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Home My WebLink About38854-ZNo: CERTIFICATE OF OCCUPANCY 2/4/2015 37338 Date: 2/4/2015 THIS CERTIFIES that the building ALTERATION Location of Property: 64157 Route 25, Greenport, SCTM #: 473889 Sec/Block/Lot: 56.4-20.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/30/2014 pursuant to which Building Permit No. 38854 dated 5/6/2014 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: INTERIOR ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Wells, Thomas & Lum, Jean (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 02-03-2015 38854 12-15-2014 Resomm PHC t rize Signature Town of Southold a P.O. Box 1179 53095 Main Rd ' ► W Southold, New York 11971 631-765-1981 No: CERTIFICATE OF OCCUPANCY 2/4/2015 37338 Date: 2/4/2015 THIS CERTIFIES that the building ALTERATION Location of Property: 64157 Route 25, Greenport, SCTM #: 473889 Sec/Block/Lot: 56.4-20.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/30/2014 pursuant to which Building Permit No. 38854 dated 5/6/2014 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: INTERIOR ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Wells, Thomas & Lum, Jean (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 02-03-2015 38854 12-15-2014 Resomm PHC t rize Signature (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 38854 Date: 5/6/2014 Permission is hereby granted to: Wells, Thomas & Lum, Jean PO BOX 314 East Marion, NY 11939 To: Interior alterations to an existing single family dwelling, non -substantial, with flood permit as applied for. At premises located at: 64157 Route 25. Gree SCTM # 473889 Sec/Block/Lot # 56.4-20.1 Pursuant to application dated To expire on Fees 11/5/2015. 4/30/2014 and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION $431.20 CO - ALTERATION TO DWELLING $50.00 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT wO 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 #: 38854 Date: 5/6/2014 Permission is hereby granted to: Wells, Thomas & Lum, Jean PO BOX 314 East Marion, NY 11939 To: Interior alterations to an existing single family dwelling, non -substantial, with flood permit as applied for. At premises located at: 64157 Route 25. Gree SCTM # 473889 Sec/Block/Lot # 56.4-20.1 Pursuant to application dated To expire on Fees 11/5/2015. 4/30/2014 and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION $431.20 CO - ALTERATION TO DWELLING $50.00 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 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'eleattical 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, 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 property 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 $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. 3 2� I i•} New Construction: Old or Pre-existing Building: (check one) Location of Property: '-1 ► S `ja ,.A +P D 5�,, r, �c� P4 1 l 9 1 1 House No. Street I Hamlet Owner or Owners of Property: __3 LS Suffolk County Tax Map No 1000, Section -.'_Block (,e - Lot 14 - �L • 1 'Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept. Approvil: Underwriters Approval: Planning Board -Approval: Request for: Temporary Cerf�ficate- Final Certificate:(check one) Fee Submitted: $ Applicant Signature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 roger. richert(d-)town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Wells/Lura Address: 64157 Rt 25 City: Southold St: NY Zip: 11971 Building Permit #: 38854 Section: 56 Block: 4 Lot: 20.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: REP Electric License No: 46288 -me SITE DETAILS Office Use Only Residential X Indoor X Basement Commerical Outdoor 1st Floor New Renovation 2nd Floor Addition Survey Attic INVENTORY Service Only X Pool Hot Tub Garage Service 1 ph Heat Duplec Recpt 21 Ceiling Fixtures 2 HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors 4 Main Panel A/C Condenser Single Recpt Recessed Fixtures 14 CO Detectors 2 Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches 20 Twist Lock El Exit Fixtures TVSS Other Equipment: 2 -paddle fans, 1 -exhaust fan Notes: Inspector Signature: Date: Dec 15 2014 81 -Cert Electrical Compliance Form.xls J FEB - 4 2015 CERTIFICATION Date: e—/3// Building Permit No. Owner: (Please print) Plumber: &, -C/(, (Please print) I certify that the solder used in the water supply system contains less than 2/10 of I % lead. f� Sworn to before me this day of 20 /5 Notary Public, 7Ltlk County MCHAEL PATRICK HARRWGTM NOWY Pubk S ft dNrw Yc* Na 01HAO29M ammoCwmM EWm MMrr 24 20 Ir, �of SOUry� Ile cOUtli'l TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ [ ] FOUNDATION 2ND [ [ ] FRAMING/ STRAPPING [ [ ] FIREPLACE A CHIMNEY [ [ ] FIRE RESISTANT CONSTRUCTION [ [ ] ELECTRICAL (ROUGH) [ [ ] CODE VIOLATION [ REM ] ROUGH PLUMBING ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION ] ELECTRICAL (FINAL) ] CAULKING DATE 71<311� INSPECTOR / pf SOUjyo� G Q TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTJON [ ] FOUNDATION IST [ [ ] FOUNDATION 2ND [ [ ] FRAMING/ STRAPPING [ [ ] FIREPLACE & CHIMNEY [ [ ] FIRE RESISTANT CONSTRUCTION [ [ ] ELECTRICAL (ROUGH) [ [ ] CODE VIOLATION [ REMARKS: ;- -e,, «-eG - DATE ROUGH PLUMBING (A% ]INSULATION G J FINAL j FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION ] ELECTRICAL (FINAL) ] CAULKING % C/l£r 1v / INSPECTOR 6 vs cDUlff'1, TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 1 ] FOUND ] FOUND ] FRAMING ] FIREPLA ] FIRE RESI ] ELECTRIC ] CODE VI REMARKS: NSPEC7ROUG2HPLUR N TION 1ST [TION 2ND [ ]INSULATION STRAPPING [ ]FINAL .E 8� CHIMNEY [ ] FIRE SAFETY IN SNR CONSTRUCTION [ ] FIRE RESISTANT P AL(ROUGH) [ ]ELECTRICAL (Fl OLATION [ ] CAULKINQ DATEIV INSPECTOR W&/ -t BING CltlZ�� NSPECTION PENETRATION (FI TOWN OF SOUTFIOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/ STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE � � INSPECTOR � r4f so TOWN OF SOUTHOLD BUILDING DEPT. 7654802 INSPECTION FOUNDATION IST FOUNDATION 2ND FRAMING/ STRAPPING FIREPLACE & CHIMNEY FIRE RESISTANT CONSTRIXTION ELECTRICAL (ROUGH) CODE VIOLATION - REMARKS: ROUGH PLUMBING INSULATION FINAL FIRE SAFETY INSPECTION FIRE RESISTANT PENETRATION ELECTRICAL (FINAL) I CAULK!W DATE .r -INSPECTOR pF SOUr�,o� coul '1,�` TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 1 ] FOUND ] FOUND ] FRAMING ] FIREPLA ] FIRE RESI ] ELECTRI ] CODE V NSPEC�N TION iST [ ROUGH PLUM .TION 2ND [ ]INSULATION /STRAPPING [ ]FINAL .E 8 CHIMNEY [ ]FIRE SAFETY IN SNR CONSTRUCTION [ ] FIRE RESISTANT P :AL (ROUGH) [ ]ELECTRICAL (Fl IOLATION [ ]CAULKING IIBING �^l_ T/� � ISPECTION IElIETRATION (FI DATE �' �T' c � INSPECTOR SO/y ela�K4_�_ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION IST FOUNDATION 2ND FRAMING/ STRAPPING FIREPLACE & CHIMNEY FIRE RESISTANT CONSTRUCTION ELECTRICAL (ROUGH) CODE VIOLATION REMARKS: ] RjWGH PLUMBING INSULATION FINAL FIRE SAFETY INSPECTION FIRE RESISTANT PENETRATION ELECTRICAL (FINAL) CAULKING I Arm ago w ww. 0 �ffal DATE. INSPECTOR 700 TOWN OF lzI [ ] FOUNDATION IST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE A CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ ] ELECTRICAL (ROUGH) [ ] CODE VIOLATION LD 13UILD17 DEPT. 1802 [ ] ROUGH PLUMBING [ ] INS ION [ INAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (FINAL) [ ] CAULKING DATE INSPECTOR pF SO(/r�� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] FOUNDATION 2ND [ ] FRAMING/ STRAPPING [ ] FIREPLACE A CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ ] ELECTRICAL (ROUGH) [ ] CODE VIOLATION REMARKS: [ ] ROUGH PLUMBING [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION [ ELECTRICAL (FINAL) [ ] CAULKING DATE � INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net PERMIT NO. Examined 120 Approved 20 Disapproved a/c 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: Phone: Expiration 20_�i� k V it F I j i ing Inspector () APPLICATION FOR BUILDING PERMIT APR 292014 Date K') . C E P T. INSTRUCTIONS TO'^'"; nF SOuTNOLD ,� I z 4 , 20 1 L� tthis appticatton MUS I 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 Occupancy. f. Every building permit shall expire if the work 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 inspectioi State whether applicant(sowner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises �� 5 �L �� 3 • ►- v.�� (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. '� 2-31 Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 0415-1 Mo,�a v2D 5�.�-, L� , t3.q \\"i-1 House Number Street Hamlet County Tax Map No. 1000 Section `t 7 3 9 S� `1 Block ZS Subdivision Filed Map No. Lot `E - -z L . l Lot 1571 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy S , A b-Lj f AV ,\ L-� r}�Yom, � b. Intended use and occupancy S,rS L L- C-; eA-r- \ ".i "-" m -!;-- 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition er Wori5 I A T.;:- Q. 41 (Description) 4. Estimated Cost )-V5 L -N ,--0 5. Fee (To be paid on filing this application) If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars ► 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. N I P, Dimensions of existing structures, if any: Front `7 tc " Rear 10 (0 Depth } `F Height Number of Stories z y -,L- C N Dimensions of same structure with alterations or additions: Front C C '146 � r� Depth Wight Number of Stories ArtiaA`g r C - Dimensions of entire new construction: Front Rear Depths Height umber of Stories / t kTT" e—\ 0 ' 'Klq_: C..> , T-4 c- 9. Size of lot: Front t `l 1 -3i Rear 15 '7 . S (- I Depth 10. Date of PurchaseZ c= ► o Name of Former Owner Oks 11. Zone or use district in which premises are situated MZ ZJ-�C� 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO -K 13. Will lot be re -graded? YES NO Y Will excess fill be removed from premises? YES NO ->—\1 14. Names of Owner of premises Address 4'A 1 �;-T Mvk Phone No. ie31- 1+1 -1 - I`+ t 3 Name of Architect Address �"'T'r` `� Phone No Name of Contractor -Ao S4. w Address 12 es- L L- Phone No. &'3) - -7 !os - 17 y `] Fri. 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 MAZA-. QUIRED. Ob. Is this property within 300 feet of a tidal wetland? * YES N * 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 * IF YES, PROVIDE A COPY. STATE OF NEW YORK) , / SS: COUNTY OF5U-,-410 /l0 Y1tQS w� (`S �l ►'t L �t h1 being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (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�efore me t 's , Q t S day of GUY' 20 al�-� K L4�� Not o Public WENDY L KUKLA NOTARY PUBLIC -STATE OF N No. O1 KU6176871 Qualified in Suffolk Ci My Commission Expires Nove— — -- Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 roaer.richertfcvfowri soilrioid.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: �,��- Date: Company Name: _ CZ ( Name: �Cf License No.: Zg VIA Cz Address: Phone No.:. 7e,/ 7 Cc�0i JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: *Cross Street: /V37> *Phone No.: .3 74� i C)p 3 V Permit No.: � Tax -Map District: 1000Section: Y _ Block: Lot: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) q",:,> 1-10 I (Please Circle All That Apply) *Is job ready for inspection: ES / O Rpugh In Final *Do you need a Temp Certificate: YES / NO Temp Information (if needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service: Re -connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION 1 6 82=Request for Inspection Formes �� Scott A. Russell SUPERVISOR SOUTHOLD TOWN HALL - P. O. Box 1179 Telephone #: (631) - 765 -1560 MICHAEL.COLLINS@TOWN.SOUTHOLD.NY.US SUFFQ Ir James A. Richter, R.A. Michael M. Collins, P.E. w � C7 53095 Main Road - SOUTHOLD, NEW YORK 11971 Fax #: (631) - 765 - 9015 JAMIE.RICHTER@TOWN.SOUTHOLD.NY.US Office of the Engineer Town of Southold STORMWATER MANAGEMENT CONTROL PLAN REVIEW COVER SHEET ( TO BE COMPLETED BY THE APPLICANT) PLEASE NOTE: All Contact & Project Information Requested by this FORM is Nessary for a Complete Application. APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) /J NAME: ot�tc� �o�t1 rte. �V ADDRESS: 6 X/ l n PROPERTY OWNER: (if Different from Applicant) NAME: ADDRESS: Telephone Number: &3/ q2 7l C0 3 Telephone Number: Completed Applications can be picked up at the Engineering Department after being notified by the Department, or; it can be Mailed to the Applicant with the submission of a Self Addressed 8.5' x 11" Envelope & Appropriate Postage. DATE: 41//V Property Address / Location of Construction Work: tl,�1142 Rd SCTM#: 1000 6"6 �— D.� District Section Block Lot Required Documents for Stormwater Review: Copy of Complete Building Permit Application. Stormwater Management Control Plan. (2 Sets) Note: SMCP's are required whenever Grading or Excavations exceed 5,000 ST, when New Impervious Surfaces are created, and/or when existing Roof Systems, Driveways, Patios or other Impervious Surfaces are Re -Surfaced. De Minimis Projects will NOT be Subject to the Submission of a SMCP During the Stormwater Review! Note: These Projects would be Limited to Interior Renovations, Replacement of exterior Doors & Windows, Deck Construction with Loose Fit Decking, Installation and/or Modification of Mechanical Systems or other similar Work. A Complete Description of the Scope of Work Proposed under the Building Permit Application. A Completed Sto a er Revi w Checklist. If No or NA are Indicated, Justification is Required. 1-7'FOK E Reviewed By0 A proved• WWGG❑] A dit nal Information Required: RING DEPARTMENT USE ONLY **** Date: 3 u �/ ,0 U �. STORMWATER DATE: S C T M #' MANAGEMENT 7 / �f ) ��0 �O District Section CHAPTER 236 CONTROL PLAN CHECK LIST /Agent, Contractor. Other) / APPLICANT: (Pro rt Owner, Design Professional,g NAME: ((( 0 r✓1Gi S � C4U ,1 d", ! Telephone Number: Block Lot - S M C P - Plan Requirements: The applicant must provide a Complete Explanation and/or validation of all Information Required by this Checklist if it has not been provided! 1. A Site Plan drawn to scale Not Less that 60' to the inch MUST show all of the following items: YES NO NA If You answered No or NA to any Item, Please Provide Justification Here! If you need additional room for explanations, Please Provide additional Paper. a. Location & Description of Property Boundaries b. Total Site Acreage. , t c. Existing - Natural & Man Made Features within 500 L.F. of the Site Boundary as required by § 236-17(C)(2). �O a! d. Test Hole Data Indicating Soil Characteristics & Depth to Ground Water. O� e. Limits of Clearing & Area of Proposed Land Disturbance. f. Existing & Proposed Contours of the Site (Minimum 2' Intervals) OOO g. Location of all existing & proposed structures, roads, driveways, sidewalks, drainage improvements & utilities. Wo -bn h. Spot Grades & Finish Floor Elevations for all existing & proposed structures. O 1. Location of proposed Swimming Pool and discharge ring. 0 j. Location of proposed Soil Stockpile Area(s). k. Location of proposed Construction Entrance/Staging Area(s). �O I. Location of proposed concrete washout area(s). O�O M. Location of all proposed erosion & sediment control measures. O0� 2. Stormwater Management Control Plan must include Calculations showing that the stormwater improvements are sized to capture, store, and infiltrate on-site the run-off from all impervious surfaces generated by a two (2") inch rainfall / storm event. 3. Details & Sectional Drawings for stormwater practices are required for approval. Items requiring details shall include but not be limited to: a. Erosion & Sediment Controls. b. Construction Entrance & Site Access. c. Inlet Drainage Structures (e.g. catch basins, trench drains, etc.) d. Leaching Structures (e.g. infiltration basins, swales, etc.) 00 0O� O00 FUttivl x JWl_Y Uiecl< List- IUJJAN LU 14 4 APP[ lCA 1 lOt-4 PAGE l of 4 TOWN OF SOUTHOI_D I, LOODPLAiN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION 1 GENERA[. PROVISIONS (APPLICANT to read and 5ien)- 1. No work may stat until a permit is issued. 2 The permit may be revoked if any false statements are made herein. 3. If revoked, all work must cease until permit is re -issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. 5. The permit will expire if no work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local, state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Administrator or his/her representative to make reasonable inspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HER IN AND IN ATTACHMENTS TO _ THIS APPLICATION ARE, TO THE BEST OF MY KNOt E, TRUE AND ACCURATE. (APPLICANTS S�i'stATURE) DATE_ _° 129 I0' NAMEADDRESS TELEPHONE APP � �� -� A,� L,.��, !� `4� � S � �1�-� a �� ►�U� �i "(—t �-� 3 ENGINEER CL a>> To avoid delay in processing the application, please provide enough information to easily identify the project location. Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known landmark A sketch attached to this application showing the project location would be helpful. U'lsI tACc-'A 4�`D o2G.ar_1 T FDP(93) APPLIC I -JON = __ PAGE 2 OF a DESCRIPTION OF WORK (Check all applicabic boxes): A. STRUCTURAL DEVELOPMENT ACTIVITY STRUCTURE TYPE O New Structure X Residential (1-4 Family) ❑ Addition O Residential (More than 4 Family) Alteration ❑ Non-residential (Floodproofutg? O Yes) ❑ Relocation O Combined Use (Residential & Commercial) O Demolition C1 Manufactured (Mobile) Home (10 Manu - 0 Replacement (actured Home Pack? O Yes) ESTIMATED COST OF PROJECT S 5v) 000 B. OTHER DEVELOPMENT ACTIVITIES. Cl Fill O Mining O Drilling O Grading O Excavation (Except for Structural Development Checked Above) O Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage improvements .(including Culvert Work) O Road, Street or Bridge Construction Cl Subdivision (New or Expansion) O Individual Water or Scr System O Other (Please Specify)' After completing SECTION 2, APPLICANT should submit form to Local Administrator for review. c completed by ECTION 3: DPLAIN DE'1'ERMINATI N o LOCAL ADh1INl RAT R The proposed development is located on FIRM Panel NO, Dated The Proposed Development: O Is NQJ located in a Special Flood Hazard Area (Notify the applicant that review is complete and NO FLOODPLAIN DEVELo PME 4T PERMITt REQUIRED) O Is located in a Special Flood Hazard Area - FIRM zone designation is 100 -Year flood elevation at the site is: Ft. NGVD (MSL) O Unavailable O The proposed development is located in a floodway. IBFM Panel No. Datcd^ O Scc Section 4 for additional iastructloas. !1 SIGNED APPLICATION. PAGE 3 OF a SECTION a ADDITIONAL INFORMATION REQUIRED (To he completed by LOCAL ADMINISTRATORI The applicant must submit the documents checked below before the application can be processed: O A site plan sho—u-tg the locatioo of all e)osting structures, water bodies, adjacent roads, lot dimensions and proposed development. O Development plans, drawn to scale, and speezficatioru, including where applicable: details for anchoring structures, proposed elevation of lowest floor (including basement), types of water resistant materials used below the first floor, details of floodproofmg of utilities located below the first floor and details of enclosures below the first floor. ❑ Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acres, whichever is the lesser, the applicant must provide 100 -year flood elevations if they arc not otherwise available). O Plans showing the extent of watercourse relocation and/or landform alterations. ❑ Top of new fill elevation Ft. NGVD (MSL). 0 FloodprooCmg protection level (non-reFt: NGVDMSL. Forsidential only) (MSL). flood�i-oofed structures, app hcaut must attach certification from registered engineer or architect. ❑ Certificato regulatory flood from a registered engineer that the proposed activity in a way will not result in any increase in the height of the 100 -year flood. A copy of all data and calculations support inS this finding must also be submitted. ❑ OtheT SECTION 5 PERMIT DETERMINATION fro be completed by LOCAL ADMINISTRA'1.0—M I have determined that the proposed activity. A. O Is B. O Is not . in conformance with provisions of Local Law # .19 The permit is issued subject to the conditions attached to and made part of this permit. SIGNED , DATE If BOX A is checked, the Local Administrator may issue a Development Permit upon payment of designated fee. If BQX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from the Board of Appeals. APPEALS Appcaltd to Board of Appcals? O Ycs O No Hearing dart: Appeals Board Decision --- Approved? O Yes D No APPLICATION a PAGE a OF i SECTION G: AS -BUILT ELEVATIONS !Tobe submiticd by APPLICANT before Certificate of Compliance is issued) The following information must be provided for project structures. This section must be completed by a registered professional engineer or a Licensed land surveyor (or attach a certification to this application). Complete I or 2 below. 1. Actual (As -Built) Elevation of the top of the lowest floor, including basement (in_ Coastal High Hazard Area , bottom of lowest al member of the lowest floor, excluding piling and columns) is - S. Z Fr GVD MSL). 2. Actual (As -Built) Elevation of floodproofing protection is Fr. NGVD (MSL). NOTE: Any work performed prior to submittal of the. above information is at the risk of the Applicant. SECTION 7• COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will complete this section as apQticable based on inspeetioo of the project to ensure compliance with the community's local law for flood damage preveution- INSPP-CTIONS: DATE BY DEFICIENCIES? DYES ONO DATE BY DEFICIENCIES? DYES ONO DATE BY DEFICIENCIES? DYES ❑ NO SECTION & CERTIFICATE OF COMPLIANCEfTo be completed by LOCAL AQNIINISTT l M . Certificate of Compliance issued: DATE BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CER'T'IFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HAZARD AREA (O" ER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. fD PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: SA M, V� q -U -s 13 0 NEW BUILDING O EXISTING BUILDING �^ 9 O VACANT LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HE, RF -By CERTIFIED WITH THE REQUIREMENTS OF LO CAL LAW # , 19 SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19-, AS MODIFIED BY VARIANCE # , DATED SIGNED• DATED: C/C(93) REScheck Software Version 4.5.0 Compliance Certificate Project Wells Residence Energy Code: Location: Construction Type: Project Type: Climate Zone: Permit Date: Permit Number: Construction Site: 64151T Main Road Southold, NY 11971 2010 New York Energy Conservation Suffolk County, New York Single-family Alteration 4 (5750 HDD) Owner/Agent: Designer/Contractor: John Condon Condon Engineering, P.C. 1755 Sigsbee Road Mattituck, NY 11952 631-298-1986 Compliance: Compliance: 0.1% Better Than Code Maximum UA: 1372 Your UA: 1370 The % Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum -code home. Envelope Assemblies Floor 2: Slab -On -Grade: Heated Insulation depth: 1.7' Wall 1: Wood Frame, 16" o.c. Window 1: Wood Frame:Double Pane with Low -E Door 1: Solid Wall 2: Wood Frame, 16" o.c. Window 2: Wood Frame:Double Pane with Low -E Door 2: Solid Wall 3: Wood Frame, 16" o.c. Window 3: Wood Frame:Double Pane with Low -E Wall 4: Wood Frame, 16" o.c. Window 4: Wood Frame:Double Pane with Low -E 1,517 10.0 0.799 1212 524 23.0 2.0 0.048 21 57 0.320 18 39 0.400 16 524 23.0 2.0 0.048 21 74 0.320 24 21 0.400 8 306 23.0 2.0 0.048 13 41 0.320 13 309 23.0 2.0 0.048 13 34 0.320 11 Compliance Statement. The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2010 New York Energy Conservation Construction Code requirements in REScheck Version 4.5. KO co the mandatory require ents li ted in the REScheck Inspection Checklist. John J. Condon, P.E. Z Name - Title Signa Dafte Project Title: Wells Residence Report date: 03/24/14 Data filename: CACondon Engineering\HERS\Wells\Wells ResCheck.rck Pagel of 8 Project Title: Wells Residence Report date: 03/24/14 Data filename: C:\Condon Engineering\HERS\Wells\Wells ResCheck.rck Page 2 of 8 REScheck Software Version 4.5.0 Inspection Checklist Energy Code: 2010 New York Energy Conservation Construction Code Requirements: 0.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. section Pro-Inspection/Plan Review Plans Veirlfled l"llll�cil YeriflQtl G( ilei Y 1,-"1 `: I sfti t trrpticrns & Re .1D Value value 103.2 'Construction drawings and ?❑Complies [PR111 documentation sufficiently ❑Does Not demonstrates energy code °��°� Not Observable compliance for the buildings ,t�� . ❑Not Applicable envelope. 103.2, Construction drawings and, " ` ,,❑Complies "%� 403.7 [PR3)1 � documentation sufficiently demonstrates code � �, ❑Does Not energy r❑Not Observable compliance for lighting and mechanicals stems. Systems i ❑Not Applicable serving multiple dwelling units �� r must demonstrate compliance, with the commercial code.,, 403.6 Heating and cooling equipment is Heating: Heating: ❑Complies [PR2J2 sized per ACCA Manual S based Btu/hr Btu/hr ❑Does Not on loads per ACCA Manual j or Cooling: Cooling: ❑Not Observable :other approved methods. Btu/hr Btu/hr ❑Not Applicable Additional Comments/Assumptions: s /,v57;4/ -L- l b6 t D F•�Q 1 X5v1,A77,0P o -J IWS / . 5' 4kF F`3-0 G0ktZ A691MC r4-. A ->q4 U,, /wSc.c. e,v To SAO, 3%4 �"4- C&5AW L.L. WI*LC- 111 High Impact (Tier 1) 2 Medium Impact (Tier 2) 13 Low Impact (Tier 3) Project Title: Wells Residence Report date: 03/24/14 Data filename: C:\Condon Engineering\HERS\Wells\Wells ResCheck.rck Page 3 of 8 2010 New Yuck (Foundation Inspection Complies? ` tomn�ents/Ie►ssumptions �. Ene 303.2.1 Exposed foundation insulation ❑Complies [FO1112 protection. ❑Does Not ❑Not Observable ❑Not Applicable 403.8 : Snow melt controls. :❑Complies [FO12F ❑Does Not ❑Not Observable' ❑Not Applicable Additional Comments/Assumptions: 111 High Impact (Tier 1) 12 1 Medium Impact (Tier 2) 13 1 Low Impact (Tier 3) Project Title: Wells Residence Report date: 03/24/14 Data filename: C:\Condon Engineering\HERS\Wells\Wells ResCheck.rck Page 4 of 8 SecItiaq . #' FratlM� I #tau��t n I pection Pians Verified." Value �� V*rme Vs1�e Gomp1 7 Carit�rtentsc%A�zturaptloas : & iR ' IQ 402.4.4 Fenestration that is not site built F ❑Complies [FR20]1 is listed and labeled as meeting € t' +❑Does Not i AAMA/WDMA/CSA 101/I.S.2/A440 a❑Not Observable for has infiltration rates per NFRC❑Not 400 that do not exceed code :+ Applicable limits. w 402.4.5 IC -rated recessed lighting fixtures []Complies [FR16]2 sealed at housing/interior finish RM ❑Does Not ' and labeled to indicate Mt; = 2.0 , r Not Observable cfm leakage at 75 Pa. ❑Not Applicable 403.2.1 Supply ducts in attics are R- R- ❑Complies [FR12]1 insulated to R-8. All other ducts R- R- ❑Does Not '441 in unconditioned spaces or outside the building envelope are []Not Observable insulated to R-6. Not applicable if ❑Not Applicable all systems are ductless. 403.2.2 ;All joints and seams of air ducts, , �� Complies [FR13]1 air handlers, filter boxes, and $� } Does Not building cavities used as return Not Observable ducts are sealed.Not Applicable 403.2.3 Building cavities are not used as sqComplies 11114ot (FR15]3 ducts or plenums."7 Does Not ;�Not Observable Applicable 403.3 ; HVAC piping conveying fluids R- R- '❑Complies (FR17]2 above 105 QF or chilled fluids []Does Not below 55 QF are insulated to R-3. ❑Not Observable ❑Not Applicable 403.4 :,Circulating service hot water R- R- ❑Complies (FR18]2 pipes are insulated to R-2. ❑Does Not 14+ ❑Not Observable ❑Not Applicable 403.5 Automatic or gravity dampers are �' �`�' "'' ❑Complies (FR1912 installed on all outdoor air ❑Does Not intakes and exhausts. ❑Not Observable ME ❑Not Applicable Additional Comments/Assumptions: 111 High Impact (Tier 1) 12 1 Medium Impact (Tier 2) 13 1 Low Impact (Tier 3) Project Title: Wells Residence Report date: 03/24/14 Data filename: C:\Condon Engineering\HERS\Wells\Wells ResCheck.rck Page 5 of 8 2010 New . York 11*4"#ian linsoectlon` _` Cbmplles?, _ Comments/Assumptions Ene` 303.1 All installed insulation labeled or ❑Complies UN1312 installed R -values provided. ❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 111 High Impact (Tier 1) 2 1 Medium Impact (Tier 2) 3 Low Impact (Tier 3) Project Title: Wells Residence Report date: 03/24/14 Data filename: C:\Condon Engineering\HERS\Wells\Wells ResCheck.rck Page 6 of 8 5eeti irtal Inspection ProvisionsPlias, Plant V01111104,, value .�� farmed [F14]1 C+tmrrndr►!:§JAumpilQns & R jo ❑Does Not leakage of 8 cfm to outdoors, or ❑Not Observable 402.4.2, Building envelope tightness ACH 50 = ACH 50 = ❑Complies 402.4.2.1 verified by blower door test result' !❑Does Not [FI17]1 of &It;7 ACH at 50 Pa. This ;❑Not Observable requirement may instead be met ❑Not Applicable via visual inspection, in which 403.1.1 case verification may need to { _x � n ❑Complies V1912 occur during Insulation � []Does Not Inspection. � ❑Not Observable 402A 3 ; Wood -burning fireplaces have Complies [F118]2 j gasketed doors and outdoor ❑Does Not [F11012 combustion air., Not Observable Not Applicable 403.2.2 Duct tightness via post- cfm cfm ILJComplies [F14]1 construction with maximum ❑Does Not leakage of 8 cfm to outdoors, or ❑Not Observable 12 cfm across systems. For rough -in tests, verification may ❑Not Applicable need to occur during Framing Inspection, with maximum leakage of 6 cfm across systems and 4 cfm without air handier. 403.1.1 Programmable thermostats { _x � n ❑Complies V1912 installed on forced air furnaces. � []Does Not � ❑Not Observable []Not Applicable 403.1,2 Heat pump thermostat installed ❑Complies [F11012 on heat pumps. '�'� (' ❑Does Not ❑Not Observable ❑Not Applicable 403.4 l Circulating service hot water sr ❑Complies V11112 systems have automatic or i ° t ❑Does Not accessible manual controls. []Not Observable []Not Applicable 403.9.1 Readily accessible switch on ❑Complies IF112.13 3 heaters for swimming pools. ❑Does Not ❑Not Observable ❑Not Applicable 403.9.2 'Timer switches on pool heaters " J ❑Complies [F119]3 and pumps are present. d ° ° F❑Does Not -14 ❑Not Observable ❑Not Applicable 403.9.3 Heated swimming pools have a ❑Complies IF12013 cover. Covers on pools heated ❑Does Not over 90 QF are insulated to R-12. '[]Not Observable ❑Not Applicable 401.3 Compliance certificate posted.❑Complies [F1712 � °. ❑Does Not Q.❑NotObservable ❑Not Applicable 303.3 Manufacturer manuals for k ❑Complies [Fi1813 mechanical and water heating❑Does k Not equipment have been provided.. 111,1 I ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 111 High Impact (Tier 1) 12 Medium Impact (Tier 2) 13 1 Low Impact (Tier 3) Project Title: Wells Residence Report date: 03/24/14 Data filename: C:\Condon Engineering\HERS\Wells\Wells ResCheck.rck Page 7 of 8 11 High Impact (Tier 1) 2 1 Medium Impact (Tier 2) 3 1 Low Impact (Tier 3) Project Title: Wells Residence Report date: 03/24/14 Data filename: C:\Condon Engineering\HERS\Wells\Wells ResCheck.rck Page 8 of 8 ,� ,. �� € s �:� T �3 1,., + s .% al ''WW.. 3��sy T Er. I1 1 1 1 I1 1 I� 1 1 I� I op Ln 113/4" 27-1112" 16'-1" B'-71/2" 15-0" -------------------------- -------------,----------------- -------------- 1 V I 1 20'-1" I EX. NON BEARING WALLS TO BE REMOVED 1 , 1 ` 1 I HOT C3 1 STONE 1 1 , 1 I I� _ � 1 ' I) t � �I 1 I I f� �I1 1 LINE OF EX. BEAM ABOVE 1 it 1� li 10 1 ;I �9 I; NEW OPEN STAIR 1 1 1 � 6 i� 5 3 � 12 RISERS @ 8' 2 11 TREADS @ 10g' ;1 1 I: INCL. NOSING 34'-4 1/4' M EX. BRICK WALL TO BE REPOINTED AS NECESSARY BREAK UP SLAB AROUND PERIMETER AND INSTALL NEW RIGID INSULATION EX. WINDOW TO REMAIN (TYP.) LINE OF EX. BEAM ABOVE BOILER I 1 1 ----------------------------------------------------------------------------- NEW 3" P.C. SLAB WITH RADIANT HEAT (TYP.) 16'-03/4' NEW 2X4 STUD WALL WITH 312' CLOSED CELL FOAM INSULATION DEMENT BOARD r -NEW 3- P.C. SLAB WITH I IRRADIANT HEAT \-1/Y RIGID INSULATION `V FOOTING EX. P.C. SLAB TYPICAL BUILDING SECTION SCALE: 1/4* = T -V EX. BRINK WALLS TO BE REPOINTED AS NECESSARY PRIOR TO INSTALLATION OF co INSULATION (TYP.) N FV Pam are prepared by Condon Engineering, P.C. it is a violation of the New York State Education Law, Article 145, Section 7209, for any person unless acting under the direction of a licensed Professional Engineer, Architect, or Land Surveyor, to alter any item In any way. If an item bearing the seal of an Engineer, Architect, or Land Surveyor is altered, the altering Engineer, Architect, or Land Surveyor shall affix to the item h1s1her seal and the notation *Altered by' followed by his w signature and the date of such alterations, and a specific description of the alteration. OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE. DAT : r}2 P. ' c3'b" 53: P•,)Ti� E:L,1.__;.I:. [1 E r,r,lc, r:.NT E,T ITION F-Orl POURED 2. ' ZLJG1-I - If. l.ry ; �'C11 f Ll1fti"3lf':� 3.iP ! ILATION It. 1 ir!,`ll_ - CON, i i 11-i ON EPl! 3T [37- CO?.71i'-TP. FOF; C.() ALL CONSTRUCTI0i•1 ;;', NLEET TI -17 RECO IIREl'.lEP TS OF TE -'.E CODES OF NE'i.'1 YC;D,K STATE. N01" R` Sn0NSif3LE FOFI DESIGN OR C01,!STRUCTION ERi GFiS. VITH ALL CODES OF NEW YOR ,K S r!'-,) & TOWN CODES AS REQUIRED AH � �nr Ic nF a ,.-S�+�. r,. VJiiIU iVrriVfLr,�'Iv!.IaLvr',il R-10 RIGID INSULATION 2'-0"-AROINJD PERIMETER .BREAK UP SLAB AROUND PERIMETER AND INSTALL NEW RIGID INSULATION t ? AiCl.� ,w r. A s; e,. ..,..•,p(� Ary �^`*n � �� ,C,�..x. LE"nl .r�r „R , N � t� i r..3 i � �;.,�tr F aaa,4'a,� (%�➢'F'C.�l� 1� t,.;'�i� 1�1 kwl.,i;4�«x. NOTES: 1. WORK IS LESS THAN 50% SUBSTANCIAL IMPROVEMENT IN ACCORDANCE WITH FEMA REGULATIONS. 2. BUILDING IS LOCATED IN FEMA FLOOD ZONE AE(7) PER FEMA MAF' 36103CO15DH 3. ALL BUILDING MATERIALS LOCATED BELOW ELEVATION 9 TO BE FLOOD RESISTENT. ELEVATION TO BE VERIFIEDBY SURVEYOR. 4. LOWER LEVEL ELECTRIC TO BE REWIRED BY OWNER.