HomeMy WebLinkAbout34172-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEP~RTMENT
office of the Building Inspector
Town Eall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33410
~te: 11/25/08
THIS CERTIFIES that the building WOOD STOVE
Location of Property: 1900 PINE NECK RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
Co%k~ty Tax Map NO. 473889 Section 70 Block 9 Lot 3
subdivision Piled Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 17, 2008 pursuant to which
Building Permit No. 34172-Z dated SEPTEMBER 19, 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 WOOD STOVE IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to THOMAS F PASSANANT & GIORGI ALYCE
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF H]~ALTH APPROVAL
ELB~-r~IC2%L C~-rIFICATH NO.
PL~ C~ERTIFIC3%TION DATHD
N/A
N/A
Rev. 1/81
" ' ~ 765 1802
~_._~.~?~_~£~_~'I]~LI~TION 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 naturalor
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal ($-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. 8ubmit Plarafing Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) nou-conforming uses, or buildiugs aud "pre-existing" land uses:
1. Accurate survey of propel%,' showing all property lines, streets, building and uuusual natural or topographic
features.
2. A properly completed applicatioa aod consent lo respect sigmed by the applicant. Ifa Certificate of Occupmcy is
~ denied, the Building Inspector shall state the reaso~s Iherefor in writing to the apl~licant.
C. Fees
' 1. Celtificate of Occupancy - New dwelling $25.00, Additions to dwelling .$25.00, Alterations to dwelling $25.00,
Switmning pool $25.00, Accessory huddling $25.00, Additions to accessot~ building $25.00, Businesses $50.00
2. Ce~xificate of Occupancy on Pre~existing Building - $100.00
3. Copy of Ce~ificate of Occupancy - $.25
4. Updated Ce~ificate of Occupancy ~ $5000
5. Temporary Certificate of Occupancy - Residential $15 00, Conmaercial $15.00
New Coustm~tion: __ Old or Pre-existing Building:
Loeation of Property: ~Z(.q'OO t~dJ't/¢--,,o~c ,,U ~__~
House No. Street
Suffolk C;unty'r mp No 000, S tiou_ 0.7 tO _
Subdivision
Permit No
Health Dept. Approval:
Plalming Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ ~_~". ~
Dale of Pemait.
Date.
~ - (check one)
Hamlet
Filed Map. Lot:
Applicant:
Underwriters Approval:
Final Certificate: ~ _ (check one)
pplican~-~~
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. 34172 Z
Date SEPTEMBER 19, 2008
Permission is hereby granted to:
THOMAS F PASSANANT
1900 PINE NECK RD
SOUTHOLD,NY 11971
for :
INSTALLATION,PER MANUFACTURES,SPECS OF AN INTERIOR WOOD BURNING
STOVE AS APPLIED FOR.
at premises located at 1900 PINE NECK RD SOUTHOLD
County Tax Map No. 473889 Section 070 Block 0009 Lot No. 003
pursuant to application dated SEPTEMBER 17, 2008 and approved by the
Building Inspector to expire on MARCH 19, 2010.
Fee $ 200.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork.net
Examined q hc~ , 200~
Approved O~ ltq ,200~
Disapproved a/c
Expiration
PERMIT NO..~q[ 7~
Building Inspector
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
Flood Pemait
Storm-Water Assessment Form
Contact:
Mail to .'~O.n,~q2
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
,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 cowanenced 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 tlu'oughout 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, housing code, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant or nX~e, if a corporation)
(Mailing ~td&ess of applicant)//f.~j
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises .~. o,~$ ~{~ ~.~ ~$ c,~. e.v ,~
(As on the 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
Location of land on which proposed work will be done:
~I6u~e Number Street
Hamlet
County Tax Map No. 1000
Subdivision
Section d/'?30°oOff :. Block:70o - 2 Lot-
~ ";i .~;'~i. Eiled Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ,/ ~',-"-'-'-':~,//), ~e ~ .,o//-,, ~.
b. Intended use and occupancy_
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated Cost
5. If dwelling, number of dwelling units
If garage, number of cars
Fee
Addition Alteration
Other Work~'~// c.~,,,o,/ ~'3,.,,-....,..~,--~-/-'o,,~
(Description)'---J
(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 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
Depth Height. Number of Stories
Rear
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear .Depth
9. Size of lot: 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 premise's///a~x?~'(~..//.~Xl/R,c~'Address//7o~,/7;',~ t-~,~,¢ _/"~,,~_, Phone No.
Nme of Architect Address Phone No
N~eofContracto~.~,,~ ~,,~'=o Address~o~. /2¢ PhoneNo.
15 a. Is this prepay within 100 feet of a tidal wetl~d or a ~eshwater wetl~d? *YES__NO * IF YES, SOUTHOLD TO~ TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this prope~y within 300 feet of a tidal wetland? * YES~
* 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
· IF YES, PROVIDE A COPY.
NO j
STATE OF NEW YORK)
COUNTY OF..~-f~/X~S:
O,~ O-~a ~"'/~dd/';,,~,-~,-,,;"" being duly sworn, deposes and says that (s)he is the applicant
'(Name of individual ~ignJng contract) above named,
(S)He is the t/)~./..., .,,,-,
(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 thjt% ~'~~~~
/(j~ day of ,.~2~ 20 ~
Notary ~N]~?~ Y0~ ~ignature o f ~.l~pl]cant
Qualified hi Su(qlilk ~ ~, _
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]
[ ] FRAMING / STRAPPING [ ~,,,]'~FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
I 1 ,IRE,~S,ST~ C0.ST.~0. I 3 Frae RF.S,STA.T P~.~TRAT~0N
REMARKS: f/~~ ~
DATE /~~,/~///~ ~ INSPECTOR ~~
?ml,D INSPECTION REPORT I DATE [
FOUNDATION {1ST)
FOUNDATION (2ND)
ROUGH FI~4aM~I~G &
pLt~I]BING
ENSL-LATION PEiR N.Y. --
STATE ENERGY CODE
FFqAi,
ADDITIONAL
FiLE NO. .'~, ~.7 PAGE
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NORTHERN®
TOOL 4- EQUIPMENT
Drolet Wood Stove -- 95,000 BTU, Model# HT2000
OCCUPANCY OR
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i iTHOUT CERTIFICATE
-"- OCCUPANCY
Description
Extra-large stove heats up to 2700 sq. fi, Boasts 5/16in. steel plate on top, Firebox is lined with firebricks and has a king-sized ash drawer. Will
accept logs up to 19in, long, Heavy-duty cast iron door has adjustable handle. SIng~e easy-to-operate air control. Optional biower available
I~n~ 1589681 (sold separately).
BTU rating is related to seasoned cord wood, the more common fuel burned in this stove.
Key Specs
s BTU Output: 90,000
· Heating Capability (sq. ft.): 2,700
· Blower ~ncluded: No
· Blower {CFM): N/A
· Blower Power Supply (Volts, Amps): N/A
· Heat Settings: I ,-
· Fuet Type: Wood
· Igniter: Manual
· Thermostat Included: No
· Door Opening W x H (in.): 17 3/4 x 9
· Firebox Size W x D (in.): 22 1/2 x 18
s Flue Collar Size (in,): 6 .....
· Max. Log Size Accepted (L in,): 19
· EPA Exempt: No
· Dimensions L x W x H (in.): 30 x 29 1/4 x 34
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AS REQUI~E:; .A~D CONDITIONS OF
_ SOL%IOLD TOWN ZBA
........ S3~JTHOLD TOWN FL~NNI~ 8Ok, D
SOUTHOLD TOWN TRUSTEES
N,Y.S, DEC
Genoret Specs
In Stock
Ship Wt. 503.0 lbs,
Iterm~ 158976
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APPROVED AS NOTED
DATE: ~i I~ct I c:~_ ~.p. ¢r=¢~//7 ~
NOTIFY BUILDI;~O ¢::?.RTMENT AT
765-1802 8AM ~'~) 4::,t FOR THE
1. FO~,.~OA,ION TWO REQUIRED
FOR POURED CO;4CRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONST,~CTION MUST
BE COMPLETE F~R C.C.
ALL CONSTRUCTION SHALL ME~ THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
I of 2 8/29/2008 12:51 I
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Phone: 952-894-9510
~. of 2 8/29/2008 12:51 PM
Tow n o_f Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF ~
Item N umber:
PROP TY LOCATION: S.C.T.M. #:
strict Section Block Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW
(NOTE: A Check Mark(~)for each Question is Required ¢or a Complete Applicatij)n}/'V~///~ ~- -- --Y~es .o
7 ........................ .s
y ' leadn9 and/or construction activities as we as all S e --
Improvements and the permanent creation of impervious surfaces,)
2 Does the Site Plan and/or Survey Show All Proposed Drainage S~ructures Indicating Size & Location?
This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFIow! --
3 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural r~
Existing Grade Involving more than 200 Cubic Yards of Matedal within any Parcel? --
4 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of
Five Thousand (5,000) Square Feet of Ground Surface? __
5 Is there a Nalural Water Course Running through the Site? E~
Is this Project within the Trustees jurisdiction or within One Hundred (100') feet cfa We land or Beach'~ --
6 Will there be Site preparation on Ex[sling Grade Slopes which Exceed Fifteen (15) feet of Vedical Rise to E~
One Hundred (I00') of Horizontal Dislance? __
7 Will Driveways, Parking Areas or other impervious Surfaces be Sloped to Direct Storm Water Run-Off
into and/or in the direction of a Town right-of way? __
8 Will this Projoct Require flle Place entoittaterial, RemovalofVege~ation and/or the ConstFucfion of
any Item Within the Town Right-of-Way or Road Shoulder Area? --
(This item will NOT include the Installation of Driveway Aprons.)
9 Will this Project Require Site Preparation wilhirl the One Hundred (100) Year Floodplain of any Watercourse? E~ --
NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark in the Box, aStorm.Water, Grading,
Drainage & Erosion 6ontrol Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Permit!
EXEMPTION: Ye~s N~o
Does Ihis project meet the minimum standards for classi~ca on as an Agdcuftural Project?
Note: If You Answered Yes to this Question, aStorm-Water, Grading, Drainage&ErosionControiPan s NOT RequiredI
STATE OF NE\Y YOP, K.
~(l that he/she i* fl~c .... O~.~,~.~ ..... . ........................................................
(Owner Con ac o , Agent Corporale O~icer, otc }
Owllel- and/ol representative of the Owller of Owner's, atd is duly authorized to l)erforlll or have perk)rmed file s~d work alqd Io
tm~e m~(t file this application; fl~at idl smtemen~ confined in d~is applicaOon are ~e to t]ae best of his ~owledge ired heliefi and
flaat tim work will he perlbrlned m fl~e rammer set forfl~ in the application fi]ed herewifl~.
Sworn to befcme me d~is:
.................... Z..O .............. ...................