HomeMy WebLinkAbout41138-Z ��p�gdFFDI���Gy Town of Southold 1/4/2017
P.O.Box 1179
a' 53095 Main Rd
oy� p� - Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 38756 Date: 1/4/2017
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 2165 Old Orchard Rd, East Marion
SCTM#: 473889 Sec/Block/Lot: 37.-341
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/2/2016 pursuant to which Building Permit No. 41138 dated 11/2/2016
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:
"AS BUILT"PARTIALLY FINISHED BASEMENT AND OUTDOOR SHOWER TO AN EXISTING ONE
FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Fisher,David&Douglas
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41138 01-03-2017
PLUMBERS CERTIFICATION DATED
16
0 t d Signature
o��u o xco TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y z TOWN CLERK'S OFFICE
o • SOUTHOLD, NY
0
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#: 41138 Date: 11/2/2016
Permission is hereby granted to:
Fisher, David & Douglas
1500 Brecknock Rd Apt 318
Greenport, NY 11944
To: legalize an "as built" basement alteration as applied for.
At premises located at:
2165 Old Orchard Rd, East Marion
SCTM #473889
Sec/Block/Lot# 37.-3-4.1
Pursuant to application dated 11/2/2016 and approved by the Building Inspector.
To expire on 5/4/2018.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $884.80
CO -ALTERATION TO DWELLING $50.00
Total: $934.80
7
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 electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead.
5. Commercial building,industrial building,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
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.
New Construction: Old or Pre-existing Building: (check one)
Location of Property: 2 mo eg-c p-J) V__9
House No. Street Hamlet
Owner or Owners of Property: V50 6�is �✓
Suffolk County Tax Map No 1000, Section Block I�S Lots
Subdivision ( r Filed Map. Lot:
Permit No. `C Date of Permit. Applicant: l(J1�
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
dd
Fee Submitted: $ 1-7
�kp licant Signature
\\pF SOU��®l
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G Q
Southold,NY 11971-0959 fly y® roger.riche rt(a�town.southold.ny.us
C®UNN,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To- Fisher
Address: 2165 Old Orchard Road City: East Marion St: New York Zip: 11939
Building Permit#: 41138 Section: 37 Block: 3 Lot: 4.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Custom Lighting of Suffolk License No: 38893-ME
SITE DETAILS
Office Use Only
Residential X Indoor X Basement X Service Only
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 12 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors 2
Main Panel A/C Condenser Single Recpt Recessed Fixtures 10 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: 2- Combination Smoke/ CO Detectors
Notes:
Inspector Signature: Date: January 3, 2017
0-Cert Electrical Compliance Form.xls
SO
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ti o
cou
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG..
[ ] FOUNDATION 2ND [ ] SULATION
[ ] FRAMING / STRAPPING [ FINAL m /
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
�/Pb ,QsyarI Ks �✓
co win
DATE I I11 INSPECTOR
SOblyO
�y00UNi`1,��
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION ,
[ ] FOUNDATION 1ST [ ] R GH PLEIG.
[ ] FOUNDATION 2ND [ ] . SOLATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: 1 iNyxwplrcl
y ti 64AI
N ter ► l
DATE j V INSPECTOR
OF SOUlyo
TOWN OF SOUTHOLD BUILDING DEPT.
765-1602 `
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] SULATION
[ ] FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
RE1111AR S: 7'�Y�O�� ar✓ Vhf �m'�` o�
OLIN r
DATE 1 INSPECTOR
Of SO�TyOIo
4 coum,
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) �� ELECTRICAL (FINAL)
REMARKS: /
rl G�
DATE 1 ? INSPECTORS
IDDelfino Insulation Co. Inc.
317 Burman Blvd,Calverton,NY 11933
Phone:(631)329-7181 Fax:(631)329-7159
December 22,2016
Doug Fisher
PO Box 273 DD
East Marion,NY 11939 1�' DEC 2 7 2016
Re: 2615 Old Orchard BUILDING DEPT.
East Marion,NY 11939 TOWN OF SOUTHOLD
To Whom it may concern,
This letter is to confirm that Delfino Insulation installed SES 2 Ib.Closed Cell Spray Foam at the above
reference jobsite. We sprayed 3"of closed cell foam in the Sleepers Over Slab Floor which is equal to an
R-20 insulation value.
Thankyou
Tammy Mazzara
Manager
Delfino Insulation Co.
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION (IST)
y
-------------------------------
FOUNDATION(2ND)
- z
o �
r
LT® -�
ROUGH FRAMING& y
PLUMBING
INSULATION PER N.Y-.
STATE ENERGY CODE
• l ti� I �i 4ita�i
FINALDiruwA K twtu/w S r + A ' AVIA .,
�� Dr wit l Cans I
ADDITIONAL C MMENTS
3
- 15- pA _ l •0 .06 0 o
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TOWN OF SOUTHOLD- BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying9
TOWN HALL Board of Health
SOUTHOLD,NY 11971 "t 4 sets of Building Plans
TEL:(631)765-1802 Planning Board approval
FAX:(631)765-9502 J Survey
SoutholdTown.NorthFork.net _ PERMIT NO. L Check,
Septic Form
„N.Y.S•D.E C
Trustees
C.O Application
Flood Permit
Examined 20 Single&Separate
l Storm-Water Assessment Form
/ tact: ,,..ff
Approved � 20` l Ma or�L //�
Disapproved a/c
Ph e: 4 (y — LJ L¢
Expiration M ,20
ector DD =
APPLICATION FOR BUILDING ERMIT
NOV - 1- 2016' l
Date
INSTRUCTIONS
BUI 1 ]G�DM ST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
�sEis'a °a� Pian 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 inspections.
(Signature of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises F'KSMW
(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 proposed work will be done: t-
2c&e,
House Number Street Hamlet
County Tax Map No.1000 Section Block otr
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
3. Nature of work(check which applicable):New Building Addition Alteration
Repair - Removal Demolition Other Work
.. , (Description)
4. Estimated Cost 14 �' 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 occupancy,specify nature and extent of each type of use.
7. Dimensions of existing structures,if any:Front 40,2( Rear 2:2+4, Depth
Height ICo-�-� Number of Stories
Dimensions of sa a structure with alterati ns gr additions:,Front 2- i ,...,-Rear - , 7
Depth �,0� Height �t`F Number of Stories
8. Dimensions of entire new construction:Front Rear -Depth h";
Height Number of Stories
9. Size of lot:Front Rear Depth
A`
10.Date of Purchase Name of Former Owner
11.Zone or use district in which premises are situated
12.Does proposed construction violate any'z ring law,ordinance or regulation?YES NO
,t
13.Will lot be re-graded?YES NO Will excess fill be removed from premises?YES NOLW�4
14.Names of Owner of premises V 0 q5E-1;Le-r Address2t/109 4).D& Phone No.A&I-439, 7��
Name of Architect [, _ A Addr-ss P1 &(2 Phone No
Name of Contractor Address ,. Phone No. /
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES ,NO v
*IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAYBE QUIRED.
b.Is'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 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—Z
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF c
Fv
-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 kno ledge and belief,and that the work will be
performed in the manner set forth in the application filed therewith
Sworr t before me thi
day of 20_
A-01
Notary Public Signature of Applicant
,:ONNIE D. BUNCH
Noi,,)ry Public,State of New York
No.01 BU6185050
,; ualified in Suffolk County
i ornmission Expires April 14,2 0�0
SubdivWon%i t :+ +'+ Filed Map No. Lot l 0 f, ?, a
, .s !7i s,:'i , f rr t:,f , .• i „3f , i{. .
2. State existing use'and.occupancy of premises and intended use and occupancy of proposed=nstruction:tr i i?
a. Existing,use and occupancy
b. Intended use and occupancy ��
3. Nature of work(check wIifcli'applicable):New Building Addition Alteration '
RepairRznovl„T Demolition Other Work
(Description))
,f• f, escri tion
4. Estimated Cost ;; �>�Ov 1,- Fee
. %v ; �,:,�,,- (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
•)t
6. If business,,commercial or mixed occupancy,specify nature and extent of each type of use.
7. Dimensions of existing sti ictures,if any:Front 40,2 Rear { Depth�c!
Height 161-4-1 Number of Stories I .-
Dimensions of sante structure with alterati ns-9r-.additibns:1Front 7 21 ! ! �'Rear I-,
Depth Height ��
De Number of Stories
�
8. Dimensions of entire new construction:Front Rear `"Depth
,"Height ANumber of Stories
9. Size of lot:Front Rear Depth
c , ,;• ui7'j�t;' L'^,D' .+!vz _ .. , !', I •{! t,",,.f' 3 . ,-c >s •
10.Date of Purchase
Name of Former Owner•,f
• ,' rt:'i rffi i':.+!:,sif(t.tis'� I.'. i.f l.•• . /I :" . , � •}5 ,1•. I , I � .:6. • t '
11.Zone or use district in which premises are situated
12.Does proposed con&dai'on violate ariy'z f tiih' '14,,,ordinance or'regulation?'YES •NOT
13.Will lot be re-graded?YES NO Will excess fill'be removed from premises?YES 'NO �
14.tNames,Q£Qwner._opr ises, "",f �.Aclilress �!f)d.f� honlo; l- 7X6
Name of Architect:rt ( �c Get ;Address, , ,hone No
Name of ContractorAddress ,„• ri;!,.'t_•t,m.•r., -Phone No.;
” '::;',.J• :!!tf 1s i c',:'!;f:f:r: 'tf, '•,'..•.i " di; ', ' ,.. ipr'.t: k•• .t ^i, `A'vi ("t
15 a.Is this,pi`bperEy withiwl 000 feet of a:, dal wettand-or asfreshwater�*etland?." S•••• ANO,✓.
*IF'YES§;:S`OUTIHOLD TOWN TRUSTEES'&D,.E.C.-PERMITS MAY,BE ` QUIRED:'=i r'
b.Is`ttu`st'propert}�`tiiit-11'u`ri�300•feet`ofa'tidalwetlarid?s*'YES''' •''''NO'S ")'�{i •.t. - ' ,' ,. "
*IF YES,D.E.C.PERMITS MAY BE REQUIRED: r; _-r. , •. . '
16.Provides surgey,to tscale,with accurate foundation plan and distances to property lines.
,i.:,•
17.If elevation at any point on property is at 10 feet or below,must provide topographical data on su ey.
18.Are there any covenants and restrictions with respect to this property?*YES NO
*IF'YES,PROVIDE A COPY.-,>,i.•s.:�. •,.. , .r,., •, ,.�•a, „ , .• " � ,, .. ' ",a" art . ',; t ,
STATE OF NEW YORK)
Ss-
COUNTY OF`G�c
uj t•
duly'swom,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the / ^/moi k2Gf__
(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 kno ledge and belief;and that the work will be ,
performed in the manner set forth in the application filed therewith.
Swowtq before me this
day of 20� !
rA
Notary-Public °_ + Signature of Applicant,
;;ONNIE D. BUNCH
lvvarf Public,State of New York
No.01 BU6185050
:1uaHfied In Suffolk County
Coemission Expires April 14,2��
0�S0�/j,�o!
Town Hall Annex J 41 Telephone(631)765-1802
54375 Main Road pax(631)765.
P.O.Box 1179 • roger.richedde4 n.sou�liot�.ny.us
Southold,NY 11971-0959
BUMDING DEPARTMENT
TOWN OF SOUTHOLD '
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY- �. Date: I
Company Name: CU -(-CM Ur4 h+im /
Name: '
License No.:
Address: G)S> Qy tqsa
"Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Address: 10 f pg
*Cross Street:
*Phone No.: g
Permit No.: '
Tax-Map District: 9000 Section: 2 Block: _ Lot: 46
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
Z YL I
I
(Please Circle Al!That Apply) ,
*is job ready for inspection: YES/ NO Rough in Final f
*Do-you need a Temp Certificate: YE �NQ j
Temp Information (if-needed)
*Service Size: 9 Phase 3Phase 100 950 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: - PAYMENT DUE WITH APPLICATION �,\li ��
.�
\ I .
\�882-Request for Inspection Form G
C/
TOWN— OF SOUTHOLD PROPERTY RECORD C'XR—D
OWNER STREET 2/ (, '--
VILLAGE DIST. sub. LOT,
FORMER OWNER N E ACR
W TYPE OF BUILDING
SES. VL. FARM COMM. CB. MISC. Mkt. Value
LAND imp. TOTAL DATE REMARKS -7 L_Zfq gqp. elf,
�3)
-3 7-3 `3
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
Tillable I
Tillable 2
Tillable 3
Woodland
Swampland FRONTAGE ON WATER
Brushland FRONTAGE ON ROAD
House Plot DEPTH Z,
BULKHEAD
Total DOCK
TOWN OF SOUTHOLD PROPERTY�t-s`RECORD RD-
OWNER STREET Zf 55 VILLAGE DIST. ` ` SUB. -LOT
r�..-�- fir%(.-��' ' ! --^=' tx....�t....1 '=�- �,L,TJ Q/�CI7/��'�I L��� �' `� ✓'e'�J ,. � a.
FORMER OWNER v N E
S W TYPE OF'BUILDING
i
ES. SEAS. VL. ' FARM COMM. CB. MISC. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
001,
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
'illable 1
illable 2
illable 3
/oodland
wampl-and FRONTAGE ON WATER
r.ushlond FRONTAGE ON ROAD
ouse Plot DEPTH tj '
BULKHEAD
otal DOCK
�t.)p/ Y`�RtttyYYY I'Y. Q.i Jlf! S ( �6rkj b'.tr ryM {1 -i�.*3 SY t
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1. :. : - � _ � End= ��■ESI■■■��■■■■■■■■■■■■■■■■■■■
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a
•• • , � � �u • •••
Rooms 2nd •• ®-
•• MEN •t►
.� TOWN -OF SOUTHOLD PROPERTY RECOttD CARD
oao - � 7 3 , rt
OWNER �s ) STREET '�� VILLAGE
DIST':= SUB. LOT
C/i U d car / C �e tom/ % /�j O L V, VliMD
FORMER OWNER N E -ACR '
S W :TYPE OF BUI'L'DING
,ES bb SEAS. VL. FARM COMM. CB. MISC. Mkt. Value i
LAND IMP. TOTAL DATE REMARKS 7)1 Y16
A:o0 1" 00 7. .3 _ x:
.04Z2p 10liql ! Z - /�-
AGE BUILDING CONDITIO.
NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre
F illable 1
"illable 2
- 1
"illable 3
Voodland
-wompland FRONTAGE ON WATER
;rushland FRONTAGE ON ROAD
louse Plot DEPTH I,
dA
BULKHEAD
otal DOCK ,
SEEM
EMEEMEMOSEMEMN■MEMEN
SEE■I MEMENIMMEME
Extension Fire P I ioce
• __ -
Rooms Ist Illoor
Rooms 2nd Floor =
Porch C.4 M �® •. -7
Breezeway -� • -
Ga
7- _®.
Patio __
B.
Total
4:4
S C.T.M. NO. DISTRICT: 1000 SECTION: 37 BLOCK: 3 LOT(S):4.1
PIPE LOT 12A LOT 1OA
PIPE
0 L EDW FD o 2'E S 31*01'30" E FD 1.3'E WOOD FE.I.5'N80.00'
EL 15.1 EL >)3.4,ONC.
MON
, FD -
LOT 12 LOT_ 11 p
10 y N
l
A( 0 RE R VE
Tl .I) EL 10.9
O �J yp EL 13.0 LOT 9
N
24 t' 34.4. 21.5'
I 15.3' 4.0 \
STORAGE
N (TO BE REMO D)
PROPOSED r; OOF OVER
EL 16.1 ��N (�0 BE REM ED)
24.3' 10.0' h 11'
t 5.3'
EXISTING
1 STY, FR.
DWELLING
12165 N
1ST FL
EL 15.5
EXISTING
PWOPO SED 0 SCREENED
/ of PORCH
[�] 16.0' 1 22.4' a tL�
7 15.1'
EL 14.6 /
Oto
, C / � I •� _! -' G PIPE
0Q v� O
0 �. FD o 4//'N 120.15
- - co .� \O LE I?
L -�
tC� _
WATER
,z METER 0
EL 16.2 FENGE 12
pE. o.2'E Rp,\1. o L.$Z.
R�431.68 go ��
A g� (30
CL 12.79 —`
CC 15.16 oR CL 13.94 �
of
A r j ID AA&
U.P.119
` 4^ t
FIRM ZONE X
N
ADD PROPOSED ADDITION 03-03-08 THE WA SUPP. , ND CE '`L --
LOCATIONS S D 08SERVATIONS
REVISE HOUSE DIMENSIONS 11 -27-07 AND OR DATA OBTAINED FROM OTHERS.
AREA 8,523 S.F. OR 0.2 ACRES ELEVATION DATUM: _ASSUMED
UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY, GUARANTEES INOICA TED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE' FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREM1SES AT THE TIME OF SURVEY
SURVEY OF. LOTS 10 & "11 1
CERTIFIED T0: DAVID FISHER: _
MAP OF. GARDINER'S BAY ESTATES -SECTION 2
FILED, SEPTEMBER 23, 1927 AS #275
SITUATED AT EAST MARION
TOWN OF SOUTHOLD KENNETH M. WOYCHUK L.S.
SUFFOLK COUNTY, NEW YORK Land Surveying and Design
j P.O. Boz 3, Mattituck, New York, 11952
FILE # 27-97 SCALE, 1"=20' DATE. SEPT. 12, 2007 PHONE (891) 298-1588 FAX (631) 298-1588
N. Y. S. LIC NO. 50227 maintaining the records of Robert J Hennessy
Generated by REScheck-Web Software
Compliance Certificate
Project FISHER HOUSE
Energy Code: 2015 IECC
Location: Southold, New York
Construction Type: Single-family
Project Type: Addition
Climate Zone: 4 (5572 HDD)
Permit Date:
Permit Number:
Construction Site: Owner/Agent: Designer/Contractor:
2165 OLD ORCHARD ROAD DOUGLAS FISHER FRANK UELLENDAHL
EAST MARION, New York 11939 OWNER ARCHITECT
o' 'o K® ;, et .o- o ;.7.,iM�;i*a��.�zk�;''' :��•:t;�.���y7���.��;�-"'�a�6� -` � �,h+Grp::3.,�.s��`:•fa'�';s,,�,..•._ `w.¢�u�.M1an,���= ,};,�
Compliance: 0.0%Better Than Code Maximum UA: 78 Your UA: 78 Maximum SHGC: 0.40 Your SHGC: 0.32
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
Gross Area Cavity Cont.
Perimeter
Ceiling: Flat or Scissor Truss 456 38.0 0.0 0.030 14
Wall: Structural Insulated Panels 462 22.0 0.048 22
Wall:Wood Frame, 16in.D.C. 160 13.0 0.0 0.082 10
Window:Wood Frame,2 Pane w/Low-E 20 0.310 6
SHGC: 0.32
Window:Wood Frame, 2 Pane w/Low-E 12 0.290 3
SHGC:0.31
Wall:Wood Frame, 161n.D.C. 232 15.0 0.0 0.077 18
Floor:All-Wood Joist/Truss Over Uncond.Space 110 0.0 2100 0.042 5
Compliance Statement. The proposed building design describe hire i consistent with the building plans,specifications,and other
calculations submitted with the permit application.The propose it g h e n designed to meet the 2015 IECC requirements In
�REESSch/-e�c'k.Version
e5'.5.01and
to comply with the mandatory requ re a I' a the REScheck Inspection Checklist.
Name-TitleC Sin r Date
"fit 4Z7
NEV Al-
Project Title: FISHER HOUSE Report date: 10/30/16
Data filename: Pagel of 9
REScheck Software Version 5.5.0
Inspection Checklist
Energy Code: 2015 IECC
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 Plans Verified Field Verified
# Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions,
&Req.ID
103.1, :Construction drawings and ❑Complies
103,2 !documentation demonstrate ❑Does Not
[PRI]1 ;energy code compliance for the ❑Not Observable
U
:building envelope.Thermal
:envelope represented on ❑Not Applicable
construction documents.
103.1, ;Construction drawings and ❑Complies
103.2, documentation demonstrate ❑Does Not
403.7 energy code compliance for '
[:]Not Observable
[PR3]1 ,lighting and mechanical systems.
v I Systems serving multiple ❑Not Applicable
;dwelling units must demonstrate
compliance with the IECC
Commercial Provisions.
302.1, Heating and cooling equipment is: Heating: Heating: ;❑Complies
403.7 sized per ACCA Manual S based Btu/hr ! Btu/hr !❑Does Not
[PR2]2 on loads-calculated perACCA
Cooling: Cooling: 1,❑Not Observable
�j Manual J or other methods Btu/hr Btu/hr
approved by the code official. ! ; ❑Not Applicable
Additional Comments/Assumptions:
11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 1,3 1 Low Impact(Tier 3)
Project Title: FISHER HOUSE Report date: 10/29/16
Data filename: Page 2 of 9
Section Plans Verified Field Verified
# Foundation Inspection Value Value Complies. Comments/Assumptions
& Req.ID 1
[ See the
002. .2 Slab edge insulation R-value. R- R- ;❑Complies I table fo twee s e Assemblies
1 ❑ Unheated ;❑ Unheated ❑Does Not
U ❑ Heated ❑ Heated ;❑Not Observable
I :❑Not Applicable
402.1.2 ;Slab edge insulation ft ft ;❑Complies ;See the Envelope Assemblies
[F03]1 1 depth/length. ;❑Does Not ;table for values.
v I ;❑Not Observable
❑Not Applicable
303.2.1 A protective covering is installed ❑Complies f
[FO11]2 to protect exposed exterior ❑Does Not
,g) insulation and extends a ❑Not Observable
minimum of 6 in. below grade.
❑Not Applicable
403.9 Snow-and ice-melting system ❑Complies
[FO12]z controls installed. ❑Does Not
�} ❑Not Observable
❑Not Applicable
Additional Comments/Assumptions:
1 I High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: FISHER HOUSE Report date: 10/29/16
Data filename: Page 3 of 9
Section Plans Verified Field Verified
# Framing/Rough-in Inspection Value Value Complies? Comments/Assumptions
& Req.ID
402.1.1, !Glazing U-factor(area-weighted ; U- ; U- ,❑Complies ;See the Envelope Assemblies
402.3.1, average). ;❑Does Not table for values.
402.3.3, ;❑Not Observable
402.5 6 ; ;❑Not Applicable
[FR211
v
;
303.1.3 ;U-factors of fenestration products ❑Complies 1
[1711411 :are determined in accordance ❑Does Not
U
!with the NFRC test procedure or []Not Observable
;taken from the default table. ❑Not Applicable
402.4.1.1 ;Air barrier and thermal barrier ❑Complies
[FR23]1 installed per manufacturer's ❑Does Not
U ;instructions. ❑Not Observable
❑Not Applicable
402.4.3 ;Fenestration that is not site built ❑Complies
[FR20]1 :is listed and labeled as meeting ❑Does Not
u
AAMA/WDMA/CSA 101/I.5.2/A440 ❑Not Observable
or has infiltration rates per NFRC ❑Not Applicable
400 that do not exceed code
limits.
402.4.5 IC-rated recessed lighting fixtures ❑Complies
[FR16]2 sealed at housing/interior finish 4 ❑Does Not
and labeled to indicate s2.0 cfm ❑Not Observable '
leakage at 75 Pa. ❑Not Applicable
403.2.1 ;Supply and return ducts in attics ❑Complies
[FR1211 I insulated >= R-8 where duct is ❑Does Not
u >= 3 inches in diameter and >= ❑Not Observable
R-6 where<3 inches.Supply and ❑Not Applicable
return ducts in other portions of
;the building insulated >= R-6 for
;diameter>=3 inches and R-4.2
;for< 3 inches in diameter.
403.3.3.5 Building cavities are not used as ❑Complies
[FR15]3 ducts or plenums. ❑Does Not ;
f ❑Not Observable
EJ Not Applicable
403.4 HVAC piping conveying fluids ; R- R- ;❑Complies
[FR17]2 above 105 4F or chilled fluids ; ❑Does Not ;
U below 55°F are insulated to?R- ; ,❑Not Observable
3.
;❑Not Applicable
403.4.1 !,Protection of insulation on HVAC ❑Complies
[FR24]1 piping. ❑Does Not
❑Not Observable
❑Not Applicable
403.5.3 Hot water pipes are insulated to R- R- ;❑Complies
[FR18]2 ?R-3. ;❑Does Not
j ;❑Not Observable
❑Not Applicable
403.6 Automatic or gravity dampers are iE]Not
❑Complies
[FR1912 installed on all outdoor air ❑Does Notintakes and exhausts. ❑Not Observable
Applicable
Additional Comments/Assumptions:
1 I High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3)
',Project Title: FISHER HOUSE Report date: 10/29/16
Data filename: Page 4 of 9
I I High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: FISHER HOUSE Report date: 10/29/16
Data filename: Page 5 of 9
Section Plans Verified Field Verified
# Insulation Inspection Value Value Complies? Comments/Assumptions
&Re .ID
303.1 All installed insulation is labeled ❑Complies
[IN13]z or the installed R-values ❑Does Not
provided. ❑Not Observable
I❑Not Applicable
402.1.1, ;,Wall insulation R-value. If this is a; R- ; R- ;❑Complies ;See the Envelope Assemblies
402.2.5, ;mass wall with at least 3/z of the ❑ Wood ;❑ Wood ;❑Does Not table for values.
402.2.6 ;wall insulation on the wall ;❑ Mass ❑ Mass :❑Not Observable '
[IN3]1exterior,the exterior insulation E] Steel F] Steel ;❑Not Applicable
U !requirement applies(FR10). '
;
;
303.2 ;Wall insulation is installed per ❑Complies
[IN4]1 'manufacturer's instructions. ❑Does Not
[]Not Observable
!{ ❑Not Applicable
Additional Comments/Assumptions:
1 I High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3)
Project Title: FISHER HOUSE Report date: 10/29/16
Data filename: ' Page 6 of 9
Section Plans Verified Field Verified
# Final Inspection Provisions Value Value Complies? Comments/Assumptions
& Req.ID
402.1.1, ;Ceiling insulation R-value. ; R- ; R- ;[]Complies ;See the Envelope Assemblies
402.2.1, 1 ;❑ Wood ❑ Wood ;❑Does Not table for values.
402.2.2, I❑ Steel ❑ Steel ;❑Not Observable
402.2.6 ;
[Fill' ; ;[]Not Applicable
;
;
303.1.1.1,;Ceiling insulation installed per ❑Complies
303.2 :manufacturer's instructions. ❑Does Not
[17I21' ;Blown insulation marked every
300 ftz. ❑Not Observable
❑Not Applicable
402.2.3 lVented attics with air permeable ❑Complies
[FI22]2 insulation include baffle adjacent ❑Does Not
to soffit and eave vents that ❑Not Observable
extends over insulation.
i ❑Not Applicable
402.2.4 ;Attic access hatch and door ; R- R- ;❑Complies
[FI3]' insulation >_R-value of the []Does Not
adjacent assembly.
❑Not Observable
I ;❑Not Applicable
402.4.1.2 ;Blower door test @ 50 Pa. <=5 ; ACH 50= ACH 50 = ;❑Complies
[FI17]' ;ach in Climate Zones 1-2,and :❑Does Not
;
<=3 ach in Climate Zones 3-8.
❑Not Observable
I ;❑Not Applicable
403.2.3 ;Duct tightness test result of<=4 cfm/100 ; cfm/100 ;❑Complies
[FI41' cfm/100 ft2 across the system or ft2 ft2 ;❑Does Not
<=3 cfm/100 ft2 without air
handler @ 25 Pa. For rough-in :❑Not Observable
tests,verification may need to ; ;❑Not Applicable
occur during Framing Inspection.
403.3.2 ;Ducts are pressure tested to ; cfm/100 ; cfm/100 ;❑Complies
[FI27]' determine air leakage with ; ft2 ft2 []Does Not
;either: Rough-in test:Total
leakage measured with a :❑Not Observable
pressure differential of 0.1 inch ; ; ;[]Not Applicable
1w.g.across the system including
the manufacturer's air handler I ; ;
enclosure if installed at time of
;test. Postconstruction test:Total
leakage measured with a
pressure differential of 0.1 inch ;
jw.g. across the entire system
including the manufacturer's air
handler enclosure.
403.3.2.1 ;Air handler leakage designated ❑Complies
[FI24]' by manufacturer at<=2%of ❑Does Not
;design airflow. ❑Not Observable
❑Not Applicable
403.1.1 Programmable thermostats ❑Complies
[FI9]2 j installed for control of primary ❑Does Not
heating and cooling systems and
initially set by manufacturer to ❑Not Observable
code specifications. ❑Not Applicable
403.1*2 ;Heat pump thermostat installed ❑Complies
[FI1012 on heat pumps. ❑Does Not i
❑Not Observable ;
❑Not Applicable
403.5.1 Circulating service hot water ❑Complies
[FI11]2 systems have automatic or ❑Does Not
accessible manual controls. ❑Not Observable
❑Not Applicable
11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3)
Project Title: FISHER HOUSE Report date: 10/29/16
Data filename: Page 7 of 9
, � e
v
SectionPlans Verified Field Verified
# Final Inspection Provisions Value Value Complies. Comments/Assumptions
& Req.ID
403.6.1 JAII mechanical ventilationsystem 1❑Complies
[FI25]z fans not part of tested and listed ❑Does Not
HVAC equipment meet efficacy ❑Not Observable
and air flow limits.
1EINot Applicable
i
403.2 Hot water boilers supplying heat ❑Complies
[FI26]z through one-or two-pipe heating ❑Does Not
systems have outdoor setback ❑Not Observable
control to lower boiler water ❑Not Applicable
temperature based on outdoor
I temperature.
403.5.1.1 Heated water circulation systems ( []Complies
(FI28]2have a circulation pump.The fi ❑Does Not
system return pipe is a dedicated ❑Not Observable
return pipe or a cold water supply ❑Not Applicable
I pipe. Gravity and thermos-
syphon circulation systems are
II not present.Controls for j
+circulating hot water system
pumps start the pump with signal
for hot water demand within the
occupancy. Controls
automatically turn off the pump
when water is in circulation loop
is at set-point temperature and
no demand for hot water exists.
403.5.1.2 Electric heat trace systems ❑Complies
[F129]2 comply with IEEE 515.1 or UL ❑Does Not
515.Controls automatically !!❑Not Observable
adjust the energy input to the ❑Not Applicable
heat tracing to maintain the
desired water temperature in the
piping.
403.5.2 !I Water distribution systems that ❑Complies
[F130]2 lhave recirculation pumps that ❑Does Not
}pump water from a heated water ❑Not Observable
supply pipe back to the heated ❑Not Applicable
water source through a cold
iwater supply pipe have a
i demand recirculation water
}system.Pumps have controls
I that manage operation of the
I pump and limit the temperature
of the water entering the cold
water piping to 1049F.
403.5.4 1 Drain water heat recovery units ❑Complies
[FI31]2 tested in accordance with CSA ❑Does Not
1355.1. Potable water-side ❑Not Observable
iii pressure loss of drain water heat ❑Not Applicable
recovery units < 3 psi for
individual units connected to one I
or two showers. Potable water-
side pressure loss of drain water
heat recovery units<2 psi for
,individual units connected to
{three or more showers.
404.1 :75%of lamps in permanent ❑Complies I
[F16]1 :fixtures or 75%of permanent []Does Not
;fixtures have high efficacy lamps. ❑Not Observable
Does not apply to low-voltage []Not Applicable
lighting.
404.1.1 ;Fuel gas lighting systems have ❑Complies
[F123]3 no continuous pilot light. ❑Does Not
J ❑Not Observable
j
IE]Not Applicable
1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: FISHER HOUSE Report date: 10/29/16
Data filename: Page 8 of 9
1 i
Section Plans Verified Field Verified
# Final Inspection Provisions Value Value Complies? Comments/Assumptions
&Req.ID
401.3 {Compliance certificate posted. {❑Complies
[FI7]2 i ❑Does Not
I ❑Not Observable
❑Not Applicable
303.3 I Manufacturer manuals for ❑Complies
[FI18]3 !mechanical and water heating ❑Does Not
systems have been provided.
i ❑Not Observable
❑Not Applicable
Additional Comments/Assumptions:
11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3)
Project Title: FISHER HOUSE Report date: 10/29/16
Data filename: Page 9 of 9
,'i
2015 IECC Energy
Effidency Certificate
Above-Grade Wall 40.00
Below-Grade Wall 0.00
Floor 0.00
Ceiling/ Roof 38.00
Ductwork(unconditioned spaces):
s••
Window 0.31 0.32
Door
Reating : •• s . •
Heating System:
Cooling System:
Water Heater:
Name: Date:
Comments
iForm Insulated Concrete Forms I Concrete Homes Page 1 of 6
Worm Insulated Concrete Forms
Effective as of as of April 24th 2014 All Reward Wall Systems ICF product line(iForm and
eForm) are no longer available
Reward Wall Systems products lines have been discontinued and consolidated.All of your
future ICF construction needs can be fulfilled by Fox Blocks ICFs and the Fox Blocks 19 ICF
manufacturing locations across all of the US and Canada.
Reward's brands and assets are now property of Airlite Plastics Co.Read more on the ICF
acquisition here
The Innovative Insulating Concrete Form
The iForm,where the"i" stands for innovative,was developed and created in 2001 as the state of the
art insulating concrete form product with many efficient design features. The EPS foam panels on
each side are 2.5" inches thick and have a foam density of 1.5 pcf. The iForm was the first ICF
product to be universal-meaning no top,bottom, left or right side corners. The full-height plastic tie
inserts are spaced 6 inches on center providing a very strong form for concrete placement. Each tie
has two horizontal cross bars spaced 8 inches on center symmetrically, allowing for optimum concrete
flow through the form. The EPS foam panel on each side is 2.5" inches thick with a foam density of
1.5 pcf.
The furring strips are not only full height and spaced 6 inches on center but are also made of thick
plastic for proper attachment strength. The iForm product line include forms that have 4", 6", 8", 10"
and 12"thick concrete walls. The Worm 90-degree corners are unmatched with their double bridging
and full-height H-bracket fastening strips. The H-Bracket provides strong corners for placing
concrete while at the same time allowing for excellent fastening options in the corners.
Configurations
The iForm line of insulating concrete forms by Reward Wall Systems includes many different
configurations to increase the constructability of any project. The form configurations include
straight, corner,ledge,taper top, 45 degree corner and a T-form. All of the ICFs have 6 in on center
ties and 2.5" of foam on each side and have an R-value of 22.
Specifications
http://www.rewardwalls.com/products/ifonn/ 11/1/2016
<t ,,i$orm Insulated Concrete Forms Concrete Homes Page 2 of 6
Straight
fill f
i '
1 ,
Form Width Length Concrete Return Surface Area Concrete Vol
Width lyd fills
9" 48" 4" n/a 5.33 SgFt 15.1
11" 48" 6" n/a 5.33 SgFt 10.0
13" 48" 8" n/a 5.33 SgFt 7.5
15" 48" 10" n/a 5.33 SgFt 6.0
17" 48" 12" n/a 5.33 SgFt 5.0
90° Corner
13
- - - -�
Concrete Concrete Vol
Form Width Length Width Return Surface Area f'
1 d tll
y
9" 31" 4" 19" 5.55 SgFt 17.8
11" 33" 6" 21" 6.00 SgFt 11.3
13" 35" 8" 23" 6.44 SgFt 8.1
15" 31" 10" 19" 5.54 SgFt 8.3
17" 39" 12" 27" 7.33 SgFt 5.0
http://www.rewardwalls.com/products/ifonn/ 11/1/2016