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Home My WebLink About34134-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33566 Date: 02/26/09 THIS CERTIFIES that the building FIREPLACE Location of Property: 730 BAY AVE (HOUSE NO.) County Tax I4ap No. 473889 Section 143 Subdivision Filed Map NO. MATTITUCK (STREET) (HAMLET) Block 3 Lot 13 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 27, 2008 pursuant to which Building Permit No. 34134-Z dated SEPTEMBER 3, 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 FIREPLACE IN AM EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JENICE L MALECKI (OWNER) of the aforesaid building. ~oFMOLK CO~I~I~f DEPART~I~T OF HI~ALTHAPPROVi~L BLEt-rKICAL CERTIFICA77{ NO. PLIERS C~a(TIFICJ%TION DA-r~ N/A N/A N/A 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 A. For new building or new use: /~ 1. Final survey of property with accurate location of all buildings, pmp¢.y tines, streets, and un~gual natu~____~] topographic features. 2. Final Approval fi'om 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 cousent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the rcasous therefor in writing to the applicant. C. Fees 1. Certificate ofOecupancy - 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 New Construction: Location of Property: --] .3 L~ House No. Owner or Owners of Property: Old or Pre-existing Building: Suffolk County Tax Map No 1000, Section I ~ ~ Su vi ion tCd - Permit I 3 Health Dept. Approval: (check one) Block 000 Fi ed Map. q? DateofPermit..~--~ - O~ Applicant: · Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: Fee Submitted: $ ~ 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. 34134 Z Date SEPTEMBER 3, 2008 Permission is hereby granted to: JENICE L MALECKI 251 EAST 32ND ST APT 5G NEW YORK,NY 10016 for : INSTATJ.ATION OF A FIREPLACE AS APPLIED FOR at premises located at 730 County Tax Map No. 473889 Section 143 pursuant to application dated AUGUST BAY AVE MATT/LAUREL Block 0003 Lot No. 013 27, 2008 a~ld approved by the Building Inspector to expire on M3kRCH 3, 2010. Fee $ 200.00 ~~/~ Rev. 5/8/02 ORIGINAL TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION FRAMING/STRAPPING [ ]FINAL FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: DATE ~' ~ / / -- 0 ~ INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION REMARKS: [ ] ROUGH PLBG. [ ] INSULATION [~FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION FO~ATION (2ND) ROUG~ F~G & ~S~ATION PER N. STATE ~NERGY CODE ~DITION~ COUNTS TOWN ~ SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork. net Examined C~. / ,~ Disapproved a/c Expiration 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 PERMIT NO. 3 L//7-.~ ~-('~ Check Septic Form N.Y.S.D.E.C. - i '~ Trustees ~ ,~ ~ [~ ~ ~ [~ Flood Permi[ ,20 ~ 5/ ~_ u ~ -~ 'l Storm-Water Assessment Form 'B'~ld(ng/tnspector APPLICATION FOR BUILDING PERMIT Date 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 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 &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 throughom the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever umil the Building Inspector issues a Cerffficate 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 mouths 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 ora 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 de/moll~ as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing }t6de,~at~re.guiat')6~nd to ~tmit authorized inspectors on premises and in building for necessary inspections. ~ /~ (Mailing addr~s of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder PWI, Nameofownerofpremises ~ j_.~t~\CI~ L.~' (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 No. 1. Location of land on which proposed work will be done: House Number Street County Tax Map No. 1000 Section [~ Block Subdivision ' / "/AT7 Hamlet 3 Lot Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction3. a. Existinguseandoccupancy ~O,L~.,L/~- ~f/iL"/' ~gHS. LLhd(-- O-C~D,~tOff/~ ]/-- b. Intended use and occupancy ~C/td(;J/~ ~b~iL'-f ~)l~/~L/~k/~,- -- Off-~g{.dFAP~c( ~- '~ 4. 5. 6. 7. Nature of work (check which applicable): New Building_ Repair Removal Demolition Estimated Cost ~; ]! 0 tO ~) ! If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration Other WorklldS'~v{bl~OIJ O~ (Description) Number of dwelling units on each floor (To be paid on filing this application) If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front ~. ~ { ~ Rear Depth Height. Number of Stories '7... same structure with alterations or additions: Front /q//A Rear Dimensions of Depth. Height Number of Stories Rear .Depth Dimensions of entire new construction: Front Height Number of Stories 75: d ear ~'- /Z - O~ Name of Former Owner Depth Size of lot: Front Date of Purchase 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 ~5/ Will excess fill be removed from premises? YES NO X 14. N~esof~nerofgremises ~M~ 'kddress~/, Name of Architect ~ 50~O~ Address ~1~ ~ ~, ~,g~hone No ~1~) . Name of Con~actor Ad,ess PhoneNo. 7'- 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 B,E REQUIRED. '.. b. ls this property within 300 feet cfa tidal wetland? * YES NO fi(. * 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 · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF~S: ~ ~IQ~ ~ /-- /~-LEC~-- { being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, CONNIE O. BUNCH (S)He is the Notap/.p.?bl, j,c),..S~ ,te~Naew Vomk (Contractor, Agent, Corporate Officer, etc.) 0ual~"~'~'~'~0~unt,/ , qommissiofl Expires/~r 14, 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 knowle~ll~and-b~f; and that the work will be performed in the manner set forth in the application filed therewith. / £ Sworn to before me this/~ /q ~ /// // Notary Public I ~ S~nat[~ of Applicant row____ n o_ f Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A District Section Block Lot STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL pL~fil CERTIFIED BY A DESION PROFESSIONAL IN THE STATE OF NEW YORK. Item Number: (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) Yes No Wfil this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? (This item will include all mn-off created by site clearing and/er construction activities as well as all Site Improvements and the permanent creation of impervious surfaces.) Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating S ze & Location? This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFIow! -- Will this Project Require any Land Filling, Grading or Excavation where ~here is a change to the Natural Existing Grade involving more than 200 Cubic Yards of Matefial within any Parcel? Five Thousand (5,000) Square Feet of Ground Surface? Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction or within One Hundred (10ff) teet of a We and or Beach? oneWill there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise tOHundred (100') of Hodzontal Distance? Will Driveways, Parking Areas or other impervious Sudaces be S~oped to Direct Storm-Water Run-Off ~ ./ into and/or in the direction of a Town fight-of-way? ~ __ V Wilt this Project Require the Placement of Material, Removal of Vegelation and/or the Construction of any Item Within the Town Right-of-Way or Road Shoulder Area? (This item will NOT include the Installation of Driveway Aprons.) Will this Project Require Site Preparation within the One Hundred 100) Year Floodplain of any Wa ercourse? NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark in the Box, a Storm-Water, Grading, Drainage & Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Permit! EXEMPTION: Does this project meet lhe minimum standards for classification as an Agricultural Projecl? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan s NOT Requiredt Ye__A N~o STATE OF NEW YORK, e'-. . I [} COUNTY OF ........... ~..{~..e.. SS C (Name of individual signing Document) ~ ~ . ~0~NI[ D. ...................... ;;;';;';z a; ;;";';;"g;';',;;'&'"'" .............. , ," , p ~ ~*,"~, ,,,~m~ss~ ~x~r~ap~114, Owner and/or represenufive of d~e Owner of Owner's, m)d is duly aud~orized to perform or have performed ~e smd work and to m~e ~d file this application; ~at ¢I smtemenb contained in dfis application are U~e to the best of his ~owledge m~d beliefi fl)at d~e work will be perkmned in dm manner set ford~ in ~e applica6on filed herewith. Sworn to belbt,~/.jne tiffs; ............. 2.g. ...................... da, of FORM - 06/07 lpplicant) MAIN IIOAD A 'PI ;OVED AS NOTED ~ '~ ~ -~ 765-1802 8AM TO 4~M FOR THE ALL CON~RUCTION SHALL FOLLOW,NG iNSPECTfONS' iMEET T~ R~U,~=-=,,.~ ..... BE COMPLETE FOR CO. / ~ : [ ' : i ,, } 'l ~EQU/REMENTSOFTHECODESOFNEW / , ~ ; ~ ', : ~' ' ~ ~ - ~ 4¢?