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fir. r Town of Southold Annex 8/1/2014 P.O.Box 1179 : 54375 Main Road ' ► Wti Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37059 Date: 8/1/2014 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1855 Cox Ln, Cutchogue, SCTM#: 473889 Sec/Block/Lot: 96.-3-7.4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 2/1/2013 pursuant to which Building Permit No. 37784 dated 2/4/2013 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: GARAGE ADDITION TO A SINGLE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Glover,Robert&Glover,Terri (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 37784 08-15-2013 PLUMBERS CERTIFICATION DATED t riz ignat e 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 #: 37784 Date: 2/4/2013 Permission is hereby granted to: Glover, Robert & Glover, Terri 1855 Cox Ln Cutchogue, NY 11935 To: construct a 566 sq. ft. garage addition to an existing dwelling as applied for At premises located at: 1855 Cox Ln, Cutchogue SCTM # 473889 Sec/Block/Lot# 96.-3-7.4 Pursuant to application dated 2/1/2013 and approved by the Building Inspector. To expire on 8/6/2014. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $426.40 CO -ADDITION TO DWELLING $50.00 Total: $476.40 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: I. Final survey of property with accurate location of all buildings, property lines,streets,and unusual natural or topographic features. 2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I% lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees I. 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 of Occupancy- Residential $15.00, Commercial $15.00 Date. New Construction: Old or Pre-existing Building: LIZ (check one) Location of Property: �S S Cyjy 6g � 1 House No. Street �-�✓�y Hamlet Owner or Owners of Property: �Codt t f' L, (7/vG1 t �.ti(.' GAOy�� Suffolk County Tax Map No 1000,Section D 96. y U Block 01.0 DLot 00-2-0001 Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 5d tsb Applicant Signature guFFO�,� Town Hall Annex p� C� Telephone(631) 765-1802 54375 Main Road Fax (631) 765-9502 P.O. Box 1179 0 • Southold, NY 11971-0959 ��1J►ol `l•�p�' roper.richerttu7town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Robert Glover Address: 1855 Cox La City: Cutchogue St: NY Zip: 11935 Building Permit#.. 37784 Section: 96 Block: 3 Lot: 7.4 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: East Country Electric License No: 1005-e SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage X INVENTORY Service 1 ph Heat Duplec Recpt 3 Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 2 Wall Fixtures 3 Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures 2 CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 3 Twist Lock Exit Fixtures TVSS Other Equipment: Notes: Inspector Signature: Date: Aug 15 2013 Electrical Certificate.xls 7 TOWN OF SOUTIIOLD BUILDING DEPT. 765.1802 IINSPECTION [; TION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION I 1 FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION I l ELECTRICAL (ROUGH) C 1 ELECTRICAL(FINAL) REMARKS: DATE � � 3 INSPECTOR 3 7 of s TOWN OF SOUTNOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATI 1ST [ ] ROUGH PLBG. [ ] FO ATION 2ND [ ] INSULATION [ FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE .3 INSPECTOR J i 3 oF soulyolo TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ;ROU" PLUMBING FOUNDATION 2ND [ ULATION FRAMING / STRAPPING [ FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION CAULKING REMARKS: ( r ti DATE INSPECTOR �O�y�4E SOUjya� 'Y�OUNT'l, TOWN OF SOUTHOLD BUILDING DEPT. 76S-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] I UL [ ] FRAMING 1 STRAPPING [ FIN [ ] FIREPLACE & CHIMNEY [ ] FIRE SPECTION [ ] FIRE RESISTANT CONSTRUCTION [ J FIRE RESISTANT PENETRATION [ J ELECTRICAL (ROUGH) [ J ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATEIN PE T R S C O OF SOUTy�6 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 [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) REMARKS: DATE INSPECTORS all if o r i77 K F,X i / - PLUAMING INSULATION STATE ENERGY CODE pr ADDITIbNAt COMMENTS I W11 PA � t Own - 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 SoutholdTown.NorthFork.net PERMIT NO. Z Z Check Septic Form N.Y.S.D.E.C. Trustees C.O. Application Flood Permit Examined 9"20 1) Single&Separate Storm-Water Assessment Form Contact: Approved 201 Mail to: /'j. cltyor 3 Disapproved a/c /12SS Cox- Los Phone: Expiration 20 A Building Inspector ? ; PLICATION FOR BUILDING PERMIT FEB — 1 2013 Date 20 INSTRUCTIONS BLDG DEPT, ar�ouTfa --a.-Thl pletely 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 wort:authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name, if a corporation) ?ss 60x tom. C4tc�4 a y".6� (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Oc Net Name of owner of premises allo&47- L 6ilot etz r41i exp.' (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. Location of land on which,pr000`�ed �t�f1NvM11fiV—d&n& 185S_ Cox LR Ouch o House Number Street Hamlet County Tax Map No. 1000 Section 0c6 -Ob Block b3 00 Lot 007 . D6 t 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 b. Intended use and occupancy 1-A'0-7e 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work Cxt/tASe o� (Description) 4. Estimated Cost OW 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 Tw a Cz ) 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. A--,',/i0- r 7. Dimensions of existing structures, if any: Front �7,S' Rear 7. S Depth y6 Height Number of Stories Z Dimensions of same structure with alterations or additions: Front , Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front `� Rear a Y -r,,Pept4 4*f Height Number of Stories / 9. Size of lot: Front a l Rear a/S Depth 10. Date of Purchase /A2lo( Name of Former Owner 4, GCS-&4 Tie 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 Y Will excess fill be removed from premises? YES NO 14. Names of Owner of premises 'R G/vveZ Address /1rs5" Gok La Phone No. 73y- brY Name of Architect .S'�',p4e') elz.S5�7`ti Address 3e ;,�z Sa,t4,pr,*Phone No •2dr3.-S'3J7- Name of Contractor -7'8.D Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO X * 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. 18. Are there any covenants and restrictions with respect to this property? * YES NO X * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY O 1 d'b&Rt (f de of being duly sworn, deposes and says that(s)he is the applicant (Naive of individual signing contract) above named, (S)He is the 6W4)6K_ _ (Contractor, Agent, Corporate Officer, etc.) CON TANCE:t f of said owner or owners, and is duly authorized to perform or hawa �tl � c� cmake and file this application; that all statements contained in this application are true to the besiis kIyS.Aj&q qilief; and that the work will be performed in the manner set forth in the application filed therewith. QuatlRod In Suffolk County #IV CogNf hftn 1"im Juno 01, 2016 Sworn before me tl day o 20 1 A, Notary Public Signature of Applicant Town of Southold - Chapter 236 - Stormwater Management r SWPPP - Storm Water Pollution Prevention Plan Assessment Form GENERAL INFORMATION: (All Requested Information is Required for a Complete Application) APPUCANTME: Owner-Agent-Consultant-Contractor or Other(Circle One) Property OWNER:IE Dlfrmnt than Applleanq C d< Address: !�S Address: Telephone aX: 2 3 Y (_ Fax t): Telephone tl Fax E-Malik' !?IXC "J J E-Mail: / cru Property Address: Brief Description of Construction Activity,Proposod Structural BMPa,Soil ex-T.M.AI: 1000 Sabatiration BMPs,Project Scope and/or Sequence of Construction Activity j DLYW Melon BbWr Let IProvkle AdMonai Pegg as Neared) i Nsme of Con' r and/or Contact Person Responsible for trnplementation of SWPPP: Address: �_____K_.,_.„..--__'��.2•.:..,f—:__.....__.�c�_✓_1�V__ ; Telephone t. Fax -------------------------------------------------- E-Mail: --_------_--_----,-----_-.__-__-._-.---,------_-E-Mail: .....-.. --------------------------------------- i Name of Persons Responsible for Installation B Mpintenance of Erosion Control Practice: T ^-- '----'--'-" ---+W -y- Address- ----------------------------------------- --- i Telephone# Fax# --------------------------------- - _. _.. E-Mail: ------------------------------------- F Total Area of AN ----------------------------------------- Total Area of Land Clenaing Project Percale: and/or Ground Disturbance: -----------------------------.-__---.--_---___ (9.F.!Aare) (e,F.rAaaa) Project Duration: Stag End ---------------------------------- (Anticipated) ._ __ __ _____ ____ __ _._ ..(Anticipated) Date: Date: . .------_.-.___.___.__.-,..--___..._,.-....-...-..._.,.__,._...----`-------- i I. (erode!of CelendarDays) ! Will this Project - _ _____.__...____.___.__-__ _ je (v�or More Acres at - AnyOneTimeDuringtheProposedDevelopment7 Yes No ---- ---- -------------------------------------- If YES:Please Ans%iw the Followingi -------•--_--_--._,-.------____----__IfYES:PleaseAns%iwtheFollowingl _ ------- -_. __,» __.__ . ---_---__-_---- a. Does the Applicant have a Qualified Inspector On Q Q Staff To Conduct the Required Inspections 7 Yes No b. Does the SWPPP Indicate How Frequently the Site Q List the NAMES or description of all Polantislly Impacted Waterbodies andfor Wetlands: i Inspections will Occur and for What Period of Time 7 Yes No i• j c. Does the SWPPP Adequately Identify Alf Temporary and/or Permanent Soil StabalizattonMeasures 7 Yes No "-� "-"--'-" -------------•----- d_ Does the SWPPP Adequately Identify a Complete Q Q .._.....__.._._.__........,........_......................•__..__ _........._ .._ _. _ ._ . Project Phasing Plan 7 Yes No status of tmpaeted wa e. Does the SWPPP Indicate Additional Site Specific �1dy Ng.TMDt,3g3(d)t fisted,Impaired_) Pradlces that Will be Utilized to Protect Water Quality? Yes No i f. Has the Applicant Submitted a Completed DEC Notice Type of Impacted Waterbod,leg.Lake,Creek, Of Intent and SWPPP Acceptance Form for Review = Q y say.Pond,sound,Freshweterwrslena..,) i by the Town of Southold? Yes No i STA-17 OF NF.W YORK, I. COUNTYOF...........................................SS That I,.......� 2. ....... LIJ v�. .............................being duly sworn,deposes and says that lie/she is the applicant for Permit, I (Name of individual signing Ddenaw t) And that he/she is the d.``f .4........... I. .................... ........ .............. (Owner,Contractor.Agent,Corporate Officer,etc.) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to I 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 herewith. Sworn to before me this; CONNIE D. BUNCH I I Notary PublicNo.01 State of ork �.. ...... ...............day of.. ���-�... ...__,20.13 0 r � Notary Public: .... 11--d....�_,.., , ,1\_ Qualified in Suffolk Cotun ......... ............... I tStgnalure 55JUf1'l='X{l1t`t)S'A�+ il 14,2 SWPPP Assessment FORM: 03-12 i X3113 4' --ice - tis u� C✓J P ai 4 Tdim Ebb Aunnex J R Telephone(680 765.1902: 54875 Main Road P.O..B=1179 Mger.rtchertCci "OWn.�nV us Southold,NY 11971-0959 a "v1111S it BUMDING DEPARTM ANT TOWN OF SOUTH-OLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: p—v G� "-� Date: Company.Name: T C.0 v v\v' Plarrle: I - ai(Z.. ri_icense.IVa.: ©Q S C= Address, KOO �,� r` �:. S c�uT4a 01d, (Iv t l `��': l Phone t lo.: CD l 7�o7 8 JOBSITE INFORMATION, (*Indicates- requlmd information) *Name- '� WE e. */dress: 8 � G, C.a.. C�f� osw E /U y i�pis *Cross Street: T s *Phone No.: - 3 Penrlit No.: 77$ Tax Map Plstrict: .1000 Sectlow_.f6 Block: 3 Lot: 7. ,V *BRIEF DESCRIPTION OF WORK(Please Print Cle irly) NNU MF Axm 4%C (#lease Circle At That Apply) *Is.,ob ready firer inspection: . - � YES/ NO Rough In-' *-' n' * Final.. *b*you need a Temp Ceacate: YES/ NO Temp information (If needed) *Service Size: 1 Phase. 3Phase 400 150. 200 300= 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Infbnnation: PAYMENT DILE WITH APPLICATION SURVEY OF LOT 2 N SUBDIVISION OF PROPERTY CLUSTERED SET- OFF w E LOT NUMBERS REFER TO "SUBDIV1510N OF PROPERTY CLUSTERED 5ET-OFF PREPARED FOR LEANDER GLOVER" S MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY AS FILE NO. 1134q CERTIFIED TO: MPARM" ROBERT GLOVER ROBERT GLOVER TERRI GLOVER MWA78 CU 1MWUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S$}O C SUFFOLK COUNTY TAX # 1000 - qb - 3 - 1.4 P /g0, it SURVEY DATE: 08-23-2007,0q-27-2007 �jCy &�-' /� FOUNDATION °° 0INAL 5 Y - 20 , + 0 �::. •90, � o gCh(sl A� 43 /�96 OO10 t3 •� �$YY • fat 01 kl NOTE-5: 90 v SANITARY AND WELL WERE INSTALLED TO COMPLY WITH /'ll0l• �1°ry OF NEW r REQUIREMENTS FOR SUBDIVISION APPROVAL AND BOTH �Y CONFORM TO CURRENT STANDARDS FOR SINGLE FAMILY tb, RESIDENGE5 WITH UP TO 4 BEDROOMS. 4" 5EPTIC LINE TO i •8} ""°""°""'" "°''"�'y ��a_a. SEPTIC, TANK WILL BE REPLACED, AND INSPECTED BY * * �,., a.York�. .,., 5.6D.H.5. UPON INSTALLATION. SUBDIVISION APPROVAL WAS GAINED UNDER S.GD H5. REF. # 510 - OI - 0004 `G�'.: �O bthg�LOW d PrOCt,cs a e4opteG TOPO LINES REFERENCE COUNTY TOPO MAPS PROP05ED DRY WELLS & DIAMETER 5 FOOT DEEP TO CONTAIN 2" OF RAINFALL, MINIMUM 20' FROM 5EPTIG �`b "" AREA = 43,561 S.F. OR 1.0000 Acres JOHN C. EHLEkS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIC SCALE I"= 50' RIVERHEAD,N.Y. 11901 I _ 369-8288 Fax 369-8287 REF.-\\Compagserver\pros\07\07-197c.pro a. P # 3 7 7g`e�c r BUILDING PERMIT EXAMINER CHECKLIST *Date Submitted: Date Reviewed: 2 Lo Applicant: P. 6&c/e?� Owner: / 610ver- FF Architect/Engineer: �S t Estimated Cost: SCTM# 100.0 ��' Subdivision: Zone: Conforming? Property Address: . City. Pre COs? Building Permits (Open/Expired): BP -Z/Go Z- ,Info: BP -Z/C/o Z- ,Info: BP -Z/GO Z- , Info: BP -Z/C/o Z- ,Info: BP -Z/GO Z- ,Info: Single& Separate Search Required? Y or N Determination: 3TORrr4W4-T1r,,R,_:PM144AF: REQ. Lot Size: ACT. Lot Size: REQ. Lot Cov.A07b ACT: Lot Cov. REQ. Front J ACT. Front f 5 i ' RLQ Side ACT. Side �1-?REQ. Rear PROP. Rear REQ. Height. 3-57/ ACT. Height R E 6t, s*Tiq S!DES A C T Project Description: Waterfront? Y or N? If yes, water body: Panel# Flood Zone: Bulkhead/Bluff Distance: ADDITIONAL APPROVALS REQUIRED PLA AlS(4) SIGNED, 5Fi1-F-b SuRVeY DR SITE PI-,AN_�. Suffolk County Health: Y or N - If yes, *Bed#: _ *Date: _/_/ *Permit#: Town Septic: Y-N - If no, certification required: Y or N Received: Y or N By: NYS DEC: PRE-DEC9nn5 Y or N - Date: ! / Permit #: or NJ Letter-=Notes: Southold Trustees: Y or N - Date: / / Permit #: or NJ Letter—Notes: Southold ZBA: Y or N - Date: / / Permit th —Notes: Southold Planning: Y or N- Date: / /_ Permit#: —Notes: Town Landmark C of A: Y or N DTE: _/_/_ *NYS CODE Vompliance(page 2): Y or N CoNTKA<T--0R kIceNS A15�4BJLITY L.I/lB1LI Ty 1A/o�JC/�fENS CoMp�NS.�}T/Oi1/_� Notes: a Fee Structure: Calculation: Foundation: SF X $ , =$ First Floor: SF + Initial Fee: $ Second Floor: SF + Additional Fee ( : $ Other: SF SFX $ . =$ Total: SF +Initial Fee: $ + Additional Fee ( : $ C of o FEES AS BUILT FEE TOTAL: S NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGR.APHIC DESIGN CRITERIA: Ground Snow Load:20_ Wind Speed: 120MPH Seismic Design Category;B Weathering: Severe Frost Depth: 36" Termite: M-H Decay: S-M Design Temp: II -lee Shield Underlay: YES Flood Hazards: USE/OCCUPANCY CLASSIFICATION: HEIGHT/FME AREA: TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEERED/PRESCRIPTIVE FULL FRAMING DESIGN ELEMENTS: Y/N HEADERS: Y/N WALL STUDS: Y/N GIR-DERS: Y/N CEILING JOISTS: Y/N FLOOR JOISTS:Y/N ROOF RAFTERS: YIN LUMBER SPECIES AND GRADE: YM WINDOW AND DOOR SCHEDULE: .MISSLE TEST REQUIREMENTS: Y/N EGRESS 5.7 S.F.: Y/N LIGHT 8%: Y/N `TENT 4%: Y/N NAILING/CONSTRUCTION SCHEDULE: YIN MEANS OF EGRESS: YIN PLUMBING RISER DIAGRAM: Y/N LOCATION OF FIRE PROTECTION EQUIPMENT: YIN TRUSS DESIGN: Y/N CERTIFICATION: Y/N ENERGY CALCS: YIN (RESCRECK) TOTAL COMMIENCE? 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