HomeMy WebLinkAbout32438-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31964
Date: 10/30/06
THIS CERTIFIES that the building AS BUILT ALTERATIONS
Location of Property: PVT RD
(HOUSE NO.)
County Tax Map No. 473889 Section 10
INNER BAY
(STREET)
Block 9
FISHERS ISLAND
(HAMLET)
Lot 14
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
OCTOBER 19, 2006 pursuant to which
Building Permit No. 32438-Z
dated
OCTOBER 19, 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 "AS BUILT" ALTERATIONS (ELECTRIC AND PLUMBING) TO AN EXISTING ONE FAMILY
DWELLING AS APPLIED FOR.
The certificate is issued to RICHARD & ELIZABETH DALKOWSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
3009686
10/05/06
PLUMBERS CERTIFICATION DATED
10/03/06 EMERY HEMESRAY
Rev. 1/81
Form No.6 r-'--
TOWN OF SOUTH OLD I
BUILDING DEPARTMENT i
TOWN HALL ;i OCT I 6 2 ;8
765-1802 ~__
APPLICATION FOR CERTIFICATE OF OCCUPANCY --1S~.d1 S', _~~
11ris 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 electrica] installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifYing that the solder used in system contains less than 2/10 of] % 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:
]. 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 Bui]ding.. $] 00.00
3. Copy of Certificate of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $]5.00, Commercial $15.00
Date. October 13, 2006
New Construction:
x
Old or Pre-existing Building:
(check one)
Location of Property:
271
House No.
Gloaming Extension
Street
Fishers Island
Hamlet
Owner or Owners of Property: Richard L. Dalkowski and Elizabeth S. Dalkowski
Suffolk County Tax Map No 1000, Section
Subdivision nl a
Permit No. '3:J. Y-3 d' -Z' Date of Permit.
Health Dept. Approval:
Planning Board Approval:
010.00
Block 09.00
Filed Map. nl a
Lot
014.000
Lot:
nla
ID~ I!J -of" App]icant: Richard L. Dalkowski
Underwriters Approval:
Request for:
Temporary Certificate
Fina] Certificate:
x
(check one)
Fee Submitted: $ 25.00
~l ~ .6- 31 '1 v-J
~G 1 \~4
~ L. i-b-..a
Applicant Signature
Stephen L. Ham, III
T_ ".U, $309$ Mala RoIld
P.O. Bole 1119
SoGlIloId. New York 11971.Q9S9
BUILDING DID'ARTMBNT
TOWN OF SOUTHOLD
CER TIFICA TION
Date: ~, ~ (Ju,
Building Permit No.
3)'-13 %
Owner:
'8\G\-U\{) \:)~ Kc)~,<:,. \
(please print)
Plumber:
0mr~ ~f7NrI~<;~ LIe.... Z5~~ -0\(:)
lease print)
FIX (631) 765.1823
TcIqlboDe (631) 76S-t8()2
I certify that the solder used in the water supply system contains less than 2/10 of 1% lead.
II-fGvG 'DOf/0. ~ Tl~ R~ l'O -ptt?- f-J(NSC- r::<1C( I~ C/:lS7 \ 2. '-((.> ~
6~)
Sworn to before me this '3r-&
day of Om be,v, 20~
r:Jr~ ~hjrh~
Notary Public, ~county
ROXANNE SPAULOING
NOTARY PUBLIC, STATE OF NEW YORK
No. 01SPfi1B9~2
UUAI 1111 IlIN SUI I 01 K C:OUN I Y
MY COMMISSION lXl'lIILS AUG. U, ,0013
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BY THIS CERTIFICATE OF COMPLIANCE THE
NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
FULTON STREET - NEW YORK, NY
10038
40
CERTIFIES THAT
Upon the application of
upon premises owned by
MYSTIC ISLE REAL TV
P.O. BOX 475
FISHERS ISLAND, NY 06390
RICHARD DALKOWSKI
271 GLOAMING STREET
FISHERS ISLAND, NY 06390
271 GLOAMING STREET FISHERS ISLAND. NY 06390
3009686
Certificate Number:
3009686
Application Number:
Building Permit:
BDC: n511
Section:
Block:
Lot:
Described as a occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located inion the premises at:
Basement, First Floor, Second Floor, 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 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 5th Day of October, 2006.
Name OTY Rate Ratin. Circuit Im
Miscellaneous
as buiilt 1950
with.some upgrades
Alarm and Emergency Equipment
Sensor
Appliance. and Accessories
Range
Exhaust Fan
Furnace
Wiring and Device.
Receptacle 36 0 General Purpose
Switch 27 0 General Purpose
Fixture 5 0 Flourescent
Fixture 26 0 Incandescent
Receptacle I 0 20 amp Laundry
Receptacle I 0 30 amp Dryer
An as built inspection. of the delineated electrical installation, detennined that an obvious hazard is not present and the insta~n is believed to
be in comformance with the applicable reference standard for the estimated period of construction of the prenrises wiring system.
2 0
Smoke
50
Amp.
F.H.P.
Oil
I 0
I 0
I 0
Continued on Next Page
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This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
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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
E!Imm .
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MYSTIC ISLE REAL TV
P.O. BOX 475
FISHERS ISLAND, NY 06390
RICHARD DALKOWSKI
271 GLOAMING STREET
FISHERS ISLAND, NY 06390
271 GLOAMING STREET FISHERS ISLAND, NY 06390
Application Number:
3009686
3009686
Certificate Number:
Section:
Lot:
Building Permi!:
BDC:
ns11
Block:
Described as a occupancy, wherein the premises electrical system consisting of
electrical devices and wiring, described below, located in/on the premises at:
Basement, First Floor, Second Floor, 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 5th Day of October, 2006.
Name OTY Rate Ratin. Circuit il'M
seal
2 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.
c~ CME Architecture, Inc.
~ 32 Crabtree Lane, P.O. Box 849
Woodstock, CT 06281
(860) 928-7848 FAX (860) 928-7846
I 8 .'
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October 6, 2006
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----...
Gary Fish
Town of Southold
Building Department
Town Hall
53905 Main Street
Southold, NY 11971
~- '--
--<~......
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----.J
Re: Dalkowski Residence
271 Gloaming Ex!.
Fishers Island, NY
Dear Mr. Fish,
Please be advised that to the best of my understanding and knowledge, plumbing work at
the above referenced residence including replacement of existing toilets, sinks and the
installation of a new washer hookup has been completed in accordance with the
applicable codes ofthe State of New York.
~,~~
NY architectural license number 029794
10.700
Date
The foregoing instrument was signed and acknowledged
Before me this 7 'i1J day of OW bey 2000 .
~~Ir1. 'J~~
"'Notary public
State of Connecticut
My commission expires
SUSAN M. LALUMIERE
lVQ7~Y PUBUC
MY COMMISSION EXPIRES FEB. 28, 2008
Toll Free 1-888-291-3227
An Equal Opportunity Employer
www.cmeengineering.com
CM~ CME Architecture, Inc.
~ 32 Crabtree Lane, P.O. Box 849
Woodstock, CT 06281
(860) 928-7848 FAX (860) 928-7846
0(;, I 8 2J6
October 6, 2006
I ~--..
. -
__.-J._
..,_' c I
'--..---.1
Gary Fish
Town of South old
Building Department
Town Hall
53905 Main Street
Southold. NY 11971
Re: Dalkowski Residence
271 Gloaming Extension
Fishers Island, NY 11971
Dear Mr. Fish,
Please be advised that to the best of my understanding and knowledge, electrical work at
the above referenced residence including replacement of existing outlet devices with GFI
outlets, installation of recessed lighting fixtures, installation of dedicated outlets for
washer and dryer and other outlet device upgrades, has been completed in accordance
wit e applicable codes of the State of New York.
Evelyn ole SmIth,
NY architectural license number 029794
10.7-00
Date
The foregoing instmment was signed and acknowledged
Before me this 7 <t!J. day of Oc.ivher
200,", .
~ /Yi - ';}OJU~VPAL
/ Notary public
State of Connecticut
SUS
MY CO
. '_~ LUMIERE
"VBLle
,,,,RES FEB. 28, 2008
My commission expires
Toll Free 1-888-291-3227
An Equal Opportunity Employer
www.cmeengineering.com
MATTHEWS & HAM
ATTORNEYS AND GOUNSELORS AT LAW
38 NUGENT STREET
SOUTHAMPTON, NEW YORK 11968
PHILIP B. MATTHEWS
(JOI2-1992)
STEPHEN 1. HAM, III
BARBARA T. HAM
631-283-2400
FACSIMILE 631-287-1076
e-mail: Matthamesq@aol.com
October 13, 2006
Mr. Gary Fish
Town of Southold Building Department
P.O. Box 1179
Southold, NY 11971
Re: Application for Certificate of Occupancy
for Richard L. Dalkowski
(SCTM No.1 000-01 0.00-06.00-014.000)
Dear Gary:
In connection with the referenced matter, I have enclosed an Application for
Certificate of Occupancy and my check to the Town of Southold in the amount of the
$25.00 fee.
Please issue the Certificate of Occupancy covering the plumbing and
electrical work for which Mr. Dalkowski previously performed and for which he
subsequently made application for a building permit and forward it to me along with the
pre-existing Certificate of Occupancy for the single-family dwelling at 271 Gloaming
Extension on Fishers Island.
If you require any further information, documentation or payments before
taking these actions, please give me a call immediately.
Sincerely,
\ \) ,
,
)
~~&- f-h-,
-'
Stephen L. Ham, III
Enc-loSUres
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
oJ TEh: (631) 765-1802
FAX: (631) 765-9502
....... northCorlLnetlSoutlloldl
BUILDING PERMIT APPUCATION CHECKLIST
Do you have or need the foUowin&. before applying?
Boon! of Health
4 _ of Building PIlIns
Planning Boon! ~va1
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Co.tad:
Mail to:
PERMIT NO. ;
.20_
.20_
Examined
Approved
Disapproved ale
Phone:
Expiration
.20_
r-- ,
-~,~
I'! '
'[I
_ j I APPLICA nON FOR BUILDING PERMIT .......
I , I Date(JC("~ 3 .20() <0
----: .: " I INSTRUCTIONS
i---,-a. fiiif~jfi.ill(Jil~ completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets of plllllS, acour8le plot plan to scale. Fee according to scbedule.
b. Plot plan showing location oflot and of buildings on premises, relationship to Iidjoining premises or public streets or
areas, and _ya.
c. The work: co"""'" by this application may Dol be commeoced before issuance of Building Permit
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the appliconl Such a pennit
shaII be kept on the premises available for inspection threughoot the wade.
e. No building shaII be occupied or used in whole or in part for any pwpose what so ever untiI the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shaII expire if the work: authorized bas Dol commenced within 12 mOllths after the date of
issuance or h.. not been completed within 18 months limn such date.lfno zoning amendments or other regnlations affeeting the
property have been enacted in the interim, the Building Inspector may aothori2le, in writing. the extensiOll of the permit for an
liddition six lDOIlths. Then:after, a new permit shaII be required.
APPUCATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pmsuant to the
Building Zone Ordinoncc: of the Town of Southold, Suffolk County, New York, and other applicshle Laws, Ordinances or
Regulations, for the construction of buildings, lidditions, or alterations or for removal or detno\itiOll .. herein deaa1bed. The
applicant _ to comply with all applicshle laws, ordinances, building ,code. houaing code. and regulations,~and to admit
aothorized inspectors OIl premises and in building for necessary inspections. - \ ~
~~~~ '
(Signature of cant or name, if a corporatioo)
fDB<:t"IC Z(,i"g ~ :c~[~/tvy
(Mal _of applicant) Cko 3 <t 0
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
-d~e."" + !)IJ \.1.0 Il.........
Name of owner of premises R~~ l
Building Inspector
OCT - 6 2,006
~--<-) L\q.',~\\ ~.
(As on the tax roll or latest deed) .
If applicant is a corporation, signature of duly authorized officer
'tc..\ \.(0<./,'<.'\
(Name and title of corporate officer)
Builders License No.
Plumbers License No. '2..'" /_ ~ M P
Electricians License No.
Other Trade's License No.
1. Location ofland on ~hich proposed wor
~ '"\ G- \oi:L....,:
House Number Street
will be dpne:
\ ,,~,\<,> '"
F S~!;. l' ~\6..-.J
Hamlet
County Tax Map No. 1000 Section
Subdivision
/0
Block l'
Filed Map No.
Lot I 1..1
Lot
(Name)
2. State existing use and occupancy of ~ises and in~ 118" and occupl!IICY of proposed constnJction:
a. Existing use and occupancy 5,~")le -{;.,......\" C1---e\k-.:,
'. \
b. Intended use and occupancy S'~tQ ~~I'l ~ V "
3. Nature of work (check which applicable): New BuildinR Addition Alteration ,
Repair Removal Demolition OtherWorl< ~lIAAY~
~- . (DeSCri ion)
4. Estimated Cost :.s: cJ1:f <I. 0(\ Fee
5. If dwelling, number of dwelling units
If garage, number of cars
6. Ifbusiness, commercial or mixed occupancy, specifY nature and extent of each type of use. ~"I
/)4' Rear "1..\'
7. Dimensions of existing structures, if any: Front 01 17'<
Height -alii . Number of Stories ~
(To be paid on filing this application)
Number of dwelling units on each floor
Depth
3l\'
Dimensions of same structure with alterations or additions: Front ~ A '\l') e.
Depth Height Number of Stories
Rear
8. Dimensions of entire new constnJction: Front N/A Rear Depth
Height Number of Stories
~ 1''' Rear~ S. a.~' q-y. ~1 .
9. Size oflot: Front J . Lf.) Depth
10. Date of Purchase (ctn Name of Former Owner Lev ~\kowSl<'1
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO X
13. Will lot be ....graded? YES NolL Will excess fill be removed 1iom P'\'IIlises? YES NOX
- 1'3 St.1~ l-loilo...12.) -
I4.NamesofOwnerofpremisesR~ \)41\Ir.....s~daress5>A-/I>....er ()b'la.() Phone No. ~D-q3'i5-6q'fJ.O
Name of Architect Address Phone No
Name of Contractor Address Phone No.
ISa. Is this property within 100 feet ofatidal wetland ora freshwater wetland? "YES X NO _ (fri'- fJ'" 'S~ 1:"7
" IF YES, SOUlHOLD lOWN TRUSlEES & D.E.C. PERMQ;ll 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: .
COUNTYO~
being duly sworn, deposes and says that (s)be is the applicant
(Name of individual signing conllact) above named,
(S)Heisthe tlUlh~r
(ConlIactor, Agent. Corporate Officer, etc.)
of said owner or own.... and is duly authorized to perfurm or have perfurmed the said wnrl< and to make and file this application;
that all statements contained in this application are troe to the best ofhis koowIedge and belief; and that the wnrl< will be
performed in the IDlIIIIl<l" set furth in the application filed therewith.
~~.,-:,~~--
,..,~ 'PJ
otary lie
ROXANNE SPAULDING
NOTARY PUBLIC. STATE OF NEW YORK
No 01 SPBl13942
aU^1 1111 II IN SlJn OtK COLIN TY
MY t:UMMISSION lXI'II1fS ^UG. II. 20~
'....