HomeMy WebLinkAbout41662-Z Town of Southold 12/14/2017
a
P.O.Box 1179
53095 Main Rd
o4,yQ` o�� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39406 Date: 12/14/2017
THIS CERTIFIES that the building RESIDENTIAL ALTERATION
Location of Property: 16500 Main St.,New Suffolk
SCTM#: 473889 Sec/Block/Lot: 117.-9-13
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/15/2017 pursuant to which Building Permit No. 41662 dated 5/24/2017
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:
"AS BUILT"INTERIOR ALTERATIONS TO CONVERT STRUCTURE WITH THREE APARTMENTS TO A
ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Fudjinski,John
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41662 06-29-2017
PLUMBERS CERTIFICATION DATED
u ho Signature
o�S�FFut�CoTOWN OF SOUTHOLD
BUILDING DEPARTMENT,
0.
co
z TOWN CLERK'S OFFICE
oy_. 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)
Permit#: 41662 Date: 5/24/2017
Permission is hereby granted to:
Fudjinski, John
PO BOX 104
New Suffolk, NY 11956
To: As built interior alteration to convert a structure with three apartments to a single family
dwelling as applied for.
At premises located at:
16500 Main St., New Suffolk
SCTM # 473889
Sec/Block/Lot# 117.-9-13
Pursuant to application dated 5/15/2017 and approved by the Building Inspector.
To expire on 11/23/2018.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $1,072.80
CO -ALTERATION TO DWELLING $50.00
ZInspe
22.80
C � 4,t;;
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 I%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 in 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 $15.00
/ JDDate.
New Construction: Old or Pre-existing Building: (check one)
Location of Property: <—
House No. Street n Hamlet
Owner or Owners of Property: F f A _ (� 7n V( '
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No._W6 �!_ Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval: /
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted:$
Appli i ure
SOUTy®l
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G • �Q roger.richert(ab-town.southold.ny.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Fudjinski
Address: 16500 Main Street city:New Suffolk st: New York zip: 11956
Building Permit* 41662 Section: 117 Block: 9 Lot: 13
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: "AS BUILT" DBA: License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor 1st Floor X Pool
New Renovation 2nd Floor Hot Tub
Addition Survey X Loft X Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 6 Ceiling Fixtures 1 HID Fixtures
Service 3 ph Hot Water GFCI Recpt 3 Wall Fixtures 1 Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures 10 CO Detectors
Sub Panel A/C Blower Range Recpt 20A Fluorescent Fixture Pumps
Transformer Appliances pW Dryer Recpt Emergency FixtureTime Clocks
Disconnect Switches 11 Twist Lock Exit Fixtures TVSS
Other Equipment: "AS BUILT" - "ELECTRICAL SURVEY"- "NO VISUAL DEFECTS"
Notes: 1- Range Hood.
Inspector Signature: Date: June 29, 2017
0-Cert Electrical Compliance FormAs
Nov, 30, 2017 9:41AM No, 7859 P, 2
Town of Southold
Building Department
Southold,NY
August 16,2017
RE:PEX affidavit
I,John Fudjinski,the home owner of 16500 Main Street,New Suffolk,NY 11956 used only PEX water
supply tubing for the installation of a new sink in my kitchen.
Sincerely,
John Fudjinski
nPD
D
NOV 3 0 2017
BIDING DEPT.
'OWN OF SO UMOLD
i
sooryo
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION .
[ ] FOUNDATION 1ST [ ] R UGH PLBG.
[ ] FOUNDATION 2ND [ ] SULATION
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: `� •d�Wn/�� S "Vlawe(
Pke,
4ve4& 9 ,1
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DATE = 3I INSPECTOR
rjf so
TOWN'OF SOUTHOLD BUILDING DEPT.
765-1802
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 INSPECTOR
OF 50(/lyo
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] MULATION
[ ] FRAMING / STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE INSPECTOR ofil
� 1 *. � . . ,, s . s rs•
F,
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IMULATION
STATE ' • f
1 M0WFAI m a� A
ME O—WA
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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
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined ,20 D
[E(g[Eurf[E
Single&Separate
DStorm-Water Assessment Form
Contact:
Approved � ,20 SAY 1 5 2017 Mail to: MT) (flab lZ. �tens-O
Disapproved a/c
BUILDING DEPT. Phone: 9177- 23a— 5?3 Z.
TOWN OF SOUTHOLD
Expiration Z 7 ,20
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date ' , 20 1-7%
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
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.
(Signature ofraapplica i e,if a cccorporation)1v k-ew �Vat)� f✓�u p.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
� w
Name of owner of premises a� L Y1 j S
(As on the tax roll or latet eed)
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:
IGg)u - nr;vn 5
House Number Street Hamlet
County Tax Map No. 1000 Section BlockLot _
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
b. Intended use and occupancy A21-Ho u,&g
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost Fee
P' (W,be paid on filing this application)
5. If dwelling, number of dwelling units i d Dumber 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.
A. 14 ..l 'Jl�Xfi
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
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 NO Will excess fill be removed from premises? YES NO
14.Names-of Owner of premises Address Phone No.
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
* 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)
r 'JSS:
COUNTY OF�t itl S�) V_I C, rLAd I ing duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)abiJe named,
(S)He is the 11e r
(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 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
day of MaLA 20J_I _
SAWV:�j X - �Z'IVW24 CEY L. DWYER
Notary Public NOTARY PUBLIC,STATE OF NEW YORK Sig scant
NO.01 DW6306900
QUALIFIED IN SUFFOLK,COUNTY
COMMISSION EXPIRES JUNE 30,
I
q SO�T�,
Town Hall Annex D pe �6x18
54375 Main Road N {631)765-g5 D
P.O.Box I179 G Q ro er rtrwn.souf 5075.n .0
Southold,NY 11971-0959 '�°� �O MAY 3 1 201
BUILDING DEPT.
BUILDING DEPARTMENT TOWN OF 50UTHOLD
TOWN OF SOUTHOLD - �
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY- rj P ' s IF, Date:
it-7-
Company Name:
Name:
License No.:
Address:
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name: r
*Address: S') O
*Cross Street: - „
g-3Pe*Phone No.: q0 - 23 a. t53-3 _D-
Permit
rmit No.: Itl 6 6_z1_
Tax-Map District: 1000 Section: Block: Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly) E
(Please Circle All That Apply)
*Is job ready for inspection: YES/ NO Rough In Final
*Do you need a Temp Certificate: YES/ NO
Temp Information (it needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
o
82-Request for Inspection Form I
�I I
Nov, 30. 2017 9:41AM No, 7859 P. 1
Attn: Southold Town Building Department
11/30/2017
As requested,please find the signed PEX affidavit and final electrical inspection for permit#41662.We
are scheduled forthe final walkthrough on Tuesday, December 5,2017,
16500 Main Street
New Suffolk, NY 11956
Any questions, I Can be reached at 917-8325832.
Thank you,
Jean Marie Fudjinski
D CC�C[l�t�
D
NOV 3 0 2017
BUILDING DST.
TOWN OF SOIUTHOLD
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FOUNO "n - '
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QA ODOR �mON
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FRAME RB 3.3'S. BEL%vw BLOCK CURB E ROW :. _'•:::.:'_::•.:-•: EDUCATION LAW.
i 8 C o T�t 30 e • 0'4 EE `• COPIES OF THIS SURVEY MAP NOT BEARING
GARAGE !� N J 4' �� 1�, 4 •��P"�T DRALlYAY e• 4- THE LAND
SURVEYOR'S INKED SEAL OR
h yr e e 1 00.005 EMBOSSED SEAL SHALL NOT BE CONSIDERED
U Land Surveyor
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CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE
MICHAEL/F
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cPC BARBEL LENDING INSTITUTION USTED HEREON, AND
RA BUTTERfyORTH TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. PHONE (631)727-2090 Fax (631)727-1727
OFFICES LOCATED AT U41UNG ADDRESS
THE EXISTENCE OF RIGHTS OF WAY 1856 Main Road P.O. Box 16
AND/OR EASEMENTS OF RECORD, IF Jamesport, New York 11901 Jamesport, New York 11947
ANY. NOT SHOWN ARE NOT GUARANTEED.
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