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21853-Z
t t FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23658 Date MAY 18, 1995 THIS CERTIFIES that the building NEW DWELLING Location of Property 2260 INDIAN NECK LANE PECONIC NY House No. Street Hamlet County Tax Map No. 1000 Section 86 Block 4 Lot 6.5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 10, 1993 pursuant to which Building Permit No. 21853-Z dated DECEMBER 27, 1993 was issued, and conforms to all of the requirements of the applicable provisions Of the law. The occupancy for which this certificate is issued is A ONE FAMILY DWELLING WITH ATTACHED GARAGE AND OPEN PORCH AS APPLIED FOR. The certificate is issued to TORKELSEN BUILDERS INC. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 93-SO-16 MAY 15, 1995 UNDERWRITERS CERTIFICATE NO. N347427 APRIL 3, 1995 PLUMBERS CERTIFICATION DATED MAY 11, 1995 MIKE JACOBI PLUMB & HEAT Building Inspector Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD,N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ...1 2/n Z...................................... No 21853 Z Permission Is hereby granted To: ..... -: � -.%.............. ../...y7s. .....................I......... to .. ..... ... .. GGGa......B�Gl...... . . . a'. . ...... L•!t .. .,r ' ....... P� (/ LLC�� .................................................................................................................................................................. .................................................................................. at premises located at......'........�..O...... 'y.: p ..... ............................... /-! County Tax Map No. 1000 Section .......Z6.......... Block.........�.`.............. Lot No. ....... ...... /293 pursuant to application dated .......................................................... 19..............., and approved by the Building Inspector. Fee $.... ./.!.. U � Building Inspector Rev. 6/30/80 rr nn x Form No. 6 TOWN OF SOUTHOLD MAY g 1995 BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form) . 3. Approval of electricafl installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contairs less than 2/10 of 1% lead. 5. Commercial buildin , industrial building, multiple residences and similar buildings and installations,�a certificate of Code Compliance from architect or engineer re,i)onsible for the building. 6.. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1 . Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00., Commercial $15.00 Date �.Y. . . � -. .!.� . . . . . . . .. . . . . . . . . New Construction. S . . . . Old Or Pre-existin� Building. . . . . . . . . . . . . . . . . aa6U �w «ti �� �� �� �� � ca.�.c Location of Property. . . . . . .. . . . . . . . . . . . . . . � . . . . . . . . . . . . . House No. Street Hamlet Onwer or Owners of Property.��`�( LS 4-"� AV LI��L/��Qf. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . County Tax Map No 1000, Section. O 8� . . . . . . .Block. .l. . . . . . . . . . . . .Lot. . sf. . . . . . . . . . . . . . . . < 3 Subdivision.n . . /GQ . . ��� 5. . . . . . . . . . .Fil d M:ip. . . . . . . .Lot. . . . 3.`. . . . . . . . . . . . . . . .P. .&t Permit No.Vdl.; : , , ,7'. . .Date Of Permit. f �, ¢ Applicant./efiq,6!'GS6'!V _ !3Ot LA healthDept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . .. . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Cert 'fic�. . . . . . . . . . Final Certicate. . . . V . . Fee Submitted: $. . . . . . . . . . . . . . . . . . . . . . . . . . . Rlt 5�2- GAO. . . . . . . . . . . . . .��:. . . . . . . . . . . .. . . . 3LP59 n . _�...T TEL. 765-1802 �pS�FF���pG TOWN OF SOUTHOLD y�c OFFICE OF BUILDING INSPECTOR zT P.O. BOX 728 v' TOWN HALL SOUTHOLD, N.Y. 11971 MAY 11995 C E R T I F I C A T I O N Date Building Permit No. Owner LA14k:7S J o r Ilc l Seal (please print) Plumber�(I (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber ' signature) Sword to before m this _day of 19, Notary Publi WME L.CLEW Notary Public, / County WMINKIC.SuleotNwNA No.4979505 Q"Mied N Suffolk Coo* Co missan Expires DWAWA r 4 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000484 - VIOREME3 Ofi ELECTRICITY F 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date APRIL 01,1995 Application No.on file 83929294/94 N 347427 THIS CERTIFIES THAT only the electrical equipmene6s described below and introduced by the applicant named on the above application number in the promisee of TORKLSEN BU11rDERS, W/SIDE INDIAN NECK LANE, PECONIC, N.Y. in thefollowinR location; K Basement ® Ise Ft. ® Ynd Ft. GAR/ATTIC/OUT %rtio,086 Blm,lr4 Lot 5 was examined on MARCH 30,1995 and found to be in compliance mpliance with the National Electrical Code. FIXTWIE FIXTURES EC RANGES COOKING DKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ACLES SWITCHNS INCANDESCEWI FLUORESCENT I OTHER I HAT. K.W. AMT. K.W. MIT. K.W. MIT. K.W. Anti. N.P. 37 43 40 36 1 1 1 1 1 2 F DRYERS FURNACE MOTORS PUTURE APKIANCE REDNNS SPECIAL RSC'FTj TIME CLOCKS I SELL UNIT HEATERS I MULTI.OUTLR DIMMERS Mr. K.W. OIL H.P. GAS N.P. HAT. NO. A.W.G. AMT. AMP. Mr. AMPS. TRANS. AMT. N.P.t�4� AMT. WAITS 2 F 2 - 1 SERVICE DISCONNECT NO.OF S E R V 1 C E M1i. AMP. TYPE 1/TW 1/3SV S/3\V 3/AW NO.O CCkCOND. OF CC .of . NO.OF HI.IFG OF MI'L G NO.OP NEVTRAts OF MALL 1 200 CB X 1 2/0 1 2/0 OTHER APPARATUS: JACUZZI-1 PANELBOARDSFI-1 CIR. 60 G.F.C.II-6 SMOKE DETECTORT-2 RICHARD KLEINFELDT LIC.#665-E 114 CARLTON AVE GREW MANAGER ISLIP TERR. , NY, 11752 11 Per. This certificate must not be cleared in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. g%SFFO(KCIn Town Hall, 53095 Main Road w at Fax (516)765-1823 P. O. Box 1179 • .F Telephone (516)765-1802 Southold, New York 11971 ,f. OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD April 26 , 1995 Torkelsen Builders Inc. P.O. Box 1475 Southold, NY 11971 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons : xx An application for Certificate of Occupancy is(,,/ not on file. (Enclosed) xx No Underwriters Certificate on file xx The check is not on file. $25.0q.,/ xx No Health Department Approval on file. No final inspection has been made. xx No Plumber Solder Certificate on file. (All permits involving plumbing being issued after April 1, 1984) . BUILDING PERMIT # 21853-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. oaf% L'!,- ,�.AS � � , I_ LOT;�`►, ' Lsi!� ICI = . 4 _ ,fe W lam,_ • l� �,_ _.�« �_ . _ = tr� �L��'���1����4 7W-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL REMARKS: DATE INSPECTO 21 v M-13a BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST ( ] ROUG PLBG. [ ) FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING FINAL REMARKS: ale 4�1 /Ns!`�/�,�TidYt/•vs/� Gr DATE INSPECTOR 21,i SQ � C�-��d�` M-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] R OH PLBG. [ ] FOUNDATION 2ND [ INSULATION [ ] FRAMING / [ ] FINAL - j REMARKS: Cof DATE INSPECTO M-11102 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ I ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: i DATE INSPECTOR M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST /] ROUGH PLBG. ( ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ll�--Ilce DA INSPECTOR r- M-1802 BUILDING DEPT. I NSP CTION [ ] F DATION 1ST [ ] ROUGH PLBG. [ FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ( ] FINAL REMARKS: DATE INSPECTOR M-1802 BUILDING DEPT. 1 TION FOUNDATION 1ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING ( ] FINAL REMARKS: DATE INSPECTOR (-A ENERGY CODE CALCULATIONS (For Non-Electric Heat-) Design Criteria 6, 000 Degree Days O.A. 10OF I .A. 70OF FOR: I .. �,� J.. PER: .-j(.z� DATED: 3 L r DESIGN THERMEL SIIBSYS'I'EM AREA "U" RATING REMARKS Exterior ior Walls (opaque) 131.1 ( O3 arl5_? / Gla z in /6 4 2 / . 33 153 Doors J 1b 23 Ceiling/Roof (Opaque) /SS l aJ� 0 Skylights 20 Floor � Foundation Walls Slab Insulation F NE TOTAL 0' 7 CE • TLr 9¢ Notes : Building Envelope Systems to meet requirements of 7815. 2 11VAC Equipement to meet requirements of 7815. 11 034254-1 Y A 2254 r �V 11VAC Systems to meet requirements of 7815. 12 �P �� Duct Systems to meet requirements of 7815. 13 g�fiSS10NP Ventilations Systems to meet requirements of 7815 . 14 ® /= Insulation of Piping Systems to meet requirements of 7815. 15 Service Water Heating Systems & Equipment to meet requirements of 7015. 21 Electrical & Lighting Systems & Equipment to meet requirements of 7815. 31 To the best of my knowledge, belief, & professional judgement, these plans are in_____.__ So compliance with the code 7 Y �, , 1 0093 9eFy _ BOARD OF HEALTH . . . . . . r FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . Fen SURVEY _ . . . . . . . . . . . DEC TOWN OF SOUTHOLD CII[CF �6 �.S j CC low BUILDING DEPARTMENT Y TOWN HALL SEPTIC FORNI . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 IC)WN 0v UTHOLn ,.i CALL ?.�5:.317_ . . . . . . . . . Examined . /. : . . 7. . . . . .. I . G MAIL TO : Approved . . . . . . 199- Permit _ . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Buil ng In �ector) APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . . . . . . . . . .. 19 . . . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the 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 �/t'l� Ls1SLJX�. 6Jl�d�125 .!ti (as on the tax roll or latest deed) If appl, pts corps oosignature of dulyy authorized officer. ( ame and title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . / I. Location of land on which proposed work will be done. �D. . . . . � . . . . . . . . . . 3 3� , 5 3. , /�� . . . ... . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . ©1f•b. . . . . . . . . Block . . . . . . . . . . . . . . Lo4;;�. . . . . . . . . . . . . . ,,nn np J Subdivision .NR .d�- . u/./.�a . . V�.rs. . . . . . . . . . . Filed Map No. �. . . . . . . Lot . ?5 . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . .V� Ci� �• • • . •�� H'� b. Intended use and occupancy . . . ��!. . . /ELrSi pL�.LCL�� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . X . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . (DRSF,ription) 4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . . . . . . . . . . . . . . . Number of dwellingunits on each floor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If garage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . /. . . . . . . . . . . . . . . 6. If business, commercial or mixed occu Y ncy, specify nature and extent of each t pe of use . . . . . . . . . . . . . . . . . . . 00 7. Dimensions of existingstructures, if an Front . . . . . . . . . . . . . . . Rear . . Depth . Sy.r.. . . . . . . . . Height A . . . . . . . . . . . . Number of Stories . .L' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structurz with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new constriction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front G'.. . Rear . X& . . . . . . . . . . . . . . . . Depth - . . . . . . . . . . . 10. Date of Purchase . . Name of Former Owner .QKI f/) ¢ 11. Zone or use district in w}lich premises are situated .R�`. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ! U. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . A . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes ;�_ No 14. Name of Owner of premises To�Gt l SGrn {dQs. . Address 0?7&)`. . ff73 . . . . . Phone No.7.f Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . Name of Contractor /'TiRta. cstl w ��?.S • , . . . . Address PP.AC?15.{y ��. . . . . . Phone No. 7&J. .4. .?. . ..p . 15. Is this property within 300 feet of a tidal wetland? *Yes. . . . . . . . Ko, x *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. K STATE OF NEW E� COUNTY OF . . . . . . . . . S.S . . . . . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) mf 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. ;wom to before me this . . . .day f 19�( Z dotary Public, . . . :. . . . . . County — ROBER71.SC0 7JR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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