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HomeMy WebLinkAbout32872-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33416 I~te: 12/02/08 THIS CERTIFIES that the building ADDITION Location of Property: 90 DEER DR (SOUSE NO.) County Tax Map No. 473889 Section 114 Subdivision Filed Map NO. __ MATTITUCK (STREET) (HAMLET) Block 10 Lot 1 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MA~RCS 30, 2007 pursuant to which Building Permit No. 32872-Z dated APRIL 2, 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 ATTACHED ONE CAR GAP~AGE ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. · ~ne certificate is issued to CLIFFORD D POLACEK ( OWNER ) of the aforesaid building. S~FOLK C~3I]I~TYDEPAR~ENT OF SF2%LTH~PRO~L~L N/A gI~gt'l~IfJ[5 c~KTIFICATH NO. 4011001 09/10/08 PLUMBERS CERTIFICATION DATED N/A Authorized Signature Rev. 1/81 Form No. 6 TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN ttALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department xvith the following: A. For new building 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 llealth Dept. of'wate.~ supply aud sewerage-disposal (S-9 form). 3. Approval of elects%al iustallation fi-om Board of Fire Unde~,riters. 4. Sworn statemeut from plumber ce:lifying dmt the solder used in system contains less than 2/10 of 1% lead. 5. Co~panercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance flora architect el engilmel responsible fo~ thc building. Submit Planning Boaid Approval of completed site plan ~equirements. B. For existing buildings (prier to April 9, 1957) nou-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey ofp~ope~l) showing all plopetly lines, sh'eets, building and unusual natural or topogiaphic features. 2. A properly completed application aud cmsent h) n~pect sibmed by the applicant. Ifa Certificate of Occupancy is denied, the Building lnspectc*~ shall slate the ~casons therefor m walling to tI~e applicant C. Fees 1 CtrtificateofOccupancv New ,v llin~, $?'~ /I ), .,\dditions to dwelling $25.00, Alte~atious to dwelling $25 00. Switmning pool $25.00, Accessoiy building $2500 Additions lo accesso:y building $25.00, Businesses 2 Ce~lificateofOccupancy oa P c e:x s ~, B c m~, $I0000 3 Copy of Ceaificate of Occupancy $25 4 UpdatedCmlificateofOccupancy. $5000 5 Tempora~yCemficateolCccupa~cv xes~cenha $1500, CommeicialS1500 New Constm~tiou: ~ Old oi Pre-existing Building: (check one) ' ' ~ fflamlet - Suffnlk C3unty Tax Map No tO00, Section ~/ ¢ Block .__dO [¢ Lot __~ / Subdivision Filed Map. I et: Planning Board Approval: Request for: Temporary Certificate FeeSubn-htted:$ ~ :~ Final Certificate: ~ __ (check one) James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 # 0385C BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE Date: November 25, 2008 THIS CERTIFIES that the construction of a one-car garage addition to the existing dwelling At 2905 Westphalia Road, Mattimck, New York Suffolk County Tax Map # 114-10-1 Conforms to the application for a Trustees Permit heretofore f'fled in this office Dated 10/26/06 pursuant to which Trustees Permit # 6482A Dated 11/15/06 and was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the construction ora one-car garage addition to the existing dwelling The certificate is issued to CLIFFORD D. POLACEK owner of the aforesaid property. Authorized Signature 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 SABAT ELECTRIC 50 PAT LANE MATTITUCK, NY 11952, Located at 2905 WESTPHALIA RD MATTITUCK, NY 11952 Application Number: CLIFFORD POLACEK 2905 VVESTPHALIA RD MATTITUCK, NY 11952 4011001 Certificate Number: 4011001 Section: Block: Lot: Building Permit: . BDC: ns11 Described as a Residential occupancy, wherein the )remises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: Attached Garage, 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 tot# Day of September, 2008. Name OTY Rathe Rating Wiring And Devices Fixture 2 0 GFCl Circuit Breaker 1 0 20a Outlet 2 0 Outlet 6 0 Receptacle I 0 20a Receptacle 7 0 Switch I 0 Circui~ T¥1~ Fixture Gen, Purpose Spedal/twistlock Gen, Purpose Gert, Purpose I of I 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. 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. 32872 Z Date APRIL 2, 2007 Permission is hereby granted to: CLIFFORD D POLACEK 2905 WESTPHALIA ROAD MATTITUCK,NY 11952 for : ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 90 DEER DR MATTITUCK County Tax Map No. 473889 Section 114 Block 0010 Lot No. 001 pursuant to application dated MARCH 30, 2007 and approved by the Building Inspector to expire on OCTOBER 2, 2008. Fee $ 200.00 k/ / ~////)J // / ~-~-A~It hori zed ~3.q~ur~ ORIGINAL Rev. 5/8/02 New York $1.1o Deparlment el Envllonmtnlll Conll~lUon ~ed on tile ~n~Orlnation you have Yubl#~tted, o~ ~nvironmental Con~efvetion hal d#termin.d ~ ~ prom.ct is, the New York State Department that the parcel Greater than 300' :rom inventoried tidal wetlands, b~ndward o~ a aubJtantia~ man-made structure greater than 100' ~n length wi, ich uae constructed ~tior to 9/20/77. Landward o: the 10' above mean men level elevation contour on a ~andward o: the top. graphic creel o~ a biu:~, cll~: or dune which grunter t~an'lO' In elevet~, a~vm mean #es level. There/ore, no permit Ji required und.r the Tidal Wetlands Act (Article 25 o: the ~nvironmen~el Conservation Law). PlJaie be advised, however, that no construction, sedimentation or disturbance et any kind may take place seaward o~ th~ 10' contour or topographic crest without · permit. It is your reaponsibilit~ to ensure that al~ nec·assay precautions are taken to prevent any aedimuntat~on or other alteration or disturbance to the ground sur~acv or Vegetation in thl~ area ma a result o~ your project, Such prucautiona may include providing adequate work ·rea between the 10' contou~ or topogtaphlc c~eet and the pro,sci (i.e. a ~5' to 20' wide construction area) or erection et · teml~ar·~¥ tents, bar,iai, or hay bale berm, Please note that ·ny additional work, or modification t9 ~he pro~#Ct aa described, m~y require authorllation by thin Department. ~,e#ae ponta~t thi~.of:ice 1: much are contemplated. 21ease be turther advlwJd that this letter deem not :eli·ye you O~ the re~ponaibllit~ o~ obtaining any necesaa~¥ pe~mita et approvals :rom other agencies. Ovputy Xegionageermit A~ministrator TOWN OF SOUTHOLD BUILDING DEPT, 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] INSULATION [ ]FRAMING / STRAPPING [~'~INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: INSPECTOR DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG.  [ ]INSULATION [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT C~~UCT~_ ~[ ~] ~,,E~RESISTANT PENETRATION REMAR~ KS: ~ - DATE INSPECTOR ~ ~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [~/FOUNDATION 1ST [ [ ] FOUNDATION 2ND [ [ ] FRAMING / STRAPPING [ [ ] FIREPLACE & CHIMNEY [ [ ] ~ m~r~rr mu~rto~ [ REMARKS: ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION INSPECTOR DATE James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 24,2007 Clifford Polacek 2905 Westphalia Road Mattituck, N.Y. 11952 RE: CLIFFORD POLACEK 2905 WESTPHALIA RD., MATTITUCK SCTM# 114-10-1 Dear Mr. Polacek: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, January 24, 2007: RESOLVED, that the Southold Town Board of Trustees APPROVE the amendment to Permit #6482A to an additional 18" to the width of the garage to accommodate a 10' door, and all as depicted on the plan surveyed by Young and Young approved January 24, 2007 by the Board of Trustees. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. James F. King President, Board of Trustees JFKJhkc James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6482A Date of Receipt of Application: October 26, 2006 Applicant: Clifford D. Polacek SCTM#: 114-10-1 Project Location: 2905 Westphalia Rd., Mattituck Date of Resolution/Issuance: November 15, 2006 Date of Expiration: November 15, 2008 Reviewed by: Board of Trustees Project Description: To construct a one-car garage addition on the northwest side of the existing dwelling. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the plan received on October 27, 2006 and survey prepared by Howard W. Young received on October 27, 2006. Special Conditions: The installation of gutters and drywells to contain the roof run-off. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jam F~. King, Presid~t Board of Trustees TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802, FAX: (631) 765-9502 www. northfork.net/Southold/ Examined ,20 Approved ,20__ Disapproved a/c Expiration 20__ PERMIT NO. 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: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ,20 7 a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months atSer 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, housin,,g code and regulatio/af, and to ~tmit authorized inspectors on premises and in building for necessary inspections. / \, ~ -~/~/h / J /) ]~ (S-i-gnat~r~/of applicant or name, if a corporation) /// CLIFF POLACEK 2905 Westphalia Rd. (MailiM~,~J~{~ State whether applicant is owner, lessee, agent, architect, eng/neer, general contractor, electrician, plumber or builder Name of owner of premises C[[~PO'V~J [9. (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. l OOO Location of land on whic_Lh p~lopo~ed wo[~ v~ill be done: 2. toJ'' Ix/'el/,9.1 lt . House Number tStreet County Tax Map No. 1000 Section Subdivision (Name) Block [(0 Lot Filed Map No. Lot 2. State existing use and occupancy of premises arAd intendffd u,se and qccupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ff ~ v~ 0 -- 7'0. v'c~ ~ ¢ 3. Nature of work (check which applicable): New Building_ Addition Repair Removal Demolition Other Work 4. Estimated Cost Fee 5. If dwelling, number of dwelling units If garage, number of cars Alteration (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 't ~(9/ Depth 7. Dimensions ofgxisting structures, if any: Front (0 (O, q Rear Height ¢ 5' Number of Stories I Dimensions of ~} structure with alterations or additions: Front Rear 7D DepthLj.'~ Height '~' Number of Stories 8. Dimensions of entire new construction: Front ] Z, Height [ ~ ~ Number of Stories 9. Size oflot: Front 177' Rear IZ5/ _Depth 10. Date ofPurchase 10--,~-/ ?~ Name of Former Owner 11. Zone or use district in which premises are situated Depth 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO ~ 13. Will lot be re-graded? YES NO X Will excess fill be removed from premises? YES__ NO ~( Name of Architect Address ' ~ Phone No Name of Contractor ] jTe & Address Phone No. ]5 a. Is this prope~y within 100 feet of a tidal wetl~d or a freshwater wetland? *YES ~' NO * IF YES, SOUTHOLD TO~ TRUSTEES & D.E.C. PE~ITS MAY BE REQUIRED. b. Is this prope~y within 300 feet of a tidal wetl~d? * 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) COUNTY OF~S: CC.. [[(~.4,,f¢[ 0' ~IO-(0-.IL. being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (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 tree 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 ff-Z day of t'/d,4cg~/-J 20 _-- ' / NotaWP~lic ' - KATHLEEN DBEXLE~ Notary public, Stale ol C0m~[~0n ~pires April '~Sigr~re of A'~plicant ,.× TOWN OF SOUTHOLD PROPERTY REI:ORD CARD OWNER STRE~ ~:/.- v,,~GE D,ST. SU,. ,OT/9 S W ~PE OF BUILDING ~ES. ~/~ S~S. VL. FARM COMM. CB. MISC. Mkt. Volue ~ND IMP. TOTAL DATE REMARKS rilbble 3 No~l~nd ~w=mplond FRONTAGE ON WATER 3rus~lond FRONTAGE ON ROAD / ~ ~ ~ouse Plot DEPTH BULKH~D Votel D~K 3. aa COLOR TRIM Foundation Both ~/~ Dinette Basement Floors K. /al 173/. Ext. Walls ~/~,/-~ ~'~ Interior Finish Fire Place Heat DR. Type Roof Recreation Room 331o Porch Dormer Breezeway Driveway Garage ~>, ~} ~' ;,.79, Io ~1~ ~ 15o i..zc~ oio, ¢ Rooms 1st Floor Rooms 2nd Floor 2300 BR. FIN, B. Extension IIIII COLOR TRIM 'Foundation j~ ~' ] Bath ,,' Basement / ,_ // Floors Ext. Walls ,,~ ~ Interior Finish Fire Place Type Roof ]Recreotion Room Heat Rooms ]st Floor Rooms 2nd FIoo N E S ! ! / Lo~ I=t ~ Young & Young 400 Ostrander Avenue, Riverhead, New York 11901 631-727-2303 Howard W. Young, Land Su~eyor Thom~ C. Wolpert, Professorial Engineer Robert C. T~t, Arekiteet Ronald E. Pf~ Landscape Architect Dougl~ E. Ada~, ProfesSorial Engineer AREA = 22,04-/ ~2. FT. · ~DDIVt~ION 1'4AP 'DEE~ F'A~K" FILED IN THE OFFIO~ OF THE GLBR~ O~ ~FFOLK OOUN~ ON JUL~ 25, I~0 A~ FILE NO. 3204. · FLO0~ IN~U~ANGE ~ATE ~AP - ~EB PANEL NU~BE~ ~U~.VEYO~.'~ GE~.TIFIGATION · ~IE HE~-E~'f' C.E~.TIF'f' TO r~LIFF PnLAP-IEK THAT THIS .E:UP.V'E¥ ~IA~ Pt~EPA~ED IN AG, COI~4~ANGE ~IITH THE OO~E OF 5,1fl~VEY Oblt=i= POLAOEK LOT I~I "PEER PAt~.K" At Mo~.~itu¢k, Tomn of ~ouf. hold SuFFolk Oount~J, Ne~ York Tax HoC District mood Section 1t4 a~ock Io Lot FOUNDATION LOGATION E~J~ POUNDATION LOGATION ADDED FIftH ZONE LINE HAP PI~EPAP. ED AU~. ;2, 200'~ DEC. 14, 200(~ ~ALE: 1"=40' .~9~ NO. 200'~-0,20 FL D~4~. 200S_O4¢O_H NOTE: I. SUFFOLK COUNTY TAX MAP DIST. I000 SECT. 114 BLK I0 LOT I I (,,%' OF THE C~BK OF SUFFOLK ~U~Y ON JU&Y ~5, 1960 AS FILE NO. LAW REWS~O.S YOUNG & YOUNG OCT. 22, 1990 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK AUG. 6, ALDEN W. YOUNG HOWARD W. YOUNG SUEVEY FOR: CLIFF POLA CEI~ LOT /VO. SCALE: / = ~0'I DATE: MAR. 27, 1990 90-0188 UNAUTHORIZED ALTERATION OR AODITION TO THr8 SURVEY IS A VIOLATION OF SECTION ?209 OF THE NE'// YORK STATE EDUCATION COPIES OF THiS SURVEY MAp NOT BEARING THE LAND SL/RVEYOR'S iNKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALI~ TRUE COPY GUARANTEES IN~IC~,TED HEREON SHALL RUN OCCUPANCYOR USEIS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQU. IRED AND CONDITIONS OF d / / SOUIHOLDTO~hNZ~A , ~ SOUTHOLD TOWN TRUSTEES ! ~ ,N,Y,S, DEO ks,,/''$ CERTIFICATION OF NAILING & CONNECTIONS REQUIRED. ApPJ;~DV~D AS NOTE{3 765-1802 8AM TO 4PM FOR THE FOLLOW~NG ~NSPECTIONS: 1, FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & pLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE coMPLETE FOR C O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF T~IE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR r DESIGN OR CONSTRUCTION ERRORS. · ~OMPLY WITH CHAPTER 46. FLOOD DAMA(3E PREVENTION sOUTHOLD TOWN CODE, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. &.LI FF [90L.A C El(