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HomeMy WebLinkAbout29156-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29919 Date: 12/17/03 T~IS CERTIFIES that the building ACCESSORY Location of Property: 290 OLD FIELD CT MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 120 Block 3 Lot 8.27 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building permit heretofore filed in this office dated FEBRUARY 13, 2003 pursuant to which Building Permit No. 29156-Z dated FEBRUARY 14, 2003 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 WILLIAM F & THERESA KRUKOWSKI (OWNER) of the aforesaid building. SI/FFOLK CO~l"f DEPAR~qT OF ~{ A~PROVAL N/A ELE~-rRICAL CERTIFICATE NO. 3523 05/02/03 PL~MBERS CERTIFICATION DA'~ N/A Rev. 1/81 ed ~gnature 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. 29156 Z Date FEBRUARY 14, 2003 Permission is hereby granted to: WILLIAM F KRUKOWSKI MATTITUCK,NY 11952 for : CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL IN THE REQUIRED REAR YARD AS APPLIED FOR at premises County Tax Map No. 473889 Section 120 pursuant to application dated FEBRUARY Building Inspector to expire on AUGUST located at 290 OLD FIELD CT MATTITUCK Block 0003 Lot No. 008.027 13, 2003 and approved by the 14, 2004. Fee $ 150.00 Authorized Signature COPY Rev. 5/8/02 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: A. For new building or new use: l. 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. Ifa 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~d~elling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swinuning 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 Date. New Construction: Location of Property: o~-~ o House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section _ Subdivision eermitNo, o~/~-~-~- DateofPermit. Old or Pre-existing Building: Street /.gO (check one) Block oO Filed Map. Applicant: Lot Lot: Hamlet 0~- o2~7 Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Underwriters Approval: Final Certificate: (check one) Applicant Si~aatur[ Nassau Suffolk Electrical Inspections, Inc. 5A Canal Street * Center Moriches, New York 11934 · T~I: 631-878-3500 * Fax: 631-878-3764 Application: 3523 Issued to: Krukowski Address:. 290 Old field Ct Village: Mattituck Date: 5/2/03 Introduced By:DeLane Electric Lic#:4354-E was examined and approved up to the above date and was in compliance with the NEC Switches Receptacles Fixtures G .F.L Pool Panel Whirlpoo[ 2 2 I 2 30A Oven Carbon Fans Dishwasher Washer/Amps Dryer/Amps Range/Amps MOnoxide Smoke Bell Furnace Oil Gas Heat Zones ~ Detectors Transformers Meter Amps Phase Motors Inground Pool 1-11/2HP Other Equipment: Out,Res This certificate must not be altered in any manner Section: 120 Block: 03 Lot: 8.27 Applicant/ Owners Nmne Architect/ Engineer: SCTM u: District 1,000 Sect~ot: /o.,1~) Block Date Reviewed: Date Single & separate Reqmreo cm-,~fication: (Yes / No) Project Dese ption: Subdimsmn AGENCX~EILMITS REQUIRED FOR REVIEW Permit .N.A. NO YES Number Suffolk County Health Dept. New York State D.E.C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: Note : 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ]~JLATION [ ] FRAMING [/,/~j~FINAL ] FIREPLACE & CHIMNEY //'~ ~ } INSPECTOR DATE 'OWN OF SOUI'HOLD UILDING' DEPARTMENT 'OWN HALL OUTtIOLD, NY 11971 EL: (631) 76.6..1802 AX: (631) 765-9502 .. /~/ ,2003 pproved ,20..~k~. isapproved a/e ~piratian PER.M~ NO.. / Bnilding Inspector BU~D~G PERMIT APPLICATIO~ ~H~CKLIST Do you have or need the following, before applying? Bo~d of Heal~ 3 se~ ofB~l~g PI~ Pl~nn{nC Bo~d approval . Check N.Y.S.D.E.C. T~ees CoRrECt: APPLICATION FOR BUILDING PERMIT ~ 3 ?' "~ ' i INSTRUCTIONS a. T~Jais application MUST. b~, ~omt~etely fi/led in by typewriter or in ink mad submitted to the Bmlding Ir~pector with 3 its ofplan~k-~'c~at6 plot plan to seater~de according to schedule. b. Plot p an showing location of lot and of buildings on'premises, relationship to adjoining premises or public sweets or eRs, and waterways. c. The work covered by this application may not be commenced before issuance of Bu/lding Permit. pon approval of this application, ~e Bu//ding Inspector will issue a Building PermSt to the applicant. Such a permit .all be kept on the prom/scs available for h:tspectio~ 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 ;ues a Cert/f/cate of Occupancy. f. Every building permit ahall exp/re if the work authorized has not commenced wJtb~n 12 months after the date of aance or has not been completed w/tMr, 18 months from such date./fno zoning amendments or other regulations affecting the >perry have been enacted in the interim, the Building/nspeotor may authorize, in writing, the extension of the permit foz an dition six months. Thereafter, a new permit sha!~ be required. APPLICATION IS HEREBy MADE to the Bn//ding Deparlmaent for the issuance cfa Building pmrmt pursuant to the ~Iddr~g Zone ©rdinancc of the Town of $outhold~ SuffoLk Coun.~,, New York, and.other applicable Laws, Ordinances or gu[atmns, for the construction oflmilding% additions, or alterattons or for removal or demohtien as here/n described. The ¢Iicant agrees to comply with al1 applicable laws, ord!~_uces, bul/ding code, housing code, and regulations, and to admit :horized inspectors on premises mad in bui/d/ng for necessary/mpectiens. "IMMEDIATELY" OCCUPANCY ENCLOSE POOL TO CODE USE IS U~'~[..A~,~F~jI. upon aFORa WITHOUT CERTIFIC (Signature of apphcam or name, ifa corporation) (Marling address of~pplJ.~mnt) / me clowner OfprerniseS~.).3t.i[ i /k~ ~i~tl~tD(~mkSi 765-1802 9 AM TO 4 PM FOR THE roil'or latest deed) . ; ': ........ ~ - pphc~t is a co~orafio~ silage ofd~y auto,ed offi~ - ~ ~,>N . TWO REQUIRED ~,UH~D CONCRETE (Name and title of corporate officer) 2ders License No.____oQ tubers License No. ctdcians License N~..- ter Trade's License ~. }:IOt~H . FRAMING & PLUMBING 3, INSULATION ~ CONSTRUCTION MUST 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, Location of land on which o os · ' pr p ed work will be Co~ T~ Map No. 1000 S~on~ _ Bl~ck a. Existing use and occupancy tffEO7/)~£/~ ~ ~ b. Ir[tended use and occupancy Nature o f work (check which applicable): New Building Repair Re~noval Demolition 4. Estimated Cost 5. If dwelling, number of dwelling un/ts If garage, number of cars Addition Altera:~on OtherWork /~0~ ~£D~lOb PD~g& (c:,q ' 0 ~7~ (Descripdo~n) X Fee ~y ~ ,~t)o/_.) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. 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 Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size of lot: Front Rear .Depth 10. Date of Purchase Name of Former Owner 1 i. Zone or use district in which premises are situated 12. Does proposed construction v/~late any zoning law, ordinance or regulation? YES__ NO 13. Will lot be re-graded? YES__ NO ,//Will excess fill be removed from premises? YES ,/ NO__ 14. Nan2es of Owner of premises {.Dm. k~£ u ~:Otas/c / Address~~. ,P~on¢ Name of Architect (-~&'b~&~ /BICH~ Address.,~/ NameofContractor/~}%0by ~ ~O/)6C~'e'-~ Address t-pi 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *yEs NO * ~ YES, SOUTHOLD TOWN TRUSTEES & D.E,C. PERMITS MAY BE REQUIKED. 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 topograpkical data on survey. STATE OF NEW YORK) SS: COUNTY OF ) f~/qAOf> )/ ~ ,~20,Dt~d/d.~,/:~ being duly sworn, deposes ami ~ays that (s)he is the applicant [Name of individual si~ing contract) above n~rn.ed, (S)He is the t~ o/.O r, OqF ~-b~-- (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly author/zed to perform or have performed the said work and to make amd file th/s applicati that all statements contained in this application are true to the best of Ns knowledge and belief; and that the'work will be performed in the maturer set forth in the application filed therewith. Sworn to before me this dayof ~- 2003 Not~ Public / ignatum of Applicant /oqo'-1flS-5ob./ TH E LOCATION OF WELLS, WATER SERVICE LINES, SEPTIC TANKS AND CESSPOOLS SHOWN HEREON ARE FIELD OBSERVA- TIONS AND OR DATA OBTAINED FROM OTHERS, iq-o.oo' 'qS~ 2.oo. oo ~ :. q,~,.~+ · CERTIFIED ONLY TO:, By DESTIN G, GRAF N.Y,S. LIC No. 50067 TAX LD. No, t O O O - I 2-0 - O 3 - 8.2.7 DESTIN G. GRAF LAND SURVEYOR