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Home My WebLink About35355-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34867 I~te: 03/17/11 TIIIS ~I~TIFIBS that the building INTERIOR ALTERATION Location of Property: 695 THERESA DR MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 115 Block 15 Lot 6 subdivision Filed Map No. __ LOt No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 9, 2010 pursuant to which Building Permit No. 35355-Z dated FEBRUARY 23, 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 MINOR ALTEP~ATION AND BATHRROM ALTERATION IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. q~ne certificate is issued to RICHARD & MARGARET RUTKOWSKI (OWNER) of the aforesaid building. ~UFI~3I~K C~)~ DEPAR~gBT OF }~g~_51~{ APPRO~%L R;.RC~rK£C~J~ C~I(TIFIC3~ NO. PLUMBER~ c~TIFICATION DA'r~ N/A 10/29/10 N/A /~ A/ut' r~i zed~ignat ure 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. 35355 Z Date FEBRUARY 23, 2010 Permission is hereby granted to: RICHARD RUTKOWSKI 695 THERESA DR MATTITUCK,NY 11952 for : MINOR INTERIOR ALTERATION TO AN EXISTING DWELLING AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 115 purs,,mnt to application dated FEBRUARY Building Inspector to expire on AUGUST 695 THERESA DR MATTITUCK Block 0015 Lot No. 006 9, 2010 and approved by the 23, 2011. Fee $ 200.00 Autt~6rized Signature ORIGINAL Rev. 5/8/02 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 Buildil A. For new building or new use: t. Final survey of property with accurate location of all buildings, property topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal 3. Approval of electrical installation from Board of Fire Underwriters. 4. 5. ~~reets, and unusual natural _~!or Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from amhitect or engineer responsible for the building. Submit Planning Board Approval of completed site plan requirements. Bo 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 $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 :3--/¥--// New Construction: Old or Pre-existing Building: LocationofProperty.-~ ~ ~'~'~ 7'"/-/E',,~,E-~/5~ ]5~./~&-- House No. Street Owner or Owners of Property.'X'X/ ~ [ GlV.q ~d> d~t4 7-'.k: O!A/G/<: [ Suffolk County Tax Map No 1000, Section ]/~ Subdivision PEEP hlo t~ Ct~ ~ ~."F-,,,~T~'.,.~ PermitN'~o. 35 3~-,~Z Date of Permit. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~--O · EPO (check one) T'r- / T Hamlet Block / &~ Lot Filed Map. q~ Lot: Applicant: ~/CK~ ~~~o~l Unde~riters Approval: Final Certificate: J (check one) 54375 Main Road P.O. 1½ox 1179 Somhold, NY 11971-0959 Telephone (631) 765-1802 F;Lx ((;31 ) 76&9502 rofler, richort~town southo d ny us BUII~I)ING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION I Issued To: R & M Rutkowski I I Address: 695 Theresa Dr City: Mattituck St: NY Zip: 11952 Building Permit #: 35355 Section: 115 Block: 15 Lot: ~l / WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Custom Lighting of Suffolk License Ne: 38893-me SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement [~ Service Only ~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 3 ph Hot Water GFCl Recpt Main Panel NC Condenser Single Recpt Sub Panel AIC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: 1-exhaust fan Ceiling Fixtures I~ HID Fixtures Wall Fixtures ~ Smoke Detectors Recessed Fixtures I'~ CO Detectors Fluorescent Fixtur¢~ Pumps Emergency Fixture Time Clocks Exit Fixtures ~ TVSS Notes: 1st floor alteration Inspector Signature: Date: Oct 29 2010 81-Cert Electdcel Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] Fo~ATION 2ND [ ] INSULATION [ ~./]~FRAMING / STRAPPING [ ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION [ ] FIREPLACE & CHIMNEY [ [ ] FIRE RESISTANT CONSTRUCTION [ REMARKS: /~~ DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] RRE RESISTANT C0NS1RUCTI0~ [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~] ELECTRICAL (FINAL) REMARKS: TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS~JI~KTION [ ] FRAMING / STRAPPING [//~:INAL [ ] FIREPLACE & CHIHHEY ( ] FIRE SAFETY INSPECTION [ ] FII~RF. SlST~iT~ [ ]FIRE.ESlSTARTmLm~TIOH REMARKS: TOWN'~F SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork. net Examined 20__ Approved '~-- ~' ., 20/c~9 Disapproved *ftc Expiration .ff,7-.,~_.~ , 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 Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date '-~'E~. --~ ) ,20 / O a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets &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 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 0 W/,,/E/'~ Nameorownerofpremises ~/C. HO~D [~-rl~owS~ / .w i~/~-~qi~CT (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. 1. Location of land on which proposed work will be done: House Number Street TT /Tb,[ (_...Ex Hamlet County Tax Map No. 1000 Section ]/~' Subdivision ~C~EP ~tOt-E C~.ereT~ _-~r'~TE-~ Block / ~" Lot ~ Filed Map No. ~-6; ~ Z~' 1~,6~.' '~,, 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existinguseandoccupancy 0t~E F~,~ IL-~/ 15v~/~t._a_ttdO- b. Intended use and occupancy ONE 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost-' -;~ ~') 0o0 J Fee 5. If dwelling, number of dwelling units If garage, number of cars j Addition Other Work 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. 7. Dimensions of existing structures, if any: Front ~'~,~- ~ Rear Height t" 6¢'o~t Number of Stories / Dimensions of same structure with alterations or additions: Front Depth b/'~ Height / s~-~ 8. Dimensions of entire new construction: Front AJ/A Height Number of Stories / Rear / / 0 9. Size of lot: Front / ] O t 10. Date of Purchase I0 --Jcl_ g r7 L/~OO Depth t~8 o~' 7- 5'" Rear /--r/~ Number of Stories Rear .Depth Depth Name of Former Owner 11. Zone or use district in which premises are situated t~ -/7/O 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 t4t~ac-~o4~r' e, ur~o~/c?c~r}ss nm-rrr, to$ t,,y ~r/5~, Phone No. NameofArchitect Iqoc--rc /3, c. Ho~4o ~o~o Address -~o,.~r~o,.~ ~ t~7! Phone No 76~'~ Name of Contractor 1>*~ coeosra,~c-rww ~uuress ~_~f~__~ rnone 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. 18. Are there any covenants and restrictions with respect to this property? * YES__ NO · IF YES, PROVIDE A COPY. STATE OF NEW YORK) sS: COUNTY OF~U tl///:JrglC,--O~e'T'' /~ t4'T-/e-o ~-q/~--] 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 ali 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 ~,.t~)~,~/~ day of ~ ~. 20 / 0 { r/ Signature of Applicant Town Hall Annex 54375 Main Road P.O. Box 1179 · Soulhold, NY 11971-0959 Bur[.r~ING DF_,PARTMENT TOWN OF SOUTHOI.n APPLICATION FOP, ELECTRICAL INSPECTION REQUESTED BY: ~,~ ~"~, ~,x-~3~,, ' C°mpany Name: ' -02x'St'~ ~L Name: Ll~nse No.: ~ ~ ~ ~ . Address: Phone No.: Telephone (6.!11) 765-1802 ,roger. richertC~o (~.~ioTu~t~.ny. us JOBSITE INFORMATION: (*Indicates required infom~ation) 35-_3 5'b- *Name: *~dress: *Cross' Street: *Phone No.: Permit No.: Tax Map District: 1000 Section: //~' Block: '/.~' Lot: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) (Please Circle All That Apply) *Is.job ready for inspection: .*Do you need a Temp Certiflca{e: Temp'lnformation (If needed) · · Service Size: 1 Phase 3Phase 100 · New Service: Re-connect Underground Additional InfOrmation: 82-Request for Inspection Form NO Rough In ~ Final ) YES/(~ 150 200 300 350 400 Other Number of Meters Change of Service Overhead PAYMENT DUE WITH APPLICATION ./ooo-/,,~-/.:-~ TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREE~ /~ g ~ VILLagE D~ST. SUB. LOT ~' -~ ' s w ~PE OF BU~N~' I . RES, ~]O S~S. ~ FARM COMM. CB. MISC. Mkt. Value ~ND IMP. TOTAL DATE REMARKS Swampl~d FRO~AG~ ON WATER 3rush~n~ FR~TAGE ON ROAD ~use Plot DEPTH BULKH~D Fotal DOCK COLOR. Extension Extensi~>n Z~/2-~F°und°ti°n Porch lZ x/~, > Porch G~rage t I 7~ "3asement -Zxt, \~'alls Fire Place Type Roof >,ec reation Room ~>ormer ~0 / )rivewoy Total Bath FIo~rs Interior Finish Heat Rooms 1st Floor Rooms 2nd Flcor Dinette FIN. B. 695 Theresa Drive Mattituck, NY 11952 March 15,2011 BY HAND Town of Southold Building Dept. Town Hall Annex 54375 Main Road Southold, NY 11971 Premises: Permit No. 35355-Z Richard & Margaret Rutkowski 695 Theresa Drive, Mattituck, NY 11952 $CTM # 1000-115-15-6 Dear Ladies/Gentlemen: Enclosed please find your Memo, the completed application for Certificate of Occupancy for my minor alteration, and my check no. 917 in the sum of $50.00 payable to the "Town of Southold" for the Certificate of Occupancy fee. Please call me at work (765-4330) when the CO is ready for pickup. Thank you. Very truly yours, Margaret Rutkowski /mr Encls. BLDG, 0EPT. TOWN Of SOUTHOLD Town Hall Annex 54375 Main Road P.O. Box 1179 Southold~ New York 11971-0959 Telephone(631)765-1802 Fax(631)765-9502 March 11,2011 Richard Rutkowski 695 Theresa Drive Mattituck, NY 11952 BUILDING DEPARTMENT TOWN OF SOUTI-IOLD TWO WHOM IT MAY CONCERN: ~,~ Following Items Are Needed To Complete Your Certificate of Occupancy: __ Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of $$0.00. __ Final Health Department Approval. Plumbers Solder Certificate. (NI permits involving plumbing after 4~1184) __ Trustees Certificate of Compliance. (Town Trustees#765-1892) __ Final Planning Board Approval. __ Final Fire Inspection from Fire Marshall. __ Final Landmark Preservation approval. Building Permit: 35355-Z minor alteration ~EQUIRED, /'=~ 0~ ,P, Z~X./,, 1000-115-15-6 . RUTKOWSKI RESIDENCE ~ . 695 Theresa Drive SK-1 :'~ ' ' .Mattituck NY ' ~,?-~ I ' CHORNO ASsoCIATES ' SOUTHOLD, N~ YOR~ THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND/OR FROM DATA OBTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE DtSPOSAL SYSTEMS FOR THIS RESIDENCE WJLL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES APPLICANT': ADDRESS -- - TEL.-- N. 87019 '20 "W. SUFFoLK ,~ V~-NU~' lot 18,~.00 ' ' $~pf[c fan# Lot $~ NOTE: · -' MONUMENi' 0 -' PIPE S UBDIV/$1CW MAP F/LEO IN THE OFF/CE OF ~H~C~BK JAN, ~ YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK SURVEY FOR: NATHAIV C. MARDEl? 8 MAI?ION C, MAl?D~ LOT NO. 40 ~,~ o~ ~~ "DEEP HOLE Cl?EEK ESTATES" i ~ · ow~ o, SOUTHOLD co.,