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Home My WebLink About14422-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building... ~/.qqd.. b.~v., fa ~.n.g..~ .~9.v.e. ....................... Location of Property .... !9..~.t.c..kp.v.y. Rd. & 1160 Chestnut Rd, Southold House No. Street Hamlet County Tax Map No. 1000 Section . .0.~4 ....... B]ock .... 0.6 ......... Lot ..... 0..~ .~ ......... Subdivision ............................... Filed Map ;No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..0c.t....22 .......... , 1985. pursuant to which Building Permit No..1.6. q .2.2.Z. ............. dated ~.o.u,..6 ..................... 19~35., 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 ......... ·.. ¥ o.o.d, b u~.n J. ug..a t o.v.e. ....................................................... The certificate is issued to .4 .E~31. S.~EENET~ ........... ..................... of the aforesaid building. Suffolk County Department of Health Approval ........... Iq.. [./i ............................ UNDERWRITERS CERTIFICATE NO ................... ~ [.fi ............................ Rev. 1/81 Building Inspector FO~ NO. S TO~'H OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 14422 Z Permission is hereby granted to: ........ ~.~z~./.~.~....~-~..v..~..P..~-~ .......... ~.o.~.z:...~...~..c~,~.......~ .......... ...... / ~o ........ ~.~.~.~.......~....~.~.~.~.....~.~.....~ .................. ...................................................................................................... ~....~~ ......... ,, ,,,,, ,~.,ed ,,~zc....~c~.~......zG....¢..~.,...~7~ ....... ...................................................................................................... / .......~.r~.o....~.~.~.~ co~,~, Tax Mop No. ,ooo Sec,o, ...,Q..~-...~.. ~,o~k ....O..~.. ........ Lot No..,O.~C ........ pursuant ,o application dated .G.~;~..,.~,~-~ ........... % ........ , 192~,'~and approved by the Building Inspector. Fee $...~. Rev. 6/30/80 ~ .DE T TOWN O~ soEn~OL~ BuildingTown Departmen~ Hall ~,PPLICATION FOR CERTIFICATE Instructions Ao This application must be filled in typewriter OR ink, and submitted ~ 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 [ines, 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 similar 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. For existing buildings (prior to April 1957), Non-confo, rming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty showing all property lines, streets, buildings and unusua~ 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 ' l' ........ New Building ............. Q~ or Pre-existing Bg~ld.[0g ............ Vacant Land ..... ,~ ....... Location of Property .'~..~. · ~, ' ........................ ..................... House No. ~ .~ Street Owner or Owners of Property ............... ~ .......................... CountyTax Map No. 1000Section. . ~l ....... Block .... ~ ....... ....... Subdivision )~ ................................. ~ /// Filed Map No~~...~L°t~.N° .............. .~' Permit UolDate of Permit J~/~--.Applican, Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval ............ ~( ........ Planning Board Approval ...................... Reque~ for Temporary Ce~ ..................... Final Certificate .... ~ ............... Fee Submitted $ ....... ~ .... ~ .~... Construction on above described building anti, eats all a~able ~l /lt%~ Rev. 10-10-78 FIELD I NS]~ECTI~N COMMENTS FOUNDATION FOUNDATION (2nd) I{OUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS ~'~.~*: ~ ..u.EAu OF ."'CTR,CrrY 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~1~ CE~IFIES THAT O~y t~ e~t~ ~u~ment ~ ~CH~ ~w ~ int~u~ by t~ ~nt ~m~ on the a~ ~i~ti~ numar ~ t~ p~m~s of iff t~ follow~g I~at~n; ~ Bmement ~ I,t FI. ~ 2~ ~. ,~tlon Bilk ~ examin~ on ~ P~ [ JJ [)~ ~ ~ q }~ ~) and found to be in compliance with the requirements of rh~ B~rd. Lot OUTL~lrS ! ~YIRS SWITCHLrS FIXTURES RANGES OVENS DiSH WASHERS EXHAUST FANS $~RVI~ IN$CON~ S E R V I J,l ,17.941 ~ This certificate mu~t not be a~tered in any manner; return to the office of the Board if incorrect. Inspectors may be identifl~l by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COFY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MAHHER. Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD Tow~ H^LL, SOUTHOLD, N. Y. 11971 765-1802 Enclosed please January 14, 1986 fin~ your Build. lng Permit #14422Z for your wood stove. We have your application for the Certif- icate of Occupancy but we require a $5.00 check. The final inspection was done and everything was found to be correct. Please send us your check so we can fin- alize this. Thank you. Yours truly~ Building Dept. Sec. You can do it,,, A, MAJOR CAUSE OF CHIMNEY RELATED FIRES IS FAILURE TO MAINTAIN REQUIRED CLEAR- ANCES (AIR SPACES) TO COMBUSTIBLE MATERIALS. IT IS OF UTMOST IMPORTANCE THAT THIS CHIMNEY BE INSTALLED ONLY IN ACCORDANCE WITH THESE INSTRUCTIONS. "DO IT RIGHT" with PRO-JET! PRO-JET Chimney is available in 3 models: Congratulations[ You have made a w;se choice m your setechon of a PRO-JET insulated chimney system. You've purchased a hne quality system researched, devdoped and tested to precise standards of quality in manufacturing. It's so easy to ~nstall ... you can do it step-by-step. Each chimney system component ~s designed to fit together perfectly and easily. If you're handy w~th a few basic tools and have a general knowledge of carpentry, you can install your PRO-JET ~nsulated chimney system over a weekend or have a professional install ~t for you in a few hours. Before you ~nstall your PRO-JET Sys- tern, read these instruchons carefully and follow them exact[y. Failure to do so may bring about hazardous condi- hons resulting in property damage, bodily harm or fatalities and may void the UL certification. If after reading the instruchons you are unsure as to your ability to install the chimney yourself, call the dealer from whom you made the purchase and ask his advice or enhst the ser- vices of a professional. SSG The PRO-JET Chimney is ideal for any building heat- Hi-Temp 3103 The Hi-Temp 3103 Chim- ney System is manufac- tured from a higher quahty stainless steel and dense fibre insuragon. It is en- gineered to withstand high temperatures of airtight heating appliances burning gaseous, hquid or wood fuels. The Hi-Temp 3103 is tested and approved to withstand temperatures of up to 2100°F (1150°C) for three 10 minute intervals. exceed 1000°F (538°C). Listed to UL103-HT Hi~Temp 3000 The Hi-Temp 3000 Chim- ney System is manufac- tured from a higher quatity stainless steel and dense inert ceramic fibre insula- tion. It is engineered to withstand high tempera- tures of airtight heating appliances burning gaseous, liquid or wood fuels. The Hi-Tamp 3000 is tested and approved to withstand temperatures of up to 2100°F (1150oC) for three 30 minute intervals. exceed 1200OF (650oC). Listed to ULC-S629M. REGULATIONS/BUILDING CODES/UL& ULC APPROVALS Before you start, remember to consult the appliance manufacturer's installa- tion 9aide for specific chimney require- ments and always consult your local budding authority regarding permits, Pro-Jet chimney parts listed and pro- duced under the Factory Inspection and Fo#ow-up Program of Underwr/t- ers' Laboratories carry their Inspection mark and have been tested in accor- dance with American National Stan- dard ANSI 131-1 fUL I03) (UL IO3-HT) and CAN 4-S-60~ fULC S-604) or UL C S-629M. Chimneys installed in accordance with these instruct/oRs w/Il comply with nat/oRal safety stand- dards such as NFPA 31, 54 or 211, The AIA National Building Code, the National Building Code of Canada, C.S.A. and local build/nd codes, CAUTION: An interior chimney is pref- erable wherever possible. The contin- uous "Deep Freeze" temperature to which an extenor chimney is exposed may result ~n operating problems such as poor draft, excessive condensation of combustion products and rapid accumulation of creosote when con- nected to a woodburning appliance with a lower stack temperature. One wood-burning appliance Any wood-burmng appliance should have ~ts own chimney for safety and for proper control. There are many reasons for not connecting more than one apphance to a chimney. If the appliance is designed for open front or open door use, so you can wew the fire through a screen, it is a "fireplace" and needs all the draft the chimney can produce. Connecting an "air-tight" or controlled draft h~gh efficiency wood stove to a chimney which is also used for a gas furnace may plug up the chimney with creosote deposits. Th~s may lead to carbon monoxide po~son- ~ng dthere is ~nadequate venhng when the gas furnace ~s used. The National Building Code of Can- ada stipulates that engineered chim- ney system installahons for use in dwdlings constructed for three or more families must be eac{osed above the room In which the heating apphance is located. This enclosure must have a fire resistance rating equal to or greater than that of the floor or roof assembly through whmh they pass Clearance Remember the clearances referred to throughout this guide are the MINI- MUM requirements, if addihonal space is available - use ~t. The required "clearances" are to be an un-obstructed AIR SPACE ONLY - Do not fill these areas wath any matenat especially in- sulation. If re-insulating your attic area in the future maintain this clearance. As w/th all heahng apphances, you must take care of your PRO-JET System The entire system should be inspected periodically and a regular cleamng cycle should be determined, *C,'~ UT/ON: "Not recommended for use w~th high sulphur coal as the heahng fuel. The flue gas from such coal can cause excessive, corrosive acPon on the chimney, resulting In deteRoration of the chimney and cre- atmg a serous fire hazard ~n and around the chimney structure. If such coal,s used, there must be frequent ¢nspechon and cleaning of the ch¢mney" Note: When chimney is installed w~th an Ohver-MacLeod hrep ace, use the installation instructions suppl~ed wdh the fireplace j 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved . .~...o~/....q~....., 19 .~. ~ermit No..t(.~/..9(..g?.~...-2~~' Disapproved a/c ............................. .;/ ...... APPLICATION FOR BUILDING PERMIT 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 (~r 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 d~molition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build~l~, housing-~de, and rel]ulations, and to admit authorized inspectors on premises and in building for necessary insp~[p~/ _ / V~ ~ ....... .......... ... (Signature of applicant, or name, if ~ corporation) State whether applicant is owner, lessee,ag~ect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .... . .~7-..~..O~..~... S..Oq,' .-~..~_..~...~..C~. ........................................... (as on ~he tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.. ~ ,~. ~ ..... ~: ./:. :.'... Plumber's License No ......................... Electrician's License No ....................... 1 Location of land on which proposed work will be done .................................................. · / /o /4o l '/ ..... .'r. . . ?. ...... .m .................................. House Number Street Hamlet County Tax Map No. I000 Section ....... 5.~. ....... Block ...... ~0 ........... Lot.. ]..~ ............. ! Filed Map No Lot ~ Subdivision .............. ' ..................................................... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...> . . ,/: ................................. b. Intended use and occupancy ..... .~.. ~:-.../~..~~,_.~ ............. 3. Nature of work (check which applicable): New Building ..... Repair .............. Removal .............. Demolition ........... i.. Other Work ............. 4. Estimated Cost ............ .~7.. (..'~..~...~. ........... Fee .... .'~..~...'.~7.."77. ............ · (to be paid on filing this application) 5. If dwelling, number of dwellifig units ............... Number of dwelling uniti on each floor ............... If garage number of cars 6. If business, commercial Or mixed occupancy, specify nature and extent of each typ~ of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear ....... Height ............... Number of Stories ......................... j . Dimensions of same structure with alterations or additions: Front ............ Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear i Depth Height Number of Stories 9 Size of lot: Front Rear Depth 10. Date of Purchase ............................. Name of Former Owner . 1 1. Zone or use district in which premises are situated .............. 12. Does proposed constructinn violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ............................ Will excess fill be removed, from premises: Yes 14. Name of Ownerofpremises .................... Address ......... Name of Architect Address Name of Contractor Address Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions property lines. Give street and block number or description according to deed, and sho~ street names and indicate whethe~ interior or corner lot. STATE OF NEW YORK, COUNTY OF S.S ................................................. being duly sworn, deposes and says that he is the applicani (Name of individual signing contract) ~buvu named. Vie is the .............................................................. (Contractor, agent, corporate officer, etc,) ~f said owner or owners, and is duly authorized to perform or have performed the sa!d work and to make and file thi~ application; that all statements contained in this application are true to the best of his knowledge and belief; and that th6 ~vork will be performed in the manner set forth in the application filed therewith. 5worn to before me this ............ · '~.f. ~ ..... day of .... .~..e~.. . . , 19 ................. ......... ~rt ~l~ & O[ Vo~ (Signature of applicantl _~_BJ~C, State ef New York _ NI)._4~ _~j' SQf~lk County,~ -*;