlor fltlings are mechanicelly
fastened. Crimp Jame for round metal duds have a canted lap of at least 1 1/2 indres end are hastened with a minimum of three
equally spaced sheet-metal screws.
Exceptions:
Jdnt and seams covered with spray polyurethane foam.
Where a partially inaccessible dud connection exists, mechanicel fasteners cen be equaNy spaced on the exposed portion of the
jdnt so as to prevent a hinge eHed.
Contlnuously welded and kx*tngiype bngttudinal Jolms and seams on durds opereting at less than 2 in. w.g. (500 Pa).
~ Dud tlghtness test has been peAomted and meets one of the tolbwing test criteria:
(f) PostconsWdion leakage to outdoors task Less than or equal to 8 cfrn per 100 fr2 of condttioned floor area.
(2) Postconsfrudion trial leakage test (rxiuding air handler endosure): Less than or equal to 12 cfin per 100 fit.
(3) Rough-In total leakage test wkh air handler installed: Lass than or equal to 6 cfrn per 100 ft2 of conditoned floor area.
(4) Rough-in total leakage test wkhout air handler installed: Less than a equal to 4 dm per 100 ft2 of condi8oned tkxx area.
Temperature Controls:
~ Where the primary heating system La a forced air-furnace, at least Drat programmable thermostat Is Installed to contrd the primary
heatlng system and has sat-prints ini8alized at 70 degree F for the heatlng cyde and 78 degree F far lha cooling ryde.
~ Heat pumps having supplementary electrio-resistance heat have controls that prevent supplemental heat operetlon when the
compressor can meet the treating load.
Heating and Cooling Equipment Sizing:
Project Title: GEPPEL 8 SESTA RESIDENCE Report date: 04!17/13
Data filename: Untitled.rdc Page 3 of 4
' ~ Adddional requirements for equipment siting are inducted by an inspection for compliance with the International Residential Code.
~ For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 20091ECC Commerdaf
Building Mechanical andlor Service Water Heating (Sections 503 and 504).
Circulating Service Hot Water Systems:
~ Circulating service hot water pipes are insulated to R-2.
~ Circulating service twt water systems indude an automatic or accessible manual switch to turn off the circulating pump when the
system is not in use.
Heating and Cooling Piping Insulation:
~ HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3.
Swimming Pools:
~ Heated swimming pools have an on/off heater switch.
~ Pod heaters operating on naturel gas or LPG have an electronic pilot light.
~ Timer switches on pool heaters and pumps are present.
Exceptions:
Where public health standards require continuous pump operation.
Where pumps operate within sdar- and/or waste-heat-recovery systems.
~ Heated swimming pods have a cover on or at fha water surface. For pods heated over 90 degrees F (32 degrees C) the cover has a
minimum insulatbn value of R-12.
Exceptions:
Covers are not required when 50% of fhe heating energy is from site-recovered energy or solar energy source.
Lighting Requirements:
~ A minimum of 50 percent of the lamps in permanently installed Bghtlng fixtures can be categorized as one of the folbwing:
(a) Compact fluorescent
(b) T-s or smaller diameter linear fluorescent
(c) 40 lumens per watt for lamp wattage 15
(d) 50 lumens per watt for lamp wattage > 15 and 40
(e) 60 lumens per watt for lamp wattage > 40
Other Requirements;
~ Snow- and ice-matting systems with energy supplied from fhe service to a building shall indude automatic contrds capable of shutting
off the system when a) the pavement temperature is above 50 degrees F, b) no predpitatlon is falling, and c) the outdoor temperature is
above 40 degrees F (a manual shutoff contrd is also permitted to satisfy requirement'c').
Certificate:
D A permanent certificate is provided on or in Me elecMcel dishitartion panel IisUng the predortdnant insulatlon R-values; window
U-factors; type and effidency of space-conditioning and water heatng equipment. The certificate does not cover or obstruct the visiDllity
of the circutt directory label, service disconnect label or dh~ required labels.
NOTES TO FIELD: (liullding Department Use Only)
Project Title: GEPPEL & SESTA RESIDENCE Report date: 04/17N 3
Data filename: Untltled.rdc page 4 of 4
2010 New York Energy
Conservation
Construction Code
Certificate
Ceiling /Roof 30.00
Wall 21.00
Floor /Foundation 19.00
Ductwork (uncondldoned spaces):
s.. r
Window 0.33
Door 0.33 NA
Hearing System:
Cooling System:
Water Heater:
Name: Date:
Comments: