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HomeMy WebLinkAbout29008-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPAiqCY No: Z-29144 Date: 12/23/02 T~IS CERTIFIES that the building ADDITION Location of Property: 2235 BRIGANTINE DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 79 Block 4 Lot 62 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 12, 2002 pursuant to which Building Permit No. 29008-Z dated DECEMBER 16, 2002 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 ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. · ~ne certificate is issued to WILLID~M S KELLY & SANDRA L SIKORSKI (OWNER) of the aforesaid building. S~-FFOLKCOUNT~fDEPARTMElqTOF~tR.~_LT~PROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION D~l'mu Rev. 1/81 N/A N/A N/A FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUITDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 29008 Z Date DECEMBER 16, 2002 Permission is hereby granted to: WILLIAM S KELLY PO BOX 1680 SOUTHOLD,NY 11971 for : INSTALLATION OF A FIREPLACE TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 079 pursuant to application dated DECEMBER Building Inspector to expire on JUNE 2235 BRIGAiqTINE DR SOUTHOLD Block 0004 Lot No. 062 12, 2002 and approved by the 16, 2004. Fee $ 150.00 Authorized Signature Rev. 5/8/02 ORIGINAL !! ? ? ?~--i;-~-q TOWN OFSOUTHOLD ......... , BUILDING DEPARTMENT I TOWN HALL ' I 9 5!::9~'~' '[ 765-1802 APPL~ATI~N FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: 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. Bo 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 $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- $25.00 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: '~. Location of Property: Z ~-~S ~-Y~,.~t7~ ~ House No. Street Owner orOwnersoferoperty: ~,]JZ~--~T--A/~A, ~ ,~ Suffolk County Tax Map No 1000, Section '~ Block Subdivision . .~_-_ ~ ~12F~ ~/'~"7~_-~ FiledMap. I'Z- Iq-O - (check one) · 5/'-/-/ Hamlet Lot Lot: Permit No. ~,~ CD' ~ ,Date of Permit. IZ- I~,'- (DF Applicant: t~4~.~ Health Dept. Approval: ]k/~/~_ )~rc-5~(.~_~ lc/'(. Underwriters Approval: Planning Board Approval: ~A Request for: Temporary Certificate Final Certificate: 'x~' (check one) Fee Submitted: $ ~- Appli~tur~" / Applicant/ Architect/ Engineer: SCTM ~: Districl: I,O00 Section: Date Reviewed: Date Submitted: erojecl I..ocation: ~Q_ ~ 3 ~ Single & separate Required cerl~ficalion: _(Yes / No) Zoning D/sir/cC (I,ol sizc: Req. [From Yard ~ Subdivis!oJ~ Nan,e: Req, Pro~s~:~l [Side Yard { ~' ' ' Propose: ~ [R~r Yard Project Description: ~.t~/P~t<.C.~ AGENC~PERMITS REOUIRED FOR REVIEW N.A. .,Permit . NO yES Number Suffolk County Health Dept. New York State D.E.C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULA/T~ON ] FRAMING ]~~F L [ [ ] FIREPLACE & CHIMNEY DATE FOUNDATION (1ST) FOUNDATION (2_ND) ROUGIt FRAM~G & PL~G ~S~ON ~ N. Y. STA~ E~ CODE TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined Approved Disapproved a/c Expiration {-O ff/O ,20 Or4 PERMIT NO. BUILDING PERMIT APPLI. CATION CHECKLIST Do you h~{ve or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application MUST be completely filled in by typewriter oi- in ink and submitted to the Building Inspector with 3 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 appligation, 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. ~ / // -- (Signath,.r~ppli~an~or named if a corporation) (Mailing address of applicant) applicant i~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder State whether Nmne of owner of premises If applicant is ap~oration, signature of duly authorized officer (As on the tax roll or latest deed) (Name and title of corporate officer) Builders License No. [ ,'~ I '-~---D~'/~' - ~ Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposed work will be done: House Number Street Hamlet County Tax ,M~tp No. 1000, ?ction ?.~G~i Block /-I Lot Subdivision 1M~ ~-C'~_ [ ~T~ ~.j;'/,f,~I'Q"~ Filed Map No. ,'~lCl-I Lot (Name) 6:-/ 2, State existing use and occupancy ofpr~/nises'and intended use and occupanc7 oflSropose~l constrdction: a. Existing use and occupancy '~._.-51-' 1'~~ , b. Xntended use and occupancy SZ iLe , 3. Nature of work (check which appliCable): New Building. o Addiiidn'" Alteration'¥~' Repair Removal Estimated Cos~ ~: ~ ,ac' If dwelling, number of dwelling units If garage, number of cars Demolition Other Work (Description) Fee (To be paid .on filing this application) Number of dwelling units on each floor If business, commercial or mixed occupancy, specify nature and extent Of each type of .use. Dimensions of existing structures, if any: Front V~g~ ° Rear Height Z~ ~ Number of Stories Z_ Dimensions of same structure with alterations or additions: Front Depth ,~' ' Height_ Zt~' ' Dimensions of entire new constmctionl Front Height ~.~ .i Number of Stories Z~ Size of lot: Front Idh/fi)' . Rear ] c~t~)? 10. Date of Purchase ~" /O ' ~)~7~ Name of Former Owner · $/[''t Rear --//d~ .' Number of Stories 'Z_ Rdar '4c~t Depth Depth 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? ~ES !'. ' NOq' Will excess fill be removed from premises? YES__NO !4. Names of Owner ofpremises_f '. ~{ -~-~ _t_3-4 Address Name of Architect ~t(/A'gl~:'~ Address Nme of Contractor ~ ~ ~&k.k~l Address Phone No. 15 a. Is this prepay within i 00 fe~ of a tidal wetland or a keshwater wetland? *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. PE~ITS ~Y 'BE REQUIRED. .... ' ~s~ ~'~ 16. Prohde smey, to scal~, ~lh occ~ate [oundatmn plan ~d distances to prOp}~y lines. 17. If elevation at ~y point ~h prop~y ~S at"i 0 feet or below, must provide topographical 'data on su~ey. STATE OF NEW YORK) .- ' · SS: COLrNTY OF ) x~--~/-J-~C~q,,2~. ~. ~__~t--L-~---t being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract).above named, (S)He is the (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. Swo ,r~.bTfo~eaym~;hiv(.~ , 20 (~Nota~Pu~li!~;~'~ JOYCE M. W1LKINS Notary Public, State of New York No. 4952246, Suffolk County ,+ HOL?5~ ..,2 ,u. PI?E OF NA~ DEC ~0 S.C. DEPT. OF HEALTH SERVICEs SUF"OLK CO. O£PT. ^."'ov^L H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS For THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO DEPT. OF HEALTH SERVICES. (s) APPLICANT SUFFOLK COUNTY DEPT, OF HEALTH SERVICES -- FOR APPROVAL FOR CONSTRUCTION ONLY DATE: H. S. REF NO,: l'2JO APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL OWNERS ADDRESS: DEED: L. ~4/'A P TEST HOL£ STAMP SEAL Owner's Nome ~'--'~/./J ~'~ /,-'~.-]C.d~'~-~-~-~ ' Job No. GUTTER DRAIN DIRECTION ENDWALL OVERHANG WIDTH SIDEWALL OVERHANG WIDTH Vented Non-Vented MAIN BUILDING ROOF PITCH: __/12 PORCH/LEAN-TO ROOF PITCH: ~/12 EYEBROW OVERHANG ROOF PITCH __/12 ~ea,d~d / ~OT ~ "~;2A~'.I~ I ~C ~ ~,/~"-~, ~:~ FOR THE '- .... [...~.~:.......k.~.~._......~. ........ ~ ........ ~ ............ ~ ............ ~ ........ :....: ................. , ........................ , ............ F~.w~.~~. ..................... , ........................ J'~"~ '~' J'"h'~'"~"~' J ~ '~"'~ ~"J"~ '?"':: [ ~ ~ ~"!' ~ '~'"~'~' J'~ ~"'~' ~"'h'~ i" ~"FORpO~E~cONCR~: : :: II f~ ~ := ~ ~.~. ~ ..... [..~1/~..1 D.:. = ~ }~ ~ ~ ~OD{~NO~}RE{po~!B~ FOR ~ t ...................... i'"'~ ........ 7: ............. ~:~~~:~'"7":: ........ :"":""~'"':'"'~'"'r'"=:..:.: ........... ........ ~7"?'"="": :?::~~':""~- ~:. ..~..: :'~:r ............. .: ~ ~ ............ . ~ :~ ..................... ~ "~: :'"'?"="~ ..................: 'OCCUP4~= ............................ . FOUNDATION OPTIONS~ :' ' :' [ ~~F~~~:: .~A~':' ~'~ :~ ~ USE JS ( ) ( ) ~.L O~[NaONS AJ~ HOielAL One 5quote £quois Feet FORM 86A 5/01 (Use Lorgest Scole Possible) Date: Owner's Signature: '~' Owner's Nome tf__IdP.~,l Z~t ,:.,,,&L~.J~J~dl,; Job No. GUTTER DRAIN DIRECTION £NDWALL O~RHANG . WIDTH SIDEWALL OVERHANG Vented WIDTH (cite one) N on - Vent ed FOUNDATION OPTIONS ( ) ( ( · u. m4e~ao~s ~a[ t~m~L One Squore Equols Feet FORM 86A 5/01 (Use Lorgest Scale Possible) Date: Owner's Signature: Owner's Nome GUTTER DRAIN DIREC'nON ENDWALL OVERHANG W1DTH SIDEWALL OVERHANG W1DTH Vented Non-Vented ~ No. PORCH/LEAN-TO ROOF PITCH: __/12 EYEBROW OVERHANG ROOF PITCH __/12 FOUNDATION OPTIONS ¢ ) ( { ~ OI~NS,~S ~ ~:W~- One Square Equals Feet Date: C)wner's Signature: FORM 86A 5/0t (Use Lorgest Scole Possible) :,.: V// :} :'~. , :: :;,': ground level SuPerior Clay , flue liner .,... SuperiOr Clay smoke chamber ~. Superior Clay damper 8uperior Clay Rumford .---... throat Finish to Just cover edge of throat Std. 9" llrebrlck-.. · rebriek or refractory hearth Rctnf. hearth Reinf cone, B footer R FORD FIREPLACES FIREPLACE THROAT D,~PER ,SMOKE CHAMBEI~" FLUE TILE, oTHER' DiI{/IEN$ION$: .... :~;:'~ 'SIZE (AxF} (flame) (base x %24",wkte 24"xl2" 4"x16" 8.5"x18"~24" 8.5"x13" 24" 12" 13.5" 13.5" ' 24".28" 12" 24" :::::30'[wlde 30"x12" 9"x24" 13"x27"x30" 13"x!3" 30" 12" 13,5" 15" 28"-32" 12", 30" ~:~6~,.wlde' 36"x14" 9"x24" 13"x27"x30,' 13"x13" 36" 14" 13.5" 18" 32".38" 14" 30~' · .42~de ~ 42"xl5" 9"x30', 13"x34"x30" 13"xl8" 42" 15" 15" 21" 38"-42" 15" 30" ~ ~ 9"x30" 48" 16" 22 5" 42"-48" 16" 30 .... ,.~4,8.,, wide 48"x 16" 16"xa4"x30" 16"x20" 18" . fill solid base . ~ Surround A ,, ~|0~mm.to · Wi'L[ t,~iNl' i-4ELi ¥ ¢ SAN'~A. Si i/.OF~.SK!" SCALE STATE'I~IENT OF INTENT THE WATER ~UPt~LY AND $~'~tAGE SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVtCE~, APPLICANT SUFFOLK COUNTY DEPT· OF HEALTH SERVICES -- FOR APPROVAL P'OR CONSTRUCTION ONLY DATE: H. S. REF. NO.: APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT· BLOCK PCL. ~ o79 4 ~ OWNERS ADDRE~: S,./'~JTHOL:~, ¼ :'-4 I iC~Ti DEED: L. ~/A P. ·EST HOLE ~"TAMP OUTTER DRAIN DIRECTION EN~LL OVERH~Gi / WIDTH NN SIOF'WA~/ k ~t~1/t Non-Ve'Sted MAIN BUILDING ROOF PITCH: __/12 EYEBROW OVERHANG ROOF PITCH __/12 Overhead Door/Opening Information ,.~ ~ w.,~ ~,..~, ~--~. ~- ' : I ' ' ' ' '" ...... i. i · i i ~ : :: .... : : ::~ ~ ~ E ; E : : ; · ~ E ,E E ~ E E.E ~ : : : ~: : : : ~ : :..: : ~ : : ~ : E :~: : : ' ~ : : : ~ · ~ : : : : . . ~ ~ : : ~ ~ ~ //::e:: :,~: :~e ~ ~'~: : , : ..... : : ........ : : . : : : : : ....... : : , : : : : · ~' : :: ~ ~:~ ~ .~,~. ¢...~ FOUNDATIO PTIONS ! o ~-.- = Z ~ : ! Z CH~D WAU. ( ) ~L I~l~aO~S ~: NOW.AL. One Square £qu eet ./~_ ~. . rn.u ~A ~/hi fuse L~;~=~ Date. 3- (0~_ Owner's Signature.