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Home My WebLink About30870-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31423 Date: 02/02/06 T~IS ~fIFIES that the ]~uilding FIRELACE Location of Property: OFF EAST END RD FISHERS ISLAND (HOUSE NO.) (STREET) (HAMLET) County Ta~ Map No. 473889 Section 7 Block 3 Lot 3.3 Subdivision Filed Map No. __ LOt No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 22, 2004 pursuant to which Building Permit No. 30870-Z dated DECEMBER 28, 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 INSTALLATION OF A FIREPLACE IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to NANCY M MURPHY (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CmTIFICATH NO. PLDMBERS CERTIFICATION DA'£~U N/A N/A N/A / ' Signature Rev. 1/81 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 thc 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: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. 1£ a Certificate of Occupancy is denied, the Building Inspector shah 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 - $25.00 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. /~ (check one) New Construction: Old or Pre-existing Building: LocationofProperty: /~-3 ~,~,.~.~ ~(t /~--a~ House No. Street Owner or Owners of Property: :~L//~-~ r~ /7~, /~ ~- ,9/t v Suffolk County Tax MapNo 1000, Section ~' ,~-f ~' ~) Block/ Filed Map. ~' Date ofPermit. Ig/l~/ot/ Applicant: Underwriters Approval Final Certificate: /~ (check one) ApplicanffSi~nature Subdivision PermitNo..~O~ y (~ Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ 7 '~-, a:~ Hamlet Lot ,yO~o r_xv3 Lot: 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. 30870 Z Date DECEMBER 28, 2004 Permission is hereby granted to: NA~NCY M MURPHY 20 CHURCH STREET GREENWICH,CT 06830 for : INSTALLATION OF A FIREPLACE AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 007 pursuant to application dated DECEMBER Building Inspector to expire on JUNE OFF EAST END RD FISHERS ISLAND Block 0003 Lot No. 003.003 22, 2004 and approved by the 28, 2006. iFee $ 150.00 Authorized Signature ORIGINAL Rev. 5/8/02 01/31/2006 3.3:31 FAX 831 766 7798 FIELD I~$PECTION REI~ORT DATE FOU~D.,~TION (1ST) FOU'~ D.~.TION CO~ 002 ADD1TIOBIAL CObiZvI'~/~I'S LT IJsEcu RITY FIREPLACE Ultim Installstion Instructions This installation manual will help you obtain a safo, efficient, dependable installation for your fireplace and chimney system. Please read and understand these installation instructions before beginning your installation. CAUTION: Do not attempt to modify or alter the construction of the fireplace or ils components. Any modification or alteration of construction may void the warranty, listings and approvals of this system. In that case, Security Chimneys International Ltd will not be responsible for damages. Install the fireplace only as descfibod in these instructions. PLEASE RETAIN THIS MANUAL FOR FUTURE REFERENCE WARNING: The fireplace cannot be operated without a door. Consult your dealer to select the correct door model of your choice. Listed to standards ULC-S610 UL-127 APPROVED AS NOTEO FEE: i'~ _ BY: / ~ ~_ SECURITY CHIMNEYS I~E~ATIONAL LTD NOTI~ BUILDING DEpA~TME~i2~ontemy St. ~vM, Q~, C~a~, 87L 3T6 Td.: (450) ~3-~ 7654~02 B~ TO 4PM FOR FOLLOWING INSP~CTI~ ~" ~ 1. FOUNOAT~N ' ~0 REoUIREO FOR POUREO CoNCR~ ~, ROUGH ' F~UtNG & PLuUBING ~. INSU~T~N 4. FINAL' CoNsTRUCTiON uUST B~ c~PLETE FOR C.O. ALL CONS~UCTION sH~L ME~ REoUIREME~$ O~ ~ ~O~S OF N~ YoRK sTATE. NOT RESPONSIBLE FOR DESIGN OR ~STRUCTt~ ERRORS* OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY ,/~L CONSTRUCTed SHALL MEL~a?~I~:3UIREMENTS OF THE CODES OF NEW YORK STATE. u z ~.~ ,,1 APPENDIX SPECIFICATIONS Weight 385 I~s Height 36" Width 36" ~epth 24 Chimney weight ASHT+ (6" dia.): 6.25 Ibfft. Chimney weight S-2100+ (6" dia0: 10.8 Ibfft. CLEARANCE TO COMBUSTIBLES REPLACEMENT PARTS Baffle ~fmetory (2 pieces) PR-IS02205 Back refractory PR-SR2203 Right side refractory PR-SR2204D TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 76~-1802 FAX: (631) 76~9~02 www. north forkmet/Southold/ PERMIT NO. Examined ~ Approved Disapproved Expiration BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Ptmming Board approval Survey Check : Septic Form N.Y.S.D.E.C. Tms~es Co~et: Building Inspector ud4 DEC Z Z APPLICATION FOR BUILDING PERMIT Date /t~ PeC ,20 V~' 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 prem!ses, relationsh!p to adjoining premises or public streets or areas, and watev,vays. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval 0fthis application, the Building Inspector will issue a Building Permit to thc 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 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 lg months from such date. If no zoning amendments or other regulations affecting thc property have been enacted in the interim, the BuiMing 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 B0i!ding 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, ordin~ceS, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary impeetions. (Signature of applica~t~' n~ame, if a corporation) (Mailing address of applicam) Name of owner of premises State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder (As dn tl~e tax roll or latest deed) 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. Location of land on which proposed work will be done: .- ~ House Number Street Hamlet County Tax Map No. 1000 Section 7 Block Subdivision Filed Map No. (Name) Lot Lot ],3 3. Nature of work (check which applicab~): New Building Repair Removal ~ Demolition Stat~,existing use and occupancy of premises and intencl?~ use and o~gupo-ey of proposed ~onstrugtion:. ~ ~ . . . a. Existinguseandoccupancy ~?,~f~c o~ CA/,~ . Additiors: Alt~tion. ? Other Work 4. Estimated Cost If dwelling, number of dwelling units If garage, number of cars (Description) Fee / f ~ (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 ofuse. 7. D~mens~ons ofemstmg structures, ~fany. Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth H~i~ht ' '~ :Number Of Stodes 8. Dimensions ofantire new construction: Front Rear Height Number of Stofie~, ': ~ 9. size of lot: Front 10. Date of Purchase Name of Formgr Owner Rear Depth 11. Zon~ or use district inwhich prmnlses are sitaated 12. Do~s proposed construction, violate any zoning lav~, o~dinanca or regulation? YES. NO , ~ 13. Will lot be re-graded? YES . .NO s'/Willexcessfiliberomovedfi'ompr~mises?YES NO. ~ 14. Names~fOwnerofpremises /t~-~--T ha, ,'~,~,-/~ AddressgV6~£.,fgr./ PhoneNo. ~'3 t~f ~'~ Name of Architect Address Phone~No Name 0fContractor I~P '~*~A/,~7. Addmsg. ~/5~.. ~t_/L Phone No. ~-,¢~,~ ?']/2~ 15 a. is this 0roperty Within 100 feet of a tidal Wetland or a fresh~,,ater w~lmd? *YES NO ~ * iF YES, SOVmOLO TOW TRUSTEES a D.E.C. PERMrrs REQVrRED. 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. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: cot~rrv OF55d~ol~) ~0¥~-0~ '~' /~/LO4~O~, ~V' ~i~dulyswom,~dsays~(s)beis~e~lic~t ~e of ~d~l si~ng ~) a~ve ~ (S)He is ~e : ' (Conm~r, Agent, Co~omte Office, ~c.) 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. Signatut~ of Applicant ROY, ANNE SPAULDING NOTARY PUBLIC, STATE OF NEW YORK No 01SP6113942 (IHAI [I Il D IN SUI I OI K (,'(}[IN IV MY {;OMMISSION IXPI [,'-; ^ il; !. ;'[ ~/