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HomeMy WebLinkAbout35551-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA=RTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34373 Rte: 05/25/10 THIS CERTIFIES that the building ALTERATIONS Location of Property: 895 HOLBROOK LA MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map NO. 473889 Section 113 Block 6 Lot 14.5 Subdivision Filed Map No. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 28, 2010 pursuant to which Building PeI~nit No. 35551-Z dated NL~Y 14, 2010 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is "AS BUILT" ALTERATION TO LIVING SPACE ABOVE ATTACHED GARAGE IN AN m×¥MTING ONE FAMILY DWELLING AS APPLIED FOR. (4 BEDROOM LIMIT PER S.C.H.D.) The certificate is issued to PAUL PAWLOWSKI of the aforesaid building. (OWNER) S~FOI~K C~)[~q~f DEP~/~T~T OF }~J~TH EI~t-r~IC~J~ Cq~RTIFICATH NO. PL~ C~RTIFICATION DA'r~u 3859 N/A 05/03/04 ~/ut~lgnature' ' 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 use: 1. Final survey of prope~ with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval froin Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of eleCtrical installation from Board of Fire Undenvriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commt~reial building, industrial building, multiple residences and Simila~ 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-cenforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of prope~'oj 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 OccupancyonPre-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: Old or Pm-existing Building: (check one) House No. Owner or Owners of l'ropony: .. - Suffolk County TaxMap No 1000, Seetion Subdivision Permit No. ~% ~ ~- / Date 0fPermit, Street Hamlet Blcck ~p Lot :'O{ . ~ Filed Map. Lot: Applicant: H~lth Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ c:~ Final Certificate: (chec~///~ Applicant Sig ature / Nassau Suffolk E[eclrical Inspections, Inc.. 5~ Canal Strut * C¢~¢r Moriches, Now York 11934 * Te{: 631-g78-3500 * Far~ 63[=878-3764 AppLication: 3859 Date: 5/3/04 Issueat to: Pawlowski Address:. 895 Holbrook Lane Village: Mattituck Introduced By. Modem Electric East Lic~: 4253-E was examined and appro~ed up to the above date and was in compliance with the NEC /~cI~1 1si Raerl~l Residerflal [] Poel Oe~ G~rage J]j~lSe[llS[ J-~J ~,ld Jjoo-j~'l OOlllll~d~ Fl~Tub ~ Switches Receptacles Fixturos G.F.I. Water Pump Whirlpool Fans Dishwasher Washer/Amps Dryer/Amps RangalAmps Monoxide 2-Ex Bath I ~ I 1-Wall oven 1 Fureaoe Oil Gas HeatZones · Smoke . Bell Meter Amps Phase Motors 1 2OOA UG 1 l-Caoktop This corOficate must not b~ in any manner 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. 35551 Z Date MAY 14, 2010 Permission is hereby granted to: PAUL PAWLOWSKI 1785 CROWN LAND LANE CUTCHOGUE,NY 11935 for : "AS BUILT" ALTEP~ATION TO AN EXISTING ATTIC OF A FOUR BEDROOM DWELLING AS APPLIED FOR at premises located at 895 HOLBROOK LA County Tax Map No. 473889 Section 113 Block pursuant to application dated APRIL 28, 2010 Building Inspector to expire on NOVEMBER 14, MATTITUCK 0006 Lot No. 014.005 and approved by the 2011. Fee $ 400.00 Authorized Signature ORIGINAL Rev. 5/8/02 JOHN FOKINE P.C. CONSULTING ENGINEER P.O. BOX 1064 SHELTERISLAND, NEW YORKl1964 631-749-5089 Southold Building Department Main Road Southold, New York, 11971 May 20, 2010 Re: Pawlowski Residence: Per request this is to verify that the construction was completed as per the plans submitted. John Fokine P.C.. 1'OWN OF SOU/NOLD (. JOHN FOKINE P.C. CONSULTING ENGINEER P.O. BOX 1064 SHELTER ISLAND, NEW YORK 11964 631-749-5089 Southold Building Department Main Road Southold, New York, 11971 May 12, 2010 Re: Pawlowski Residence: Per request the following should complete your records for this permit: Finished room height meets the New York State code. The existing Anderson Window 3452 meets and exceeds venting (4%)& light (8%)requirements, along with egress requirements. a. Venting existing 5.91 sq/fi required = 5.56 sq/fi b. Light existing = 13.9 sq/fi required = 11.12 sq/fi c. Egress existing = 5.91 sq/ft required = 5.7 sq/fi John Fokine P.C.~~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ] ROUG~BG. [ ] IN/,SULATION [~INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ]F~R~mTAmCO. Smuc'r~ [ ]m~RmS'rAmmiLm~'no. REMARKS:__~/~~ DATE INSPECTOR-~ TOWN OF SO~DING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] 1~4~~ ~F~AL~ ~ [] FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] FIRE-GAi:E¥~INSPECTION [ ]FI~I~.SiSTANT~ [ ]FIRERESlSTANT~NL=TRATION DATE/~//~ INSPECTOR~ FOUNDATION (IST) ..=..- . FO~A~ON (2~) · ROUGH ~O ~ PL~O ~8~ON P~ N. Y. STA~ E~ CODE TOWi*t OF SOUTHOLD BUILDING DEPARTI~IENT TOWN HALL o ', SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined ~tic~ ,20 I© [ 20 {3 Disapproved a/c 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 Flood Permit Storm-Water Assessment Form Contact: Mail to: ~"D~. "~ 0, ~ Expiration Ii/]c~ ,20 {~_ nu' d~i¢-''~/~---''~ ~ i ' g Inspector ~ompletely filled in by t~ewriter 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 promises or public streets or areas, and wate~ays. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon approval of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such a pemit shall be kept on the promises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pan for any pu¢ose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Evew building pe~it shall expire if the work authorized has not commenced within 12 months a~er the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other m~lations affecting the property have been enacted in the interim, the Building ~spector may authorize, in writing, the extension of the pe~it for an addition six months. Thereafter, a new pemit shall be required. ~PLICATION IS HEREBY M~E to the Building Dep~ment for the issu~ce of a Building Pe~it 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~descfibed. The applicant agrees to comply with all applicable laws, ordinances, buil~g~7~g code, a~egulations~d to admit authorized inspectors on premises and in building for necessa~ inspections. ~ /// ~ t ( .... )(S~gnamre o~p!i~or name, if~ration) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eledtrician, plumber or builder Name of owner of premises (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. LocatiQmof land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section Subdivision Block Lot 'fl.,,% Filed Map No. Lot State existing use and occupancy of premise, s and intents[ed us'e and occupancy of propose'd a. Existing use and occupancy --~¢181,.~ -Jcl_.,.,_ ~ ~r' b. Intended use and occupancy ~% ~,.~ 3. Nature of work (check which applicable): New Building. Repair Removal Demolition Addition Other Work co.nstruction: 4. Estimated Cost ~>,~, 7 qc"~-~ 5. If dwelling, number of dwelling units If garage, number of cars Alteration Fee (Description) (To be paid on filing this application Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify natur,e and, ~ent o f each type o f use. Dimen i n . . . . ~,>O s~.,1,~ ~,, 7. s o s of existing structures, if any. Front ~ Rear Depth Height. Number of Stories Dimensions of same structure with alterations or additions: Front /(--)~~)/ ~ Rear Depth, Height Number of Stories 8. Dimensions of entire new construction: Front b)On,''''~- /l Rear Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase r,./~ cu Name of Former Owner Depth 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO X 13. Will lot be re-graded? YES NO ~ Will excess fill be removed from premises? YES NO__ 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES/v`. * 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. NO 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. 18. Are there any covenants and restrictions with respect to this property? * YES NO ~ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OFSvI4'-~S: 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.) ~oiary Public, State ot New Y0r~ P~0.01BU6185050 ~ (~ualified in Suffolk Count' of said owner or owners, and is duly authorized to perform or have performed the sM~ ~5¢~'hhx~'[~ ~t[~} an~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, . c~ ~nt~ day of~ ~ Notary Public 201 0 ' % ,gnature 01~3/~plica~t ,_c,,o-//,~ -~'-/~d~r TOWN OF SOUTHOLD PROPERTY OWNER RM£R OWNER ' . :ES, 'SE~S. VL.~ I f IMP. TOTAL FARM LAND DATE VILLAGE E W COMM. CB. MISC. Mkt REMARKS RECORD CARD ]/-3 ~ DIST1 SUB. LOT .~ ' ~ , TYPE OF BUILDING 39o~ - FARM Acre :l~g COND Value Per Acre Voodlond wampk~d rushland FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD DOCK [ 75.00' o.,'w ~ oD"° FRAME ~ ~ 4. ~,, SURVEY WAS PREPARED FOR A SPffCiFIC PURPOSE hJ Ld HOLBROOK 200.00', Barrett, Bonacct 8, VanWeele, P.C. PROPERTY IVlATTITUCK 'FINAL' '"' ,,.+,\ SURVEY LANE \ PbOOR PLAN 2266 2468 EXISTING CLOSET :*i~ .' EXISTING BATHROOM · 15';5" ·. ' ' ' " 16" O/C EXISTING _z E~XISTING EGRESS ANDERSON WINDOWS /~ NOT 5: Att WAttS ANt? STRUCTIJRU UXISTINd UNt?UR ORIdlQNAb C,O, Att I~LUCTR. IC~ OIJTbUS ANt? WIRINd If. XISTIN~ IJNPI~R ORIdlONAt C,O. ATTIC SPACB WAS NOT BNLAR~BP OR Ab~RBI? PROM ORI~IONAt C,O, FINISH WORK ONLY I. INSULATION OP KNI~P. WALL5 ANt? CUILIND TIP-5 2, PR,WVAtU TO WAttS ANt? CEILIN~ 2"X 10".RAFTERS EXISTING APPROVED AS NOTED DAT~' *~'/~ ..P.# NOTIFY BUILDING DEPARTMENT AT 785-1802 8 A~ TO 4 PM FOR THE FOLLOWING INSPECTIONS 1· FOUNDATION - TW~ REQUIRED FOR POURED CONCRETE 2 ROUGH-FRAMING, PLUMBING, STRAPPING, ELECTRICAL & CAULKING 3 INSULATION 4. FINAL - CONSTRUCTION & ELECTRICAL 2" X 6" COLOR TIES EXISTING MUSTSECOMPLETE FORC,O, ALL CONSTRUCTION SHALL MEET THE REOUIREMENT$ OF THE CODES OF NEW YORK ~rATE, NOT RESPONSIBLE FOR DESfGN OR CONSTRUCTION ERRORS, 2" X 4" STUD WALL EXISTING\ kN /A-rlC AREA CONVERTED TO LIVING SPACL --5/4" DRYWALL ACRYLIC STUCCO FINISH R 19 WOOL BA'FF INSLULATION 13 WOOL BATT INSLULATON FINISHED LIVING SPACE 3/4" AC PLY SUB FLOOR CARPET FINISH ~ EXI..CiTING FAMILY ROOM CR055 51¢CTION UNDERWRITERS CEFFDIFICATE REQUIRED OCCLII¥'j~C',~CFt USEIS UNLAWFUL WITHOUT CERTIFICATE OFOCCUPANCY !ON SHALL ENTS OF THE ::~K STATE, JOHN FOKINE PC CONSULTING ENGINEER P.O. BOX 1064 SHELTER ISLAND N,Y. 11964 631-749-5089 PAWLOWSKI RESIDENCE 895 HOLBROOK LANE MATTITUCK, NY STERLING HARBOR DESIGNS P.O, BOX 37 SOUTHOLD NY 11971 631-22-8578 SCALE 1/4 INCH = 1 FT 4/22/2010 TOFf