HomeMy WebLinkAbout32712-Z
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32273
Date: 02/26/07
TIllS CERTIFIES that the building
ADDITION
Location of Property: 500 YOUNGS
(HOUSE NO.)
County Tax Map No. 473889 Section 141
AVE
(STREET)
Block 1
MATTI TUCK
(HAMLET)
Lot 30
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
FEBRUARY 12, 2007 pursuant to which
Building Permit No. 32712-Z
dated
FEBRUARY 12, 2007
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 ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to VICTOR & BARBARA RUTKOWSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
03/27/96
N-381389
PLUMBERS CERTIFICATION DATED
N/A
~o~
Rev. 1/81
,
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
Yv\o-J)
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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 fonn).
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 2/1 0 of] % lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a cel1ificate
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. t'/
~l/(
C. Fecs
I. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, AJterations to dwelling $25.00,
Swimming pool $25.00, AccessOlY building $25.00, Additions to accessory building $25.00, Businesses $50.00.
2. Certificate ofOccup3ncy on Pre-existing Building _ $100.00
3. Copy of Certificate ofOccup"ncy _ $.25
4. Updated Certific"te of Occupancy - $50.00
5. Tempor"ry Certificate ofOceupancy - Residential $15.00, Commercial $15.00
)-:
Date.
Lf/;}../o 7
I '
New Constmction:
Old or Pre-existing Building:
Location of Property: !)" 0 Q
House No.
'-/lJ<.NVCr ,t<J.vl'L
. Street
(check one)
Owner or Owners of Propel1y: V { ~ -r" I'Z. -I-. /5 ~R-II'tf'l-1'l
Suffolk County Tax IVIap No 1000, Section 473 G"r 9 I'll Block
/J1.g "17, k, c /<
Hamlet
R l" Tlo::'d c-v r k'. .
Subdivision
000 I
Lot
636
Permit No.
Filed Map.
Lot:
"3 ~.., / 2. .. 'z.. Dale of Permit.
2..//2./87 Applicant: V/c../dfC.. J?u7J:({J<.)sk,'
, ,
Health Dep!. Approval:
Underwriters Approval:
Planning Board Approval:
Request for:
Temporary Certificate
Final Cel1ificate:
/
(check one)
Fee Submitted: $
J 5': <lO
~.'1d)<\2
CfJ-tJd273
'\
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Applicant Signature
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.
32712 Z
Date FEBRUARY 12, 2007
permission is hereby granted to:
VICTOR & BARBARA RUTKOWSKI
500 YOUNGS AVE
MATTITUCK,NY 11952
for :
CONSTRUCT AN ADDITION TO EXISTING ONE FAMILY DWELLING AS APPLIED
FOR. THIS PERMIT REPLACES BP 23133.
at premises located at
500 YOUNGS AVE
MATTI TUCK
County Tax Map No. 473889 Section 141
Block 0001
Lot No. 030
pursuant to application dated FEBRUARY 12, 2007 and approved by the
Building Inspector to expire on AUGUST 12, 2008.
Fee $
75.00
o. ized Signature
Rev. 5/8/02
ORIGINAL
THE NEW YORK BOARD OF FIRE UNDERWRITERS
P~l\Gr: 1
U.q"j19'J
I
BUREAU OF ELECTRICITY
BS JOHN STREET, NEW YORK, NEW YORK 10038
Date
lfll.RCH :~7 j 1~J;)6
Application No. an fit#'
1 Hi)lt1:.>>:'JG/31j
N ~8j3H9
THIS CERTIFIES THAT
only the electrical equipment as described belo." and introduced by the applicant mnned' on the above opplkBtion number in the premu6s oj
Vlcrrcn Elrr!:\lWBKI r !1t]0 YGUNt',S AJJE., r-m.TTlTUCE:; ;,1[. Y 0
in thefolloacinlllocation; IKJ BfJllemenr. [Z] 1..' Fl. D 2nd /0'1. OU'I' Sf>('tion B1QCk l.ot
U'GS examined ml ~E1RCH 2:'. ,1096 andfound to be in compliance with the National Electrical Code.
FIXTURE
OUTLETS
ECIPT AeLIS SWITCHES
FIXTURES
INCANDESCENT FLUORESCENT
OTHER
RANGES
AMT. ICW.
COOKING DECKS
AMT. K.W
OVENS
DISH WASHERS EXHAUST FANS
AMT. ".W.
AMI.
K.W.
AMI.
H. P.
1(1
'/
1\
10
DRYERS
FURNACE MOTORS
FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS
AMT. K.W.
OIL
H.P. GAS
H,P,
AM1
NO.
A. W. G. AMl. AMP. AMT. AMPS.
BELL
TRANS.
UNIT HEATERS MULTI-OUTLET
SYSTEMS
AMT. H. P. NO. OF feET
DIMMERS
AMI. WATTS
,.j {;ult')
SERVla DISCONNECT
AMI.
AMP.
TYPe
NO. OF S ,E R V
METER
EQUIP. 1 A' '1W l,1f 3W 3 if 3w 3 Jl 4W NO. ~E~'B COND. OF ~C~i:gNO. NO. Of HI.lEG
C E
O~. ~:LrG NO. OF NEUTRALS
A.W.G.
OF NEUTRAL
OTHER APPARATUS:
PI'.DDLB r/.cN- 1
llOTOm,: 1-.P n, r.
PANELBL1ARnS: 1.1 (,IR. 100
f:ABl\'r ETJV;ClJ.'Rl::
"~) PAT MN}J
IJIC. #42G(~ E
~r~
v
_L MANAGER
E"~TTITurK~ ~ri, 119~j:~
:U..
Pi'
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
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[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
[ ] ROUGH PLBG.
[ ] INSULATION
~INAL I!e',
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENEmATION
REMARKS:
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
[ ] ROUGH PLBG.
[ ] INSULATION
[j{FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
REMARKS: ~
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765-1802
BUilDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS: ~ o/c
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[ ~NSULATION
[ ] FINAL
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DATE
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765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] ~ATION 2ND
[ ..-1FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS: ~.-et'/ ~-.~
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[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
DATE /;/G/9~
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765-1802
BUilDING DEPT.
INSPECTION
[ ] FOUNDATI N 1 ST
[ ] FO DATION 2ND
FRAMING
[ ] ROUGH PlBG.
[ ] INSULATION
[ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ;:1.0 p:L':.7ee./~
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INSPECTION
[ ] FOUNDATION 1 ST
[ ] .,niNDATION 2ND
[ ~FRAMING
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
.
[ ] FIREPLACE & CHIMNEY
~
REMARKS:
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INSPECTOR
765-1802
BUilDING DEPT.
INSPECTION
[ C6g.uN'';~TION 1 ST
[ ~OUNDATION 2ND
[ ] ROUGH PlBG.
[ ] INSULATION
[ ] FINAL
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARKS: fi,~~~~~A-?-
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FOUNDATION ~ I':;T) _ 11 I:
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ROUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
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BOARD OF HEALTH ............
3 SETS OF PLANS ............
SURVEY .....................
CHECK...... .............. . ..
SEPTIC FORM................
FORM NO.1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
. TEL.: 765.1802
Examined 11jt!-.tf.. . .. . .., Ill. r 3,) (J J...
Approved.. .1;).'/....., 1s9f.' Permit No. ~.{3.(~.yY
Disapproved ale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NOTIFY
CALL
MAIL
TO:
................................~..
lFoJ7f7f-~-~..~ . . . . .. . (B~i~~"e or)
:}Ii~~ '.APPLlCATION FOR BUILDING PERMIT
.J, .",-",_ /
~.. .... 81.!; .,J . INSTRUCTIONS
~%ioF OE.>r
a. This appliCittd\~S!lt@e completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plar(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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
. /
Date... . Nf'-Y. , ..L... .,I~ .(t.:?
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 Southold, 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, housin~ code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
. .Kr.~ .fit::,:,~ );MP.r.O~\"1.;~5.{~BJ)'1..~.c.
(Sigllature of applicant, or name, if a corporarlOn)
. . P:Q.. .'i!.o./f.:.9 7.'" f' GY".ee...'-Ipc:?Y.-t;;, ~J:Y: . I. 1.<f:Iy
(Mailing address of applicant) .
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. .
. .. .. .. .. .. .. . . . .. .S !-! .d.J:e: ~. .. .. . . .. .. . . .. . . . . . . . . .. . . .. . . .. . . . . . . .. .. . .. .. .. .. .. . .. . .. . . . . .
Nameofownerofpremises ... \.h~i-9.-=-. .f.B.,.t:(I4~r.+.. .ey.tj<o~$k~............................
(as on the tax roll or latest deed)
If apPI21is a corporal" n, ign u of duly authorized officer.
..... "Z~ t;ti~~~;;~ra:~ ~ffic~;;'f"".s,....
Build r'sLicense No. .. .I.3J.Q.'. .tI:~..........
Plum ber's License No. ........................
Electrician's License No. ......................
Other Trade's License No. .....................
I. Location of land on which proposed work will be done. .................................................
. '" .. .. .9?q. ., . . . . . .. . .. . ... . Yo. ~~S.~. .. /h?<.. . .. . . . .. . M;t~tt\ t ~<; k-... . .. .. .. "
House Number Street Hamlet
County Tax Map No. 1000 Section .... \ 4.-. i. . . . . . . .. Block ...... l. . . . . . . . . .. Lot...:3 9. . . . . . . . . . . . .
Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. .............. Lot...............
(Name)
2. Slate existing llse and occupancy of premises and intended use and occupancy of proposed construction:
. r"\ ff.?'\Ji'
a. Existing use and occupancy.....I... .T.p'\.I:'-.'.l ''\'.... .€'.<;,l qf'..I.. .'.'1\................................
~ - 1. RJln~ ~'~!lja :/'1"" :Ii" Ji)"-
b. Intended use and occupancy..... .\.... .I;\.\~ .\. 1" J. '-.:"::s.~1~~~~-;:""""""""""
t!U8ElSlr a'W'''.
........
3. Nature of work (check which applicable): New Building. . . . ... . . . . Addition. . . !~.. Alterati~n ..........
Repair .............. Removal . . . . . . . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . .
. (Description)
4. Estimated Cost. . . . . . . . . . gJ .cr:av. ,. ~. . . . . . . . . . . . . . Fee.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(to be paid on filing this application)
5. If dwelling, number of dwelling units. . . . . . . t . . . . . .. Number of dwelling units on each floor. . . .!. . . . : . . . . . . .
If garage. number of cars ....... -:-:-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. If business, commercial or mixed occupancy, specify nature and extent of each !X..pe of use. . . . . .-:-:-. . . . . . . . . . . . .
7 D. . f" 'f F e".:...-' R fD ~ /' D h .~ I< I
. unenslOns 0 eXlstmg structures, 1 any: ront..........-...... ear...../......... ept .... .t. . . . . . . . . .
Height .....l Y? .'. . . . . . Number of Stories. . . . .1. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
,< '- I to I
Dimensions of same structure with alterations or additions: Front .......U: >. . . . . . .. Rear... .'. S. . . . . . . . . . .
Depth. . . .3..f:! . '. . . . . . . . . . . . . . Height . . . . . .1.7. ~ . . . . . . . . . . . . Num ber of Stories. . . . . . L . . . . . . . . . . . . . . .
8. Dimensions of entire new construction: Front. . . . .1 ~:. . . . .. Rear..... .J. 3. ~. . . . . Depth. . . . .1.7.'. . . . . .
Height ..... .1.1.'.. . . . . Number of Stories. . . . . . . .! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front .... . . .5 :e.R.,. . . 5. ~ ,,~~ tear. . . . . . . . . . . . . . . . . . . . .. Depth ......................
10. Date of Purchase ..... J ':1 t. 'I. . . . . . . . . . . . . . . . . . Nam~f Former Ojl'ner .....~......................
II. Zone or use district in which premises are situated. . . . . . . . K ~~. \ iJg 1':'t .1.4 1.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. D~es proposed construction vt~~e any zoning law, ordina~ce or regulation: .. tV.C? . . . . ..... . . . .,... . . . . . . . .. .
13. Will lot be regraded ...... ~~: .~t.:l:K' . . . . ,. . . . . . WIiI excess fill b~removed from pre!plses: ,~~"' No
14. Name of Owner of premises V.~. . . ':'J. '<'~~'((," . . . . Address ~lY!'-:'f~" y~. J':f:r.t:f... Phone No. a~'P. ~ .~~ ?S'.
Name of Architect. '<.GI' . . . . . . . . 'J' . . . . . . . . . . Address. . . . . . . . . . . . . . :1" . . Phone No. . . . . ... . . . . ...:.... .
Name of Contractor!. t. ~. . .8,.,. ..l<.-1'Y',5 . . . . . . . Address 8~,.~~ ~'l ~1' fi.f'.-\' . . . Phone No. ~.? 7. : !.? :;:!;>. . .
15.Is this property located within 300 feet of a tidal wetland? *YES....NO.~ .
*If yes, Southold Town Trustees Permit may he required.
PLOT DIAGRAM '
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
S-ek:..
SL-VJ-<2u'
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?\U. r.O!V~Ti7iUCTiu;,~ SHALL \'..~':::~T
T[~:;: AEOU~REfi,m'H'~fS OF 'fH:1: N.'~/.
S"J\Ti: CO~STRUCTION & E~!~,7).,'.:~\f
CC;')~t1i. NO"RfSpmJSI~l.E' FO:1i
uF.S:GK ~i'I CONSJ"i'iUCTlor~ EFlI'I(l:<S
STATEOFNEWYOR~f,.L SS
COUNTY OF . . . . .'$",. . : \ . . . . . . .
.. .., .. . t..~ ~('I.U). . .1f!(:'.If. /c7Z-.. . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant
, (Name of individual signing contract)
above named.
He is the. . . . . . . . . . . . . . . . . . . . . . . . .
.. ... '" ..... .......... .... ..... ..... ...... ....... .'... ........
(Contractor, ent, corporate officer, etc.)
of said owner or owners, and is duly authorize 0 perform or have performed the said work and to make and file this
application; that aU 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.
Sworn to before me this
drh; l 'U: AeW Si . .... IW8J.
~O:) lIIOlI"S . ~L" "ON
10N III -lS Od AW10II
.W':t..ImS '1.lH38011
TOWN
(Joo-/;f/-/-3d .
. OWNER
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: ~ i tc't:;,,(~ ' -? t<
1
; FORMER OWNER
o
...
(, . .
RES, ~)O
LAND
. IMP,
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60
-LOO
. 3&00
<:> 0
3(Po(;>
joO
O()
'I !J:) So2" Cl
AGE
i NEW
I FARM
I
I
I
I, Tillable
I
Woodland
"
Meadowland
Hause Plot
Total ....
NORMAL
Acre
~ l.\~o ~~~ d~l3~t
F SOUTHOLD PROPERTY RECORD CARD
00 VILLAGE DIST. SUB. LOT
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F ARIJ.
Mkt. Value
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COMM, CB, MICS,
TOTAL
DATE
REMARKS
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BUILDING CONDITION
BELOW
ABOVE
Value Per
Acre
Value
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
/001
~
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BULKHEAD
,,-
DOCK
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M.1ts;/(og.
Mf/iln
Extension
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, Garage
Patio
\
O. B.
Total
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, & BUILDING INC. SHEET NO. OF
P.O. Box 676
GREENPORT. NEW YORK 11944
(516) 477-1255
CALCULATED BY
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