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HomeMy WebLinkAbout29023-ZFORM NO. 4 TO~ OF SOUTHOLD BUILDING DEPARTMENT Office oI nhe Building Inspector Town Hall Eouthold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-30256 Date: 06/25/04 T~IS C~RTIFIEB t~at the ~uildlng NEW DWELLING Location of Property~ 2700 FAIRWAY DR (HOUSE MO-) (STREET) County Tax ~4ap No. 473889 Section 109 Block 5 CUTCHOGUE ( ~L~_MLET ) ~t 14 _ 13 SLzbdivlsi~ Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed iht his office dated DECEMBER 18, 2002 pu~S,lm~t to which Building Permit No. 29023-Z dated DECEMBER iS, 2002 was issued, and conforms to all of the requirements of the applicmble provisions of the lmw. The occupancy for which this certificmse is issued is ONE FAMILY DWELLING WITH COVERED PORCH, SCREENED PORCH, BRICK PATIO ATTACHED TWO CAR GARAGE AS APPLIED FOR. The certificate is issued to KAREN L & W_~LTER R PAULICK (OWNER) of the aforesaid building. 06/21/04 1162778 01/08/04 03/24/04 PECO~IC PLUMBI~G & HEAT A~ri~ed Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES ~TIL FULL COMPLETION OF THE WORK AUTHORIZED3 PERMIT NO. 29023 Z Date DECEMBER 18, 2002 Permission is hereby granted to: foL : JAMES J PALLON 284 CHASE WAY MANCHESTER NH, 03104 CONSTRUCTION OF A SINGLE FAMILY DWELLING WITH ATTATCHED CAP=AGE W/O POOL AS APPLIED FOR at premises located at 2700 FAIRWAY DR CUTCHOGU~ County Tax Map No. 473889 Section 109 Block 0005 Lot No_ 014.013 pursuant to application dated DECEMBER 18, 2002 a/Id approved by the Building Inspector to expire on JUNE Fee $ 1,684.20 18, 2004. // / ~ Au t ho~/i/z e~S i gnma _t u r e ORIGINAL Rev. 5/~/02 Form No, 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ILkLL 765-1802 This application must be f-ffled in by type,awitcr or ink and submitted to the Building Depat~nent with the following: For new building or new use: 1_ Final smvey of property with accurate iocauon of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and seweragc4ispusal (S-9 tbrm). 3. Approval o f electrical installatton from Board o f Fire Underwriters. gwom statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industriaI building, multiple residences and sitrdlar buildings and installations, a certitinate of Code Compliance from a-clfitect or en~neer responsible for the boilding. 6. Submit Planning Board Approval of completed site plan requir*mcnts. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate ~twcy of property ~howing all property_ lines, streets, building and unusual rattuml or topographic fearn, res. 2. A properly completed application and come_at to inspcc[ sig~ed by the applicant. If a Certificate of Occupancy is denied, the B~tilding h~spector shall state the reasons therefor m writing to the applicant. 1. Certfficate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dxvelling $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-e_xis/ing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Telnporary Certificate of Occupancy - Residential $15.00. Commercial $15.00 Old or Pre-existing Building: Block O~ Filed Map. Applicant: Underwriters Approval: New Construction: Location of Property: House No. Street Owner or O,amers of Property: ~ 4- ~-~ ~"~ Suffolk County Tax Map No 1000, Section ] 0~ VermitNo. 2qO~"~ "~ DateofPermit. I-Ieo. lth Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Final Certificate: (check one) C.u-ret4 oc. u g' D>t. Hamlet Lot __t'dC. Lot: (check one) Applicant Signature Towel Hail, 53095 Main Road P.O_ Bmr 1179 $outhold, New York 11971-0959 Fax (631) 765-9502 Telephone (631) 765-1g02 BU!P.B[NG DEPARTMENT TOWN Ole $OUT~IOLD CERTIFICATION Building Permit No_ ~ O~)-3 (please print) (please P~0 / / I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this c~ c/~'--~' dayof ./{4~RC/d , 20o(/ ~ICKI L. LOPER ~ll~i~l IIhSUfl u · BY THIS CERTIFICATE OF COMPLIANCE THE NiEI /V YORK BOARD OF FIRE UNDEF .WRITERS BUREAU OF ELECTRICITY 40 FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by ROSLAK ELECTRIC WALTER PAULICK P.O. BOX 164 2700 FAIRWAY DR C UTCH©GUE, NY 11935-2453, CUTCHOGUE, NY 11935 Located at 2700 FAIRWAY DR CUTCHOGUE, NY 11935 ,Application Number: 1162778 Certificate Number." 1162778 Section: 109 Block: 05 Lot: 14.13 Building Perm;t: BDC: NS11 Described as a EcsidemiM occupancy, wherein the premises ele. ctrical system consisting electrical devices and wiring, described below, located in/on the premises at: Basement, First Floor, .Attached G~age, Outside, Attic, was inspected in accordance with the installation, as set below, was National Electrical Code and the detail of the forth found to be in compliance therewith on the §th Day or Jaimary, 2004. Nam~e QTY Rat~ Radno_ CilcuJt Type Alarm and Emergency Equipment Sensor 1 0 Carbon Monoxide Appliances and Accessorie~ Exlxanst Fan 2 0 F.H.P. Hydro Massage Tob, Residential 1 0 Oven 1 0 4.5 Kg' Dish\Vasher 1 0 1 2 KW 1 0 t H.P. Pump 2~lotor Furnace 1 0 Gas Ag Con&tioner 1 0 48.000 BTU Panels I 100 20 I 50 Wiring and Devices Receptacle 55 0 General Pmrpose S~4tch 60 0 Geac~al Propose Fix'Ire 63 0 Incandescent seal GFCI Circuit Breaker 4 0 20 amp Continued on Next Page 1 of 2 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 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 ROSLAK ELECTRIC WALTER PAULICK P.O. BOX 164 2700 FAIRWAY DR CUTCHOGUE, NY 11935-2453, CUTCHOGUE, NY 11935 Located at 2700 FAIRWAY DR CUTCHOGUE, NY 1 i 935 Application Number: 1162778 Certificate Number: 1162778 Section: 109 Block: 05 Lot: 14A3 Building Permit: BDC: NS11 Described as a wherein the premises electrical consisting of Residential occupancy, system electrical devices and wiring, described below, located in/on the premises al: Basement. First Floor, Amached Garage, Outside, Altic, was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was found to be in therewith the grh of 2004. compliance Day on January, 16 0 Dinmaers Paddle Fan 3 0 FL,~tttre 10 0 Fluorescent Receptacle 2 0 20 LaunckD- amp Multi Outlet System 12 0 FT Receptacle GFCI 14 0 Ser~Sce 1 Phase 3W Serdce Rating 200 .~aperes Service Disco~ect: 1 200 cb Meters: I seal ~ or' ~ This certit~cate may not be altered in any way and is validaled only hy the presence of a raised seal at the location indicated. LOT 13 FAIRWAY FARMS ___ ~, CUTCHOGUE 98-350~ 1 ENERGY CODE CALCULATIONS CHAPTER 5 SECTION 501 Detached One and Two Family (For Non-Electric Heat) For: Design Criteria "5750 Degree Days Zone I 1B SUBSYSTEM AREA DESIGN CODE DESIGN CODE '%1" "U' UA UA ExtefiorWails 2~/~ O. Ig~g 0ll4 .~0 P,~'~ / ,~ Z~, 2~ Floor OwrUnheated Space 2 ~ ]O O .O / 0.05 13Z. 0a 1.~'' 00 Heated Slab On Grade 6.5 Unheated Slab On Grade 4.5 Basement Wall 0.1 Crawl Space Wall 0.06 3"3 f.z/7 J"3 8. o NOTES: Construction shall comply with 502.1.1 moisture eontxol mid 502.1.4 air leakage Building Envelope Systems to meet requirements of Section 501 The mechanical systems end equipment including: H'VAC Equipment, HVAC Sysieius, Duct Systems, Ventilation Systems and Insulation of Pip/rig Systems to meet requirements of Section 503 Service Water Healing Systems & Equipment to meet requiremenm of Section 504 El~c/rieal & Lighting Systems & Equipment to meet requimnents of Section 505 To the best of my knowledge, belief, & professional judgement, these plans are in compliance with the code. OWNER TOWN OF SOUTHOLD PROPERTY .RECORD'CARD STREET ~) -,/0 '~'-'~ N VILLAGE W SEAS. VL. IMP. TOTAL ........... 1(~.o FARM I Ac, R.., ½ :?,:,,+, I ITYPE OF BUILDING DATE COMM, CB. MICS. Mkt. Va'lue REMARKS liable FRONTAGE ON WATER 'oodland FRONTAGE ON ROAD eadowl~nd DEPTH ~use Plot BULKHEAD ~tal Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 12/18/02 Transaction(s): Septic Permit - Construct - Resid. Receipt: 1585 Subtotal $1o.oo Check#: 1585 Total Paid: $10.00 Name: Mcgahan, D W BX602 Wick Rd Cutchogue, NY 11935 Clerk ID: BONNJED Internal ID: 64S23 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICFS OFFICE OF WASTEWATER M4NAGEMENT SUFFOt,K COUNTY CENTER RIVERHEAD. NEW YORK 11901 (63 It 852-2100 APPLICATION FOR EXTENSION, RENEWAL OR TRANSFER OF EXISTING PERMIT TO CONSTRUCT SEWAGE DISPOSAL AND WATER SUPPLY FACILITIES FOR SINGLE FAI~HLY DWELLING Before cumpleting this application rater to "Instructions to Renew. Extend or Transfer an Existing Permit for Single Family Residence" on reverse side of this application. EXISTING REFERENCE NUMBER Ri0-98-0124 TAX MAP NUMBER: District 1000 Section i 109 Block 5 Lot 14.13 NAME OF APPLICANT Karen Lute Pauliek and Walter R. Paulick (If name is different from original applicant, see instructions for transferring a permit and complete section 6 belo~x.) ADDRESS 30 Terry Place, Riverhead, New York 11901 PHONE 631-369=3100 4 NAME OF AGENT (If not applicant) None ADDRESS DATE OF ORIGINAL APPROVAL 10/8/98 57:,.~~-~2 ~rI =~ (l,f m0ce than 6 years 0Id, a new appl~m0n xe [ be*e4g reda 6. TRANSFER. OF PERMIT: I hereby, transfer all rights and interest in t~e above. ,refcre~-d_~ l-gx~mit~the_. =. : newl apphcant named above, ~ ~~ ~: ~ .~.~ m,} . P~NT NAh~ James a. a~d Margare~ M. Fallen ', // / ' D4T~,6*~/~/02~ ADD'SS 284 Chasa Wa~, ~nchester, ~ P~O~ Application is hereby made to [ ]extend, [ ]renew, iX]transfer a permit to construct a water supply and sewage disposal system for a single family residence in accordance witti the application, surveys and plans submitted. I hereby cerdfy that I have examined the complete application and the s~atements therein are true and correct, and chat all work shall be done in accordance with all applicable Town, County, State and Federal Laws and Codes. "Any false statement made herein is punishable as a rrfisdemeanor pursuant to S210.TCf~o(~/[ew York State Penal Law." SIG,*,T,_,RE OFAP.L,¢A , GENT LSOAE .AT ,zO PRINT NAM]~ Walter R. Pauliek TITLE 0truer If you are ma 'king substantial revisions m' modifications to a prgl,ect that has already received a permit to construct from the Department. or if the permit is more than six (6)),ears did. a new application will be required. Follow the instructions as cxplmned itt Subrms~lon Requirements For S~n[le Patrol5 Residences (W~ ~r~ -04 ). Renewed permits are subject to an5' changes ;n standards enacted after the approval date of the o~gmal p¢~xrnt. DEPARTMENT USE ONLY Pemfit is ExtendedIRenewcdYTrans farted Uutil /O --~ '~O/'~' Number of Bedrooms Approved Signature of Department Representative ~~~-a Date WWM-104 (Rev. 03/01) PAGE I OF 2 BUg[ DING PERb'HT EXAMINER CHECK LIST DATE REATE~VED: /Z/~/02 DATE SUBMITTED: IZ. scm DISTRrCT: L000. SECTrOS: , B _OCr: EOT: STREETADDKESS:~/20~) ~1~ ~- CITY' ~Z~60e St,~D1YISION:~ PROJECT DESC~TION: ~ ,~ ~ a P** c ESTBL~TED PROJECT COS~O~ARP~TECT/~:~tcL~ FAST T~CK? mO / S~GbE & SEP~TE CERTWICATION-~Q~D? NOTES: LOTS 40.flfl0SF -t00-24. Lot reeo~ifion (C~ATED before Jane 30, 1983). ~DERS~ED LOTS PRObl JAN.1997 100 25. Merger., A non,centime'ne at an~ time at~¢r ~'1,,82 ZONINO DrSTRICT: ~ e o co CONFORMING? ~/-~ REQ. LOT SIZE: k4(B,eS~h ACT. LOT SIZE: qCS\(STREQ. LOT COVc:>TV,,~ _ACT, LOT COV. -~ ~_- - PROP. FRONT ';~ ~xEQ SIDE [_~2~? ACT. SIDE KEQ. FRONT REQ. RE.aR 3-~ PROP. P~AR ~q~ REQ. )~i~HT. PROP~EIGHT WATER FRONT? p/t DESCRIPTION: PANEL #: ~ FLOOD ZONE: ~ .... Tox~rNfEPI'IC RECEIPT/r'Y'~ N NEW 'i ORK STATE DE~--~i;m~-,~c w~/Ts 5.'ES SOU2~OLD TOV~rN TRUSTEES: YES TOWN ZONING BOARD APPROVAL: Y'ES 5'ES or~, Y-ES o~ TOWN PLAN. BOARD APPROVAL: TOWN IffSTORICAL PRE (SPLIA): NYS ENERGY: ~~') OR NO : ~.."Q~TZr EGRESS (18 H nhifi.? 4 sq total) ..-- v~rq ~ (SQ. BUILDING PERMITS OPEN/EXPIRED: BP HAVE PRE CO'S: Y ORN BP NOTES: FT. x 4%) -Z / C/0 Z- -Z / C/0 Z- FEE STRUCTURE: FOUNDATION: e-9, ~'-q~ SE FIRST FLOOR: ~ t',~,,6 G SF SECOND FLOOR: SF OTHER: SF TOTAL: 5' ~._~ _SF 1. ( f,96~ 2.( SFX$ .50=$16-~q ~+$ INIT OTHER TOTAL FEE FEE FEE SF)- ( SF)= SFX $__=$ +$ +$ = $ 7G5-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING [ ]FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ~"'~'~' DATE INSPECTOR BUILDING DEPT. INSPECTION F/OUNDATION 1ST FOUNDATION 2ND [ ] I~OUGH PLBG. [ ] INSULATION [ ] FRAMING [ ] FINAL [ REMARKS: ] FIREPLACE & CHIMNEY // ~') DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [-~ROUGH PLBG. [ ] F~DATION ~ND [ ] INSULATION [ ~.RAMING ] FINAL [-~ FIREPLACE & CHI,MNEY REMARKS .~ //~.~.~__ ~ DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY REMARKS: -~"~' ]./~JGH PLBG. INSULATION [ ] FINAL DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2NO [ ] FRAMING [ ] ROUGH PLBG. [ ] INS~ri0N [~NAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: /~) ~, ~ DATE ~ INSPECTOR INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] FRAMING [ ] ~ULATIO~I [ '-~I=INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS. /"~"~ ,~ DATE INSPECTOR~'~'~/~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS~JI~ATIOH [ ] FRAMING [/*/] FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION REMARKS: ~~'_ ~) / DATE INSPECTOR FOUNDATION (1ST) ....................... FO~ON (~) PL~G ~S~A~ON PER N. Y. STA'IE ~GY CODE BUILDING PEP, MIT APPLICATION CHECKLIST Do ynt~ [mve or need the follo,a'h~, before applying? Board of Health 3 sets of BaildLng Plans Planning Board approval Su.r~ ey. Check Septic Form N.Y.S.D.E.C. 20_ ~ Mail to: APPLICATION FOR BUILDING PEII3HT INSTRUCTIONS a. Tkis application MUST be eomplctcly fdled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate pict plan to scale. Fee according to schedtfle. b. Plot plan showing loeatton of lot a~d of buildings on premises, relationship to adjoining premises or public streets or areas, and watemvays. c. The work covered by this application may not be commenced before issumace of Buildhig Pen~fit. d. Upon approval of this application, thc Building Inspector will issue a Building Permtt to the applicant. Such a permit shalF'3e kept on the premises available for inspection throughout the vOork. e. No building shall be occnpied or used in whole or in part lb? may purpose what so ever until the Bt61ding Inspector issn. es a Certificate of Occupancy. f. Every_ building permit shall expire if the work authorized lies not cmmnenced within 12 months after the date of issuance or h~s not been completed wit}fin 18 months from such date. If no zouing ame~clments or other re=o~iatinns affecting the property b_ave beeu enacto3 in the interim, the Building inspector may,authorize, in writing, the extension of the permit for ma addinon slx months. Thereafter. a new permit shall be required. APPLICATION IS HEREBY M.~dDE to the Building Department for the issmmace cfa Building Permit pursuant to the Building Zone Ordinm~ce of the Town of Southold, Suffolk County, New York. and other applicable Laws. Ordiaaances or Regxilations, for the cons'traction of buildings, additions, or ;~.!tcrations or for removal or demolSnon as herein described. The applicant a~ces to compl3 with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authonzed inspectors on preruises and in bnilding for necessary inspection_s. Z/~(- (Sigmmre b¥~p~or l~e, ifa corporation) (2~lailing ad.ess of applicant) State whether applicm~t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner ofprmnises K~ ~ ~'"P-- F,'~32L'tC~ (As on the tax roll or latest deed) If applicm~t is a co~poration, signatm'e of duly author/zed officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electr/cians License No. Other Trade's License Location of land on wh/ch proposed work will be done: ttouse Number Street Hamlet County Tax Map No. 1000 Section {0'~ Block ~' Subdivision ~ ~Pl-CMx ~ Filed Map No. (Name) Lot Lot 2. State existing use and occupancy of premises and/ntended use and occupancy of proposed coustmction: a_ Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition Alteration Other Work 4. Estimated Cost ,~ 5. If dwelling, number of dwelling units If garage~ number of cars Fee (Description) (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 Dl0e of use. 7. Dimensions of ex. isting structures, if any: Front Rear _Depth Height Number of Stories Dimensions of same structure with alterations or additibns: Front Rear Depth Height_ Number of Stodes 8. Dimensions of entire new consmzction: Front Height Number of Stories 9. Size of lot: Front Rear Rear .Depth .Depth 10_ Date of Purchase Name of Former O~mer 11. Zone or use district in which premises are situated : 12. Does proposed construction x4olate any zoning law. ordinance or regulation? YES__ NO 13. Will lot be re-graded? YES__ NO ill excess fill be iremoved fi-om premises? YES NO 14. Names of Owner ofpremises ~TO~L'l~[./ Address ~ 1-Ct~ Name of Architect Address ' Phone No Name of Contractor ~)O,J(, plo ~/Pv/gi'r~/ Address !p o 15 a_ Is this property x~fthin 100 feet of a tidal wetland or a fi-esh~ater wetland? *YES NO '-/ * IIF YES, SOUTHOED TOWN TRUSTEES & D.E.C. PERMI'['S [VL4.Y BE REQ~D. b. Is tkis property within 300 feet of a tidal wefland? * YES ] NO * IF YES, D_E_C. PERMITS MAY BE REQLTIRED. l 6. Provide survey, to scale, xvith accurate foundation plan and distances to property lines. /~l. 17. If elevation at any point on property is at 10 feet or below% must provide topographical data on survey STATE OF NEW YORK) IDff~./6 t.~ ~'t C(, ~ being dui3, sworn, deposes and says that (s)he is the appl/cant (Nme of indix'idual si~Ling contract) above named, (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorizcd to perform or have pbfformcd tbe said work and to make and file this application; that all statements contained in this application are tree to the best of' his Imowledge and belief: and that the work wii1 be performed in the manner set forth in the application filed therewith.. Swomcto before me thi~ ,'V~,, !~-?.~f '"~) ~,. -.. CLAIRE Commission ~"~ir~s Sigu_a~J.r e~.c~ _D~pp l/cant