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Home My WebLink About28926-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29173 Date: 01/07/03 '£~£S CERTIFIES that the building WOOD STOVE Location of Property: 3570 KENlqYS RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 54 Block 5 Lot 23 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 15, 2002 pursuant to which Building Permit No. 28926-Z dated NOVEMBER 18, 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 INSTALLATION OF WOOD STOVE IN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ROBERT & MARIA LUDWIG (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF ~EALTHAPPROVAL ELEt-£~ICAL CERTIFICATE NO. PLL~WBERS CERTIFICATION D~rF~3 Rev. 1/81 N/A N/A N/A 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. 28926 Z Date NOVEMBER 18, 2002 Permission is hereby granted to: ROBERT LUDWIG 3570 KENNYS RD SOUTHOLD,NY 11971 for : INSTALLATION/CONSTRUCTION OF A WOOD STOVE AS APPLIED FOR at premises located at 3570 County Tax Map No. 473889 Section 054 pursuant to application dated NOVEMBER Building Inspector to expire on MAY Fee $ 150.00 KENNYS RD SOUTHOLD Block 0005 Lot No. 023 15, 2002 and approved by the 18, 2004 . Rev. 5/8/02 COPY Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCuP'ANCY 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. Bo For existing buildings (prior to April 9, 1957) hon-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. 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: Location of Property: Owner or Owners of Property: ~-~ q[- Suffolk County Tax Map No 1000, Section c~-Ot~ Old or Pre-existing Building: (check one), House No. ' Sh'~et Hamlet/ Block Lot Date o f Permit. //!/~//~O ~,- Underwriters Approval: Subdivision Permit No. ~ Health Dept. Approval: planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Final Certificate: Filed Map. Lot: Applicant: /7~,.~:~-- ~,_t2,gDt.~[{~-~ (check one) 6. ~ts-eme~H~t4e~, with Tee-supported outside Ch h'drtey Cloam.ee lo Welt I./f,¢ Al Will Band (T-WB Fire $to~)/Wall Spacer II Chimney ii ~'~ (T*S ot Loner) DS Wall Support (T.WSK) on Outah~, WIll H~mpton Hearth ~,, (631) 263-48~i2 Fax (631) 2~4 20 W~t Main Stoat S~ampton, NY 11~9 *The end of the chimney seotlon must exlend Into t~e zoom minimum of 4Th'' 10eyelid the face of the wall. 17 votn, m~.XlO~ Osx) ~ ~ · ~ PL~G % L~ /. / m ~mON~ CO~ C I' : ~ ~ ' ~ TOWN OF SOIJTHOLD BUILDIi~G DEPARTMENT TOWN P.3zLL ' SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ BUILDING PERMIT APPLICATIQN CHECKLIST Examined /[,/~ ,20 ~ Approved t({{~ ,20~ Mail to: Disapproved a/c ~~ ~__//~ Phone: Expiration ,20 q Building Inspector Do you have or need the following, before applying? Board of Health 3 set~ of Building Plans Planning Board approval Survcy Check Septic Form N.Y.S.D.E.C. Trustees Contact: APPLICATION FOR BUILDING PERMIT Date ,20 ~ 'i INSTRUCTIONS ~..~..~..: a. This application MUST be completely filled in by typewriter or 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 Buildlng Permit. d. Upon approval of tlfis 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 In.qpector 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 cfa 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, i~a corporation) APPROVED AS NOIED _ " ' State whether applicant is 765-1802 9 AM-TO '4 PM FOLLOWING INSPECTIONS: .!. FO[m_n~'rlC}N . TWO REGUIRED ----'---~,~ F D R ' /__ '~ INSULATION 3. FINAl,_ - C~O}ISTRUI~TI~I~,~ tax reseed) If applicant is a corporatio~ ~L~l~[tt~l~fl~ttj~.nzea omccc aLL CONSTRUCTION I~HALL MEET" (Name and title of CI~oRE~J~NT$ ~F THE N,~ STATE CONSTRUCTION I ENERGY Builders License No. 0~0'~ · ~Plmnbers License No. Electricians License No. Other Trade's License No. 1. Location o~~osed work will be done: ~ House Nmber ~ S~eet Co~ty T~ Map No. 1000 Section ~ Block Subdi~sion Hamlet Filed Map No. (Name) State existing use and occupancy ofpremisus~ [n~and ~, ended use and.occupancy of proposed construction: 2. a. Existing use and occupancy 3. ~n~ Alteration Oth~Work (Description) Nature of work (check which applicable): New Building Repair Removal Demolition Estimated Cost )~0 If dwelling, nUmber of dwelling units If garage, number of cars ~ Fee o (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 Height Number of Stories Rear Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Depth 8. Dimensions of entire new construction: Front Rear Height Number of Stories Depth Rear 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 zo.~l'a~, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO f'x Will excess fill be removed t~om premises? YES 14. Names of Owner of premises fF_~.~ ~2DW/~ddress ~7~~ ~3Phone 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 R~ED. 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 m property lines. 17. If elevation at any point on property is at 10 feet or bel'0-Vi;}-rhQ§T pl:0~de topographical data on survey. STATE OF NEW YORK) SS: COUNTY O~ ~ ]:2~_/'~ (J.[d[A.l{ ~.. being.duly swgm, deposes and says that (s)he is the applicant (Name of individual signi~ contract) above named, (S)He is the ~' (Contractor, Agent, Corpomt~ 0~ce~ ~tc~) of said owner or owners, and is duly antborized to p _erform or~V,e performeff the said we.,k and t~ make and rile this application; that all statements contained in this application are true to the~est °fh~s knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swo,9~q~before me th~ ~ ~t . day of C~~ 20C.~ EOV~qNA L. CALLEN Netary Public, State ol New Yodl No. 4991462 (~ualified in Suffolk Count~ .,,..., ~mmbslonExpires February 3. ~ o'(/'c( . ~. Signatur~ of Applic~7