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Home My WebLink About27877-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28483 Date: 05/31/02 THIS C~TIFIES that the building Location of Property: 3745 MILL RD (HOUSE NO.) County Tax Map No. 473889 Section 67 Su]0division Filed Map No. ALTEPJ~TION PECONIC (STREET) (HAMLET) Block 2 Lot 10 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 2, 2001 pursuant to which Building Permit No. 27877-Z dated NOVEMBER 7, 2001 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 INSTALLATION OF WOOD STOVE IN AN EXISTING ONE F~24ILY DWELLING AS APPLIED FOR. The certificate is issued to ROBERT BERNARD & WF. ( OWNER ) of the aforesaid building. S UFFOI~KCOUITTYDEPARTMENTOF HKALTHAPPROVAL ELEc£KICAL CERTIFICATE NO. PLUMBERS CERTIFICATION N/A -//~//Z~~ ~ignature 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) PERMIT NO. 27877 Z Date NOVEMBER 7, 2001 Permission is hereby granted to: ROBERT & WF BERNARD 2737 MARION ST BELLMORE,NY 11710 for : INSTALLATION OF A WOOD STOVE TO MANUFACTURERS SPECIFICATIONS at premises located at 3745 County Tax Map No. 473889 Section 067 pursuant to application dated NOVEMBER Building Inspector. MILL RD SOUTH/PEC Block 0002 Lot No. 010 2, 2001 and approved by the Fee $ 150.00 Authorized Signature Rev. 2/19/98 COPY Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or i~k and submitted to the Building Department 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 electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. 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 topograplfic 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 applican}. 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 Building - $100.00 3. Photocopy of Certificate of Occupancy- $ 0.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: Old or Pre-existing Building: (check one) LocationofProperty: ~7~~' .'~L~ ~ . House No. ~Street ! Hamlet Owner or Owners of Property: ~ ~ Suffolk County Tax Map No 1000, Section ~ '7 Subdivision PermitNo. _ .7977--2_ DateofPermit. ,]1/7/0l Block Filed Map. Applicani: Lot Lot: Health Dept. Approval: Plarming Board Approval: · Request for: Temporary Certificate Fe~ Submitted: $ ~,5-, ~ Underwriters Approval: Final Certificate: (check one) ' /X~plichnt Signature 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATIONlST [ ] FOUNDATION 2ND [ ] FRAMING [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL ['~] FIREPLACE & CHIMNEY REMARKS: ~ ~,¢ /~, ~ ~ INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION I ST [ ] FOUNDATION 2ND [ ] FRAMING ROUGH PLBG. INSULATION FINAL [~,]. FIREPLACE & CHIMNEY _/~d~(~ ~.~ ~ r...,..~ .~ REMARKS: INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATIONIST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS~JLATION [ ] FRAMING [ -~FINAL [ ] FIREPLACE & CHIMNEY .....,~s~ ~~ ~ ~ DATE INSPECTOR 'INSPECTION. REPORT ' ~O~NDATION · PLUM~ING ~ILAM~OH PER N. Y.' CODE · ~ - ( TOW OPSOVTt V BUILDING OEP SOUTHOLD, ~ 1197~ a~o~ O~T I TEL: 76~1802 PE~T NO. / Examined / Approved Disapproved aJc 7 2 7 BUILDING PERIV]IT APPLICATION CHECKLIST Do you have or need the following, before applying ? Board of He4dth 3 sets of Buildi~g Plans Surve7 Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and 8ubmitted to the Building Inspector with 3 sets of plan.% accurate plot plan to scale, Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relation.qhip to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Buildlng 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 v~hat-so-ever until a Certificate of Occupanc3 is issued 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 bu/ldings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing eerie, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. \ (Signature ofa3pli~n¥6~ -a~ne, ifa corporation) . z 7"' State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, eleotricio_n; plumber or.builder Name of owner of premises (as on the tax roll or latest 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. 1. OCCUPANCY OR USE IS UNLAWFUL II/ITUhl IT t~C~T[i~IPgTC OF OCCUPANCY NOTIFY BUILDING DEPARTMENT AT U,.t~._.L~..___n~.. CERTIRCATE ALL CONSTRUCTION SHALL MEET 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: t. FOUNDATION - TWO REQUIRED E, ROUGH - FRAMING A FLUMBINQ INSULATION 4, FINAL o CONSTRUCTION MUST BE COMPLETE FOR C.O. CODES. NOT RESPONSIBLE FOR CountyTax Map No. 1000 Section Subdivision (Name) Locatio.n of land on which proposed work wi~ll be done~ House Number Street t ~/ THE REQUIREMENTS OF THE N.Y. $TATE CONSTRUCTION & ENERGY State existing use and occupancy of premises and intended use and oceupanc3(ofproposed e°nstmetion: a. Existing use and ocCUpancy '~ b. Intended use and ocoupancy o Nature of work (cheek which applicable): New Building. Repair Removal Demolition Estimated Cost t~,wS? If dwelling, number of dwelling units If garage, number of mars Fee Addition Alteration other Work Tfi/m.q' .... / ~D~scfip6ori) (to be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height 8. Dimensions of entire new construction: Front Height Number of Stories 9. Size of lot: Front Rear Number of Stories Rear Depth 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 or regulation: 13. Will lot be re-graded · Will excess fill be removed fi'om premises: YES NO 14. Names of Owner of premises Address Name of Architect Address Name of Contractor Address 15. Is this prOperty within 100 feet of a tidal wetland? *YES Phone No. Phone No PhOne No. NO · IF YES, SOUTHOLD TOWN ~TRUSTEES 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. gTATE OF NEW YORK) SS: ~OUNTY 0I~,.~, ,~ , },~ ~. ,~ behg d~y sworn, d~oses ~d sa~ ~at (s)he is ~e a~lic~t )f s~~l~i~: ~ ~y a~ to p~om or Mve p~om~ ~e s~d Work ~d to ~e ~d ~e ~S a~cation; ~t ~ smtmmm. ~n~ ~th~.,~m~ ~e me to ~e be~ ~,~owl~ge ~d beHeff ~d ~t ~e work wi~ be )~o~ ~ ~~ f~e ~cafion filed th~. ' :~: ~ ' \ Sig~at~ of Applicant~ '