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39669-Z
Town of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 37494 Date: THIS CERTIFIES that the building WOOD STOVE Location of Property: 9520 Sound Ave, Mattituck SCTM #: 473889 Subdivision: Sec/Block/Lot: 122.-2-24.3 Filed Map No. 4/13/2015 4/13/2015 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/19/2015 pursuant to which Building Permit No. 39669 dated 3/30/2015 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 in an existing one family dwelling as applied for. The certificate is issued to Steadman, Gregory & Steadman, Catherine of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Auth d Si ature Permit #: 39669 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 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) Permission is hereby granted to: Steadman, Gregory & Steadman, Catherine PO BOX 567 Laurel. NY 11948 To: wood stove in an existing one family dwelling as applied for. At premises located at: 9520 Sound Ave. Mattituck SCTM # 473889 Sec/Block/Lot # 122.-2-24.3 Pursuant to application dated To expire on 10/12/2016. Fees 3/19/2015 Date: 3/30/2015 and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION $200.00 CO - ADDITION TO DWELLING $50.00 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined , 20 Approved 1 6 , 20 Disapproved a/c. Expiration , 20 MAR 19 2015 ^ol DG, DEPT PERMIT NO. 3 9 E 1.9 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 Permit Storm -Water Assessment Form Contact: Mail to: W \C�-Q--- Phone: S3 TION 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 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 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 name, if a corporation) ff-407—d Aq,,m' e (Mailing addresss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder U Name of owner of premises ���1� U ✓%ad'�YJ Cfi�2� (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 �6_ aD House Number proposed X2 10 ct Street will be done: Hamlet County Tax Map No. 1000 Section a?- "-Block' ` ° ;' „ Lot ' Subdivision 1.jil ,`Ali? ecl:`1V>a N6 Lot 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /& UL -2 b. Intended use and occupanc5AORC �ilP 1 ml- �GSfT1�� 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars (Description) Fee (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 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 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_ 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 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.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. NO 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) ,I'�- SS. CO=—---C w (i i,� H4being duly sworn, deposes and says that (s)he is the applicant (Name of individual ri�ig contract) Bove named, (S)He is the uA" c�er\ , 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. before me th" day of jA0Vff141"-20 I S "' "-'' Puha Signature of Applicant Igo%,State dtNe�Y r Quafified;In Suffolk Co Commission -Expires July 18� 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 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: 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 $I5. 0 \ Date. \ l New Construction: Old or Pre-existing Building: (check one) Location of Property: O\ Sac) �;� u Q h�:� House No. Street Hamlet Owner or Owners of Property: 0[-)- AeC zs-TEP�-� Suffolk County Tax Map No 1000, Section Qa- Block o2 Lot— Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Filed Map. Date of Permit. Applicant: Underwriters Approval: Lot: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant Signature ,34fo L3 � TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND[ ];-INAL S ION r(' [ ] FRAMING / STRAPPING [ v T� [ - ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING RRMARI[C. DATE INSPECTOR TOWN OF SOUT OLD MOPERTY RECORD CARD OWNER f STREET VILLAGE DISFR1eT1 SUB. LOT .Ire c uGK FORMER OWNER N E ACREAGE \\ J/ �',�}o r19 ICP S.� W TYPE OF-BUILD.ING RES. v SEAS. VL. FARM COMM. IND. -: [C130", MISC. Est. Mkt." Value LAND IMP. TOTAL DATE REMARKS 0/" �1 4 0 (5 "/d Gr -o o/os . ¢o el ; / o,%as_Z7 - - L 11 / 7o 16 ak !) 3 4�J . r j S 506 1�P►"/ 4%12 oi � �.� �bt � t 4. (A AGE BUILDING CONDITION NEW NORMAL BELOW. ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value FRONTAGE ON ROAD Tillable 1 BULKHEAD 24Z Tillable 2 DOCK Tillable, 3 Woodland Swampland Brushland House Plot 1 Total I 54/ a J ., ' .,-60Foundation Bath xtension Basement �L L Floors xtension _ 3 �� Ext. Walls ' nterior FinishOD - — XtenslOn .:. Fire Place' Heat o \ .<L Porch Roof Type. _. Porch. Rooms 1st Floor reezeway . Patio Rooms 2nd Floor 7. bro,ge;x � o }(. ?%`a � ar � � 5^- � Driveway Dormer _ a� •3,/ -- : �#.. N TOWN OF SOUTHOLD ,,�-.�-z^.- � '.," src "x+a t{.� 1�;,, u,€ i� `�' ' �,. '�'L"A-e 7'.s L^.'•�`t t .. • PROPERTYEC �•` ROR®`CARD :. �. ...� OWNER ; STREET / �'� VILLAGE DI&T-RIC°r' - SUB... ' LOT FORMER OWNER N Eas 0 ACREAGE r S ` 6,-bICKL" soA' W a/119/ TYPE OF BUILDING 'RES. Jv SEAS. VL. FARM COMM. I IND. I CB. I MISC. I Est. Mkt. Value LAND IMP. TOTAL DATE REMARKS r n p, s--� v 3 �; -c� a y�o o � 8• is L ✓• AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm y Acre Value Per. Acre ;.r Value FRONTAGE 'ON ROAD Tillable 1 BULKHEAD Tillable 2 DOCK Tillable, 3 - s. Woodland Swampland = .. . Brushland House Plot - - F Total NO. M-. Bldg, Extension Extensip'n reez'eway Ir -I wwwwW iS kot J � •l "��fr �h k �• 14v'A :µ t. x #�Nn4 t aT jf' r r� ff-M 13 Tm:z ftwo It Two oft Of -1- Imp ftw :z 5 N I �ac ic proo ements de r& TYPE 2 THERMAL FLOOR PROTECTORS ine K-ovatue of this product is R=1.56. This RwValue mug equal to or greater than that specified in the heat Producir appliance's installation instructions and labeling. PROTECTEURS THERMIQUES DE PLANCHER uL I -vo La r6sis#encs thermique de cue Produit est R =1, 56. La resistance thermique Boit etre 6gale ou sup6deu�'e � ��i1p. specifies dans les instruG#ions d'installation et ins etiauettes de Vappareil de rhauffage. _ PROTECTORES TERMALES DE SUELO TIP() 2 Valor -R de este productes R� Cste Valor -P', V% h ,... .. Iwai mayor i e epi en las trCciones, de in talad& y 1a ebqueta del aparato productor de calor. u 3/19/2015 SANDHILL 18"x48" Black UL1618 Type 1 Ember Protection Board -Gifts - Giftable Items -All Giftable Items Sears sign injoin for free My Location Cart SANDHILL 18" x 48" Black UL1618 Type 1 Ember Yp Sold' by: Shopchimney.Com Protection Board I Description Item # SPM7407651002 Model # 5007 Used to extend floor protection for existing fireplace hearths that are not large enough to meet the required 18" beyond loading doors. This board meets the latest UL 1618 standard Type 1, for ember protection only.18" x 48" Black UL1618 Type 1 Ember Protection Board Ratings ,& Reviews 0 Reviews have been submitted for this product Questions & Answers 0 Questions I ask a question Customer Service Order Status Shipping & Delivery Returns & Exchanges Give Us Feedback Stores & Services Store Locator Weekly & Local Ads Parts Direct $63.99 In Stock for Shipping enter ZIP code for pricing > ? Store Pickup Not Available View Alaska/Hawaii Pricing http://www.sears.com/sandhilI-18inch-x-48inch-black-U l6l8-type-1/p-SPM7407651002?pagelnd=product¤tProductTitle=sandhilI%2dl8inch%2dx%2d4.' . 1/3 DOW FDR J" S7 INSafrarwe CO. : -- SOUD FUEL CHECKLW Wo, 7w ,PhototaI ay � Fast flooi ❑ saawnem attadxrd? dq Yes O No g ,Yes O No V Ya O No lomdon: Garage' O TYPE OF FUEL Wood O Coo! O Peoft O Odd (desaib.) O ym 12w. P." r,.m mt.wrs9 C7 Yes O No iM OF NEATEN O Room heater F�ata p Fireplace insert or hearth stove . : ❑ Central be" rnct CoralectT Cl Yes Q No... a1w V456 3...8irirc �µye ,ameEta 6 naman e d numberDIPELgNT " Di -L 1Q1C Year Matarod ZW 1 lnstafled by oorwactml )fYss O No WATER TOTOG unit TWMdfor nwmdaaured Mbalad? 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(NOW: If dntral turnac0 or add-on tumace, give plerwrn and wee n air duct clearances In Ramaft)_ y f. swe of urit nearest to wall 2. Rear of wit b wall ----i-- In. — — TOP A !�lr� 3. hori:a(ftl ssovetRM W COMM 4. Vert W "Weg ps to Well & BO1lernofw*ff)%W �..Z.tr..-� .r. 61�' {$ t & Unit b edp of floor "ecdon - 1 L r sklew. In. FMM. 17 IV tX.ar. o..... In. Hreplaw R=rt or hearth Clearance to manta store mot M 1f • - —�._ M. REiAMM (also um omar skia+Yneoasaary)_ _f.� am �� 5*1;fi --lQd� * &Am aV.4;1 floo R'` -tw 5" o f /70i1cOMAIS&b& SIJ JJf re/ on "NJ �ni�.sunr� ,�jp /�ftctton � Q. s] i