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Home My WebLink About39642-ZTown of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 37501 Date: THIS CERTIFIES that the building WOOD STOVE Location of Property: SCTM #: 473889 295 Bailey Ave, Greenport Sec/Block/Lot: 34. -4-5 4/8/2015 4/8/2015 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/2/2015 pursuant to which Building Permit No. 39642 dated 4/2/2015 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 installed in an existing one family dwellingas s applied for. The certificate is issued to 295 Bailey Ave Corp of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 41 711�ed S' atur ��vFFnl,r�oTOWN OF SOUTHOLD BUILDING DEPARTMENT ' TOWN CLERK'S OFFICE o • SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 39642 Date: 4/2/2015 Permission is hereby granted to: 295 Bailey Ave Corp 13235 Main Rd Mattituck. NY 11952 To: Wood stove installed in an existing one family dwelling as applied for. At premises located at: 295 Bailey Ave, Gree SCTM # 473889 Sec/Block/Lot # 34.4-5 Pursuant to application dated To expire on 10/1/2016. Fees: 4/2/2015 and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION CO - ADDITION TO DWELLING $200.00 $50.00 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 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 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: 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. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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. ZZ New Construction: Old or Pre-existing Building: ✓ (check one) Location of Property: �� (�'�, A'y (� House No. Streef Hamlet Owner or Owners of Property: L�.JZyy Suffolk County Tax Map No 1000, Section 34 Block Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (che (one) Fee Submitted: $ p nt Signature FMLD INSPM�4N a— vog'r FOLINDAITODT (IST) FOUNDATiQN (2ND) ROUGH FRABnNQ & PLUMBING IMULATION PEA N. Y. STATE ENE.nGy cbpB FINAL - TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do.you have or need the following, before applying? TOWN HALL _ . Board of Health SOUTHOLD, NY 11971 4,sets of Building Plans TEL: (63,1) 765-1802 ;.: Planning Board approval FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y,S.D.E.C. Trustees `,C.0. Application . Flood Permit Examined ; 20 Single & Separate Storm -Water Asseent Aorm Contact: Approved ,,20 Mail'to: J0 Disapproved a/c Phone: (e3 1 t446- Expiration 44—Expiration , 20 Building Inspector - APPLICATION FOR BUILDING PERMIT :Date / 2 Z , 20 /5 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 adjoimn&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" Inspecto'r 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 uil°ding Department for the issuance of a. Building Permit pursuant'to the Building Zone Ordinance of theTown 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, an regul _'ons, and -to admit authorized inspectors on premises and in building for necessary inspections. (Si re of applicant or name, if a corporation) �o v r& (Mailing address of applicant), State whether applicant is owner,- lessee, agent, architect, engineer, general contractor, electrician, -plumber or builder Name of owner of premises (As on thi fax roll or 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.- Loc do a of land on which proposed work'will.be done: -r- . -. ___. 19P . A I/ -I=r 6 A / /1/ House Number Street ( Hamlet �l pit, i Q .zl# yV03 t County Tax Map No.' 1000 Section Block Subdivision 2. State existing use and, occupancy of a. Existing use and occupancy. b. Intended use and occupancy_ Filed Map No. and intended use t, 7. Lot of propq,,ed construction: lei GUa� � S �d7f 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal. Demolition Other Work !,(„3!QQ (Description) 4. Estimated Cost � (� Fee (To be paid on filing this application) f 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. =3f business; -commercial 'qr, mixed occupancy, specify nature and extent of each type of use. 7. "Dimensions of existing structures; if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. "Dimensions of entire new construction: Front Rear. Depth. Height Number of Stories ' 9. Size of lot: Front "' .'. Rear P : Depth 10. Date .of PurchaseName 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 e-Will:excess,fil:l be removed from premises? YES NO.”, 14. Names of Owner of premises Address Phone No: Name of Architect_ "Address Phone No Name of Contractor, ` ? ' AddressPhone No. 15 a. Is this .property within 100,feet of'a tidal wetland ora freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN,TRUSTEE S,,&`D.E.0 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 Jfoundation 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`eovenants and' restrictions with respect to this property?* YES NO * IF, YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) 11( {4.NJL`. C/�IiTI� being -duly sworn;deposes and says :that..(s)he is the applicant -(Name of individual signing contract) above named, -- (S)He is the�� "rt t if (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 this dayo 20 .. -, e-) al .. Notary Public CONNIE D, BUNCH Notary per, 3tgte o -New York, No. OIBUSIS5050 Duat4tied to Sti tfblk ON* �Co Commts®ton Expires 14, Signature of Applicant PFV ,SUFFa�� T(o>>l�.%�1 WARTIER, Scott A. Russell rte: (1 SUPERVISOR � I�� A. A� G IEh\4IENT SOUITIOLD TOWN HALL - P. O. Box 1179 53095 Main Road - SOUTHOLD, NEW YORK 11971 Town of Southold CHAPTER 236 - STORIYIWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT) Do • . THIS PROJECT INVULVE ANY OF THE E FOLLO 17ING yes 1�,& ` (CHECK ALL THAT APPLY) A. Clearing, grubbing, grading or stripping of land which affects more -than 5,000 square feet of ground surface. B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area.' r" Ci -tea nr rinrntinn nit Zlnnpe vNihirh t!vri-erl: 10 Feet vertical rise to _......._ 100 feet of horizontal distance. Q [TD. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. . Site preparation within the one -hundred -year f loodplain as depicted on FIRM Map of any watercourse. F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind rep lacemen_ , of impervious surfaces. _;_ :..__..... . If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building pep'artment with your Building Permit Application. APPLICANT: (Property Owner, Design Professional, ,Agent, Contractor, Other) NAMw h E: M, 6b � • v :f'n^tiy Contact Information __V5- Property Addwess / Location of Construction Work: ._Aj......... ......... s.C.T.M. 1000 Date District Section Rlock Lot ""l,(M LiJMAING DE=PAI? "h1E_N'1_ USE ONLY:„" Reviewed By: _ Efate: Approved for processing Buildirrg Permit. Storrt� eater 'lar�adenrent Cer_troi Plan INoi Required, Stoft-nwater l;ll r agetlicnt iof tiol 'Plan is Required. (For wafd io En?,i.eering vepa! irnei.l ,o' Revitvl.) rEST. 1974 DUUTC ST T) BY VERMONT CASTINGS Convection Heater Model 2460,2461', 2462. Homeowner's Installation and Operating Manual If this heater is not properly installed, operated, and maintained,.a house fire may'result.' For safety, follow all installation, operation and maintenance directions. Contact local building officials about restrictions and installation inspection requirements in your area. NATIONAL We recommend that our woodburning FIREPLACE. INSTITUTE' hearth products be installed and serviced by professionals who are certified in the -U.S. by the National Fireplace Institute® (NFI) as. NFI Woodburning Specialists or who are certified in Canada by d CERTIFIED Wood Energy Technical* Wood Energy TrainingrubuWETT TechnlcolTralning DO NOT DISCARD THIS MANUAL: Retain for future use 7001136 9/10 --