HomeMy WebLinkAbout32679-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32635
Date: 09/28/07
THIS CERTIFIES that the building ADDITION & ALTERATION
Location of Property: 195
(HOUSE NO.)
County Tax Map No. 473889 Section 97
DEERFOOT PATH
(STREET)
Block 7
CUTCHOGUE
(HAMLET)
Lot 22
Subdivision
FHed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
fi1ed in this office dated
JANUARY 16, 2007 pursuant to which
Building Permit No. 32679-Z
dated
JANUARY 29, 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 ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to DONALD & NATALIE WILCENSKI
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPAR'l'MEIIT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
3029442
09/17/07
PLUMBERS CERTIFICATION DATED
09/24/07 PETER VICTORIA
~~~
thorized Signature
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 in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new IIse:
I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic features.
A Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form).
W 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
1. 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. g/2Q/07
New Construction:
Old or Pre-existing Building: r/
'Mf0
l Ut /r C'n.5 t ~
'7
( check one)
(Jdr ho,j Je
amlet
Location of Property:
I q 5 -peer -fOol-
House No., / Street
Owner or Owners of Property N 11 fa /rf .. . Yurr Ci Ir/
91
Block
Lot
22
Suffolk County Tax Map No 1000, Section
SubdiVIsion
Filed Map.
Lot:
Penmt No. 31,1.. 1 ~
Date of Pennit.
\~2q-O,? Applicant: W:\C€.iI1S\",\'
Health Dept. Approval:
~\flo,
Underwriters Approval:
Planning Board Approval:
Request for:
Temporary Certificate
Final Certificate: /
~~ut~
Applicant Signature
(check one)
Fee Submitted: $
.~ ~ Or')
~.1?\5\
( I) t; 3d ~ 35
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.
32679 Z
Date JANUARY
29, 2007
Permission is hereby granted to:
D & N WILCENSKI
195 DEERFOOT PATH
CUTCHOGUE,NY 11935
for :
ALTERATIONS & ADDITIONS TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR
195 DEERFOOT PATH
CUTCHOGUE
at premises located at
County Tax Map No. 473889 Section 097
Block 0007
Lot No. 022
pursuant to application dated JANUARY
16, 2007 and approved by the
Building Inspector to expire on JULY
29, 2008.
Fee $
735.20
I~ c.u~
, Authorized Signature
ORIGINAL
Rev. 5/8/02
97..,-2.2-
l!IeJiID""~ ~~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 ~
~ ~
~ SABAT ELECTRIC DONALD WILCENSKI ~
~ 50 PAT LANE 195 DEERFOOT PATH ~
~ MATTITUCK, NY 11952, CUTCHOGUE, NY 11935 ~
~ ~
~ Located at 195 DEERFOOT PATH CUTCHOGUE, NY 11935 ~
~ 3029442 3029442 I
~ Application Number: Certificate Number: ~
~ Section: Block: Lot: Building Permit: 32679 BDC: n511 ~
~ ~
~ 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, Detached Garage, Outside, Attic, ~
III A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed III
~ 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 14th Day of September, 2007. ~
~ Name OTY Rate Rating Circuit ~ ~
~ Alarm and Emergency Equipment ~
~ Sensor 2 0 Carbon Monoxide ~
~ Sensor 7 0 Smoke fo!I
~ Appliances and Accessories ~
~ Dish Washer I 0 1.2 KW ~
~ Exhaust Fan 3 0 F.H.P. ~
~ Hydro Massage Tub (Therapeutic) I 0 III
fo!I Furnace I 0 Gas fo!I
~ Air Conditioner I 0 42.000 BTU ~
~ Panels ~
~ I 30 4 ~
~ ~~~~g and Devices 40 0 Fixture ~
~ Fixture 37 0 Incandescent ~
~ Fixture 3 0 Flourescent ~
~ Outlet 8 I 0 General Purpose ~
~ Receptacle 51 0 General Purpose seal ~
~~ %0 ~~ ~
~ Continued on Next Page I of 2 ~
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
l!I~.l!I
I!I.I!I
I. BY THIS CERTIFICATE OF COMPLIANCE THE 1
~ 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 ~
~ ~
~ SABAT ELECTRIC DONALD WILCENSKI ~
~ 50 PAT LANE 195 DEERFOOT PATH ~
~ MATTITUCK, NY 11952, CUTCHOGUE, NY 11935 ~
~ ~
~ Located at 195 DEERFOOT PATH CUTCHOGUE, NY 11935 ~
~ 3029442 3029442 ~
~ Application Number: Certificate Number: ~
~ Section: Block: Lot: Building Permit: 32679 BDC: ns11 ~
~ ~
~ 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, Detached Garage, Outside, Attic, ~
~ 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 14th Day of September, 2007. ~
~ Name OTY Rate Ratio. Circuit IYm; ~
~ Receptacle I 0 20a Laundry ~
~ Paddle Fan 6 0 ~
~ Disconnect 1 0 60a Air Conditioner ~
~ Receptacle 8 0 GFCI ~
~~~ ~
~ 1 Phase 3W Service Rating 200 Amperes ~
~ Service Disconnect: 1 200 cb @!
~ Meters: 1 ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ -~ ~
~ ~
~ 2 of 2 ~
~ ~
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
I!I~.I!I
W I I c}e-1>1 SA:.'
Town Hall, 53095 Main Road
P.O.. Box 1179
SouthoJd, New York 11971-0959
Fax (631) 765-9502
Telephone (631) 765-1802
,.
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
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CERTIFICATION
I
Date:
,~.-,
Building Permit No. ~ 1A. i 'j - ~
owner:~ W\ \C.~l;
(please print) .
Plumber: _P e-\e.,r \l i c.. +Or i Q
(Please print)
lead.
I celiify that the solder used in the water supply system contains less than 2/1 0 of 1%
&I/~~
(Plumbers Signature)
Sworn to before me this /9
--~
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day of ~~jJ?81~a:. 20 of
If,n~ I~
Notary Public, JlJ1 (..-fo Lf<
County
3~fo79 7-
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
REMARKS:
[ ] ROUGH PLBG.
[ ] INSULATION
\><1 FINAL Ai "
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
F~ ~~ ~ 0 It:,
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DATE
1~;-s-01
INSPECTOR ~ ~
3~71 Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
[ ] ROUGH PLBG.
[ ] INSULATION
p( FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
otl1:t I )
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DATE '1 ~ ;;. ~o 7 INSPECTOR ?
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
~
3 'J-fo 11 ~
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] RRE RESISTANT CONSTRUCTION
REMARKS:
DATE 6 --7 .-- 0 7
{><J ROUGH PLBG. k t,
J><!INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
,
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INSPECTOR
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[ ] FOUNDATION 1 ST P<f ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
~ FRAMING I S~RAPPING [] FINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRIJCnON [ ] FIRE RESISTANT PENETRATION
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INSPE~TOR ~~
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DATE
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JAMES J. DEERKOSKI, P.E.
260 Deer Drive
Mattituck, N.Y. 11952
(631) 298-7116
2. 9
,
_____.,J
Date: March 19,2007
To: Town of Southold Building Dept.
Re: First & Second Foundation Inspections
Wilcinski
195 Deerfoot Path
Cutchogue, NY 11935
Permit#32679
To Whom It May Concern:
First and Second Foundation inspections was preformed at the above-mentioned
construction site, and the damp proofing was installed correctly and meets all state and
local building codes. Any other questions please call.
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Date: March 19, 2007
JAMES J. DEERKOSK1, P.E.
260 Deer Drive
Mattituck, N.Y. 11952
(631) 298-7116
"
~ '~
. -)
To: Town of Southold Building Dept.
Re: First & Second Foundation Inspections
Wilcinski
195 Deerfoot Path
Cutchogue, NY 11935
Permit#32679
To Whom It May Concern:
First and Second Foundation inspections was preformed at the above-mentioned
construction site, and the damp proofing was installed correctly and meets all state and
local building codes. Any other questions please call.
SANFORD LENT PE
48 ORIOlE ST.
PEARL RIVER,. NEW YORK 10965
845-300.0707
SOUTHOLD BUILDING DEPT
PERMIT # ).J. (, I G/
~95 DEERFOOT PATH OJTCHOGUE NY
ALL STRAPlNG HAS BEEN INSTALLED ACCORDING TO PLANS ON COMPLETE
STRUCTURE
FOUNDATION (1ST)
~
COMMENTS ~~
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FIELD INSPECTION REPORT DATE
~-----------------------------------
FOUNDATION (2ND)
ROUGH FRAMING &
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INSULATION PER N. Y. ' ,..
STATE ENERGY CODE ~ 01(, l:: 0;' . 'h '~, W-. / -'L..; V- - ~ .,
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. ADDITIONAL COMMENTS ./. -" _'./ / f
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL .
SOUTHOtD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
PERMIT NO.
'"1;)t.~
,
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.D.E.C.
Trustees
Contact:
Examined
,20~
,20&
Approved
Disapproved ale
Mail to:
Expiration
l/YJ ,200L
CA...t- ~ Phone: t+w- ''3-f- 7..:2..',1(
plv ..........\:: '''H'i - (., ?,I.o(.
U-aL ~(l,,-"'''''3-I.o'''-\:'
APPLICATION FOR BUILDING PERMIT
Date ~~V~
,e..
,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 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 oftms 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 South old, 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
authorized inspectors on premises and in building for necessary inspections.
of applicant or name, if a corporation)
2....(-(...) ~;"'_~ 'Do?",..._~
(Mailing addr ss of apPlicantlJ';j. I L<; :S
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
.-r: tJ; Je~V1$ *- / /)1:>""" I J .!
(As on the tax roll ol-Iatest deed)
If applicant is a corporation, signature of duly authorized officer
~uJY'l..QAL
tV&I,fr..!:..e
W. /~VlSI:-..
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
tv/ tY
,
1. Location ~land on which roposed work willbe done:
eei2-rou'T' PA->","
House Number Street
c..-+cC-t~
Hamlet
v-e .
tJ.
County Tax Map No. 1000 Section q /
Subdivision t10lJ~ ~
(Name)
Block 1
Filed Map No. 3'2- ~O
Lot
Lot
dd-
'Z.."t--
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .5'''1 k r:;....," I 7 (lyS,"J~~ .
b. Intended use and occupancy S'....f[, hftA-,'I., 'fl.,J.J......<.J1
.
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
Y-
Alteration ;;Z
4. Estimated Cost
/5:D,06u
/
(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 ~ ' .5 ~ear Yo'? ,.
Height / '5 / Number of Stories /
Dimensions of same structure with alteration~ ~1}dditions: Front io' 3 .,
Depth q J . Height c:E!'L Number of Stories
Depth
c3J''7''
8. Dimensions of entire new construction: Front 'fa ~ .-
Height '-Y' Number of Stories
Rear
~
L(o' J .. Depth
Rear '10 (5 .,
OJ.
<fj '.) .,
10. Date of Purchase
1(.0 /
II /-v>-/ 06
Rear / (.0 '
Depth
1;}7'
9. Size oflot: Front
Name of Former Owner
'])c;-oJ ur A-
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 bere-graded? YES'_NO-i Will excess fill be removed from premises? YES_ N01
14. Names of Owner ofpremises'l)<\- oJ. (...J, I c.-.J I<-'.Address 1..-l1.~ ~:J_"''''' G...I<Ji1'1ione No. '), '-1/1. z-IY
Name of Architect --.:J, "'"' ~..",lc..o{"l.-' Address 2-<... ~k&::'- Phone No 'Z.."i r. ll,,-
Name of Contractor tJ/.. Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO ~
* IF YES, SOUTH OLD 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:
COUN"'"'y" OF )
~ ~~~ ~ being duly sworn, deposes and says that (s)he is the applicant
(Name of indivi I signing contract) above named,
(S)He is the
(WV n P> r
(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 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
IlD-th dayof ,}Qf\U() ~ 20~
\.j h1uJ A-n (j<,. (1if;g l'
Notary Public
SHARON L. BAlEK
Notary Public. State at New 'forti
No. 4863757 0
Qualmed in Suffolk County
Commission Expires October 20. '-l/.) I
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TOWN OF SOUTHOLD P.OPERTY RECORD CARD
95 VILLAGE DISTRICT SUB.
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OWNER
LOi #-$1
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E. Den ta.
FORMER OWNER
r~ J'.'-,'
N ACREAGE 6'7
;
S W TYPE OF BUILDING
FARM COMM. I MISe. I Est. Mkt. Value
TOTAL DATE REMARKS
n;~
~ES. cf) I ()
LAND IMP.
-'00
tlO 0 I
-4\00 I
C <L A~'35
~no.~
700 (
3).~l \
AGE
NEW
BUILDING CONDITION
BELOW
ABOVE
Farm
Acr
Value Per Acre
Value
FRONTAGE ON WATER
FRONTAGE ON ROAD
BULKHEAD
DOCK
.
/Go
rillable 1
'illable 2
'illable 3
v. b~flh
/2..5
Voadland
.wampland
: rush land
lause PIi!lP'
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'otal
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BEDROOM No 2
BEDROOM No. 1
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PATIO ON GRADE
SUN ROOM
BATH No 2
KITCHEN
WALK-IN CLOSET
LIVING ROOM
BATH No 1
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1ST. FLOOR PLAN (EXISTING)
SCALE: 1/4" = 1'-0'
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NOTE:
EXISTING EXT. WALL: 2X+
EXISTING WALL HT.: 7'-6"
EXISTING HEADERS: 2X6
I-lOUSE ALTERATION I ADDITION
DEERFOOT PATI-l, CUTCI-lOGUE, NY
Jaruary 18, 2001 6CALE 1/4" . "Oil
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