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Home My WebLink About31969-Z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-31786 Date: 08/28/06 THIS CERTIFIES that the building SOLAR PANELS BEND (STREET) Block ~ MATTI TUCK (HAMLET) Location of Property: 80 BLOSSOM (HOUSE NO.) County Tax Map No. 473889 Section 115 Lot 30 Subdivision Filed Map NO. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 4, 2006 pursuant to which Building Permit No. 31969-Z dated MAY 5, 2006 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 INSTALLATION OF SOLAR PANELS IN AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JOSEPH & MARY SIECZKA (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2100983 06/09/06 PLUMBERS CERTIFICATION DATED 08/06/06 BURTS RELIABLE h"d!!!::::. Rev. 1/81 I I' 10 ,~__.JI- APPLICATION FOR CERTIFICATE OF OCCUPANCY Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 rl A:JS e " . ,J 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: 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. 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 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 Old or Pre-existing Building: AJptJ...) \u f)..-o I k . . ~ Date. / {~ (check one) Ave.. l8-) ';;O()(P New Construction: ~;;L f(" House No. Owner or Owners of Property: .Jose" ~ , Iv/... -If; Iv c k Location of Property: Street Hamlet Suffolk County Tax Map No 1000, Section 6 I{~ -=I- In... r'i Block ANN , ~ Sr'+, C<....'<:<:.., Lot ..3 0 Subdivision Permit No. -"3 I '1 {, q 7 Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate ~ Fee Submitted: $ .2 ~ {oD Date of Permit. S/ S-!iJ' Filed Map. Applicant: Ou-> tv e r ~ Lot: Underwriters Approval: Final Certificate: (/ [J/.,~ (check one) ~./(,)l6c,y Co !l: ? 17~~ 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. 31969 Z Date MAY 5, 2006 permission is hereby granted to: JOSEPH & MARY SIECZKA 6285 NEW SUFFOLK AVE MATTITUCK,NY 11952 for : INSTALLATION OF SOLAR PANELS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 80 BLOSSOM BEND MATTI TUCK County Tax Map No. 473889 Section 115 Block 0006 Lot No. 030 pursuant to application dated MAY 4, 2006 and approved by the Building Inspector to expire on NOVEMBER 5, 2007. Fee $ 150.00 ~~, I Authorized Signature ORIGINAL Rev. 5/8/02 I/..C _/ __~/) rn.rn ~ BY THIS CERTIFICATE OF COMPLIANCE THE ~ i NEW YORK BOARD OF FIRE UNDERWRITERS i ~ BUREAU OF ELECTRICITY ~ ~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~ ~ CERTIFIES THAT 3 I Cr'b C; ~ ~ ~ ~ Upon the application of upon premises owned by ~ ~ ~ ~ ~~~~ ~~~~ ~ ~ ~:i-r~i~~,U~~~~~~VE t~i-r~iu~~,U~~~~~5~VE i ~ ~ ~ Located at 6285 NEW SUFFOLK AVE MATTITUCK, NY 11952 ~ ~ ~ ~ Application Number: 2100983 Certificate Number: 2100983 ~ ~ Section: Block: Lot: Building Permit: BDC: ns11 ~ ~ ~ ~ Described as a Residential 0-599 square ft. occupancy, wherein the premises electrical system consisting of ~ i electrical devices and wiring, described below, located in/on the premises at: i ~ First Floor, photovoltaic, Outside, ~ ~ A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ~ ~ herein, was conducted in accordance with the requirements of the applicable code and/or standard ~ ~ promulgated by the State of New York, Department of State Code Enforcement and Administration, or other ~ ~ authority having jurisdiction, and found to be in compliance therewith on the 9th Day of June, 2006. ~ F.!l Name OTY Rate Rating Circuit ~ ~ ~ Miscellaneous ~ ~ 1-40 amp back feed ~ ~ Alarm and Emergency Equipment ~ F.!l Solar Panel 40 0 ~ ~ Inverter Unit 1 0 6-KW ~ ~~~~ ~ ~ ~::~::::~: : ~ ~~ ::~~ il ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I seal ; ~ ~ ~ 1 of 1 ~ I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I rn.rn , c 1 Town Hall, 53095 Main Road P,O, Box 1179 Southold, New Yark 11971-0959 lG 2 I L~c,_ -'La I Fax (6:iIT7o)=9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date:il:u j (,(. 5 -I G,;J" oa,h Owner: -?k'ie.r .a. /.-.u cr (Please print) Plumber: --13 ( <..1 f s R ~ , ,- n b /-f? (Please print) 3030'8-7 P<.Q"; Ie Building Permit No, I certify that the solder used in the water supply system contains less 2/100fl% lead, Sworn to before me this~ (Plumber ignature) day of I1-v'jJJ I-- ,2002.. L./J?,-~~ <?( ~~ Notary Public, Julf" l~ County BERN~OEm L TAPLIN NOT~RV PUBLIC 114844893 State of New York " ",idinq in Suftalk C~.nty C.tftCi'i\f~r:xplle~ ~~1".}1'~~ 3l1'~ Z- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] INSULA~ A \ [ ] FRAMING I STRAPPING I/<i FINAL (?OL.Af<, f>/fNc LV [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: F~~ '--<L 0. / DATE ~,-1 - 0 (, INSPECTOR ~~ I ~ . . FIELD INSPECTION REPORT DATE COMMENTS . Lv.." [.; FOUNDATION (1ST) ..1)~ - (f""'"l -1)"" ------------------------------------ I -~~ FOUNDATION (2ND) >~ ;t\ z 0 C/!' a . ~~ ROUGH FRAMING & C) ~ .51 PLUMBING ~ '"l g 0(1 . ~ ~ ~~ t"' INSULATION PER N. Y. ~ ~ '"l STATE ENERGY CODE 3> ~ - . - . , .A . <. ';-..5/ .; >...{, :'FJ~ ..tJl L /'\ '-6t VA ,....-""7 ~ J / 1'> Y tI j FINAL fc: . ADDmONAL COMMENTS U\ (\'\ ., No ^~ '.:P ~. ~ -- [.; .., - ~ I .." If\~ , '"l 4 S~ =: t'l Z~ =: )> ~ [.; .." :-' .. f r j.) f If) TOWN OF SOUTHOLD BUILDING DEPARTMENT . TOWN HAl,L i SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.net/Southold/ PERMIT NO. 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 ~J 9 C, 9~ Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Examined is- ,20 Ok 2/ s-. 20 OC Approved Disapproved alc Phone: d. q 't -y y d. ~ ( t/ ,C;- ,20-.2Z fJ~ I Building Inspector Expiration l\'\ltj 4 r; i "\~ ' ~ : ~PPLICATION FOR BUILDING PERMIT j) c",; Date /lJdl/ 7' 20bl> '- INSTRUCTIONS i , _ a.'1iilsapplication 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. 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 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ?~R.rJJew};;~t/(~ ~ (Mailiff address of applicant) ~/I'.r:J..- State whether applicant C ~~essee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises ~.s~j /~ oL m~ ~.~ (As on t e 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. I. Location of land on which proposed work will be done: ? z.J' ~ AlaU.Sr .a lie A-tte House Number Stree~ Ad/if -b- ,-L.- Hamlet ,\',.',...., :- , ..., j"V, -Lot. _...Lot 30 County Tax Map No. 1000 Section Subdivision 1/5' Block t;;, Filed Map No. , ~ , ~. '. (Name) I 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Ph (/alL .i-~ .' ~ b. Intended use and occupancy 4Ld/~J $"& III 1/ /Jtf..K~ , 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition Other Work Alteration c;&>/a;- .I?~ ,M J/4 , (Description) 4. Estimated Cost .,~ Iff) Fee 5. If dwelling, number of dwelling units If garage, number of cars I (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. 7. Dimensions of existing structures, if any: Front Height Number of Stories Depth Rear Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size oflot: Front Depth Rear 10. Date of Purchase Name of Former Owner II. Zone or use district in which premises are situated 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. Names of Owner of premises Name of Architect Name of Contractor Address Address Address Phone No. Phone No Phone No. IS 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 ) , /11 /lIlv j:JjJ;) S)~ 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 ~, 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. looh '?1i/S&::"~ o ry Public BONN J DOROSKI NOlllryPublic, teOfNew'lbrll No.Ol006095328,Suffol~~unlJ Term Expires July 7. 20..lLf- U.~RA.C" ,HIE:. :.: :":""lDARID IN P'f MODULE RAC!{S" SOLARMouNt u.s. and other patents pending. Code-Compliant Planning and Assembly with California Building Code Certification Installation Manual 214 Contents Letterofcertification ........................................2 Part I. Scope. certification, and installer responsibility ........3 Part II. Procedures for code-compliant installations using the SolarMountModule Mounting System .......4 Part III. Installing SolarMount with top mounting clamps . . . . . . .9 Part IV. Installing SolarMount with bottom mounting clips ... .15 Warranty ................................................ .20 ',"c, :,,:>>"(/:"<:'i ";:'J', ,;'.;</:',,' .;:,':"':;",-:,, ,.,< ,":",:.',:c:: <: Mn~a9~el~9n1f!~':j1lpTi~~59~,g~mip~$~:1l~S,)',,~~:.~~erlri-~Hcllm~:~~'?f : '; ",,;'/Ws:'in~~BaT;~r!~~5:~Wflte-:~p4pl!~a#ons@~~.eoijt.: ...., Pub 040316 111 March 2004