HomeMy WebLinkAbout32196-Z
Form No.6
TOWN OF SOUTH OLD
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:
I. 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 2/1 0 of I % 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:
I. 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
I. 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
Date. 7 -zs - oC::>
.
New Construction:
Old or Pre-existing Building:
><-
""-AI'" STReeT
Street
( check one)
l\.Je""-' SuFi'oL/<-
HamIet
Location of Property:
{ CaS-OO
House No.
JosePH
F.... 0 J I'V S It..
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
Block
'1
Lot
[3
Subdivision
Filed Map.
Lot:
Permit No. 3.71 q ,~
Health Dept. Approval:
Date of Permit.
Applicant:
Underwriters Approval:
Planning Board Approval:
Request for:
Temporary Certificate
Final Certificate:
/
(check one)
~c:~
Fee Submitted: $ ~.;J
&-C. 70~8'~
Co~ 3n~f
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.
32196 Z
Date JULY
11, 2007
Permission is hereby granted to:
JOSEPH H & & JOAN M. FUDJINSKI
564 FIRST ST
BROOKLYN,NY 11215
for :
FORCED HOT AIR, NATURAL GAS FURNACE INSTALLED 1970'S IN PREXISTING
DWELLING (MAIN HOUSE) AS APPLIED FOR.
at premises located at
16500 MAIN ST
NEW SUFFOLK
County Tax Map No. 473889 Section 117
Block 0009
Lot No. 013
pursuant to application dated JUNE
27, 2006 and approved by the
Building Inspector to expire on JANUARY
ill, 200.a~
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Fee $
300.00
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ORIGINAL
Rev. 5/8/02
.JAMES A. JII"c::!!!-:R'nll.~:~..?~5fR~NTSTREET -J GR!5!5N~~RT,NY 11944
ARCHlfECIURE
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June 28, 2006
Southold Town Building Department
Southold Town Hall
P.O. Box 1179
Southold, New York 11971
Re: Fudjinski Residence
Main Street, New Suffolk
SCTM #: 1000-117-09-13
Gentlemen:
The Fudjinski Residence, located at 16500 Main Street in New Suffolk, has a 100,000 Btu,
Forced Hot Air, Natural Gas Fumace, which appears to have been installed in the early 1970's. This
Fumace heats approximately one half of the first floor area with sheet metal ductwork extending to
five Supply Registers.
I have reviewed this "As-Builf' installation with Mr. James Fogarty, a licensed technician, to
verify that this Natural Gas Furnace and related heating system was installed in a satisfactory
manner and meet the New York State Energy and Building Codes that were in place during that
time.
, ,":'::","
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OWNER
TOWN OF SOUTHOLD PROPERTY RECORD CARD
(1-2
STREET f t c:: O'j:
(U .. r: ..
/11e... 'j! j :1',., t
VILLAGE
DISTRICT SUB.
LOT
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FORMER OWNER
']00
'loa
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t/-3tfeJ
5~oo
AGE
NEW
;tj:. .f.o\.~
- "".,,,;..
Due.
~y
cQ , ?Ulli c...J
I Est. Mkt. Value
. ~ E ACREAGE
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d. 'Il ..Jf.... i2 ~ r t-j,. "'.....tl1. J t'rH t" I O\~
S '1: f1 W TYPE OFBUILDING
V':" yoU .J.i-11I:1 r]C Kel:' G,,D, Da. ",i.17 'l-iW.
VL. FARM COMM. I IND. I CB.
N
I MISC.
TOTAL
REMARKS
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DATE
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BUILDING CONDITION
NO~L BELOW
Form
Acre Value Per Acre
nllable 1 ,
nlloble 2
nllable. 3
Noodland
)wamplft _
lrush land
-laLlSe Plot
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Extension
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BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/SoutholdJ
PERMIT NO. 2;;2.11'.:6
Examined I" r
Approved l' r 11
Disapproved ale
,20~
,20~
Mail to:
Phone:
Expiration ~ I(
,20~
Dil. .
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date
JUNb 2~
20 OG,
'-
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
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 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 what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPLICA nON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of South old, 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, h ing code n lations, and to admit
authorized inspectors on premises and in building for necessary inspections.
Fflr..rr b.T. Gr~~T /'I.r. IM'f
(Mailing address of applicant)
State whether applicant is owner, lessee, age~ngineer, general contractor, electrician, plumber or builder
UUDJ.''''S./<....
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
JOGoEfl-j
Name of owner of premises
(Name and title of corporate officer)
Builders License No. f,J / A
Plumbers License No. I
Electricians License No.
Other Trade's License No.
N~
.
N/A
l'-1/A
,
I. Location of land on which proposed work will be done:
I "'SOD tJA,~ S-tRt.€.-r
House Number Street
I-J e-..) 0(.) Ff"oLI<-
Hamlet
County Tax Map No. 1000 Section
Subdivision
111
Block 9
Filed Map No.
tot '3
'i': Lot
----..,
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ---R (. S ID e;, N G~ G.llf 1/ A C G €"sso~ jI'" SE.A.sOU"(.."~F>~~
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b. Intended use and occupancy _Jlfj~'''06NCl. WIT H M<<.e55CJR.1 VE-A'SONA'- t:1 P/H~iM ell''' S
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
4. Estimated Cost <:k 5 ClC:lC::> ::'S'
.
Addition
Other Work Ne'AJ
--t 3~
Alteration ~
BoIU:;~ " lieAT""
(Description)
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. N,/,4
f
7. Dimensions of existing structures, if any: Front SeE:: A1tl'\cJ~g PL.~ Depth
Height Number of Stories 'L
Dimensions of same structure with alterations or additions: Front J.J./A
Depth Height Num~ Stories
8. Dimensions of entire new construction: Front N/A Rear
Height Number ofStdries
l~' Rear (~l
9. Size oflot: Front _ <A...J \.oU
Rear
Depth
,
Depth -152-
10. Date of Purchase
Name of Former Owner
11. Zone or use district in which premises are situated
F\-40
12. Does proposed construction violate 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.Namesofownerofpremises~vO.Jl7ws~i Address Phone No. 731.f t,301
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _ NO ~
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
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 topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF )
J~m SI50 Ii, R,<: WTe(L., being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
ARCH TSc--r
(Contractor,
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 knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
200G
BONNI . DOROSKI
Notary Public. State 01 NewYort
NO.OID06095328.SuffOlk~1l/
Term Expires July 7, 20
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