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HomeMy WebLinkAbout25153-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-27478 Date: 12/18/00 THIS CERTIFIES that the building ADDITION & ALTERATION Location of Property: 1700 SAGE BLVD GREENPORT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 53 Block 5 Lot 12.8 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 2, 1998 pursuant to which Building Permit No. 25153-Z dated SEPTEMBER 2, 1998 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 ADDITION & ALTERATIONS WITH TWO DECKS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DENNIS KEDJIERSKI (OWNER) of the aforesaid building. SUFFOLK CO~E~TY DEPARTMENT OF ~IEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A H-046036 07/05/95 12/12/00 DENNIS KEDJIERSKI 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. 25153 Z Date SEPTEMBER 2, 1998 Permission is hereby granted to: for : DENNIS KEDJIERSKI 1700 SAGE BLVD. GREENPORT~NY 11944 CONSTRUCT AN ADDITION & DO ALTERATIONS WITH 2 DECKS TO AN EXISTING ON FAMILY DWELLING AS APPLIED FOR & TO THE COND. OF TRUSTEES#4215 & DEC 1-4~ at premises located at 1700 SAGE BLVD GREENPORT County Tax Map No. 473889 Section 053 Block 0005 Lot No. 012.008 pursuant to application dated SEPTEMBER 2 1998 and approved by the Building Inspector. Fee $ 536.20 Buildin~ Inspect~ ORIGINAL Rev. 2/19/98 Form 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 inspector with the following: for new building or new use: i. Final survey of property with accnrate' location-o-f-Al-1%uildings, 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 o{ 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Ppre-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 a 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 Buildinm - $i00.00 3. Copy of Certificate of Occupancy - , 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 t /~?/~ / Da e ...... ../../._ ........................... New Construction ........... Old Or Pre-existing Building ................. Location of Property 17Oo ~&~ ~k~'~, House No. Street Hamlet Onwer or Owners of Property....~ .~.A;..~.,.S..'.~..k~..~. !.~?.~ .~.'~. ....................................... County Tax Map No 1000, Section .............................. Lot ...................... Subdivision .. Filed Map ~- i'Ll% Permit No Date Of Permit Applicant Health Dept Approval · Underwriters Approval v------ Planning Board Approval ........................ / Request for: Temporary Certificate ........... Final Certicate..~... ...... Fee Submitted: $ .... ..~.~ ................... COt~M£NT~ ' · ' '. ........ ' SULATIOH PER'~. Y. STATE EHERGY CODE FI;;AL '. Town Hall, 53095 Main Road P. O. Box 1179 Southold, NewYork 11971 Fax (516) 765-1823 Telephone (516) 765-1802 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION DATE: Building Permit No. ~b5 A~'~ -2.2. (please print) Plumber: D FN~L5 ~.~'JP~3'"IE~, (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ( P lumbers S i~nature ) Sworn to before me this lc=Q- day o f~Fd-~z3 ~/l Notary Public, Jt~f~$~ , C~unty NOTARY PUBLIC, State of New No._01ST6008173. Suffolk County I erin Expires June 8, Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Fax (516) 765-1823 Telephone (516) 765-1802 DEC. 11, 2000 MR. & MRS. DENNIS KEDJIERSKI P.O. BOX 438 SOUTHOLD, N.Y. 1971-0438 To Whom This May Concern: We are unable to complete your Certificate of Occupancy because of the following reasons: An application for Certificate of Occupancy is not on file. (Enclosed) No Underwriters Certificate on file. The check is (not on file.)$25.00 No Health Department Approval on file. No final inspection has been made. XX No Pluraber Solder Certificate on file. (Ail permits involving plumbing being issued after April 1, 1984). BUILDING PERMIT # 25153-Z Please contact our office on this matter. cooperation. Thank you for SOUTHOLD TOWN BUILDING DEPT. STATE OF NEW YORK ) ) ss CQUNT~ QF SUFFOLK ) being duly sworn, deposes and says That deponent ~s over the age of 18 years and resides al That on the '? day of 2000 deponent archdect/eng~neer, licensed by the State of New York, hereby states that s/he accepts full responsibility for the accompanying plans compliance with the New York State Fire Prevention and Building Code (9 NYCRR); said plans pertain to property located at SCTM# 1000- 5-3 - ~-- £~, ~© street address Architect/Engineer Sworn to befq, re me this of ooo. Notary Public HELLENE D. HORNE Notary Public, State of New York No. 4951364 , Qualified in Su[folk cc: A~'Sfl'~f~" Expires May 22, / I oard Of $outhold Town Trustees SOUTHOLD, NEW YORK PERM!T NO. 4215 DATE: .. 5/26/94 ISSUED TO ..... DENNIS KJ&DJIEi~SKI Aulhorizalion Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New. York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the ' REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Beard adopted at a meeting held on 5/26/94 19 .04, and in consideration of the sum of $ 150.00 paid by . .Dennis Kedjierski of ...... Southold , N.Y. and subject to the Terms and Conditions Ihted on the reverse side hereof, of Southold Town Trustees aufhorlzes end p. ermlts the followinc Reconstr. 1-faro. dwell, add. 2nd fl. & 7~ front porch, a 27'X20' 2-car gar. remove 2,000st concrete park. area, remove small smoke house & shed, remove 1,500st concrete patio, 2 replace with 12~X20' timb. deck & stairs, replace timber pier P nail mn accordance w,fh the dele,led spec,f,caflons as presented ,n pilingfhe originating application, pier, cdnst. 6'X40' floating dock extef~sion for gang way, install water & elect, service to Sage IN WITNESS WHEREOF, The said Board of Trustees here- Basin by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this dat,e. NEU YORK STATE DEPARTMENT OF EBVIRONMENTAL CONSERVATION DEC PERHIT NUMBER 1-4T58-00936/00001-0 FACILITY/PROGRAM NUMEER($) PEr'lIT Under the Envirereente~ Conservation LaY EFFECTIVE DATE JuLy 8, 1994 EXPiRATiON DATE(g) July $1, 1997 .~_~YPEO~PERMIT ·Nee QRene~a[ OMedification DPermit to Construct QPermit toOperate · Article 15t Title 5: Protection · 6NYCRR 608: Water Quality of Waters Certification Article 15, Title 15= Uater B Article 17t Titles 7, 8: SPDES Supply D Article 19= Air Pollution Article 15~ Title 15: Water Control Transport D Article 23, Title 27= Mined Land Article 15, Title 15: Long Reclamation island UeLLs D Article 24: Freshwater UetLands Article 15~ Title 27: ~tLd~ Scenic and Recreational Rivers · Article 25= Tidal Wetlands Other= PERMIT ISSUED TO Dennis Kedjierskl ADDRESS OF PERHiTTEE 5 Sandy Drive Smithtown, NY 11787 CORTACT PERSON FOR PERMITTED ~ORK NAME AND ADDRESS OF PROJECT/FACILiTY Kedjierski Property Sage BLvd. Arshemomaque!Sage Basin connecting to SouthoLd Bay LOCATION OF PROJECT/FACLLITY SCTM IOD0-53-5-12.2 & P/O 12.3 D Article 27, Title 7; 6BYCRR 360: Solid Waste Managenmnt D Article 27, Title 9; 6NYCRR 37"5; Hazardous Waste Narmgement D Article 34: Coastal Erosion Management D Article 36: FLoodplain Management D ArticLes 1, 3, 17, 19, 27, 37; 6GYCRR 380; Radiation Control ITELEPHOBE NUNSER 516-724-6491 TELEPHONE NUMBER COUNTY TOUR Suffolk SouthoLd WATERCOURSE ~ NYTM COORDINATES Sage Basin connecting to I SouthoLd Bay CESCRIPTIQ~ O:/[JlEtil7m/~31'IVI'IY ALterations & additions to an existing single family dwelling, including 2nd story addition~ garage, front porch, grave[ driveway~ decks, 6 foot Ride timber pier ~ith associated ramp~piLest f[oat~ electric & water, and stairway ,ith platform. This proposal also includes removal of existing concrete and concrete rubble, removal of existing solid fill dock, fi[[ and plantings. ALL ~ork in accordance ~ith p[ana stamped RYSDEC approved July 8, 1994. By acceptance of this permit~ the permittee' agrees that the permit is contingent upon strict compliance uith the ECL, all applicable regulations, the General Conditions specified (see page ~) and any Spocia[ Conditions included as part of this permit. DEPUTYGeorgeCHIEFw. HammarthPERHIT ADMiNiSTRATOR: I ADDRESS DATE I 7/11/94 Page of 6 ~ CE~DITI~ · ! nspect ior~s 1. The permitted site or facility, including relevant records, is subject to in- spection at reasonable hours arzJ intervals by an authorized representative of the Deparl~'ent of Enviro~'ental Conservation (the Deparb~unt) to determine ~ether the permittee is c~'plying with this permit and the ECL. S~ch represen- tative rray order the work suspended pursuant to' EC~ 71-0301 ar~ SAPA 401(3). A copy of this permit, including all referenced maps, drawings and special c6nditions, rmst be available for inspection by the Depar~n~nt at all tirres at the project site. Failure to produce a copy of the permit upon request by a Depar~q"ent representative is a violation of this permit. Permit 2. Other 6. Ghanges and ~ I s The Deparb~ant reserves the right to rrodify, suspend or revoke this permit ~hen: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the ECL and pertinent regula- tions is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) newmaterial infor~'ation is discovered; or d) envirom'ental conditions, relevant technology; or applicable law or regulat ion have material ly changed since the permit v~s issued. 3. The permittee rrust s~bmit a separate written application to the Deparb~nt for renewal, m2dification or transfer of this permit. Such applicationmust include any foms, fees or supple'r~ntal info.~tion the Departrrant - requires. Any rene~al,,rr~ification or transfer granted by the Deparb~ent trust be in writing. 7'ne permittee must subnit a ren6wal appl ication at least: a) 180 days before expiration of permits for State Pollutant Discharge El imination Syste"n (~,,PEES), Hazardous V~ste M~nagsment Facilities (}~WF), major Air Pollution Control (ACC) and Solid ~ste Management Facilities (?~=); and b) ~'~ days before expiration of alt other permit types, 5. Lhless expressly provided for by the Departrrent, issuance of this pecmit does not rrodify, supersede or rescind any order or determination perviously issued by the Depari~ent or any of the tern's, conditions or re.quir,~rents contained in such order or determination. ' Legal Ct~l igat ions of PermJttee The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all da"rages, direct or indirect, of ~hatever nature and by vC~rr~ver suffered, arising out of the project described in this permit and has agreed to indemnify and save harmless the State from suits, actions, d~ages and costs of every ha're and description resulting frcm this project. 7. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the irrpaim'ent of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 8. The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-of-v~y that may be required for this project. Page 2 of 6 95-20-6a (7192)-- 25c ADDITiONAl. GENERAL CONDITIONS FOR ARTICLES 15 (Title 5), 24, 25, 34 9~ That if future operations by the State of New York require an al- teration in the posit~on of the structure or work herren authomzed, or if, in the opinion of the Department of Environmental Conservation 13 -. ~it.shall cause unreasonable obstruction to the free navigation of said ware. rs or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstruchons, or hazards caused thereby without expense to the State, and ~f, upon the expiration or 14 revocation of this permK, the structure, fill, excavation, or other i~od~ficat~on of the watercourse hereby authonzed shall not be com- 15 pleted, the owners, shaH, w~thout expense to the State, and to such extent and in such time and manner as the Department of Enwronment'al Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to ~ts former condition the navigable and flood capacity of the watercourse. No claim shall be made against 10 That the State of New York shall In no case be hable for any damage 16 by or result from future operations undertaken by the State for the 11, Granting of this permit does not relieve the apphcant of the responsl- 17 the U.S. ^rm¥ Corps of Engineers, U,S, Coast Guard, New York State Office of Genera] Serwces or local government which may be required. of any wetland or waterway by suspended solids, sediments, fuels, TIDAL WETLANDS and 6 NYCRR Parl 608 ( ) other environmentally deleterious materials associated with the project Any material dredged in the prosecution of the work herein permitted shall be removed evenly, w~thout leaving large refuse pdes, ridges across th? bed of a waterway or floodplain or deep holes that may have a tendency to cause damage to navigable channels or to the banks of a waterway There shall be no unreasonable interference with navigation by the work herein authorized, If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any port,on of the uncompleted structure or fdl and restore the site to ~ts former condition. No claim shall be m~de against the State of New York on account of any such removal ot alteration. If granted under 6 NYCRR Part 608, the NYS Department of Environ- mental Conservation hereby certifies that the subiect project will not contravene effluent limitations or other hmltatlons or standards under Sections 301, 302, 303, 306 and 307 of the Clean Water Act of 1977 (PL 95-217) provided that all of the conditions hsted hereto are met All activities authorized by this permit must he in str*ct conformance with the apprQved plans submitted by the applicant or his agent as part of the permit application Such approved plans were prepared by D. KEDJIERSKI LAST REVISION on 6/28/94 (PAGES 1-4) SPECIAL CONDITIONS Any debris or excess material from construction of this projeot shall be completely removed fromthe adjacent area (upland) and removed to an approved upland area for disposal. N~ debris is permitted in tidal wetlands. There shall be no disturbance to vegetated tidal wetlands as a result of the permitted activity. The storage of construotion equipment and materials shall be confined to within the project work site and/or upland areas greater than 15 4. Floats and ramps may not rest on vegetated tidal wetlands. No permanent structures may be built on dock without first obtaining Department approval. Docks may not (a) extend laterally beyond property lines, (b) be placed so that docked boats extend over adjacent property line, (c) interfere with navigation, (d) interfere with other landowners riparian rights. To protect the values of the tidal wetland, a permanent vegetated buffer zone shall be established. There shall be no disturbance to the natural vegetation or topography within an area extending ~5 linear feet landward of the t-ida-t--wet-~a~d-boundary. ~]-4738-00936/0000]-0 Page 3 of 6 NEW YORK STATE DEPARTMENT OF ENVIRONMENIAL CONSERVATION SPECIAL CONDITIONS 25 Tidal Wetland For Article. ( A row of staked hay bales or approvable erosion control devices shall be placed 15 feet landward of the tidal wetland boundary at commencement of regulated activities and remain in place until project is completed and all disturbed areas stabilized with vegetation. 9e Roof runoff shall be directed to drywells a minimum of 55 linear feet landward of the tidal wetland boundary for immediate on-site recharge. 10. Road, driveway, and/or parking areas shall be graded to direct runoff away from tidal wetlands. 11. No dredging is authorized as part of this permit. 12. No fill other than the 3 cubic yards shown on the approved plan, has been authorized. 13. This permit is not automaticly transferable upon sale of property. Permits may be transferred upon written request to the Division of Regulatory Affairs SUNY Bldg #40, Stony Brook, NY 11790 with permission of permittee to a new owner. 14. Ail areas of soil disturbance resulting from this project must be stabilized immediately following project completion or prior to permit expiration, whichever comes first. Plantings must be inaccordance with letter from the U.S. Soil Conservation Service to Mr. Kedjierski dated April 8, 1994 and the NYSDEC approved plan. 15. NOTICE COVENANT The permittee shall incorporate the following language as a notice covenant to the deed: "Regulated tidal wetlands associated with the subject site (Sage Blvd. Arshamomaque) are located at S~FFOLK County Tax Map Number: District 1000, Section 53, Block 5, Lot 12.2,P/O 12.3 otherwise known as the properties of Dennis Kedjierskl and his heirs, assigns or successors. This property is subject to the provisions of New York State Environmental Conservation Law (ECL) Article 25 or its successor, and the conduct of regulated activities may occur only pursuant to ECL Article 25 if prior approval is given by the New York State Department of Environmental Conservation (NYSDEC) or its successor. Regulated activities include, but are not limited to the erection of any structure(s); excavation; dredging grading and filling; DEC PERMIT NUMBER 1-~738-00936/00001-0 FACJ'[q.Y ID NUMBER PROGRAM NUMBER Page 4 of 6 9:5-20-6f 7/87--25c NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 25 SPECIAL CONDITIONS Tidal Wetlands For Article_ (_ 3 clearing of vegetation; and application of chemicals." This deed covenant shall be recorded with the Clerk of SUFFOLH County within 90 days of the issuance of this permit. A copy of the covenanted deed or other acceptable proof of record, along with the number assigned to this permit, shall be sent within one calendar year of the issuance of the permit to: NYSDEC, Regional Manager, Bureau of Marine Habitat Protection, SUNY Bldg. 40 Stony Brook, New York 11790-2356. SUPPLEMENTARY SPECIAL CONDITIONS (A) THRU (F) ATTACHED. DEC PERMIT NUMBER I-~738-00936/00001-0 FAC~tT~-y ID NUMBER PROGRAM NUMB[R Page 5 of 6 Albert J. Kmpski, President John Holzapfel, Vice President William G. Albertson Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hail 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 May 27, 1994 Mr. Dennis Kedjierski 5 Sandy Drive Smithtow~ NY 11787 BLD Re: SCTM 953-5-12.2 Dear Mr. Kedjierski, The following action was taken by the Board of Town Trustees during its regular meeting held on May 26, 1994 regarding the above matter: WHEREAS, DENNIS KEDJIERSKI applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, as per revised survey dated March 10, 1994, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 26, 1994 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board mer~bers have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW TttEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of DENNIS KEDJIERSKI to reconstruct an existing single family dwelling, adding a second floor, a 7' front and side porch and gravel driveway. Construct a 27' X 20' two car garage on the existing concrete parking area and in addition, remove approx. 2,000 s.f. of concrete parking area from in front of the house. Also remove a small concrete block smoke house and shed. Remove approx. 1,500 s.f. of concrete patio and two concrete ramps from the rear and sides of the house as per the drawing, and replace it with a 12' X 20' timber deck, and stairs attached to the rear of the house. Replace the solid filled timber pier with an open piling pier. Construct a 6' X 40' floating dock (with a 5' X 10' extension for a gang way) on four pilings at the end of the existing pier. Install water and electric service to the dock. Located Sage Blvd., Arshamomoque, Southold. SCTM ~53-5-12.2 Permit will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. CAC Bldg. Dept. 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ]FRAMING /~ [~I~INAL REMARKS~/~.~ --~ ~ ~ -/ / / /" 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION tST [ ] FOUNDATION 2ND [ ] FRAMING [ ] ROUGH PLBG. [[ .~ATION [ ] FIREPLACE & CHIMNEY 765-1802 BUILDING DEPT. INSPECTION ] FO/UNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL // DATE /(~) / I*"~ lq ~-~ INSPECTOR 1U-1~02 BUILDING DEPT. NSPECTION [ ~/FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ]INSULATION FRAMING [ ]FINAL 785-~80Z BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION DATE~-~~INSPECT~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ .] ROU~aH-PL'~G.~ [ ] FOUNDATION 2ND [ ~ INSULATION [ ] FRAMING [ ]FINAL [ ] FIREPLACE & CHIMNEY INSPE~ 765-1802 BUILDING DEPT. INSPECTIO/N [ ] FOUNDATION 1ST [,d~] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ ] INSULATION [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ~ROUGH PLBG. [[~FFRAUMN IDNA~ION 2ND i i IFNINSAU~ATION [ ] FI REPLACE & ~.~/~_N_.E.~Y_~ REMARKS: DA*' /~h~ 765-180:) BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ [ ] FOUNDATION 2NO [ [~--]"F~MING [ [ ] FIREPLACE & CHIMNEY ROUGH PLBG. INSULATION FINAL R£MARKS:~ DATE: ~ I N SPECTOR _~~'?~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 8~ro~4~5 BUREAU OF ELECTRICITY ~- 40 FULTON STREET, NEW YORK, NY 10038 Date' DECE}'~ER 13,20~;~ Application No. on file i~:898B97/97 H 070148 THIS Cr:RTIFIES THAT only the electro'cai eqnipment as described below and introduced by the applicant named on ~hq above application nttmber is Jn the premises of DENNIS KEDJIERSKX, 17OO SAGE BI/VD. ~ GRE,~NPORT, ~Y~ in the following location; ~ Basement [] 1st FI. [] 2nd FI. GAR/aTr~C/©UT Section Block Lot was examined on D'I~C]~}~]~ 04,2~103 and found to be in compliance with the National Electrical Code.. OUTLETsFIXTURE RECEPTACLES SWITCHES INCANDESCENt OTHER 57 24 J."YEt. I FUi ?A"L'2CEFE22 RANGES SPECIAL REC'PT. AMt. AMP, 1 9.5 1 7.3 i 1.2 tIME CLOCKS BELLIUNITHEATERSUNIT HEATERS MULTI-OUTLET II sERvicE DISCONNECT ~ NO. OFI S METER 200 I ! X EXHAUST FANS DIMMERS T' ;; E R ¥ I C NO, OF CC COND. A.W.G. NO. OF NEU?RAI.S A.W.G. PER · O{= CC COND. OF N~UTI~AL 1 2/03 NO. OF HI,LEG OF HI-LEG 2/0 I~I%RLPOOL BA~; WELL PUI,~ AIR CONDITIONERS-2 1.5TON- 1 2.5 TON-1 POWER TO BOAT DOCK -2 50 ~P ~CPT-1 ~TORS;1-1.5 H.P. ,1-2.5 H~P. ,2-F H.~ P~E~O~D~,2-1 CIR. 60 <<< Co.tin.ed on Page 2 >>> GENERAl. blANAGER This certlflcote must not be altered In any manner; return to the office of the Boord if Incorrect. Inspectors may be Identified by their credentials, COPY FOR BUILDING DEPARTMENT. THIS DOPY OF CERTIFICATE MUST NOT BE ALTEREb IN ANY MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS ~6~,~35 BUREAU OF ELECTRICITY ~ 40 F~ULTON STREET, NEW YORK, NY 10038 D~e DECE~ER 13,2~ ~pt~a~. No. on~v t/~97/97 ~{ ~70148 THIS CERTIFIES THAT on~ ~e e~c~al equ~ment ~ desc~ed be~w and in.educed ~ ~e aDD,cant ~med on ~ above applicon nu~er ~ in ~e prorates ~ DENNIS KEDJIERSKI, 17q)~ SAGE BLVD. ~ GREE19PORT, N-~' w~ examined on DECE~ER ~4 ~ 2~ and fout~ to be in complY.ce with the NaHonal Elec~aI Code.. f ~RE ]~C=~,~,==~ mm,~u== ] FIX~RES RANGES COOKING DECKS OVENS DISH WASHERS I EXHAUST FANS O.L~ ............... INCANDENE~ KUORE~ENT OTHER ; ,T. K.W. ~,T. ~.W. ~.1, K.W. %MT. K.W. i AMT. H.P. I SERVICE DISCONNE~ ~T~F} S E R V I C ~ S~-IOZ(E DETECTOR: - 5 DENNIS KEDJIERSKI 5 SANDY DRIVE SMITHTO%~N, NY, 11787 Per i~GENERAL MANAGER This certificate must not be altered In any manner; return to the office of the Board if Incorrect. Inspectoxs may be identified by their credentials. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER, THE NEW YORK BOARD OF FIRE UNDERWRITERS 8054977 BUREAU OF ELECTRICITY ~' ,~ E5 JOHN STREET, NEW YORK, NEW YORK 10038 Date' JULY O5,1995 4 t~.tionMo o. fite ~7337595/95 H e46036 THIS CE~IFIES THAT o~y the electrical ~uipment ~ ~scrib~ below a~ int~uced by t~ applicant ~d on the o~e application number in the prorates of D~NNIS ~D~H~, 17~ SAG~ BL~., ~ 1~-53-5-12.8, G~ENPOR~, u~s examined on ~ 26,~995 and found w be in compliance with the NaMonal Elect~c~l Code. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLfTS SWITCHES FLUORESCEN? OTHER DRYERS OTHER APPA~RATU$: S E R I C . O~.~.CC~CON~ O~%C. CO.~. 2/0 NO. OF HI-LEG NO. OF NEUTRALS A.W G. OF NEUTRAL 1/0 5 SANDY DR/V~ SMITHTOWN, NY, 11787 OBNI~I~AL MANAGER 11 This certificate most not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BULD NG DEPARTMENT TH S COPY OF CERT FICATE MUST NOT BE ALTERED IN ANY MANNER. ~eeeeeeeeeeeeeeeeeeeeeee I; 1 ll i · To N SO T.OLD [JLII ,]111 2 2 1994 )[~!BUILDING DEPARTMENT xamined .. ..... , Disapproved a/c ..................................... (Building UILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURVEY ................... ~CIIECK .................... SEPTIC FORM .............. MAIL TO: Date .-7/. -~ x- 19 ?q , 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 giving a detailed description of layout of property must be drawn on the diagmm 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 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. A~PPLICATION 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 applicfi~nt, or name, if a corporation) ...r. ?..~?.r...~.¢.~.,...s ~ ;?..qo~ q..~. y..t.t 7?. 7 .... (Mailing address of applicant) State whether applicant is owner, .lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ~ . .~. .v. . .,Cff<-. . .... (. ?.~. g. ?;?8. . . .'7,/f. .~.o,/.q.~. .................................................. Nameofownerofpremises E~'I~1~ o~ ~tl[;~ F, K)£L/~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ......................... Plumber's License No .... l ~2~ 'ii~L' i;'illi ' Electrician's License No.. Other Trade's License No. 1. Location of land on which proposed work will be done .................................................. ,70o Hou~ Number Street Hamlet County Tax Map No. 1000 Section ........ ?~ ....... Block .... ~ ........... Lot. ?~; Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructiog: a. Existing use and occupancy ................ ~ .................................................... b. Intended use and occupancy ~t~'*g~ ~a~th ~$~eg~ ' Nature of work (check which apl~licable): New Building . Repair .............. Rem< Estimated Cost .. ~.~, .%. q .o .0... 5. If dwelling, number of dwelling · If garage, number of cars ..... 6. If business, commercial or mixed 7. Dimensions of existing structure,, Height . . 7./fi/ ......... Num] Dimensions of same structure wi~ Depth ..... ~.~ .12 .......... 8. Dimensions of entire new constn Height ............... Numl 9. Size of lot: Front .... iq.,. ~.~ '.. 10. Date of Purchase .. ?/.~.~./fl.q. 1 1. Zone or use district in which prei Addition ...~. J~ite~ati~n~,:~ ~al .............. Demolition .............. Other Work ............. j (Description) ........... Fe ............. e ...... - .......... ? '-,L' ',, ',.~' '=~,: , . · (to be paid filln~!h,l~;~gpl~Bon) nits .... ( ..... Number of dwelling units on each floor ............... occupancy, specify nature and extent of each type of use ...~ .... ,if any: Front.~ .~.t.[,[ ...... Rear .. yj.t ......... Depth..~;. [~.....,.,. ........ ~er of Stories / ................ 'i .............................. alterations or additions: Front .............. Rear .. q~ ~ .......... . HeiSt ..... ~.q ~ ~.'~ .......... Number of Stories .. g. .................. ction: Front ............... Rear ............... Depth ............... ,ar of Sto~es . .' ........ ;, .................................. - ......~. .... ........ " ............. GVfi'; k' hi32' ......... ........ ' ....... Name of Fomer Owner ............................. discs am situated ..................................................... 12. Does proposed construction viola te any zoning law, ordinance or regulation: ~ o 13. Will lot be regraded . .¥.q~. .... I' ' '.: '> ....L',~ ..... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~,~.qqs~j!. ( .~Ae..~.~?.,.~... Address .o.~.~.~.r~ ~.~.'ri.~.~..~. ... Phone No. Name of Architect .. ~.k¢ I ' ' i ............... Name of Contractor, ~'~' ]" ~ i ] ............. Address . . Phone No ................ ...... , .............. Address . Phone No ................ 15. Is this property within 3~0 feet of a tidal wetland? *Yes...~ ..... No ......... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~ umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, z COUNTY OF,.~!~. S~.S ....... ~.fT.n.~.i.S.,./.~ ~.. B.3~'. !..~..S ...~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signiflg contract) above named. He is the ~> ~ ~ ' (Contractor agent corporate officer etc ) of said owner or owners, and is dulyi 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. Sworn to before me this .......... ~..c~. ......... day of ,i ,)'/,~ Notary Public~ .~.: ~ .~nty No. 4961364 ~- ture of applicant) Qualified in Suffn k County -~,,~,~.e~, ~. Commission Expires Ma~ 22, 19 / ' , .,~,