Loading...
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 ~ I I ~ I ~ I ~ ~ I I Located at I I I I I ~ I ~ i I 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 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. ~ ~ ~ ~ ~ I ~ ~ I i ~ ~ ~ ~ I I I ~ I ~ I ~ I ~ I I I ~ I ~ ~ [QJ1@i2ll2Jj2Jl"lreJJi'1[21Y?~1r?1@f?Jl2l~El@@JE!@Jgrj?1@@~Ef@@i ~ ~ I ~ ~ I ~ I ~ ~ I Located at I = ~ I I = i I ~ . I I I I 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 . I ~ ~ . ~ ~ I = I = ~ . ~ = ~ I ~ I I ~ I ~ ~ I = I ~ = ~ ~ 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 .' n iJ October 6, 2006 I ----... Gary Fish Town of Southold Building Department Town Hall 53905 Main Street Southold, NY 11971 ~- '-- --<~...... I ----.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~ '....