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Home My WebLink About42275-Z R� +-5Z 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 Plans TEL: (631)765-1802Planning Board approval FAX: (631)765-9502Survey Southotdtownny.gov PERMIT NO. Z Check Septic Form N.Y.S.D.E.C. Trustees Q,t (I .)k ppl icatio t Flood Permit Examined 20 Single&Separate mmmm Truss Identification Form Storm-Water AssessmentForm C� Contact: p Approved__ ,20 Mail to: „� N V`Vl W�� N Y Disapproved a/c.-. C ... BUILDING Phone Expiration 120 ....,_.___ " D NOF SOI]tU L . AtTildr1i Inspect APPLICATION FOR BUILDIN RMIT Date ,20 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) (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises C tiG __. 1.. ._ ..............._m........................ (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: _AA yyL,Vza_ 4g ....... c t cit X House Number Street Hamlet County Tax Map No. 1000 Section �2S Block Lot Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy yno— _ p _....__ a?. b. Intended use and occu ancy 3. Nature of work(check which applicable):New Bru.i.lda`ng Addition Alteration Repair—,....—Removal— Demolition Other Work�i was c 1( (Des nptOL Estimated Cost Fee (To be paid on filing ........ this application) If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars (( -, 5. If business,commercial or mixed occuparic Qcify nature and extent 01"'el ch type of use. L" Dimensions of existing structures,if any:Front Rear Depth Height Number of Stories- Dimensions Dimensions of same structure with alterations or'sCTditrons'Front Rear Depth Height. Number of Stories Dimensions of entire new construction:Front Rear Depth Height Number of Stories Size of lot:Front Rear Depth 0.Date of Purchase Name of Former Owner 1".Zone or use district in which premises are situated 12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO V 13.Will lot be re-graded?YES NO II Will((excess fill be removed from premises?YES NO 14.Names of Owner of prcntises °F:Sy1;Q tls�e Address D33-1" r'nUphone leo. 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 v'_ 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 V/ 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) S; COUNTY Olsffie LJ cz, _„ 6 being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the q yam_ (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. TRACEY L.DWY'ER NOTARY PUBUC,STATE OF NEW YORK Sworn to before me this NO.01 DW6306900 _day of 20��] QUALIFIED IN SUFFOLK COUNTY V c ES JUNE 30,2� _... 1 > _ ' c tns�rws,�loN EXPIRES Notary Kublic Signature of applicant Corm 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: I_ 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. New Construction: _Old or Pre-existing Building:._ (check one) Location of Property: — House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section L „_ Block " Lot � Subdivision _._.... ._.Filed Map•W...._ Lot: . Perm _�..it No. Date of Permit.. ..- Applicant:_ �.... ...... ... Health Dept.Approval: -.. _Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: „� (check one) Fee Submitted: $ _ �pP@icant Signature. .••�. .-_ I r usler Wood burning stove 12/20/17 Window 3 AT 19' 1 I 1Q" 56" I 3 Stone Wall IT 56" 19' -- c wuv�� Jy "'°YtudN�I �1iu j Specifications and Clearances: Iw 06-08-17 Physical' Measurements: le r nce (Clonf°)b &Ze 45,00 BTL)s W ififm.� Mu f �� ur r r��f NurrrNrf EPA u�rarnsffrr root fMru ��. .� .��. _....... . ... � ..�_.....w�.. ._...�.--- ....w Efficiency '78% Near fug ��u� � � �. w� .. _ _.�.._.. ...w,...,..,... 20 Beare Tame up to 8 hours VIeatl f up to a fr mount y. g � nd no heat . .. Frr�f„�xrf 1:,iN 9 u,ubk;f%, l eiip,r11u.Nnruu,uNar II`iom a oru)er IV .... ......... fA::j)drr°r�r..r�,ri N rig N. r�ru'�;th 1 ” Fh.�e . � � IIra fir o rear a" � rr�� dffrff th double all. Nf)d �lw d rffI �q shl kl ': . . -'ll . . .�__ Ash 4Ian r''o IrfmJk r ,' 'urrN ... . 4' ,r .. .m..�. ,,,,. a o��tim'rMrf I k!;, rrd,,r Kit fu ..a.. rPo...N.0....1R #rc."_.r.... r..4rferl... ...... .,..., Yes � fuuuuuuurrffro . a, .. heat rw�u...m..r... w Pkk rrrr: �'effied "r N a ul;uu^r7 fra,r.rt°ua° Nr.urrr �°,��,r�ei' f Acllid a "r'Vegr ht 4&4 lbsN shippung Weight "»500 Is Corner H" ou n wfth u,t ll N'f a e a�u�� d rear m s��iel&�� , w,' Ieq�N'ienda �deii' ` ruroirr r:oii're Nva (,m'NlewrurrYdce!s: (see frrlf if forMNINuIr'':tla'111130rwll,'') n... „„...... M to �,fu°a,� �o-r Nf f rfi�rx�,ru�r fug ErE @�uu� INea;th Plad P'�11:1 t ”" ( fy � � � f f r+" Ski 20" ffiurirr7um Size Rr M�91r,:lurfa) r °'I°' "°VV 14 'N12"" I':"� With, prv?V�_ff'f?.� .bf.,,uig�., 1� ��"�f�,rlurar N�w'r rc�u� f''r.��rfu �lru�r.r ('��` rk r Fiait f f��..r1 rrr�+ 1!�wl ii crr'1f u:�N Tyr r��e 611 J3 l,C CrJI r rN xf��:lnsAon pas''Ip yuo tila)va. 8"l9"� " k r e C, d &de 15' Extenarbn p&;Sf o ,w of .°fr.uve 8° US C I rrr :,�'rf,f _ Specifications and Clearances: 1p. 2 IRev. 06-08-47 _I 1,;13 A 4 r u am ................... .. I , N� Parallel Comer .. ..�_�. �. ..0...� _._. .. Clearances l Ml opnector 140IRear feat Shield 0 5� cU -41 8cm 2 5 V 5 � 10 2°5' �,.c..Ir.n hrnIle CV : fiM or � � fi �� 7 44un 32? fib _ ._F- .1 Cfi " ; . t , . mfiC ', urou. 8 e V8ro t8 -Ihrrr Heal Sherd Rear l Shreld 1 crn D_ �,_....� .__.C.o, F uMa _ --- _ ..m .,.� . .a��. fi kx e WOW a� uro8I ahRear��nt�� '�� 5. cm . 5 - . un I105.4uwnm_ Vase Cleerine (iluroherw.,riraroscu ra ISG '�.ueP° 6fi fi R urIlluroau�u� ul �e 6tln Vim"_ fiu°Iro ee 8�I1,,,1A.... fi fi _ ...._ �� I�Baa�ln�uuun apc�vee �ro "" 'firm ee I 'I'I! fi.fi o Alcoveceffir from oorwft _._ �_ e I�II�FIA�� fi'fi _ ��C �g��D IIIA V �/�PoVV �C��Y�n'l �filY' 1 S� �I�tV��_..�. �. �_...,�..,..m. V . A! veeIV1�$. fuIY'rwGACbrflfi1roV� VeVII nIY'Ce toIY' '._.... � �. rlrn ee NI`P -211 '"' Vll iil li lili ai. II'i I Specificationsand Clearances: p. � M IRev. 06-0i..17 AMA (U,$);—, 7-I 1 (CAPD - 2lrnA (US 1 $iN2icm (CAM x '�w 36-1/21n (U h 44-MW113cm (CAM ^mm Y .^i" p 8iN21 an (US) R 131 (CAI ! LIM CT KILL¢Q004 ca mp The irnirnirnmum floor protection for USS installations is,361/2"x 33.1/2" The minimum floor protection for Installations in Canada is 44 1/ m x 37 1/2" installations in Canada require 19"(45®72 cm)of floor protection on both side and front. Dear clearance required only if stovepipe runs horizontally back above the top or behind the stove. 7 r 14�� .FT' r I � 9 u .,, � .. D " yam TT A � IW+ k R � E2 � 0 L � .a.., FRONT VIEW SIDE VIEW CLEARANCES APPLY WITH STOVE IN FIREPLACE ALSO