HomeMy WebLinkAbout33315-Z
FORM NO.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Date: 09/13/07
No: Z-32592
THIS CERTIFIES that the building
ALTERATION
Location of Property: 3405 GRAND
(HOUSE NO.)
County Tax Map No. 473889 Section 107
AVE
(STREET)
Block 1
MATTITUCK
(HAMLET)
Lot 8. 1
SUbdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
AUGUST 2, 2007 pursuant to which
Building Pennit No. 33315-Z
dated
AUGUST 13, 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 "AS BUILT" ALTERATION TO CONVERT GARAGE TO HABITABLE SPACE IN AN
EXISTING SINGLE FAMILLY DWELLING AS APPLIED FOR.
The certificate is issued to WILLIAM LEWENDOSKI
(OWNER)
of the aforesaid building.
N/A
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
3041199
08/13/07
09/05/07 H2M LABS, INC.
PLUMBERS CERTIFICATION DATED
~~izE:f:::--
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled lfl by typewriter or ink and submitted to the Building Depalirnent with the following:
A. For new building or new IIse:
I. Final survey of propeliy 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 fom1).
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 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 Celiificate 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,
Swirruning 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 Celiificate of Occupancy - $50.00
5. Temporary Celiificate of Occupancy - Residential $15.00, Commercial $15.00
Date.
8-;;13.01
New Construction:
)(
Location of Property
3'-t05
House No.
Old or Pre-existing Building:
Grt:1Ad t1Y-L
( check one)
('(\~ rJ::.
Hamlet
Street
Owner or Owners of Property: ~€.AtLD$.b
Suffolk County Tax Map No 1000, Section \ D \
Block
1
Lot~_
Subdivision
PennitNo. '333/5
Date of Permit.
~ Filed Map.
Applicant:
Lot:
Health Dept. Approval:
Underwriters Approval: ________
Plarming Board Approval:
Request for: Temporary Certificate
" ~ D.3
Fee Submitted: $ d ->
Final Certificate: ~
(check one)
fJ.....RL- I70YI.
,- Co 2::'b~ 5lj'J
x
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.
33315 Z
Date AUGUST
13, 2007
Permission is hereby granted to:
WILLIAM LEWENDOSKI
PO BOX 739
MATTITUCK,NY 11952
for :
CONVERSION OF GARAGE TO HABITABLE SPACE AS APPLIED FOR "AS BUILT"
at premises located at
3405 GRAND AVE
MATTI TUCK
County Tax Map No. 473889 Section 107
Block 0001
Lot No. 008.001
pursuant to application dated AUGUST 2, 2007 and approved by the
Building Inspector to expire on FEBRUARY 13, 2009.
Fee $
400.00
iJk~ ~
. Authorized Signature
ORIGINAL
Rev. 5/8/02
/()7. - / -5(. I
l!I~~~l!I
I BY THIS CERTIFICATE OF COMPLIANCE THE I
~ NEW YORK BOARD OF FIRE UNDERWRITERS ~
~ BUREAU OF ELECTRICITY ~
~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~
~ CERTIFIES THAT ~
~ ~
~ Upon the application of upon premises owned by ~
~ ~
~ WILLIAM LEWENDOSKI, III ESTATE OF WILLIAM LEWENDOSKI ~
~ 23 MILLER RD 3405 GRAND AVE ~
~ LAKEWOOD, NJ 08701 MATTITUCK, NY 11952 ~
~ Located at 3405 GRAND AVE MATTITUCK, NY 11952 ~
~ ~
~ Application Number: 3041199 Certificate Number: 3041199 ~
I Section: BELOV'J3lock: Lot: Building Permit: 333/S- BDC: ns11 I
~ Described as a occupancy, wherein the premises electrical system consisting of ~
~ electrical devices and wiring, described below, located in/on the premises at: ~
~ First Floor, garage to living space, ~
~ 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 ~
~ ~=:rity having jurisdiction, and found to b~~~ C~::lianc=a:i::rew~I:C:i~ th:voel3th Day of August, 2007. ~
~ Miscellaneous ~
~ S,B,L: ]000-]07-1-8.] ~
~ as built conversion of garage ~
~ to living space-] 992 ~
~ Alarm and Emergency Equipment ~
~ Sensor I 0 Smoke ~
~Wir~gandD~c~ ~
~ Outlet 7 0 General Purpose ~
~ Switch 4 0 General Purpose ~
~ Receptacle 4 0 General Purpose ~
~ Receptacle I 0 GFCI ~
~ Outlet 3 0 Fixture ~
~ Fixture 3 0 Incandescent ~
~ An as built inspection, of the delineated electrical installation, determined that an obvious hazard is not present and the installation is believed to ~
fa!] be in comformance with the applicable reference standard f~r the estimated period of construction of the premises wiring system. ~
~ No visual defects: an elctrlcal survey has been made of the exposed electrical equpment In the premises indicated. No obvious unsatisfactory ~
~ condition was found. seal ~
~ ~
~ I of I ~
I 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
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09/05/07
5"1' as
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16311298-31173
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H2M LABS, INC.
:!i7S~~ RcsJ. Mdvte NY 11747
~'}EI.J4.3>4o,~~(631)42I).84;J; NYSOOHlr>#'04n3
HARRY GOLOMAN WATER TESTING.
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MAlTlTlICK, Ny 11952
AA:n To 631-298-"'640
Federal 10
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Clili:ld 10. : WillIAM lEWfNOOSKI
34el GRANO AVE,MAlTtruCK SOURCEcea)
APt. FlOW-2c:aPM. (SL.R-SAkASH)
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Af1G/2007
09105/07 WED 14:39 [TX/RI NO 5200) ~002
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6312985252
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RE.
CONSULTING ENGINEERING SERVICES
2074 MAIN ROAD, P.O. BOX 456, LAUREL, NY 11 84B
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631-29B-5252
AUG I 0
August 9, 2007
Southold Building Department
Southold, New York
Lewandoski Residence - Garage Conversion
3405 Grand Avenue
Mattituck, NY
To the best of my knowledge, belief and professional jUdgment, the plans submit-
ted for the above-captioned residence, dated 8/1/07, are in compliance with the New
York State Building and Energy Code that existed when the conversion was made in
1985.
Very truly yours,
08-09-2007 16:43 SOUTHOLD BUILDING DEPT 16317659502
PAGE2
]3 3/s;;z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
REMARKS:
[ ] ROUGH PLBG.
[ ] INSULATION
V<f FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
-e~rj-~ ~,~~~
DATE F - g..~- 07
INSPECTOR ~~
.
.
FIELD INSPECTION REPORT DATE I .. COMMENTS U}."
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FOUNDATION (1ST) U\...,
t\J""
------------------------------------
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FOUNDATION (2ND) ~~
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INSULATION PER N. Y. -- toJ
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STATE ENERGY CODE
11~ ') 'I 07 ~J___O S2 ,;;, IJ!:. A ~ ~
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FINAL -rK-r, l\Y..,{ ~ j) , ~~U~ 7T
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ADDITIONAL COMMENTS f
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.:rOWN OF SOUTHOLD
BUILDING DEPARTMENT
~OWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765:1802
FAX: (631)765-9502
www.northfork.net/SoutholdJ
PERMIT NO.
'? ? 3 I') e
BUILDING PERMIT APPLICATION 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.DEC.
Trustees
Contact:
Examined
fJh'l- ,20 () 7
i/I f ,20'Q2
Approved
Disapproved ale
Mail 10:
./' ,"!'~.-
:1 ~
Phone:
Expiration
,2€JL
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date
~h.~
,20~
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 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 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, housing code, and regulations, and to admit
."tlmri~d '"'p,ct= 00 rrem'= Md " bWldio, fo. o~~"., m",~""o'~~Jtfi1i'U ;
./' (Signa of applicant or name, If a corporatlOn)
(\UG - 2. ) ( / . ,,f>
, ;23 c M I'J.J
" ~'~.:.., ,,' .~,~ (Mailing address of applicant) 0 0
State whether a~ieari-Rfo;~:;;::l~e, agent, architect, engineer, general contractor, electrician, plumber or builder
E-f-t;..C-\LlOlZ- - [STare c.8 l.t9:tl~""" l.,,~ l~ .Jiz-
Name of owner of premises f'---8rQT~ c$ 19.J:-U-A1M. ~veVldk,'$k.:. ,--r..a-
(As on the tax 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.
I. Location ofland on which proposed work will be done:
3'-fOC) G a.!>.NI:> A\NL
House Number Street
. M~-HCh.lC..k .
Hamlet
(Name)
Lot
Lot
~."c I
County Tax Map No.1 000 Section
Subdivision
IO(
Block
Filed Map No.
2. State existing use and occupancy of premises and illtended use and occupancy of proposed construction:
a. Existing use and occupancy ~e.'5 I d[eli1.C'!l
I
b. Intended use and occupancy
1<.e <3 I d2.e.VI. c..a......
Addition
Other Work
Astf....,t:..r
6_1H1 ~"',,^,,-,
7'>> P""x,/",.t5'-t?II' ./
AlteratIOn ;/
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
,4-c, '" ~ of
4. HstimateEl Cost ~ /0 CI
(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 (~C> (
Height /5 ( Number of Stories .
Rear
'-t (j?' ,
Depth
'7,'\
Dimensions of same structure with alterations or additions: Front EJc:.vvw?~
Depth S ClJ't>--L Height ~ Number of Stories
Rear S~
~
<;;:~
It 85" Auu.-.,
9. Size oflol: Front Rear Depth :I;;2/2.u.litJ1nJ2-
10. Date of Purchase I C\~ ~ "'_Name of Former Owner 0Pi}j-f~(tU ?et1.JLIk1t2t
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO /'
~~ Depth
8. Dimensions of entire new construction: Front S Q..flM,J.. Rear
Height "",>O/\i\.u Number of Stories "3a"""-O
13. Will lot be re-graded? YES_NO --?- Will excess fill be removed from premises? YES _ NO~
23,#1,.."... "....,pI ~"'1'
14. Names ofQ.wner ofpremisesw' ~A"""... /)....4"K, Address/~ ,-oJ ~r Phone No. $".:":2 -.2.20 ..
Name of i\lrlfk-K" /t'",;fMro',,6.( //'- ~'/i." Address .! ~ 71' /of ~- .('a4~hone No 2- 7'? -S:z. ..s-"...z...
Name of Contractor . Address v,-..,<.- '7 Phone No.
15 a. Is this property WIthin 100 feet of a tidal wetland or'it freshwaler wetiand? "YES _NO ~
* IF YES, SOUTHOLD TOWN TRUSTEES &.o.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet ofa tidal wetland? * YES_ NO~
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation ~lan 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 "lORK).:Jel'l-s.ei
SS:
COUNTY OFOU"Il,v )
{J..J I U /;'.tV\ ~ e(~IitJ)('J,;~J~.j '11t being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
2')Cec~ - ?<3~;t~
(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 slaiements contained in this application are true to the best ofh;s knowledge 8nd belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to bLore me this J
-~-~~
Notary Public
Sandra Manna
M NOlary Public of New Jersey'
y Commission Expires Oct 13,2016
>-jut!; 09 07 05:47p
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6312985252
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NEW YORK STATE
~~ERGY CONSERVATION CONSTRUCTION CODE
~~_n~ing n-Ign by Thennal Ratlnlllllethod Part 7815.2
. Bldg .( Iw '''''A",~~ J AI:r/~.c...e'
.?~ d~ k.L_'" /9v,.
;41 Mn r>-- .....(
Drwg :?..-.... 7- Z.
!foAI""- 0 I RA/'- ri ~ .
Date Jf~~ 7
Design Thermal
Subsystem Area "U" Rating Remarks
Exlerior Walls (Opaque) JS>4 -~'" ~ -135"
24c> -, (;!:4~ S"/_,
Floor .07? #.1/.-._, ..,;,,"" -
"'~~~ <1'-"''''~
CeilinalRoof (Opaque) 2.?f _...5 <:)
Glazina 2. % <J , 5"2- -1.1
Doors /7 ..z. 4 -1'-3
Skvliahts .2.5' % ~ .C :2 6
Foundation Walls
Slab Insulation
TOTAL -r..7:t. Complies with 7815.2
NQtu:
Non-electric heat design criteria 6000 degree days.
HVAC Equipment to meet requirements of7815.11.
HVAC Systems to meet requirements of7815.12.
Duct Systems to meet requirements of 7815.13.
Ventilation Systems to meet requirements of 7815.14.
Insulation of Piping Systems to meet requilel'T18nts of 7815.15.
Service Water Heating Systems and Equipment to meet requi
Electrical and Lighting Systems and Equipment to meet req .
08-09-2007 16:43 SDUTHDLD 8UILDING DEPT 16317659502
PRGE3
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SURVEY OF
DESCRIBED PROPERTY
SITUATE
MATT/TUCK, TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
SURVEYED FOR: WILLIAM lEWENDOSKI
TM# 1000-170-01-008. I
SURVEYED 10 MAY 2007
SCALE 1"= 50'
AREA = 81,739 S,F
OR
1.676 ACRES
.
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OWNER
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House Plot
Total
TOWN OF SOUTHOLD 'OPERTV RECORD CARD
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DATE
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Value
FRONTAGE ON ROAD
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PLUMJ;UNG::>/a~~>,,,, CERTIFICATE Dr ()caJpp.-rJcy
ALL PL ING-WASTE ~,,"'-.. SOLDER USE: D I rJ r/A-rE'1L
Ea.UNESNEED'" ~PLYSYS7t.^f c{/f7\/MJT
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ALL CONSTRUCTION sHAll ~~=
MEET THEREQUIRWENTS OF ntE
cODES OF NEW YORK STATE, 1_ '
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CERTIFICATION OF t
NAILING & C,ONNECTIONSI
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, -_DATE; ~,f;3h BP.# '3 ;3?/S J. - ---~o NCy OR
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FOLLOW:NG lii:7';'.;3: OF OCCUPANCY
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FOR POURED U: ',~"ETE
2, ROUGH, FRAM,i;0 ,~ PLUMBING
3. INSULATION
4, FINAL - CONSTRUCTiON MUST
BE COMPLETE FOR e.o.
ALL CONSTRUCT:J:, SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE, NOT RESPONSIBLE FOR
TO TIlE BEST OF MY KNOW'LEOGE. BELIEF AND PROFFESS DNA
THESE PlANS ARE IN COMPLIANCE WITH THE N Ys BUILD! G A
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DRAWING NUMBER
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