HomeMy WebLinkAbout52433-Z of sou ryolo Town of Southold
* * P.O. Box 1179
G . � 53095 Main Rd
CouNM Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 46852 Date: 02/12/2026
THIS CERTIFIES that the building AS BUILT HVAC
Location of Property: 55 Knollwood Ln Mattituck, NY 11952
Sec/Block/Lot: 107.-6-12
Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 09/30/2025
Pursuant to which Building Permit No. 52433 and dated: 11/03/2025
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" HVAC system to an existing single-family dwelling as applied for.
The certificate is issued to: Piotr Uklanski ,Alison Uklanska
Of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL:
ELECTRICAL CERTIFICATE: 52433 11/14/2025
PLUMBERS CERTIFICATION:
IL Xell,17
A orized Signature
pFso�r TOWN OF SOUTHOLD
BUILDING DEPARTMENT
' SOUTHOLD, NY
{
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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#: 52433 Date: 11/03/2025
Permission is hereby granted to:
Piotr Uklanski
55 Knollwood Ln
Mattituck, NY 11952
.To:
Legalize an "as built" HVAC system to an existing single-family dwelling as applied for per
manufacturers specifications.
Premises Located at:
55 Knollwood Ln, Mattituck, NY.11952
SCTIVI# 107.-6-12
Pursuant to application dated 09/30/2025 and approved by the Building Inspector.
To expire on 11/03/2027.
Contractors:
Required Inspections:
Fees:
As Built HVAC $500.00
CO-RESIDENTIAL $100.00
Total S600.00
Building Inspector
ho��pF SOUr�,�l
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 G • Q
Southold,NY 11971-0959 �O
CDUNV
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Piotr Uklanski
Address: 55 Knollwood Ln City: Mattituck St: NY Zip: 11952
Building Permit#: 52433 Section: 107 Block: 6 Lot: 12
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: Electrician: AS BUILT License No:
SITE DETAILS
Office Use Only
Indoor Basement Service F Solar F
Outdoor (✓ 1st Floor r Pool r Spa r
Renovation 2nd Floor F Hot Tub F Generator r
Survey �: Attic F Garage ri Battery Storage
INVENTORY
Service 1 ph F Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan
Service 3 ph (- Hot Water GFCI Recpt 2 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser 2 Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower 2 Range Recpt Ceiling Fan Combo Smoke/CO
Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors
Disconnect 2 Switches 2 4-LED Exit Fixtures
Other Equipment:
Notes: " AS BUILT NO VISUAL DEFECTS " HVAC (2)AC's
Inspector Signature: X s Date: November 14, 2025
Sean Devlin
Electrical Inspector sean.devlin(D-town.southold.ny.us
55KnollwoodHVAC
OF SOGTyO�
# TOWN OF SOUTHOLD. BUILDING DEPT.
co 631-765-1802
.INSPECTION
[ ] FOUNDATION 1 STJ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND. [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [vf.FINAL } 0+6
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
] 'FIRE RESISTANT CONSTRUCTION [ ] .FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
] CODE VIOLATION ; [ ] PRE C/O [ ] RENTAL
REMARKS:
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INSPECTION
[ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] .FINAL
[ " ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[" ] ELECTRICAL (ROUGH) P<J�ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS;
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Docusign Envelope ID:83D74888-A7F2-488A-9E57-EA803568201D
OsuFFoiirc
o� o TOWN OF SOUTHOLD—BUILDING DEPARTMENT
x ' Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
j11t5 Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownnygov
Date Recei d
APPLICATION FOR BUILDING PERMIT E 0
For Office Use Only 5 E P 3 0 2025
PERMIT NO. 5 � �Ob Building Inspector: LI l3
Building De6�artrnent
T Town of Southold
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an..
Owner's Authorizatidn form,(Page 2)shall be completed:
Date:9/28/2025
OWNER(S)OF PROPERTY:
Name: Piotr Uklanski and Alison Uklanska SCTM#1000-107.-6-12
Project Address:55 Knollwood_Lane,_Mattituck, NY 11952
Phone#: Email:
Mailing Address 55 Knollwood Lane, Mattituck, NY 11952
CONTACT PERSON.
Name: Eric Elkin
Mailing Address: 1351B1ay Ave,_ Greenport,_NY 11944
Phone#: 315-521 _4669 Y ... . ._._ Email:,eric.elkin@compqqq.com m_
DESIGN PROFESSIONAL INFORMATION:
Name: N/A - As Built CAC
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:N/A-As Built CAC
Mailing Address:
Phone#: Email:
-DESCRIPTION OF:PROPOSED CONSTRUCTION
❑New Stru re ❑Ad\d^ition `],Itera for❑Repair El Demolition Estimated Cost of Project:
❑Other ` ,`,� $
Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? DYes ❑No
1
Docusign Envelope ID:83D74888-A7F2-488A-9E57-EA803568201 D
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ❑No IF YES, PROVIDE A COPY.
❑'Check Box After Readin ' The ownerjcontractorjdesi n profess is res onsiblefor.all,draina a and g p p g d storm water issues as provided by "
Chapter 236 of the Town code. 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 orRegulations,for the construction of buildings,
additions,alterations or for removal or demolition.as'herein described:The applicant agrees to.comply with all applicable laws,ordinances,building code, ,.
housing code and regula#ions and to admit authorized inspectors on premises'and in building(s)for,necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name): ��=, �1�; [Muthorized Agent ❑Owner
._gw�..�_.. ... ,... = ... .__._. n...._,. .. .�..... .._...
Signature of Applicant:
Date: 9 �o` Z j
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
SS: Qualified in Suffolk County
COUNTY OF
Commission Expires April 14,2 O��
)
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 all statements contained in this application are true to the best of his/her knowledge and belief; and
that the work'will be performed in the manner set forth in the application file therewith.
Sworn before me this (
aDl1�day of �\ , 20 "�,1+n'tip v l
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
Piotr Uklanski and Alison Uklanska residing at 55 Knollwood Lane, Mattituck, NY
I,
do hereby authorize Eric Elkin to apply on
m 9 hAV to the Town of Southold Building Department for approval as described herein.
Signed by:
Q�tSbin, ���abt,S�a pib; ULwai 9/29/2025 9/29/2025
Owner's Signature D4A123368F8D44A... Date
Alison Uklanska Piotr Uklanski
Print Owner's Name
2
FD( -L BUILDING DEPARTMENT- Electrical Inspector
oSUF Koo��
TOWN OF SOUTHOLD
+vo Town Hall Annex- 54375 Main Road - PO Box 1179
oy Southold, New York 11971-0959
�® Telephone (631) 765-1802
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All information Required) Date:
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: 7
Address:
Cross Street:
Phone No.: -
Bldg.Permit#: 'jay 3 email:
Tax Map District: 1000 Section: t p Block: G Lot: 1 Z_
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
C-��-
Square Footage:
Circle All That Apply:
Is job ready for inspection?: ❑ YES ❑ NO ❑Rough In ❑ Final
Do you need a Temp Certificate?: ❑ YES ❑ NO Issued On
Temp Information: (All information required)
Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals D 1 2 D H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
N SURVEY OF PROPER
AT MATTITUCK
TOWN OF SOUTHOL
SUFFOLK COUNTY, A
1000 107-06 12
SCALE. 1.=30'
JANUARY 28. 2022
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APPROVED AS NOTED
B.R
COMPLY WITH ALL CODES ; . FE2 0® ' BY
NEW YORK STATE &TOWN C:OL-11 .
NOTIFY BUILDING DEPARTMENT AT
REQUIRED AND CONDITION . 631-765-1802 8AM TO 4PM FOR THE
SOUTHOLD TOWN ZBA FOLLOWING INSPECTIONS:
SOUTHOLD TOWN PLANNING BOARD FOUNDATION-TWO REQUIRED
SOUTHOLD TOWN TRUSTEES FOR POURED CONCRETE
N.Y.S.DEC ROUGH-FRAMING&PLUMBING
SOUTHOLD HPC INSULATION
SCUD FINAL-CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL,MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATEDESIGN OR. RESPONSIBLENOT
CONSTRUCTION ON ERRORS
4
Additional
Certification
May Be Required.
ELECTRICAL
INSPECTION REQUIRED
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