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Home My WebLink About34611-ZFORM NO. 4 TOWN OF SOUTROLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34693 I~ate: 11/19/10 THIS CERTIFIES that the building DECK ~ation of Pr(~0ert¥: 375 FARMERS RD (ROUSE NO.) (STREET) County Tax Map NO. 473889 Section 139 Block 3 Subdivision Filed Map NO. Lot No. MATTITUCK (HAMLET) Lot 31.1 conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 15, 2009 purs,,~nt to which Building Pern~it NO. 34611-Z dated APRIL 15, 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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to REGINA A ORLOWSKI ( OWNER ) of the aforesaid building. SUFFOLK CO~TYDEPARTMENT OF HEALTH APPROVAL R~t-r~ICAL CERTIFICATHNO. PLUMBERS CERTIFICATION DA-r~u N/A N/A N/A Rev. 1/81 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. 34611 Z Date APRIL 15, 2009 Permission is hereby granted to: REGINA ORLOWSKI P.O. BOX 472 MATTITUCK,NY 11952 for : ERECT DECK ATTATCHED TO DWELLING. THIS PERMIT REPLACES BP # 31334 at premises located at County Tax Map No. 473889 Section 139 pursuant to application dated APRIL Building Inspector to expire on OCTOBER 375 FARMERS RD MATTITUCK Block 0003 Lot NO. 031.001 15, 2009 and approved by the 15, 2010. Fee $ 150.00 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. 31334 Z Date AUGUST 4, 2005 Permission is hereby granted to: REGINA ORLOWSKI MATTITUCK,NY 11952 for : ERECT DECK ATTACHED TO DWELLING. THIS PERMIT REPLACES BP 10224. at premises located at County T~ Map No. 473889 Section 139 pursuant to application dated AUGUST Building Inspector to expire on FEBRUARY Fee $ 150.00 375 FARMERS RD MATTITUCK Block 0003 Lot No. 031.001 4, 2005 and approved by the 4, 2007. Rev. 5/8/02 ORIGINAL ('l~llS PEPS. IT~,MUST BE KEPT ON THE PRF~ISES Ul~lI~ FULL CO~,PLETION OF THE WORK AUTHORIZED) DQte 'PU~. to applleatlon 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 A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusua na ~ topographic features. 2. Final 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 from plumber certifying that the solder used in system contains less 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 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. New Construction: Location of Property: C. Fees 1. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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 (check/ne) Date. Old or Pre-existing Building: House No. 'Street v Health Dept. Approval: Owner or Owners of Property: ~)~ '~'~' -T./'P6-, Suffolk County Tax Map No 1000, Sectio~~. _ Block Subdivision Filed Map. [~ DateofPemit. /0/~Applic~t: Unde~fiten Approval: Lot Lot: Planning Board Approval: Request for: Temporary Certificate Final Certificate: ~/' (check one) Fee Submitted: $ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING / STRAPPING FIREPLACE & CHIMNEY [ FIRE RESISTANT CONSTRUCTION [ REMARKS: [ ] ROUGH PLBG. [ ] INSULATION ~)<~..FI NAL ] FIRE SAFETY INSPECTION ] FIRE RESISTAI¢I' PENETRATION INSPECTOR. "/~~ DATE ~'- ~'-(~- o 7 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: INSPECTOR~ DATE / 0~-'1~-~ /0 ~'LELD LNSPECTIONREPORT I DAT~ ] COMMENTS FO~ATION (1ST) FO~DATION (2~) ROUGH ~G & PL~G ~S~A~ON PER ~. Y. STATE ENERGY CODE ~moN~ COUNTS FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 Examined ................. 19 ... Approved ................ , IV remit ~o ............ ................................... / ... . . /. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application NO.../..~ .~..~.. !/... Date ....... /~-/~, ..... ' ./.;),9'/.~ ~,'~ aua.-d~ q:) o rc~a.4~ 1/. ~ ~ ~~ ~STRUCTIONS ~ w~ ~,~ Wpewr' ' i~_~d s.~ to the Building Inspector, w~th 3 sets of plus, ~dcu an to sclc. Fee a b. Plot plan show~g location of lot ~d of bu~d~ on premises, relations~p to adjoining p~mbes or public streets or areas, ~d ~ving a det~ed description of layout of prope~ must be drawn on the dia~ which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Buildhg Pe~it. d. Upon approv~ of ~is application, ~e Bu~d~g Inspector will issue a Bu~ding Pe~it to the applic~t. Such pe~it sh~l be kept on the premises ava~able for inspection ~rou~out ~e work. e. No bufld~g sha~ be occupied or used in whole or in pa~ for any pu~ose whatever until a Ce~ificate of Occupancy ~1 have been granted by the Building Inspector. ~PLICATION IS HEREBY MADE to the Bufld~g Depagment for the issuance of a Bufld~g Pe~it pursuant to the Bu~ding Zone ~d~ance of ~e Town of Sou~old, Suffolk County, New York, and other applicable Laws, Ordinances or Re~lations, for ~e construction of bufld~, additions or ~terafions, or for mmov~ or demolition, as herein descfibed.~ ~he app~c~t a~ees to comply with ~ applicable laws, ordnances, build~g code, housing code, ~d regulations, ~d to' admit authored ~specto~ on premises and in bu~dings for neces~ ~spections. ~ · . ~ .... .. ~.. ......... 9 ................. n ~ailing address of applica~) State whe~er applic~t is owner, lessee, agent, ~chitect, en~eer, gener~ ~t~actor, electhcian, plumber or builder. .... ......... ................. .................... ....... Nme of owner of premlse~ . .~.t~ .t., ........ ~. ,.., .~.~.,.~..~ .................................... . ~ r ~ Y~ ~ ~ (~on~o~latest deed) If applicant is a co~oration, signature of duly authohzed officer. ~ Builder's License No .... '?. .... ~ t-' '?' ,tx". t" ..... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number County Tax Map No. 1000 Section .................. Block .................. Lot ................... 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 f... &. ;z7 ~.:.< .~. {.'t] ...... ~'~ '3:2 ~ 'L'' '~' ~ .'*v~ · -(. ....................... b. Intended use and occupancy .. ~.....~.. ~. 'id-'t'< ................................................ ~ 3. N'at~re if work (check which applicable): New Building .......... Addition .......... Alteratio; ....[~..-.... Repair .............. Removal .............. Demolition ..... : ........ Other Work ............... o o (Description) 4. Estimated Cost ............. .-~.. (.3. !~ .................. Fee / ~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commerciai or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions 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 ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed cOnstruction violate any zoning law ordinance or regulation: ..... Will lot be regraded ~.h:.t'5."f). tO...~..~.¥, p.c9.S. ~... Will excess fill h~r&moved from premises: Yes ~ Name of Owner of premises .................... Address ~ .,:'}. [ ! )~ ¢.[~ . Phone No ................ Name of Architect .......................... Address Name of Contractor ~.~ ./~..%~ .1,~...~...~*fO/~6. Address i~i~i~ iPh°nePhone No.:gr...q~.'~'.q:.$° ................ .% .o.... 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. S.S ....... ~'?. ?..~..L. 7..~.:. ......... ~}~i~'. ~. 5 :. ?. ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .......... .~.'.f.4...~./..f. (h..c'...--.Q ?. !~.. ..................................................... (Contract'Crr-, 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 ................... f.~...day of. ~ ~.~. J.., 197.7 Notary Public .................................. County ~: ! · BABETrE C CONR · - ~- / ~ '-,-" ~' . ...... / ~ / ~,t-~../~NOTARy PUBLIC, ~tate o "~ '~"' ~ ~/~-~/~'~/~,_~lUff.ol~. ~o_un~. No. S2-~fl~r~r /2' . (Signature of applicant) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-1802 Approved ...... . .:¢l .¢Permitmo. . .:.: .:. : Z Disapproved ale ....... ~"~' ' ' ' ' '~' '.~L' .................. ........................... : ...... (Building Inspector) Application No ........... ~ .... APPLICATION FOR BUILDING PERMIT Date ....... .~/.. '.'~..):.../..~, 1 ~..~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessa~ctions,. (Signature, of a~l~ican't, c~. nam. e, ff a corpor, ati~n) (Mailing address of applicard~) State w~lle~ther applicant is owner, lessee, ag~3t, architect, engineer, general contractor, electrician, plumber or builder. ..... ..... ................................................. Name of owner of premise:. ~.~ .o,~ .~ .... ~. ,/p:'..,.,~. ~. '~:b ~" .~' .~:' ................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... .T....~...~..7~..(?.. ~ .... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .............................. , ................... ...................... ......... ......... House Number Street Hamlet County Tax Map No. 1000 Section .................. Block .................. Lot ................... 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 . .x/...~4::Jt..-Y~.; .~..54. ..... "~'" '6~' "'O':' '~' 'Q' k' i '%~'' '5 ...................... b. Intended us~ and occupancy . ~,...~.. '~'..~..[..~ .............................................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration '~'~J Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ,_~ 0 0 Fee [ '~-' ~ (Description) (to be paid on fding this application) 5. 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 ............... 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 ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................. ,..>,~ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes /,~o 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, S.S COUNTY OF ................. ....... ~. '.~..~../~..L.g~ ~ ......... .~f.~..~../~.. ?. ......... being duly sworn, deposes and says that he is the applicant (Name of individual si~g contract) above named. .......... :. ¢. He is the (Con~;~t', ~;~;;a~; ;~;;,'ei~.~ ............................ of s~d owner or ownem, ~d is duly authored to perfom or have perfo~ed the mid work ~d to m~e ~d file ~s application; that ~1 statements cont~ed ~ this app~cation ~e ~ue to the best of his ~owledge and be~ef; ~d ~at ~e work will be perfomed in the m~ner set fo~h ~ the application filed therewith. Sworn to before me t~s ................... of ............. Nota~ Public, ................................ Coun~ ~ F ~ / ~ ~ ~:'~c s~,~. ~~ ~.~-~ .......... ~//<~. /~..~°~J~g~,~ ~o~2;~7:, ~ ~ //(Si~ature of app~c~t) ~ '~ ~ - -- ~ ~ Co~On E~tres ~'~ -~ ~ V ~ Total ltall AllllCX 54375 Main Road 1'.O. Box 117!/ Southohl. NY 11971-09,~9 Tclcphot~c (631 ) 763-1802 Fax (631) 763-9,502 BI III,DIN(; 1)I~;PARTMI~]NT TOWN OF $OUTHOLD November 1, 2010 Regina Odowski PO Box 472 Mattituck, New York 11952 RE: 375 Farmers Road, Mattituck TO WHOM IT MAY CONCERN: The following items are needed to complete your Certificate of Occuancy: -'"""J Application of Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of $25.00 __ Final Health Department approval. __ Plumbers Solder Certificate. (All pein'fits involving plumbing after 4/1/84) __ Trustees Certificate of Compliance. (Town Trustees #765-1892) __ Final Planning Board approval. __ Final Fire Inspection from Fire Marshal. __ Final Inspection from the Building Dept. __ Final Landmark Preservation approval. Building Permit: 34611-Z deck TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 October 10, 1980 Stanley Sepko R.F.D. Mattituck, New York 11952 Dear Sir: This is to notify you that Building Permit No. issued _ May 19, 1979 to Bruno 0rlowski will expire on November 1~'~ 1980 10224Z If more time is required to complete the Job and obtain a Certificate of Occupancy, you may apply, bY letter, for a six (6) month extension. If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, H. FISHER ~ : Sr. Building Inspector GHF/mw APPROVED AS NOTED DATE: 5'/ FEE: (~ BY. ~ 765-2660 9AM fo 4PM FOR REQUIR. ED INSPECTIONs: 1. BEFORE ~AC~FILLING FOUNDA. 3. BEFORE COV~JNG P~:~5 OF ANY 4. FINAL W~ JO~ C~MPLETED NOT RESPot~5JGL~ FO~ D~51GN OR CONSTHUcTJoN 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N.Y. STATE CODE AND TOWN ~OU$~N~ qO]~ & 1 BID6 DEPI. TOWN OF SOUTHOI_D