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Home My WebLink About30856-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30689 Date: 01/13/05 THIS CERTIFIES that the building ALTERATION Location of Property: 3865 GRAND AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 107 Block 1 Lot 4.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 16, 2004 pursuant to which Building Permit No. 30856-Z dated DECEMBER 16, 2004 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 WOOD STOVE INSTALLATION IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to GEORGE T LAVIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A Authorized Signature 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. 30856 Z Date DECEMBER 16, 2004 Permission is hereby granted to : GEORGE T LAVIN MATTITUCK,NY 11952 for INSTALLATION OF A WOOD BURING STOVE AS APPLIED FOR. SPECS ON SITE FOR INSPECTOR REVIEW. at premises located at 3865 GRAND AVE MATTITUCK County Tax Map No. 473889 Section 107 Block 0001 Lot No. 004 . 001 pursuant to application dated DECEMBER 16, 2004 and approved by the Building Inspector to expire on JUNE 16, 2006 . Fee $ 150 . 00 r utho ized , ignature ORIGINAL Rev. 5/8/02 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 ink and submitted to the Building Department with the following: A. 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. B. 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 topographic features. 2. A properly completed application and 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 applicant. %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- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. 1 L 05 New Construction: ✓ Old or Pre-existing Building: (check one) Location of Property: 3g6 S 4 6SITU House No. Street Hamlet Owner or Owners of Property: <j'efur Q T. V j N Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: Permit No. O$ Date of Permit. j '( b _G S Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ �3C) 9 ¢C, Appliofint Signature 3 Z 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL 61400D STbVE) [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION 11-1 REMARKS: ""�`Q " `" „�` • 4¢' DATE /�L- �� 0 � INSPECTOR � " c FIELD INSPECTION REPORT DATE COMMENTS d � FOUNDATION(1ST) -------------------------------------- FOUNDATION -----------------------------------FOUNDATION(2ND) z 0 ROUGH FRAMING& — y PLUMBING r INSULATION PER N.Y. - -- y STATE ENERGY CODE FINAL ADDITIONAL COMMENTS 9 O I)z M7 O — z x r� r x d TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 60 Survey www. northfork.net/Southold/ PERMIT NO. o Check Septic Form N.Y.S.D.E.C. i�, Trustees Examined !i �ri ,20 Contact: Approved t20-9 Mail to: Disapproved a/c Phone: Expiration 20 p., 6 20�" uidctor li i, APPLICATION FOR BUILDING PERMIT , INSTRUCTIONS Date 20 a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 waterways. 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 issue a Building Permit to the applicant. Such a permit shall be kept do the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months.Thereafter, a new permit shall be required. 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,ho sing code,and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. \ . r-- (Signaturerof appli ant or name,if a corporation) (0,!� Gmrk P111ve Aliirm rucc< (Mailing address o applicant) N S 2- tate tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder d (AJ Ale r Name of owner of premises G-0orqt- T� L" APPROVED AS NOTED (As on the tax roll or heed ,rz2 B.P # If applicant is a corporation, signature of duly authorized officer FEE. IJ �c.� (Name and title of corporate officer) NO IFY BUlt. itv:; RTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPcCTInNS: Builders License No. I. FOUNDATION T RFnUIRED Plumbers License No. FOR POURED Electricians License No. 2. ROUGH - FR,`t. PI_i-P--RING Other Trade's License No. 3. INSULATION 4. FINAL C�,",T._, , .-. N MUST Location of land on which proposed work will be done: BE Covr"> t''. ,.o. E ,C^�, , nc-'e)4Q6:� House Number Street 1'I�I IAC. TE. NOT RESPONSIBLE FOR ON County Tax Map No. 1000 Section__ 10 -7 Block / DESIGN OR CONSTRUCTION RRORS. Subdivision Filed Map No. Lot (Name) Y,a'e existing use and occupancy of premises and intende use and occupancy of prop ed construction: a. Existing use and occupancy 12 E �� Ln a it ea ;l p917t" b. Intended use and occupancy K ture of work(check which applicable): New Building Addition Alteration pair Removal Demolition Other Workj K,CI(C,-F-�� (,vim D S(Ofi Estimated Cost /!V �j),. py Fee (Description) (To 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 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 Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Dat2'of.P_urchase Name of Former Owner 11. Zone r use district in which premises are situated 12 Ddes proposed construction violate any zoning law, ordinance or regulation? YES NO 13.'Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO 44. Nknes•of Owner of premises Address Phone No. _ line of Architect Address Phone No Name of Contractor Address Phone No. 15 a..Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 1 . If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. STATE OF NEW YORK) ��,,` SS: COUNTY OF-'" �� A iti being duly sworn,deposes and says that(s)he is the applicant (Name ofWvidual signing contract)above named, i (S)He is the (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 t (o day of 20�!�� Notary Public Signature of Applicant 8ARBAPA ANN RUDDER Notary Public,state of New York No.4855805 Qualified in Suffolk Count Commission Expires April 14,.U� �: LEPRECHAUN WOOD STOVE COMPACT EFFICIENCY The small but powerful Leprechaun can heat up to 800 square feet of living space and cook your meals.It comes with a convenient polished cast iron hotplate for you to heat or cook your food.You can enjoy and experience our extraordi- nary fire in its large viewing area.Its compact size makes it versatile and is a pleasure to own in any home. TOP OR REAR-VENTING The Leprechaun is top or rear-vented and can be equipped with an outside air kit,ideal for today's airtight homes.Built of durable cast iron with brick-lined firebox,the Leprechaun loads from the front and is easy to use. LIMITED LIFETIME WARRANTY All Waterford products are covered by a worry free warranty that assures many years of fire viewing enjoyment. t Emissions(gms/hr) 3.1 gms. FRONT SIDE Maximum BTU* 33,000 26' Typical Sq.Ft.Heated 800 14-1/2' Maximum Log Size 15 in. Burn Time(typical)* up to 8 hours Average Shipping Weight 249 lbs. UHeight 25-1/4 in. _ Width 14-1/2 in. ter Depth 23 in. Flue Diameter 6 in. *BTU range and burn time depend on type of wood,climate conditions and installation. •EPA phase II certified •Built-in hotplate •Brick-lined firebox •Ceramic safety glass with air wash •Tap or rear venting •Limited Lifetime Warranty •'Heat shield • •Outside air connector Alcove and mnhdl kn --—A --