HomeMy WebLinkAbout26986-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29220
Date: 01/27/03
I~{IS CERTIFIES that the building ADDITION
Location of Property: 425 SKUNK LA CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 97 Block 4 Lot 1
Subdivision Filed ~p No. __ Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 21, 2000 pursuant to which
Building Permit No. 26986-Z dated DECEMBER 21, 2000
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 PORCH ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
Ge certificate is issued to GREGG M & DOROTHY M KONARSKI
( OWNER )
of the aforesaid building.
SUFFOLK COUIF~YDEPARTMENTOF~R~_L~TIA~PROVAL N/A
ELEC~{ICAL CERTIFICAI~E NO. 1106753 01/06/03
PLUMBERS CERTIFICATION D~r~D N/A
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUIT~ING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 26986 Z Date DECEMBER 21, 2000
Permission is hereby granted to:
GREGG M KONARSKI
425 SKUNK LA
CUTCHOGUE,NY 11935
for :
DEMOLITION OF EXISTING FRONT PORCH & CONSTRUCTION OF NEW PORCH FOR
A SINGLE FAMILY DWELLING AS APPLIED FOR. REPLACES 25547Z.
at premises located at 425
County Tax Map No. 473889 Section 097
pursuant to application dated DECEMBER
Building Inspector.
SKUNK LA CUTCHOGUE
Block 0004 Lot No. 001
21, 2000 and approved by the
Fee $ 75.00
Rev. 2/19/98
ORIGINAL
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. 25547 Z Date FEBRUARY 18r 1999
Permission is hereby granted to:
GREGG M KONARSKI
425 SKUNK LA
CUTCHOGUErNY 11935
for :
DEMOLITION OF THE EXISTING FRONT PORCH AND CONSTRUCTION OF A NEW
PORCH FOR A SINGLE FAMILY DWELLING AS APPLIED FOR.
at premises located at 425
County Tax Map No. 473889 Section 097
pursuant to application dated JANUARY
Building Inspector.
SKUNK LA CUTCHOGUE
Block 0004 Lot No. 001
29 1999 and approved by the
Fee $ 75.00
ature
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 Department with the following:
Ao
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
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
New Construction: d/
Location of Property: ~ ~, 5'~
House No.
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
Subdivision
Date.
Old or Pre-existing Building:
Street
(check one)
Ha-ml¢i O
Block
Lot /
Filed Map.
Permit No. ~ Date of Permit._~ecemleg 2// ~aVApplicant: ~t~75,
Health Dept. Approval: Underwriters Approval:
Lot:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ /~5'~,1fl61 .
Final Certificate:
/ (check one)
-App(~nt Sighature- '
BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD Of FIRE UNDERWRITERS
BUREAU Of ELECTRICITY
40 FULTON STREET- NEW YORK, NY 10038
CERTIFIES THAT
Upon the application of upon premises owned by
SABAT ELECTRIC GREGORY KONARSKI
50 PAT LANE 425 SKUNK LANE
MATTITUCK, NY 11952, CUTCHOGUE, NY 11935
Located at 425 SKUNK LANE CUTCHOGUE, NY 11935
Application Number: 1106753 Certificate Number: 1106753
Section: Block: Lot: Building Permit: BDC: NS11
Described as a Residential occupancy, wherein the premises electrical system consisting of Fa
electrical devices and wiring, described below, located in/on the premises at: ~
First Floor, Outside, Porch/Deck,
was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was
found to be in compliance therewith on the 6th Day of January, 2003.
Name QTY Rate Rating Circuit Type
Additional Charges
Rough inspection by R. Richert
on 12/13/02
Wiring and Devices
Receptacle 4 0 General Purpose
Switch 4 0 General Pm-pose
Fixture 3 0 Incandescent
Paddle Fan 1 0
seal
1 of 1
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
SKUNK L A NE ( BAY AVE. )
BUILDING PERMIT REVIEW CHECK LIST
Application Name: KO}~/:}/~Sj/-2~- CC~'626
Architect/Engineer: Date Submitted:
SCTM #: District: 1,000 Section:
Subdivision Name: J~.~ ,~(o~g---L/~.a-~
Zoning Dis~ict: [~t size: Actual:
[Ftonl Yard Pro~s~: ] ~[Side Yard Pro~sed:
Project Desc~ption: N~ ~gv~m
Req.
I ILo! coverage __ Proposed: ]
AGENCY PERMITS
REOUIRED FOR REVIEW N,A.
Suffolk County Health Dept.
New York State D.E.C. 6//'
Town Trustees
Town Zoning Board approval:
Town Planning Board approval: '//
Permit
NO YES Number
Flood Plane Elevation ???
Flood Zone:
Notes:
765-1802
BUILDING DEPT.
~/~ ~[~~FO~ ,~~UND__ AT ION 1 ST ROUGH PLBG,
/[ ] FOUNDATION 2ND INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
jDATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ]~GH PLBG.
[~J' INSULATION
[ ] FRAMING
[ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
/
DATE 3/~///~
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ]R~BG.
[ ] FOUNDATION2ND [/,~INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ~,~C ~_~
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [
[ ] F/OIJNDATION 2ND [
[ ~]' FRAMING [
] ROUGH PLBG.
] INSULATION
] FINAL
[
REMARKS:
] FIREPLACE & CHIMNEY
DATE /~/,~;~/~
INSPECTOR . ~~~.
765-t802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION l ST [ ] ROUGH PLBG.
[[ ]] :ORAUMN iDNA~ION 2ND [[ , ]/~V] Fi~TION
[ ] FIREPLACE & CHIMNEY
REMARKS: ~
DATE
INSPECTORr~/~~-~
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: 765-1802
Examined 20
Approved ., 20
Disapproved a/c
I~UILUIINU lq=KIVll I 'A~FLi(~A I'ION
Do you have or need ~e follo~E, before applyin
Board of Heal~
3 sets o~Buildin~ Plans
S~ey_
Check
Septic Fo~
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
Building Inspector '
APPLICATION FOR BUILDING PERMIT
Date De. C 2. { ,200¢
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 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 permi'
shall be kept on the premises available for inspection througho.ut the work.
e. No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupar
is issued by the Building Inspector.
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?ounty, 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 co?nply with all applicable laws, ordinane.es, building code, housing code, and regulations, and to admit
authorized inspectors on premises and in building for neeesfiary inspections.
(Sig~l'al/ure of applicant or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of pi'emises
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
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 Map No. I000
Subdivision
(Nme)
Section
Block q
Filed Map No.
Lot
Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy {)r.,-.-.o {, ~/, F~,~ I~o,.~c (
b. Intended use and occupancy I~ ~ (c) ,~ ]' rq ,~ c 1t F,e ,...~. )t ?~ o ,~ ¢ ~
Nature of work (check which applicable): New Building.
Repair Removal Demolition
Estimated Cost ~/ 5'" o v u, Fee
If dwelling, number of dwelling units
If garage, number of cars
Addition y' Alteration
Other Work
(Description)
(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
Depth
Dimensions of same structure with alterations or additions: Front
Rear
Depth Height.
Dimensions of entire new construction: Front
Height Number of Stories
Size of lot: Front Io'3. o c,
O. DateofPurchase /.T¢_~ 12. I~'t~
1. Zone or use district in which premises are situated
Rear
Name of Former Owner
Number of Stories
Rear Depth
Depth 5"-~ $-, ~. ']
2. Does proposed construction violate any zoning law, ordinance or regulation:
3. Will lot be re-graded /v e
4. Names of Owner of premises
Name of Architect
Name of Contractor
Will excess fill be removed from premises: YES NO
/~..v~-~yJ4,'Address qzq' ~'JCv,vl( i~ ~ Phone No. '7,/y-~qCg
Address Phone No
Address Phone No.
5. Is this property within 100 feet of a tidal wetland? *YES NO y
· IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
6. Provide survey, to scale, with accurate foundation plan and distances to property lines.
7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
TATE OF NEW YORK)
SS:
:OUNTY OF )
EtZe_,~<, ,](o ,'t,/~ (~ SI("! being duly sworn, deposes and says that (s)he is the applicant
(Name/o~' individual signing contract) above named,
¢)He is the
(Contractor, Agent, Corporate Officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
~at all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
erformed in the manner set forth in the application filed therewith.
Notary Public
~-,*ELENE O. HORNE
.,Jo~ar¥ Public, State of New York
No. 4951364
,~uahfied m Suffolk County
~, ,'i~s;on Expires May 22, ~0 0//'
Signature of ApFlicant
OCCUPA,~CY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUP~,~']CY
UNDERWRITERS CERTIFICATE
REQUIRED
APp.IIO~P AS NOTED ~,_~, ~?,0~
DA~ ~B.R ~ ~,,
N~ BUILDING DEPA~E~
766-1K2 O
K~NG INSPE~ONS:
1. FOUNDATION - ~0 REQUIRED
~ ~RED
2. R~H -
3. INSU~
4. FINAL - CONS~U~ON
BE ~M~t ~ ~0.
A~ CONSTRU~ION SHALL ME~
~E REQUIREMENTS OF ~E N.Y.
STATE CONSTRU~ION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESGN OR ~NS~U~N ERRORS
L.