HomeMy WebLinkAbout30317-ZFORM NO. 4
No: Z-30200 Date: 05/14/0%
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
(THIS
BUILDING PERMIT
PERMIT MUST BE K~PT ON THE PREMISES L~NTIL
COMPLETION OF THE WORK AUTHORIZED)
FULL
PERMIT NO. 30317 Z
Date MAY
14, 2004
Permission is hereby granted
TWO WOOD
to:
DANIEL F & KATHLEEN M. KELLY
60 RUTH STREET
SMITHTOWN,N~f 11787
BURNING STOVES FIRST & 2ND FLOORS INSTALLED 1970
CERTIFIED BY JOSEPH FISCRETTI, P.E. 5/14/04.
at premises located
Country T~x Map No. 4'73889 Section 026
pursuant to application dated MAY
Building Inspector to encpire
Fee $ 150.00
at 2760 VILLAGE LA .......... ~R[ENT
Block 0001 Lot No. 020.001
14, 2004 and approved by the
on NOVEMBER 4, 2005.
\
ORIGINAL
Rev. 8/8/02
Form No. 6
TOWN OF SOUTIIOLD
BU ILDENG DEPART3~NT
TOVCN ItALL
765-1802
APPLICATION FOR CERTH~'ICATE OF OCCUP3aNCY
This application must be filled in by typewriter or hik mad submit[ed to the Building Deparmacnt with the following:
1. Fimal survey of proper ty ;vllh accurate location of all bulld~ngs, properly lines, streets, mid unusual nataral or
tcrpographic features.
2. Finai Approval from Health Dept. o£ water supply and sewerage disposal (S-9 form).
3. Approval of electrical imtallation Ecom Bored of Fire Urtdea'writers.
4. Sworn statement fi-om plmnber certifying that the solder used i~ system contains less than 2/10 of 1% lead.
5. Comm~cial; building, industrial bhilding, multip~ rcsldences and similar buildings and installatians, a certificate
of Code Complimlce f:mm arctStect or mlgineer responsible for the building.
6. Submit Planaing Board Approval o[ completed slle plau requiremems.
B. F~r eftsti~g bulldings (pri~r t~ Apri~ 9~ ~957) n~n~c~nf~rming ~ses~ ~r bu~dings and "pr~ex~sting~ ~and uses:
1. Accurate survey of prOperty showing all property lines, streets, buildit~g and ~musua/natural or topographic
rearm-es.
2. A properly completed apIthcation and consent to inspec£ si~ed t)y the applicant. It'a Ceriificatc of Occupancy is
derdcd, tile Bill ding Inspector shall state the reasons therefor in writilxg to the appllcanl.
C. Fees
1. Certificate ofOccppancy - 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 btdhiing $25.00, Businesses $50.00.
2, Cerllftcate of Occupancy *m Pre-existing Building $100.00
3. Copy ol'Cmtiflcate of Occupancy - $.25
4. Updated Certkqcate of Occupancy- $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Comraerck41 $15.00
New Construction:
Location of Property:
House No.
Oxmer or Owners ol'Property:~z~_~x
Suffolk Co~mty Tax Map No 1000, Section
Subdix4.sioa
Permit No.
Hcalth Dept. Approval:
Plmming Board Approval:
Old or Pr~st~g B~ding: ~ (cli~k one)
Ffl~ Map. Lot:
Date of Permit. App~cant:}X~. ~ ~ ~
Undem,riters Approval:
Request for: Temporary Certificalc
Fee Submitted: $ _ \~j> o~ ,0~1
Final Ceatificate: ,/~ (check one)
PROFESSIONAL ENGINEER
1725 HOBART ROAD/PO~ox616, $OUTHOLD, NEWYORK1197~
TEL631-765-2954, FAXG35614~516 · e-mail: joseph~Eschet~,com
Date: May 14, 2004
Rcference: 2760 Village Lane
Building Department
Southold Town
Main Road
Southold, NY 11971
De~ Sk,
I have inspccted the two stoves, one on the first floor and one on the 2nd floor. The stoves were
installed in the late 1970's and manufacturer's installation instructiozzs are not available. I have lbund
them to bc installed in accord PA 211.
Joseph Fischctti, P.E.
TOWN OF SOUTHOLD
BUILDING DEPAA/TNIENT
TOV~! HALL
SOUTHOLD, Nnl5 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Approved
Disapproved
Expiration ,20
PERNIIT NO. ~
BUII.DING PERMIT APPLICATION CHECKLIST
Do you t~ave or nccd d~c following, before applying'?
Board of Health
4 sets of Building Plans
Septic Form
Trustees
Contact:
Mail to:
}4[?/'i I~ ~ APPLICATION FOR BIU/LDING PERMIT
~~ ~T~L2 ~. ENSTRUCTIONS
issues a Cc~ificate of Occupancy.
apphcant a~ees to comply with all apphcable laws, ordinances, bulldog code housh~ c~e, and rcbmbtio~, ~d to a~t
S~te whether applic~t is owns', lessee, agcztt, ~chitect, en~neer, gencr~ con.actor, electhdan, plmnbcr or bulld~
(As on'the tax roll or latest deed)
If applicant is a corporation, signatta-e of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricim~s License No.
Other Trade's License No.
1. Location of land~ oJa w~ch proposed ~.vork will be Aonc: ~
House N~b~ ~cct Haml~
Co~tyTmxMapNo. 1000 Section 2 ~ Block
Subdivision Filed Map No.
~ame)
State existing use and occupaacy of premises mtd intended use and occupancy of proposed eonstracfion:
a. Existinguseand0ccupancy~_<~c~X~ ~c,,_r¥~.¥..~ C~t~,~.Nx¥~.
x-3 ~ ',3
b. letendeduseandoccupancy~%mx-xc~.~, ~vc~_~w'~[.¥~ktJ._'~\Xx.p,~,
3. Natureofwork(checkwhichapplicable):New'Bu./tding :
Repair Removal Demdiifion
4. Estimated Cost
5. If dwelling, number o f dwelling umts
ff garage; number of cars
Addition Alteration
Other Work , . )~o~r c~xr,~
~..~-q e.~ (Descr~'ption)
Fee
(To be pakl on filing this epplicatinn)
\ Number of dwelling udits on each floor
6. If business, commcrcial or mixed occqpancy, speci~ natme and extent of each type of use.
7. Dimensions of existing structures, if m~y: Front
Height Number Of Stories
Rear
Dimensions of same structure with alterations or additions: Front
Depth Height_ Number of Stories
8. Dhncnsions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear " Depth
10. Date of Purchase [2~,~,~,~'~ \~'*zName of Fenner Ownm'
] 1. Zone or use d/strict in wb/ch premises arc situated
Depth
12. Does proposed construction violate any zoning [sw, ordioance or regulation? YES NO ~
13. Will lot be re-graded? YES NO '~ Wdi excess tilt be removed from prermses. YES NO
14. Names of Owner et v~mdiscs x~5.._~_ %-eX_k-X--~.-X _\,."~a,~Aaaress_L~c~_~k~_~N. __ ~Ph%n2 ~o. _'D~ 5~Skk: ~ sc
Nm~e of Architect Address ~ ~Phone No ~5-~o'~
Name of Contractor Addrcss ~xn~ PhoneNo.
15 a. Is this property within 100 feet ora tidal wetland or a lhishwater wetlm~d? *YES__
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PER2MITS NLCY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO
* IF YES, D.E.C. PERM2TS MAY BE REQUIRED.
NO
16. Provide survey, to scale~ with accurate foundation plan and distances to propcu:[y lines.
17. if elevation at any point mt property is at 10 feet or below_ must prox4dc tupographical data on survey~
STATE OF NEW YORK)
SS:
COUNTY o~k~ ,~.~xo
L~--k~r',k,~ e' ex C'~, ~kk~ being duly swo~ depos~ ~d says that (s)he is the appl~c~t
(Name ofindividu~ si~ng con~act) abo~e nme&
(S)He is thc
(Contractor, Agent, Corporate Officer. erc.~
of said owner or owners, and is duly authonzed to perform or have peffomxed the said work and to make and file this application:
that ag statements contained in this apphcafion are true to the best of his knowleog~ and brief: ami I)J:tl I}/(: work wiI] be
pertbrmed in the mmmer set tbrth in the apphcafion filed therewlla.
20 o'~
~ ] Signature of Applicant -