HomeMy WebLinkAbout49867-Z ho�a0F Soo rHo�o Town of Southold
* * P.O. Box 1179
of 53095 Main Rd
Comm,
omm,��`A Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 46960 Date: 04/08/2026
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 65490 Route 25 Greenport, NY 11944
Sec/Block/Lot: 53.-5-12.6
Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 11/06/2019
Pursuant to which Building Permit No. 49867 and dated: 10/11/2023
Was issued, and conforms to all of the requirements of the applicable provisions of the law.
The occupancy for which this certificate is issued is:
Addition and alterations including raising of dwelling per FEMA to an existing single-
family dwelling (brick house #30) as applied for.
The certificate is issued to: Breezy Shores Comnty Inc
Of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL:
ELECTRICAL CERTIFICATE: 49867 4/2/2026
PLUMBERS CERTIFICATION: Derek Hennessey_ 1 8/2025
AV ed gnature
ostiFai TOWN OF SOUTHOLD
BUILDING DEPARTMENT .
y x TOWN CLERK'S OFFICE
"o • �ti SOUTHOLD, NY
--
BUILDING PERMIT
(THIS PER MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 49867 Date: 10/11/2023
Permission is hereby granted to:
Breezy Shores Comnty Inc
PO BOX 925
Mattituck, NY 11952
To: Raise house per FEMA and construct addition and alterations to existing single family
dwelling (brick house #30) as applied for, with flood permit and per Trustees # 9867.
(Replaces BP#46981)
At premises located at:
65490 Route 25
SCTM #473889
Sec/Block/Lot# 53.-5-12.6
Pursuant to application dated 11/6/2019 and approved by the Building Inspector.
To expire on 4/1112025.
Fees:
PERMIT RENEWAL $221.20
Total: $221.20
Building Inspector
TOWN OF SOUTHOLD
r' gUFFat -
4W�y BUILDING DEPARTMENT
4; TOWN CLERK'S OFFICE
o • �� SOUTHOLD, NY
y�al ��pe rsr
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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#: 46981 Date: 10/15/2021
Permission is hereby granted to:
Breezy Shores Comnty Inc
PO BOX 925
Mattituck, NY 11952
To: Raise house per FEMA and construct addition and alterations to existing single family
dwelling (brick house #30) as applied for, with flood permit and per Trustees # 9867.
At premises located at:
65490 Route 25, Greenport
SCTM # 473889
Sec/Block/Lot# 53.-5-12.6
Pursuant to application dated 9/29/2021 and approved by the Building Inspector.
To expire on 4/1612023.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $292.40
CO-ADDITION TO DWELLING $50.00
Flood Permit $100.00
Total: $442.40
Building Inspector
ho�X�pF SOUTyolo
Town Hall Annex Telephone(631) 765-1802
54375 Main Road G Q
P.O.Box 1179 y�
Southold,New York 11971-0959 oliYcDUm,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Breezy Shores Community Inc.
Address: 65490 Rt 25 Cottage #30 city: Greenport st: NY zip: 11944
Building Permit#: 49867 Section: 53 Block: 5 Lot: 12.6
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Electrician: Daniel Wllcenski License No: 4723ME
SITE DETAILS
Office Use Only
Commercial Indoor X Basement Service Solar
Residential X Outdoor X 1st Floor X Pool Battery Storage
As-built Renovation 2nd Floor X Hot Tub EV Charger
New X Addition Attic X Spa Generator
Survey Mezzanine Garage Dock
INVENTORY
Service 1 ph In-wall Heater Recpt 40 Ceiling Fixtures 5 Smoke Detectors 1 Pump
Service 3 ph Hot Water GFCI Recpt 7 Wall Fixtures 3 CO Detectors Heater
Main Panel A/C Condenser Single Recpt 2 RecessdFixtures 20 Combo Smoke/CO 2 Transformer
Sub Panel A/C Blower 2 Range Recpt 50a Ceiling Fan 4 Heat Detectors Salt Gen
Transfer Switch Mini Split 2 Dryer Recpt 30a UC Lights Fridge 1 AutoCover
ARC 12 Blower Heads Switches 34 Pucks Lights Dishwasher 1 Mini Fridge
GFI SepticDisconnect Emrgency Strobe 4'LED Microwave 1 Garbage Disp.
ARC/GFI 3 ERV Exit Lights Bath Exhaust 2 Hood 1 Dehumidifier
Other Equipment:
Notes: Cottage # 30 Two Story House w/ Crawl
Inspector Signature: Date: April 2, 2026
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OCT 8 2025
Town Hall Annex f�,®� ®Gy Duildhlq PIP?.p'`'Ilt Ibphone(631)765-1802
54375 Main Road s o � 4°��° of`"" `''
P. O. Box 1179 vs Z
Southold, NY 11971-0959
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BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION �*
Date: `� J
Building Permit No. /
Owner: 44,�-,Cy Dc>u4
`1 (Please print)
Plumber: 4emeL��/
(Please print)
I certify that the solder used in the water supply system contains less than 2/10 of 1% lead.
(Plumbers Signature)
Q-i-h
Sworn to before me this U
da of CAD 20__R5
�Joatw � ��/ -
Notary Public, 51 1 County
TRACLY•L, DWYM
NOTARY PUBLIC,STATE OF NEW:YORK
NO.,01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
COWSWOf EXPIRES JtJNE 30,2QaVp
pE S0!/Tyolo -
-4Q�f # # TOWN OF SOUTHOLD BUILDING DEPT.
ia
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°ycou 631-765-1802
INSPECTION
X0IFNDATION 1ST [ ] ROUGH PLBG.
NDATION 2ND [ ] INSULATION/CAULKING
MIN TRAPP [ ] FINAL
[ ] FIREPLACE &CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION Q� PRE C/O [ ] RENTAL
REMARKS: i
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DATE 10 1 INSPECTOR
SOUT,�,°�c
* ' TOWN OF SOUTHOLD BUILDING DEPT.
'oum 631-765-1802
. . . INS-PECTION
[ ] FOUNDATION 1ST/REBAR [ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ -] FRAMING/STRAPPING [ ] FINAL
] FIREPLACE & CHIMNEY [ ] °FIRE SAFETY INSPECTION
[ ]. .FIRE RESISTANT CONSTRUCTION [ ]. FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[. ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS: 0 I Vm / OLLs�
10
DATE - 3 - INSPECTOR
Of SOUTyo IT c2:. TOWN OF SOU�jrl
HOLD BUILDING DEPT.
°y o m, ,� 631-765-1802
INSPECTION
[ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] .INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] .FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[�J ELECTRICAL (ROUGH) . [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS: 6t-t'ck u vi c a
c oJe_5 la ro ec 4 t Te,S
DATE INSPECTOR alMLLUA1,96
J -
UF SOUTyO�
.''TOWN OF SOUTHOLD BUILDING DEPT.
loum, 631-765-1802
INSPECTION
[ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] .FINAL
[ ] FIREPLACE-&`CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT:PENETRATION:
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL-(FINAL)
[ ] CODE VIOLATION [ ' ] PRE C/O [ ] RENTAL
D -
REMARKS: iI eg� �G a.�. � lill � S
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vLC e o .eat RA-
DATE - INSPECTOR .
�apF SOUTyO � �� L✓ � I �® �� Cry
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* * TOW O SOUTHOLD BUILDING DEPT.
IOU 631-765-1802 �re,,_Sy
INSPECTION
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] .FINAL
[ ] FIREPLACE &-CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS: ti✓
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DATE INSPECTOR
i
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# . # TOWN OF SOUTHOLD BUILDING DEPT.
Courm,�' 631-765-1802
R�
INSPECTION
[ ] FOUNDATION 1 ST/ REBAR [ ] RO H PLBG.
[ ] FOUNDATION 2ND [ ] SULATION/CAULKING
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O' [ ] RENTAL
REMARKS: 0 "0;(- o
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DATE IINSPECTO
NORTH FORK DRYWALL & INSULATION
• _ / Post Office Box 1230 •Mattituck,New York 11952
• -- = == (631)298-5451 Phone•(631)298-7326 Fax
- - _ - Barry Murphy Cell (631) 804-8511
• .Drywall nfdiinc@optimum.net 'I
#-- Insulation nfdi@optonline.net
•
Steel Studs i
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• Acoustical Ceilings a Z ,20
M(631) 298-545,1'--, /
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OCT 29 2025
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QUADRANT 6 ELASTDCHEM
PERFORMANCE MATERIAL
S5P 1 � 2025
INSULATION CERTIFICATE
OQuadrant Enviroseal HFC CC A&B SIDE(CLOSED CELLj, .
®Quadrant Enviroseal No Mix OC A&B SIDE(OPEN CELL)
MInsulthane 450 No Mix OC A&B SIDE(OPEN CELL)
Minsulthane Extrm HFO HLA&B SIDE(CLOSED CELL)
ONatural Polymers Therm Light 0.4 OC A&B SIDE(OPEN CELL)
QINatural Polymers Therm 2.0 HFO WINTER CC A&B SIDE(CLOSED CELL)
. 61
Na"-CaA 6DI [rEPO 9n Ll
(� A NO Manufacturer: Lot/Batch:
JOBSITE: ryle-f N DATE OF INSTALLATION:
0
,A, iT [UNY' S INSULATION C �RP -
Spray Foam. ®rywall. Spackle & Paint
44 DREXEL DR,BAY SHORE NY 11706
PHONE 631-943-8364/631-455-4322
EMAIL: ANTHONYINSULACORPAZ@GMAIL.COM
INSTALLED BY: Cev= t-A-'ynci m
scannedvnt�
CamScanner
QUADRANT 9 ELASTDCHEM `
PERFORMANCE MATERIAL
INSULATION CERTIFICATE
=Quadrant Enviroseal HFC CC A&B SIDE(CLOSED CELL)-
=Quadrant Enviroseal No Mix OC A&B SIDE(OPEN CELL)
=Insulthane 450 No Mix OC A&B SIDE(OPEN CELL)
CInsulthane Extrm HFO HLA&B SIDE(CLOSED CELL)
=Natural Polymers Therm Component OC A&B SIDE(OPEN CELL)
=Natural Polymers Therm 2.0 HFO Summer CC A&B SIDE(CLOSED CELL)
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Manufacturer: Lot/Batch:
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JOBSITE: Gl de-e (7 jyq DATE OF INSTALLATION:
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A ' S INSLT IL,ATIOPT CORP-
Spray Foam, drywall, Spackle & Paint
86 E INDUSTRY CT, DEER PARK NY 11729
PHONE 631-943-8364
EMAIL: ANTHONYINSULACORPA2@GMAIL.COM
INSTALLED BY: �c<%�✓>� lV��i�(1 ter_
MCamScanner
'SUM 0 s .
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 hUs://www.southoldtownny.gov
Floodplain Development Permit Application
"PROPERTY WFORMATION Flood Zone:AC--6) & FIRM Panel: SCTM#1000-53-9- 12.1p
Address: &54-9 D Vout ��,
City: L '�I� }�� Zip: It 4-+
CONTACT PERSOIV Name:�&A!� `mil eL LC-&J1QA(-�L tA Phone#: (051-690--0041
Mailing Address: � j
PROJECT DESCRJRTiCN
1pt,�lr C�v u6e i a 0-9`'i b Co"PLY 0 k�.W(4 iZ67GvLx1
l �JZY-. 2Ud�Q, k3c0 )OV- �)TO pe FA LL d�s `vt
t;SECTION A'STRUCTURAL U,EVELOP(VIENT(CHECK ALLTHATAPPLY) ♦' `"
Type of StrtYclure Type of Shictural Acty
A
Residential(1,to 4 families) ❑New structure
❑Residential(more than 4 families) ❑Demolition of existing structure
❑ Combined use ❑Replacement of existing structure
❑Non-residential ❑Relocation of existing structure
❑ Elevated ❑ Addition to existing structure
❑ Flood proofed(attach certification) ❑Alteration to existing structure
❑Manufactured Home ❑ Other:
❑Located on individual lot
❑ Located in manufactured home park
SECTION B OTHER I�EVEL`OPMENT(CHECK ALL`TFtAT APPLY){ u
❑ Clearing of trees,vegetation or debris ❑ Mining ❑ Grading ❑ Drilling ❑ Dredging
❑Connection to public utilities or services ❑ Paving ❑ Placement of fill material
Drainage improvement(including culvert work) ❑ Roadway or bridge construction
❑ Fence or wall construction ❑ Watercourse alteration (attach description)
❑ Excavation (not related to a structured development) ❑ Other development not listed (specify):
"By signing below 1 agree`to the terms and condrtwns of thrs p�rmtt artd certify to the best of my knowledge the information contained
in thEs application is true and accurate:l understand.that no work may start until a permits issued''The permit may be revoked�f any
false statements are m +11
ade 'If revoked,aU work must cease'until permit i$le issued Develornentshall nc►tbe used or occupied
until a Gent of Cornp6ance rs4issued The permit w. j ei ire if rio work is cornrnenced within"one year of issuahce Qther permits may be
'required to fulfil requirements tApplicant gives cpnsent to local authority or representative to make reasonable mspeetions
<to verify compliance
Application Submitted By 4' it)i am ): Ij L,(E-UENDp4t_ �A
Signature of Applicant: Date: gvlgvla)21
I
U.S. DEPARTMENT OF HOMELAND SECURITY j
Federal Emergency Management Agency Expiration Dates eNoovember 30,2018
National Flood Insurance Program
ELEVATION CERTIFICATE
Important:Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2).insurance agent/company,and(3)building owner..
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number.
Mary Dowd
A2. Building Street Address(including Apt,Unit,Suite,and/or Bldg. No.)or P.O. Route and Company NAIC Number:
Box No.
Cottage 30(brickhouse)-Sage Boulevard
City State ZIP Code
Greenport New York 11944
A3. Property:Description(Lot and Block Numbers:Tax Parcel Number,Legal Description,.etc:)
SCTNI:No: 1000=5 PIO 12.6 Cottage 30,"Breezy Shores"
A41 Building Use"(e.g.,Residential,Non-Residential Addfion;Accessory,etc.) summer:cottage
A5: .Latitude/Longitude.. Lat N:41;deg 4'45' Long.W-72 deg 22'W Horizontal Datum: ❑IVAD'1927 ❑x"NAD 1983
:
A6: Attar at least. photographs df the building if the Certificate is being used to obtain flood rnsurarnce.
A7. Building Diagram Number-: 9
At3 For a.bwldmg'wdh a' awtspace.or enclosure's):
a), Square footage 6,crawlspace or enclosure's) 1 404 sq..t
h
b) Number of pe .ibwd gpenmgs m the::crawispace orenciosure(s)within 1 0 foot above adiacent--grade U
c) Total net area of flood openings m A8 b sq rn .
d) Engineered flood openings? Q Yes ❑No
A9.Fora building with an attached'garage:
a) Square footage of attachQd;garage sq ft
li) N,umber ofaerrnanent flood.openings m the attached garage within hO foot above adjaoent;grade
c) Total netarea.of flood openings in A9.b so in
d) Engineered flood openings? ❑Yes ❑No
SECTION B—FLOOD.INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP Community Name&Community Number B2:County Name 03, State
Town of Southold 1366813 Suffolk New York
B4..Map/Panel B5.Suffix B6. FIRM Index B7.FIRM Panel B8,Flood Zone(s) B9.Base Flood Elevations)
Number Date Effective/ (Zone.AO,use Base #
Revised Date Flood Depth)
36103CO169 H 09/25/2009 09/25=9 AE 6
B10. Indicate the:source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9:
❑FIS Profile ❑x FIRM ❑Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item.B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑x No
Designation Date: ❑ CBRS. ❑ OPA
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 1 of 6
r
National Flood Insurance Program
■
Elevation
Certific ;ite
and Instructions
2022 EDITION
)VD StiG
COP
FEMA
U.S. DEPARTMENT OF HOMELAND SECURITY OMB Control 0 2 6
Federal Emergency Management Agency Expiration Datee::O6/30//30/206
National Flood Insurance Program
ELEVATION CERTIFICATE AND INSTRUCTIONS
PAPERWORK REDUCTION ACT-NOTICE
Public reporting burden for this data collection is estimated to average 3.75 hours per response.The burden estimate includes the time for
reviewing instructions,searching existing data sources,gathering and maintaining the data needed,and completing and submitting this form.
You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form.Send comments
regarding the accuracy of the burden estimate and any suggestions for reducing the burden to:Information Collections Management,
Department of Homeland Security, Federal Emergency Management Agency,500 C Street SW,Washington, DC 20742, Paperwork
Reduction Project(1660-0008).NOTE:Do not send your completed form to this address.
PRIVACY ACT STATEMENT',
Authority:Title 44 CFR§61.7 and 61.8.
Principal Purpose(s):This information is being collected for the primary purpose of documenting compliance with National Flood
Insurance Program(NFIP)floodplain management ordinances for new or substantially improved structures in designated Special Flood
Hazard Areas.This form may also be used as an optional tool for a Letter of Map Amendment(LOMA),Conditional LOMA(CLOMA), Letter
of Map Revision Based on Fill(LOMR-F),or Conditional LOMR-F(CLOMR-F),or for flood insurance rating purposes in any flood zone.
Routine Use(s):The information on this form may be disclosed as generally permitted under 5 U.S.C.§552a(b)of the Privacy Act of 1974,
as amended.This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA-003—National
Flood Insurance Program Files System of Records Notice 79 Fed. Reg.28747(May 19,2014)and upon written request,written consent,by
agreement,or as required by law.
Disclosure:The disclosure of information on this form is voluntary; however,failure to provide the information requested may impact the
flood insurance premium through the NFIP.Information will only be released as permitted by law.
PURPOSE OF THE ELEVATION;CERTIFICATE'
The Elevation Certificate is an important administrative tool of the NFIP.It can be used to provide elevation information necessary to ensure
compliance with community floodplain management ordinances,to inform the proper insurance premium,and to support a request for a
LOMA,CLOMA, LOMR-F,or CLOMR-F.
The Elevation Certificate is used to document floodplain management compliance for Post-Flood Insurance Rate Map(FIRM)buildings,
which are buildings constructed after publication of the FIRM,located in flood Zones Al—A30,AE,AH,AO,A(with Base Flood Elevation
(BFE)),VE,V1 V30,V(with BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AR/AO,and A99.It may also be used to provide elevation
information for Pre-FIRM buildings or buildings in any flood zone.
As part of the agreement for making flood insurance available in a community,the NFIP requires the community to adopt floodplain
management regulations that specify minimum requirements for reducing flood losses.One such requirement is for the community to obtain
the elevation of the lowest floor(including basement)of all new and substantially improved buildings,and maintain a record of such
information.The Elevation Certificate provides a way for a community to document compliance with the community's floodplain
management ordinance.
Use of this certificate does not provide a waiver of the flood insurance purchase requirement.Only a LOMA or LOMR-F from the Federal
Emergency Management Agency(FEMA)can amend the FIRM and remove the federal mandate for a lending institution to require the
purchase of flood insurance. However,the lending institution has the option of requiring flood insurance even if a LOMA/LOMR-F has been
issued by FEMA.The Elevation Certificate may be used to support a LOMA,CLOMA; LOMR-F, or CLOMR-F request. Lowest Adjacent
Grade(LAG)elevations certified by a land surveyor,engineer,or architect,as authorized by state law,will be required if the certificate is
used to support a LOMA,CLOMA, LOMR-F,or CLOMR-F request.A LOMA, CLOMA,LOMR-F,or CLOMR-F request must be submitted
with either a completed FEMA MT EZ or MT-1 application package,whichever is appropriate.If the certificate will only be completed to
support a LOMA, CLOMA, LOMR-F, or CLOMR-F request,there is an option to document the certified LAG elevation on the Elevation Form
included in the MT-EZ and MT-1 application.
This certificate is used only to certify building elevations.A separate certificate is required for floodproofing.Under the NFIP, non-residential
buildings can be floodproofed up to or above the BFE.A floodproofed building is a building that has been designed and constructed to be
watertight(substantially impermeable to floodwaters)below the BFE.Floodproofing of residential buildings is not permitted under the NFIP
unless FEMA has granted the community an exception for residential floodproofed basements.The community must adopt standards for
design and construction of floodproofed basements before FEMA will grant a basement exception. For both floodproofed non-residential
buildings and residential floodproofed basements in Communities that have been granted an exception by FEMA,a floodproofing certificate
is required.
The expiration date on the form herein does not apply to certified and completed Elevation Certificates,as a completed Elevation Certificate
does not expire, unless there is a physical change to the building that invalidates information in Section A Items A8 or A9,Section C,Section
E,or Section H.In addition,this form is intended for the specific building referenced in Section A and is not invalidated by the transfer of
building ownership.
Additional guidance can be found in FEMA Publication 467-1,Floodplain Management Bulletin:Elevation Certificate.
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 1 of 19
U.S. DEPARTMENT OF HOMELAND SECURITY OMB Control No.1660-0008
Federal Emergency Management Agency Expiration Date:06/30/2026
National Flood Insurance Program
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON PAGES 9-19
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner.
SECTION A=PROPERTY INFORMATION FOR,INSURANCE COMPANY USE
Al. Building Owner's Name: MARY DOWD Policy Number:
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No.: Company NAIC Number:
COTTAGE 30(BRICKHOUSE)-SAGE BOULEVARD.
City: GREENPORT State: NY ZIP Code:
A3. Property Description(e.g., Lot and Block Numbers or Legal Description)and/or Tax Parcel Number:
SCTM: 1000-53-05-P/0 12.6 COTTAGE 30, "BREEZY SHORES"
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.): RESIDENTIAL/SUMMER COTTAGE
A5. Latitude/Longitude: Lat.N41 dg 4'45" Long.W-72dg 22'58" Horizontal Datum: ❑kAD 1927 Z NAD 1983 ❑WGS 84
A6. Attach at least two and when possible four clear photographs(one for each side)of the building(see Form pages 7 and 8).
A7. Building Diagram Number: 8
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s): 1,521.00 sq.ft.
b) Is there at least one permanent flood opening on two different sides of each enclosed area? ®Yes ❑ No ❑ N/A
c) Enter number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade:
Non-engineered flood openings: Engineered flood openings: 5
d) Total net open area of non-engineered flood openings in A8.c: sq. in.
e) Total rated area of engineered flood openings in A8.c(attach documentation-see Instructions): 1,000.00 sq.ft.
f) Sum of A8.d and A8.e rated area(if applicable-see Instructions): 1,000.00 sq.ft.
A9. For a building with an attached garage:
a) Square footage of attached garage: sq.fL
b) Is there at least one permanent flood opening on two different sides of the attached garage? ❑Yes ❑ No ❑ N/A
c) Enter number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade:
Non-engineered flood openings: Engineered flood openings:
d) Total net open area of non-engineered flood openings in A9.c: sq. in.
e) Total rated area of engineered flood openings in A9.c(attach documentation-see Instructions): sq.ft.
0 Sum of A9.d and A9.e rated area(if applicable-see Instructions): sq.ft.
SECTION B-FLOOD INSURANCE RATE MAP.(FIRM)INFORMATION
B1.a. NFIP Community Name:Town of Southold B1.b. NFIP Community Identification Number:360813
B2.County Name:Suffolk B3. State:NY B4. Map/Panel No.: 36103CO159 B5. Suffix:H
B6. FIRM Index Date: 09/25/2009 B7. FIRM Panel Effective/Revised Date: 09/25/2009
B8. Flood Zone(s): AE B9. Base Flood Elevation(s)(BFE)(Zone AO, use Base Flood Depth): 6
B10. Indicate the source of the BFE data or Base Flood Depth entered in Item 139:
❑ FIS ® FIRM ❑Community Determined ❑Other:
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 ®NAVD 1988 ❑Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ®No
Designation Date: ❑CBRS ❑OPA
B13. Is the building located seaward of the Limit of Moderate Wave Action(LiMWA)? ❑Yes ®No
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 2 of 19
ELEVATION CERTIFICATE
IMPORTANT:MUST FOLLOW THE INSTRUCTIONS ON PAGES 9-19
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No.: FOR.INSURANCE COMPANY USE
COTTAGE 30(BRICKHOUSE)-SAGE BOULEVARD Policy Number .
City: GREENPORT State: NY ZIP Code:
Company,NAIC Number:
SECTIQIRC—BUILDING ELEVATION INFORMATION.(SURVEY REQUIRED) 1
C1. Building elevations are based on: ❑ Construction Drawings*` ❑ Building Under Construction* ® Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations—Zones Al—A30,AE,AH,AO,A(with BFE),VE,V1 V30,V(with BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AR/AO,
A99.Complete Items C2.a—h below according to the Building Diagram specified in Item A7. In Puerto Rico only,enter meters.
Benchmark Utilized: GPS Vertical Datum: NAVD1988
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 ® NAVD 1988 ❑Other:
Datum used for building elevations must be the same as that used for the BFE.Conversion factor used? ❑ Yes ❑ No
If Yes,describe the source of the conversion factor in the Section D Comments area. Check the measurement used:
a) Top of bottom floor(including basement,crawlspace,or enclosure floor): 5.20 ® feet ❑ meters
b) Top of the next higher floor(see Instructions): 9.00 ® feet ❑ meters
c) Bottom of the lowest horizontal structural member(see Instructions): ❑ feet ❑ meters
d) Attached garage(top of slab): ❑ feet ❑ meters
e) Lowest elevation of Machinery and Equipment(M&E)servicing the building
(describe type of M&E and location in Section D Comments area): 6.70 ® feet ❑ meters
f) Lowest Adjacent Grade.(LAG)next to building: ❑ Natural ® Finished 4.30 ® feet ❑ meters
g) Highest Adjacent Grade(HAG)next to building: ❑ Natural ® Finished 4.50 ® feet ❑ meters
h) Finished LAG at lowest elevation of attached deck or stairs, including structural
support: 4.30 ® feet ❑ meters
.SECTION D=SURVEYOR,'ENGINEER;OR ARCHITECT;CERTIFICATION ,
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by state law to certify elevation
information.I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any
false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes ®No
❑Check here if attachments and describe in the Comments area.
Certifier's Name: Howard W.Young License Number:45893 -( _ OF
Title: Land Surveyor izD L�y�5 .,
Company Name:Young&Associates Land Surveying, Engineering and Geology PLLC
Address:400 Ostrander Avenue
city: Riverhead State: NY ZIP Code: 11901
N U)i
Signature: 1 ' Date: 101/y m �,% g 3
Telephone: (631)727-2303 E .. Email: 1P
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments(including source of conversion factor in C2;type of equipment and location per C2.e; and description of any attachments):
ALL VENTS: Smartvent Inc. Model#1540-510
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 3 of 19
I
ELEVATION CERTIFICATE
IMPORTANT:MUST FOLLOW THE INSTRUCTIONS ON PAGES 9-19
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No.: FOR INSURANCE COMPANY USE
COTTAGE 30 (BRICKHOUSE)-SAGE BOULEVARD
Policy:Number:
City: GREENPORT State: NY ZIP Code:
Company NAIC Number
SECTION E. BUILDING,MEASUREMENT,INFORMATION(SURVEY NOT REQUIRED) .
FOR'ZONE AO,ZONE AR/AO;AND ZONE A(WITHOUT BFE)
For Zones AO,AR/AO,and A(without BFE),complete Items El—E5. For Items E1—E4, use natural grade,if available. If the Certificate is
intended to support a Letter of Map Change request,complete Sections A, B,and C. Check the measurement used. In Puerto Rico only,
enter meters. ,
Building measurements are based on: ❑Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
El. Provide measurements(C.2.a in applicable Building Diagram)for the following and check the appropriate boxes to show whether the
measurement is above or below the natural HAG and the LAG.
a) Top of bottom floor(including basement,
crawlspace, or enclosure)is: ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor(including basement,
crawlspace, or enclosure)is: ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions),the
next higher floor(C2.b in applicable
Building Diagram)of the building is: ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage(top of slab)is: ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is: ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S AUTHORIZED'REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B,and E for Zone A(without BFE)or Zone AO must
sign here. The statements in Sections A,B, and E are correct to the best of my knowledge
❑ Check here if attachments and describe in the Comments area.
Property Owner or Owner's Authorized Representative Name:
Address:
City: State: ZIP Code:
Signature: Date:
Telephone: Ext.: Email:
Comments:
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 4 of 19
ELEVATION CERTIFICATE
IMPORTANT:MUST FOLLOW THE INSTRUCTIONS ON PAGES 9-19
Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No.: :.FOR INSURANCE COMPANY.USE-
COTTAGE 30 (BRICKHOUSE)-SAGE BOULEVARD -
Polio Number
City: GREENPORT State: NY ZIP Code:
Company NAIC Number
SECTION..G ,COMMUNITY INFORMATION(RECOMMENDED FOR COMMUNITY OFFICIAL COMPLETION)'
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Section A, B, C, E,G,or H of this Elevation Certificate.Complete the applicable item(s)and sign below when:
G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,
engineer,or architect who is authorized by state law to certify elevation information.(Indicate the source and date of the
elevation data in the Comments area below.)
G2.a. ❑ A local official completed Section E for a building-located in Zone A(without a BFE),Zone AO, or Zone AR/AO,or when item
E5 is completed for a building located in Zone AO. .
G2.b. ❑ A local official completed Section H for insurance purposes.
G3. ❑ In the Comments area of Section G,the local official describes specific corrections to the information in Sections A, B, E and H.
G4. ❑ The following information(Items G5—G11)is provided for community floodplain management purposes.
G5. Permit Number: G6. Date Permit Issued:
G7. Date Certificate of Compliance/Occupancy Issued:
G8. This permit has been issued for: ❑New Construction ❑ Substantial Improvement
G9.a. Elevation of as-built lowest floor(including basement)of the
building: ❑feet ❑meters Datum:
G9.b. Elevation of bottom of as-built lowest horizontal structural
member: ❑feet ❑ meters Datum:
G10.a. BFE(or depth in Zone AO)of flooding at the building site: ❑ feet ❑ meters Datum:
1310.b. Community's minimum elevation(or depth in Zone AO)
requirement for the lowest floor or lowest horizontal structural
member: ❑feet ❑ meters Datum:
G11. Variance issued? ❑Yes ❑ No If yes,attach documentation and describe in the Comments area.
The local official who provides information in Section G must sign here.I have completed the information in Section G and certify that it is
correct to the best of my knowledge. If applicable, I have also provided specific corrections in the Comments area of this section.
Local Official's Name: Title:
NFIP Community Name:
Telephone: Ext.: Email:
Address:
City: State: ZIP Code:
Signature: Date:
Comments(including type of equipment and location, per C2.e;description of any attachments;and corrections to specific information in
Sections A, B, D, E, or H):
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 5 of 19
ELEVATION CERTIFICATE
IMPORTANT:MUST FOLLOW THE INSTRUCTIONS ON PAGES 9-19
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No.: FOR INSURANCE COMPANY,USE,
COTTAGE 30(BRICKHOUSE)-SAGE BOULEVARD
Policy Number
City: GREENPORT State: NY ZIP Code:
Company NAIL Number
SECTION H=BUILDING'S FIRST FLOOR•HEIGHT INFORMATION FOR ALL"ZONES
(SURVEY NOT REQUIRED)(FORiNSURANCE„PURPOSES ONLY),
The property owner,owner's authorized representative,or local floodplain management official may complete Section H for all flood zones
to determine the building's first floor height for insurance purposes.Sections A, B, and I must also be completed. Enter heights to the
nearest tenth of a foot(nearest tenth of a meter in Puerto Rico).Reference the Foundation Type Diagrams(at the end of Section H
Instructions)and the appropriate Building Diagrams(at the end of Section I Instructions)to complete this section.
1-11. Provide the height of the top of the floor(as indicated in Foundation Type Diagrams)above the Lowest Adjacent Grade(LAG):
a) For Building Diagrams 1A,1B,3,and 5-9.Top of bottom ❑feet ❑ meters ❑ above the LAG
floor(include above-grade floors only for buildings with
subgrade crawlspaces or enclosure floors)is:
b) For Building Diagrams 2A,2B,4,and 6-9.Top of next ❑feet ❑meters ❑ above the LAG
higher floor(i.e.,the floor above basement,crawlspace,or
enclosure floor)is:
H2. Is all Machinery and Equipment servicing the building(as listed in Item H2 instructions)elevated to or above the floor indicated by the
H2 arrow(shown in the Foundation Type Diagrams at end of Section H instructions)for the appropriate Building Diagram?
❑Yes ❑ No
'SECTION I PROPERTY OWNER(OR OWNER'S-AUTHORIZED REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B,and H must sign here. The statements in Sections
A, B, and H are correct to the best of my knowledge. Note:If the local floodplain management official completed Section H,they should
indicate in Item G2.b and sign Section G.
❑ Check here if attachments are provided(including required photos)and describe each attachment in the Comments area.
Property Owner or Owner's Authorized Representative Name:
Address:
City: State: ZIP Code:
Signature: Date:
Telephone: Ext.: Email:
Comments:
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 6 of 19
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON PAGES 9-19
BUILDING PHOTOGRAPHS
See Instructions for Item A6.
Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No. FOR INSURANCE COMPANY USE
COTTAGE 30 (BRICKHOUSE) -SAGE BOULEVARD
Policy Number:
City: GREENPORT State: NY ZIP Code:
Company NAIC Number:
Instructions: Insert below at least two and when possible four photographs showing each side of the building(for example, may only be
able to take front and back pictures of town houses/rowhouses). Identify all photographs with the date taken and "Front View,"'Rear View,"
"Right Side View,"or"Left Side View."Photographs must show the foundation. When flood openings are present, include at least one
close-up photograph of representative flood openings or vents, as indicated in Sections A8 and A9.
. r
Photo One
Photo One Caption: Clear Photo One
r
.A
Photo Two
Photo Two Caption: Clear Photo Two
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 7 of 19
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON PAGES 9-19
BUILDING PHOTOGRAPHS
Continuation Page
Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No.. FOR INSURANCE COMPANY USE
COTTAGE 30 (BRICKHOUSE)-SAGE BOULEVARD
Policy Number:
City: GREENPORT State: NY ZIP Code
Company NAIC Number:
Insert the third and fourth photographs below. Identify all photographs with the date taken and"Front View,"'Rear View," "Right Side
View,"or"Left Side View."When flood openings are present, include at least one close-up photograph of representative flood openings or
vents, as indicated in Sections A8 and A9.
i
tr
r
I
Photo Three
Photo Three Caption: Clear Photo Three
E'
i
Photo Four
Photo Four Caption: Clear Photo Four
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 8 of 19
DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
INSTRUCTIONS FOR COMPLETING THE ELEVATION CERTIFICATE
The Elevation Certificate is to be completed by a land surveyor,engineer,or architect who is authorized by state law to certify elevation
information when elevation information is required or used for Zones Al-A30,AE,AH,AO,A(with Base Flood Elevation(BFE)),VE,V1-
V30,V(with BFE),AR,AR/A,AR/AE,AR/A1 A30,AR/AH,AR/AO,or A99.
Community officials who are authorized by law or ordinance to provide floodplain management information(herein referred to as"local
floodplain management official")may also complete this form. For Zones AO,AR/AO,and A(without BFE),a local floodplain management
official,a property owner,or an owner's authorized representative may provide floodplain management compliance information on this
certificate in Section E, unless the elevations are intended for use in supporting a request for a LOMA, CLOMA, LOMR-F,or CLOMR-F.
Certified elevations must be included if the purpose of completing the Elevation Certificate is to obtain a LOMA,CLOMA, LOMR-F,or
CLOMR-F.
The property owner,the owner's authorized representative,or local floodplain management official can complete Section A and Section B.
The partially completed form can then be given to the land surveyor,engineer,or architect to complete Section C.The land surveyor,
engineer,or architect should verify the information provided by the property owner or owner's representative to ensure that this certificate
is complete.
For insurance purposes only,a local floodplain management official,a property owner,or an owner's authorized representative may
provide First Floor Height details in Section H for any zone.
In Puerto Rico only,elevations for building information and flood hazard information may be entered in meters.
Note:Section C can be used for insurance and compliance in any zone; however, Section E can be used only for compliance in Zone AO
and Zone A.
SECTION A—PROPERTY INFORMATION
Items Al-A4.This section identifies the building,its location,and its owner. Enter the name(s)of the building owner(s),the building's
complete street address or property description(e.g., lot and block numbers or legal description),and/or tax parcel number. If the
building's address is different from the owner's address,enter the address of the building being certified.If the address is a rural route or a
Post Office box number,enter the lot and block numbers,the tax parcel number,the legal description,or an abbreviated location
description based on distance and direction from a fixed point of reference. For the purposes of this certificate,"building"means both a
building and a manufactured(mobile)home. For properties with multiple buildings, include a description for the specific building.
A map may be attached to this certificate to show the location of the building on the property.A tax map, Flood Insurance Rate Map
(FIRM),or detailed community map is appropriate. If no map is available,provide a sketch of the property location,and the location of the
building on the property.Include appropriate landmarks such as nearby roads,intersections,and bodies of water.For building use, indicate
whether the building is residential, non-residential,an addition to an existing residential or non-residential building,an accessory building
(e.g.,garage),or other type of structure.Use the Comments area of the appropriate section if needed,or attach additional comments.
Item AS.Provide latitude and longitude coordinates for the center of the front of the building. Use either decimal degrees(e.g.,
39.504322°,-110.758522°)or degrees,minutes,seconds(e.g.,39°30' 15.56",-110°45'30.68")format. If decimal degrees are used,
provide coordinates to at least six decimal places or better.When using degrees,minutes,seconds, provide seconds to at least two
decimal places or better. Provide the datum of the latitude and longitude coordinates(FEMA prefers the use of NAD 1983). Indicate the
method or source used to determine the latitude and longitude in the Comments area of the appropriate section.When the latitude and
longitude are provided by a land surveyor,check the"Yes"box in Section D.
Item A6.The certifier must provide at least two and when possible four photographs showing each side of the building taken within 90
days from the date of certification.The photographs must be taken with views confirming the building description and Building Diagram
number provided in Item A7.To the extent possible,these photographs should show the entire building including foundation. In addition,
.when applicable,provide a photograph of the foundation showing a representative example of the flood openings or vents.All photographs
must be in color and measure at least 3NW. Digital photographs are acceptable.Additional photographs may be requested by local
floodplain management officials or for insurance purposes to show additional detail regarding the building characteristics or features.
Item A7.Select the Building Diagram(shown on pages 17-19)that best represents the building.Then enter the diagram number and use
the diagram to identify and determine the appropriate elevations requested in Items C2.a-h.If you are unsure of the correct diagram,
select the diagram that most closely resembles the building being certified.
Item A8.a.Provide the square footage of the crawlspace or enclosure(s)below the lowest elevated floor of an elevated building with or
without permanent flood openings.Take the measurement from the outside of the crawlspace or enclosure(s). Examples of elevated
buildings constructed with crawlspace and enclosure(s)are shown in Diagrams 6-9 on pages 18-19. Diagram 2A,213,4, or 9 should be
used for a building constructed with a crawlspace floor that is below the exterior grade on all sides. If there is no crawlspace or enclosure,
enter"N/A"for Items A8.a-f.
Item A8.b.Indicate if there is at least one permanent flood opening within 1.0 foot of the adjacent grade on at least two exterior walls of
each enclosed area identified in ABA.A permanent flood opening is a flood vent or other opening that allows the free passage of water
automatically in both directions without human intervention. If the crawlspace or enclosure(s)have no permanent flood openings, or if none
of the openings are within 1.0 foot above adjacent grade,enter"0"(zero)in Item A8.o-f. If there is no crawlspace or enclosure,enter"N/A".
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 9 of 19
SECTION A-PROPERTY INFORMATION(Condnueao
Item A8.c.Enter the total number of permanent non-engineered and/or engineered flood openings in the crawlspace or enclosure(s)that are no
higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening.If the interior grade elevation is used,
note this in the Comments area of Section D.
Item A8.d.Enter the total measured net open area of permanent non-engineered flood openings indicated in A8.c in square inches,excluding any
bars,louvers,or other covers of the permanent flood openings.Non-engineered openings that meet the requirements of NFIP Technical Bulletin 1
are assumed to provide one square foot of rated area for each square inch of net open area.If the net open area cannot be measured,provide in
the Comments area of the appropriate section the size of the flood openings without consideration of any covers and indicate the type of cover
that exists in the flood openings.
Item A8.e.Enter the total rated area of the permanent engineered flood openings indicated in A8.c,in square feet.Attach a copy of the Individual
Engineered Flood Openings Certification for a specific building or an Evaluation Report issued by the International Code Council Evaluation
Service(ICC ES)for all engineered openings,and indicate the manufacturers name and model number in the Comments area of the appropriate
section,if applicable.Flood openings cannot be considered engineered flood openings without documentation.If no documentation is available/
provided,enter the net open(unobstructed)area of the flood openings in A8.d instead.
Item A81 Complete only if permanent engineered and permanent non-engineered flood openings are both present Enter the sum of A8.d(net
open area of all non-engineered openings)and A8.e(total rated area of all engineered openings).Non-engineered openings that meet the
requirements of NFIP Technical Bulletin 1 are assumed to provide one square foot of rated area for each square inch of net open area.For
example,a non-engineered opening with 140 sq.in.of net open area(i.e.,rated for 140 sq.ft.of enclosure area),combined with two(2)
engineered openings rated for 200 sq.ft.each,would yield 140+400=540 sq.ft.rated area.If eitherA8.d orA8.e is"0",then enter"N/A"forA8.f.
Item A9.a.Provide the square footage of the attached garage with or without permanent flood openings.Take the measurement from the outside
of the garage.If there is no attached garage,enter"N/A"for items A9.a-f.
Item A9.b.Indicate if there is at least one permanent flood opening within 1.0 foot of the adjacent grade on at least two exterior walls of the
attached garage identified in A9.a.If the attached garage has no permanent flood openings,or if none of the openings are within 1.0 foot above
adjacent grade,enter"0"(zero)in Items A9.c-f.If there is no attached garage,enter"N/A".
Item A9.c.Enter the total number of permanent non-engineered and/or engineered flood openings in the attached garage that are no higher than
1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening.This includes any openings that are in the
garage door that are no higher than 1.0 foot above the adjacent grade.If the interior grade elevation is used,note this in the Comments area of
Section D.
Item A9.d.Enter the total measured net open area of permanent non-engineered flood openings indicated in A9.c in square inches,excluding any
bars,louvers,or other covers of the permanent flood openings,and enter the total in Item A9.d.Non-engineered openings that meet the
requirements of NFIP Technical Bulletin 1 are assumed to provide one square foot of rated area for each square inch of net open area.If the net
open area cannot be measured,provide in the Comments area of the appropriate section the size of the flood openings without consideration of
any covers and indicate the type of cover that exists in the flood openings.
Item A9.e.Enter the total rated area of the permanent engineered flood openings indicated in A9.c in square feet.Attach a copy of the Individual
Engineered Flood Openings Certification for a specific building or an Evaluation Report issued by the ICC ES for all engineered openings,and
indicate the manufacturers name and model number in the Comments area of the appropriate section,if applicable. Flood openings cannot be
considered engineered flood openings without documentation.If no documentation is available/provided,enter the net open(unobstructed)area
of the flood openings in A9.d instead.
Item A91 Complete only if permanent engineered and permanent non-engineered flood openings are both present.Enter the sum of A9.d(net
open area of all non-engineered openings)and A9.e(total rated area of all engineered openings).Non-engineered openings that meet the
requirements of NFIP Technical Bulletin 1 are assumed to provide one square foot of rated area for each square inch of net open area.For
example,a non-engineered opening with 140 sq.in.of net open area(i.e.,rated for 140 sq.ft.of enclosure area),combined with two(2)
engineered openings rated for 200 sq.ft.each,would yield 140+400=540 sq.ft.rated area.If either A9.d orA9.e is"0",then enter"N/A"for A9.f.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Complete the Elevation Certificate using the Flood Insurance Study(FIS)and FIRM in effect at the time of the certification.
The information for Section B is obtained by reviewing the FIS and the FIRM panel that includes the building's location.Information about
the current FIS and FIRM is available from FEMA by visiting msc.fema.gov or contacting the local floodplain management official.If a
Letter of Map Amendment(LOMA), Letter of Map Revision Based on Fill(LOMR-F),or Letter of Map Revision(LOMR)has been issued by
FEMA, please provide the letter date and case number in the Comments area of Section D or Section G, as appropriate.
For a building in an area that was mapped in one community but is now in another community due to annexation or dissolution,enter the
community name and six-digit Community Identification Number of the community in which the building is now located in Items B1.a and
B1.b;the name of the county or new county, if necessary, in Item B2;and the FIRM index date for the community identified in B1.a, in Item
B6. Enter information from the actual FIRM panel that shows the building location,even if it is the FIRM for the previous jurisdiction, in
Items B4, B5, BT B8, and B9.
If the map in effect at the time of the building's construction was other than the current FIRM, and you have the past map information
pertaining to the building,provide the information in the Comments area of Section D.
Note: Indicate in the Comments area of Section D if using information based on best available data, such as base-level engineering or
advisory flood hazard data(contact the local floodplain management official to confirm).
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 10 of 19
SECTION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION(Condnueo
Items B1.a—b NFIP Community Name and Community Identification Number.Enter the complete name of the community in which the
building is located in B1.a,and the associated six-digit Community Identification Number in Bl.b. For an unincorporated area of a county,
enter the county name and"unincorporated area",and the six-digit number of the county.For a newly incorporated community, use the name
and six-digit number of the new community. Under the NFIP,a"community"is any state or area or political subdivision thereof, or any Indian
tribe or authorized native organization which has authority to adopt and enforce floodplain management regulations for the areas within its
jurisdiction.To determine the current community number,see the NFIP Community Status Book,available on FEMA's website at
wwwfema gov/national-flood-insurance-grogram-community-status-book.
Item B2.County Name.Enter the name of the county or counties in which the community is located. For an unincorporated area of a county,
enter the county name.For an independent city,enter"independent city."
Item B3.State.Enter the two-letter state abbreviation(for example,VA,TX,CA).
Items B4—B5.Map/Panel Number and Suffix. Enter the 10-character"Map Number"or"Community Panel Number"shown on the FIRM
where the building or manufactured(mobile)home is located. For maps in a county-wide format,the sixth character of the"Map Number"is
the letter"C"followed by a four-digit map number. For maps not in a county-wide format,enter the"Community Panel Number"shown on the
FIRM.
Item B6.FIRM Index Date.Enter the effective date or the map revised date shown on the FIRM Index.
Item B7.FIRM Panel Effective/Revised Date.Enter the effective date shown on the current FIRM panel.The current FIRM panel effective
date can be determined by visiting msc.fema.gov or contacting the local floodplain management official. If the area where the building is
located was revised by a LOMR,include the LOMR effective date and the LOMR case number in the comments area of Section D.
Item B8.Flood Zone(s). Enter the flood zone,or flood zones,in which the building is located.All flood zones containing the letter"A"or V'
are considered Special Flood Hazard Areas(SFHAs).Each flood zone is defined in the legend of the FIRM panel on which it appears.If the
area where the building is located was revised by a LOMA,CLOMA, LOMR-F,or CLOMR-F,include the flood zone shown on the LOMA,
CLOMA,LOMR-F,or CLOMR-F,and add the effective date and case number in the comments area of Section D.
Item 69.Base Flood Elevation(s)(BFE).Using the appropriate Flood Insurance Study(FIS)Profile,FIS Data Table(e.g.Transect, Floodway,
etc.),or FIRM panel,locate the property and enter the BFE(or base flood depth)of the building site to the nearest tenth of a foot(nearest
tenth of a meter, in Puerto Rico).If the building is located in more than one flood zone in Item B8,list all appropriate BFEs in Item B9.
BFEs are shown in the FIS or on a FIRM for Zones Al—A30,AE,AH,V1 V30,VE,AR,AR/A,AR/AE,AR/A1—A30,and AR/AH; base flood
depths are shown for Zones AO and AR/AO. Use the AR BFE(or base flood depth)if the building is located in any of these zones: AR/A,AR/
AE,AR/A1 A30,AR/AH,or AR/AO.
In A or V zones where BFEs are not provided in the FIS or on the FIRM, BFEs may be available from another source.For example,the
community may have established BFEs or obtained BFE data from other sources(e.g.,Base Level Engineering)for the building site.For
subdivisions and other developments of more than 50 lots or 5 acres in Zone A,establishment of BFEs is required by the community's
floodplain management ordinance.If a BFE is obtained from another source,enter the BFE in Item B9.The BFE entered in Item B9 must be
based on hydrologic and hydraulic analyses.In an A Zone where BFEs are not obtained from another source,enter N/A in Item B9 and
complete Section E.
Item B10.Indicate the source of the BFE or base flood depth that you entered in Item B9.If the BFE is from a source other than the FIS,
FIRM,or community,include the name of the study,the agency or company that produced it,and the date when the study was completed.
Visit msc.fema.gov or contact the local floodplain management official to access the current FIS and FIRM.
Item B11.Indicate the elevation datum to which the elevations on the applicable FIRM are referenced as shown on the map legend.The
vertical datum is shown in the Map Legend and/or the Notes to Users on the FIRM.
Item B12.Indicate whether the building is located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA).
OPAs are portions of coastal barriers that are owned by Federal,State,or local governments or by certain non-profit organizations and used
primarily for natural resources protection.CBRS areas and OPAs are no longer shown on the FIRM;please use the maps available at
www.fws.gov/cbra/maps/index.htmi to complete Item BI2.Federal flood insurance is prohibited in designated CBRS areas or OPAs for
buildings or manufactured(mobile)homes built or substantially improved after the date of the CBRS or OPA designation.For the first CBRS
designations,that date is October 1, 1983.Information about CBRS areas and OPAs may be obtained on the FEMA website at
www fema gov/national-flood-insurance-program/coastal-barrier-resources-system.
Item B13.Indicate whether the building is located seaward of the Limit of Moderate Wave Action(LiMWA).If the LiMWA is not shown on the
FIRM,check the"No"box.Information about the LiMWA and other coastal flood zones may be obtained on the FEMA website at
www.fema.gov/flood-maps/coastal/insurance-rate-maps.
SECTION C-BUILDING ELEVATION INFORMATION (SURVEY-REQUIRED)..,
Complete Section C if the building is located in any of Zones Al—A30,AE,AH,A(with BFE),VE,VI—V30,V(with BFE),AR,ARIA,AR/AE,
AR/A1—A30,.AR/AH,orA99.If the Certificate is being completed to demonstrate compliance with local floodplain management
requirements,contact the local floodplain management official to find out any additional requirements.Section C may also be completed
for insurance purposes to determine the building's First Floor Height in any flood zone(including Zones AO,AR/AO, B, C,X and D).In
addition, complete Section C if this certificate is being used to support a request for a LOMA,CLOMA, LOMR-F,or CLOMR-F.
To ensure that all required elevations are obtained, it may be necessary to physically enter the building(for instance, if the building has a
basement or sunken living room,split-level construction,or Machinery and Equipment(M&E)).
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 11 of 19
SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)(Continued)
Land surveyors may not be able to gain access to some crawlspaces to shoot the elevation of the crawlspace floor. If access to the
crawlspace is limited or cannot be gained,follow one of these procedures.
•Use a yardstick or tape measure to measure the height from the floor of the crawlspace to the"next higher floor,"and then subtract
the crawlspace height from the elevation of the"next higher floor."If there is no access to the crawlspace, use the exterior grade
next to the structure to measure the height of the crawlspace to the"next higher floor."
•Contact the local floodplain management official of the community in which the building is located.The community may have
documentation of the elevation of the crawlspace floor as part of the permit issued for the building.
•If the property owner has documentation or knows the height of the crawlspace floor to the next higher floor,try to verify this by
looking inside the crawlspace through any openings or vents.
In all three cases, use the Comments area of Section D to provide the elevation and a brief description of how the elevation was obtained.
Note: If any item does not apply to the building,enter"N/A"for not applicable.
Item C1.Indicate whether the elevations to be entered in this section are based on construction drawings, a building under construction, or
finished construction. For either of the first two choices,a post-construction Elevation Certificate will be required when construction is
complete. If the building is under construction, include only those elevations that can be surveyed in Items C2.a—h. Use the Comments
area of Section D to provide elevations obtained from the construction plans or drawings.Select"Finished Construction"only when all
M&E such as furnaces,water heaters, heat pumps, air conditioners,and elevators and their associated equipment have been installed and
the grading around the building is completed.
Item C2.A field survey is required for Items C2.a—h. Most control networks will assign a unique identifier for each benchmark. For
example,the National Geodetic Survey uses the Permanent Identifier(PID). For the benchmark utilized, provide the PID or other unique
identifier assigned by the maintainer of the benchmark. For GPS survey, indicate the benchmark used for the base station,the
Continuously Operating Reference Stations(CORS)sites used for an Online Positioning User Service(OPUS)solution(also attach the
OPUS report),or the name of the Real Time Network used.
Also provide the vertical datum for the benchmark elevation.All elevations for the certificate, including the elevations for Items C2.a—h,
must use the same datum on which the BFE is based.Show the conversion from the field survey datum used if it differs from the datum
used for the BFE entered in Item B9 and indicate the conversion software used.Show the datum conversion,if applicable, in the
Comments area of Section D.
For property experiencing ground subsidence,the most recent reference mark elevations must be used for determining building
elevations. However,when subsidence is involved,the BFE should not be adjusted.
Note: Enter elevations in Items C2.a—h to the nearest tenth of a foot(nearest tenth of a meter, in Puerto Rico); if data is surveyed to the
nearest hundredth, round to the nearest tenth.
Item C2.a.Enter the elevation measured at the top of the bottom floor(excluding the attached garage)indicated by the selected Building
Diagram(Item A7).For buildings elevated on a crawlspace, Building Diagrams 8 and 9,enter the lowest elevation of the top of the
crawlspace floor in Item C2.a,whether or not the crawlspace has permanent flood openings(flood vents).
Item C2.b.For Building Diagrams 2A through 9 in any flood zone, including Zones B, C,X, and D,enter the elevation measured at the top
of the next higher floor(excluding the attached garage)indicated by the selected Building Diagram(Item A7). For buildings requiring more
than two floors or levels to be surveyed,such as those with multiple floors or multi-level enclosures,enter the additional surveyed
elevations and floor descriptions in the Section D Comments, and clarify which floors are entered as Item C2.a and C2.b.
Item C2.c. For floodplain management compliance,this elevation is required for all Building Diagrams 5 and 6 in V Zones in areas
seaward of the LiMWA,and in other areas regulated for coastal flooding hazards. Enter the elevation measured at the bottom of the lowest
horizontal structural member of the floor indicated by the selected Building Diagram(Item A7)or the figure below.This elevation can be
entered for Building Diagrams 5 and 6 in any flood zone, including Zones B, C,X, and D. For Building Diagrams other than 5 and 6(if
applicable),enter the C2.c elevation as indicated in the figure below. If this item does not apply to the building, enter"NIA"for not
applicable.
Item C2.d.If there is an attached garage,enter the lowest elevation for top of attached garage slab. (Because elevation for top of attached
garage slab is self-explanatory,attached garages are not illustrated in the Building Diagrams.)
Item C2.e.Enter the lowest platform,floor, or ground elevation supporting the lowest electrical, heating,ventilation, plumbing, and air
conditioning M&E and other utilities servicing the building,which may be located in an attached garage or enclosure or on an open utility
platform. Note that elevations for the M&E items are required regardless of their location. Local floodplain management officials are
required to ensure that all new M&E servicing the building are protected from flooding.Thus, local officials may require that elevation
information for all M&E, including ductwork, be documented on the Elevation Certificate. If the M&E is mounted to a wall, pile,etc.,enter
the platform elevation of the M&E. Indicate the lowest M&E type and its general location(e.g.,on floor inside garage,on platform affixed to
exterior wall)in the Comments area of Section D or Section G, as appropriate.
Note: For more guidance on floodplain management compliance for utilities, including M&E, refer to FEMA P-348, Protecting Building
Utility Systems from Flood Damage.The list of M&E and the elevation requirements for documenting floodplain management compliance
are different than the NFIP insurance M&E discount eligibility considerations.See Section H Instructions for additional information.
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10122) Page 12 of 19
SECTION.C—BUILDING ELEVATION INFORMATION.(SURVEY REQUIRED),(Continueao`.
Item C21 Enter the finished Lowest Adjacent Grade(LAG)elevation of the ground,sidewalk,or patio slab next to and in direct contact
with the building. For a building in Zone AO, use the natural grade elevation,if available. Indicate whether the natural or finished grade was
used. If natural grade was used,attach the source of the information(e.g.,a grading plan).For buildings under construction in any flood
zone,enter the LAG elevation at the time of the survey. Note: Natural grade means the undisturbed natural surface of the ground prior to
any excavation or fill.
Item C2.9. Enter the finished Highest Adjacent Grade(HAG)elevation of the ground,sidewalk,or patio slab next to and in direct contact
with the building. For a building in Zone AO, use the natural grade elevation if available.Indicate whether the natural or finished grade was
used. If natural grade was used,attach the source of the information(e.g.,a grading plan).For buildings under construction in any flood
zone,enter the HAG elevation at the time of tie survey.
Item C2.h.Enter the finished LAG elevation of the lowest ground,sidewalk,or patio slab next to and in direct contact with the structurally-
attached-deck supports or stairs structurally attached to the building. For buildings under construction in any flood zone,enter the lowest
LAG at the time of the survey.
BUILDING ON BUILDING WITH BUILDING ON PIERS,POSTS,
SLAB BASEMENT PILES,COLUMNS,OR
PARALLEL SHEAR WALLS
C2.a
C2.a \\ \.
f --
C2.a C2.c
C2.c GRADE ADJAC... ;/ •"
GRAQE:' :.�; .... .
Figures for use in determining Item C2.c
SECTION.D='SURVEYOR,.,ENGINEER,OR ARCHITECT CERTIFICATION
This section of the Elevation Certificate may be signed by only a land surveyor,engineer, or architect who is authorized by state law to
certify elevation information.Complete as indicated and place your license number,your seal(as allowed by the state licensing board),
your signature,and the date in Section D.You are certifying that the information on this Certificate represents your best efforts to interpret
the data available and that you understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,
Section 1001. Use the Comments area of Section D to provide relevant and clarifying information not specified elsewhere on the
certificate, including supporting information for Iatitude/Iongitude source forA5;openings forA8/A9; LOMR data for Section B; BFE and
BFE source data for B9/B10;datum conversion for C2;grading plan for natural grade used in C2.f-g; machinery type and location for C2.e;
and any other relevant information identified in the instructions or needed for clarification.If attachments are included,check the
attachments box and describe the attachments in the Comments area.
SECTION E.=BUILDING MEASUREMENT INFORMATION(SURVEY,NOT.REQUIRED) '
FOR ZONE AO ZONE ARIAO,AND
ZONEA(WITHOUT BFE):
Complete Section E if the building is located in Zone AO,Zone AR/AO,or Zone A(without BFE)and the Certificate is being completed for
the purpose of documenting compliance with local floodplain management requirements.If the Certificate is being completed to document
compliance in other flood zones,including Zone A(with BFE),to support a LOMA, CLOMA, LOMR-F,or CLOMR-F request, or to provide a
ground elevation for flood insurance rating,complete Section C instead of Section E. Explain in the Section F Comments area if the
measurement provided under Items El—E4 is not based on the"natural grade."Natural grade means the undisturbed natural surface of
the ground prior to any excavation or fill.
Indicate whether the measurements to be entered in this section are based on construction drawings,a building under construction,or
finished construction. For either of the first two choices,a post-construction Elevation Certificate will be required when construction is
complete. If the building is under construction,include only those measurements that can be determined in Items E1—E4. Use the
Comments area of Section F to provide measurements obtained from the construction plans or drawings.Select"Finished Construction"
only when all Machinery and Equipment(M&E)such as furnaces,water heaters, heat pumps,air conditioners,and elevators and their
associated equipment have been installed and the grading around the building is completed.
Note: Enter heights in Items El—E4 to the nearest tenth of a foot(nearest tenth of a meter, in Puerto Rico).
Items E1.a and b.Enter in Item E1.a the height of the top of the bottom floor(as indicated by C2.a in the selected Building Diagram, Item
A7)above or below the natural HAG. Enter in Item E1.b the height of the top of the bottom floor(as indicated by C2.a in the selected
Building Diagram,Item A7)above or below the natural LAG. For buildings in Zone AO,the community's floodplain management ordinance
requires the lowest floor of the building be elevated above the HAG at least as high as the base flood depth on the FIRM.
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 13 of 19
SECTION E-BUILDING MEASUREMENT INFORMATION(SURVEY NOT REQUIRED).
FOR ZONE AO,AND ZONE A(WITHOUT BFE)(Condhiie Q .
Item E2.For Building Diagrams 6-9 with permanent flood openings(see pages 18-19),enter the height of the next higher floor or
elevated floor(as indicated by C2.b in the selected Building Diagram, Item A7)above or below the HAG.
Item E3.Enter the height, in relation to the HAG next to the building,for the top of attached garage slab.(Because elevation for top of
attached garage slab is self-explanatory, attached garages are not illustrated in the diagrams.)If this item does not apply to the building,
enter WIA"for not applicable.
Item E4.Enter the height, in relation to the HAG next to the building,of the platform elevation that supports the M&E servicing the building.
See Item C2.e for additional details on M&E. Indicate the M&E type in the Comments area of Section F.
Item E5.For those communities where this base flood depth is not available,the community will need to determine whether the top'of the
bottom floor is elevated in accordance with the community's floodplain management ordinance.
SECTION F-'PROPERTY OWNER(OR OWNER'S AUTHORIZED REPRESENTATIVE)CERTIFICATION
Complete as indicated.This section is provided for certification of measurements when completing Sections A,B,and E. If Section E is
completed by a property owner or property owner's authorized representative in Zone AO,AR/AO,orA(without BFE),then the community
should confirm the heights in Section E to ensure compliance with community floodplain management ordinances. If Section E is
completed by a local floodplain management official,then complete Item G2.a and Section G instead of Section F.The address entered in
this section must be the actual mailing address of the individual who provided the information on the certificate.Check the box as indicated
if including attachments and describe in the Comments area.
:SECTION G . COMMUNITY INFORMATION(RECOMMENDED'FOR COMMUNITY OFFICIAL COMPLETION)
The community official who is authorized by law or ordinance to administer the community's floodplain management ordinance can
complete Sections A, B,C, E,G or H of this Elevation Certificate and sign this section. Section C may be completed by the local official per
the instructions below for Item G1.
Item G1.Check if Section C is completed with elevation data from other documentation that has been signed and sealed by a licensed
land surveyor,engineer,or architect who is authorized by state law to certify elevation information. Indicate the source of the elevation data
and the date obtained in the Comments area of Section G. If you are both a community official and a licensed land surveyor,engineer,or
architect authorized by state law to certify elevation information,and you performed the actual survey for a building in any flood zones
(including Zones A99,B, C.X and D),you must also complete Section D.
Item G2.a.Check if information is entered in Section E by the community for a building in Zone A(without a BFE),Zone AO, or Zone AR/
AO,or when the community certifies Item E5 for a building in Zone AO.
Item G2.b.Check if information is entered in Section H by the community for insurance purposes.
Item G3.Check if the community official is correcting information provided in Sections A, B, E and H. Describe corrections in the
Comments area of Section G.
Item G4.Check if the information in Items G5—G11 has been completed for community floodplain management purposes to document the
as-built lowest floor elevation of the building. Section C of the Elevation Certificate records the elevation of various building components
but does not determine the lowest floor of the building or whether the building,as constructed,complies with the community's floodplain
management ordinance.This must be done by the community. Items G5—G11 provide a way to document these determinations.
Item G5.Permit Number. Enter the permit number or other identifier to key the Elevation Certificate to the permit issued for the building.
Item G6.Date Permit Issued.Enter the date the permit was issued for the building.
Item G7,Date Certificate of Compliance/Occupancy Issued. Enter the date that the Certificate of Compliance or Occupancy or similar
written official documentation of as-built lowest floor elevation was issued by the community as evidence that all work authorized by the
floodplain development permit has been completed in accordance with the community's floodplain management laws or ordinances.
Item G8.New Construction or Substantial Improvement.Check the applicable box."Substantial Improvement'means any reconstruction,
rehabilitation,addition, or other improvement of a building,the cost of which equals or exceeds 50 percent of the market value of the
building before the start of construction of the improvement(or meets the community's more restrictive standards, if applicable).The term
includes buildings that have incurred substantial damage,regardless`of the actual repair work performed.
Item G9.a.As-built lowest floor elevation. Enter the elevation of the lowest floor(including basement)when the construction of the building
is completed and a final inspection has been made to confirm that the building is built in accordance with the permit,the approved plans,
and the community's floodplain management laws or ordinances. Indicate the elevation datum used.
Item G9.b.As-built lowest horizontal structural member. Enter the elevation measured at the bottom of the lowest horizontal structural
member of the floor indicated by the selected Building Diagram(Item A7)or in the figure at the end of the instructions for Section C.
Indicate the elevation datum used.
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 14 of 19
SECTION G,;-COMMUNITY INFORMATION(RECOMMENDED FOR COMMUNITY.OFFICIAL'COMPLETION) (C6ntinuea7-
Item G10.a.BFE.Using the appropriate FIRM panel, FIS,or other data source, locate the property and enter the BFE(or base flood
depth)of the building site. Indicate the elevation datum used.
Item G10.b.Community's minimum elevation or depth requirement.Enter the elevation(including freeboard above the BFE)to which the
community requires the lowest floor or the lowest horizontal structural member to be elevated. Indicate the elevation datum used.
Item 1311.Indicate Yes if a variance from the floodplain management regulations(Title 44 CFR§60.6)has been issued for the building,
attach the supporting documentation,and describe the attachment in the Comments area of this section. If no such variance has been
issued, indicate No.
Enter your name,title,and telephone number,and the name of the community and add any comments.Sign and enter the date in the
appropriate blanks.
,SECTION H;=''BUILDING'S FIRST FLOOR HEIGHT INFORMATION'FORALL ZONES
{SURVEY NOT REQUIRED)(FOR INSURANCE PURPOSES ONLY)'
In any flood zone the property owner,owner's authorized representative,or local floodplain management official may complete this
certificate for rating purposes to determine the building's first floor height and identify the elevation of Machinery and Equipment(M&E)
servicing the building.Sections A, B,and I must also be completed.
Note: If Sections C and/or E and H are all completed,then information in Section C will prevail for insurance purposes and for compliance.
Item H1.a.For Building Diagrams 1A, 1 B,3,and 5-9 shown on pages 17-19,enter in Item H1.a the height to the nearest tenth of a foot
(tenth of a meter in Puerto Rico)of the top of the bottom floor(as indicated in the selected Building Diagram, Item A7)above the LAG.
Refer to the arrows on the Foundation Type Diagrams on page 16 that indicate which floor to use to determine the height for Item H1.a.
Item H1.b.For Building Diagrams 2A,2B,4,and 6-9 shown on pages 17-19,enter in Item H1.b the height to the nearest tenth of a foot
(tenth of a meter in Puerto Rico)of the top of the next higher floor or elevated floor(as indicated in the selected Building Diagram,Item A7)
above the LAG. Refer to the arrows on the Foundation Type Diagrams on page 16 that indicate which floor to use to determine the height
for Item H1.b.
Note:The LAG is the lowest point of the ground level immediately next to a building.
Item H2.Indicate"Yes"if all of the following M&E servicing the building, inside or outside the building,are elevated to at least the height of
the location shown by the H2 arrow in the Foundation Type Diagrams on page 16:central air conditioner(including exterior compressor),
furnace,heat pump(including exterior compressor),water heater,and elevator M&E. For contents-only insurance coverage, all of the
following appliances will need to be elevated to at least the height of the location shown by the H2 arrow in the Foundation Type Diagrams
below:tclothes washers and dryers and food freezers.
Note: For both building and contents coverage,all of the M&E and appliances listed above must be elevated per the Foundation Type
Diagrams on page 16 to be considered for the M&E mitigation discount.
Indicate"No"if any of the M&E listed above is not elevated to at least the height of the location shown by the H2 arrow in the Foundation
Type Diagrams on page 16.
The diagrams on the following page illustrate the six NFIP Foundation Type Diagrams. Each foundation type corresponds with one or more
of the eleven Building Diagrams shown at the end of this Elevation Certificate.The arrows on the diagrams indicate which floor to use to
determine H1.a and H1.b The arrows marked as H2 show the minimum elevation required to be eligible for the M&E mitigation discount.
SECTION I-PROPERTY OWNER(OR OWNER'S AUTHORIZED REPRESENTATIVE)CERTIFICATION.
Complete as indicated.This section is provided for certification of measurements when completing Sections A, B,and H. If Section H is
completed by a local floodplain management official,then complete Item G2.b and Section G instead of Section 1.The address entered in
this section must be the actual mailing address of the individual who provided the information on the certificate.
Check the box as indicated if including attachments(e.g., required photos)and describe in the Comments area.
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 15 of 19
Foundation Type Diagrams(for use in Section H):
Slab on Grade(Non-Elevated) Elevated without Enclosure on Posts,Piles,or Piers
i 71 Corresponds to EC Corresponds to EC
H2 1 Diagrams 1A, 16 _. Diagram 5
and 3
H1.a -
H1.a II .
Note:If the building has more than one floor,the Machinery and &H2
Equipment should be on the second floor or higher. G.— —--____ ___._____--____.
Basement(Non-Elevated) Elevated with Enclosure on Posts,Piles,or Piers
Corresponds to EC "" F Corresponds to EC
f Diagrams 2A,2B Diagram 6
and 4 '
H1.b
&H2 m H1.a - &H2
Crawlspace(Elevated,including Non-Elevated Elevated with Enclosure Not on Posts,Piles,or
Sub-Grade Crawlspace) Piers(Solid Foundation Walls)
Corresponds to EC Corresponds to EC
a Diagrams 8 and 9 ° ! Diagram 7
H1.b
H1.b
H1.a
4 �_...., &H2 &H2 '••... H1.a
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 16 of 19
BUILDING DIAGRAMS
The following diagrams illustrate various types of buildings.Compare the features of the building being certified with the features shown in
the diagrams and select the diagram most applicable. Enter the diagram number in Item A7,the square footage of crawlspace or
enciosure(s)and the area of flood openings as indicated in Items A8.a—f,the square footage of attached garage and the area of flood
openings as indicated in Items A9.a—f,and the elevations in Items C2.a—h.
In A, B,C,X and D zones,the floor elevation is taken at the top finished surface of the floor indicated;in V zones, areas seaward of the
LiMWA,and in other areas regulated for coastal flooding hazards,the floor elevation is taken at the bottom of the lowest horizontal
structural member(see figure at end of instructions for Section C).
DIAGRAM 1A: DIAGRAM 1B:
All slab-on-grade single-and multiple-floor buildings(other All raised-slab-on-grade or slab-on-stem-wall-with-fill
than split-level)and high-rise buildings,either detached or single-and multiple-floor buildings(other than split-level),
row type(e.g.,townhouses);with or either detached or row type(e.g.,townhouses);with or
without attached garage. without attached garage.
Distinguishing Feature—The bottom floor is at or above Distinguishing Feature—The bottom floor is at or above
ground level(grade)on at least one side.* ground level(grade)on at least one side.*
8
C2.a C2.b
C2.a NEXT HIGHER NEXT HIGHER i
i FLOORxK i FLOOR i
BOTTOM FLOOR
GRADE BOTTOM FLOOR GRADE
Ed.
rz9
C2.f—h :.'`exisliiig'gratle) .. .. : ... ... .. � C2.f—h `:�';<isn .• ed'e ....... . .... .. ..... .... ...........
DIAGRAM 2A: DIAGRAM 2B:
All single-and multiple-floor buildings with basement(other All single-and multiple-floor buildings with basement(other
than split-level)and high-rise buildings with basement, than split-level)and high-rise buildings with basement,
either detached or row type(e.g.,,townhouses);with or either detached or row type(e.g.,townhouses);with or
Without attached garage. without attached garage.
Distinguishing Feature—The bottom floor(basement Distinguishing Feature—The bottom floor(basement or
or underground garage)is below ground level(grade)on underground garage)is below ground level(grade)on all sides;
all sides.* most of the height of the walls is below ground level on all sides;
and the door and area of egress are also below ground level on
all sides.*
C2.a
C2.b C2.a NEXT HIGHER G2.b
NEXT HIGHER FLOOR
FLOOR
GRADE
GRADE
` BOTTOM FLOOR
\�I BASEMENT �::"...r.�.c:: -. •_s:. -- -- ----------------
BOTTOM FLOOR _
BASEMENT
i
'fI1Y1119 b.
d.••die a n -b tl team 2d
::' C2.f-h ::.•eiiisting'gradey.:..:;:r:::. .• ....:... •r:':i•: , ." C2.f—h �exlsht+y:yFdd) �.:
*A floor that is below ground level(grade)on all sides is considered a basement even if the floor is used for living purposes,or as an office,
garage,workshop,etc.
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 17 of 19
BUILDING DIAGRAMS
DIAGRAM 3: DIAGRAM 4:
All split-level buildings that are slab-on-grade,either All split-level buildings(other than slab-on-grade),either
detached or row type(e.g.,townhouses);with or without detached or row type(e.g.,townhouses);with or without
attached garage. attached garage.
Distinguishing Feature—The bottom floor(excluding garage) Distinguishing Feature—The bottom floor(basement or
is at or above ground level(grade)on at least one side.* underground garage)is below ground level(grade)on all sides.*
%D ,��
C2.a C2.b
C2.b '
HIGHER
IGHER FLOORS
LOORS ' GRADE
NEXT HIGHER NEXT HIGHER
GFLOOR BOTTOM FLOOR FLOOR
TTOM BASEMENT
OOR
y...:....w ,:.. ...
r 4e��.e>astuig grade)`•" •' "' ' ' "' existing grade)
DIAGRAM 5: DIAGRAM 6:
All buildings elevated on piers,posts,piles,columns,or All buildings elevated on piers,posts,piles,columns,or
parallel shear walls.No obstructions below the elevated parallel shear walls with full or partial enclosure below the
floor. elevated floor.
Distinguishing Feature—For all zones,the area below the Distinguishing Feature—For all zones,the area below the
elevated floor is open,with no obstruction to flow of floodwaters elevated floor is enclosed,either partially or fully.In A Zones,the
(open lattice work and/or insect screening is permissible). partially or fully enclosed area below the elevated floor is with or
without openings**present in the walls of the enclosure.Indicate
information about enclosure size and openings in Section A -
C2_b Property Information.
NEXT HIGHER
I FLOOR I NEXT HIGHER
C2.a FLOOR
C2.a 1 C2.b
ELEVATED- ELEVATED
FLOOR FLOOR
A8.a—c
GRADE GRADE
EN OSURE Determine
enclosure size&
openings,if any.
_. .....
a, 'a es deCerriin'eil'fi
Y FrVzn
.•C2.f—h • � 3.1 'C2.f—h `"� Y •,C2.C''4l�orwrones'`�'•`'
existing grade) C2.c and other existing grade) and other
regulated areas) regulated areas)
A floor that is below ground level(grade)on all sides is considered abasement even if the floor is used for living purposes,or as an office,garage,
workshop,etc.
**An"opening"is a permanent opening that allows for the free passage of water automatically in both directions without human intervention.Under the
NFIP,a minimum of two openings is required for enclosures or crawlspaces.The openings shall provide a total net area of not less than one square inch
for every square foot of area enclosed,excluding any bars,lowers,or other covers of the opening.Alternatively,an Individual Engineered Flood
Openings Certification or an Evaluation Report issued by the ICC ES must be submitted to document that the design of the openings will allow for the
automatic equalization of hydrostatic flood forces on exterior walls.A window,a door,or a garage door is not considered an opening;openings may be
installed in doors.Openings shall be on at least two sides of the enclosed area.If a building has more than one enclosed area,each area must have
openings to allow floodwater to directly enter.The bottom of the openings must be no higher than 1.0 foot above the higher of the exterior or interior
grade or floor immediately below the opening.For more guidance on openings,see NFIP Technical Bulletin 1.
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 18 of 19
BUILDING DIAGRAMS
DIAGRAM 7: DIAGRAM 8:
All buildings elevated on full-story foundation walls with a All buildings elevated on a crawlspace with the floor of the
partially or fully enclosed area below the elevated floor. crawlspace at or above grade on at least one side,with or
This includes walkout levels,where at least one side is at or without an attached garage.
above grade.The principal use of this building is located in Distinguishing Feature—For all zones,the area below the first
the elevated floors of the building. floor is enclosed by solid or partial perimeter walls. In all A
Distinguishing Feature—For all zones,the area below the zones,the crawlspace is with or without openings**present in
elevated floor is enclosed,either partially or fully.In A Zones,the the walls of the crawlspace.Indicate information about
partially or fully enclosed area below the elevated floor is with or crawlspace size and openings in Section A -Property
without openings"present in the walls of the enclosure. Indicate Information.(If the distance from the crawlspace floor to the top
information about enclosure size and openings in Section A - of the next higher floor is more than 5 feet, use Diagram 7.)
Property Information.
C2.a , C2.b
1
C2.b
C2.a NEXT HIGHER GRADE NEXT HIGHER
FLOOR FLOOR
GRADE C2.f C2.g
C2.f WALKOUT LEVEL C2.g
(ENCLOSURE) CRAWLSPACE
_
A8.a A8.b� A8.a
AB.b—c OPENINGS"
OPENINGS" OPENING"
DIAGRAM 9:
All buildings(other than split-level)elevated on a sub-grade
crawlspace,with or without attached garage.
Distinguishing Feature—The bottom(crawlspace)floor is
below ground level(grade)on all sides.*(If the distance from the
crawlspace floor to the top of the next higher floor is more than
five feet,or the crawlspace floor is more than two feet below the
grade[LAG]on all sides, use Diagram 2A or 2B.)
C2.a C2.b
GRADE NEXT HIGHER
FLOOR
C2.f C2.g
OPENINGS'
A floor that is below ground level(grade)on all sides is considered a basement even if the floor is used for living purposes,or as an office,garage,
workshop,etc.
••An'opening"is a permanent opening that allows for the free passage of water automatically in both directions without human intervention.Under the
NFIP,a minimum of two openings is required for enclosures or crawlspaces.The openings shall provide a total net area of not less than one square inch
for every square foot of area enclosed,excluding any bars,lowers,or other covers of the opening.Alternatively,an Individual Engineered Flood
Openings Certification or an Evaluation Report issued by the ICC ES must be submitted to document that the design of the openings will allow for the
automatic equalization of hydrostatic flood forces on exterior walls.A window,a door,or a garage door is not considered an opening;openings may be
installed in doors.Openings shall be on at least two sides of the enclosed area.If a building has more than one enclosed area,each area must have
openings to allow floodwater to directly enter.The bottom of the openings must be no higher than 1.0 foot above the higher of the exterior or interior
grade or floor immediately below the opening.For more guidance on openings,see NFIP Technical Bulletin 1.
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(10/22) Page 19 of 19
Nq(%7
Frank Wolfgang Uellendahl Architect
123 Central Ave POB 316 Greenport, NY 11944 t: 631.631.0041 e: frank.ueliendahI@gmaii.com
April 27, 2025
a. APR 3 0 2025
Submitted to: Building Inspector's Office
Town of Southold -''Gd'^erg anti ��
Project: Alterations to the Brick House #30 at Breezy Shores in
Greenport,
65490 Route 25, Greenport, NY 11944
Owners Mary Dowd and Michael Myers
Permit # 46981
FOUNDATION INSPECTION
As per building permit dated 10.15.2021 the brick house was raised by a house lifter and the
existing foundation walls were extended by circa 22" to FEMA El. 8'. The interior footings
were raised accordingly to support the elevated new floor system.
I inspected the footings and raised foundation walls including the required flood vents.
I herewith certify to'the best of my professional knowledge that all work was performed as
per NYS code and as per the architect's foundation specifications.
Sincerely,
QED Ap;
Fra k Uellendahl, RA`
Q �
Frank Wolfgang Uellendahl Architect
123 Central Ave POB 316 Greenport, NY 11944 t: 631.477.8624 e: frankU DD
Ir c�61
October 12, 2021 OCT 1 3 2021
BUH, INIG DUT.
Submitted to: Building Department TOWN OF SOUTH OLD
Town of Southold
Att.: Nancy Dwyer
Owners: Mary Dowd and Michael Myers
Brick House #30, Breezy Shores Community Inc.
Greenport, NY 11944
Regarding: Site Plan Amendment with Cesspool Locations
1
CESSPOOL VERIFICATION
Dear Nancy,
please find attached four copies of the amended site plan for the Brick House at
Breezy Shores as per your request.
The plan document depicts the locations of two existing brick cesspools which are
shared with the adjacent dwelling, cottage #29. According to the owners the
cesspools have been maintained by Morris Cesspool on a regular basis, and they
stated that they have not had any problems.
I spoke to Doug Morris yesterday, and he confirmed that the cesspools are in good
working condition.
.I also learned that the Breezy Community Board worked with Glynis Berry of Peconic
Green Growth back in 2015 to discuss funding for a community alternative waste
water treatment system which they hope to realize in the not too distant future once
the technology improves and the cost comes down.
nc ely,
F nk Uellendahl, RA
N
E
ilk
W
s Breezy Shores
Cesspool Map
6.2
63
- 65 _
6.3 -
5.0
4.4 4.4
---- -- - 4.4 4.2- 4.1
5.3 4.1
stone roadway -
5.0 -, ,..----r--------^-
3A b
62 5.5 Sc -0
3.8
9 3 Cb
3 3.q 3.1 3.'1 •
-0.4 3.5 4.8 1 4•► E
-0.5 A '01�1rt S i
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5. .J m R Z
I.l 4.6 cC n �T �K �fL`
-0 5 2' 3.8 4.6 O _ c, 4.2 4.3 4.2
1.3 3.8 4. 4 3 5.3 3
to;
2. 4.5 53 5.4 5.2 5.2 4.'1 4.8 L43
-0. 4.0 4.9 ------..--._.__�_-----�3 3.l db C 5.5
1.5 4.1 3.q - _a.... 4.0 4.6 4.8
3.q
5A :4.6 of buNdwed=4.5 5. 5.1 5.4 5.4 4.6 4.6 4.4 4.0
_O.�• of bulkfiMd 5.2 4.q
of buiW>Md 43 2.0 _ ___ 4. b
0• inter-tidal =--------1-Z----------=------ M`-IV`1 5.3_ _ 5.4 5.6 OfbWM*ad.4.6
inter-t4dal 5.5 5.3
-O.ft,.-_05-- ------ .5 -0.5 mares
-Lq ------ -0.4 -OS ----- -------- -
OS
_-°s------- MLW- -------------- _ ck Revetment _ _
_1A -1.8 -1.8 i.l - -O.
. . . •
- '9 i _Tl�!
O 42
---- --- - - . .. -O.J -- T/J 0.4 0 4
-1.8 -- __ 4 ------ ---- �.e
_ a
-2.0 -I.q -1.8 -1.8 -I.q -1.8 -2.0 -2.2 T/J i T/J
-� -2.1 -2.2,
O U }mil
12 01
L
V L
� 41
Main Cesspool A E
4
Overflow Cesspool
She Iter Isla
Prepared by:
Sea Level
Mapping z Wet Well
P. O. Box 538
Riverhead, NY
631-722-3390
SCALE V= W Dead (Non-Functioning)
oagrTopographic 5urvey l �,
NT5
-- Prepared for"Breezy Shores"
Part of SCT#1000%W4-12.5 �. '' ••�e� - prove
Surveyed June 28, 2005
Situate: Greenport oar St�,,e
Town: Southold
i Suffolk County, NY
Datum: M.S.I.
NGVD'29
Range: 2.5'
- j
` 17
_---.. -- ----- _ ..__...._. .---- - Shelter Island 5ovnd
4b -
8.0
- - - A.I
TA
-7.6
6b 6.2
�-1-DOQ-53-5-12.5 .. Y
U � � � jlUZ V �
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co
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4 4 66 bb• . ball b5 65 &.0 J{3 � r 1.4 17 �.6 j.5 / 5.3 11.8 � �rj � 4.A 4.5
4.0 4.0 3.A 4.1 .2 .2 4.4 4.l 6.i ~�.,� J
1.0 18 - -z -1.1 z 6.0 O 41 4.4
8.6 8.0 '1.6 1.3 .4 7, V
4 8 0 5A 6.8 l.A. '1.8 5.4 '� .� 4.3
5.2 1.4 8.2 '1.8 '1.4 _
TLd - bulkhead 4, 6."i 63 5.A 5.3-tee-4 MH o -
-4.2 ----- top Of bulkhead. 45 4.6 LO -O�j•- .0.8.
T/J 0.2 TM 0.4 OJ T j I 0.5 O5 -- -- ------ __ 2. T/J 45
4.6 Of b" a !6 -O.7
-�-a --------�¢,-- ----c��-----�b."f 0 0.T aA .r_�------- --------------?------- IT/i
10p bulkhead a7 \j1 _
---- •.p:i-- •a6-- O.A 1.0 MHWY - 1.1 1.0 ___�---------------- 2.2
T/J , ' "p,p- --- 0.1 O.8 0.8 0.5 4.0 3.6 -0.1
•22i -2.2 �� -2.4 -2.2 T/J' -2.2 �#1------ T/J O.6 05 0.0
-22 -2.3 -tJ.'f---- r0:1------ 12 _ ' TM T/d - -2.2
'aa---------fib--- - -- ------0.8-----4.9----------� TJ
>, >, -2.2 MLW -a.r--- ---oe---------- N ---=z?s-----b-8-----
+' -2.2 T/J i ; -22
-22 -2.2 -2.3 -2.0 '-2.0 -2.3 -2.2 11
2 0 -2.2 1 T4 -2.2 -2.4 '-2.6
E E E
;A 4A
4A � E
iA
; land Sound
ROBERT H.FOX
r N"PL.8#F 50197
6/30/2005 q.52:04AM
� G•.\SLM�xzypro
t'
• o • e e
: B a
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,P►� �.�:_....�.:. +� a �e�l��O1l�eL•1i'/
r - - M A 0I ZMAN
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
Southoldtownny.gov PERMIT NO. D�j Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
n / Flood Permit
Examined V' J ,20 r., ,t ._„ Single&Separate
Truss Identification Form
NOV — 6 2019 Storm-Water Assessment Form
Contact: _ ( // ��II II
Approved '20 : . .. .. "_ Mail to: fi L� l�lC. eo U/
Disapproved a/c J�
//// JJL b/ nn
Phone: &J - qq -4(oLf
Expiration ,20
Bui mg Inspector DISAPPROVAL
APPLICATION FOR BUILDING PERMIT
Date QoUeLMkC , 20 L9
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans,accurate plot plan to scale. Fee according to schedule.
b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered.by this application may not be commenced before issuance of Building Permit:
d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection,throughout the work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of 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 kA AQLi( 1DQW 0 4 �—U C.0 2 �-1 L(ZS
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.
Location land on which proposed work will be done: �tC� �j�SC
1. L i n of h
�40 v 12o�-i� 2-G 61&kQ�L) PC 6 rz9=zL(I �5HVWO
House Number Street Hamlet
County Tax Map No. 1000 Section JC3 Block t7� Lot 2.(P
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 SC7�J C_ CC A-CPf .
b. Intended use and occupancy `'((C=�CIZ _ y`Z��(.) `�l� `�j UCZ)e-a0(�>,
3. Nature of work check which applicable): New Buildin Addition '�/ Alteration 'V
( g
Repair Removal,''` Demolition Other Work
(Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front : 1 Rear Depth
Height o 2., `a Number of Stories `( �
Dimensions of same structure-with alterations or additions: Front r Rear 1544
Depth Sit ` h i,,t,. I Height 22.�,4�.t Number of Stories Z
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase , Name.of Former Owner..
11. Zone or use district in which premises are situated
12. Does proposed construction'violate any zoning law, ordinance-br regulation? YES VINO
13. Will lot be re-graded?YES NO Will excess fill be'removed from premises?YES '+/ NO '
14.Names of Owner of premises tp -M46tSAddress ((koo 4W4,Sf-N Phone No.W 2423-32�
Name of Architect ' �,t,LV_L.YddiIdad Address %3(6 2fj2t ' Phone No C�3C-�7?-p102�
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES ✓; NO
* IF YES, SOUTHOLD TOWN TRUSTEES.&D.E.C. PERMITS MAY BE REQUIRED:
b. Is this property within 300 feet of a tidal wetland? * YES V",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 V
* IF YES, PROVIDE A COPY.-
STATE OF NEW YORK)
SS:
COUNTY OF��ffp(�
'� LGIL LE'LU 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 before me this
- day of I)('UeLU66r 20K)
TTRAACEY L. DWYER
NOTARY PUBLIC,STAFE OF NEW YORK
01 DW6306900
Notary Publ QUALIFIED IN SUFFOLK COUNTY Signature of Applicant
COMMISSION EXPIRES JUNE 30,2G'a
. r
BREEZY SHORES COMMUNITY INC
Sage Blvd.
Greenport,NY 11944
December 1, 2020
The Board of Directors of Breezy Shores Community Inc. (BSCI) 2020/2021, consisting of
Martha Brooks President; Jennifer Wagner, VP; Mary Dowd VP; Diane Nelson, Treasurer; and
Lauren Heidenry, Secretary, hereby affirm that we have reviewed the repair and renovation
proposal for Mike Myers and Mary Dowd, cottage 30,which was prepared by:
Frank Uellendahl
PO Box 316
Greenport,NY 11944
(631)477-8624
frank.uellendahl@gmail.com
and have no objections thereto.
Thank you,
Diane Nelson,
Treasurer; on behalf of the Board of Directors
BREEZY SHORES COMMUNITY, INC. P.O.BOX 925 MATTITUCK, NY 11952
boardcabreezyshores.com
Glenn Goldsmith,President \Xof so, Town Hall Annex
A.Nicholas Krupski,Vice President �� ®�� 54375 Route 25
P.O.Box 1179
Eric Sepenoski J Southold,New York 11971
Liz Gillooly va
Elizabeth Peeples @ Telephone(631) 765-1892
Fax(631) 765-6641
90�cDUNNI
BOARD OF TOWN TRUSTEES n
TOWN OF SOUTHOLD U E f
April 17, 2025 i r
APR 3 0 2025 -J
Frank Uellendahl
PO Box 316 � �€�61�°�`�
Greenport, NY 11944 TOW
RE: MARY DOWD & MICHAEL MYERS
654990 ROUTE 25, BREEZY SHORES COTTAGE #30, GREENPORT
SCTM#: 1000-53-5-12.6
Dear Mr. Uellendahl:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, April 16, 2025:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative
Amendment to Wetland Permit#9867, as issued April 14, 2021, for the 50"x70" landing
flanked by two sets of 11"x39" stairs leading down to grade; and as depicted on the site
plan prepared by Frank Uellendahl, received on March 19, 2025, and stamped
approved on April 16, 2025.
Any other activity within 100' of the wetland boundary requires a permit from this office.
This is not a determination from a--y ocher ege icy.
If you have any questions, please call our office at (631) 765-1892.
Sincerely,
Glenn Goldsmith, President
Board of Trustees
2 ,4 GF
M, BOARD OF SOUTHOLD TOWN TRUSTEES
SOUTHOLD NEW YORK
PERMIT NO.9867 DATE: APRIL 14,2021
ISSUED TO: MARY DOWD& MICHAEL MYERS
PROPERTY ADDRESS: 65490 ROUTE 25,BREEZY SHORES COTTAGE#30,
GREENPORT
U.
SCTM# 1000-53-5-12.6
AUTHORIZATION
Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in
AP accordance with the Resolution of the Board of Trustees adopted at the meeting held on ril 14,2021, and in
�1 consideration of application fee in the sum of$250.00 paid by Mary Dowd&Michael_Myers and subject to the
Terms and Conditions as stated'in the Resolution,the Southold Town Board of Trustees authorizes and permits
the following:
Wetland Permit to raise the existing 1,474sq.ft.,brick house to FEMA flood plain requirements;
basement to be filled with sand &gravel; at existing mudroom.entry remove existing covered
landing with brick steps on the north and south side and replace with a 79x7' mudroom,a
42"x58"landing and six 12"x5811 steps to grade; extend the mudroom roof to cover landing and
steps with one support column; existing porch to be repaired; and construct dormer
enlargements and window replacements;with the condition that the gutters to leaders"area
routed to the drywelI shown on the plan; and as depicted on the site plan prepared by Frank
W.Uellendahl,Registered Architect, received on March 9,,2021,.and.stamped approved on
April 14,2021.
affixed,and these
IN WITNESS WHEREOF;the said Board of.Trustees hereby causes its Corporate Seal to be aff
presents tobe subscribed by a majority of the said Board as of the l4th day of April,2021.
0 Vag fat
V
ca
e
V,
U(0
.............
TERMS AND CONDITIONS
The Permittee Mary Dowd&Michael Myers residing at 65490 Route 25,Breezy Shores
Cottage#30, Greenport,New York as part of the consideration for the issuance of the
Permit does understand and prescribe to the following:
1. That the said Board of Trustees and the Town of Southold are released from any and all
damages, or claims for damages, of suits arising directly or indirectly as a result of any
operation performed pursuant to this permit,and the said Perm.ittee will,at his or her own
expense, defend any and all such suits initiated by third parties, and the said Permittee
assumes full liability with respect thereto,to the complete exclusion of the Board of
Trustees of the Town of Southold.
2. That this Permit is valid for a period of 24 months,which is considered to be the estimated
time required to complete the work involved, but should circumstances warrant,request for
an extension may be made to the Board at a later date.
3. That this Permit should be retained indefinitely,.or as long as the said Permittee wishes to
maintain the structure or project involved,to provide evidence to anyone concerned that
authorization was originally obtained.
4. That the work involved will be subject to the inspection and approval of the Board or its
agents, and non-compliance with the provisions of the originating application may be cause
for revocation of this Permit by resolution of the said Board.
5. That there,will be no unreasonable interference with navigation as a result of the work
herein authorized.
6. That there shall be no interference with the right of the public to pass and repass along the
beach between high and low water marks.
7. That if future operations of the Town of Southold require the removal and/or alterations in
the location of the work herein authorized,or if, in the opinion of the Board of Trustees,
the work shall cause unreasonable obstruction to free navigation,the said Permittee will be
required, upon due notice,to remove or alter this work project herein stated without
expenses to the Town of Southold.
8. That the said Board will be notified by the Permittee of the completion of thework
authorized.
9. That the Permittee will obtain all other permits and consents that may be required
supplemental to this permit,which may be subject to revoke upon failure to obtain same.
10. No right to trespass or interfere with riparian rights. This permit does not convey to the
permittee any right to trespass upon the lands or interfere with the riparian rights of others
in order to perform the permitted work nor does it authorize the impairment of any rights,
title, or interest'in real or personal property held or vested in a person not a party to the
permit.
' I
Inspector' i ` s!J `
BUILDING DEPARTMENT- Electrical' f- A, jf' TOWN OF SOUTHOLD r
.. 0c,
f,ZTown Hall Amex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
`?f f (631) 765-1802 - FAX (631) 765-9502 ;::�,
Telephone :.3
southoldtownn ov ro seand southoldtowri �aU;, �, ;;:
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: o ?
Company Name. t ,
Electrician's Name:' c""s a
License No.: y7z3 -AA - Elec. email: W,, Ice,-t'V,
Elec. Phone No: d,3t - 7-74-, - gM request an email copy of Certificate of Compliance
Elec. Address.: / -ry /J 4C.
r7
JOB SITE INFORMATION (All Information Required)
Name: r-t-�z.
Address: f
Cross Street: Jam( .9-
Phone No.:
email:
Bldg.Permit#: Ll9 7
�
Tax Ma District: 1000 Section:
Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Ple se Print Clearly):
Square Footage: —5D "
Circle All That Apply: Final
Is job ready for inspection?: � YES❑NO �Rough In
Do you need a Temp Certificate?: YES �NO Issued On
Temp Information: (All information required)
Service Size 1 Ph❑3 Ph Size: A # Met
Old r#
❑New Service ire Reconnect[]FI d Reconnect(]Se ' e ReconnectQU erground QOverhead
# Undergrou Laterals 1 2 H Frame Po Work done on S ice? Y N
Add itionaYl nformation:
PAYMENT DUE WITH APPLICATION 1o&z,
S O 77"
1 � �
PERMIT# Address:
Switches
Outlets
GFI's
Surface
Sconces
H H's
UC Lts Fridge HW POOL
Fans Mini Fr. W/D" LZ`�' Panel
Pump
Exhaust Oven stAl Sump Heater
Trnsfmr
Smokes DW Generator Salt Gen.
Carbon Micro GrbDis Waver Bond
Lights
Heat Pucks ERV
HOT TUB/SPA
Inst Hot DeHum Transfer Disc
Combo Cooktop Minisplit4 Blower
AC AH C� Hood Blower
Service Amps Have Used
Sub Amps Have Used
Comments
1 Vu7 Uj
a
�Al P)ke- 4�g42 ;E�4 A 117041
i
CP Certified, Residential Count Sheet Application #
Alarms Type Qty Wiring Device Type Qty
Sensor Smoke Switch General Purpose
Sensor Carbon Monoxide Switch Light Dimmer
Sensor Combo Smoke/CO Switch Fan
Appliances Types ig��
Motion Sensing 3
Furnace Gas/Oil ecrLight activated
Boiler Gas/Oil/Electric Motor Control
Heat Pump Mini-Split/Central Switch Disconnect
Air Condioner Windo /Central Receptacle General Purpose 3`1
Range Gas lectri Receptacle Ground Fault
Wall Oven Gas/Electric Receptacle Arc Fault
Cook Top Gas/Electric Receptacle Air Conditioning `Z
Microwave Wall/Oven Receptacle Clothes Dryer
Dish Washer Plug/Hard Wired Receptacle Clothes Washer
Jacuzzi Tub Plug/Hard Wired Receptacle Electric Range
Pool/Hot tub Type Qty Receptacle Dish Washer r
Pool Above Ground Receptacle Electric Car
Pool In-Ground Receptacle Garbage Disposals
Pool Portable Receptacle CATV/Telephone
Pool Filtration Light Fixture Surface o�
Pool Control Switches Light Fixture Recessed C>
Pool Sub Panel Light Fixture Wall Sconces 3
Pool Light Fixtures Light Fixture Tracks [ ] Heads [ ]
Pool Heater Light Fixture Drop Pendent
Hot Tub Plug/Hard Wired Fixture Paddle Fan
Service Type Qty Fixture Paddle Fan/Light
Single Phase Overhead Fixture Bath Fan
Single Phase Underground Fixture Bath Fan/Light A—
Main Panel Amperage Fixture Bath Fan/Light/Heat
Main Panel Spaces Electric Heat Baseboard
Sub Panel Amperage Electric Heat Wall Mount
Sub Panel Spaces Electric Heat Radiant Floor
Entrance Cable Conductor Size Circuit Breakers Single Pole
Meter Pan Amperage Circuit Breakers Double Pole
Reconnect C/H or Electrician Circuit Breakers Ground Fault
Generator Essential Circuit Circuit Breakers Arc Fault r 2
Generator Whole House Circuit Breakers GFCI/AFCI Combo
Transfer Switch Auto Thermostat Line Voltage
Transfer Switch Manual Thermostat Low Voltage
q < S
N APR - 2 2026
APPROVED BY H PROPOSED
ADDITION &
ALTERATIONS
:BOARD OF (RUSTEES EL 3.34 S A G E B L V D
wv ❑DO M
DATE ,ru` ` RUN-OFF CALCULATION; MAGE
E C E V E FOR 2° OF RAIN TO BE CONTAINED ON SITE
COTTAGE 1,523 SF.100% run-off coefficient= GREENPORT NY
_ GARAGE '"� ' 253.83 Cu.Ft. 130
MAR — 9 2021 PROPOSED(2)8'x3'DRYWELLS® 1267 Cu.Ft EACH
_� �� y EL 3.52 WOH GUTTER LEADERS FOR ROOF RUN-OFF ARCH
% T
Rm MINA
`'� �`� 9 9y 123 MflK AvRE
ROM 316
Southold Town MWO W 11944
Board of Trustees m 631 OWNERS
�.
W DU
Nl� ryo. 021 �pQ; �,. 1600
OF�E JI DRYWELL.8 x3 , ' �UM
~OF N EL 4.26 : 'EL 4.17 0 '�'-W 3248
PROPOSED
C-4 C-5 I
RENOVATION &
49 SF ADDITION
EL 3.44
HOUSE TO BE
RAISED TO F.F. Q-30
EL. 8.00 iiiiii CAMERA LOCATION FOR PHOTO VIEIY #2
E B3-
EL , EXT'G FOOTPRINT OF COTTAGE 1,474 SF
PROPOSED FOOTPRINT C-30 1,523 SIF
C_29 EL 4. EL 4.28 INCREASED COVERAGE 3.0 % = 49 SF
EA 38
PROPOSED 49 SF ADDMON
�63)DRYWEI LINE OF HAY BALES
FLOOD ZONE AE _ AND SILT FENCE EXISTING STRUCTURES
�
EL 5.06 EL. 6AS PER ELEVATION
CERRFlCATE,01/18/19 EL 4.05 EXISTING BULKHEAD = TIDAL WETLANDS BOUNDARY pa. 0104/2021
BY YOUNG&YOUNG,M CLF• 1/32'=1'-0'
J SCTM# = 1000-53-05-12.6 SITE PLAN
TOWN OF SOUTHOLD m wic
EXISTING REVETEMENT
SHELTER ISLAND SOUND SUFFOLK COUNTY, NEW YORK A-1
®Z1 MR NO
SITE PLAN
PROPOSED
® w� MAR - 9 2021 r--",F E E 0 V E
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E)WG FOOTPRINT OF BRICK HOUSE = 1,474 SF AN —xaE
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CC ADOMON&
MAR - 9 2021 U) ALTERATUS
Southold Town EIDOWD
Board of Trustees coffml
GREENPORT, W
130 ffdM VM
WINDOW SEAT DRAWERS 5.4'
ATTIC STORAGE AITIC /STORAGE ACE
MR UaLDCNL
123 CWK AVOK
P.0ax 316
3.0' ammm,W 1190
snNc AREA U 631-477 04
0.
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Sce 3/ir= I--r
I� V CC ADD PROPOSED
D ALTERATIONS
ECIFICATIONS
MAR 9 202� ODOW
WINDOWS TO BE REPLACED:
DERSEN, 400 SERIES. COTTAGE
Southold Town G S TO BE HIGH PERFORMANCE LOW—E GLASS
12" Board of Trustees RIOR COLOR: WHITE GREENPORT NY
3" " / \ ALL TRIMWORK, CORNER do FASCIA BOARDS, SOFFITS: #� zr
/ \ VERSATEX, COLOR WHITE
MES
WINDOW TRIM: ARCHRECT
NEW DORMER
VERSATEX: 1x4 w/ HISTORICAL STOOL — WHITE R"Uu1W
.�_
/ \ MAIN ROOF AND DORMER ROOFS: r 123 COOKAM
P
o \ RED CEDAR SHINGLES R�� q�i W 11944
51 631-477 8624
./ \ SIDING ON ALL DORMERS f � �`rv' ELZF 5-,
\ RED CEDAR SHINGLES a:• OWNERS
MASTER BEDF 0
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60 5MT N
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FOYER BEDROOM 2 COLOR: WHITE
NEW STAI ASE TO C D STAIR LANDINGS: 1�c6 TWIN FINISH, SOLID PLANK
8 0 TIMBERTECH GREY II
PORCH RAILING:
1.5"x1.5' BALUSTERS: PermaPorch PVC
a COLOR: WHITE
6.3
,•, 4.3� co E G FLOOR SYSTEM TO BE RAISED / STUCCO
/ EXISTING BASEMENT: _
/ TO BE FILLED WITH SAND AND GRAVEL
BRICK STRUCTURE TO BE RAISED TO FEMA EL 8 s
/ AND CONCRETE
STUCCO T BE APPLIED n�O HIDE SN TO BE E NDED
AM
DALE 07/31/2019
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3/4/2021 Gmail-TRUSTEES APPLICATION-THE DOWD RESIDENCE#30
G m a l I Frank Uellendahl<frank.uellendahl@gmail.com>
TRUSTEES APPLICATION - THE DOWD RESIDENCE #30
1 message
Frank Uellendahl <frank.uellendahl@gmail.com> Thu, Mar 4, 2021 at 4:36 PM
To: Frank Uellendahl <frank.uellendahl@gmail.com>
Lk ''
I � '
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PHOTO#3, NORTH DIRECTION-01.20.2020
it
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PHOTO#4, NE DIRECTION
https://mail.google.com/mail/u/O?ik=7d673c7l 75&view=pt&search=all&permthid=thread-a%3Ar-3993167125019695853&simpl=msg-a%3Ar-15909807... 1/1
Glenn Goldsmith, President ®g Town Hall Annex
54375 Route 25
A. Nicholas Krupski,Vice President ® ��®
P.O. Box 1179
Eric Sepenoski Southold, New York 11971
Liz Gillooly Telephone(631) 765-1892
Elizabeth Peeples ®� �� Fax(631) 765-6641
, ;
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD .CID
,
CERTIFICATE OF COMPLIANCE �,���a��► a `';`�r,rd
Ion-
#2284 C Date: August 26, 2025
THIS CERTIFIES that the raising of the existing 1 474sq ft brick house to FEMA flood plain
requirements; basement filled with sand & gravel,• removal of existing covered landing with brick steps
on the north and south side and replacement with a TxT mudroom a 50"00" landing flanked by two
sets of 11"x 39"steps leading down to grade; extension of the mudroom roof to cover landing and steps
with one support column,• and construction of dormer enlargements and window replacements,
At 654990 Route 25 Breezy Shores Cottage#30, Greenport
Suffolk County Tax Map#1000-53-5-12.6
Conforms to the application for a Trustees Permit heretofore filed in this
office Dated March 9,2021 pursuant to which Trustees Wetland Permit#9867
Dated April 14, 2021,was issued and Amended April 16,2025 and conforms to all of the
requirements and conditions of the applicable provisions of law. The project
for which this certificate is being issued is for the raising,of the existing 1 474sq.ft. brick house
to FEMA flood plain requirements; basement filled with sand&gravel; removal of existing covered
landing with brick stems on the north and south side and replacement with a TxT mudroom, a 50"00"
landing flanked by two sets of 11"x 39"steps leading down to grade-, extension of the mudroom_ roof to
cover landing and steps with one support column-, and construction of dormer enlargements and window
replacements.
The certificate is issued to MARY DOWD&MICHAEL MYERS owners of the aforesaid property.
Authorized Signature
BUILDING DEPARTMENT-Electrical Inspector -} ttt i ..,
,1 TOWN OF SOUTHOLD i..•'�
own Hall Annex - 54375 Main Road - PO Box 1179 OCT 1 5 2024
c' -0959
Southold, New York 11971
• ' Telephone (631) 765-1802 - FAX (631) 765-9502
x ,
` iamesh southoldtownny aov - seand ansoutholdtowff 740v�!-9,qc
t :rr•xc�`"
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: o
Company Name:: ,.d IN•►IcGtiSIC,' Gle---4-1 / CaN—✓�. .� c, .
Electrician's Name: c "s i
License No.: 97 Z3-A C— Elec. email: w, Ice,r 14 e -J-1 cAD ' '
Elec. Phone No: 6-31 -Z7� �z�� 04 request an email copy of Certificate of Compliance
Elec. Address.: • a i3 .c / 7 -ramp IJ AA Oct.
JOB SITE INFORMATION (All Information Required) eo
Name: `9 rL-c Z- S'1, s� s �� �,N 4'
Address: S b 6f
Cross Street: N J't-
Phone No.: 2i36 - �
Bldg.Permit#: L1q C' 6 7 email: /-► J}-
Tax Ma District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Ple se Print Clearly):
7 c L �n &IL IPIL t . -3
Square Footage: 1757 "
Circl® All That Apply:
YES❑NO Rough In Final
Is job ready for inspection?:
®
Do you need a Temp Certificate?: YES r7 NO Issued On
Temp Information: (All information required)
Service Size 1 Ph❑3 Ph Size: A # Met Old r#
❑New Service ire ReconnectOFl d Reconnect[]Se a Reconnect[�U erground
verhead
# Undergrou Laterals 1 2 H Frame Po Work done on S ice? Y N
Additiona nformation:
PAYMENT DUE WITH APPLICATION
t-f-�°1�S 1
20 o aZ 4�qce
4WO
I kD..$
APR 0 4 2023
SuJL.01v.,b 1)F-pI.
�a®9�17�LY(���f`�Y I�Sf�!r•
. ......
BUILDING DEPARTMENT-Electrical Inspector `f"1 ' /�
.::
TOWN OF SOUTHOLD dYl ! his
.. V
Town Hall Annex-54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX(631) 765-9502
.:: rogerrO)-southoldtownny.gov— seandO)-southoldtownny.gov
APPLICATION FOR ELECTRIC AL INSPECTION
ELECTRICIAN INFORMATION (Ail Information Required) Date:
Company Name: Custom Lighting of Suffolk Inc
ectrician's Name: Benjamin Doroski
License No.: 38893-ME Elec. email: CLOS5170@g il.com
lec. Phone No: 631-298-4588 0 o C 1 request an email copy ertificate of Compliance
lec.Address.: PO Box 1698 Mattituck NY 11952
JOB ITE INFORMATION (All Information Required)
Name: Dowd-Myers
ddress: 65490 Main Road#30 Greenport NY 11944
Cross treet:. Sage Blvd
Phone o.: 6 84-6481
BIdg.Permi : 46981 email:
Tax Map Distric . 1000 Section: Block: Lot:
BRIEF DESCRIPTIO OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Renovation of house, ne electrical outlets,wiring and lighting
Square Footage: 1523
Circle All That Apply:
Is job ready for inspection?: ❑ YES❑✓ NO ❑Rough In ❑ Final
Do you need a Temp Certificate?: ❑ YES❑NO Issued On
Temp Information: (All info_r tion required)
Service Size❑1 Ph®3 Ph Size. A # Meters Old Meter#
El New service -]Fire Reconnect❑Flood Reco ect❑✓ Service Reconnect❑Underground❑Overhead
#Underground Laterals 1 2 H Frame ole Work done on Service? Y N
Additional Information: Main Feed from Garage,House is a 20 mp Sub Panel
PAYMENT DUE WITH APPLI T N'q�l lvs •
T, r* 4uqV
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVAL
DATE: November 18, 2019
TO: Frank Uellendahl(Dowd)
PO Box 316
Greenport, NY 11944
Please take notice that your application dated November 6, 2019:
For permit to: construct additions and alterations to an existing seasonal cottage to be
altered to a single-family dwelling
Location of property: 65490 Main Road Greenport, NY Breezy Shores Cottage#30)
County Tax Map No. 1000 - Section 53 Block 5 Lot 12.6
Is returned herewith and disapproved on the following grounds:
The proposed construction, on this conforming lot in the R-80 District, is not allowed
pursuant to Article XXIII, Section 280-123 which states; "A non-conforming building
containing La non-conforming use shall not be enlarged, reconstructed,or structurally
altered or moved, except as set forth below: unless the use of such building is changed to
a conforming use."
Authorized Sign ture
Note to Applicant: Any change or deviation to the above referenced application may
require further review by the Southold Town Building Department.
CC: file,Z.B.A.
PROPOSED
y ADDMON &
s
ALTE MONS
ODMD
SPECIFICATIONS COTTAGE
ALL WINDOWS TO BE REPLACED:
Y ANDERSEN, 400 SERIES. GREENPORT NY
t
3" ' / \ GLASS TO BE HIGH PERFORMANCE LOW—E GLASS #30 BR02Y SHORES
/' \ EXTERIOR COLOR: WHITE
/ N.
/' \ ALL TRIMWORK, CORNER & FASCIA BOARDS, SOFFITS: ARCHITECT
NEW DORMER VERSATEX, COLOR WHITE oLulaw
z 123 CENTRAL AVENUE
/ \ WINDOW TRIM: NY 11yµ
d. M o \ VERSATEX: 1x4 w/ HISTORICAL STOOL — WHITE TET 631 4nss2a
MAIN ROOF AND DORMER ROOFS: OWNERS
MASTER BEDF RED CEDAR SHINGLES Two,DW
-T SIDING ON ALL DORMERS 160OYSIRmu MNN
RED CEDAR SHINGLES
727-03 3248
2'-0"
_ CORNER COLUMN TO SUPPORT MUDROOM ROOF:
WOOD
POST,
WRAPPED IN VERSATEX,
0o ao COL WHITE
FOYER BEDROOM 2 STAIR LANDINGS: 1 6 TWIN FINISH, SOUD PLANK
NEW STAI ASE TO C D TIMBERTECH GREY II
8�� PORCH RAIUNG:
1.5"x1.5" BALUSTERS: PermaPorch PVC
COLOR: WHITE
a, 6.3'
ao EXT G FLOOR SYSTEM TO BE RAISED STUCCO
4.3'
BASEMENT-
TO BE FILLED STING MWITH SAND AND GRAVEL
� � e
BRICK STRUCTURE TO BE RAISED TO FEMA EL 8
EXISTING CONCRETE FOUNDATION TO BE EXTENDED
AND STUCCO TO BE APPUED TO HIDE SEAM DATE: 07/31/2019
j SCN E N.T S
CROSS SECTION
CROSS SECTION
ONG.NAME
A-4
®� M NO
PROPOSED
ADDITION do
� � ALTERATIONS
❑DOWD
Ila COTTAGE
GREENPORT NY
130 BM SHORES
ARCHfTECT
� ERAM(un1ENow�
123 CENTRAL AYE181E
P.O.BOX 316
6Ef7F(IRE,NY 11944
TEL 631-477 BM
OWNERS
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EXISTING SOUTH ELEVATION um
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FORM NO: 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVAL
DATE: November 18, 2019 �(
TO: Frank Uellendahl(Dowd) t
PO Box 316 y
Green port,NY 11944
Please take notice that your application dated NovembLAP
er 6, 20;19 , p.N `( -
For permit to construct additions and alterations to an exiA !seasonal Gotta e� to be
altered to a sm le
Location of ro 3 Shores Cotta a#30
P P
County TaxMap �,�( � 12 6
1 l
Is returned liere �' 11
The ro sed co istridi is not allowed.
ursuant:to Articl n=conformin buildin
containin .a non- (,( b L /�� cued .or.structurall.
altered or moved , - eh building is changed to
a conforming-use.
Authorized Sign tune
Note to Applicant: Any change or deviation to the above referenced application may
require further review by the Southold Town Building Department. I `�
CC:file,Z.B.A. . ,p
a
P6
oil 00-
U �omoNSD EL 3:34 :�. .D
�g ALTERATIONS
on
RUN-OFF CALCULATION: COTTAGE
FOR 2'OF RAIN TO BE CONTAINED ON SITE
6' COTTAGE L523 SF.100%run-off
Cu.F{ GREENPORT NY
F -GARAGE- 130 BREEZY ORES
PROPOSD MTH (s) �rrWE LDZERSR RO 126
G` ,9y EL 352: Wl
;ARCHrrFcr
FRW Ual9M
123 CWK kW
P.Qy 944
316
6RMM 631,4N 11944
. � m:6J1-4n 8614
WO N96
e wwa�
DRYWELL 16M.PEMMM
3
EL: 426 >EL 41T
PROPOSED C-4 C-5 1
RENOVATION k
49 SF AMMON
EL 3.44
HOUSE TO BE,,
RAISED
C :30
EL.8'.M,
CAMERA LOCATION FOR PHOTO VIEW 2
EXT'G F F #
E1 6'34/ _ ExrG FOOTPRINT OF COTTAGE 1,474 SF
PROPOSED FOOTPRINT C-30 1,523.SF
C-Z9 INCREASED COVERAGE 3.0% = 49 SF
EL 438 EL 428 PROPOSED 49 SF ADDmON
DRYWELL UNE:OF HAY BALES
FLOOD ZONE AE AND"SILT FENCE EXISTING STRUCTURES
EL 5.06 EL 6
AS PER ELEVATION
CERTIFICATE,01/18/19 EL 4.05 EXISTING BULKHEAD = TIDAL WETLANDS BOUNDARY DATE 10/25/2019
.
BY YOUNG h YOUNG,LS SCAIF NJS
sNil
SITE PLAN
J SCTM# = 1000-53-05-1 .6
EXISTING REVETEMENT SHELTE TOWN OF SOUTHOLD
R ISLAND SOUND SUFFOLK COUNTY, NEW YORK A-1
®� M No
SITE PLAN
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, NEW YORK
'CERTIFICATE OF OCCUPANCY
NONCONFORMING PREMISES DATE: July 24, 1984
THIS IS TO CERTIFY that the
Pre C.0.#Z12637
/ J Land
/X/ Building(s)
/X/ Use(s)
located at 67380 Main Road Arshamomague Greenport
Street Hamlet
shown on County tax map as District 1000, Section 0 3.00, Block 05.0
Lot 001 .001 doesknot)conform to the present Building Zone Code of the
Town of Southold for the following reasons:
There are 6 dwellings on one lot There are 5 non-conforming
seasonal cottages. -
On the basis of information presented to the Building Inspector's Office,
it has been determined.that the above nonconforming. J_/Land. /X/Building(s)
Jx/Use(s) existed on'the.effective .date the present Building Zone Code.of.the
Town of Southold, and maybe continued pursuant to and subject to the appli-
cable provisions of said Code:
IT IS FURTHER.CERTIFIED that, based upon information presented to
the Building Inspector's Office, the occupancy and use.for which this Certifi-
Property contains 5-1 story houses, 1-2 story
cate is issued is as follows:house, 2-accessory bldgs. , .25 seasonal cottages,
2 garages, 2 sheds (37 bldgs. ) . This property has access to Rt. 25 a
State maintained highway, in the A zone.Non-conforming seasonal dwellings.
Charlotte Sage, Michael Sage, James Sage
The Certificate is issued to & Patricia Sage.
.(owner,
of the aforesaid building.
Suffolk County Department of Health Approval. N/A
UNDERWRITERS CERTIFICATE NO. N/A
NOTICE IS HEREBY GIVEN that the owner'of the above premises HAS
NOT CONSENTED TO AN INSPECTION of the premises by the Building Inspec-
tor to determine if the premises comply with all applicable codes and ordin-
ances, other than the Building Zone Code, and therefore, no such inspection
has been conducted. This Certificate, therefore, does not, and is not intended
to certify that the premises comply with all other applicable codes and regula-
tions.
N4_+,
Building inspector
II I
STATE OF NEW YORK) ss.:
i' COUNTY OF SUFFOLK)
�I
I� I, CHARLOTTE SAGE, residing at Sage Boulevard, Greenport,
New York, being duly sworn, deposes and says:
That I am one of the present owners of the premises located
at Main Road (Route 25) , Greenport, New York, designated on the Suffolk
County Tax Map as District 1000, Section 053.00, Block 05.00, Lot
t:•3
and more particularly set forth on survey for Richard Mohring
dated March 24, 1984 by Young & Young attached hereto;
That I •am familiar .with said premises
That the structures situated thereon and,highlighted in red
on the attached survey for Richard";Mbhring have :been designed, arranged
. sicallY. occu ied as sin gle fand h amilydwellings or.seasonal cottages `.
....
as` depicted"on is survey,
Tthendxt :x�sting structe epre
t;
is good;
That 'I make this' af>davats'in the knowledge,:that the Building
Department of the Town of=:Southold will, rely on the accuracy 'the.reof
in. issuing a certificate''pf 'occupancy for.:a nofiL-conforming, pre
existing use for the structures depicted on the attached survey.
d 4L . ... . ... : : : :
Charlotte Sage
Sworn to before me this
,V%4o<, day of May, 1984.
No ar u lic
0WIN . PRICE; JR.
ROTARY PUBLIC,STATE EF NEW YORK
kwiding in Suffolk Co.st^,.re of appoin:m l
My Cammissi0a Ezuires March 30. 19 ;C—
��
444t`
ptiff
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Frank Wolfgang Uellendahl Architect
123 Central Ave POB 316 Greenport, NY 11944 t: 631.477.8624 e: frank@frankuellendahl.com
September 30, 2021
Submitted to: Building Department
Town of Southold
Project: Renovation, Alterations and Dormer Additions
at the Brick House #30, Breezy Shores, Comm. Inc.
in Greenport, NY
Dear Amanda and Nancy,
Attached with this letter please find the building permit application for the Brick House at
Beezy Shores in Greenport.
On November 18, 2019 a Notice of Disapproval was issued by your department to construct
Additions and alterations to an existing seasonal cottage to be altered to a single-family
Dwelling.
On January 21, 2020 1 scheduled a meeting with Mike Verity to discuss this application in
more detail. According to Town records the 82.6 acre property is improved with 3 dwellings,
one brick building (dwelling), 2 garages, 28 seasonal cottages and 20 sheds.
Mike agreed that the Brick House is considered a conforming use as a year-round dwelling
and would not need to apply for a variance unless the mudroom addition is located within 75
feet of the tidal wetland boundary. The proposed addition is 79.2 ft off the existing
revetement and bulkhead.
Mike said to ignore the disapproval and proceed with the wetland permit application.
Iegards,
Fra k Uellendahl, RA
Frank Wolfgang Uellendahl Architect
RW
123 Central Ave POB 316 Greenport, NY 11944 t: 631.477.8624 e: fran 1 --1col
7
U V R DD
October 12, 2021 OCT 1 3 2021
BUILDING KEPT.
Submitted to: Building Department TOWN QP SOUTHOLD
Town of Southold
Att.: Nancy Dwyer
Owners: Mary Dowd and Michael Myers
Brick House #30, Breezy Shores Community Inc.
Greenport,.NY 11944
Regarding: Site Plan Amendment. with_ Cesspool Locations
CESSPOOL VERIFICATION
Dear Nancy,
please find attached four .copies .of.the .amended site plan for the. Brick :House. at.
Breezy Shores as per your request.
The plan document depicts the locations of two existing brick cesspools which are
shared with the adjacent dwelling, cottage #29. According to the owners the
cesspools have been maintained by Morris Cesspool on a regular basis, and they
stated that they have not had any problems.
I spoke to Doug Morris yesterday, and he confirmed that the cesspools are in good
working condition.
.I also learned that the Breezy Community Board worked with Glynis Berry of Peconic
Green Growth back in 2015 to discuss funding for a community alternative waste
water treatment system which they hope to realize in the not too distant future once
the technology improves and the cost comes down.
*nkUellendahl,
RA
as
;W
y
� 10 QaoQ�1
04 4
a�►
a �
i �
:1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.(2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR ERECTION OF FENCES(3)CONES OF THUS SURVEY MAP NOT BEARINO THE LAND SJRVEYOR•S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.(4)CERTIFTCAR
INDICATED 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 ASSICNEES OF THE LENDING INSTITUTION.CERTIFICATIONS ARE NOT 7RAN91MLE 70 ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS (5)THE LOCATION OF WELLS(W),SEPTIC TANKS(ST)@ CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS
010
vv ` AT 400 Ostrander Avenue,Riverhead,Now York 11901
1� W.631.'121.2303 fax.631.12'7.0144
\ '}�' (�� (�ad�m•�ln�®'youngonglnoering.com
Howard K Young,Land Surveyor
.63 `� Thomas G.Wolpert,Professional Engineer
w Douglas E.Adams,Professional Engineer
Robert C.Tast,Architect
�� 3/H5 334 S
3 9�
/
SURVEYOR'S GERTIFIGATtON
S�6 /n O ^ / •04� 9?,�O •
/8 HOWARD W.YOUNG,N. 5 L.S.NO.4&3
Iss
341 pis' SURVEY FOR
355
MARY 00YO
m,M
w �67 COTTAGE 50, "13REEZY SHORES"
I r ,
1 40�// , V of Greenport, Town of Southold
/ Suffolk County, New York
SURVEY
S � County Tax Map District 1000 sect;..53 91QCk 05 L.t P/0 12.6
G40/ MAP PREPARED JAN. 2019
Record of Revisions
p RECORD OF REVISIONS DATE
Iso
PLAN so 0 15 DO 60
�o►z 5aa10. 1" = 50'
SCALE: I°= 30'
VERTICAL DATUM =NAVD MODJo$NO.2014-0002
DW6.20lo_0203-Iavd88\2010_0203_aottage_0050 of I
G] = MONUMENT SET ■= MONUMENT FOUND Q= STAKE SET ®= STAKE FOUND
GENERAL NOTES N PROPOSED
ADDITION &
1. ALL WORK
ACCORDANCE�TWITHH THEERIAL, ND20118IINTERNATONALEQUPMENT SHALLBBUILDING EL. 3.34 S A G V DCODE E IN W ALTERATIONS
0
ENERGY
CONSERVATION D THE 2018 INTERNATIONAL
R N ION CODE (ECC) AND LOCAL AUTHORIT ES.
2. AL CONCRETE SHALL BE STONE AGGREGATE WITH A o -]DOWD
MINIMUM 28 DAY STRENGTH OF 3000 PSI
3. ALL LUMBER SHALL BE GRADE STAMPED DOUGLAS FIR- RESIDENCE
LARCH STRUCTURAL GRADE #2 OR BETTER. RUN-OFF CALCULATION: -
4. PROVIDE DOUBLE HEADERS AND TRIMMERS AT ALL FOR 2" OF RAIN TO BE CONTAINED ON SITE
STAIR AND FLOOR OPENINGS, POSTS AND PARALLEL
PARTITIONS, EXCEPT AS NOTED ON DRAWING. 'p-9�j COTTAGE 1,523 SF:100% run-off coefficient= w GREENPORT, NY
5. BRIDGING TO BE PROVIDED FOR ALL JOISTS AND GARAGE 253.83 Cult. o #30 BREEZY SHORES
FLOOR BEAMS. SPACING NOT TO EXCEED 8.0 FT. D�/liF PROPOSED (2) 8'x3' DRYWELLS (� 126.7 Cult. EACH 65490 ROUTE 25
6. ALL DIMENSIONS AND GRADE CONDITIONS TO BE
qy EL. 3.52 WITH GUTTER LEADERS FOR ROOF RUN-OFF ARCHITECT
VERIFIED BY CONTRACTOR(S) PRIOR TO START OF
CONSTRUCTION AND ORDERING OF MATERIALS. THIS Z FRANK UELLENDAHL
FOUNDATION HAS BEEN DESIGNED FOR A SOIL
123 CENTRAL AVENUE
BEARING CAPACITY OF TWO (2) TSF AND GRADES J
o P.O.BOX 316
LESS THAN 57. CONTRACTOR SHALL VERIFY THAT GREENPORT, NY 11944m TEL: 631-477 8624
THESE CONDITIONS ARE MET. ALL FILL BENEATH o
CONCRETE SLABS TO BE COMPACTED TO 95%
OWNERS
RELATIVE DENSITY.
7. ALL HEADERS 6.0 FT IN LENGTH AND OVER TO BE & MICHAELL WEIRS
SUPPORTED BY DOUBLE UPRIGHTS, 9.0 FT AND OVER 1600 4TH STREET N
BY TRIPLE UPRIGHTS. ALL HEADERS TO BE DRYWELL(8 X3 ST. PETERSBURG
MINIMUM OF 2-2x8 OR AS SHOWN ON DRAWING. '' '' Z 33
727-
� 7- 823 3248 48
8. PROVIDE FIRESTOPPING AT ALL LEVEL EL. 4.26 EL. 4.17
PENETRATIONS C_4 3
9. PROVIDE FLASHING AT ALL ROOF BREAKS, PROPOSED
CHIMNEYS, SKYLIGHTS, EXTERIOR DOORS, WINDOWS RENOVATION Q �
AND DECKS ETC..
10. DO NOT SCALE DRAWINGS. 49 SF ADDITION `
11. DESIGN CONSULTANTS OR RECORD ARCHITECT- HOUSE TO BE EL. 3.44 r
ENGINEER ARE NOT RESPONSIBLE FOR THE -d
RAISED TO F.F. /
INSPECTION, SUPERVISION, OR ADMINISTRATION OF EL. 8.00
THIS CONSTRUCTION PROJECT, FEDERAL, STATE
AND LOCAL ZONING AND BUILDING CODE COMPLIANCE
SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR. EXT'G F.F.-
i o 0 0
12. THIS DRAWING IS AN INSTRUMENT PREPARED TO IEL. 6.34/ FLOOD ZONE AE EXT'G FOOTPRINT OF DWELLING 1,474 SF
FACILITATE CONSTRUCTION AND SHALL NOT BE EL. 6 PROPOSED FOOTPRINT C-30 1,523 SF
CONSTRUED AS A CONTRACT BETWEEN BUILDER AND
OWNER. AS PER ELEVATION w
-29 INCREASED COVERAGE 3.0 % 49 SF
EL. 4.38 EL. 4.28 CERTIFICATE, 01/18/19 = z
13. THIS STRUCTURE HAS BEEN DESIGNED IN '�MAIN CESSPOOL
ACCORDANCE WITH THE NEW YORK STATE ENERGY BY YOUNG & YOUNG, L.S.
CONSERVATION CODE. _ 1E]
PROPOSED 49 SF ADDITION m 3
14. ENGINEER TO BE NOTIFIED IN WRITING OF ALL r f 8'X3'�DRYWE L LINE OF HAY BALES
CHANGES PRIOR TO AND DURING CONSTRUCTION. AND SILT FENCE ® EXISTING STRUCTURES o 0
15. ELECTRICAL AND MECHANICAL COMPONENTS TO BE
DESIGNED AND SPECIFIED BY OTHERS. EL. 5.06 OVERFLOW z o
16. CONTRACTOR SHALL OBTAIN ALL PERMITS AND CESSPOOL
INSURANCE NECESSARY TO PROTECT THE ENGINEER EL. 4.05 EXISTING BULKHEAD = TIDAL WETLANDS BOUNDARY � DATE: 09/30/2021
AND OWNER.
17. DO NOT BACKFILL AGAINST FOUNDATION WALLS SCALE: 1/16" = 1'-0"
UNTIL FLOOR SYSTEM INSTALLATION IS COMPLETE. 3
WINDBORNE J SCTM# = 1000-53-05-12.6 SITE PLAN
DEBRIS PROTECTION SCHEDULE TOWN OF SOUTHOLD o
EXISTING REVETEMENT �i�E DWG. NAME
PRECUT WOOD STRUCTURAL PANELS WITH A THICKNESS v o� o� oY o� oV o� o� o� ov o`, o SUFFOLK COUNTY, NEW YORK A-1
OF MIN 7/16 INCH ARE TO BE PROVIDED TO COVER SHELTER ISLAND SOUND �+ o DWG. NO
THE GLER T OPENINGS OF THE PROJECT: SITE PLAN ®�
FASTENER TYPE: 1/4° LAG SCREW BASED ANCHOR WITH
2-INCH EMBEDMENT LENGTH, SCREW SPACING: 16 INCHES,
GENERAL NOTES N PROPOSED
ADDITION &
1. ALL WORK MATERIAL, AND EQUIPMENT SHALL BE IN o W ALTERATIONS
ACCORDANCE WITH THE 2018 INTERNATIONAL BUILDING EL. 3.34 S A G E B L V D
CODE (IBC) AND THE 2018 INTERNATIONAL ENERGY z
CONSERVATION CODE (IECC) AND LOCAL AUTHORITIES.
2. ALL CONCRETE SHALL BE STONE AGGREGATE WITH A o DO�
MINIMUM 28 DAY STRENGTH OF 3000 PSI
z
3. ALL LUMBER SHALL BE GRADE STAMPED DOUGLAS FIR-
LARCH STRUCTURAL GRADE #2 OR BETTER. RUN-OFF CALCULATION: RESIDENCE
4. PROVIDE DOUBLE HEADERS AND TRIMMERS AT ALL FOR 2" OF RAIN TO BE CONTAINED ON SITE
STAIR AND FLOOR OPENINGS, POSTS AND PARALLEL �'
PARTITIONS, EXCEPT AS NOTED ON DRAWING. 'p-9�j COTTAGE 1,523 SF:100% run-off coefficient= w GREENPORT, NY
5. BRIDGING TO BE PROVIDED FOR ALL JOISTS AND GARAGE 253.83 Cu.Ft. o #30 BREEZY SHORES
FLOOR BEAMS. SPACING NOT TO EXCEED 8.0 FT. O�///F PROPOSED (2) 8'z3' DRYWELLS @ 126.7 Cu.Ft. EACH w 65490 ROUTE 25
6. ALL DIMENSIONS AND GRADE CONDITIONS TO BE WITH GUTTER LEADERS FOR ROOF RUN-OFF
VERIFIED BY CONTRACTOR(S) PRIOR TO START OF EL. 3.52 N ARCHITECT
CONSTRUCTION AND ORDERING OF MATERIALS. THIS Z FRANK UELLENDAHL
FOUNDATION HAS BEEN DESIGNED FOR A SOIL
123 CENTRAL AVENUE
BEARING CAPACITY OF TWO (2) TSF AND GRADES J
o P.O.BOX 316
LESS THAN 5%. CONTRACTOR SHALL VERIFY THAT o GREENPORT, NY 11944
TEL: 631-477 8624
THESE CONDITIONS ARE MET. ALL FILL BENEATH
CONCRETE SLABS TO BE COMPACTED TO 95%
RELATIVE DENSITY. OWNERS
DOWD
7. ALL HEADERS 6.0 FT IN LENGTH AND OVER TO BE & MICHAAELYMY RSS
SUPPORTED BY DOUBLE UPRIGHTS, 9.0 FT AND OVER 1600 4TH STREET N
BY TRIPLE UPRIGHTS. ALL HEADERS TO BE DRYWELLf.8 X3 ST. PETERSBURG� ': ,�. .; ;:' ' o
MINIMUM OF 2-2X8 OR AS SHOWN ON DRAWING. 704
7 FLORIDALO 33823 3704
248
8. PROVIDE FIRESTOPPING AT ALL LEVEL EL. 4.26 EL. 4.17
PENETRATIONS
9. PROVIDE FLASHING AT ALL ROOF BREAKS, PROPOSED C-4
CHIMNEYS, SKYLIGHTS, EXTERIOR DOORS, WINDOWS RENOVATION
AND DECKS ETC.. 49 SF ADDITION
10. DO NOT SCALE DRAWINGS.
11, DESIGN CONSULTANTS OR RECORD ARCHITECT- HOUSE TO BE EL. 3.44
ENGINEER ARE NOT RESPONSIBLE FOR THE RAISED TO F.F. ,,r • r
INSPECTION, SUPERVISION, OR ADMINISTRATION OF lo
THIS CONSTRUCTION PROJECT. FEDERAL, STATE C-30 EL. 8.00
AND LOCAL ZONING AND BUILDING CODE COMPLIANCE
SHALL BE THE RESPONSIBILITY OF THE EXT'G F.F._
CONTRACTOR. i
EL. 6.34�
12. THIS DRAWING IS AN INSTRUMENT PREPARED TO FLOOD ZONE AE EXT'G FOOTPRINT OF DWELLING 1,474 SF
FACILITATE CONSTRUCTION AND SHALL NOT BE ' EL. 6 PROPOSED FOOTPRINT C-30 1,523 SF
CONSTRUED AS A CONTRACT BETWEEN BUILDER AND
OWNER. AS PER ELEVATION w
-29 EL. 4.38 EL. 4.28 CERTIFICATE, 01/18/19 INCREASED COVERAGE 3.0 � = 49 SF z 13. THIS STRUCTURE HAS BEEN DESIGNED IN '�MAIN CESSPOOL Z
ACCORDANCE WITH THE NEW YORK STATE ENERGY BY YOUNG & YOUNG, L.S. PROPOSED 49 SF ADDITION m 3
CONSERVATION CODE.
14. ENGINEER TO BE NOTIFIED IN WRITING OF ALL r- f 8'X3'�DRYWE L LINE OF HAY BALES o CHANGES PRIOR TO AND DURING CONSTRUCTION. ® EXISTING STRUCTURES _
15. ELECTRICAL AND MECHANICAL COMPONENTS TO BE AND SILT FENCE o N
DESIGNED AND SPECIFIED BY OTHERS. EL. 5.06 Z o 0
16. CONTRACTOR SHALL OBTAIN ALL PERMITS AND \ OVERFLOW Q
CESSPOOL
INSURANCE NECESSARY TO PROTECT THE ENGINEER �U
AND OWNER.
EL. 4.05 EXISTING BULKHEAD = TIDAL WETLANDS BOUNDARY �� DATE: 09/30/2021
17. DO NOT BACKFILL AGAINST FOUNDATION WALLS SCALE: 1/16" = 1'-0"
UNTIL FLOOR SYSTEM INSTALLATION IS COMPLETE. 3
WINDBORNE J SCTM# = 1000-53-05-12.6 99 SITE PLAN
DEBRIS PROTECTION SCHEDULE TOWN OF SOUTH OLD �� DWG. NAME EXISTING REVETEMENT
PRECUT WOOD STRUCTURAL PANELS WITH A THICKNESS S U FFO LK COUNTY, NEW YO R K A-1
OF MIN 7/16 INCH ARE TO BE PROVIDED TO COVER o-- �� ov o� oY �� o� ov o� �� SHELTER ISLAND SOUND �+ o DWG. NO
THE GI OPENINGS OF THE PROJECT: SITE PLAN ®�
FASTENERER TYPE: 1/4' LAG SCREW BASED ANCHOR WITH
2-INCH EMBEDMENT LENGTH, SCREW SPACING: 16 INCHES,
GENERAL NOTES y PROPOSED
W ADDITION &
1. ALL WORK
ACCORDANCEATEWITH THHE 200181P�RNATIOALL NAL BE
EL. 3.34 S A G E B L V D o ,,� ALTERATIONS
J
CONSERVATION CODE (IEOCC) ENERGY
AUTHORITIES.
2. ALL CONCRETE SHALL BE STONE AGGREGATE WITH A EDOWD
MINIMUM 28 DAY STRENGTH OF 3000 PSI
3. ALL LUMBER SHALL BE GRADE STAMPED DOUGLAS FIR- I
LARCH STRUCTURAL GRADE #2 OR BETTER. i RUN-OFF CALCULATION: N CORAGE
4. PROVIDE DOUBLE HEADERS AND TRIMMERS AT ALL FOR 2" OF RAIN TO BE CONTAINED ON SITE
STAIR AND FLOOR OPENINGS, POSTS AND PARALLEL COTTAGE 1,523 SF:100% run-off coefficient= GREENPORT NY
PARTITIONS, EXCEPT AS NOTED ON DRAWING.
F 253.83 CLI.Ft. #30 BREEZY SHORES
5. BRIDGIFLOORNG TO BEAMS. B SPACINGED NOT OR ALL TO EXCEED JOISTS8.0 FT D ---� Q�� GARAGE
PROPOSED (2) 8 x3 DRYWELLS ® 126.7 Cult. EACH �
6. ALL DIMENSIONS AND GRADE CONDITIONS TO BE
VERIFIED BY CONTRACTOR(S) PRIOR TO START OF q` - EL. 3.52 WITH GUTTER LEADERS FOR ROOF RUN-OFF ARCHITECT
CONSTRUCTION AND ORDERING OF MATERIALS. THIS B UA K U U i �1 ST E E S
FOUNDATION HAS BEEN DESIGNED FOR A SOIL TOWN OF SOUTHOLD � FRANK RALAVENUE
BEARING CAPACITY OF TWO (2) TSF AND GRADES n E C E V �-- � 123 c�NiRaIP o.BOX 316
LESS THAN 5%. CONTRACTOR SHALL VERIFY THAT ®�+T� ' a �s U Lc I m GREENPORL NY tt944
THESE CONDITIONS ARE MET. ALL ALL BENEATH R�r, t o TEL 631-477 8624
CONCRETE SLABS TO BE COMPACTED TO 95% i •, •, •; MAR 1 g L OWNERS
RELATIVE DENSITY. I 2025
7. ALL HEADERS 6.0 FT IN LENGTH AND OVER TO BE ' ' '• •• ' MARY DOWD
• I � & MICHAEL MYERS
SUPPORTED BY DOUBLE UPRIGHTS, 9.0 FT AND OVER l;-`,.; •;•; ••• ,•
Southold Town J 16DO 4TH STREET N
BY TRIPLE UPRIGHTS. ALL HEADERS TO BE DRYWELLt 8 x3 , '• Board of Trustees sT. PEIERSBURG
MINIMUM OF 2-2x8 OR AS SHOWN ON DRAWING. T FLORIDA 33704
�- •' •• 727-823 3248
8. PROVIDE FIRESTOPPING AT ALL LEVEL EL. 4.26 .• EL. 4.17
PENETRATIONS
9. PROVIDE FLASHING AT ALL ROOF BREAKS, PROPOSED -4
CHIMNEYS, SKYLIGHTS, EXTERIOR DOORS, WINDOWS RENOVATION U t �, ;�
AND DECKS ETC.. 149 SF ADDITIO
10. DO NOT SCALE DRAWINGS.
11. DESIGN CONSULTANTS OR RECORD ARCHITECT- EL. 3.44 - o
ENGINEER ARE NOT RESPONSIBLE FOR THE s
INSPECTION, SUPERVISION, OR ADMINISTRATION OF HOUSE TO Bf
THIS. CONSTRUCTION PROJECT. FEDERAL, STATE RAISED TO F.f. -30 EXTG FOOTPRINT OF DWELLING 1,474 SF ,
AND LOCAL ZONING AND BUILDING CODE COMPLIANCE EL. 8.00 ! ������ PROPOSED FOOTPRINT C-30 1,523 SF W ° •
SHALL BE THE RESPONSIBILITY OF THE
EXTG F.F.= o �
12. THI CONTRACTOR. EL M
RAWING IS AN INSTRUMENT PREPARED To . 6. /1 INCREASED COVERAGE 3.0 % 49 SF=
FACILITATE CONSTRUCTION AND SHALL NOT BE
CONSTRUED AS A CONTRACT BETWEEN BUILDER AND ® PROPOSED 49 SF ADDITION
OWNER. EL. 4.38 EL. 4.28 a m
13. THIS STRUCTURE HAS BEEN DESIGNED IN ® EXISTING STRUCTURES a
ACCORDANCE WITH THE NEW YORK STATE ENERGY
CONSERVATION CODE. -1 m
14. ENGINEER TO BE NOTIFIED IN WRITING OF ALL r- �l$'X3'i DRYWE L LINE OF HAY BALES 0 0
CHANGES PRIOR TO AND DURING CONSTRUCTION. FLOOD ZONE AE - _
15. ELECTRICAL AND MECHANICAL COMPONENTS TO BE EL 6 `� AND SILT FENCE W N N N
zz
DESIGNED AND SPECIFIED BY OTHERS. EL. 5.06 � �0 2 o 2
16. CONTRACTOR SHALL OBTAIN ALL PERMITS AND AS PER ELEVATION Q o
INSURANCE NECESSARY TO PROTECT THE ENGINEER CERTIFICATE, 01/18/19 EL. 4.05 EXISTING BULKHEAD = TIDAL WETLANDS BOUNDARY is DATE 05J28/2021
AND OWNER. BY YOUNG & YOUNG, L.S.
17. DO NOT BACKRLL AGAINST FOUNDATION WALLS scaLE: 1/32°= 1'-0'
UNTIL FLOOR SYSTEM INSTALLATION IS COMPLETE. I o Y
WINDBORNE SCTM# = 000-53-05-12.6 SITE PLAN
DEBRIS PROTECTION SCHEDULE TOWN OF SOUTHOLD DWG. NAME
EXISTING REVETEMENT
PRECUT WOOD STRUCTURAL PANELS WITH A THICKNESS v SUFFOLK LINTY, NEW YORKg A-1
OF MIN 7/16 INCH ARE TO BE PROVIDED TO COVER V oY o� ov o-- �� o-- o-- o� SHELTER ISLAND SOUND �+ ®� DWG. NO
THE GLAZED OPENINGS OF THE PROJECT: SITE PLAN
FASTENER TYPE: 1/4° LAG SCREW BASED ANCHOR WITH
2-INCH EMBEDMENT LENGTH, SCREW SPACING: 16 INCHES,
Generated by REScheck-Web Software
Compliance Certificate
Project THE DOWD MYERS RESIDENCE
Energy Code: 2018 IECC
Location: Southold, New York
Construction Type: Single-family
Project Type: Alteration
Climate Zone: 4 (5572 HDD)
Permit Date:
Permit Number:
Construction Site: Owner/Agent: Designer/Contractor:
65490 ROUTE 25 DOWD MYERS Frank Uellendahl
BREEZY SHORES #30 OWNERS ARCHITECT
GREENPORT,NY 11944 16314778624
frank.uellendahl@gmail.com
compliance: Passes using prescriptive requirements for-alteration projects
Slab-on-grade tradeoffs are no longer considered in the UA or performance compliance path in REScheck. Each slab-on-grade
assembly in the specified climate zone must meet the minimum energy code insulation R-value and depth requirements.
Envelope Assemblies
Prop.Gross Area
Assembly or Cavity Cont. Prop.
Ceiling 1: Flat Ceiling or Scissor Truss 49 48.0 0.0 0.026 0.026 1 1
Ceiling: Cathedral Ceiling 1,700 48.0 0.0 0.022 0.026 37 44
Wall:Wood Frame, 24"o.c. 332 30.0 0.0 0.047 0.060 16 20
Wall 1:Wood Frame, 24" o.c. 1,392 36.0 0.0 0.043 0.060 60 84
Floor:All-Wood joist/Truss 1,414 48.0 0.0 0.021 0.047 30 66
Window:Wood Frame 27 0.290 0.320 8 9
SHGC: 0.31
Window:Wood Frame 548 0.300 0.320 164 175
SHGC: 0.31
Door: Glass Door(over 50%glazing) 20 0.290 0.320 6 6
SHGC: 0.32
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 2018 IECC requirements in
REScheck Version : REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Name-Title Signature Date
Project Title: THE DOWD MYERS RESIDENCE Report date: 10/15/21
Data filename: Page 1 of 9
OCCUPANCY OR
APPROVED AS NOT D USE IS UNLAWFUL
DATE: /0 B•P.# WITHOUT CERTIFICATE
FEE:40/d. O BY:. OF OCCUPANCY
NOTIFY BUILDING DEPARTMENT AT
765-1802, 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION 7 TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING Cost AiPLY WITH ALL CODES OF
3. INSULATION NEW YORK S T ATE & TOWN CODES
4. FINAL - CONSTRUCTION MUST AS REQUIRED AND CONDITIONS OF
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE SOUTHOLD TOWN ZBA
REQUIREMENTS OF THE CODES OF NEW SOUTHOLD TOWN PLANNING BOARD
YORK STATE. NOT RESPONSIBLE FOR �S�o 7
DESIGN OR CONSTRUCTION ERRORS. SOUTHOLD TOWN TRUSTEES
N.Y.S.DEC
FLOW
COUPLYWI` H C00FrEp 14gTRUSS PLACARDING REQUIRED
Sol Ham. uo`�"m4w.} crone
ON Rr- UMM
RETAIN STORM WATER RUNOFF
PURSUANT TO CHAPTER 236 All exterior lighting
OF THE TOWN CODE. installed,replaced or
repaired shall conform
to Chapter 172
Blower door of the Town Code
and ductwork
testing required.
PLUMBER CERTIFICATION
ON LEAD CONTENT BEFORE
Must provide Manuals CERTIFICATE OF OCCUPANCY
1%1 and S as per SOLDER USED IN WATER
NYS Energy Code SUPPLY SYSTEM CANNOT
EXCEED 2110 OF 1%LEAD.
DESIGN CRITERIA: PROPOSED
ADDITION &
W ALTERATIONS
GROUND SNOW LOAD - 45 PSF.
LIVING AREAS AND DECKS - 40 PSF.
SLEEPING AREA - 30 PSF.
WIND SPEED - 130 MPH
DOWD
SEISMIC DESIGN CATEGORY - B
WEATHERING - SEVERE
FROST LINE DEPTH - 36" 52-8 1/2"
RESIDENCE
TERMITE - MODERATE TO HEAVY 8°
DECAY - SLIGHT 'I�
ICE SHIELD UNDERLAYMENT REQUIRED - YES ---------------------------- ----- W GREENPORT, NY
w #30 BREEZY SHORES
I
I
DESIGN IN ACCORDANCE WITH AMERICAN FOREST
I _ 65490 ROUTE 25
PRODUCTS WOOD FRAME CONSTRUCTION MANUAL
FOR 1&2- FAMILY HOUSE - PRESCRIPTIVE DESIGN METHOD I EXT'G WOOD BURNING
I BEDROOM 2 BEDROOM 1 FIREPLACE i ARCHITECT
CLO. I o FRANK UELLENDAHL
WINDOW SCHEDULE ; I 123 CENTRAL AVENUE
I CDP.O.BOX 316
GREENPORT, NY 11944
I I TEL: 631-477 8624
LIVING ROOM lCD
PROPOSED WINDOWS ARE ANDERSEN PRODUCTS 400 I I �T= OWNERS
GLASS TO BE HIGH PERFORMANCE LOW-E GLASS CLO I W MARY DOWD
SCREENS ARE PROVIDED FOR ALL WINDOWS AND DOORS i l & MICHAEL MYERS
HARDWARE - METRO COLLECTION: ANVERS, SATIN NICKEL FINISH I ALL INTERIOR WALLS EXPOSED I � 1600 4TH STREET N
ST. PETERSBURG
INTERIOR FINISH: PRE-FINISHED WHITE I STUCCO & DRYWALL REMOVED I FLORIDA 33704
EXTERIOR COLOR: WHITE I
I 727- 823 3248
GRILLES AS PER ELEVATIONS: NO GRILLES I W
NOTE: tempered glass for units below 18" off FIn.R. - V.I.F. M I PORCH
o I � A
Tv .t( �ti
Mark Size Description Quantity t BATH RM. 13 s
;/�t`` 7
1ST FLOOR -A
°O I FIXTURES REMOVED IN 2010 EXT'G CHIMNEY TO BE REMOVED i I r
TW24510 DOUBLE-HUNG - SUN PORCH 12 I OIL TANK AND BURNER IN BASEMENT p
TW18510 DOUBLE-HUNG - SUN PORCH 2 I TO BE REMOVED
TW24410 DOUBLE-HUNG - LIVING RM, MUD RM. 7
TW26410 DOUBLE-HUNG - DINING RM, BR 2 4 I KITCHEN DINING ROOM ; .�
TW24310 DOUBLE-HUNG - KITCHEN 3
I W z
CX15 CASEMENT - BR 2, egress 1
TW2436 DOUBLE-HUNG - BATH 1, LAUNDRY 2 I MUDROOM/ENTRY
CID
00
ND FLOOR I I ME
TW24210 DOUBLE-HUNG - BR 1 10 I D W I W
I � z
TW2446 DOUBLE-HUNG - BR 1, YOGA RM. 2
TW38510 DOUBLE-HUNG - BR 1, YOGA RM. 1 I I
TW24310 DOUBLE-HUNG - BATH 2 2
I �
CXW155 CASEMENT - BATH 2 1 I
L
30x68 ENTRY DOORS - THERMA-TRU 2 -------- — ------- -----------------------------------------------------
N
S140STC FULL LIGHT COVERED Zz
CD
PORCH z
DRAWING SCHEDULE
° EXISTING 1ST FLOOR PLAN o o DATE: 09/
J 12 J 12 J 83" J 12 J 12°I SCALE: 3/i 6" = 1'-0°
1
-0
A-1 SITE PLAN - GENERAL NOTES
A-2 EXISTING FLOOR PLAN EXISTING
A-3 PROPOSED 1ST FLOOR PLAN, PARTIAL FOUNDATION PLAN Y Q 1 ST FLOOR PLAN
A-4 2ND FLOOR PLAN
�W
A-5 CROSS SECTION A-A DWG. NAME
A-6.1 EXT'G & PROP'S SOUTH ELEVATION cn
A-6.2 EXT'G & PROP'S WEST ELEVATION A-2
A-6.3 EXT'G & PROP'S NORTH ELEVATION o DWG. NO
A-6.4 EXT'G & PROP'S EAST ELEVATION o
A-7 CONNECTORS, CRITICAL PATH
A-8 NAILING SCHEDULE, FRAMING NOTES
® NEW WALL PROPOSED
ADDITION &
52'-8 1/2" ® EXISTING WALL o ALTERATIONS
" 10'-9 3 4" " " ———- REMOVED WALL J
8 17-0" 13'-3 8 9-11
-------------------------------------------- -----------------
J
TW26410 TW26410 TW26410 TW26410 TW24410 TW24410 TW24510 TW24510 TW24510
RESIDENCE
j I ��I NEW GAS FIREPLACE I =
BEDROOM 2 0 �I�
II INSERT i GREENPORT, NY
I �I o
I I #30 BREEZY SHORES
I I �Ij o I 65490 ROUTE 25
Ln
' DINING ROOM J iol o
I ��I N � n o f ARCHITECT
I W S D I I a I Z FRANK UELLENDAHL
I W I _x I I C-' I 123 CENTRAL AVENUE
I o P.O.BOX 316
NEW STEPS o GREENPORT, NY 11944
I
TEL' 631-477 8624
——
I o
28"z80" 6'=8" II -------------� I OWNERS
I N CLG HGT. S D N I I 6 " DOWD
I I LIVING ROOM PORCH 3-0 1 & MICHAELYMYERS
I _--- ~' FUN CO 36 36"x8O" I a 1600 4TH STREET N
BATH RM. o I ST. PETERSBURG
`o I N. CT- I I Z 3704
7 7- 823DA 33248
AC 0 W L L----------1� o
10'x3' ISLAND
M I L------------J
°o cr 4:
CABINETS SHELVES UP KITCHEN � r' � I ip w _
r f
n
N LAUNDRY RM. I I o f s
N
lf) _
M ® ® ———
I D W DW INI
I L J IW117111AI o laZ
0
I TW24310 TW24310 TW24310 TW24410 TW24410 TW24510 TW24510 TW24510
I 36 z80" MUDROOM o ADJUST MASONRY OPENING ' PROPOSED 1 ST FLOOR PLAN
I ------ -----------------�
-------------------- SCALE: 3/16" = 1'-0"F W
0
CRAWL SPACE FOUNDATION m
STORAGE BENCH I I I I
' U
I " o o 03 4" SUBFLOOR, NAILED AND GLUED CV N CRAWL � M�off F.J. O.C..3,_6
L ___
__________J I I SPACE I , I R-48 CLOSED CELL INSULATION
6x6 TRT'D POST TO SUPPORT MUDROOM ROOF I 7'-0" I 2"X6" TREATED SILL
WRAPPED IN VERSATEX _ I - ____J ; I 1/2" CONC. BOARD UNDERNEATH FRAMING DATE: 09/30/2021
FOOTING FORM BF22 I ' . 6„MIL POLY VAPOR BARRIER ON COMP. GRAVEL SCALE: 3/16" = 1'-O"
STAIR LANDINGS: 1 x6 TWIN FINISH, SOLID PLANK �� " L————————J 8 POURED CONCRETE WALL WITH #5 VERTICAL FOUNDATION NOTES 3 z PROPOSED
TIMBERTECH GREY OR SIMILAR 10 DIA. POURED CONC. FOOTING ,REBARS ,(� 24 O.C. Y 1ST FLOOR PLAN
PORCH RAILING: BIGFOOT SYSTEMS: 1 —4 X 8 POURED "CONCRETE FOOTING WITH STRENGTH = 3000 PSI AT 28 DAY ASTM C-94 FOUNDATION PLAN
1.5"x1.5" BALUSTERS: PermaPorch PVC FOOTING FORM BF22 3-#4 REBARS - 3 ABOVE BOTTOM OF FOOTING o 0
COLOR: WHITE (OR: 24"x24"x12" FOOTING) 1 2"X12" ANCHOR BOLTS @ 46" O.C. READY MIX CONCRETE. �� DWG. NAME
BITUMINOUS DAMPPROOFING TO GRADE ALL FOOTINGS, FOUNDATIONS, ETC SHALL REST ON N� A-3
FOUNDATION PLAN SILL SEAL AND COPPER TERMITE SHIELD ALL FOOTINGDS AND FOUNDATIONS SHALL BE FORMED. � DWG. ND
e�
U) PROPOSED
ADDITION &
W ALTERATIONS
o ��JI
N
J
W
FEDOWD
U
Z
N RESIDENCE
TW24210 TW24210 TW24210 TW24210 TW24210
W GREENPORT, NY
'7= #30 BREEZY SHORES
65490 ROUTE 25
\\ 2x6 HEADER (2)2x4 POSTS 5 4'
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30 YR ARCH'L GRADE ROOF SHINGLE ON 15 LBS BIT. FELT
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FOLLOW MANUFACTORER'S GUIDELINES FOR INSTALLATION
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RIDGE STRAPS EACH RAFTER PAIR 5/8 CDX PLYWOOD SHEATHING
2x8 COLLAR TIES @ 24" O.C. 2x8ROOF RAFTERS @ 24" O.C. w/L-R-48-FOAM-INSUL-ATION GREENPORT NY
5/8" CDX PLY SHEATHING 5/8�� GWB ALL CATHEDRAL CEILINGS
" ON 2x8 R.R. @ 24" O.C. 2'-0" VENTED ROOF OVERHANG o30 BREEZY SHORES
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HURRICANE CLIPS EACH DORMER WALL CONSTRUCTION ARCHITECT
RAFTER TO WALL STUD 1/2 GYPSUM BOARD
NEW DORMER NEW DORMER LENDAHL
2x6 STUD WALL @ 16" O.C. o FRANK RALAVENUE
30-CLOSED=CELL FOATJNSU911ON Y 123 CENTRAL AVENUE
Z P.O.BOX 316
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-co 5/8" CDX PLYWOOD SHEATHING m TEL' 631-477 8624
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NET AREA OF NOT LESS THAN ONE SQUARE INCH FOR N RESIDENCE
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STAINLESS STEEL INSULATED SMART V S: 1,200 SQ.IN.
BOTTOM OF SMART VENTS TO BE +/- EL.4.5'MSL
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SIMPSON H2A HURRICANE
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RAFTER TO STUD. - NAILS ® 4" O.C. AT ARCHITECT
TYPICAL ALL RAFTERS EXTERIOR EDGE OF ALL o FRANK UEIlA
r 123 CENTRAL AVENUE
4 - 8d NAILS EACH END SHEATHING. o P.O.BOX 316
APA RATED PLYWOOD TO cREENPORr, NY 11944
TEL• 631-477 8624
EXTEND TO TOP OF TOP PLATE
0
OWNERS
2 x 6 STUDS ® 24" O.C. W MARY DOWD
& MICHAEL MYERS
1600 4TH STREET N
ST. PETERSBURG
FLORIDA 33704
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2ND FLOOR DORMER
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1-1/4" 20 GAGE STRAP W/ 1-1/4" 20 GAGE STRAP W/
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STUD - EACH END - TYP. STUD - EACH END - TYP.
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GENERAL NOTES FRAMING NOTES NAILING SCHEDULE TABLE 3.1 - WFCM
w ADDITION &
1. ALL WORK MATERIAL, AND EQUIPMENT SHALL BE IN Joint Description Nail Sizes Nail Spacing o La ALTERATIONS
• ACCORDANCE WITH THE 2018 INTERNATIONAL BUILDING 1. ALL FRAMING LUMBER SHALL BE GRADE STAMPED
CODE (IBC) AND THE 2018 INTERNATIONAL ENERGY DOUGLAS FIR-LARCH STRUCTURAL GRADE No. 2 OR ROOF FRAMING
CONSERVATION CODE IECC AND LOCAL AUTHORITIES. BETTER' X Rafter to To Plate Toe- ailed all Height: 10 ft Spacing 16" O.C. Table 3.3A 4 - 8d per rafter
( ) P � � ) - 9 � P 9 ( )
2. ALL CONCRETE SHALL BE STONE AGGREGATE WITH A 2. ALL SHEATHING TO BE APA RATED, EXPOSURE 1, 5/8" Ceiling Joist to Top late Toe-nailed n/ per joist o ODOWD
MINIMUM 28 DAY STRENGTH OF 3000 PSI MIN. THICKNESS OR AS NOTED. Ceiling Joist to Parallel Ra er (Fa e-nailed) n� each lap W
Ceiling Joist Laps ov r Partitions Face-nailed) n/a each lap W RESIDENCE
3. ALL LUMBER SHALL BE GRADE STAMPED DOUGLAS FIR- 3. ALL SUBFLOORING TO BE APA RATED STURD-I-FLOOR Collar Tie to Rafter 7Face-nailled) n/a per tie
LARCH STRUCTURAL GRADE #2 OR BETTER. ALL SUE 1 RING MIN. THICKNESS. ALL EDGES OF, Blocking to Rafter ( o -nailed) 2 - 8d each end N
4. PROVIDE DOUBLE HEADERS AND TRIMMERS AT ALL PLYWOOD TO I SET ON SOLID BLOCKING. GLUE AND Rim Board to Rafter End-milled) 2 - 16d each end
STAIR AND FLOOR OPENINGS, POSTS AND PARALLEL NAIL PLYWOOD SUBFLOOR TO FLOOR JOISTS. WALL FRAMING W GREENPORT, NY
PARTITIONS, EXCEPT AS NOTED ON DRAWING. n #30 BREEZY SHORES
4. ALL HEADERS 6-0 AND OVER SHALL BE SUPPORTED Top Plate to Top Plate (Fac -nailed) 2 - 16d per foot o
5. BRIDGING TO BE PROVIDED FOR ALL JOISTS AND WITH DOUBLE UPRIGHTS, 9-0 AND OVER WITH Top Plates at ntersection Face-nailed) 4 - l6d joints-gach side 65490 ROUTE 25
FLOOR BEAMS. SPACING NOT TO EXCEED 8.0 FT. TRIPLE UPRIGHTS. ALL HEADERS SHALL BE A Stud to Stud Face-nailed 2 - 16d 24 o.c.
6. ALL DIMENSIONS AND GRADE CONDITIONS TO BE MINIMUM OF 2-2X8 OR AS SHOWN ON DRAWING. Header to Header (Face-nailed) 16d 16" o.c. along edges
� ARCHITECT
VERIFIED BY CONTRACTOR(S) PRIOR TO START OF 5. SOLID BLOCKING SHALL BE PROVIDED FOR ALL JOISTS Top or Bottom Plate to Stud (End-nailed) 2 - 16d per 2x4 stud W FRANK UELLENDAHL
CONSTRUCTION AND ORDERING OF MATERIALS. THIS AND FLOOR BEAMS AS PER N.Y.S. CODE OR AS NOTED 2 - l6d per 2x6 stud o
" n 2 - 16d per 2x8 stud r 123 CENTRAL AVENUE
FOUNDATION HAS BEEN DESIGNED FOR A SOIL ® 8-0 O.C. MIN. PROVIDE 2 SPACE FOR AIR o P.O.BOX 316
BEARING CAPACITY OF TWO (2) TSF AND GRADES CIRCULATION IN ROOFS. Bottom Plate to Floor Joist,Bandjoist,Endjoist or Blocking (Face-nailed) 2 - 16d 1.2 per foot GREENPORT, NY 11944
LESS THAN 5%. CONTRACTOR SHALL VERIFY THAT m TEL 631-477 8624
THESE CONDITIONS ARE MET. ALL FILL BENEATH 6. DOUBLE FRAMING AROUND ALL OPENINGS ( skylights, FLOOR FRAMING o
CONCRETE SLABS TO BE COMPACTED TO 95% stairs etc. ) OR AS NOTED ON DRAWINGS. OWNERS
RELATIVE DENSITY. Joist to Sill Top Plate or irder (Toe-nailed) 4 - 8d per joist MARY DOWD
7. DOUBLE UP FRAMING UNDER ALL POSTS AND PARALLEL Bnd ing to Joist JToe-nailed 2 - 8d each end
7. ALL HEADERS 6.0 FT IN LENGTH AND OVER TO BE PARTITIONS OR AS NOTED ON DRAWINGS. Blocking to Joist Toe "1
2 - 8d each end & MICHAEL MYERS
SUPPORTED BY DOUBLE UPRIGHTS 9.0 FT AND OVER Blocking to Sill or Top Plate ( Toe-nailed) 3 - 16d each block leaf 4TH STREET N
' Ledger Strip to Beam (Fac -nailed) 3 - 16d each joist J ST. PETERSBURG
BY TRIPLE UPRIGHTS. ALL HEADERS TO BE 8. ALL FLUSH WOOD CONNECTIONS SHALL BE FASTENED Joist on Ledger to earn (Toe-nailed) 3 - 8d per joist o FLORIDA 33704
MINIMUM OF 2-2x8 OR AS SHOWN ON DRAWING. WITH RATED GALVANIZED METAL CONNECTORS BY Band Joist to Joist(End-nailed) 3 - 16d per fist
� 727- 823 3248
8. PROVIDE FlRESTOPPING AT ALL LEVEL "TECO" OR APPROVED EQUAL. Band Joist to Sill or Top Plate (Toe-nailed) 2 - 16d per foot
PENETRATIONS 9. NAILING SCHEDULE SHALL BE AS PER THE N.Y.S. ROOF SHEATHING
9. PROVIDE FLASHING AT ALL ROOF BREAKS, BUILDING CODE AS A MINIMUM. ALL 2X6 STUDS
SHALL RECEIVE 5-10D NAILS AT SILL AND PLATE. Structural Panels 8d 4" o.c. perimeter zone
CHIMNEYS, SKYLIGHTS, EXTERIOR DOORS, WINDOWS nP f.�-
AND DECKS ETC.. ALL EXTERIOR NAILS SHALL BE GALVANIZED. other 6 o.c. edges of //e ;; �
panel, 12 o.c. interior j14r 4-
10. DO NOT SCALE DRAWINGS.
y
10. PLYWOOD SHEATHING TO BE NAILED WITH 8 d ® 4" of panel r o
" Diagonal Boar, Sheathing
11. DESIGN CONSULTANTS OR RECORD ARCHITECT- o.c. EXTERIOR EDGES AND 6 d 0 12 ► a
o.c. 1" x 6 or 1 x 8" 2 - 8d per support
ENGINEER ARE NOT RESPONSIBLE FOR THE INTERMEDIATE. 1" x 10" or wider 3 - 8d per support
INSPECTION, SUPERVISION, OR ADMINISTRATION OF
THIS CONSTRUCTION PROJECT. FEDERAL, STATE 11. ALL INTERIOR AND EXTERIOR FINISHES, FLASHING CEILING SHEATHING W
AND LOCAL ZONING AND BUILDING CODE COMPLIANCE AND WATERPROOFING SHALL BE BY ARCHITECT.
SHALL BE THE RESPONSIBILITY OF THE Gypsum Wallboard 5d 7" edge / 10" field (
CONTRACTOR. 12. ALL ROOF RAFTERS SHALL BE ATTACHED TO THE PLATE
AND STUD WITH GALVANIZED HURRICANE TYPE WALL SHEATHING o _1 CD
12. THIS DRAWING IS AN INSTRUMENT PREPARED TO
CONNECTORS BY "TECO" OR APPROVED EQUAL FOR Structural Panels 8d 6" edge / 12" field 2Z
FACILITATE CONSTRUCTION AND SHALL NOT BE TIMBER PILE FOUNDATIONS, PROVIDE HURRICANE Fiberboard Panels fs
a
CONSTRUED AS A CONTRACT BETWEEN BUILDER AND CUPS AT ALL PERIMETER JOIST TO GIRDER 7 / 16" 6d 3" edge / 6" field a W W
OWNER. CONNECTIONS. 25 / 32" Bd 3" edge / 6" field a
13. THIS STRUCTURE HAS BEEN DESIGNED IN 13. ALL PRE-ENGINEERED LUMBER SHALL BE GEORGIA
ACCORDANCE WITH THE NEW YORK STATE ENERGY PACIFIC GPI SERIES WOOD-]-BEAMS AND LVL Gypsum Wallboard 5d 7" edge / 10" field m 3
CONSERVATION CODE. PRODUCTS OR EQUAL ALL JOISTS, GIRDERS AND Hardboard 8d 6� edge / 12n field o
14. ENGINEER TO BE NOTIFIED IN WRITING OF ALL HEADERS SHALL HAVE BEARING STIFFENERS INSTALLED Particleboard Panels 8d 6 edge / 12 field
CHANGES PRIOR TO AND DURING CONSTRUCTION. AS PER MANUFACTURERS RECOMMENDATIONS. WEB Diagonal Board Sheathing W N N
15. ELECTRICAL AND MECHANICAL COMPONENTS TO BE STIFFENERS SHALL BE REQUIRED AT ALL LOAD AND n "" " " P pp
BEARING POINTS AT A MINIMUM. 1 x 6 or 1 x 8 2 - Sd per su art o 0
DESIGNED AND SPECIFIED BY OTHERS. HANDLING, STORAGE, AND ERECTION OF 1 x 10 or wider 3 - 8d per support o 0 0
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16. CONTRACTOR SHALL OBTAIN ALL PERMITS AND COMPONENTS SHALL BE AS PER MANUFACTURERS FLOOR SHEATHING
INSURANCE NECESSARY TO PROTECT THE ENGINEER RECOMMENDATIONS. DATE: 09/30/2021
Structural Panels o 0
AND OWNER. n n n n Z a SCALE: N.T.S
14. ALL MULTIPLE LVL PRODUCTS TO HAVE 2 ROWS OF 1/2 DIA. 1 or less 8d 6 edge / 1 field �_
17. DO NOT BACKFILL AGAINST FOUNDATION WALLS GALVANIZED MACHINE BOLTS ® 12" D.C.. greater than 1" 10d 6" edge / 6 field FRAMING NOTES
UNTIL FLOOR SYSTEM INSTALLATION IS COMPLETE. Diagonal Board Sheathing Y o
WINDBORNE e 12 e 12 " 12 " 12 " 1" x 10"forlwider8" 3 - 8d per supporrt Nailing Schedule
N W
DEBRIS PROTECTION SCHEDULE " "f-/
S� DWG. NAME
OR: TRUSSLOK CONNECTORS BY FastenMoster ® 16 O.C. "Nailing requirements are based on wall sheathing nailed 6 on-center at the panel edge. If wall sheathing is nailed o
3 on-center at the panel edge to obtain higher shear capacities nailing requirements Tor structural members shall A-g
PRECUT WOOD STRUCTURAL PANELS WITH A THICKNESS x be doubled , or alternate connectors , such as shear plates , shall be used to maintain the load path. DWG. NO
OF MIN 7/16 INCH ARE TO BE PROVIDED TO COVER o 2 When wall sheathingc�is continuous over connected members , the tabulated number of nails shall be permitted to g
THE GLAZED OPENINGS OF THE PROJECT: 16 be reduced to 1 - ttid nail per foot. o
FASTENER TYPE: 1/4" LAG SCREW BASED ANCHOR WITH ®�'J
2-INCH EMBEDMENT LENGTH, SCREW SPACING: 16 INCHES,
GENERAL NOTES N PROPOSED
D (� (�/� _ CC ADDITION &
1. ALL WORK
ACCORDANCEATWITH'THED20108IPNTERNATONALMENT SHALL BE INBUILDING �- � EL. 3.34 SAGE B L U D � W ALTERATIONS
0
SEP292021
CODE (IBC) AND THE 2018 INTERNATIONAL ENERGY Ono
CONSERVATION CODE (IECC) AND LOCAL AUTHORITIES. BUILDING DEPT
2. ALL CONCRETE SHALL BE STONE AGGREGATE WITH A TOWN OF SOUTHOLD o ❑DOWD
MINIMUM 28 DAY STRENGTH OF 3000 PSI
3. ALL LUMBER SHALL BE GRADE STAMPED DOUGLAS FIR- N RESIDENCE
LARCH STRUCTURAL GRADE #2 OR BETTER. RUN-OFF CALCULATION:
4. PROVIDE DOUBLE HEADERS AND TRIMMERS AT ALL "
STAIR AND FLOOR OPENINGS, POSTS AND PARALLEL FOR 2 OF RAIN TO BE CONTAINED ON SITE
PARTITIONS, EXCEPT AS NOTED ON DRAWING. 'P-9�j COTTAGE 1,523 SF:100% run-off coefficient= GREENPORT, NY
5. BRIDGING TO BE PROVIDED FOR ALL JOISTS AND GARAGE 253.83 Cu.Ft. #30 BREEZY SHORES
65490 ROUTE 25
FLOOR BEAMS. SPACING NOT TO EXCEED 8.0 FT. ��l/F PROPOSED (2) 8'x3' DRYWELLS ® 126.7 Cult. EACH
6. ALL DIMENSIONS AND GRADE CONDITIONS TO BE ` EL. 3.52 WITH GUTTER LEADERS FOR ROOF RUN-OFF ARCHITECT
VERIFIED BY CONTRACTOR(S) PRIOR TO START OF
CONSTRUCTION AND ORDERING OF MATERIALS. THIS o FRANK UELLENDAHL
FOUNDATION HAS BEEN DESIGNED FOR A SOIL J 123 CENTRAL AVENUE
Z P.O.BOX 316
BEARING CAPACITY OF TWO (2) TSF AND GRADES GREENPORT, NY
41194 LESS THAN 5%. CONTRACTOR SHALL VERIFY THAT
THESE CONDITIONS ARE MET. ALL FILL BENEATH o
CONCRETE SLABS TO BE COMPACTED TO 95% OWNERS
RELATIVE DENSITY.
MARY DOWD
7. ALL HEADERS 6.0 FT IN LENGTH AND OVER TO BE _ & MICHAEL MYERS
SUPPORTED BY DOUBLE UPRIGHTS, 9.0 FT AND OVER 1600 4TH STREET N
( ' ST. PETERSBURG
BY TRIPLE UPRIGHTS. ALL HEADERS TO BE DRYWELL.8 x3
MINIMUM OF 2-2x8 OR AS SHOWN ON DRAWING. '' '° 7 -FLORIDA333248
8. PROVIDE FIRESTOPPING AT ALL LEVEL EL. 4.26 EL. 4.17
PENETRATIONS
C-4
9. PROVIDE FLASHING AT ALL ROOF BREAKS, PROPOSED ��, U `
CHIMNEYS, SKYLIGHTS, EXTERIOR DOORS, WINDOWS RENOVATION & / ?
AND DECKS ETC.. 49 SF ADDITION
10. DO NOT SCALE DRAWINGS. q
11. DESIGN CONSULTANTS OR RECORD ARCHITECT- EL. 3.44 >L €(
ENGINEER ARE NOT RESPONSIBLE FOR THE
INSPECTION, SUPERVISION, OR ADMINISTRATION OF HOUSE TO BE ,�
THIS CONSTRUCTION PROJECT. FEDERAL, STATE RAISED TO F.F. C-30 EXT G FOOTPRINT OF DWELLING 1,474 S
AND LOCAL ZONING AND BUILDING CODE COMPLIANCE EL. 8.00 PROPOSED FOOTPRINT C-30 1,523 SF
SHALL BE THE RESPONSIBILITY OF THE EXT'G F.F.=
CONTRACTOR. EL N
. 6.34� INCREASED COVERAGE 3.0 % = 49 SF
U [)
12. THIS DRAWING IS AN INSTRUMENT PREPARED TO
FACILITATE CONSTRUCTION AND SHALL NOT BE
CONSTRUED AS A CONTRACT BETWEEN BUILDER AND PROPOSED 49 SF ADDITION
OWNER. C-29
EL. 4.38 EL. 4.28 z
13. THIS STRUCTURE HAS BEEN DESIGNED IN1E]ACCORDANCE WITH THE NEW YORK STATE ENERGY EXISTING STRUCTURES
�1_-
CONSERVATION CODE. m
14. ENGINEER TO BE NOTIFIED IN WRITING OF ALL r f 8'x DRYWEI.L LINE OF HAY BALES N
CHANGES PRIOR TO AND DURING CONSTRUCTION. FLOOD ZONE AE
15. ELECTRICAL AND MECHANICAL COMPONENTS TO BE AND SILT FENCE o
o �
DESIGNED AND SPECIFIED BY OTHERS. EL. 5.06 EL. 6
16. CONTRACTOR SHALL OBTAIN ALL PERMITS AND AS PER ELEVATION o
INSURANCE NECESSARY TO PROTECT THE ENGINEER CERTIFICATE, 01/18/19 EL. 4.05 EXISTING BULKHEAD = TIDAL WETLANDS BOUNDARY o DATE: 09/30/2021
AND OWNER. BY YOUNG do YOUNG, L.S.
� w-� SCALE: 1/16" = 1'-0"
17. DO NOT BACKFILL AGAINST FOUNDATION WALLS
UNTIL FLOOR SYSTEM INSTALLATION IS COMPLETE. 3 N
WINDBORNE SCTM# = 1000-53-05-12.6 SITE PLAN
DEBRIS PROTECTION SCHEDULE �`� TOWN OF SOUTHOLD
EXISTING REVETEMENT DWG. NAME
PRECUT WOOD STRUCTURAL PANELS WITH A THICKNESS SUFFOLK COUNTY, NEW YORK A-1
OF MIN 7/16 INCH ARE TO BE PROVIDED TO COVER �� �� �� �� oV �� ov o� o� o� o� SHELTER ISLAND SOUND S DWG. NO
THE GLAZED OPENINGS OF THE PROJECT: SITE PLAN ®�
FASTENER TYPE: 1/4° LAG SCREW BASED ANCHOR WITH
2-INCH EMBEDMENT LENGTH, SCREW SPACING: 16 INCHES,
4n PROPOSED
ADDITION &
J 52'-81/2° J o W ALTERATIONS
J8� 17'-0° JJ 10'-9 3/4° J 13'-3" JSJ W-11" J
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N I_41wa GREENPORT NYBEDROOM 2 1 » c°of sou- #30 BREEZY SHORES
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F IDINING ROOM i i i o 0
I N I I I 1 AMEND® 9 ARCHITECT
I �X S D , II I� ElV z Lr) FRANK UELLENDAHL
W" II I `" >_ 123 CENTRAL AVENUE
�"` Z P.O.BOX 316
O O I I I v l o I GREENPORT, NY 11944
"' Q II I o I m TEL 631-477 8624
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——————————————————— tv———————————————————
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I / I 3/4 SUBFLOOR, NAILED AND GLUED N N N N N
---- 3'-6' 72'-0l J I / 1 CRAWL I I o 2x8 F.J. @ 16" O.C. N M
---- ---------- R-48 CLOSED CELL INSULATION
I , I SPACE I I � � M �, �, �
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6x6 TRT'D POST TO SUPPORT MUDROOM ROOF I ;' I 7'-0" 1 ' I 2"X6" TREATED SILL 0 o 0 0 0
WRAPPED IN VERSATIX I / L—___J I 1/2" CONC. BOARD UNDERNEATH FRAMING DATE: 08/31/2023
FOOTING FORM BF22 I '; ,, I 6 MIL POLY VAPOR BARRIER ON COMP. GRAVEL a SCALE. 3/16" = 1'-0"
STAIR LANDINGS: 1x6 TWIN FINISH, SOLID PLANK --- ----I 8"
POURED CONCRETE WALL WITH #5 VERTICAL FOUNDATION NOTES g AS-BUILT
TIMBERTECH GREY OR SIMILAR 10 DIA. POURED CONC. FOOTING ,REBARS @ 24 O.C. 1ST FLOOR PLAN
PORCH RAILING: BIGFOOT SYSTEMS: 1 -4 X 8 POURED CONCRETE FOOTING WITH STRENGTH - 3000 PSI AT 28 DAY ASTM C-94 FOUNDATION PLAN
1.5"x1.5" BALUSTERS: PermaPorch PVC FOOTING FORM BF22 3- 4 REBARS - 3" ABOVE BOTTOM OF FOOTING
" " , n n READY MIX CONCRETE. <� DWG. NAME
COLOR: WHITE (OR: 24 x24 x12 FOOTING) 1/2 X12 ANCHOR BOLTS @ 46 O.C. ALL FOOTINGS, FOUNDATIONS, ETC SHALL REST ON
BITUMINOUS DAMPPROOFING TO GRADE UNDISTURBED SOIL. A-3
FOUNDATION PLAN SILL SEAL AND COPPER TERMITE SHIELD ALL FOOTINGS AND FOUNDATIONS SHALL BE FORMED. DWG. NO
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N GREENPORT NY
#30 BREEZY SHORES
65490 ROUTE 25
\ 2x6 HEADER (2)2x4 POSTS 5.4'
/
ATTIC WINDOW SEAT ATTIC / MECHANICAL ,'/ ARCHITECT
MECHANICAL EQUIPMENT ,/ o FRANK UELLENDAHL
} 123 CENTRAL AVENUE
o P.O.BOX 316
/ ' 9 GREENPORT, NY 11944
---SITTING AREA ,
/ m a- 631-477 8624
W.I.CLOSET -------- �7=_ OWNERS
!----�—
LIMITED HEADROOM & MICHAEL
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cm 1600 4TH STREET N
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N ` S D CO �———————7// ® C ST.FLORIPETEDA
33 04
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