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HomeMy WebLinkAbout31432-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z~31804 Date: 09/13/06 THIS CERTIFIES that the building ELECTRICAL UPGRADE (STREET) Block 2 SOUTHOLD (HAMLET) Location of Property: 45295 MAIN RD (HOUSE NO.) County Tax Map No. 473889 Section 75 Lot 5 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 1, 2005 pursuant to which Building Permit No. 31432~Z dated SEPTEMBER 6, 2005 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 NEW ELECTRIC SERVICE TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to TOMASZ MEJSAK (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 3002255 08/03/06 PLUMBERS CERTIFICATION DATED N/A ~J-~ ' ~orred ignature Rev. 1/81 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ------.---....." F r\UlJ L c J6 , APPLICATION FOR CERTIFICATE OF OCCUPANCY\ <,- - <<' J< This application must be filled in by typewriter or ink and submitted to the Building Departm~the tOIIOwi~g~'-" A. For new bnilding 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 coutains less than 2/1 0 of 1% lead< 5< Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance trom 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. L 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 L 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. Location of Property: ~)2qS- ouse No. ---- IOl/VJrfrz Old or Pre-existing Building: 11 fl.t'VJ Roa.d Street d;Sr:J tJ 7) Block (check one) StJUlka New Construction: Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section &00.2 Lot OOy Subdivision Permit No. '(ILl '?2 - Date of Permit: Filed Map. Applicant: ~()V1aJZ Lot: ;1 ~J Health Dept: Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: ( check one) Fee Submitted: $ r;;;;:;aJ? ~;~ Applicant Signature ~:7o~?1 c.~.z 3/80Y 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. 31432 Z Date SEPTEMBER 6, 2005 Permission is hereby granted to: T MEJSAK 45295 MAIN RD SOUTHOLD,NY 11971 for : UPGRADE OF ELECTRIC SERVICE AS APPLIED FOR at premises located at 45295 MAIN RD SOUTH/PEC County Tax Map No. 473889 Section 075 Block 0002 Lot No. 005 pursuant to application dated SEPTEMBER 1, 2005 and approved by the Building Inspector to expire on MARCH 6, 2007. Fee $ 150.00 'A--L<=. r:,~. ~ A . Authorize Signature ORIGINAL Rev. 5/8/02 '7~-._;).-~ - -~-:r @]. ~@] I BY THIS CERTIFICATE OF COMPLIANCE THE I i NEW YORK BOARD OF FIRE UNDERWRITERS i ~ 0 \ {.. BUREAU OF ELECTRICITY ~ ~ \J ~ \ ~ 40 FULTON STREET - NEW YORK, NY 10038 --=:t=f- ~ ~ 0 CERTIFIES THAT 3J,-/3;;> ~ ~ ~ ~ Upon the application of upon premises owned by ~ ~ ~ ~ LAGUN ELECTRIC MEJSAK THOMASZ ~ ~ 724 PULASKI ST 45295 MAIN RD ~ ~ RIVERHEAD, NY 11901 SOUTHOLD, NY 11971 ~ ~ Located at 45295 MAIN RD SOUTH OLD, NY 11971 ~ ~ ~ ~ Application Number: 3002255 Certificate Number: 3002255 ~ ~ Section: 075 Block: 0002 Lot: 005 BUilding Permit: 31432Z BDC: ns11 ~ ~ ~ ~ Described as a Residential occupancy, wherein the premises electrical system consisting of ~ i electrical devices and wiring, described below, located inion the premises at: ~ ~ Basement, Outside, ~ ~ A visual inspection of the premises electrical system. limited to electncal devices and wiring to the extent detailed ~ ~ herein, was conducted in accordance with the requirements of the applicable code andlor 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 3rd Day of August, 2006. ~ r.!l Name OTY Rate Rating Circuit ~ ~ ~~~ ~ ~ I Phase 3W Service Rating 200 Amperes ~ ~ Service Disconnect: 1 200 cb ~ F.!J Meters: 1 F.!J ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ; seal ~ ~ ~ ~ 1 of 1 ~ ; ~ ~ This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. ~ @].@] /()(lU'- s-~ .:? - /V] - () OWNER STREET 4 .::::;" C{' VILLAGE DIST SUB. LOT . L. .....) "'-OW\~~t~ ~()rbttnL- A.\ ~~..\r r,"- ~(U 7/!'i/('/ \!!) '\<. ,',\', !JORMER 6W~ER Oeh..KlM.l / E c?htvzrz'"L;t::/ . ACR. I N, VI'~I-Ila "c:v-s, '- '/~ ,..d'GS .::J~.'! Ov~;>II'Cit'\~~ S f/ W JYPE OF BUILDING _ ' .... -. JJ / '/.A6 ' 7/z.4.,~ /cc:I :~ jJ~ . , . VL. , COMM. MICS. Mkt. Value .RES.1 / tJ SEAS. FARM CB. , LAND IMP. TOTAL 1 DATE REMARKS - . -7"cY:O eX .:2 () 0 d<00(J .,...'" SOA/ :l./"'/".~ \-~. .., ~oO .:<.c.oo s ~ <>-0 j 1"//Q/,,, , f/.__/ '1, f/, 7,;" . 0. . . c4 7s777/;'oe "'.... 1i'4/Y.~/'''',..q-o-.:Te/Y''''(, p:CrANIK - iI}"p/Yev,d"ce"",c1] . . ::;J; Itl.2' L 1.,11_ 70 0rf() - ()V<:' 1/JV11 k fz; Uvr ~1'r7{l~ I '1/11- if . 1/1/'()2--:fP(ln~';' ()i15r'nnlJ( ,etcUY15' I,. U5-f L{ I D5 - JeJ1ne. Dvs;an;k oJ e Cf'a sed lP (.;;){ I () if (01. c. ) q;~.c1/DL/- Lld3q..Kp41f1-Dv~/an;Ic~Dr5 fa M~f~ak-~wr$'''}7~,~. ~ '"\ ).olf Vrec)0 ~3Di{/~ AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre .. Tillable FRONTAGE ON WATER . Woodland FRONT AGE ON ROAD ~~/ ra. '7rc s-'1s .. Meadowland DEPTH I 70 I House..,ik>t..- ~~ BULKHEAD ... <. , Total DOCK ? ~ TOWN OF SOUTHOLD PROPERTY RECORD CARD ~ " " " , ' "f -. 'j' ,\ I 1;{., ! .> ' ~" ~, "'", , . ., - ! - "l' Q ... I~ . " - 't '. I 1---0 ,.1.' , /J , . ~ , ' ,-,.- ,", , I~ X >.r--o ~ .. $LD ') I '\ M. Bldg. 11. -:z.6>'.3G'/f bO;<: , Extension 1-1 X ~.stl oJ. 7/ If' Extension ~ X z.. '/' -" /9.? ). ~?.<. ~li'.o zS"" I Extension S)(/~::" t!o j Foundation BR!c.J.I. Bath ( Dinette Porch . /"n:, ') Basement Floors , K. c::,Y:l.. II ?I'lRL P/A/E' Porch ( II y/ Ext. Walls Interior Finish Wfj-~L /])) LR. ~XI2. '- 72- ./ .2 4 K $-r> WOOD SHI/'/(, Breezeway , Fire Place Heat 1/ f.. S, DR. IV i) Garage I , Type Roof Rooms 1 st Floor r IBR. i ,,^D )<,-d-D ; 4" . C> sV t c.-O Patio I Recreation Room Rooms 2nd Floor FIN. B O. B. Dormer Driveway Total j 137/,( ;()~.... 30../ I f I :5 - " / . , COLOR NAr TRIM W#/r.!:~ -j7iY1 '81'-?3J~ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'> Board of Health 4 sets of Building Plans Planning Board approval Snrvey Check Septic Form N.Y.S.D.E.C. Trustees Contact: TOWN OF SOUTH OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.netlSouthoId/ PERMIT NO. Examined 07/~20~ Ol/~O~ Approved Disapproved ale Mail to: Phone: 73> f ~ ~ 211 Expiration 1-.../ '020~ I ~._-'~--~~'-i--::~')' In 1-, \ ~ 1,; , !e, tC:'ll~ Building Inspector I 2005 APPLICATION FOR BUILDING PERMIT ..,J .' '1__J Date ~ r;;::X ~ ,2000' 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 oflot 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 ofthis 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. UNDE~'W' .. S CERTlACATE "IRED OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE -- /0-1 (Signature of applicant r name, if a corporation) t(s21r; Hr.U'V/ RaC ~u-f./1JcL (Mailing address of applicant) Name of owner of premises State whether applicant is ownetJps5eerJ~NeY engineer, general contractor, electrician, plumber or builder AlE N VOl( ~ N.lf APP~OVED AS NOTED DATE:~ B.P. # ~ I if "3 :;)..c lat s Y: NO IFY BUilDING DEPARTMENT AT 765.1802 8 AM TO 4 PM FOR THE FOllOWING INSPECTIONS: 1. FOUNDATION. TWO REQUiRED FOR POURED CONCRETE 2. ROUGH. FRAMING & PLUMBING 3. INSULATION 4. FINAL. CONSTRU::TION MUST BE COMPLETE ':" C.O. All CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR ALL CONS rriLJ~ liON SHALL A ~ If applicant is a corporation, signature orm?RF~gfo (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 547(; -HE 1. Location of land on which propose ,. 'ffi House Number Street Hamlet County Tax Map No. 1000 Section Subdivision 0'1-6 Block CJoO;;:>-'" Filed Map No. --- Lot (J () '2> Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost .., /SOO. 00 Addition Alteration Other Work JJEAJ SEflItlc.E ,200/}/-fp. (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. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth 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 Rear Depth -JlO. Date of Purchase . oq b.Y /04 Name of Former Owner . ~~(JV\~I"'cv\z. -l.> CK-::,. J 11. Zone or use district in which premises are situated l\ l.- 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 - - -- Address Phone No. Address Phone No Address7.t1t fblfi~/C.I S71? Phone No.~Y- 761, - O!.oS !lfVE/U-flOHO NYII'10/ 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 apd'distances to property lines. 14. Names of Owner of premises Name of Architect Name of Contractor lFT4//Ai E~CT~C ,. . .~, 17. If elevation at any point on property is at 10 feet 0; ~Id~;' ~ust provide topographical data on survey. STATE OF NEW YORK) ss: COUNTY OF ) ~fY\fl '" z:.. /r)( J ;)(11( .' . being duly sworn, deposes and says that (s)he is the applicant (Name of individual sigmng contract) above named, (S@isthe (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 knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. --- Pamcla J. Dunn Notary Public, Statc ot New York Registration # 0 1 DU6039460 Qualified In Suffolk County My Commission h;UClS April 3, 20~ ~ N/F JEROME N FRAME GARAGE N 55'39'30"E'" ufrl Z N .. dot7' .6 o OUTHOUSE N ::;;: 203' (J) N OJ -I>> (J) GJ CTl --- r ~ -ZA;;:; DRIVEWAY --- z l> \.-- ~ " Vl -0 " J: WOOD I l> STEPS 242' ~ 0 '" " 0 i'i '" <: co ~ -< 2-STORY RESIDENCE 0> N, 0 0 ~ " ~ 0 PORCH 0> S'~'B-C' 30.0' <""" 1- 220' ,~ ~ 0 cO co, co '-J ~ CD 56'1 2 00 W 83.50 S ROAD MAIN ~ >-- "1j ~ ]trJ j; 4 .!:J>-- -< trJ Z C M '-J N o CD ':'V~PAN TEES INDICA TED HmE ON SHALL RUN DNi)' TO mE PUrSON FOR WHOM THE SURVEr' 1$ PREPARED, AND ON HIS BEHALF TO THE Ti ILE COMPANY, GOVERNMENTAL AGENCY. ~[,""'OINC IN:iT/nmON, IF LISTED HEREON, AND :<,,' T,,-![ ASSIGNEES OF THE L[NDING INSTlrunoN CLARANi[[S ARE NOT TRANSFERABLE TO A[C,'T!:)NAl INsmunONS OR SUBSEDUENT OWNERS. SURVEYED: 30 JULY 2004 SCALE 1"~ 30' AREA ~ 14,,377.72 SF OR 0.33 ACRES UNAI.jTHQ,RllEO AL TERA TION OR ADomON TO THIS SUI'i'VEY IS A V10LA TlCN OF SEcnON 7209 OF THE NEW YJRk STATE EDUCATION LAW COPIES OF THIS SURVE"Y MAP NOT BEARING THE LAND SURVUORS EMBOSSED SEAL SHALL NOT BE CON$IOERED TO BE A VALID TRUE COPY. SURVEY OF DESCRIBED PROPERTY SITUATE PECON/C, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR: TOMASZ MEJSAK BARBARA MEJSAK -'.'=t 1000-075-02-005 SURVEYED 8Y STANLEY j :'3AI\SEN, .Jr;'. PO 50X 234 NEW SUFFClU, NY I!'~' 6j 1 - 7 4--5835 '::L'AR4.NTEEO TO: TOMASZ MEJSAK 8"R8"R." MEJSAK DECISION 2000 REAL ESTATE SERVICES, INC ,:".