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HomeMy WebLinkAbout33490-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33142 Filed Map No. Lot No. THIS CERTIFIES that the building DEMO & FOUNDATION Location of Property: 16500 MAIN ST NEW SUFFOLK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 B10Ck 9 Lot 13 Subdivision conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 9, 2007 pursuant to which Building Permit No. 33490-Z dated OCTOBER 23, 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 FOUNDATION REPAIR,ADDITION/ALTERATION, COVERED PORCH REPAIR TO AN EXISTING BUILDING AS APPLIED FOR PER ZBA DEC#5962 DATED 12-12-06. The certificate is issued to JOSEPH FUDJINSKI & WF Date: 07/08/08 (OWNER) of the aforesaid building. SUFFOLK CODNTY DEPARTMSN'P OF HEALTH APPROVAI, ELECTRICAL NO. PLDMBSRS CERTIFICATION DATED N/A 3062135 06/27/08 06/30/08 VANETTEN PLUMBING Au orized Signature Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 '!'! 8 APPLICATION FOR CERTIFICATE OF OCCUPA ICY ~ ~-- Lid a' I~ - ~ ~ n,l Phis 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: l . Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Fina] 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 fi~om plumber certifying that the solder used in system contains less than 2/10 of I % lead. 5. Commercial building, industrial building, nmltiple 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: L 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. I%ees 1. Certificate of Occupancy -New dwelling $25.00, Additions to dwelling sw25.00, Alterations to dwelling $2.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate oCOceupaucy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy - $.ti 4. Updated Certificate of Occupancy - $50.00 ~. Temporary Certificate ofOccupancy -Residential $15.00, Commercial $15.00 Date. ~~g ~2~ 8 ~~~ New Constnwtion: Old or Pre-existing Building: (check one) Location of Property: /~SOO /y9//Y S7 yt=i/ Sl/f'FOZ~ House No. Street Hamlet 0~3mer or Owners of Property: }', _~ L/Zi,y(/ys'~/ Suffolk County Tax Map No 1000, Sectiar Subdivision Permit No. 3:i Health Dept. Approval: Block DOD Filed Map. Lot O/.3 L,ot t7 Date of Permit. C - LOr-' Applicant: SLAI/~~Y/iC' S>C/ Frei Plamring Board Approval: Request for: Temporary Certificate Fee Submitted: $ gi~~ Underwriters Approval:,~Q(~ ~~f Final Certificate: _~(check one) ~. C3 . ~ 3-3 ~ 4 ~ s«-d^~~ n'~.~-z91_ ,) 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) PBRMIT NO. 33490 Z Date OCTOBER 23, 2007 Permission is hereby granted to: JOSEPH FUDJINSKI & WF 564 FIRST ST BROOKLYN,NY 11215 for PARTIAL DEMOLITION & CONSTRUCTION OF A FOUNDATION OF AN ADDITION TO AN EXISTING BUILDING AS APPLIED FOR PER ZBA DEC #5962 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 OCTOBER 9, 2007 and approved by the Building Inspector to expire on APRIL 23, 2009. Fee $ 532.10 1M-Gif Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Boazd of Health SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ PERMIT NO. ~ ~ ~9o i~ Examined o 23 , 20 0 Z_ Approved !J ~~ ,20 ~~ Disapproved a/c Expiration , 20y~ 4 sets of Building Plans Planning Boazd approval Check Septic Form_ N.Y.S.D.E.C Contact: Mail (~ Building Inspector Phone: ~ ~ J ~~~ (~ Jam ~z ,~ i ~~, 4 ~ ~ `j ~ f ~ '~ ~,~, APPLICATION FOR BUILDING PERMIT ~' u ; ~ ~ v Date OGTOB'J/2.. S _, 2O d~ ' ;~= 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 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'ouilding shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a !'f,ftificate of Occupancy. r. 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, ho}r~tg code,~l d regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~ / ~ !i I (Signature of applicant or name, if a corporation) v .. . _ , State whether applicant is owner, lessee, agen architect, a gineer, general contractor, electrician, plumber or builder Name of owner of premises lr~t1_~IN (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and fitle of corporate officer) Builders License No. Plumbers License No. H/~__ Electricians License No. ~~ q Other Trade's License N~ h /q 1. Location of land on which proposed work will be done: -~Soo MAiN StR~~,T dew SuFFo~t~ House Number Street Hamlet County Tax Map No. 1000 Section ~ 1 ~ Block Q Lot ~ 3 Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy R1: SIDE,r1TIAL ~~tl} /~cce55oRyt`SEASoNgt~r~PAdtr+~ttEuzS b. Intended use and ,. z8A 5~to2 Nature of work (check which applicable): New Building Addition X Alteration, ~C Repair Removal Demolition ~ Other Work 4. Estimated Cost ~ ~50,pOD (Description) Fee ~'F.6 Z$A VARIANCE. ~~51(,2 (To be paid on filing this application) If dwelling, number of dwelling units 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 type of use. 7 Dimensions of existing structures, if any: Front ~Et° rLAN 5 Rear Height Number of Stories Depth Dimensions of same structure with alterations or additions: Front ~~ p~A N s Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front ~~~1 Reaz ~~pl Depth I'J~ 21 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises aze situated 1~ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO~ 13. Will lot be re-graded? YES_ NO~WiII excess fill be removed from premises? YES~C NO 14. Names of Owner of premisesJoSEPN ~ v.! IN sKt Address Phone No. 73~ ~ 3 O 1 Name of Architect Address Phone No Name of Contractor Address 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. PERMTI'S MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. S'~ ~Ac H £D 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: COi.TNTY OF n ) c1H 1'1't ES /-t J 1 tC~~~e(Z- being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the Officer, 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 aze 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. ' KIERAN M. CORCORAN QUALIFIED IN SUFFOLK COUNTY NOTARY #02006119838 ~f/ MY COMMISSICM1 `EXPIRES DEC. 6, 2 v~ 33~9~~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING /STRAPPING [~ FINAL [ ]FIREPLACE 8~ CHIMNEY ~'[ \] FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION REMARKS: %e- o ZC , r v~-~-~ DATE ~-/ ~ ~ ~ INSPECTOR ~-~~~~- 33~9~ ~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [~ FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION REMARKSe ~" DATE 3 ~ ~~ ~ D g INSPECTOR ~ ~%~ " - 3 3'~ 9'a z TOWN OF SOUTNOLD BUILDING DEPT. 765.1802 INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND INSULATION [ ]FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE 8~ CHIMNEY [ ]FIRE SAFETY INSPECTION [ ] FlRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION REMARKS: DATE 3 ~ ~ ~ ~ $ INSPECTOR ~;,~ 'p~~~~ ~3~9a ,~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 1 NSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE 8~ CHIMNEY [ ]FIRE SAFETY INSPECTION [QQ FIRE RESISTANT CONSTRUCTION ~ FIRE RESISTANT PENETRATION REMARKS: i/ ~ " ~;~ p DATE 3~ ~3 ~ ~ INSPECTOR ' ~o~y,OF SOUTyO~ 33~9~~ *0~ ~-~~ ~~~~~ TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ]FOUNDATION 1ST ~ ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION FRAMING STRAPPING [ ]FINAL [ ]FIREPLACE 8~ CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATI01 REMARKSAA: °2 C.e,~.~,w.,ei-~- w~, .-Q.N~-e'-an~c i /J/""" ~~../" N QI~ J1Q.~-~~ ~IiJ.d. ~`-rn~-w- !.~cflv.. Q~,, O ~7~/ r V `l a:~ ~ ~ i'YJUr-cL/ ~ OE" '~' r DATE 3 _ 7, ~ ° 8 INSPECTOR „~ ~ y~~ ~~~_ TOWN OF SOUTNOLD BUILDING DEPT. 765.1802 1 NSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ] FQtJNDATION 2ND [ ]INSULATION [,/jFRAMING / BAFFIN [ ]FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION REMARKS: DATE ~ f ~/~~ INSPECTOR j3 ~~o z TOWN OF SOUTNOLD BUILDING DEPT. 765-1802 1 NSPECTION [ ]FOUNDATION 1ST FOUNDATION 2ND [ ]FRAMING /STRAPPING [ ]FIREPLACE 8~ CFIIMNEY [ ]FIRE RESISTANT CONSTRUCTION ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION REMORKSe ., / ~~~ DATE ~ I~ ~ r~ ~ INSPECTOR - ;~ 33~~0~- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 1 NSPECTION [ I FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE 8~ CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION ~ i REMARKS: DATE ~~ INSPECTOR .,- FIEi,D INS~f'ECTION REPORT DATE COMMENTS FOUNDATION 1ST ~ ( ) d ~ N.1 FOUNDATION (2ND) ~ ~ ~ ~G '~ z l 0 ~e i. ~ o D - ~-M~-, Gow.,..o,ti._ ~r . ~- , .~~e~e 1~".L y ROUGH FR gp ~ W~4i w~- ~ ~ y AMING & PLUMBING - t{'RGr.~d¢~~7' ih.~W' (~ y 1 Cj T~~~ >~ INSULATION PER N Y ~ . . STATE ENERGY CODE y 3' ~l- ,® t~ ,a ;,~ d E Cn FINAL ~ ADDITIONAL COMMENTS I S ~. 3 3 ~ - 'f ~9 coo - - ~ ~ ~ ~ ~ CcQ 7 ~ . m S A w' ~ / (Ll -~ w y CJ Q s z y x c b y I ~~tiC ~~ ~~, ., 1 JAMES A. RICHTER, R.A. ' 705 FRONT STREET - GREENPORT, NY 11944 October 18, 2007 S DUTHOLD TOWN BUILDING DEPT P. O. Box 1 179 S DUTHOLD TOWN HALL S DUTH OLDS NEW YDRK 1 1 971 Enclosed please find the Detail for a two (2) Hour Fire Rated Wall, ANSI/UL 263 - Design No. U301. This detail will be used to separate the Apartment from the remaining residence. This detail will supersede the detail for the common wall sound attenuation partition as shown on drawing Number A-6. If you have any additional questions regarding this matter, please do not hesitate to ......r~,.r ......,f4:..o ',, ~ Q t) I ~ ~_ _ JAMES A. RICHTER, R.A. - 705 FRONT STREET - GREENPORT, NY 11944 ramr March 5, 2008 SOUTH OLD TOWN BUILDING DEPT P. D. Box 1 179 SOUTHOLD TOWN HALL SDUTHDLD, NEW YORK 1 7 971 Re: Fudjinski Residence New Suffolk, New York The Two (2) Hour Fire Rated Wall, ANSWL 263 -Design No. U301 shall be constructed in a continuous manner between the main residence and the proposed Apartment. All walls and ceilings adjacent to this fire separation shall also be constructed with two layers of 5/8" G.W.B. on each side of the partition to provide a continuous sepazation between the Apartment and all other adjacent spaces. One small window has also been added to the southerly wall in the gable end of the Storage Area above the Utility Room. This window is for light and ventilation and will be installed to code. At this time, access to this upper loft and storage area shall be by ladder only. This upper storage room will be insulated -walls, floors & ceilings -but will not be heated. This area is for storage only and does not meet the minimum requirements for habitable space. If you have any additional questions regarding this matter, please do not hesitate to contact my office. ~. ~._, j ~~%+ry'i~ry~~; ;hter ~ rchitect BXUV.U301 Fire Resistance Ratings -ANSI/UL 263 Paae Bottom Fire Resistance Ratings -ANSI/UL 263 See General Information for Fire Resistance Ratinos -ANSI/UL 263 Design No. U301 July 30, 2007 Bearing Wall Rating - 2 HR. Finish Rating - 66 Min. Load Restricted for Canadian Applications -See Guide BXUV7 1. Nailheads -Exposed or covered with joint finisher. `s firestapped 2. Joints -Exposed or covered with Flber tape and joint Flnisher. As an alternate, nominal 3/32 in. thick gypsum veneer plaster may be applied to the entire surtace of ClassiFled veneer baseboard. Joints reinforced. 3. Nails - 6d cement coated nails 1-7/8 in. long, 0.0915 in. shank diam, 1/4 in. diam heads, and Bd cement coated nails 2-3/8 in. long, 0.113 In. shank diam, 9/32 In. diam heads. 4. Gypsum Board - * - 5/B In. thick, two layers applied either horizontally or vertically. Inner layer attached to studs with the 1-7/8 in. nails spaced 6 In. OC. Outer layer attached to studs over Inner layer with the 2-3/8 In. long nails spaced 8 in. OC. Vertical joints located over studs. All joints In face layers staggered with joints In base layers. Joints of each base layer offset with joints of base layer on opposite side. When used In widths other than 48 In., gypsum board to be installed horizontally. When Steel Framing Members* (Item 6) are used, base layer attached to furring channels with 1 in. long Type Sbugle-head steel screws spaced max 24 in. OC; face layer attached with 1-6/8 In, long Type Sbugle- head steel screws spaced max 12 in. OC. htM•//Aatahacenlr•nm/roi_hin/XVV/famnlate/fTC77YT/1FRATQF/chn.vr.ancl.r..,t9„~,..e- tnn~nnn^r BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY > ~•~J 40 FULTON STREET - NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by JOHN LUDEMANNPO BOX 621 NEW SUFFOLK, NY 11956 JOSEPH & JOAN FUDJINSKI MAIN AND FOURTH STREETS NEW SUFFOLK, NY 11956 Located at MAIN AND FOURTH STREETS NEW SUFFOLK, NY 11956 Application Number: 3062135 Certificate Number: 3062735 Section: Black: Lat: Building Permit: 0 BDC: ns11 Described as a Commercial occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Basement, Firs[ 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 z~tn Day of Jnne, zoos. Name ~ Re[e Rating Cvcui Tvce Alarm and emergency equipment Sensor 2 0 0 Smoke Appliances and Accessories Air Contlitioner 1 0 Above 1500 BTU Dish Washer 2 0 1.2 Kyy Exhaust Fan 2 0 F.H.P Service Service Disconnect: 1 200 cb Service Rating200Amperes Wiring And Devices Dimmer 3 0 120 V Fixture 28 0 Incandescent Paddle Fan 1 0 Receptade 1 0 20a Receptade 13 0 GFCI Receptade 31 0 Gen, Purpose Svrilch 25 0 Gen, Purpose seal 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. 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 JOHNLUDEMANNPO BOX621NEW SUFFOLK, NY 11956 JOSEPH & JOAN FUDJINSKI MAIN AND FOURTH STREETS NEW SUFFOLK, NY 11956 Located at MAIN AND FOURTH STREETS NEW SUFFOLK, NY 11956 Application Number: 3062135 Certificate Number: 3062135 Section: Block: Lot: Building Permit: 0 BDC: ns11 Described as a Commercial 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 nth Day of June, zoos. Name ~ Rate Refine Circuits Tvce 2 or 2 seal This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. .Town Hall, 53095 Main Road P.O..IIox 1179 Southold, New York 11971-0959 ~~o~OgUFFO(,~coG ~ y~ 0 rn = ~~ • o~~ 'Ik ~ao~ BUILDING DEPARTMENT TOWN OF SOUTHOLD CTJRTIFICATION 'Fax (631) 7659502 Telephone (631)765-1802 Date: ~~ Building Permit No. __.~3 ~Y~ Owner. ~_~(/,DJ//yS~C~' (Please print) Plumber:,'Le L.i_c,~~,ic~_G. -~ ~l..r+tiF ~II~JIN~c (Please print) I certify that the solder used in the water supply system contains less than 2/10 of ] lead. _ - ---- (Plumbers Signature) S~a~orn to before me this ~O ~ ~. X~ f-l~.<,c CHR STI .HALLOCI(Ikw Yak -_ oa wY t, --- Notary Public, County day oG%% 20 a REScheck Software Version 4.1.1 Compliance Certificate Project Title: Fudjinski Residence Report Date: 10/16/07 Data filename: Untitled.rck Energy Code: Location: Construction Type: Heating Type: Glazing Area Percentage Heating Degree Days: New York State Energy Conservation Construction Code Albany County, New York Detached 1 or 2 Family Non-Electric 4% 6894 Construction Site: Owner/Agent: 16500 Main Street New Suffolk, NV 11956 Designer/Contractor: Compliance: 18.5% Better Than Code Maximum UA: 227 Your UA: 185 Ceiling 1: Flat Ceiling or Scissor Truss 710 30.0 0.0 25 Ceiling 2: Cathedral Ceiling (no attic) 319 30.0 0.0 11 Wall 1: Wood Frame, 16" o.c. 1350 19.0 0.0 74 Window 1: Metal Frame:Double Pane 12 0.480 6 Window 2: Vinyl Frame:Double Pane 12 0.480 6 Window 3: Vinyl Frame:Double Pane 28 0.480 13 Door 1: Solid 60 0.290 17 Floor 1: All-Wood JoistlTruss:Over Unconditioned Space 996 30.0 0.0 33 The proposed building represented in this document is consistent with the building plans , specifications, and other calculations submitted with this permit application. The proposed systems have been design o meet the N York State Energy Conservation Construction Code requirements. When a Registered Design Professional has s mp d and sign t e, they are attesting that to the best of his/her knowledge, belief, and professional judgment, such plans r s ifications re' pli ce with this Code. {~1~ZCH ITeGt AC~~NT l~ D Name -Title ignature Dat 7 tiir ~ ~ _ ___.J Project Title: Fudjinski Residence Page 1 of 1 Data filename: Untitled.rck Report date: 10/16/07 .:/~ ~aoo - ~7 - _ /~ TOWN OF SOUTHOLD PROPERTY RECORD CARD ~y _ ~ OWNER STREET ' j ~ ~; J VILLAGE DISTRICT SUB. LOT y,~ ~- ~6Je li f//TUd ~/ ~.r~! ~/.~/~i e'4~~ ~e ,.6 T`t- •-'` ~ -~/ y~F7~,~ r'# !>~." ~P~'C~ FORMER OWNER N E ACREAGE //~ ~~~/~la. ~ ~ vas ~`f~i~. S ~Nv~e~l ~ ~ ~`~~~` W G~,U, Da „~Q., K~ TYPE OFBUILDING of ~ ~~G/t~t~ ~' .~ RES. ~ S. ~~O VL. FARM COMM IND. CB. MISC. Est . Mkt. Value LAND IMP. 1 TOTAL DATE REMARKS ~-°~ tSJ b "~ ~` ~ d~ 3 ~/ SG/Q' / 30 ~ffd r .2,~ ,~6 l///~J' J; ~~ _ _ ` p`~ ~3 J d fU O p r,, ~ ~ ; AGE BUILDING CONDITION °~1N~93 _73 a 1 'CDV)5_; puAjcQ ~~ ,~.~ un~Acc.~,C~ ~,~/a 8'oc NEW NORMAL BELOW ABOVE FRONTAGE ON WATER /~ L~ r/~ f /~a+ vF~ Form Acre Value Per Acre Volue FRONTAGE ON ROAD ~" ~ q n"` /4 ~ rZ~ Tillable 1 BULKHEAD tillable 2 -- DOCK tillable 3 7 ~ f ,(7P e ~ n.: ~*.. ~~y ~'M' Noodland _" - - iwampla~d .... ~; ~~ _ ~'~ ~ ~ ~~ (~ ~ 3rushlond _ -louse Plot "~ ~ ~ ~~ ~.1~ !~, ~.~ i C ~~ ~~. C~~ 3i~I~- fotol ~+ ..~. - ___,©~~,~ ~Q=1 --f- ~~, Jf ~ "--~ r, ~ ' - -J/I 1 v ~~ ~ I'y ,. ~ { 7 ~• r, ~ l .fir.. [. •. ~ ! •'1 ~ v~ v\ , . ({~ C r, ~ +'~+ I ~~ i '~ ~s, M. Bldg. i~--'7> ~ 'c} G.";' ~~Gj~`.~ ~, p ! Z i Foundation i ' p ~~~~ ~i Both Extension ~ 2d i 5 ~' _ ~ ~, ~? ~ Basement /'R r' ~ Floors ~~, Extension ~~ W S T '"~~ ~ ~~ hs Ext. Walls ~ ° ~ ' ' Interior Finish ~ I Z r7- I . i ~ ~,~_;~ ~~ Extension ~ ~ ~ ~ ~ I ,I11 ``' ~'~ ~-1 ~ ~ ~ ~ 7i~ ~ ~ ~ ~ '~ F i re Place ~ ~ ~ Heat ~ '~ ". '~~~~ ~`('"p ~ T i 2 s' f +~~. , , tip' ~ i ~j'`` .Porch Y ~ Roof T e I YP ~I~"f ~ • ~s~ ° t,~,,.G ~~~ ~ U ~f I Porch ,, ^ ~„~ ..Rooms 1st Floor ~~ ~- Breezewoy ~ ~` II .Kakis ~ ,~( ~'~ Rooms 2nd Floor Garage ~_ ~ ~"'~{O x:~D - 0 ~ ~ ~ ~ ~ (Tlll~ di~~KS7Y_ ~ ~ ~ ~-~i ( Dormer ~ --~ O. B. { ~ ~ 'T /~H r , r ~c 0 APPEALS BOARD MEMBERS Ruth D. Oliva, Chairwoman Gerard P. Goehringer James Dinizio, Jr. Michael A. Simon Leslie Kanes Weisman ~o~~pF SOpjyo~ • ~O Mailing Address: Southold Town Hall 53095 Main Road • P.O. Box 1179 Southold, NY 11971-0959 Office Location: Town Annex /First Floor, North Fork Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 http://sou tholdtow n. northfork. net ~ 12 ~` ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 • Fax (631) 765-9064 'FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF NOVEMBER 9, 2006 ZB File No. 5962 -Joseph and Joan Fudjinski Property Location: 16500 Main Road (at Fourth Street), New Suffolk CTM 117-9-13 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further steps under SEQRA. PROPERTY FACTS/DESCRIPTION: The applicant's property is improved with a main dwelling with three apartments and atwo-family dwelling, evidenced by the Building Inspector's July 13, 2006 Preexisting Certificate of Occupancy No. Z-31715. Formerly, the property contained atwo-story frame hotel and 1-1/2 story frame annex with garage and separate shower structures, as shown on the October 20, 1965 survey prepared by R. Van Tuyl, Land Surveyor, BASIS OF APPLICATION: Based on the Building Inspector's August 22, 2006 Notice of Disapproval citing Section 100-241 (280-121A), a variance is requested to make alterations to convert the existing main building with three apartments into asingle-family dwelling with two apartments. FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on October 26, 2006, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant: RELIEF REQUESTED: The applicant wishes to make interior and roof alterations to an existing dwelling with three apartments, converting the main building to asingle-family dwelling with two rental apartments, as more specifically detailed on a September 21, 2006 site diagram and related drawings prepared by James A. Richter, R.A. REASONS FOR BOARD ACTION: On the basis of testimony presented, materials submitted and personal inspections, the Board makes the following findings: 1. Grant of the variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The construction of a second-floor addition over a portion of the existing building footprint is a need to replace a portion that is in disrepair. All proposed alterations will not increase the size of the structure and the applicant is requesting a reduction in the number of units of this preexisting building. Page 2 -November 9, 2006 ZB File No. 5962 -Joseph and Joan Fudjinski CTM No. 117-9-13 2. The benefit sought by the applicant cannot be pursue, other than an area variance. The buildin remained in its existing location (or footprint). 3. The variance granted herein is not substantial. 4. The difficulty has not been self-created. achieved by some method, feasible for the applicant to g was used as a hotel many years ago and has since 5. No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. ` ,+~ 6. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of the preexisting dwelling structure, while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Dinizio, seconded by Chairwoman Oliva, and duly carried, to GRANT the variance as applied for, as shown on the September 21, 2006 Diagrams Al through A4, and Diagrams S1, EX1 through EX4, prepared by James A. Richter, R.A. Any deviation from the variance given such as eMensions, or demolitions which are not shown on the applicant's diagrams or survey site maps, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. Vote of the Board: Ayes: Members Oliva (Chairwoman), Goehringer, Dinizio, Simon, and Weisman. This Resolution was duly adopted (5-0). ~;~Q~--~~a_, Ruth D. Oliva, Chairwoman 12/ tr /06 Approved for Filing FORM NO. 3 NOTICE OF DISAPPROVAL DATE: August 22, 2006 TO: Joseph and Joan Fudjinski 16500 Main Road New Suffolk, NY 11956 Please take notice that your application dated August 14, 2006 For permit to make alterations to an existins two family dwelling with three apartments, convertine it to a single family dwellin¢ with two apartments at Location of property 16500 Main Road, New Suffolk County Tax Map No. 1000 -Section 117 Block 9 Lot 13 Is returned herewith and disapproved on the following grounds: The proposed alterations are not permitted pursuant to Article XXIV Section 100-241 A which states, A nonconforming buildin¢ with a nonconforming use "shall not be enlarged, altered, extended, reconstructed or restored..." Note to Applicant: Any change or deviation to the above referenced application, may require further review by the Southold Town Building Department. CC: file, Z.B.A. Authonzed Signature ,Y.~ IY~P 1T-T 6'-P IT-Y b'-P II ..,._..e ~~ 4 '~„' 9 n C 9 II 1 I II • o ~ ., g ~~ a ~ ~~ t a 4 0 1 II C 1 ® •• a .--~ II .><~ - O 4'==tl /' n ~~ 4 °~ ~ II I O ~ 9 G _ ~1 \~l 0 ~•~O $ 1 i N ~ 1 § ~~~ ~ K s-+ '~ ~' O °~ ~ 0 Y". el 4-l ~ M T N 4 ~ ~ 4z N i I 1<'-<• 15-V Z1'-V b'-P t fjE!=oS E A •• ~p y\! m f ,~„ Existing Conditions ~ ,000.,,7.os.,a ,f rm Th~ T ~' ~ 1°, a... FUDJINSKI RESIDENCE ~ 3eS ~ lames A. Richlec, RA. ~ . Matn 8 Fourth Street ~ New Suffolk, N. Y. 11971 NY A" R-Y 6'.P 1T-2 ~ 4 ~ I m / ' 9 0 I 9 a ~~ a i~ s a X71 p O I~1 ^O ~ s i `~ ~ \ 1 9 ~ B _ ~ ~'~ I - ~...... a a 4 8 9 o n r ® -- ~ s ~8 ® ® ~ z o x §z 9 S ~ ~1 ~ r.,. a[ y ~ '"1° rrwe..a m as Mar n, zoos ditions C i E 5. ~ K,,, 1000.717-os-13 on ng xist ~ 3 P7 ~ Iq ~ ~ . ...., fficheeq AA ames A FUDJINSKI RESIDENCE J . . 8 Fourth Street i M ~ . ~ n a 11971 N Y lk S ff N . . o , ew u r' CCI ~~ Z~ MAllV STREET s. ~~ ' ' 2 STORY FRAME "HOTEL` W Z ; ~ ~ 0 - -- ,~ GATIO ~ = ~ s*oRY ~ ~. ~ "SHOW 2' i I ~~~~ ~E "ANNE%" ~ ? z ; _ 6ARAGE~, M {--- `` Z VJ J o c j~ ~i N r h-- /~ Q N i i i ~ t'~m'P>!w! nl erarrern 4! ~ ~Y is n viMa2inn d .: c" the fdet~ l'e.•<r -Sr C ' K'J' '?ythiE ~arRYaV111fT C°^•,._ s„n t5"- -;. _:. ArirYtl/0(a IrdtBE Pa?k m, e - pp seal wren rent N oortt ~ "°ad AC villd true copy. f n? !!!!1~ Indlcrte~ hereat s" ~ •a .t~}H Aer&on for v+han t~ {~ ~<, rrrliiddd and an hEs baheN Ro 1 ~t any. govemmeMal agaC' a:~._.. x i ,ifufierl lured hereon F ~, fl IQtSGei Cf 4ha ?61TdlnQ in ^ .,. J.:a. ~ a:rn:ezs are not transferah?a .o aaditi , el inadtutirma of auh~ueM owners MAP Of LAND ----~Fv" JOSEPF~ N. ~ J4AN ~(. ~'UDJ I ~~K? ~~ NEW -Si1FFou~ TOWN ~--- UTN 1, , iV,Y. SCALE 30'-'' -. !tiONU ^1 Erg'' CuARA~iTE~U T~? THE ~T~ ~O~t~ __ ~ _--~- BAN+t artQ TRUST arr~ rt~~ IIVfiER~CbUNTY Ti TLE GUf~RAN~'Y AND h1~2F ~_ CQ, _ A5 SURV~~ ACT~?,,_.5 VAS-Tt1Y~. ~ SAN ~i~~N~~ ~Rwfl s~sRV~ ~~~~~~~ l CONSENT TO INSPECTION `~ ~~ )~DT ^~..5~/• the undersigned, do(es) hereby state: Owner(s) Name(s) That the undersigned (is) (aze} the owner(s) of the premises in the Town of Southold, located at which is shown and designated on the Suffolk County Tax Map as District 1000, Section f~_, B]ock ~~ Lot 1~. That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: CER'ftFIGFYCE._ bF OGCUPt-NCY pN PRE•E.x-SfING REStI1F.NG4. HotEt_ That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises wmply with all of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, nrles or regulations of the Town of Southold. Dated: _ S~9- (7b BUILDING DBPARTMHNT TOWN OF SOUTHOLD HOUSING CODE INSPECTION REPORT LOCIITIOB: 16500 MAIN ST NEW 6UPPOLK SOBDMSZOR: MAP HO.: LOT (S) BAMB OP ONHBR (S): JOSEPH H 4 JOAN M. FUDJINSKI OCCOPAHCY: MULTIPLE RHSIDeNCS JOSEPH H c. JOAN M. FUDJINSKI ADMITT® BY: MIKE PUOJINSKI ACCgIPARIBp BY: SAME YHY AVAILABLE: SDPP. Cb. TAY ,MAP HO.: 117.-9-13 SOURCH OP RHQUBST: JOAN FUDJINSKI 5/29/06 DATE: 07 33 06 DWELLING: ~~ ~~~+ ~~ P.PAR1DQ1fS TYPH OF COBSTRDCFIOM: WOOD FRAME { STORMS: 2.0 ~ BZTlS: 5 POURDI\TIOH• HRICR CELLAR: PRAT CRANL SPACE: TOTN. ROOMS: 1ST PLR.: 4 3RD PLR.: 5 3RD PLR.: 0 BATBROg1(S): 2.0 TOILET ROOK(S): 0.0 DTILITY ROOM (SI: PORCH TYPE: FRONT COVERED DBCR TYPH: PATIO TYPH: YES CONCRETE HASHZHMAY: PIRHPLACE: WOOD STOVE GARAGB: NO DOl035TIC HOTIATBR: YES TYPH HBATBR: NOT AIR AIRCONDITIOHZHG: YYPB HEAT: OIL MARM AIR: YES HOT(O\TSR: YES OTffi: a ACCESSORY STRUCTURES: 2 FAMILY IX,'RLLING WOOD FRAME 2 STORY - 3 FJQ'IS GARAGB. TYPB OP CONST-s STORAGE, TYPE CONST.: SWIIDID9G POOL: GVSST, TYPB COHST.x OTC: +• ~3-1 ROOM APARTMENTS WITH BATHS (1 BATH, PIXTORES REMOVED IN 2002) 1-2 ROOM APARTMENTS WITN BATH. ••1ST PL. 9 RoDMS 1 BATH. 2ND FL. 4 ROOMS 1 BATH, CEMENT BLOCK FOUNDATION, BILCO DOOR 4 CONCRBTE PATIO. RHYLRLC: HP (132196-E-COZ-31719 (HEATING SYSTEM) IMSPHLT® BY: /~~ ~'/~ ~~~~~~ w"'r -'STS 08 IHSPSCfIOM: 06 09 06 G80ROB OILLEN TIME START: 9:30 AM ®: 10:30 AM Heating Plam 16500 Main Street New Suffollc, N.Y. 11956 Unit- Trane XE 90 Model# TUC1000960B5 90+ Efficiency Upflow Forced Hot Air Furnace- Natural Gas, Single Pipe Exhaust, 100,000 btu, Hot Surface Igniter S Supply Ducts- T' 1 Central Return-14"x 30" Inspected by James Fogarty Box # 102 New Suffolk, N.Y. 11956 Phone# 631-905-3252 FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE EXISTING CERTIFICATE OF OCCUPANCY No: Z- 31715 Date: 07 13 06 IBIS CBRTIFIES that the building DWELLINGS Location of Property 16500 MAIN ST NEW SUFFOLK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 Block 0009 Lot 013 Subdivision Piled Map No. Lot No. conforms substantially to the Requirements for a built prior t0 APRIL 9, 1957 pursuant tO vbich CERTIFICATE OF OCCUPANCY NO4BER Z- 31715 dated JULY 13, 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 MAIN DWELLING WITH THREE APARTMENTS & A TWO FAMILY DWELLING The certificate ie issued to JOSEPH H ~ JOAN M. FUDJINSKI (OWNER) of the aforesaid building. SUFFOLK CODNTY DEPARTMENT OF HSAI.TB APPROVAL N/A BLHCTRICAL CSRTIFICATB HO. N/A PLDFIDSRS CERTIFICATION DATED N/A *PLEASE SE8 ATTACHED INSPECTION REPORT. A thorized Signature Rev. 1/81 b~~~ ~~~ Town of Southold Erosion, Sedimentation SStorm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.#: )ono 111 9 t 3 Dlslrict section Block Lol ACTIONS MAY Item Number: (NOTE: A Check Mark (.(I) for each Question is Required for a Complete Application) Yes No ---------------------------------------------------- Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") inch Rainfall on Site? ~ ^ (This item will include all run-off created by site clearing and/or censWction activities as well as all Site Improvements and the permanent creation of impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location? Fl ! lli S rf W t C ~ ^ er ow ng ace a ontro u This Item shall include all Proposed Grade Changes and Slopes 3 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural ^ x Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 4 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of ^ X Five Thousand (5,000) Square Feet of Ground Surface? rj Is there a Natural Water Course Running through the Site? tl d B h? T f W ' ~ )( an or eac eet o a e ) Is this Project within the Trustees jurisdiction or within One Hundred (100 s Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to ^ X One Hundred (100') of Horizontal Distance? 7 Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-OH ? ^ ~( into and/or in the direction of a Town right-of-way Will this Project Require the Placement of Matedal, Removal of Vegetation and/or the Construction of any Item Within the Town Right-of-Way or Road Shoulder Area? (This Item will NOT Include the Installation of Driveway Aprons.) 9 Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse? ^ X NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark in the Box, aStorm-Water, Grading, Drainage 8 Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Pertnltl ---------------------------------------------------- EXEMPTION: Yes No Does this project meet the minimum standards for classifcetion as an Agricultural Project? Note: If You Answered Yes to this Question, aStorm-Water, Grading, Drainage &Erosion Control Plan is NOT Required) _ STATE OF NEW YORK, ............ ..... ... ...................... SS That I, .... ~~ Yl'l 5 O ~ ~....d..L..+.G.1fV`~`fr~....n. being duly sworn, deposes and says that he/she is the applicant for Pennit, .. ..... . (Name of intlivitlual signing Document) / ~ ~ I And that he/she is the ............................ ~..~7..£.4'!.1~.......................................................................................................... (Owner, Conlraclor, Agent, Corporals Officer, elc.) Owner and/or representative of the Owner of Owner's, 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 herewith. Sworn to befo//rlIeyy~~m.~te this; nn ( (_ ~ n .......................a.`.1..........~.~dayof.A(.~~T~.t`.'.................,20~? I I ~~ // Notary Public: ti02C06119838 of Applicant) FORM - i oa ~ • x ~a ;~ s°z D ~ ~ ~ I€ ~ [ ~,•~ i ~~ I € m ~ ~..,,.~. ._._... i Existing Conditions Mme-~~~-a~..a r..ir ^ q ~ ~ ~~nxaaQ xn FODJINSKI RESIDENCE I• ~ NYn 8 Fouts iboot Now Euflally N. Y. 17871 A Vb lFiiyy ~~ IFt • 00 ~ o0 y • O °z rH i» ~a < ~ $°z 0 i ii !~ ~ i~ m _ ~..,,.~. ~~ ~ :_ ,,,,.,,,_q_„ Existin Conditions g>,.. ~a ~ ~ „gyp ~„~ an FDDJINSKI RESIDENCE pp 19~In 8 FeuM 9trw1 3 N9w 9uRo9y N. Y. 11971 A Form No. 6 TOWN OF SOUTHOLD BUILDING AEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and subnutted to the Building Department with the following: A: For new banding or new use: 1. 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 farm). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber cortifying that the solder used in system contains lass than 2/10 of 1% 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 ezisting bundiags (prior to April9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property tines, streets, building and unusual natural or topographic features. 2. A properly completed application and wnsent 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. Certificato 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. Certificatc 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. S"~9- t9.6 New Construction: Old orPre-existing Building: t/ (check one) Location of Property: ICoSt70 MAIN S?RC~'f NEW .~UfFbLK. House No. Street Hamlet Ownor or Owners of Property: ~0 5 f; p N ~ . ~ U 0 .~ ~ tV S K 1 Suffolk County Tax Map No 1000, Section I I1 Block q Lot 13 Subdivision Filed Map. Lot: Permit No. Date of Pemtit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: V (check one) Fee Submitted: $ ~ ~~. ~ ~ Applicant Signatur Q.~.c-•~06 8 3 ~n2. C.o ~ 3l ~ IS