HomeMy WebLinkAbout41885-Z g11EFQq�r�oGy� Town of Southold 11/2/2017
P.O.Box 1179
a -
�' 53095 Main Rd
�ya � Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39322 Date: 11/2/2017
THIS CERTIFIES that the building ACCESSORY GARAGE
Location of Property: 100 Park Ave,Mattituck
SCTM#: 473889 Sec/Block/Lot: 123.-7-3
Subdivision: Filed Map No. Lot No.
-conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/10/2017 pursuant to which Building Permit No. 41885 dated 8/16/2017
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:
ACCESSORY GARAGE WITH STORAGE ABOVE AS APPLIED FOR
The certificate is issued to 100 Park Avenue Corp
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 418ft 10-24-2017
PLUMBERS CERTIFICATION DATED
Aut rite Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
yp�Ql � �pp4
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)
Permit#: 41885 Date: 8/16/2017
Permission is hereby granted to:
100 Park Avenue Corp
c/o Paul Pawlowski
PO BOX 783
Mattituck, NY 11952
To: construct accessory garage as applied for. Must maintain 50' front yard setback.
At premises located at:
100 Park Ave, Mattituck
SCTM # 473889
Sec/Block/Lot# 123.-7-3
Pursuant to application dated 8/10/2017 and approved by the Building Inspector.
To expire on 2/15/2019.
Fees:
ACCESSORY $324.00 y
CO -ACCESSORY BUILDING $50.00
Total: $374.00
Building Inspector
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
Date.
New Construction: AAC/tv P'?ld or Prez- xisting Building: (check one)
Location of Property: A � ,/7L g.' 0"c'
douse No. Street ` Hamlet
Owner or Owners of Property: a
Suffolk County Tax Map No 1000, Section , Block 7 Lot
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval: !1�/�
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
( ��OE OUlyo
�o
0
TOWN OF SOUTHOLD BUILDING DEPT.
765-1602
INSPECTION '
[ FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] UNDATION 2ND [ ] INSULATION
[ FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: O, ACA
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A.00L)
Sj&ftAot ✓' •
DATE' °C t9Z INSPECTOR
MUNi'I,��
TOWN OF SOUTHOLD"BUILDING -DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ]/,A4SULATION
[ ] FRAMING / STRAPPING [ ] FINAL 4Cfl
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: I1 -
�UINUA
d_V) 04,Ay,c1 ( -P-MiAlue /
'ljw �446D
VK�l
Q - c_J 0 in 05;�)
�
DATE g INSPECTOR
SOUTyolo
4 Quo,
TOWN OF SOUTHOLD BUILDING DEPT.
765-1602
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [�] ELECTRICAL (FINAL)
REMARKS:
DATE D INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
b
FOUNDATION(IST)
--------------------------------------
FOUNDATION (2ND) t�
i
ROUGH FRAMING&
PLUMBING 19 (� y
INSULATION PER N.Y. H
STATE ENERGY CODE
�ti✓ d rV' �� i r
1' ItCotk/ I1
to
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FINAL ✓ r
ADDITIONAL COMMENTS
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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 Survey
Southold town ny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined ,20 Single&Separate
Truss Identification Form
Storm-Water Assessment Form
Contact:
Approved ,20 Mail to:
Disapproved a/c
a/c
Phone:/, ze �<— �- �
Expiration '201T /
i
[EC[E
D'VR D But ector
,
APPLICATION FOR_EUILDING PERMIT
AUG 1 0 2017 -
Date—<0//V ' 20
B DRgGi�7 D . INSTRUCTIONS
a9'P7 s%pqR on > 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 partfor 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.
ignature of applicant or name,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, essee, agent, architect, engineer, general contractor, electrician, 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 titlelof.corpo`rate officer)
a3.rtl
Builders License'No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which pro setwork 2ill be done:
House Num er Street Hamlet
County Tax Map No. 1000 Section Block Lot
Subdivision i e Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy �Sf�o,,v�1
b. Intended use and occupancy
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost� �-�� Fee
(To be paid on filing this application)
5. If dwelling,-number of dwellin Number of dwelling units on each floor
If garage, num s /(: ds —z—
6. If business, commercial or mixed occupancy, specify nature and extent of
7. Dimensions of existing structures, if any: Front — Rear Depth
Height Number ofs
Dimensions of same struct ith alterations or additions: Front Rear
Depth 4 Height Number of Stories—i i,?n e•,c ,r�
8. Dimensions of entire new construction: Front Rear bepth
Height u Number of Stories ` t Ji
t
9. Size of lot: Front /20 Rear ���� --Depth--)�
10. Date of Purchase Name wrier
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO_
13. Will lot be re-graded? YES NZ�<Will excess fill b'e removed from premises? YES NO
14.Names of Owner of premises L �L�l�'fl�s me ne No.
Name of Architect Address Phone No
Name of Contractor z ��,09—j 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
* 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
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named, CONNIE Q.BUNCH
Notery Public,State of New York
(S)He is the OU6185050
(Contractor,Agent, Corporate Officer,etc.) ouanned in Suffolk CountY �,3n
commission ExPlres April 14,r — "
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't,�o before me this
1�C _day of 20
Notary Public Signat f Applicant
SO
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 ® �� roger.richert(D-town.southold.ny.us
Southold,NY 11971-0959
lyeoulm'
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: 100 Park Avenue Corp.
Address: 100 Park Avenue city:Mattituck st: New York zip: 11952
Building Permit#. 41$$5 Section: 123 Block: 7 Lot: 3
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Modern Electric License No: 4253-E
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor X 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 6 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 2 Wall Fixtures $ Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel 100A A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency FixtureSE Time Clocks
Disconnect Switches 3 Twist Lock Exit Fixtures TVSS
Other Equipment: 1- Combination Smoke/CO Detector
Notes:
Inspector Signature: Date: October 24, 2017
0-Cert Electrical Compliance Form.xls
STORIMMA
Scott A. Russell \T T
SUPERVISOR ��� i p MA \A�(Gf IENHEN T
SOUTHOLD TOWN HALL-P.O.Box 1179 �� Town of Southold
53095 Main Road-SOUTHOLD,NEW YORK 11971 .y - �
CHAPTER 236 - STORMVVA.TER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
- --- - - - - - - --
-- --- ----- - -- -- --- - - - -
DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
(CHECK ALL THAT APPLY)
Yes o
Clearing, grubbing, grading or stripping of land which affects more
an 5,000 square feet of ground surface_
❑, Exc tion or filling involving more than 200 cubic yards of material
lthin any parcel or any contiguous area.
C. Site preparation on slopes which exceed 10 feet vertical rise to
0 feet of horizontal distance-
Site preparation within 100 feet of wetlands, beach, bluff or coastal
rosion hazard area.
E. Site preparation within the one-hundred-year floodplain as depicted
-- - - --=en=)3� p_Of-any-wat-&Fc-
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! Chapter 236 does not apply to your project..
If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
and a completed Check List Form to the Building Department with your Building Permit Application.
S.C.T.M. 1000 Date
APPLICANT: (Property owner,Design Pro fIsional.Agent.Contractor,other) District
NAME gl�\ / -
Section B ot
'C
FSR LiLiILUI\G �L-PART)NUENT USE UNLL
Contact Information:
7'uM <�n.nar• "��' 666 y
Reviewed By:
- - — — — — — — — — — — — — — — — — Date: 91'ylq
Property Address / cation of Construction Work: — — — — — — — — — — — — — — — — —
Approved for processing Building Permit.
— — Stormwater Management Control Plan Not Required.
F
Stormwater Management Control Plan is Required
(Forward to Engineering Department for Review.)
FORM SMCP -TOS MAY 2014
aF SOUlyol ;
� a {
Town Hail Annex V �
.�� • O 7ftl�tf]OI n .us r154375 Main Road
P.O.Box 1179ro er.riche S
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D
Southold,NY 11971-0959
�yCOY SEP 1 2 2017
i
BUILDING DEPARTMENT BTJT_LDTD7GT rr,PT• j
TOWN OF SOUTHOLD TOWN OF sOU� oI.D �
APPLICATION FOR ELECTRICAL INSPECTION i
REQUESTED BY. Date:
1
Company Name:
_ I
Name:
License No.: 5'
Address:
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name: �X 9
*Address:
*Cross Street: c
*Phone No_: SSV
Permit No.:
Tax-Map District: 1000 ec ion: Block: Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
(Please Circle All That Apply)
*Is job ready for inspection: YE / NO Rough In Fina
*Doou need a Temp Certificate, •
YES /JO -
Temp Information (if needed)
*Service Size: 1 Phase 3Phase 6100 950 200 300 350 400 Other
*New Service: Re-connect, Underground Number of Meters Change of Service Overhead
i
Additional Information: PAYMENT DUE WITH APPLICATION
82-Request for Inspection Form
-' O��S�FFD(,trcoG
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P. O. Box 1179 N =
Southold, NY 11971-0959 1
BUILDING DEPARTMENT
NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION, PRE-ENGINEERED
WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION
Date:
Owner: /
Locati6n•of Property: ��� � /-�� �_. Aof =a �c�
Please take notice that the(check applicable fine):
New commercial•or residential:structure
-a `Addition to exist'irig-commercial or residential str ""'I'e'$
Rohabilitation.to•a_n existing'comniercial or residential}structure
to be consttiubted`drperformed at the subject property reference above will tiol'ize
(check applie `_',line): i
Truss type`construction (TT)
Pre-engineered•wood construction (PW)
•.
Timber construction
tioii'(TC)�
in the following location(s) (check applicable,line):n
Floor framing, including girders and beams (F)
Roof framing (R)
Floor and roof,framing (FR)
Signature: ,Q
Name (person submitting this form): + C / '�'����� ..•
Capacity(check applicable line):
—e Owner
wrier representative
\r,IsFReq15.docx Effective 1/1/2015
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5URVEY OF PROPERTY
W _i7 E 51TUATE: MATTITUCK
TOWN : 5O UTM O LD
S SUFFOLK COUNTY, NY
SURVEYED 07-18-201 G
FOUNDATION LOCATION 09-20-201 G
FINAL 12-02-201 G
\N �� UPDATE OG- 19-2017
0 o GP PROP. GARAGE OG-19-2017
REVISED GARAGE 08-07-2017
0
0�pc� a OQ UPDATE 09-22-2017
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SUFFOLK COUNTY TAX #
�� 7 v� 1000 - 123 - 7 - 3
0� Z CERTIFIED TO:
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100 PARK AVENUE CORP.
25�C'P �jyd- Q PAUL PAWLOWSKI
FIDELITY NATIONAL TITLE INSURANCE COMPANY
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NOTES 'Unauthorized alteration or addition to a survey
0 map bearing a licensed land surveyor's seal is a
MONUMENT FOUND JOHN C. E H LE R5 LAND SURVEYOR F E natation of section wzoe, sub-division Education
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® PIPE FOUND ��t O /►.E, New New York State Education Law"
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Area = 1.534 Acres �� Land Surveyors Said certifications shall run only
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GRAPHIC SCALE 1 50' ��/ 02D and on his behalf to the title company, governmen—
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FRAMING'UNTIL SURVEY
OF FOUNDATION LOCATI L - - - - - - - - - - - -t - - - - - - - -- - - - - - - — - - - - - - - - - -
HAS
- - - - - - - - -HAS BECEN APPROVED. ELECTRICAL
INSPECTION REQUIRED � �� �
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APPROVED AS NOTED FO U N 60"AT I ON Y(4, S-E
15/1 rb-��2 -5 1/1-6111-15/161, DATE-: COMPLY WITH ALL CODES OF
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21'-10 5/5"-- 1'-3 1/4" NEST ELEVATIONB y: AS REQUIRED AND CONDITIONS OF
1BUILDING DEPAR`ij�E�-NTAT
71- 8 AM TO 4 PM FOR THE
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