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Home My WebLink About34460-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33579 ~te: 03/04/09 THIS U~'rIFIRS that the building ALTERATIONS Location of Property: 115 HOBART RD SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) Co%lnty Tax ~p NO. 473889 Section 62 Block 3 Lot 9 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 25, 2009 pursuant to which Building Permit No. 34460-Z dated FEBRUARY 25, 2009 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 ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to JAMES WILCENSKI (OWNER) of the aforesaid building. SUFFOLK COUN~"fDEPART~NT OF HEALTH APPROVAL EI~t-l-KIC;b5 CERTIFICATE NO. PLIERS CERTIFICATION DA'I'MU 2062789 03/22/06 N/A Authorized 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 fdled in by typewriter or ink and submitted to the Building Department with th A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unus~ topographic features. 2. Final Approval fxom Health Dept. of water supply and sewerage-disposal (S-9 form). 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 2/10 ~ 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. 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: 1. 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, Swinaming 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. New Construction: Location of Property: i ( ~'- House No. Owner or Owners of Property: ~oXea Suffolk County Tax Map No 1000, Section Subdivision ~'~;~ dZ,'~,-O ~ Health Dept. Approval: Old or Pre-existing Building: (check one) Street Hamlet ~:~¢ Block B Lot q Filed Map. Lot: Date of Permit. ~-~ EDt Applicant: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Final Certificate: (check one) BY THIS CERTIFICATE OF COMPLIANCE THE NEW YORK BOARD Of FlEE UNDERWRITERS BUREAU OF ELECTRICITY 40 FULTON STREET ~ NEW YORK, NY 10038 CERTIFIES THAT Upon the application of upon premises owned by B.J. ELEC. CO. JAMES WlLCINSKI 4300 STILLWATER AVENUE 115 HOBART LANE CUTCHOGUE, NY 11935, SOUTHOLD, NY 11971 Located at 115 HOBART LANE SOUTHOLD, NY 11971 Application Number: 2062789 Certificate Number: 2062789 Section: Block: Lot: Building Permit: BDC: ns11 Described as a Residential 0-599 square ft. occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described'below, located in/on the premises at: Second Floor, 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 22nd Day of March, 2006. Name QTY Rate Rating Circuit Type Miscellaneous 2nd floor renovation Alarm and Emergency Equipment Sensor 2 0 Carbon Monoxide Sensor 4 0 Smoke Apnliances and Accessories Exhaust Fan I 0 F.H.P. and Devices Wiring Outlet 4 0 Fixture Fixture 4 0 Incandescent Outlet 24 0 General Purpose Receptacle 15 0 General Purpose Switch 14 0 General Purpose Paddle Fan 3 0 Receptacle i 0 GFCI 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. 34460 Z Date FEBRUARY 25, 2009 Permission is hereby granted to: JAMES WILCENSKI 115 HOBART ROAD SOUTHOLD,NY 11971 for : ALTERATIONS TO AN EXISTING DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP 31347. at premises located at County Tax Map No. 473889 Section 062 pursuant to application dated FEBRUARY Building Inspector to expire on AUGUST 115 HOBART RD SOUTHOLD Block 0003 Lot No. 009 25, 2009 and approved by the 25, 2010. Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 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. 3x~47 Z Date AUGUST 10, 2005 Permission is hereby granted to: JAMES WILCENSKI 115 HOBART ROAD SOUTHOLD,NY 11971 for : ALTEP~ATIONS TO AN EXISTING DWELLING AS APPLIED FOR at premises located at 115 HOBART RD County Tax Map No. 473889 Section 062 pursuant to application dated AUGUST Building Inspector to expire on FEBRUARY SOUTHOLD Fee $ 150.00 Block 0003 Lot No. 009 3, 2005 and approved by the 10, 2007. ORIGINAL Rev. 5/8/02 MA~DV' I~ omD AT ~ U?FOLK CO.,/¢ .If/ 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 REMARKS: /~~ ~ DATE FOUNDATION (1ST) , ~O~DATION ~2~'~ ROUGH F~G & PL~G ~S~ATION PER N. Y. STATE ENERGY CODE I ' Jll~N OF SOUTHOLD JILDING DEPARTMENT OWN HALL SOUTHOLD, NV,. TEL: (631) 765-]~ FAX: (631) 7654~2 www. northfork.~[~t/S~uthold/ Examined Approved [~ , 20~ Disapproved ~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: {~9 t U..4 ~,~*,L Mail to: ~ ['~' APPLICATION FOR BUILDING PERMIT Date 7/c~l 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 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. E~ery 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 comnly with all applicable laws, ordinances, buildin~ code, housim, code, and remdations and to admit authorized ins lectprs[~n premises agd ig buildlng for necessary inspections ~ ~ ~{]0,~ [.}_: (Signat~e of applicant or name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee(a~ent,~rchitect, engineer, general contractor, electrician, plumber or builder N f -- ameo ownerofpremises G hecxf x , (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. House Number Street County Tax Map No. 1000 Section Subdivision (Name) B~ck ~ ~ Eot Fi~'d Map No. Lot-- 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~-S~;O .fr_~_ ~ ~[ b. Intended use and occupancy 3. Nature of work (check which applicable): New Buildin~ Addition Repair Removal Demolition,~ Other Work Estimated est , O o u Fee 5. If dwelling, number of dwelling units If 9arage, number of cars ration (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. 7. Dimensions of existing structures, if any: Front ~.~ ,Rear ~-d Depth Height. Number of Storie~" _.~" Dimensions o.[,same structure with alterations or additions: Front Depth ~ ~ Height. Number o'¢'Sto~s 8. Dimensions of entire new construction: Front Rear .Depth Height Number of Stories Rear ~,~ 9. Size of lot: Front Rear _Depth 10. Date of Purchase~Name of Former Owner 'T' 11. Zone or use district in which premises are situated ~--~-D ~ ~'"~-~ ~ 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 14. Names of Owner of premises~'l~ 5 '~'ra~g~ k.~ Address Name of Architect Address Name of Contractor Address Phone No.7 Phone No 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. 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: COUNTY OF $~f~'~L~,_ ~'["~ ~'. ~"~-'-~- 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 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. Swom to before me this~ ~_~"/DI dayof c./~/// 20t~' /7- Notary Public _ / / ~[My ~mmis~i~ E~pires 07/02/~ S~gnature of Apphcant TOWN OF SOUTHOLDPROPERTY RECORD CARD qLLAGE ~' STREET oWNER · ' sEAS. LAND IMP. ACREAGE FAi~.M co~M. tIND' TOTAL DATE REMARKS__ TYPE OF BUILDING CB. / MISC. AGE NEW Farm Tillable 1 No~L Acre BUILDING cONDITION ]ELOW Value FRONTAGE ON' ROAD LKHEAD )ack o~_~ x Tillable 2 Tillable 3 Woodland Swampland Brushland House Plot LOT Est. Mkt. Value :zeway / ; Porch Driveway 2nd Floor DOrmer /! IgC 7" / L Y APPROVED AS NOTED NO~IF-TBU~LD[NO CLP'f~EI~TMENT AT 765-1802 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS' 'i. FOUNDATION - TWO REQUIRED 2, ROUGH - FRAMING & ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OFTHE CODES ( NEW YORK STATE. NOT RESPONSJBL FOR DESIGN OR CONSTRUCTION EF IRS. FLOOD ZONE t~/~ . COMPLY WITH CHAPTER"46" , FLOOD DAMAGE PREVENTION SOUTHOLD TOWN CODE. OCOUPANOYOR USEIS UNLAWFUL WlTHOUT OERTIFIOATE OF OCCUPANCY ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE, PI UMt~Ft~ CERTIFICATION O:d~r U CL'~?~'~ ~jT~EFORE ,SOLDER USED IN WATER SUPPLY sYSTEM CANNOT EXCEED 2/10 OF 1% LEAD. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES As REQUIRED ^ND CONDmO~S O~F SOUTHC,~2 TC~N TROSTEES NY.S. DEC UNDERWRITERS CERTIFICATE REQUIRED PLUMBING ALL PLUMBING WASTE & WATER LINES NEED TESTING BEFORE COVERING