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Home My WebLink About28923-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29476 Date: 05/30/03 THIS CERTIFIES that the building ACCESSORY Location of Property: 160 TRACK AVE CUTCHOGUE (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 103 Block 12 Lot 2 Subdivision Filed Map No. Lot No_ conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 18, 2002 pursuant to which Building Permit No. 28923-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 ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to MATTHEW RYCHLIK (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. N 359096 07/27/95 PLUMBERS CERTIFICATION DATED N/A tho ized gignature Rev. 1/81 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. 28923 Z Date NOVEMBER 18 , 2002 Permission is hereby granted to : MATTHEW RYCHLIK 160 TRACK AVE CUTCHOGUE,NY 11935 for CONSTRUCT AN ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE IN THE REQUIRED REAR YARD AREA AS APPLIED FOR. THIS PERMIT REPLACES BP#22867 . at premises located at 160 TRACK AVE CUTCHOGUE County Tax Map No. 473889 Section 103 Block 0012 Lot No. 002 pursuant to application dated NOVEMBER 18 , 2002 and approved by the Building Inspector to expire on MAY 18, 2004 . Fee $ 150 . 00 Author ' ed Signfture COPY Rev. 5/8/02 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) d1 a3 ....3....................... Date ................... .. 195... NG 22867 Z Permission Is hereby granted to: P ... ....................... ............. .. ..... ......... .......... �.......... to .... .............: ........... ........ .............. ......... ...... ... .... .... .............- ... ........: .. ............................. . .. .... .......� ... ...... �G............. � .....,fir .... ....................... � ... . .................. .. .y... ................e ...... .. ......... .. .......-......................................................................................... at premises located at....... LQ.c r........... ...... (.Y�..... — /� ....... .............................. .............................................................. ......... ....". ............................. CouniyTax Map No. 1000 Section ..... ..... Block......1 -....... Lot No. ............................ pursuant to application dated ........ Q........................ 19...2.E and approved by the Building Inspector. Fee .. ..... �• ............... . ... ........... ...... ............... Building Inspector Rev. 6/30/80 K/ FormNo.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $ G 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY'` _Ji 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 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. i��2�/`7i /o, 7�D 7.J New Construction: ld or Pre-existing Building: V (check one) Location of Property: House No. S1reet U Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Block Lot Subdivision �� - Filed Map. Lot: Permit No. Date of Permit. 3 Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: V/ (check one) Fee Submitted: $ 6 (!� 03 oWcant Signature THE NEW YORK BOARD OF FIRE UNDERWRITERS r>nCf, BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date Application No.on file THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of HAIHL7i" 1tL T,VENIft , ^;TII'HVCUE, N.Y. in thefollowing location, ❑ Basement ❑ I.st FL l_..' 2nd FL `C�II`3` .Section Block Lot was examined on '�' " ' �� ' and found to be in compliance with the National Electrical Code. FIXTURE �— FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLET$ RECEPUCLECNES INCANDESCENT FLUORESCENT OTHER IMT. K-W. AMT K.W. un 1. KW. AMT, K AMi. M.P. DRYERS j- FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS GEU UNIT HEATERS MULTI.OUTLET DIMMERS AMT. K.W. OIL H.P. GAS H.P. AMi. NO. A.W.G. AMT. AMP. MHT. AMPS. TRANS. pMi. M.P. SYSTEMS AMi. WgtiS NO.OF FEET SERVICE DISCONNECT NO.OF S E R V I C E f AMP. TYPE METER l,e lW 1,a SW 3 9WO 3 X IW NO.Of CC COND. A W.G. NO.Of M AEG A,W.G. NO.Of NEULRALS A.W G. EOWP. PER 8 OF CC.COND. OF HI-LEG OF NFUWAL OTHER APPARATUS: ROSLAK ELECTRIC L1C.tY3677-E F. O.BOX 164 CTJ'TCHI?^IIE, NY, 11935 OL40 ► MANAGER ll Per This certificate must not be altered in any manner; return to the office of the Eoard if incorrect. Inspectors may be identified by their credentials. COPY FOR r^BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 2 1185077 BUREAU OF ELECTRICITY F_ 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date JULY 27,1995 Application No.on file 07424495/95 N 359096 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of MAUM RYCHLIK, 160 TRRACK AVENUE, CUTCHOGUE, N.Y. in the following location; ❑ Basement ❑ /st Fl. ❑ 2nd FI. OUT Section Block Lot was examined on JULY 14,1995 and found to be in compliance with the National Electrical Code. FIXTURE TACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEIPINCANDESCENT1 FLUORESCENT OTHER AMT. I K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'"I TIME CLOCKS NLL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K.W. OIL I H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET SYSTEMS AMT WATTS SERVICE DISCONNECT NO.OF S E R V 1 C E AMT. AMP. TYPE METER 1 X T1 X 33 X 3 W W W 3 X tW NO.OF CC.COND. A.W.G. NO.OF HIAEG A.W NO. NEUTRALS G. A.W.G. EQUIP. PER 0 OF CC.COND. OF HIAEG OF NEUTRAL OTHER A►PARATUS: t ROSLAK ELECTRIC LIC.*3677—E P.O.BOX 164 CUTCHOGUE, NY, 11935 GENEIIIu MANAM, 11 �. Per " This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT.THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. 46 7Aqcelc � C�� 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE /& 'CHIMNEY REMARKS: DATE / d9 INSPECTOR �' 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ) INSUL [ ] FRAMING [ NAL [ ] FIREPLACE A CHIMNEY REMARKS: DATE d INSPECTOR M-11102 BUILDING DEPT. INSPECTION [ ] FOUNDATION i ST ( ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL [ ] FIREPLACE A CHIMNEY REMARKS: TC.� ,e�g; �,✓ Cdr/rn2 � Gr/t r 710 7-7 DATE ✓ INSPECTOR \ FIt*LU INSPECTION REPORT DATE COMMENTS --------__________________________-__________-__-___ I jj ro FOUNDATION ( 1ST) ----- -_ -- - ----_- - \ rc 1111--- -;�------- -- ------------ -- ------------..__ o, ,� FOUNDATION (2ND) _________________ p I II 3`yt•\ II II ROI1f.D FRAMF. 6 ------------- PLUMBING - - tt - ------------ -------------- --------------- ----------- i ii II jj N __----II— ---_-- - --_ ---_. INSULATION PER N. Y. -_------��-- _-- _--- _ - ---_ y STATE ENERGY II 11 -- CODE II --_--------------------- --_____________- t FINAL II ----------------------- — — -------- ADDITIONAL CO NTS: n -- --- -- ---------------- --- 0 d BOARD OF HEALTH . . . . . . . . FORM N0. 1 J SETS OF PLANS . . . . . . . . TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . JUj! r?(f BUILDING DEPARTMENT CHECK . • • • • • - - . . . . . . . TOWN HALL SEPTIC FORtI . . . . . . . . . . . . °- SOUTHOLD, N.Y. 11971 TEL.: 765-1802 1:OT 1 FY i CALL . . . . . . . . . . . . . . . . . Examined .'� / . ., 19 .l Jj � MAIL TO : �j t% (07 Approved . . / �. . . . . . . ., 19/. ./Permit No. . . . . . . . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) A P CATION FOR BUILDING PERMIT Date . . .6f ZU. . . . . . . . ., INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 street or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli cation. 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 issued a Building Permit to the applicant. Such permii 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 whatever until a Certificate of Occupanc} shall have been granted by the Building Inspector. APPLICATION IS HEREB E to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ord in f Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for tine gs, additions or alterations, or for removal or demolition, as herein described. The applicant aggr licable laws, ordinances, building code, housing code, and regulations, and to admit authorized ' rases and in building for necessary iBspections. /Z.C,7L-C' �'' S. . . . . . . . . . . . . . . -- (Signature of applicant, or name, if a corporation) 00�. . �9; . . �0:Z77;24?/c: ',- - - (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..-. . . . . . . . .. . . . . . . Name of owner of premises . . . . . . . . . �.�Tr/a.w. . . . / ( .�./• X �.��. . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) If appl' rat is a corporation, signature f duly authorized officer. . . . . . . . . . (Name an Lt e of corp e officer) I. Builder's License No. . . . r.� . g �. . . &7.. . . . . JUPI 19?a Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . I . Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f.t. . . . . . . . . . . . . . . . . . . . . . �ZlikK. . .zq�lb. . . . . . . . . . . . . . . . . . . .!CAZ#y cpc. . . . . . . . . . Ilouse Number Street llamlet County Tax klap No. 1000 Section . . . . . . . . . . Block . . . . . .� . . . . . . . . . Lot . — . .� . . • • • . • • Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 1. State e\ishng use and occupancy of premisesand intended u5c and occupancy of proposed construction: a. Existing use and occupancy �.0�� Ze . . . . . ... . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . . . . . . . �V �� 9L. . )-�l�f . . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . , . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . : . . . . . . . . . Other Work . . . . . . . . . . . . . , . (Description) 4. Estimated Cost . . . . . . . . . . .9 `C'. . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units oil each floor . . . . . . . . . . . . . . . . Ifgarage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . , . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 . . . . . . . . . FJ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . ./.t'9. . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . '.. . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: es , No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . Phone No. . . .q Name of Contractor . . 4f . , . . Address . P? . .. Phone o. . . ! 7 r. . . . . . . . . . 15. Is this property within 300 feet of a tidal wetland? *Yes. . . . . . . . No, . . . . . *If yes, Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all setback dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether Interior or corner lot. AP R VEDAS NOTED U ° TAE 3 a.P.# „ r r NOTI BUILDING ONAPMENT AT 3 765-1803 B AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: t �� I. FOUNDATION - TWO REQUIRED =A FOR POURED CONCRETE r I. ROUGH . FRAMING & PLUMBING R KATE 3. INSULATION 9 -FINAL CONSTRUCTION MUST lk f 4 BE COMPLETE FOR C,O, ALL CONSTRUCTION SHALL- MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS FATE OF NEW?' RX, OUNTY O!' . Lfz /r�L,<n< . . ,S�.S! 7�, /ro.nkd� ! .!7. : . . ! '� Y. . . P1 ' . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) )ove named. isthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . (Contractor, agent, corporate officer, etc.) said owner or owners, and is duly authorized to perforin or have performed the said work and to make and file this plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the )rf; will be performed in the manner set forth in the application filed therewith. orn to before me this . . . . . . . . . . . . . / . . . . . .day of. . . . . . . . . . . . . . . . . . . ., 19 r �Mary Public, . . . : . . . . . . ciet;: �� untY Notary Public, to of NY X4790982.Su olk'County C .X. COMM.Expires Nov.30, 197J vire-0f ap I ica I `ra• s N koOZ 9 9' 400 S i Z Ot Y f Y / L 6 r 4�a C, (P (P ap , -t- 2 Epi 0 p0 of ,lip ppt� (Ott 0� �D roti o� I 04 /a3 t/ SURVEY FOR Ml� 2YC,g b- K' AT CUrcu-19 UE - DATE- —AUO. 9, 1978 TOWN OF SOUfNOI:D SCALE: / ,,, x ; 50 SUFFOLK COUNTY, NEW YORK No. ;08 ',:488 NOTE *UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED TO• '� N = MONUMENT FOOPM SURVEY IS A VIOLATION OF SECTION 7209 OF THE usx1drETI7LE R TJV NY OF NEW YORK STATE EDUCATION LAW. R COPIES OF THIS SURVEY NOT BEARING THE LAND N£W YOAK SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SMALL yp(1T//O� ,�q �RBtD '0 r"Y NOT BE CONSIDERED TO BE A VALID TRUE COPY. *GUARANTEES INDICATED HEREON SMALL RUN ONLY TO pN/L/P B A N ..t THE PERSON FOR WHOM THE SURVEY IS PREPARED, G7 AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- MENTAL AGENCYAND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTITUTION.GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT �'p 45Sg3 OWNERS. it DISTANCES SHOWN HEREON FROM PROPERTY LINES AJF X00. _ TO EXISTING STRUCTURES ARE FOR A SPECIFIC N so PURPOSE AND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR THE ERECTION OF FENCES. 400 O.4TRA'NDE$ 'wwf YOUNG a YOUNG RIIVERHEAD, NEW YORKUE ALDEN W.YOUNG,PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.S.LICENSE NO.12845 HOWARD W.YOUNG,LAND SURVEYOR . 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