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Home My WebLink About39411-zTown of Southold Annex 1/12/2015 P.O. Box 1179 r 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 37375 Date: 1/12/2015 THIS CERTIFIES that the building RESIDENTIAL ALTERATION Location of Property: 5807 Westphalia Rd, Mattituck, SCTM #: 473889 Sec/Block/Lot: 113.-12-6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/9/2014 pursuant to which Building Permit No. 39411 dated 12/9/2014 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" PARTIALLY FINISHED BASEMENT AS APPLIED FOR The certificate is issued to Woychuk, Kenneth & Woychuk, Dorothy (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 12-18-2014 39411 12-16-2014 Kenneth Woychuk ut rued ignatu e Permit #: 39411 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: Woychuk, Kenneth & Woychuk, Dorothy PO BOX 3 Mattituck. NY 11952 Date: 12/9/2014 To: Electric in Basement Room. Amended 12/24/14 for "as built" partially finished basement. At premises located at: 5807 Westphalia Rd, Mattituck SCTM # 473889 Sec/Block/Lot # 113.-12-6 Pursuant to application dated 12/9/2014 To expire on Fees: 6/9/2016. and approved by the Building Inspector. ELECTRIC $125.00 AS BUILT - SINGLE FAMILY ADDITION/ALTPbkT-1QN $671.20 Building Inspector $796.20 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 property with accurate location of all buildings, property lines, streets, and unusual natural or 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. 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 DomZ/101 q New Construction: Old or Pre-existing Building: (check one) Location of Property 581r7 n(z4ye, W\a' `tom House No. Street t Hamlet Owner or Owners of Proper+(�t. Il��vniL j�xr oV( c t k - Suffolk County Tax Map No 1000, Section //3 Block Lot Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Date of Permit. Request for: Temporary Certificate Filed Map. Applicant: Underwriters Approval: Lot: Final Certificate: (check one) Fee Submitted: $ Applicant Se nature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Telephone (631) 765-1802 Fax(631)765-9502 roper. riche rtCaD-town.southoId. ny.us CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Kenneth Woychuk Address: 5807 Westphalia Rd City: Mattituck St: NY Zip: 11952 Building Permit #: 39411 Section: 113 Block: 12 Lot: 6 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: AS BUILT DBA: License No: Residential Commerical New Addition Service 1 ph Service 3 ph Main Panel Sub Panel Transformer Disconnect Other Equipment: X Indoor Outdoor Renovation Survey SITE DETAILS Office Use Only X Basement 1st Floor 2nd Floor X Attic X Service Only Pool Hot Tub Garage 6-ft of lighting track, 1 -exhaust fan Notes: Inspector Signature: Date: Dec 16 2014 81 -Cert Electrical Compliance Form.xls INVENTORY Heat Duplec Recpt 13 Ceiling Fixtures 1 HID Fixtures Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors 1 A/C Condenser Single Recpt 1 Recessed Fixtures CO Detectors A/C Blower Range Recpt Fluorescent Fixture 1 Pumps Appliances Dryer Recpt Emergency FixtureTime Clocks Switches 7 Twist Lock Exit Fixtures 9 TVSS AS BUILT ---ELECTRICAL SURVEY ---basement room ---NO VISUAL DEFECTS--- 6-ft of lighting track, 1 -exhaust fan Notes: Inspector Signature: Date: Dec 16 2014 81 -Cert Electrical Compliance Form.xls Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: (x211 i//Z"- Building Permit No. � q q � 4 Owner: )�W 6�1vyG! y 1L (Please print) Plumber: SeL� lead. (Please print) Telephone (631) 765-1802 Fax (631) 765-9502 I certify that the solder used in the water supply system contains less than 2/10 of 1% Sworn to before me this ) q -() l day of CO� 201* 61t� V\_.A—r --L Notary Public; -J u ounty (Plumb,ds Signature) CONNIE D. BUNCH Notary Public, State of New York No. 01 BU6185 50 Qualified in Suffolk Co ,t�, CommissionExpira� A,p�il " � Of S°Ujyo� kpeo� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FOUNDATION IST J FOUNDATION 2ND ] FRAMING/ STRAPPING ] FIREPLACE A CHIMNEY ] FIRE RESISTANT CONSTRUCTION ] ELECTRICAL (ROUGH) ] CODE VIOLATION REMARKS: r [ ] ROUGH PLUMBING [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION ELECTRICAL (FINAL) [ ] CAULKING e 3�cA i I- — cz�- �Ce DATE 1LA41INSPECTOR SOpp,,olo TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FOUNDATION IST ] FOUNDATION 2ND ] FRAMING/ STRAPPING ] FIREPLACE A CHIMNEY ] FIRE RESISTANT CONSTRUCTION ] ELECTRICAL (ROUGH) ] CODE VIOLATION REMARKS: [ ] ROUGH P ING [ ] IN ATION [ FINAL [ ] FIRE SAFETY INSPECTION [ 1 ARE RESISTANT PENETRATION I 1 ELECTRICAL (FINAL) [ ]CAULKING DATE r INSPECTOR -21; K 1' TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following, before applying? TOWN HALL Board of Health _ SOUTHOLD, NY 11971 4 sets of Building Plans _ TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 l -- - Survey 'k �c SoutholdTown.NorthFork.net PERMIT NO. T Check! -4- 50 .4- c : > _ r753 Septic Form N.Y.S.D.E.C. Trustees _ C.O. Application Ir— Flood Permit Examined , 20, Single & Separate DEC 1 9 2014 Storm -Water Assessment Form Contact: Approved , 20 Mail to: �O WgAtA. Disapproved a/c T=� ni , 20 Phone: (031 60-31S-5Expiration spector APPLICATION FOR—I(LDING PERMIT 20 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 shal l 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. -.1 J,// "461 ignature of applic t or name, if a corporation) �?0 &,x 3 /wf 1--r / Tv-rK &- / &Vi (Mailing address of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder r% Name of owner of premises -/- �),� r a Al! (As on/the tax roll oar 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: $807 w�sT�N141-/A�?aA1) Mx rr/Tom House Number Street Hamlet County Tax Map No. 1000 Section //3 Block 12 Lot 6 Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy & t- S rs b. Intended use and occupancy Nature of work (check which applicable): New Building Addition Alteration Repair _Removal Demolition Other Work (Description) 4. Estimated Cost If dwelling, number of dwelling units, If garage, number of cars Fee (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. Dimensions of existing structures, if any: Front Rear. Height Number of Stories Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front_ 2 73 . f5 Rear 2 /4. 99' Depth 392-46 ' 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NOS 13. Will lot be re -graded? YES NO x Will excess fill be removed from premises? YES NO. 14. Names of Owner of premises KeAmyC /► & Address 5807 w,56 oltkeel Phone No. 6 3 t -&6-t 46 f7 Name of Architect Address Phone No Name of Contractor Address 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 cam_ * 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_ r * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, CONNIE D. BUNCH Notary Public, State of New York (S)He is the No 01B'Al B-R'15n (Contractor, Agent, Corporate Officer, etc.) Qualified in Suffolk County � 1 Commission Expires April 14, 2____ 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. Swor to before me t pl?i 1— day 20 Notary Public P'05re of Applicant Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-11802 roger.rlchert(a toyin soil Aoffi nV us BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION VESTED BY: Date: P-- " 9— 1'� pany Name: No.. M JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax -Map District: e NtieA 4%y6f/ i 5807 we 54A-- COPe ce 12 oQ! 500,- 63/ 664-- &y7 'A&J1 1000 Section: /L3 *BRIEF DESCRIPTION OF WORK (Please Print Clearly) rAl Block: /,2 Lot: _j,,_ (Please Circle All That Apply) *Is job ready for inspection: Jq/ NO. Rough in Final *Do- you need a Temp Certificate: O . YES / NO . Temp Information (If needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service _,._.Re: conrlect- lltde{lground Number of Meters Change of Service Overhead _ Additional i lil i ttion: f ±':; PAYMENT DUE WITH APPLICATION DEC for lnspedionaihh V d 0 -moi / r24-c'&�o - Scott A. Russell ' >` BUFF 'r 5 ST(O IKIW�I WATIEIE, SUPERVISOR , I\\1[A\,I\A(G IE LENT SOUTHOLD TOWN HALL - P. O. Sox 1179 �� 7� �y 53095 Main Road - SOUTHOLD, NEW YORK 11971 Town of !Jou O c LIQ( d �C3 CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT) DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING (CHECK ALL THAT APPLE A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. 100 feet of horizontal distance. ❑ M D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. E. Site preparation within the one -hundred -year f loodplain as depicted on FIRM Map of any watercourse. - El F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, _ _Signature, Contact Information, Date _& County Tax Map Number! Cbapter 236 does not apply to your project. _ If you answered YES to one or more LLof the above, please submit Two copies of a Stormwater Management Control PIan and a completed Check List Form to the Building Department with your Building Permit Application. s.C.T.M. 1000 Dat APPL]CANT: (Property Owner, Design Professional, Agent, Contractor, Other] District � � � Section Block Lot Contact Information: ............... .... .. Property Addlilress 1 Location of Construction Work Reviewed BY: jf\'Z I IT - - Dale: A, proved for proce-,s n,,Buiiding hermit. Requifo(-I `>tctrr ,uttur'�l r- ?err €i' _ �r tri)( lur (tcct;r rc' f'.:: OUTSIDE BASEMEN ENTRACN �nl imr)4TI(1N 1A/AI 1 PARTIAL FINISHED BASEMENT PLAN SCALE: 1/4" = V-0" The work to the best of my knowledge, belief and professional jusdgement the was performed correctly. iM9 —// 9., /. -.a .�2 r� u 40 o_ Q J Q CO W Z w C/)U W D O00 Q L 0 N C LW U > Lu uj o W 1 z N F* � ami M b ao Eon� a�tcn:� i�: 1