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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Date: 03/20/08
No: Z-32937
THIS CERTIFIES that the building
WOOD STOVE
Location of Property: 3805 ALVAHS
(HOUSE NO.)
County Tax Map No. 473889 Section 101
LA
(STREET)
Block ~
CUTCHOGUE
(HAMLET)
Lot 24.4
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
JANUARY 28, 2008 pursuant to which
Building Permit No. 33669-Z
dated
FEBRUARY 5, 2008
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 BURNING STOVE IN EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to THEODORE PHARRIS
(OWNER)
of the aforesaid building.
SUFFOLK COUl!lTY DEPAR~ OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
N/A
PLUMBERS CERTIFICATION DATED
~ri~
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
UI
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APPLICATION FOR CERTIFICATE OF OCCUPANCV---
Tlus applicatlOn must be filled in by typewriter or ink and subntitted to the Building Department with the following:
A. Fa I' new building or new use:
1. PlIl"! survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic features.
2. Pinal Approval from Health Dept. of water supply and sewerage-disposal (S-9 fonn).
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 1 % lead.
5. Conunercial building, industrial building, multiple residences and sintilar 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 nses:
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. Celiificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00,
SWlI1uning 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 Ce!tificate of Occupancy - $50.00
5. Tlmpm"ry Certificate of Occupancy -lZesidentIal $15.00, Conunerclal $15.00
New Construction:
Old or Pre-existing Building:
Date. M ~~ Is.. zoe '3
~'~-_____L- ___________
/
Location of Property: ___ 3'305 A\.uct1.U~
House No.
Owner or Ov,-'ncrs of Property: _ _ ~k.o_~<1O.
(check one)
_CA~~ _
H-;~~
Street
r. _\-\~n'~___~_________
Suffolk COUlll)' Tax ~'lap No 1000, Section
.i 0 L_
Block f) 2-
LOI__2-__'f .L____
SubelivISIOIl.________________________ Filed Map _________ Lol ____.___~
Pernllt N.. __3~~"q_.:t:. _ _ _ Date ofPermitL~~") ~ ~'$ Appllcant.:]Udl.R. E___~~!'_,~ ---_______n
Health Dept !\pprllval.______N/-~.____________ UnderWrIters Approval: --tl-lh____ _________
Pl31Uling Boarel Approval' JJ-tA_____~
Request for'
Tempnrilry Celiificate ______
Fma! Certificate ____---'/"_ (check one)
Fee Submitted :I>
'25 (!)O
---~-
/l~~. ~
Applicant Signature
6(-t<c..7 :) q 7 i
c.o -c3~~ 3 7
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.
33669 Z
Date FEBRUARY
5, 2008
permission is hereby granted to:
THEODORE PHARRIS
993 PARK AVENUE
NEW YORK,NY 10028
for :
INSTALLATION OF A WOOD STOVE AS APPLIED FOR
at premises located at
3805 ALVAHS LA
CUTCHOGUE
County Tax Map No. 473889 Section 101
Block 0002
Lot No. 024.004
pursuant to application dated JANUARY 28, 2008 and approved by the
Building Inspector to expire on AUGUST 5, 2009.
Fee $
200.00
;?dw~ WJ /"
Authorized Signature
ORIGINAL
Rev. 5/8/02
3361:17-.
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING l)4 FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: \AI ~ ~ ~
~ ole:.
DATE 3 --7 -- 0 F
INSPECTOR ~~
,
FIELD INSPECTION REPORT DATE I
FOUNDATION (1ST)
--------------------~---_._---------
FOUNDATION (2ND)
ROUGH FRAMJNG &
PLUJYffiING
--
--- --
L,,"SCLATION PER N. Y. ----
STATE ENERGY CODE
FINAL
----
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REMARKS
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SURVEY OF PROPERTY
SITUATED AT
CUTCHOGUE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No, 1000-101-02-24.4
SCALE 1 "=30'
NOVEMBER 13, 2000
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CERTlfi'l~n rn.
Hsac MORTGAGE: CORPORATION
CHICAGO TITLt INSURANCE: COMPANY
TlTLtNo.31100-01388
THeODORt P. HARRIS
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Joseph A. Inge
Land Survey
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL I
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.N orthFork.net
PERMIT NO.
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
3 :J0(.,fif Check
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Stonn-Water Assessment Form_
Contact:
Mail to:lhu>~<lt" ~. ~vr;,
5~05 A\v~l. l.A..L, c"+.L...ye, N'1 "131""
Phone: ,\,~-.,C!>~-~LH'"
Examined
1,;1 ,20rY
d/'5- ,20ur:
Approved
Disapproved ale
I
t! )~, 20ffl
Expiration
f)~..
L Building Inspector
APPLICATION FOR BUILDING PERMIT
Date ::Jo.."..>"J
INSTRUCTIONS
Ai
,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 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.
/'
~ 9, \L--
(Signature of applicant or name, if a corporation)
3~ A\~a.k'7 L-... C~k~.AJ1I1q3S
(Mailmg address 'Q'f applicant)
State whether applicant is owner, lessee, agent, Abtl()eIJtSif1!gineer, general contrac,t9J',;&x<;:n?R3f,,~\ul!f~er or builder
MEET THE REQUiR'::.,cN":~ Gr' ",c: J-\r. .rJv.."oJ it,. ,,0,1:0
O~ CODES OF NEW ynRK STATE DATE' J/J/i : ,.., HU//'i::
'I -., ,. ~
Nameofownerofpremises \~~. \+"t"f'i5 ~;:r_..;-_~J; /?:c:......f/L-
(As on the tax roll or la~~ ~~) .c~.~ i ~H~ I
If applicant is a corporation, SiOCCU:~ ~~:I?~t?C)W officer ;o~; 'c' :C=D
(Nameandtitleofcol11~~tOn~ce~~~LAVVFUL 2.~.~;::" "~_:,\:c;CKI
Builders License No. E 3. ",",cU; AT!-""
Plumbers License No. 4. F!N,\L - C" ,I ':, f.'UST
Electricians License No. H ,] ~~ y 8E COMPll:':: r _ ",
Other Trade's License No. ALL CONSTRUCT V, SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSiBLE FOR
~j?N OR CONSmUCT,ON l:fii'iORS.
Hamle ... vlht.I....1lf
RtoHIRto
Lot 2 ~ . l.f
Lot
I. Location of land on which proposed work will be done:
'31>O~ \v~ \~ lo.,,~
House Number Street
County Tax Map No. 1000 Section -10 I
Subdivision
Block 0 'L
Filed Map No.
2. State existing use and occupancy of premises and intel1ded use and occupancy of proposed co1Jstruction:
a. Existing use and occupancy ai'5S-J?~:Jl.
,
(), Ii ,I' n
b. Intended use and occupancy ~~"b~
4. Estimated Cost
4\ 1)2.00.00
5. If dwelling, number of dwelling units
If garage, number of cars ~ A.
Addition Alteration
Other Work V :r,,~ i.JcoJ b..,r",~ ~~
4' (Description)
200. 00
(To be paid on filing this application)
Number of dwelling units on each floor
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Fee
I
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front S!1. '/ ) Rear 2. ':f. 4 '
Height f'y AO' Number of Stories 2-
Dimensions of same structure with alterations or additions: Front 3't. c.f'
Depth '3S.'t' Height ""Zo' Number of Stories
3S:.'f I
Depth
Rear J. 1. IjJ
2..
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflot: Front
::z. '3 ., I
Rear
:;2,'11.2."6'
Depth :S\2..0"-3~/. z,'
10. Date ofPurchase~Name of Former Owner '-Drofll..,l<i
II. Zone or use district in which premises are situated -Ari'<V~(~- P..~~~~~: Ac.
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO V
13. Will lot be re-graded? YES_ NO V Will excess fill be removed from premises? YES_NO_
14. Names of Owner of premises 1C..Ih.l~(I"
Name of Architect
Name of Contractor
Address ~'iO?A\~~'J 1.wt(,.c.t~oRhone No. q/ '}.S01-1 '/'1- (,
Address Phone No
Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO V
* 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.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO V
--
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTYOF~
-r~~l)'I.e. ~. ~1lA.(is being duly sworn, deposes and says that (s)he is the applicant
(Name of individual Signing contract) above named,
cJ)He is the
ow..~
(Contractor, Agent, Corporate Officer, etc.)
of saiEl 8waer er 8Y.'B.BFB, 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 thjs
~'"' day of j 1lNtJ~ 20 ~~
~ BRUCE GROSSBERG
Notary pubf1letary PubliC. State of New York
No.02GR5016140
Qualified in Queens
Commission Expires Aug. 2, tA->t'
/[~e,k
Signature of Applicant
02-04-08 07:33pm From-GRUB~ INOURSKY SHIRE
+12125540444
T-778 P.OI/04 F-874
fAX COvt;R SHEEI
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DATE:
TO:
FAX#:
FROM:
RE:
February 4, 2008
Southold Building Departmem
631 765 9502
Theodore P. Harris
3805 Alvah's Lane, Cutchugue -- Pennit to Install WOOQ Burning
Stove
As requested, I am anaching the installation specs (clearances, t:te) from the owner's manual
relating to the wood buminll stove for which I have submill~d a Buildi~ Perrl'llt Apphcl<tion,
~ted January 24, 2008. The stove IS a new JOlUl F602 CB, an EP A approved stove. The stove
will have bonom and rear heat shields and will be connected to the existing masonry chimne)l on
the 1" floor b)l a double wall stove pipe. The chimne)l was recently cleaned and inspected by
Bob Jester of Chim Chimne)l in ~enport.
The dealer for the stove is Woodbox Stove & Fireplace Center in Patchogue, New York.
Please let me know if )lOll have an)l questions or requlfC any adl:\.illonaJ information.
Thank you,
~r~arris
(917) 509 7476
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02-04-200819:17 SOUTHOLD BU L-LJ........:;...... I I -I...............'v......................l...
PClf.::C1
, rl""''-..L
02-04-08 OT:33pm From-GRUBMAN INDURSKY SHIRE
+12125540444
J,tul F 602 Wood stove Clearances
T-TT8 P.02/04 F-8T4
Stove clearilnus G~Protected SUrf~ Protected sllrfaces (NfP4 211)
!~~~~~~e~~~~_________________________"__________.________________
Single wall p.pe
W/O"t rear heatsnield
S,ngle wall p'p'
With rear heatsn,ela
sn,e,a.d single wall pIpe
W,th rear heatshield
Do"ble wall p.p.
With rUr neatshiela
Do"I>I. well pip.
W/O"t r.ar n.auh,ela
SIlk
2'"
535mm
2'"
535mm
21-
S3smm
:14"
610m'"
04-
6,omm
Bur
13.5"
345mm
11"
280mm
g"
230mm
g"
230mm
IS"
380mm
~m!!
If
330mm
11"
280mm
g"
230mm
g"
230mm
15'
380mm
SIB
'3"
330mm
13"
330mm
13"
330mm
If
300mm
'2"
30smm
llu!
11"
280mm
1'"
280mm
8"
205mm
8"
20smm
8"
205mm
Ymlfr
g"
230mm
9"
230mm
8"
20smm
8"
20Smm
8"
20smm
Connertar Unprotectecl surfi"e Protected Surt.!ce (NFPA .11)
~'!l!~'!.~_ (pip!) _ " _ _ _ _ Y~I!I~! 1!1!t!I!~I~~ _ _ .. _ _ _ _ _ _ Y~,!i~1 !n~!-!Il!t!o!1_ _ " .. _ _ _ _ _ _ " . _ . .
Single wall p,pe
Do"bl. wall pip.
18"
460mm
p.pe mfgrlistlng
6"
lsomm
pipe mfgr.lIsting
Connector
,Ielrtlnees (pIpe)
Unprotected Sllrt.!ce
Horilontallnstallatlon
Protected surt.!ce (NfPA 211)
Honlontal installation
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Single wall pipe
DO"ble wail pipe
18"
400mm
pipe mfgr.li.ting
9"
230mm
pipe mfllr.llstlng
Vel)' ,mportant'
TQP ventlvert.cal . as'"mC$ the connector pipe is ex.tin8 offthetop of the stove ana t,avellng v.rt,cally. !ftop vent.a
to any hOOlolltal runs - the .tove's position" Oietatea by tne connectOr pipe cl.arances.
~!IliJ" us"m.s tneconnector pip. .xits from the rearofthe stO'll! ana run' hOIl%ontally to the chimney.
If rear ventea to v.rti,al run.. the 5tO.., pos.tion IS a.ctatea by the COnnector pipe clearane..
Minimum alcove dimensions:
Vertical ventinll.
MjfuMum 31cove width
Maximum alCOve aeptn
H.lgnt abOve the top of the stOve
Unprotected sllrface
lleftical ventin,
Assume, top exit:
55' (1400mm)
48" (momm)
71" (180smm)
02-04-2008 19:17 SDUTHDLD BUILDING DEPT 16317659502
Protected surface (NFPA 211)
Assull1e$ top exit:
41' ('040 mm)
48" (1;120 mm)
".. !l8cs mm)
2'
PAGE2
02-04-08 07:33pm
Stove
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Heat O"lp"t '; ~8,o"" PlI.., nr.
t1ea1:lng CaP1 t, up to 800 s~ ft.
o.erilll ~t'flcltn'y ': 68%
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log ~enetn: up to ,1\"
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any no"comb"s;,bl.
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Alcove Installation
Requirements
Th. ~cntOm I'le~t Shield m",1 pe
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U./ULC or IoIIH IIJt~d ~ealth pall
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t:l<1:end 41" ('''4 em) I' om the
floer,lncl.dinS bottom ai,
spa"" Both ,i<l. ~nd rear ..~II~
mu.l be protc("llld.
AICIlVl: CelllnB and Chlrnn8y
ConneQllr Clelranc:a: F1fI18.
A _ do. ale-wall pipe
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Fireplace Clellrancllt
A; Stovlto MlImtl, m._ lleptll8"';
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