HomeMy WebLinkAbout32392-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32037
Date: 11/29/06
THIS CERTIFIES that the building FOUNDATION REPAIR
Location of Property: 16500 MAIN ST
(HOUSE NO.)
County Tax Map No. 473889 Section 117
(STREET)
Block 9
NEW SUFFOLK
(HAMLET)
Lot 13
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 19, 2006 pursuant to which
Building Permit No. 32392-Z
dated SEPTEMBER 26, 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 FOUNDATION REPAIR OF AN EXISTING DWELLING AS APPLIED FOR.
The certificate is issued to JOSEPH H & JOAN M. FUDJINSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
N/A
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Rev. 1/81
.
Form No.6
TOWN OF SOUfHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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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 2/10 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
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.
1/
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Old or Pre-existing Building: 1/ (check one)
M ,.~ 'f.
e 1-<./ S cJ t Pol"
s-r .
Street
Hamlet
New Construction:
Location of Property: I C:: 5" c ()
House No.
Owner or Owners of Property: -~CIS I? to It H +
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Suffolk County TBj< Map No 1000, Section 1/-7 3 ~ f q
Joan In Fudj (/is~ i
Block I / 7 I - 1 Lot
I?
Subdivision
Permit No. 3^-31 ~ .-Z- Date of Permit.
Health Dept. Approval:
Planning Board Approval:
Filed Map.
10 /)..0 h? Applicant:
I I
Underwriters Approval:
Lot:
Fuctj (I~Sf.. f
Request for: Temporary Certificate
Fee Submitted: $ :J. C:;, (.Ie)
Final Ce,rtificate: l/
( check one)
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, APPli~
~~. 711.{ (2-
Co 'e;:J03 7
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.
32392 Z
Date SEPTEMBER 26, 2006
permission is hereby granted to:
JOSEPH H & WF FUDJINSKI
564 FIRST ST
BROOKLYN,NY 11215
for :
FOUNDATION REPAIR OF AN EXISTING DWELLING 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 SEPTEMBER 19, 2006 and approved by the
Building Inspector to expire on MARCH
26, 2008.
Fee $
150.00
re
ORIGINAL
Rev. 5/8/02
~ y~ iPC:ScdE
PROFESSIONAL ENGINEER
1725 HOBART ROAD I PO Box 616, SOUTHOLD, NEW YORK 11971
TEL631.7652954. FAX631.6143516 . e-mail: j05eph@fischetti,com
Date:
Reference:
September 19, 2006
Fudjinski 16500 Main S1. New Suffolk
Southold Building Dept
PO Box 1179
Southold, NY 11971
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Dear Sir,
The Fudjinski's obtained building permit #21211 Z on 2/4/93 for there property on 16500 Main Street in
New Suffolk for the installation of a new foundation under an existing accessory building, They obtained a CO for
that work, This past week ends storms caused the east foundation wall of that structure to collapse, Because of the
unsound condition I have directed the contractor to temporarily support the floor structure,
I am presently working with the contractor to rebuild that east wall out of reinforced concrete consisting of
B"x 16" concrete footings with an B" concrete foundation wall. This reconstruction will be consistent with that prior
permit. Because of the emergency nature of this work I am attaching a permit application for this work that should
be expedited, Also enclosed is a check for $150,00 from Ms, Fudjinski.
I will be overseeing the reconstruction of the foundation wall to completion,
MEMfORM.OOc
1,'\()ARD CFfUH"lET) ~~,T;;iU(>UF/;i EN(~INEt_:R
3~3~;LZ
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
lXf FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
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DATE INSPECTOR ........... ~ ~
FIELD INSPECTioN REPORT .
FOUNDATION (1ST)
FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS
COMMENTS
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PERMIT NO. .2f;J51d-~
BUILDING PERMIT APPLICA nON 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 DEP;\RTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.netlS
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Mail to:
Phone:
Expiration
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$?pt- \ 9 Olo
APPLICATION FOR BUILDING PERMIT
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Date
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INSTRUCTIONS
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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.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance ofthe Town of Southold, Suffolk County, New Y and other a licable ws, Ordinances or
Regulations, for the construction of buildings, additions, or alterations or ~ r re oval or d ition a he in described. The
applicant agrees to comply with all applicable laws, ordinances, building c de, h sing c de, d re latio ,and to admit
authorized inspectors on premises and in building for necessary inspections.
( . gnature of applica t name, if a corporation)
172~ Ihb~f ~~
(Mailing address of applicant)
State whether applicant is owne , lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
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Name of owner of premises J ()'5 e Ph Fe) d I !/lAG" k I J
, (As on theYax 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.
County Tax Map No. 1000 Section_I I 7
Subdivision
Block 9
Filed Map No.-
tY~ $; f;1/c
HamletlllMMWMOInM
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1. Loc tion 06land on which ~osed w~ ~ill be done:
ouse Number Street
(Name)
2. State existing use and occupancy of premises
a. Existing use and occupancy
se and occupancy of proposed cons,truction:
b. Intended use and occupancy
/fly ~ j
3. Nature of~r (check which applicable): New Building
Repair _ Removal Demolition
'-
Addition
Other Work
Alteration
4. Estimated Cost
/O} cmo
(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
10. Date of Purchase
Name of Former Owner
11. 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 ol;:emises ih
Name of lw:hitect '\.1"; i1 ScAt
Name of Contractor
Address
Address /?2fJ JIo6~J-fi!rI
Address
Phone No.
Phone No 6'J( -76.5'-469-
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:
CO~TY OFS A~~
--..J{)S 9p h hs. ~1/J being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) aro~amed,
(S)Heisthe ~f ~~,---
(Con ractor, Agent, Corporate Officer, etc.)
Sworn to before me this
~ dayof~2<\.:2"..a
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!uffoIk CoU""
CammlaIianfxpires J.nua~ ;. ~O (C)
ork and to make and file this application;
and elief; and that the work will be
of said owner or owners, and is duly authorized to perform or have performed the s
that all statements contained in this application are true to the best of his knowled
performed in the manner set forth in the application filed therewi
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""- 765-1802 9 A
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""'-- b 1. FOUNDATIO
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~ . 3. INSULATION!
~ 4. FINAL - NSTRUCTION MUST
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~ ALL CONSTR' ON SHAll MEET
THe REQUIR. NTS OF THE N.Y.
STATE CONSlll cnON & ENERGY
CODES. Nor I ESPONSlBLE FOR
DESIGN OR TRUC110N ERRORS
B.
DEPARTM :r
10 4 PM FOR THE
ECTIONS:
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.ONCRETE
MING & PLUMBING
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AP~rO~~D AS NOTED
DATE: ').I, B.P. # 'D'J.'tA"d.. ~
FEE: 11~ BY: D{>p...
NOTIFY 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. CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
COMPLY WITH ALL CODES OF
NEW YORK STATE & TOWN CODES
AS REQUIRED ANr:J COND'TiONS OF
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SO\J;HOLD TOWN TRUSTEES
N.Y.S, DEe
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
ALL CONSTRUCTION SHALL
MEET THE REQUIREMENTS OF THE
CODES OF NEW YORK STATE.
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DISTRICT SUB.
LOT
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ACREAGE
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TYPE OFBUILDING
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DATE
LAND
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'100
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5100 (0 If 06
AGE
NEW
BUILDING CONDITION
NORMAL BELOW
Farm
Acre Value Per Acre
Value
Tillable 1
Tillable 2
Tillable. 3
Woodland
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Hause Plat
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REMARKS
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JOSEPH H.. JOAN M. FUDJ I N5K!
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