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HomeMy WebLinkAbout33321-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-32601 Date: 09/14/07 THIS CERTIFIES that the building WOOD STOVE Location of Property: 1000 MILL RD (HOUSE NO.) County Tax Map No. 473889 Section 74 (STREET) Block 2 PECONIC (HAMLET) Lot 14.1 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 8, 2007 pursuant to which Building Permit No. 33321-Z dated AUGUST 16, 2007 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 WOOD STOVE IN AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR "AS BUILT". The certificate is issued to SONYA & WALTER BRIGHAM, III (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A ~/~ Autlhori ed Signature Rev. 1/81 ,. 7fuS - ?fJ 77 \~Cr;\~: ~ ~\ APPLICATION FOR CERTIFICATE OF OCCUPANC~ ,,"-"~_. -:_~J 1IIt'\'l'I'!!'l'Qf" . ,," l..---'..--- . . This application must be filled in by typewriter or ink and submitted to the Building Department with the following: Form No, 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~.- A. For new building or new use: I. 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 2/1 0 of I % 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 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. p.,\J~ ~o ;)00, New Construction: Old or Pre-existing Building: j (check one) Location of Property: \000 House No. \-'1.:\\ Ll'Ai'c.. Street ~e..c...D<\'C- Hamlet Owner or Owners of Property: 50,'......0- d , vJ''''-''''-U' '""Q,{',~,--"""", Block Suffolk County Tax Map No I 000, Section Lot Subdivision Filed Map. Lot: Date of Permit. 8} / r. II! 7 Permit No. 3'3~;;21:C- Applicant: Health Dept. Approval: __'__._. Underwriters Approval: Plmming Board Approval: __''_. _ Request for: Temporary Certificate" Final Certificate: ___ (check one) ~~ .,,/ Applicant Signature Fee Submitted: $ ~~. I?051 Co :t:3J&O' 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. 33321 Z Date AUGUST 16, 2007 permission is hereby granted to: WALTER BRIGHAM 1000 MILL LA PECONIC,NY 11958 for : INSTALLATION OF A WOOD STOVE "AS BUILT" at premises located at 1000 MILL RD PECONIC County Tax Map No. 473889 Section 074 Block 0002 Lot No. 014.001 pursuant to application dated AUGUST 8, 2007 and approved by the Building Inspector to expire on FEBRUARY 16, 2009. Fee $ 200.00 ~ C-J-A r Authorized Signature ORIGINAL Rev. 5/8/02 j~)d-'--Z- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING pq FINAL k: [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRucnON [ ] RRE RESISTANT PENETRATION If ~ ONt jfo'f'tE . ft (7-~ 1f~ REMARKS: DATE 9 -/D-O 7 INSPECTOR ftr~ " IJ u&th'fYJ I Cd& 11 r-( ( fl-d> .A. C-();J( Z- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING [v1FINAL IIl-L G ~ ,~ [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMA"Z ~L--;';- t&f~,1 DATE r~/O) INSPECTOR FIELD INSPECTION REPORT DATE I -- COMMENTS Bi~ - ~~ FOUNDATION (1ST) -- '" ------------------------------------- ~ ~~c:: FOUNDATION (2ND) $i ~~. <.' C' 2 P en -"" ROUGH FRAMING & (/ ~ g ~ PLUMBING 1 ~ ....- -- -- ....- ----_._.~---- -_._--~-~-~- ~o: --,--- ~ INSULATION PERN. Y. 1'l "" STATE ENERGY CODE ,r/ 17 A"r, .. ~~.. " \ ,:< M L_ ,I_I r { ~r, -d// A/' ,/ r - -' 9-10-0 1110 ~y ^ .h<~ -., g C' FINAL ,//13/0 Co --t Y...:u 1 II #' V - - ADDITIONAL COMMENTS ~ 1'1. ~ t=:-ilLi 14. ~ FAA liJ ..J. \,.J :. 0 ~ Z m ~ ;0 ii. t\-- " :. (;1'l , ~ ~~ , "" c;: - 0 2 ~ L.-~ D 0: 1:1 t"i ... - ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN H~LL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.net/SouthoId/ PERMIT NO. '? 3:3.)-1 7~ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Examined Approved Disapproved ale Mail to: ;f? ,204- Phone: r---- - ---::-~ ;rJ[, ~_~... ~Io\: ; ;' In, .... ' i"' i;_8i: U ! b~V' OEP~ L---II'..'.'t~tt;l_F ~(" 'TH.Q' C) Expiration f-~ BUlldmg Inspector APPLICATION FOR BUILDING PERMIT Date ~-8 20Di '- INSTRUCTIONS 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 oflot 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 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 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 South old, 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. t or name, if a corporation) Ii.) 5'?' Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Name of owner of premises I r, 13 r\ :Via. and' As on the tax rol , or latest deed) , If applicant is a corporation, signature of duly authorized officer ~c , 1. ,. Fe, 2. ROUGH - Fn,,:.., 3. INSULATION 4. FINAL - CONSTRue BE COMPLETE FOR C.G ALL CONSTRU:. ' , ",. "cc REQUIREI,;. ; YORK STAT[ "("",\:,.3L[, r DESIGN OR CG~,) 1i,JGfIOI, ER;',i:':' 1(("(,0'l ,'C Hamlet ~HE , ,. -.....'--./'- D (Name and title of cO~ANOY OR '~2'~~G ,,,,l ! I. Location of land on which proposed work will be done: 1000 t--\; \ \ LQne.. House Number Street County Tax Map No. 1000 Section 74- Subdivision " "'~,'!''''*'''lU'lv:: ') ,'_ :t:SlOC.lC~\; /l:.L;;" , Filed Map No. (Name) Lot 14. Lot 2. State existing use and occupancy of premises and intended use and occupanc a. Existing use and occupancy W 'StoV ("\ + b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition Other Work Alteration (Description) 4. Estimated Cost Fee 5. If dwelling, number of dwelling units If garage, number of cars (To be paid on filing this application) Number of dwelling units on each floor 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size oflo!: Front Rear 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? YES_NO_ 13. Will lot be re-graded? YES _ NO_Will excess fill be removed from premises? YES_NO_ 14. Names of Owner of premises Walta t So1'f' ~~l~...Address 'lID \111\ UIIe . \'~(O\;~ Name of Architect Address Name of Contractor Address Phone No.1c31 Phone No Phone No. 7(05 'i<IT7 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.e. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. ':)";..;A 17. If elevation at any point on property is at 1 0 feet or below, must provide topograiillkal data on survey. ..... ::3~,:!:: 18. Are there any covenants and restrictions with respect to this property? * YES_NO_ * IF YES, PROVIDE A COPY. STATE OF NEW YORK) W COUNTY OF O/JffCJ L C being duly sworn, deposes and says that (s)he is the applicant ract) above named, .., f-. /-. . ) '.J ..AA) fk-.UY/t"f ' "\j' I,A' .') 3;' j (Contractor, Agent, Corporate Offitd, cite" P,,,., v' U {.! ,-, l .."..\.1....'..,..,... '~'. .', r'H' ..,....~! '.. "\ <,4.. M... . ,,!, I f 1'1.'1 of said owner or owners, and is duly authorized to perforrll or hav'e' perlorin~d the ~ai<i \~ork an'!! to make and file this application; that all statements contained in this application are true to the best of his knoWledge and oeJid~~d that the work will be performed in the manner set forth in the application filed therewith, (S@;)sthe Sworn to before me this [?...J/-... d;:Of f!'J51J. S T20flJ- f;/fld /J l--~ f2A //1 j ~1 - . IJNIMF. Notary Public NOlARYPUBUC.8TA: OFNEW NO 52-46 4771 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES NOV 3O.20.JQ.