Loading...
HomeMy WebLinkAbout14790-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N,Y, Certificate Of Occupancy No .... .z. ! 4. .6 .5 .3 ....... Date ........ J.u..ly...,16, ......... ...., .. 19 .8.6. THIS CERTIFIES that the building ...~.n.s.t.a..1.1.e.d.. 9.h.~.m.n..ey..&., .wpp.d' . .b.u.r.n.J:..rig..s.t.q.v.e' Location of Property ...1.1..3.0...G..lp.n..R. 9.a.d., ............... .Sp.u.t..hg.l.d' ~..N...Y.: .......... House No. Street Ham/et County Tax Map No. 1000 Section . . .0.7.8. ...... Block . ...0.2, ......... Lot ..... 0.2. .9 ......... Subdivision ...~/.q..W.e.~.~...C.r.e.e.k...~.s.t.a.t..e.s...Filed Map No. 3..8.4.8....Lot No...1..3 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... M.a.T.c.h...2 .8.,.., 19..8.6pursuant to which Building Permit No...1.4.7. .9 9.g ............. dated .... A. p.r.i.J,..2.6a .............. 19.8..6, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for wtfich this certificate is issued is ......... Chimney and wood burning stove The certificate is issued to ..... I?.a..r.s..T..9 .r.k.e.1. s..e.n ...................................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FORa[ NO. O TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL, COMPLETION OF THE WORK AUTHORIZED) 14790 Z Permission is hereb/granted to: ....... ~.~. ........ ..~.....~.~. ............ ......... ~.o.......Z..~.z~~....~ ...... ~z,~.~9~....2~., ...... ,o ........ ~..~.,.~.~ ....... ~z~,~...~...~, ........ ~z~.,.~.~ ............. ................ =.~ ....................................................................................................... ./... ............. at pr ................... .~ .... d ........... .... ~.~..~~~..~..~~ ............... ..~......~.~....¢..~ ................................... County Tax Map No. 1000 Section ...,~...~., .~.. ..... Block ....~..~ ........ Lot No...~.~ ........ pursuant to application dated .~~ ....... ~.~ ............... , 1~., and approv~ by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I ~ to the Building Inspec- tor with the following; for new buildings 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 of Health Dept, of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and sifnilar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15,0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~ ~.~. [,~..oo~ 5.Updated C.O. $15.00 Date ..-,,~. ............... New Building , ,~ ......... u~o or yre-existing Building ............ Vacant Land ............. Location of Property ................. Hou~ No. Street H~mlet Owner or Owners of Property ....................................................... County Tax MapNo. 10~Section,,...,....~7~ ...., Block ..,...,~ ~ ....,,., Lot.,..¢.~,... ..... . ;ubdivision. ~¢~..~ ..... Filed Map No..~,V~. ,Lot No...~ ~, ........ ermitNoJ ..... q. Z Date of Permit ~b ~Applicant ~J ~0~~ .................................. ~alth Dept. Approval ........................ Labor Dept. Approval ........................ ~derwriters Approval ........................ Planning Board Approval ...................... quest for Temporary Certificate ..................... Final Certificate ....................... Submitted $ ............................. Applicant ........................................ 76S-~,802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION AND [ ] i~JLATION FRAMING [/~ FINAL REMARKS: DATE INSPECTOR il F~ELD YNSPECTION iIDATE COMMENTS , , , FOUNDATION (1st) FOUNDATION (~d) ROUGH FRAME & '- PLUMBING -,q 3. ~1 -~ INSULATION FERN. Y. - STATE ENERGY .... ADDITIONAL COMMENTS: )e sELKIRK METALBESTOS SHEET G Model SS Chimney GENERAL INSTALLATION INSTRUCTIONS AND OWNERS D0-1T-YOURSELF GUIDE Design, Insta!lation, Operation and Maintenance Information on Chimneys for ?Vood-Burning Stoves, F,,ireplaces and Other Applications ' ' i } ' These instructions are intended especially for anyone who plans to install a IREAD ALL OF THESE INSTRUCTIONS chimney for a wood-burning appliance such as a stove, heater or fireplace. AND FOLLOW THEM EXACTLY! Because we expect that you will also select, install and operate the appliance, we have included some suggestions on chcosing an appliance, I~ARTNAME and installing it correctly, In addition, we are including some important PARTNUMBER cautions about appliance operation and chimney maintenance. Please read these instructions before beginning your installation, including all the sheets that describe how to install the chimney parts you will be using. Chlmne Pipe S18or 3~ Stom~ Collar Note:In open attic use AlS. FUELS AND APPLIANCES The Selkirk Metalbestos Model SS Ali-Fuel Chimney, diameter sizes 6, 7, 8, 10, 12, and 14 inches, may be used for gas, wood arid flquid fuel-fired residential-type appliances including cooking ranges, heating sto{,es, fireplace stoves, central furnaces, floor furnaces, steam and hot water boirers, recessed heaters, unit heaters and water heaters· It may also be used for masonry fireplaces and domestic type incinerators. CAUTIONI IF YOU ARE BURNING COAL Some types of coal in certain designs of stoves may, in rare insta~c(~s, cause corrosion of the inner parts of the Model SS Chimney. Inspect and clean your chimney frequently to keep it free of c~al, ash and soot deposit. If damage to the flue is observed, contact your Selkirk Metalbestos ~albr or Deparlment C, Selkirk Metalbestos, P.O. Box 372, Nampa, ID 8365~, with a description of your chimney problem. ff you ha~e a coal-burning appliance connect it to a U.L. listed Model SC S'entinel Chimney by Selkirk Metalbestos. The Model SS Chimney is not recommended if you are burning ocean driftwood. The salt in this wood may cause early product failure. MINIMUM CLEARANCE Where installed within buildings, the Selkirk Metalbestos Model SS Chimney may be fully enclosed at 2 inches r~inimum c earance to combustibles including framing lumber, drywall, ~laster, p ywood and other building , materials classed as combustible. For supports, see table on back page. AIR SPACE ONLY The minimum clearance to Model SS Chimney pipe means air space only The 2 inch clearance to pips, and the framing around supports and firestop must not be filled with insulation. In attics where blow-in or bart insulation may be used, install the attic insulation sheld around the chimney CHIMNEY PART USAGE The drawing shows the names and locations of commonly-used chimney parts. These are described in other instructions as follows: ·. SHEET Cel mg Support Package' aed Fihish Support Package*: C 15" Insulated Elbow*, Joist ShieK~'~: E Insulated Tee~' Wall Support Kit", . r Round Top*, F~ashing, Cleanout '~ee: I E T Rool~lousing Assembly": H Roof Support Package*, Anchor Plate*: R * If you are installing any of these parts or packages marked*, you should receive the proper instructions in the package. You may also request a complete set of instructions from your dealer. For zero clearance fireplan,cas refer to page 8. , . These installation r~quirements are based on complete chimney tests in accordance with American National Standard ANSI t31-1 (UL 103). Chimneys installed in ac. {~ L~STED cordance with these instructions will comply with national safety standards such as NFPA 31, 54 or 211, and the AIA National Building Code. Selkirk Metalbestos chimney parts LISTED and produced under the Factory Inspection and Follow-Up program of Underwriters' Laboratories, Inc., carry the LISTING MARK illustrated here. APR 2 2 1986 FORM NO. 3 TOWN OF gOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. BLDG. DERT, TOWN O_ .,.F $OUTHOL__ ~ NOTICE OF DISAPPROVAL PLEASE TAKE NOTICE that your application dated .... ~...~..C?..~L..d,~...., 19 .~.. for permit to /A(.-?~.cq..~..~. .......................................... at Location 0f Property/:/~/h/~o[ .~. .... 3~.//~/5<..~..O.~.../~.~.tle$i ........... ~?..I~..~.~.... · Ham/et County Tax Map No. 1000 Section ...(~D~.O~.. .... Block .~.~. ........ Lot . ..O...~. ~. ..... Subdivision~;..~..~...~.'..~...~.'.~.' Filed Map No...~.~/¢...o~. .... Lot No.../. 5 ........... is returned herewith and disapproved on the following grounds ............................... .... ~F../.,: ~ .-EE...4,. ,~.. ~.~.'~-.~-.>.. ~. ~:~'.,¢...,.~.....-¢:.../v ............ · ,~'zvF2. ~..c.d.F~... ~..~/~. ~../~<<-... .... C"~_¢./¢w.~..~:~.../..~...-5.~..<~..../¢~.... · ~--,~. L~//r,z,:¢~..~... ~ ,~.~.. %~...'/~../~¢.~ ~. · .~ ~..¢.~ ~7~...~¢z¢~G.: '..':. ~ .~. ¢. ~.. , ~.. ~. ~~.~... ~~-~~ .................. · ......... / ......................... ; .............................. ~¢ .~: .... . .... ~ ........... ..) ..... ../ ............... ~ ~ ¢ ~ , ....... t..{.,~..,L ..... : ......... ~~O>ff~ ~/~t~ Building Inspector RV 1/80 FORM NO. 3 TOWN OF SOUTItOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date .~.~..~.4'.C: ............... ,19 .~... ........ ~. ~.(©t~. , ..... PLEASE TAKE NOTICE that your application dated .... ~ ~4[..~.~ .... , 19 .~. for pemit to /~(.~.~ .... ~~ ................................ at Location of Property.. [.~ .... House No. Etroet Hamlet County Tax Map No. 1000 Section ...~ .... Block ~ ........ ~t . .~.~ ~ ..... Subdivisio~ ~~ F~ed Map No...~ .... Lot No.../. ~ ........... is returned herewith and disapproved on the following grounds ............................... .... /57~././.< ~,~ ~<~..~.. '?/,~...~.,~ .>.. ~~ ~..~ .~ ........... . ,~.~. ~ ~'~.~... ~~L~...~ ~ ~.~...~ ~..~.. ~.... .,. ~..~.~ e~7~...~~~.. ,: :. ~ .~. ~ ~.. ........................... Building Inspector RV 1/80 Lot I~ ,zo.O~ Lot 12 3. Nature of work (check which applicable): New Building ' Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... /to'Slt"~l~bt~4, /)ir 14~-r~t. Po~"J Y'ox Ckt~M~FJ/ (Description) 4. Estimated Cost tq./dl~...~. ~.~.~.....A'~¢.~....c'.t.4{~..~.t(~... Fee :.~....~...~.. .......................... (to be paid on filing this application) 5. If dwelling, number o f dwelling units ............... Number o f 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 ..... 6 ~: .~ .... Rear ...(¢..~: .2. ..... Depth .. ~.~.~.~. '.3.X. ...... Height .l.S.'. ........... Number of Stories . .t~. ..................................................... Dimensions of same structure with alterations or additions: Front ...~.' .~.t?.i.~7. ....... Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories .......................................... } ............ 9. Size of lot: Front ..... 10~..~. ........... Rear....7..~.'..~?.. '.47.. ~.~r..q.q Depth /?. ~.~ .' /7. . ?.$. ?: ?.q. ........ 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 15. Is this property located within 300 feet of a tidal wetland? *.Ye_~ ..... No ..... * if yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. ...... ..................... bein~ duly sworn, deposes and says thai he is the avvlicant____ __ (Name of individual signing contract) above uamed. He is the (.~64/A/~r~ .................. ........................ (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 .... o~ t~ .day of. '~ ~ , 19 ~ Notary Public, . ................................ County ~ ~ ~ it ~g ~ (Signature of applicant) Kd~fARY P~BLIC, ~hte of New Ye~k No. 4707878, Surfak ~,~72 Tefra Expires M~ch ~0,1~ ~. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Disapproved a/q,., .......... . ....: .....~ ........ ~ .... ~.~ , (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS TOWN OF SOUTHOLD Received ........... ,19... Date ~ '- ~ 19 .d'.&. .. 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 olf 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 ~ 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 wit ~ .all applicable laws, ordinances, building code, housing code, and regulations, and to admit auth°rized inspect°rs °n premises and in building f°r necessary~/~P~i°ns' (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, !essee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises /-~/~'~ ;.Tf'...~.~..~..ff.L-}'..~'..~/. ................................. i (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) .q~ 12/-"f'~'~ 21' Builder's License No .......................... Plumber's License No ....... .................. Electrician's License No. Other Trade's License No .... i .................. I. Location ofland on which prop6sed work will be done..././.o..~. .......................................... ttouse Number i Street Hamlet County Tax Map No. 1000 Section ....O. 7. g ......... Block. ..~.g ............ Lot...~..~..~ ........... ~Name) 2. State existing use and occupanc~ of premises and intended use and occupancy of proposed construction: ~. Existing use and occupancy ...; ................................................................ b. Intended use and occupancy ................................................................... ,8,,.~ ¢.~4