HomeMy WebLinkAbout21837-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 8-23037 Date June 14, 1994
THIS CERTIFIES that the building ONE FAMILY DWELLING
Location of Property 1080 KIMBERLY LANE SOUTHOLD, NY
House No. Street Hamlet
County Tax Map No. 1000 Section 70 Block 13 Lot 20.14
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 29, 1993 pursuant to which
Building Permit No. 21837-8 dated DECEMBER 14, 1993
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 TO CONSTRUCT A ONE FAMILY DWELLING WITH ATTACHED GARAGE AND
DECK AS APPLIED FOR.
The Certificate is issued to OVERLOOK COURT DEVELOPMENT CORP.
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 93-SO-52 JUNE 1, 1994
UNDERWRITERS CERTIFICATE NO. N314467 MAY 19, 1994
PLUMBERS CERTIFICATION DATED BERTSAND PLUMBING & HEATING
---'4 k -/-X�
Building Inspector
Rev. 1/81
Form No. 6 _--
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
HALLTMENT JUN y 1994 L
765-1802
BLDG.DEPT.
TOWN OF VjML0L D
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: 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 a 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 $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . .s:c ir: . . . . . . . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . . . . Old Or Pre-existing
/Building. . . . . . . . . . . . . . . . .
Location of Property. . . 1 . . . . . . . .
:`C :. . . . . . . . . . . . . 0U.fhp. �4 . . . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property. . . .&h , , . %� . . . . . . . . . . . . . . . . . . .
7 Lot. . . .` 2U. !�
County Tax Map No 1000, Section. . . . . . . . . . . . . .Block. . . l.J? . . . . . . . . . . . . .
� � h
Subdivision. /. . . . . . . . . . . . . . . . 1 . . . . . . ?L)"/. . .Filed Map. . . '.' . . .Lot. . . . �.. . . . . . . . . . . . . . .
Permit No. �:f.-3.'. .,�/.Date Of Permit. . . .��. . �"l.: l:'.Applicant. . .
. .!�119.f'
Health Dept. Approval. . . :�`.. . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . .
Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . .
Fee Submitted: $. . c '. . . . . . . . . . . . . . . . . .
Ric ylggI
. . . . . . . . . . . . .
X-a3037 APPL ANT
TEL. 765-1802
c�VEF�11i�C0 TOWN OF SOUTHOLD
�c OFFICE OF BUILDItIG INSPECTOR
c 1. rn P.O. BOX 1179
cr1 ,t�, c TOWN HALL
SOUTHOLD, N.Y. 11971 f
r ��✓�4
o�NPc p
F
C E R T I F I C A T I O N SOU�'o<p
Date
Building
,,�� Permit No. 02/&0037 z
Owner 116 WI.IIG ,17f. T.P. Anler1eo� �� '''60-�a '
(please print)
/
PlumberPoSQi7GY �dmbii/Gwa fin6
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of l% lead.
is sigature)(plum n
Sworn to before me this
c� day of
Notary Public
Notary Public, Count
rb.>asla/s
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1155013 BUREAU OF ELECTRICITY
7 88 JOHN STREET. NEW YORK. NEW YORK 10038
Date MAY 19,1994 ApplirationNo.onfile 84161594/94 11 31.4467
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the oboce application number in the premises of
MOHRING ENTERPRISE, 1080 KIMBERLY LANE�,rPOLE-14, SOUTHOLD, N.Y.
in lhefollowing i(wationr ❑X Basement ❑X /st FL NJ 2nd P1. GAR/ATTIC/OUT .Section Dlork Lot
was examined on MAY 10,1994 and found to he in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACLES $WITCHES INCANDESCENT OR FLUESCENT OTHER AMT. K W. AMT. K.w. AMi. Kw. prnI K W AMT. H P
52 52 39 52
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ISPECIAL REC'►T TIME CLOCKS I BELL UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
ILIAC R.W. OIL H.P. GAS N.P AMf NO. A.W.G. AMT. AMP. 4NT, AMPS. TRANS. AML H 0 NO.OF FEET AMr WAITS
4 — — 2 — 1
SERVICE DISCONNECT NO.OF S E R V I C E
AMT. AMP. ITPE METER 1 R tW 1,E J`n' 3 H]W ]/AW �' CC.COND. A.w,G NO.OF HI-lEG A'W'EG NO Of NEUnAlS A W G
EQUIP. PER AT OF CC COND Of HFLEG OF NEUTRAL
1 200 CB 1 X 1 2/0 1 2/0
OTHER APPARATUS.
JACUZZI-1
MOTORSs1-5 H.P. ,1—F H.P.
PANELBOARDSt2-1 CIR. 60
G.F.C.II-16
SMOKE DETECTOR:-1
390 OPERATING CORP. LIC.#268
1555 LOCUST AVE.
BOHEMIA, NY, 11716 GENERAL MANAGER
,11
Pr�
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be i entified by their credentials. "
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765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ j FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ I FINAL
REMARKS:
DATE INSPECTOR
c?z�(?3
M-1802
BUILDING DEFT.
1 SPECTION
[ FO DATION 1ST [ J ROUGH PLBG.
( J FOUNDATION 2ND [ J INSULATION
[ ] FRAMING [ ] FINAL
REMARKS:
or
DATE INSPECTO
M-lW2
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [kleFINAL
REMARKS: Z�C
c
J
DATE a INSPECTOR
C 7/ -
765-1302
BUILDING DEPT. Feu, cloa`ro,i
y I
INSPECTION��. t.�s,o�nw
�wfipiv5 ova-+--
j [ ] FOUNDATION 1ST [ ] ROUGH PLBGM-/v /RCS
FOUNDATION 2ND [ ] INSULATION
Ls [ AMING [ ] FINAL
REMARKS:
lfiNgi� �i.CEcs7!j O�w� �' � t/e'ffiD�p�
�/G�'/e/�/.dP - Pr. fiet%7 ✓oj3f�tG�o�sf EN��Y�-/Hd-s 'F/,c-r/ l� 6
--�� G,rish 3/0�k 73,e1d�-,rLti;
DATE j INSPECTOR - -�`t
�/ ,Y3 74-
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST ICTIROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL J
REMARKS: _
_ S
DATE INSPECTOR
`n
J&- V" O de al)d Land DeveloAer
323 Glen Coto kv11579
Sea CiiH, New
(516) 671-0481
Curti - � i��,.
June 7 , 1994 BLDG.DEFT.
TOWN OF SOUTHOLD I
Town of Southold
Building Department
Town Hall
p•0 1179
NOW
old, 11971
South
Re: S.C.T.M.#1000-70-13-20 . 14
health Ref. #93-5�-`'2Lot #14
paradise By The Say'
Dear Sir: lication for obtaining
Enclosed, please find the appfor the above referenced
the certificate
of occupancy
lot in Southold* lease feel free
If you should have any questions, p
to call. Thank you.
Very truly Yours,
i
Richard Mohring'---
RM:sc'!'�'n
Enclosures
F1RErLa(:E5 ZI1-3I
6.7.2.4 A ventilating hood shall be installed above an 6.7.3.8 Exhaust ducts for Type 2 clothes ch yers shall [lace
open-top broiler in a residence. a clearance of at least 6 in. (152 moil to combustible mate-
rial. If such duct passes through a wall, flour, or partition
6-7.2.4.1 The hood shall be made with tight joints and shall constructed of combustible material, all such material in
be constructed of copper with a thickness not less than 24 B the stall, floor or partition shall be cut away from the duct
& S gage [0.0201 in. (0.533 ntm)] or galvanized steel with a a sufficient distance to provide a clearance of at least 6 in.
thickness not less than 28 gage [0.016 in. (0.406 mnt)]. (152 mm) and die opening closed in mcorcbmce with
6-6.3.9.
6-7.2.4.2 A clearance of not less than hits in. (0.4 min)
between the hood and the underside of combustible mate- Exception: Exhaust ducts fin Type 2 clothes dryers shall be per-
rial or metal cabinets shall be presided. milted to be installed with reduced clearances In combustible mate-
rial provided the combustible rnatemd is poneavd as desoihed in
6-7.2.4.3 The vertical clearance above the broiler to the 'fable 5-5(h).
underside of combustible material or metal cabinet pro-
tected by the hood shall he not less than 24 in. (610 mm). 6.7.3.9 When ducts pass through walls, floors, or parti-
tions, the space around the duct shall be sealed with non-
6-7.2.4.4 The width and breadth of the hood shall be not combustible material.
less than that of the open-top broiler unit.
6-7.3.10 Multiple installations of Type 1 and Type 2
6-7.2.4.5 The hood shall be centered over the unit. clothes dryers shall be made in a manner to prevent
adverse operation due to back pressures that might be cre-
6-7.2.4.6 The hood shall be exhausted directly through ated in the exhaust. Common exhaust vents that pass
an outside wall to the outside or connected to a suitable through floors of buildings requiring the in of ver-
chimney flue used for no other purpose. The connecting tical openings shall be enclosed with approved walls having .
duct shall conform to the following: a fire resistance rating of not less than I hr when such
(a) Connecting ducts shall be made of galvanized steel chimneys are located in a building less than 4 stories in
not less than 28 gage [0.016 in. (0.406 mm)]" height, and not less than 2 hr when such chintnevs are
(b) A clearance of not less than 6 in. 1152 mm1 shall be located in a building 4 or more stories in height.
prosided between the exhaust duct and unprotected com- 6-7.4 Equipment with Integral Vents. Gas utilization
bustible material. appliances incorporating integral venting means shall be
Exception: This clearance may be reduced tf the rnrnhhstahle considered properly vented when installed in accordance
material is protected in accordance with Table 5-5jhl. with the terms of their listing.
6-7.3 Clothes Dryers.
Chapter 7 Fireplaces
6-7.3.1 All ducts expelling lint shall be prmided with a
lint collector. 7-1 Factory-Built Fireplaces. Factory-built fireplaces
shall be listed and shall be installed in accordance with the
Exception: It heir the dryer is so equipped. terms of listing. Hearth extensions shall be proricled in
accordance with the manufacturer's instructions or shall be
6.7.3.2 For Type 1 gas-fired clothes dryer exhaust, see of masonic on noncombustible construction in accordance
NFPA 54,,Vational Fuel Gas Code. with Section 7-3.
6-7.3.3 Type 2 clothes dryers shall be exhausted to the 7.1.1 Facture-built fireplaces shall be secured to tile floor
outside air. or structural framing of the building in order to prevent
6-7.3.4 Provision For make-up air shall be provided for shifting.
Type 2 clothes dryers,with a minimum free area of 1 sq in. 7-2 Masonry Fireplaces.
(645.2 mm") for each 1000 Bin per hr (1055 kJ/hr) total
input rating of the drver(s) installed. 7.2.1 Construction.
6-7.3.5 A clothes dryer exhaust shall not be connected -7-2.1.1 Fireplaces shall be constructed of solid masonry
into any chimney connector, cent connector, chimney, or units or of reinforced portland or refractory cement con-
sent. crete. Masonry fireplaces shall be supported on properly
designed foundations of masonry or reinforced portland or
6-7.3.6 Ducts for exhausting clothes divers shall not be refractory cement concrete or on other noncombustible
put together with sheet-metal screws or other fastening constructions having a fire resistance rating of not less than
means that extend into the duct and would catch lint and 3 hr, provided such supports are adequate for the load.
reduce the efficiency of the exhaust.
7.2.1.2 Where a lining of low-duty fireclay brick (ASTM
6-7.3.7 Exhaust ducts for Type 2 clothes cheers shall be C 27 fireclay brick),or the equivalent,at least 2 in. (51 rum)
constructed of sheet metal or other noncontbustihle mate- thick laid in refractors mortar (ASTM C 199. ntediunt
rial. Such ducts shall be of adequate strength to meet the dut'), or the equnalent, or Other approved lining is pro-
conditions of service with minimum thicknesses equivalent tided, the total thickness of back and sides, including the
to No. 24 galvanized steel gage. lining, shall be not less than 8 in. (203 tam).
1992 Edition
211-32 CHIMNEVS, FIREPLACES,VENTS,AND So]_IU FUEL-B URN]No;APPLIANCES
7.2.1.3 Where the lining described in 7-2.1.2 is not pro-
The be
sided, the thickness of back and sides shall be not less than and not tinclin d more than 45 degrees from erner surfaces of the smoke chamber shalti al,smooth
12 in. (305 mm).
7-2.1.6 Masonry fireplaces shall be provided with chim
ig -
des 4 Where the masonry supporting a fireplace is neys designed and constructed in accordance with the
corbels are nd to support vertical Toads from the building and requirements for construction of masonry chimneys (See-
used used to support beams or girders, corbeling tiou 3-2), or where permitted by the individual listing,
shall be as describes] in 3-1.2 as recommended for masonry approved factory-built chimneys having approved adapters
chimneys. The lintel spanning the fireplace shall be in accordance with the requirements for factory-built shim-
designed and cmtstructed to safely support the additional ncys (Chapter 2).
concentrated load transferred by the member.
7-2.2 Steel Fireplace Units.
7-2.1.5 Where it lining of low-duty fireday brick (ASTM
C 27) or the equivalent, at least 2 in. (51 ntm) thick laid in 7-2.2.1 Steel fireplace units incorporating a firebox liner of
reftacton mortar(A.STM C 199,medium duty),o-the equiv- not less than 1/4-in. (6.4-mm) thick steel and an air chamber
alent, or other approved lining is provided, the total thick- shall be installed with masonry to provide a total thickness at
,less of the smoke chamber walls including the lining,shall be the back and sides of not less than 8 in. (203 mm), not less
not less than 6 in. (152 turn). Where unlined, the smoke than 4 in. (102 mm)of which shall be solid masonry.
chamber wall thickness shall be not less than 8 in. (203 mm). Exception: Listed firebox liners shall be installed in accordance
The smoke chamber height shall not be greater than the loth the terms of the listing.
inside width of the fireplace room opening. The smoke 7-2.2.2 Warm air ducts employed with steel fireplace
chamber depth shall not be greater than the depth of the units of the circulating air type shall be constructed of
fireplace fire chamber.
metal or masonry.
45° IMax.
——— Top of smoke chamber;
base of flue liner
Smoke chamber
5 W
------------------
Fire box ----------
----
—Base of chamber
at damper opening
(depends on fireplace design)
yp
Figure 7-2(a) Sectional view of fireplace showing smoke chamber.
1992 Edition
FIREPLACES 211-33
1 in,Exterior
2 in.Interior
2in
J J 11� 2 in. 1
0(
2 m. ,ryI
4in.
^r�11
/II
e Figure 7-2(b) Fireplace clearance to combustible material.
7.2.3 Clearance. tible material properly supported and with no combustible
material against the underside thereof, Wooden forms
7-2.3.1 All wood beams,joists, studs, and other combus- used during the construction of hearth and hearth exten-
tible material shall have a clearance of not less than 2 in. sion shall be removed when the construction is completed.
(51 mm) from the front faces and sides of masonry fire-
places and not less than 4 in. (102 mm)from the back faces 7-3.2 Where the fireplace opening is less than 6 sq ft
of masonry fireplaces. (0.56 m'), the hearth extension shall extend at least 16 in.,
(406 mm) in front of the facing material and at least 8 in.
7-2.3.2 Spaces between headers or trimmers of combusti- (203 mm) beyond each side of the fireplace opening.
ble material and masonry fireplaces shall be firestopped
with noncombustible material. The material used for fire- 7-3.3 Where the fireplace opening is 6 sq ft (0.56 m2) or
stopping shall be galvanized steel not less than 26 gage larger, the hearth extension shall extend at least 20 in.
[0.19 in. (0.483 mm)) in thickness or noncombustible sheet (508 mm)in front of the facing material,and at least 12 in.
material not more than /2 in. (12.7 mm) thick. (305 mm)beyond each side of the fireplace opening.
7-2.3.3 Woodwork, such as wood trim and mantels, and
other combustible material, shall not be placed withim6 in. 7.3.4 Where a fireplace is elevated above or overhangs a
(152 mm) of a fireplace opening. Combustible material floor, the hearth extension shall also extend over the area
above and projecting more than 11/2 in. (38 mm) from under the fireplace.
a fireplace opening shall not be placed less than 12 in. (305
mm) from the top of the fireplace opening. 7.4 Accessories. Factory-built accessories for fireplaces
include such devices as fireplace heater inserts, heat
7-2.4 Accessibility. For cleaning purposes, means shall exchangers circulating air or water,etc., that may alter the
be provided for access to the venting area above and imme- combustion or heating characteristics of the fireplace. Such
diately behind any movable damper valve plate in masonry accessories shall be listed and installed in accordance with
fireplaces and steel fireplace units. the terms of their listing.
7.3 Hearth Extensions. Exception: Unlisted accessories that are acceptable to the author-
ity having jurisdiction shall,be permitted to be installed as
7.3.1 Masonry fireplaces shall have hearth extensions of approved and in accordance with the manufacturer's installation
brick, concrete, stone, tile, or other approved noncombus- instructions.
1992 Edition
211-34 CIIININL:YS,FIREPLACES,VENTS,AND SOLID FUEL-BURNING APPLIANCES
Where trim projects
! more than 11/2 in.from facing
Where trim projects
\ I up to 11/2 in,from facing
12 in.
/ 6 in.
y
6 in.
Location of combustible
fireplace trim
8 in.
Figure 7-2(c) Fireplace clearance to combustible material.
7-5 Combustion Air Ducts. constructed of masonry, galvanized steel with a thickness
not less than 26 gage (0.019 in. (0.483 mm)], or other
7-5.1 Where required by the authority having jurisdic- approved noncombustible material and shall be equipped
tion, combustion air ducts shall be installed according to with a damper that is capable of being fully closed.
this section. 7.5.3 Combustion air ducts that terminate outside the fire
jchamber but within 6 in. of the fire chamber shall be
Exception No. 1: Combustion air ducts for factory-built fire- designed and installed to prevent the direct envy of Flame,
places shall be a listed component of the fireplace and shall be embers, or ashes from the fire chamber into the duct. ,. .
installed according to the manufacturer's instructions. 7-5.4 Unlisted combustion air ducts shall be installed with
Exception No. 2: Listed combustion air duct systems for masonry a minimum 1 in. (25 mm) clearance to combustibles for all
fireplaces shall be installed according to the terms of their listing parts of the duct construction within 5 fir(1.5 m)of the duct
and manufacturer's instructions. outlet.
7.5.5 The exterior inlet of the combustion air duct shall
7-5.2 Combustion air ducts shall extend as directly as be screened,
practical from the outdoors (inlet) to a termination outside 7.5.6 Combustion air ducts shall not originate in an attic,
the fire chamber (outlet). Combustion air ducts shall be basement, garage, or other interior space.
1992 Edition
jp
3. Nature of work (check which applicable): New Building . . . . . . . Addition . . . . . . . . . . Alteration . . . .11. . . . . .
Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other
4. Estimated Cost . . . . . . . (Des
/ .7G (j(jU
�. . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
S. If dwelling,number of dwelling unit . . . . , � . . . . , , , . 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 t . . . . .
YPeofuse . . . . . . . . . . . . . . . . . . . . .
7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . .
Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . .
Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . Numb r f tones . . . . . . .
. . �� 1/ . . . . . . . . . . ,$ . . . . . . . . . . . . . . .
8. Dimensions f entire new construction: Front . �` . . . . . Rear ? . . . .r.. . . . . . . Depth . y6i
Height . . y -. . . 2. . . . . . . . . . . .
.� . Number of Stories . . . . . . . . . .
3 ? : . . . . . . . . . . . . .
9. Size of lot: Front . . 1'. :. . . . (, . Rear . . .�,� % lv .., • , , . . . Depth a`/q�,.
10. Date of Purchase . . . d5, . . . . . .
• • • • • • • •�• • • • . . . . . . . . Name of Former Owner
11. . . . . . . . . . .
Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . .12. . . . . . . . . . . . . . . . . . . . . . .
Does proposed construction�vs late any zoning law, ordinance or regulation: G
13, Will lot be regraded . . . . Will excess fill be removed from premises: Yes
14. Name of Owner of prc�is �1lA. �??a; L c , , . . Address . ? G�?�, e • 6r, Phone No.
Name of Architect .✓✓t.0 riP. (� A"4c( . , , , , , , .Address �S!G��' uu !?fir , , , , Phone No.W6,
Name of Contractor . 1j7?1N �re«plZi fvs r7�� Address . ,3,a23 /ear Ccv�t} , phone No.
15. Is this property withir 300 fe/et of a tidal wetland? * No. _
*If yes, Southold Town Trustees Permit may be required. . . • . .
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot. ,
p
STATE OF NE ORK,
COUNTY OF-. . . . . . . . . . . . . . S.S
• • • • • • • • • •.• • • • •' �4 ��O �o����V* . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the . . . . . . . . . . . . . . . . . . . . /
.. . . ./c. . .P/'. . . . . . . . . . . . . . . . . . . . . . . . . . . . ...: . . .`. . . . . . . . . . . . . .
(Contractor, agent, corporate officer, etc-. 7
)f said owner or owners, and is duly authorized to perform or have performed the,said'work'�hd,'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.
;worn to before me this. . . . . . . . . . . . . . . . . .day of. . (
•� Pub�/"". . ...�. . . . .. 19 .
Jotary Public, .! �' County
NON" ysUpSAA 4EF.OONGERO . . . . . . . . . . . . . . . . . . . . .
&10,state of Nmyo*
N .6616118 (Signature of applicant)
Nacesu 0,,W
a198 EXWi Au6.30,JW
.� 1 }y ✓
BOARD OF HEALTH
FORM NO. 1 3 SETS OP,� PLANS . : : : : : .
�9 TOWN OF SOUTHOLD SURVEY . . . . . . . .
�� BUILDING DEPARTMENT CHECK . - . .�/ . . . . . . .
111 ,..� .a. -•„ TOWN HALL SEPTIC FORCI ✓
Blf�l�. O SOUTHOLD, N.Y. 11971
70WN OF SgUTt10L,
TEL.: 765-1802 NOTIFY ; t�y.�j
a CALL �P. 1. .
• • . • • • . .
Examined .�' ✓, , , , , , , , ,, 190 PSAIL TO : •
Approved . . . . . . ., 1(0�.IIjPermit No. ,-:?1e0 �* . . . . . . . . . . . . . . . . . . . .
Disapproved a/c . . . . . . . . . . . . . . . . .!. . . . . . . . . . . . . . . . . . . .
uildi nspector).
APPLICATION FOR BUILDING PERMIT
Date ./. lU!J ?y . . . . . . . .. 19y �
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy
shall have been granted by the Building]Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Townli of Southold, Suffolk County, New York, and other applicable Laws,Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for r al or demolition, a erein described.
The applicant agrees to comply with all applicable taws, ordinances, buiIdin o , h si d , a egula ' ns, and to
p premises and in building for necessary inspe io
. . . . . . .
admit authorized inspectors on remise
(Sig ature/ofa pplican , or n/a/ ' , if`a ccorporation)�
31213
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. . . . . . . . . . . . . . . X&.,/CA/. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises . . . U /Z�H G ��42iS�LS
(as on the tax roll or latest deed)
If applicant i corporation, signature of duly �riz o -cer.
(Name and t e of corporal ���jj�
t officer) /
Builder's License No. . . . . . . .
Plumber's License No. . . 7
Electrician's License No. S_
Other Trade's License No. . . , . . . . . . . . . . . . . . / Jf
1. Location of land on which proposed work will be done. ' �✓Z
House Number Street Hamlet r J
Count Tax Ma No. 1000 Section ?v °��
Y p Block . � . . . . . . . . . . . . . Lot . . . . . . .
Subdivision . , kc ,W( �.. .fti�. �, Filed Map No. ' � � . . . . . Lot . . .�/, , . . . . . . . .
lRV
74 t
Awe)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . . N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy . .! W2//! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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�,)CCUPANCY
PLUMBER CERTIFIC,'A ION
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CERTIFICATE
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If copper tubing is used t�,Jl ROMET
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31 JNSULfNTION'x
-1. 17 4� Flp,�AL .- C0NS_TR1,JCT*N IVIUST
BE COMM-ETE FOR G-0.
r_T1()r,! SHALL MEET
ALL CONSTRU OF
THE NIX
ENTS
7 THE REQUIREM
---- CONSTRUC-T
sTATE
ION & ENERGY
ONSIBLE FOR
CODES. NOT RESP
ON ERRORS
DESM 08 CONSTRUCTI
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UNDERWRITERS CERTIFICATE
REWRED
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DO NOT PROCEED w IT-4 FWMr,P
_J UNTIL QO SURVEY OF
WATIcA
FOUNDATION MCA-,ION LF
HAS BEEN APPROVED
11_1dt0t.V__1 a
`�,O. 210 a tin shev*t door enclosures, *Lldlmg doots, and sidelit—
kit tafter*t* shell have a wissiansm c*"ttollive strength of 21.50 p"I at Is
adjacent to entry deata to be t*mpazad at safety glass.
days, with 00torlals contotminq to the t4cmq'MiZ44 AST" Standards.
17, Anchor belts Ito he provids.�d for sit foundation sills. zolto
11 All tonsttuction Is to adhorre to olkaodos havi"r 1121, v 120, max. 101-0" Irv" cornets 29. All bathrooms shall be mechAmically ventllilte�d a's per section a So$-3.3 of
�1. Too-rin4s Witt be poured stlffly� Ha1mch tootlAgs are to be .....
the N.T.A. Building Code and the *.I.$. 1norgy tarlot.
Coosar4*tIo" Conattuction coda. 'ths %.y.S. Juildinig Code. Vents shall extend thzu the roof to 0%
plumIsinq vock Is to be In accordAften with the flombloq C446 of the v.nt*4 Integrally with' slo4o.
If- craos; btidgiftV9 to be Provided In all floor span% at intervals not excetdir
& fast. bridging It* be I* x� 3N, solid wood, or metal. 29. Ali interior walla, and ceilings to be finished utth 1120 gypsom board, C,
Widl, al Code. slectzical work Is to be In *cc6rdwoca with 1:146 Mattolmal 11. Install a 4 oil poly*thylono vapor bartitr onder all slabs %2nder 111ving
alectricol Code and th**local rules onst regulations, of the; 44� soord of fitit 4111419 t*vod and spacklod tat palntlng,�
11. Nailing to be) so Per the recommended "ailing schedule of the M.Y�3. Code
12. Magnets Prot I action In to be mode for cold V*athor conctrt" and tmso"re y TM41 FittstOPOU49 to bo Provided as Pat tootten 5-402-5.3. 30. Inter lot floor finishes 0all be as Indit3ted a" Vlan3,
2. be not *Cal* slrowinqo. rollov silmossolons only. IK40att any d&SCraptoclay work, to Protect concrete and va*onry fx0fo treating.
to tho argshitoct prior to Comses"Cinq Vork" 20). Wall sheathirAq ahall be either of the followings 31. exterior voll, finish to be an noted on plans. A ..................
3M PC
Y-04
3. The architect asn4meo no t*sPonsibility for construction means, mathads, D- All r0"Ottuctl0vt luftbalv 10 be 900-FIr, 12 or h*tt". 'The 01"Intum Fb to be bi 1120 naiii-baiiwe fiberboard 32. %notatl .*IJ Aluminuso flaahlogs whatever vood abuts cnnctetft (Vatcheg#
1130 psi tot 12 and 1400 psi for 12. for #I. utility lu,.%bat &Ay qv etc.) St 0 cricket, and roof *no wall mod other location$ vhctt
toOnIquoss, **que"eto or proc*duroso at lot safety Ptocautl*mi and programs in ItI114#4 tat blocking, C*tting, and stils and plate" only. 4APA or equal graded) plywood. Joint- as tewlited.
C�naottlan with tho.noct. 214 Rent Shestislail to be 1/2", Standard P,&,tJC* dletataa� CaUJk exterior
Stbtlooring, tl.o be litl*, JAPA tic equal 9cadtd) Plywood.
4. ;'loptoductlan of those plans, In ori farm, without tive written content a( V*S14P l*o4inga, are #0 10110VA per Wq.ft, Bubtloact" t,.* be toun" and grooved at blocked an *,it unsupported odges.
the 49thitict In Prohibited. Those plans way net be (Iletl tor constructia"
Purposes In any building department, wttlratst the architect*' written Location LI,v* Dead Zatlect. Limit 22. aloble all studs on openingo over 3 ft., triple studs on aq*o1njj over 9 Storm water tunoff is to flow away from ail sides of the
authorlsotloW and/or $*aI. Any non of these plans fac any putpose, other than ��. 'Volibl* Joint= under all partitions parallel to then and tist haadec3 and foundation and garage arta. Storm water is, not permitted to
let Floor Wiss l0lbs L/3fe flow onto abUtting property, Cause erosion; daisaqe adjoining
that sp*01flosily authorized by the architect, Is Illegal, and may subinet the I
user $hotoot to the poyawnt of full commissions. 2nd FlearteleopIng 301be 1011341 L/340 00
ty Ir 4stsum*4 at a minissam of 40#0 111* pat sq. ft.
5. Soil boozing a stot*qe ai extorlor VAtlas 9- overall 5000 dogsMse days. U, $000 degree days
el pas: 0
a be encountered at tooting level tootlnqx art to Attic (storagel 201be 31ba W20 r
Attic (Iva areas) I 161b. Sibs tW240 23. Iftsuslatloo to be on follow"I Minloun property
should clay ot not to be b) Calling- roots IF-."
t*4a*iqft*d. Root(with fin coill 301bo IsIbs, U/2 40 c) Fla"'s ovtr qffh*ata4 bIsemental U- .05,
I allow) d) ftelmoitot Inoolatioa under *lobe to be 241 vidot R-10�
S. so footing to t�l rest on fill at organic $oil, but most be care led to Routine fln --*ill 301bis ?the L/ito 4) rIb*tq1I&R1R mill **site ander all exterlat� Pas:titlon 61113 t-or sl*b SCALE 1-4V U,� DAT
undisturbed soil or vochanicaily compacted xou as d**c_-xiuo4 above. (anovi balldimoo.
0, All of the miavv at* In coatationce with the M.Y.S. lto*tqy Coda.
�e,— q-
15. All steel colneass, flitch plates and loose liftielo, to be manufactured in
r�� Slab# Shall rest on to ssinto t wcCorUnto with AST" otandaitsto and Inotallod in accardAncs with Atic '$toward*. OR N ICK11-,
Am at clean *and or wavwx or tultobli%
--Peter lal Vhlch abo,41 be 00114IT coiwpact*4 004 t4opois
M vind"Vu* to WAndorao" WIqh P*rzortmnce, U-.33 or approvLd tqumi. 3114,4nj
It. W*401jaq to be 240 Aspeolt sh:nqlos. Roll toofinq AP VD.e
iMUM�Sry not to X-T- P fIll at *her door* 'Ini styllt#a to hove a In. i-,13, All Windo", skylitt-t Vn4 sUdi"Z;
t to -bo IQ I,b,, doluble covvrxq,��, Aa"ai,,t *ft*"4�ieo to be 4�oora to ftenk,t I't an' ,
uIrtmeata, af ".la. 19neggy Cad
fls4timt have Wrest On 4n arr�a of fill,
*$%to soil, but: te'd I I" 4"ovu*fdow, evi
t voil "t � I
AW"
d4sCrIb*d above.
oltehat "dog 4 W U,�
two "uAb*Z 5 voInforcing rosisi'sasy be platoal In the lower 'Vart of the I*oting 25. T1ttPlAr:** shiall be pro,-fabricated units, mopufoctuced to casstply with the
X.T.S. 9ft*s:q? code, and shell boar t.'.1ttiftcation thersof.
bonded to ptoo'eriy Supported 'footin,46 at Wells ft either side, for Mx4ftum span
av" fill of ftt. Thin way be dont, in Ilea at *w�th*nlcal: cosspoiction.
1140144104" Ila"1 ad I O&WIN
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REVISIONS By A`s n.a� •tl0• :.: .,`. ! J !`E }yu 4/Xt , .,', .i OATS g 3 .,.............
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A4 AP'V O
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ION
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F KeW, York StatA -0_424ti8t Ion
Component Performance
VeM I go Temperature inside 72 outside IS at ,15 MPH wind
ntqr*i evayn Soon
No W Total 14411 Ax6a ?,"Al 4
%jC>
Aq Total glass Art* 44,4
CIL r
Ad A Totall doot Arej 4�O
Aw * Area of opaqe wall 0 AO Aq Ad
ug 11 value of al&,�Rs a
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truest of window Area Ag
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6-el 46 ;Al�u
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outside Air Film e
A
5,1'MWW�L��,
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Siding
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0.62
znsulation
Ztuds, 2- x A--
1"' Ido Alt Film
&
So
V0, R Total
with Stud
7
A Total with vatt
Gj
U
Weighted avttage V-values reflect that tX Imt I on Is wooe
�of the Wo I I 4;e ro
ftsming,, 90% Includes batt Insul
atlon 5
ac.
uavg
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4-
V over all
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C/ X 11,71 W 1-49 ell C
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Inside Air Film
41;4
A*
Insulation
1/2* gypsum Roazd 45
joist
Z&
-side
-Top "W 'TAW
R Total joist Ll
Total qatt
R
'N'
73 of celilng construction is %06164 .a at
+
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651
-c,
4 41141
Finish Floor
TOO Alt Film r9l�14
.71
A,
Sub Flooz V*4' for rV IL-
K
Insulation
lk
Joist
nw
130ttom Alt FIla
'Z4 MA-1, 14
a 4—ilv-SON ---T
X6,
-7'% Of floor construction to be wood joist#
lnqludao satt Insulation
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will k` 1AA )L
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SUMMARY OF TOTAL THERMAL RATING
o
q.
If the Total Thermal Rating is zerol(0) or greater, the proposed
design for the building envelope complies with the Energy Code.
'44
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THE RMAL TABLE
4
AREA RAT I�G
U VALUE OSED
4
X
A, K0-F/CEIL1t.1G I�zo 6,:,C., Z,I
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% '4
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tffl WALLS "41i
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au �v `7Z
x F
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Window r�--��,:-----�--------
Pl,
T
I F LO-ORS
T
r 9 IRI*
ID?. 9A�EMENT/CELLAR WALLS
Val 1 Perimeter Feet
Ziposure Above Grade feet
N)
WrIl U-Value
A
Depth of Wall U-Value
Below Grade inches
03. SLAB INSULATION
Slab Perimeter F eet 1 4",
72
-ulation R-Value
Ins
E. INFILTRATION CONTROL *04 41 'A
Condit,toned Floor Area Sq. F t.
N
!w
F., SOUTH �ACIW GL
A Z I NG Percent
South Giass/Total Glass
n Sq. F t.
Gl, Area"Gross Wall Area Percent
Candits ned Floor Area
TOTAL. THERMAL RATING
5CALC �A if Revisioms sy DATE
DATE Al
6WN li-i4 3
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�21
AP'vD-
TITUE NO.
7,
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