HomeMy WebLinkAbout49675-Z �gUlfDli�
Town of Southold 11/15/2023
y` P.O.Box 1179
o -
�' x 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 44728 Date: 11/15/2023
THIS CERTIFIES that the building ACCESSORY
Location of Property: 1735 Brigantine Dr, Southold
SCTM#: 473889 Sec/Block/Lot: 79.4-59
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/11/2023 pursuant to which Building Permit No. 49675 dated 9/12/2023
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 pickleball court as applied for.
The certificate is issued to Poliwoda,Kenneth&Barbara
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
Au o 'zed nature
�St1FfDl TOWN OF SOUTHOLD
Sao �c�ay BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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#: 49675 Date: 9/12/2023
Permission is hereby granted to:
Poliwoda, Kenneth
1735 Brigantine Dr
Southold, NY 11971
To: Construct accessory pickleball court as applied for. Maintain minimum 15 foot setback
to rear & side property lines. Fence, if applicable, may not exceed 6'-0" in height.
At premises located at:
1735 Brigantine Dr, Southold
SCTM #473889
Sec/Block/Lot# 79.4-59
Pursuant to application dated 8/11/2023 and approved by the Building Inspector.
To expire on 3/13/2025.
Fees:
ACCESSORY $100.00
CO-RESIDENTIAL $50.00
Total: $150.00
Building Inspector
qOF SOUIyo
# TOWN OF SOUTHOLD BUILDING DEPT.
co 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I SULATION/CAUL ING
[ ] FRAMING /STRAPPING [ FINAL k C&Of
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
DATE Illdl V)lINSPECTOR
?IELD INSPECTION REPORT DATE COMMENTS
■o
FOUNDATION (1ST)
• � 1
------------------------------------ -0
en'
r
n �
FOUNDATION (2ND)
Jz
0
W
H
W
ROUGH FRAMING&
PLUMBING
r
INSULATION PER N.Y. d "�
STATE ENERGY CODE
ll `
FINAL
ADDITIONAL COMMENTS
A o
z
V.l �
N y
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TOWN OF SOUTHOLD-BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
0 Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtovvlmy.gov
Date Received
APPLICATION FOR BUILDING PERMIT
D
For office Use Only
AUG 1 1 2023
PERMIT NO. A0 Building Inspector:
lie
DUUDING DEPT•
F()J'TJ:
tions, n _owner;a
a ' tioft'
.'S� ization-t UPcoin'P1t:Lt!Uw ,.,'',.
Date:
:OWNER O PROP
ER
Name:/ n 1J-w ObA FSCTM#1000- -2
Project Address:
4 A PJ-(-I AJZ 2R' - S0604(W, lel AJ
dwr
Phone#: Email:
';'JOE�4
63 1- 39?- 6,,q(
a 4 AJ
. . P,:2 -4,
M ailin g Add ress:
C
7�
CTrPE
0
Name: kr-t,J Akotm
Mailing Address: 1233"- 19R/6)VU/1'
'Ve
Phone#: pO Email:
NF TION
{DEMq.N'PK6FESSI'0NAL I OFMAT
Name:
Mailing Address:
Phone#: Email:
ATI N:
FOW
C
Name:
El C)w.5 t�IGO
-
Mailing Address: 5-100 �4 9.4-- /,1
Phone#: ,; Email:
72, 3 y -7
SCRI OFPkd0,0SEq,1C
EINewStructure ElAddition ElAlteration El ElDemolition Estimated Cost of Project:
ir
40ther M0 (00 $
Will the lot be re-graded? E]Yes Xqo Will excess fill be removed from premises? E]Yes *No
PROPERTY INFORMATION. ;
Existing use of property: ,,pp Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes No IF YES, PROVIDE A COPY.
Check Box After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. 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,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 buildieg(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name): tpl/(meq b 6,Ca>o2 ❑Authorized Agent 6vowner
Signature of Applicant: a
CONNIE-!6!%NCH_.- -- -
Notary Public,State of New York
No.01 BU6185050
STATE OF NEW YORK
Qualified in Suffolk County
SS: Commission Expires April 14,2 d�
COUNTY OF )
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(Contractor,Agent, Corporate Officer, etc.)
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/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this �Q
day of AA20-42)
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
6�•
o�osoFFot,r�Do , TOWN OF SOUTHOLD—BUILDING DEPARTMENT
N� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY1�1971-0959
oy�0 ao�� Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov
Date Received
AP �,LICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector:
Applications and forms must be.filled.out in"their entirety. Incomplete '
applications will not be accepted. 'Where the Applicant is not the owner,an
Owner's Authorization form\(Page 2)-shall be completed."
Date: \
OWNER(S)OF PROPERTY:
Name: 1SCTM#1000-
Project Address:
Phone#: Email:
Mailing Address:
CONTACT PERSON: . S�
Name:
Mailing Address:
--- - "- _ ---- ---- - -- - - --.-. .. - M. --- V_ -- -
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email`
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alter6tt n—aRepair ❑Demolition Est mated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes El No
1
OCCUPANCY OR
APPROVED-AS NOTED USE IS UNLAWFUL
DAT Ed,
B.P. OF
CERTIFICATE
A/6-d-OV
FEBY _4� OF OCCUPANCY
NOTIFY BUILDING DEPARTMENTAT
631-765-1802 8AM TO 4PM FOR THE
FOLLOWING INSPECTIONS*
1. FOUNDATION-TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH-FRAMING&PLUMBING
3. INSULATION .MPL Y
4. FINAL-CONSTRUCTION MUST
BE COMPLETE FOR C.O. NEW YORK STA wi
ALL CONSTRUCTION SHALL MEET THEEOUJ E10 ANb_b-_bN''
AS R .
OF
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTON ERRORS
All exterior lighting
Installed,replaced or
repaired shall conform
to Chapter 172 RETAIN STORM WATER RUNOFF
.of the Town Code PURSUANT TO CHAPTER 236
11 THE TOWN CODE
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SECTION 7IC9 OF TNI NLw YORK STATI
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THE LAJ o:u... 'I. 1L OR
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tUTION,WAIAr.TILS A.I NOY TRANSFIAA
f0 ApUITIONAI I4flfutlON3 09 sloutat IM
w14P OF= LOT. 69 .
GLCIalK/e"d Ito owNeaT. STAMP
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1 RODRRJCK VAN TUYL, P, C.
7o-WN OF S -rHpc_0,N.Y. SG LAND pyFiy=yORf ORQ[N RT.
Su lk CO.Tax MdA, 0d-d ,jo4Aw:WarJ,'1060,Secy:Gly e4opt 4,Lot 59..
TAT MOLL[ BUFF.CO.aIPT.OF HEALTH DFAVICp6
STATEMENT OZ±INTENT
O• '
FOR APPROVAL OF CONsmuo 10N ONLY
�iYol THU WATER IIUPPI.V AND aEWAOE
DATE:• DiaFQML aVMEMa FOR THIS REST_
DBNCI WILL CONFORM TO THE
H.B.RIF.NO,t .-STANWDS OF SUFFOLK CO. DEPT,
OF HIALTH. SIERVICLS,
APPROVED:
17• APPLICANt