HomeMy WebLinkAbout15742-zFORM NO. 4
TO~N OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20075 Date JULY 15~ 1991
THIS CERTIFIES that the buildin~ ALTERATION & ADDITION
Location of Property ROW OFF ALPINE AVE. FISHERS ISLAND,
House No. Street Hamlet
County Tax Map No. 1000 Section 10 Block~8 Lot 3
Subdivision_ Filed Map No. Lot No.~
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 2, 1987 pursuant to which
Building Permit No. 15742-Z dated MARCH 11, 1987
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 RENOVATION,~ A~_DITION & DECK ADDITION TO EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to
JOHN C. & VIRGINIA M. BEGGS
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEP~LRTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-141392 - JULY 19~ 1998
PLUMBERS CERTIFICATION DATED JULY 9~ 1991 - JOHN C. BEGGS
Building Inspector
Rev. 1/81
FOlt~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 15742 Z
Permission is hereby granted to: , , ,
......... .'....
.~~..~,. ~.~.a...
ct pre,ises ,~,,ed ot .=.,~.~..,...~.~...~...~.:...~.~..m.,....~:~.'
County Tox Mop No. 1000 Section [ ~) Block ....... ..~..~ ........ Lot No. Q~ ~
pursuont to opplicotion doted ..... ~C~........2~... .................... , 19..~...~..., ond opproved by the
Building Inspector.
Fee $ ........................
Building Inspector
Rev. 6/30/80
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NEW YORK
765 - 1802
11971~
APPLICATION FOR CERTIFICATE OF OCCUPANCY
NEW CONSTRUCTION ....... OLD OR PRE-EXISTING BUILDING..ff...VACANT LAND ........
Location of Property.~J././~. ~0~ .O..F:.F: O.~.AL.~INV_ALf~=. rzl~NV_l~Co
HOUSE NO. STREET HAMLET
- AhA
Owner or Owners of Property .... : ~>
Coun, ty Tax Nap No. lO00 Section o o!O.. Block -.QO... Lot' ...(~.%
Subdivision .......................
Permit
Health
Filed Map ........ Lot ..........
Dept. Approval .................. Underwriters
Planning Board Approval ................
Request for Temporary Certificate
Final
Certificate ................
Fee Submitted- $ .......
. zS. - ..........
rev. 10/14/88
TOWN OF SOUTHOLD -.
'~ BUILDING DEPARTHENT
TO~N HALL
APPLICATION FOR CERTIFICATE OF OCCUPANcY INSTRUCTIONS
'This application must be ]filed in type~rlter OR ink and submitted to the Building
Inspector with the followllng; for new buildings or new use:
!. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual nhtural or topographic features.
2. Final approval of Heallh Dept. of water supply and sewerage-dlsposal(S-9 form).
3. Approval of electrlcal]installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that solder used in system contains less
than 2/10 of IZ lead. :
5. Commercial buildings, industrial buildings, multiple residences and similar.
buildings and installations, a certificate of code compliance from the Architect
or Engineer responsible for the building.
6. Submit Planning Board ~pproval of completed site plan requirements.
Fur existing buildings (P~ior to April 9, 1957] non-conforming uses, or buildings
and "pre-existlug" land uses:
l. Accurate survey of property showing all property lines, streets, buildings and
unusual natural or opographlc features.
2. A properly completed application, a consent to inspect signed by the applicant
and a certified abstract of title issued by a tltle company which shall
show single and separaie ownership of the entire lot prior to April 9, 1957.
. If a Certificate of OcCupancy is denied, the Building Inspector shall state the
reasons therefor in ~ '
~rrltln~ to the applicant.
3. Date of any housing code or safety inspection of buildings or premises, or other
pertinent information ~equired to prepare a certificate.
For Vacant Land Certificate of Occupancy:
]. An application for vacant land Certificate of Occupancy shall be submitted,
and a certified abstract of title issued by a title company showing single and
separate ownership of ~he entire lot prior to April 9, ]957 shall also accompany
the application. If a!Certiflcate of Occupancy is denied, the Building Inspector
shall state the reason~ therefor in writing to the applicant.
3.
4.
5.
6.
'er. lO/14/~8
CERTIFICATE OF OCC~ANCY - New Dwelling $25.00, Additions to Dwelling $25.00,
Alteration to Dwelling $25.00, Swimming Pool, $25.00. Accessory building $25.00
Addition to AccessOry buildings, $25.00 - Businesses $50.00.
Certificate of Occupancy on pre-existing dwelling - $IO0.O0.
Copy of Certificate of Occupancy ~ $5.00 - over 5 years - $10.00
Vacant Land Certifi;cate of Occupancy - $20.00
Updated CertificateI of Occupancy ~ $50.00
Temporary Cartlficalte of Occupancy - $25.00 Residential
$50.00 Commercial
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL. 765-1802
CERTIFICATION
Date L~ ~/~ 9/
Permit NO.
Building
Owner q~),~d~ C ~'-~ (please print)
Plumber
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
Sworn to before me
day of
19
Notary Public,
this
County
~l~nfoe~' s signature)
Notary Public
THE NEW YORK BOARD OF FIRE UNDERWRITERS 'I
'l'Ol)[)~)'J ~ BUREAU OF ELECTRICITY
~ BS JOHN STREET, NEW YORK, NEW YORK 10038
Dat~ Application No. on file
THIS CERTIFIES THAT
only the electrical equipment ~ &scrlbed belo~ and introduced by tl~ applicant ~med on the a~ve application number in the premises of
in the fotlowing locatlon ~ Basement ~ Ist FI. ~ 2nd Fl. ()tl'l' Secth,. Bilk Lot
FIXTURE FIXTURES RANGES :OOKING DECKS OVENS EXHAUST FANS
DRYERS FEEDERS
SYSTEMS
NO. OF FEET
OTHER APPARATUS:
E E V I C
OF CC COHO A. W, O NO OF Hi. LEG A W O NO, OF NEUTRALSrA, W, G,
PER ,e' OF CC, COHO, OF HI-LEG OF NEUTRAL
?,I0 1210
GENERAL MANAGER
This certificate must not be altered 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.
OUNDATION ( 1 s t)
OUNDATION (2nd)
OUGH FRAME &
PLUMBING
iNSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
Ct.,
Ct.
J I
Make sure that the chimney is in
good repair and that the flue lining is
unblocked and clean.
Q. WHAT CAN YOU DO TO MAKE
SURE THAT THE OPERATION OF THE
f,/OOD STOVE IS SAFE?
~,. Check stovepipes and chimneys
~eriodically to prevent buildup of
;reosote (the result of unburned
.]ases condensing on these surfaces).
Reduce creosote buildup by operat-
ing a hot fire for 15 to 30 minutes every
~Jay so that it will burn off little by little.
Do not use a flammable liquid (such
~s gasoline) in the same room with a
~vood stove.
Neveruse a flammable liquid to start
.he fire.
Keep the damper open while the fuel
is burning.
Be sure that all ashes are thoroughly
;Doled befor*e you dispose of them.
Use a metal container with a tightfit-
!lng lid for ash disposal.
Keep children away from the stove
3ecause they can be burned simply by
!ouching the hot surface.
Teacl~ your family how to react to fire
~y developing and practicing an
~scape plan.
The Inforfnatlon used I~1 this pamphlet is based on material
prepa/ed by the Department of Agricultural Engineering, New
York Slate College of Agriculture and Life Sciel?ces at Cornell
University and by the Deparirn~n t of Agricultural Engineering, col-
NYS DEPARTF~IENT OF STATE
OFFICE OF FiRE PREVENTION
AND CONTROL
162 WASHINGTON AVENUE
ALBANY, NY 12233
(518) 474-6746
~013-005 (10179)
')
NFPA Minimum Clearances
For Safe Installation
.....~7 roof supra.
~ ~ aupporl bracket
- slave pipe
wall protcclor
pipe. crimped end down
e floor protection
A. Listed Wood Heater
Front
Side, Back
Top
B. Single Wall Connecter Pipe
(24 gaugc or heavier}
C. Chimney Height
Combustibles
With 3t~" masonry wall or :24 gauge
she metal with 1" airspace
36" 12"
36" 12"
18"
3 feet higher than roof:
2 feet higher than any part of roof
within 10 feet {measured horizontally}.
Dc~erbra~e~
In~u~ficien(;
Height, .._
Improper
Warped, Crt
:~nner walt
Cot o51o~
SnCequate~.J~'
~Slearance
Hid,tm
Ina.deqpa,tely
Debr{~
in Flue
Qearar~8
dearance
Ma ¢leano~;
'FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-180:3
Approved.
Disapproved a/c ................................. ~
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Received ........... ,19...
INSTRUC. TIONS
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 ins~.~ ~.-~ ,,~
· ............. ........... : .........
(Signature of applicant, dr name, if a corporation)
,../~a~.c0tF__,5.r/f_~./.d~F. ,., .o..~.q .4~.. ............
(Mailing address of applicant)
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's License No .........................
Electrician's License No .......................
Other Trade's License N~i' . ....................
State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder.
·: .OW. N..~ ...................................................... . ..............................
Name of owner of premises ...~.0~..~...~/...'~.~:.~. V/'~F~f.~J./.~I...A4. ~'~.~$ ......................
(as on the tax roi1 or latest deed)
Ifapplicantisac°rp°rati°n'signature°fdulyauth°rized°fficer' ~I / '¢/ ~~
1. Location of land on which proposed work will be done ..................................................
......... . .Z4. . ¢?. . . . 6 ....... .:. . ./.:. .P. .,. . . V. .. ..............
House Number Sti'eet Hamlet
County Tax Map No. 1000 Section ..... ~. ........... Block .... (~. .......... '.. Lot...~....';; ..........
Subdivision ..................................... Filed Map No ................ Lot .... : .......... (Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . ~..b{/.~/. ( f.~J...C7'. ............................................ '
b. Ifitended use and occuPancy .'.../9.~.~..~...A~.~- ................................ ~...-.)': ...............
3. Nature of woi:k (check which'applicable): New Building . ' ... Addition.,: ........ '.. Al[6ration .1~ .......
Repair ~" Removal .... Demolition ...... i. Other Work-.
' (D ~ripti
4. Estimated Cos .................................. Fee ..... C/ .................................
tto 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 ./f,~./q: ............. i
6. If business, commercial or mixed occupancy, spe~if× natur~ and extent of eJtch t~p.e 9fuse .
7. Dimensions of existing structures, if any: Front z.~.~.. ~.. . Rear
Height ....Z./ .......... Number of Stories . ~. ............. /~rv~..~.?..(,~r~. t~/~F). ~*~_..~z4,~ ........
Dimensions of same ~tmcture with alterations or additions: Front z.'?,f~..,$~;... ...... Rear . Z,~FL ..........
Depth ... ZO. ................ Height . .r:~.. Z/ ................ Number o? Stories..~. ..................
8. Dimensions of entire new construction: Front . A/z/t- .......... Rear . g/,/&., i ....... Depth /[/~A ..........
Height . .A//.A. .......... Number of Stories . .A//,4 ...................... L ................... i ........
9. Size of lot: Front . .5.~;4'...?(4. ~..~.o~..~g..._..2 . Rear ...................... [ Depth ............. i ........
10. Date of Purchase . .Z.~. ~..~q.~..~.~'/~./y.7.8. ........ Name of Former Owner [ F~O.~..bf~4?~ .7'. ...........
11. Zone or use district in which premises are situated ........................ i ...........................
12. Does proposed construction violate any zoning law, ordinance or regulation: ./~.oI ...........................
13. Will lot be regraded .../~.0. ....................... Will excess fill be r ov d from nremises' ¥~
Name of Contractor .......................... Address .............. ~ ....Phone No ................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, ihdicate 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 comer lot.
C~GC ~l~Do~ To
STATE OF ......... k, ~c~ ~
COU~Y OF.. ~ ~.. *'~
........... ~.. C .~¢~X ................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract) :
above nam6d.
He is the . ;. ¢.~ ............................................... ~, ...........................
(Contractor, agent, corporate officer, etc.).
of said owner or owners, ~d is duly autho~zed to perform or have perfo~ed the said work and to m~e and file this
application; that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the
work will be perfomed in the m~ner set forth ~ the application filed therewith.
Sworn to before.me this
....... ~ .~ ........... day of. ~~.~ ~ ...... 19 ~
Nota~ Public, .~..~~Lunty ~C~ 1~
,. ......... ..... ...............
/, ,v~ ~ ~g~ignatureofapplicmt)