HomeMy WebLinkAbout42762-Z VEF0111r G� Town of Southold 3/18/2019
P.O.Box 1179
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40269 Date: 3/18/2019
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 695 Theresa Dr, Mattituck
SCTM#: 473889 Sec/Block/Lot: 115.-15-6
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/30/2018 pursuant to which Building Permit No. 42762 dated 6/7/2018
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:
ACCESSORY IN-GROUND SWIMMING POOL, FENCED TO CODE, AS APPLIED FOR
The certificate is issued to Rutkowski,Richard&Margaret
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 42762 03-13-2019
PLUMBERS CERTIFICATION DATED
t ed Signature
�sv TOWN OF SOUTHOLD
��oGy BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
Ol fX
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#: 42762 Date: 6/7/2018
Permission is hereby granted to:
Rutkowski, Richard & Margaret
695 Theresa Dr
Mattituck, NY 11952
To: demolish existing swimming pool and construct new accessory in-ground swimming
pool as applied for.
At premises located at:
695 Theresa Dr, Mattituck
SCTM # 473889
Sec/Block/Lot# 115.-15-6
Pursuant to application dated 5/30/2018 and approved by the Building Inspector.
To expire on 12/7/2019.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
DEMOLITION $100.00
Total: $400.00
di spector
Form No. 6
roxv-N or SO[JTHOLD
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 property 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. C6py 6-fC6rtifFate of Oocupan`cy_r.2-5 -
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00
4, roo Date. 5 W
. !L'A i-iA-t i -e ro ktto be
New Construction: �a�L G w� Old or Pre-existing Building: t t"( ¢check one)
Location of Property: (A 5
House No. Street Hamlet
Owner or Owners of Property: O, r e+ 9j6.6inK
Suffolk County Tax Map No 1000, Section l J Block. l5 Lot
Subdivision Filed Map. Lot:
Permit No. 7 �- Date of Permit. Applicant: 0 0 r ro rK Pot, t-W-c.
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ c
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/Applicant Signature
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Town Hall Annex ® Telephone(631)765-1802
54375 Main Road c� Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 �1B�p�p�p� a® roger.richert(aD-town.southold.ny.us
n i A ,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Rutkowski
Address: 695 Theresa Dr City. Mattituck St: New York Zip. 11952
Building Permit#: 42762 Section: -115 Block. 15 Lot: 6
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: JES Electric License No: 42762
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only
Commerical Outdoor X 1st Floor Pool X
New X Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceding Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 1
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1
Disconnect Switches 1 Twist Lock Exit Fixtures TVSS
Other Equipment: In ground swimming pool to include, bonding, 1-pool pump,p, pool lights, heat pump
control panel,time clock,2-GFCI circuit breakers, 1-GFCI recpticle,salt generator
Notes,
Inspector Signature: Date: March 13 2019
81-Cert Electrical Compliance Form.xls
OF SO(/T?,o
# TOWN OF SOUTHOLD BUILDING DEPT.
`ycourm��' 765-1802
INSPECTION
-_
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I ULA
O
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
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DATE INSPECTOR •
oF soulyo�
* TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG. --�-
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [�}] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS:
DATE f INSPECTOR'
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION(1ST) H
------------------------------------
'FOUNDATION (2ND)
z
ROUGH FRAMING& S
PLUMBING y
� 1
INSULATION PER N.Y: y
STATE ENERGY CODE
Vi
FINAL
ADDITIONAL C MMENTS
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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: (631) 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.O.Application
Flood Permit
Examined ,20Single&Separate
Storm-Water Assessment Form
Contact:
Approved ,20- Mail to: t1fts®tJ -Q-i , s
Iy
Disapproved a/c 4)A 6r-A IGY., CA
Phone:
Ex irati ,
D V
Lf B ' din pector
9�9MAY 3 0 2018 APPLICATION FOR BUILDING PERMIT
BUILDING DEPT® -Date "Cky 20
TOWN OF SOUTHOLD 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.
iQ 0 (:;r� pwt C94 )-C--
(Signature of applicant or name,if a corporation)
9� 00of J o,
(Mailing address of applicant) irl
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises U4 c.J, 1
(As on the tax roll or latest deed)
If applicai s a corpora o `I ' nature of duI authorized fficer
Ce.
(N mp'and title`of corporate officer)
Builders L'icense,No
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
Oq'5 _77)ej-e,-ir, m LUCA
House Number Street Hamlet
County Tax Map No. 1000 Section d'�� Block 1- Lot
1
Subdivision Filed Map No. of
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy,
3. Nature of work(check applicable): New Building on Alteration
Repair emoval rAi De olition Other Wor ®l-j
(Description),5L,�J'P.%A"
4. Estimated Cost (tt'too-,,
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of us..
7. Dimensions of existing structures, if any: Front ( Rear Depth
Height Number of Stories
Dimensions
?.
.fa....,rF
Dimensions of same structure with alterations or additions: Front k , r q Rear
Depth Height Number.of Stories..d A 1
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front df�® Rear f t 0 :' Depth `f u
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 Oe
13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YE _X_NO
14. Names of Owner of premises •ddress_ (0% ?_rll:�*'Or Phone o. bsi l{6 — ao m
Name of Architect UAddress Phone No
Name of Contractor Kyo r F y k.('A4-rAddress Q1 01) 10" 9QJPhone I q o. p(—age �q®Iq
P Qtb
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES T40
* 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.
17. If elevation at any point on property is at 10 feet or below, must provide topographical da a 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)
S:
COUNTY OF �Sv R
A-IDNI e6e f s being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named, C NNIE D.BUNCH
Notary P biic,,State of NOW Y®rk
(S)He is the No.01BU6186NO
(Contractor,AgenCorporate Officer etc.) Commission Expires April 14,2-
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 th t the work will be
performed in the manner set forth in the application filed therewith.
Sworn o before me this
day of 2019
, .L t J-c
Notary Public Signature ofApplicant
Scott A. Russell irk- 1222 ATO IRLA I WATEK-
SUPERVISOR IWANAcGf]EAMI]ENT
SOUTHOLD TOWN HALL-P.O.Box 1179 g
53095 Main Road-SOUTHOLD,NEW YORK 11971 2 �- Town of So u th o l d
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOES THIS IPROJ)ECr INVOLVE ANY OF THE E IFOlL1LOWING:
(CHECK ALL THAT APPLY)
Yes Jqo
❑ A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
[:1 P4"'4 B. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
❑m C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
❑[ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
❑r" E. 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 replacement 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 Department with your Building Permit Application.
S
Date-
APPLICANT- (Property OwnerDesign Professional,Agent,Contractor,Other) .C.T.M.lik 1000
#:
P Y , c Q� Ii _� District
NAME. ® 1 V t-K ° DL 4I�
(Pr,n,) ct) r f Block/ r Lot �( f �t `
ISiSnaNlel 'x.K, FOR BUIL ENG DEPAR'EMCN'I 1.Vii. t}.(�L�' 'axx
Contact Information
felephrnie Vmnn.r'
Reviewed By
— — — — — — — — — — — — — — — — — —
Date:
Property Address / Location of' Construction Work: — — — — — — — — — — — — — — — — —
Approved for processing Building Permit.
riv-e_ El Stormwater Management Control Plan Not Required.
f�-� l ®(� ❑ Stormwater Management Control Plan i�Required.
(Forward to Engineering Department for Review.)
FORM 11 SMCP-TOS MAY 2014
l
Town Hall Annex Telephone(631)765-1802
54375 Main Road6�..
P.O.Box 1179 • ro9er.richertCcrtowri soUt�i012d nv Us
Southold,NY 11971-0959
coumi
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: � Jv F:o r-k PODL CRS Date:
Company Name: C-5 i , C
Name: k
License No.: 03 H 15
Address: Ace_ PJ KW I M D a
Phone No.. (owl— m `7[D-7)
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Address:
*Cross Street: C� �(
*Phone No.: Ca3 I _-7q5 ® o'�c1��
Permit No.:
Tax-Map District: 1000 • Section: 11-5 Block: ,5` Lot: 6;
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
ODo�
(Please Circle All That Apply)
*Is job ready for inspection: YES / NO Rough In Final
*Do-you need a Temp Certificate: YES / NO
Temp Information (if needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
Pd
82z-Request for Inspection Form
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NOTE.
s =MONUMENT
O -PIPE
SUBD/VISIOV MAP FILED IN THE OFF/CE
OF THECL ERK OF SUFFOLKCOUNT Y O N
JAN. 28, /965 AS FILENO.4256.
WATER SER.VIC£=PRIVATE WELL
NEAREST PUBLIC WATER MAIN :4MILES
�000--IIS - f
REVISIONS YOUNG &- YOUNG -
400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
ALDEN W. YOUNG HOWARD W. YOUNG
PROFESSIONAL ENGINEER AND LAND SURVEYOR
LAND SURVEYOR. N.Y.S. LIC. NO,'12845 N.Y.S. LIC. NO. 45893
SURVEY FOR: _
a�
APPR VED AS NOTED
,DATE:
FEE: D RETAIN STORM WATER RUNOFF
gy;
PURSUANT TO CHAPTER 236
NOTIFY BUILDING DEPARTMENT AT OF THE TOWN CODE.
765-1,802,8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1-.-FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. 'ROUGH FRAMING & PLUMBING
3. .JNSULATION
4. FINAL - CONSTRUCTION MUST ELECTRICAL
BE COMPLETE FOR C.O. INSPECTION REQUIRED
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE, NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
COMPLY WITH ALL CODES OF '�a t7 l e r_ 4'
� �ad��;:� � SLY
NEW YORK STATE & TOWN CODES EnlcLosE Pool To CODE '
AS REQUIRED AND CONDITIONS OF ytJpON COMPLETION
BCFORE"WATER"
MTHOED D
�trlR7RUSTEES
SLY Mr
—U-w
rn a(,In lLa 1,
OCCUPANCY OR 0 ' Se-�6 &eVs
USE IS UNLAWFUL
WITHOUT CERTIFICATE'
OF OCCUPANCY
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