HomeMy WebLinkAbout29094-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-29265 Date: 02/12/03
THIS CERTIFIES that the building ADDITION
Location of Property: 1395 ORIOLE DR SOUTHOLD
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 55 Block 6 Lot 15 .31
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 10, 2003 pursuant to which
Building Permit No. 29094-Z dated JANUARY 10, 2003
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 TWO CAR GARAGE ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to DANIEL RICHARD & SANDRA GWYDIR
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. PENDING 01/31/03
PLUMBERS CERTIFICATION DATED N/A
Authorized ignature
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. 29094 Z Date JANUARY 10, 2003
Permission is hereby granted to:
DANIEL RICHARD GWYDIR
1395 ORIOLE DR
SOUTHOLD,NY 11971
for .
NEW CONSTRUCTION OF A TWO CAR GARAGE ADDITION TO AN EXISTING ONE
FAMILY DWELLING AS APPLIED FOR. THIS PERMIT REPLACES BP#26870 .
at premises located at 1395 ORIOLE DR SOUTHOLD
County Tax Map No. 473889 Section 055 Block 0006 Lot No. 015 . 031
pursuant to application dated JANUARY 10 , 2003 and approved by the
Building Inspector to expire on JULY 10, 2005 .
Fee $ 150 . 00
A4thorizea 8ignatur,6
COPY
Rev. 5/8/02
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)
N.fz r- @L9 07
PERMIT NO. 26870 Z Date OCTOBER 25 , 2000
Permission is hereby granted to:
DANIEL RICHARD
1395 ORIOLE DR
SOUTHOLD,NY 11971
for .
NEW CONSTRUCTION OF A TWO CAR GARAGE ADDITION TO AN EXISTING ONE
FAMILY DWELLING AS APPLIED FOR.
at premises located at 1395 ORIOLE DR SOUTHOLD
County Tax Map No. 473889 Section 055 Block 0006 Lot No. 015 . 031
pursuant to application dated AUGUST 30 , 2000 and approved by the
Building Inspector.
Fee $ 75 . 00
Authorized Signature
COPY
Rev. 2/19/98
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT 2 "
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY �J
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$25.00,Additions to dwelling$25.00,Alterations to dwelling$25.00,
Swimming pool$25.00, Accessory building$25.00, Additions to accessory building$25.00,Businesses$50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$25.00
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial $15.00
Date. 1112 a3
New Construction: el Old or Prem-existing Building: (check one)
Location of Property: 3 q� V rb la ( St)q4h a)
House No. Street Hamlet
Owner or Owners of Property: Mr -F W-5 JDa n 1 Zi G W yd 1 (//
Suffolk County Tax Map No 1000, Section `7� Block l0 Lot (�
Subdivision Filed Map. Lot:
Permit No. I O f''1 Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
10
Q�a c Co
Applicfint Signature
�C CA
O cPr�r�rJ�r1'cPr1'arJcPrJ�rJ'rJ�cPrJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�r.P�Pr1rJ�cPr�r��P�PrJ�rJ�rJ�rJ�rJr�c.PrJ'rJ�cPr.PrJ�rJ�rJ@PrJ�rJ�rJ�rJ��PrJ@PrJ�r�rJ�rJ@PcPc1�rJ�rJ� O
5
BY THIS CERTIFICATE OF COMPLIANCE THE 5
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
SBUREAU OF ELECTRICITY C5
5 40 FULTON STREET — NEW YORK, NY 10038 5
SCERTIFIES THAT
Upon the application of upon premises owned by
5 SANDY GWYDIR SANDY GWYDIR 5
5 1395 ORIOLE DRIVE 1395 ORIOLE DRIVE 5
5 SOUTHOLD NY, 11971 SOUTHOLD, NY11971 5
5 5 CCJ Located at 1395 ORIOLE DRIVE SOUTHOLD, NY 11971 55
Application Number: 1111977 Certificate Number: 1111977 5
5 Section: Block: Lot: Building Permit: BDC: NS11 5
5 Described as a Residential occupancy, wherein the premises electrical system consisting of
5 electrical devices and wiring, described below, located in/on the premises at: 5
5 Attached Garage, Outside, 5
5 5
CC5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5
found to be in compliance therewith on the 10th Day of February,2003. 5
5 Name QTY Rate Rating Circuit Twe
5 Wiring and Devices 5
55 Receptacle 4 0 General Purpose 5
5 rSwitch 2 0 General Purpose e5
Fixture 5 0 Incandescent 5
5 Receptacle 1 0 GFCI 5
5 5
5 5
5 5
5 5
seal
55
5 I of I 5
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5
5 5
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Lpt 22
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SURVEY FOR
JEAN GUILD
LOT NO.28, "HIGHPOINT MEADOWS SFrTI01, nun^
BUILDING PERMIT REVIEW CHECK LIST
DATE REVIEWED: /O/ 19/ Oen
APPLICANT NAME: 34->_Aie,4_ DATE SUBMITTED: 8-/30/210
PROJECT LOCATION /^� n
STREET: /39 S Qrldr kr,,;r CITY: SUBDIV. NAME:
ARCHITECT/ENGINEER: ���1 y L C,. t" FAST TRACK: YES OR NO
SCTM# --- DISTRICT: 1,000 SECTION: SS BLOCK: LOT:
ZONING:
ZONING DISTRICT: R40 R80 AC ONFORMING:( oR_NO REQUIRED LOT SIZE: /04, SQFT.
WHERE ACTUAL LOT SIZE FROM? Tf.,,r s/ZA,,3 ACTUAL LOT SIZE:1,23o3 SQFT.
FRONT•'PROPOSED: 42' SIDE YD: IS PROPOSED: '/ _2A.5 ' REAR ' PROPOSED:/83 '
LOT COVERAGE: ALLOWED:,3_% EXISTING: //42 sfZ % NEW: 4464 sf,7- % TOTAL: 1_orF2s 7 %
CORNER? YES o NO WAT ER FRONT? YES owQ DESCRIPTION:
SINGLE & SEPARATE CERTIFICATION-REQUIRED: YES o ONOTES: � , -Igo� / •�7��x�sn�g � `
LOTS 40,000SF--100-24. Lot recognition. (CREATED before June 30, 1983), UNDERSIZED LOTS FROM
JAN.1997 100-25. Merger. (A nonconforming at anytime after July 1, 1983.)
PROJECT DESCRIPTION ADD LT.ACC OR N/D: L9„meq tYre �
AGENCY PERMITS REQUIRED FOR REVIEW
NEED
TOWN SPETIC PERMIT: YES o
SUFFOLK COUNTY HEALTH DEPT: YES oEII
r O (BED #): DTE:—/_/ PERMIT #:RIO-
NEW YORK STATE DEC: YES or
SOUTHOLD TOWN TRUSTEES: YES or
TOWN ZONING BOARD APPROVAL: YES or
TOWN PLAN. BOARD APPROVAL: YES or
FLOOD COMPLIANCE ZONE: PANEL #:�_ FLOOD ZONE:_,
FEMA PRE-FIRM OF SOUTHOLD 3/18/80
NYS ENERGY: YES OR(NO EGRESS: VENT: LIGHT: 4��� a
NOTES: / !
/'IG,J 3iG` .r-n-r Az_ca sSQr[itc ls�2e v�. ¢r- /O/ClQ ee'rA &T-*
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR 9 4l'S'r- SF
SECOND FLR SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE/
TOT( 'f 4JC SF)- ( SF)= SFX
Z
765-1802
BUILDING DEPT.
NSPECTION
[ ."FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE � HIMNEY
RE RKS:
,DATE INSPECTO
-07
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FO ATION 2ND [ ] INSULATION
FRAMING [ ] FINAL
[ ] FIREPLACE HIMNEY
REMARK
.DATE INSPECTOR
765.1802 �?
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INATION
[ ] FRAMING FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
DATE / (D INSPE r
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ rINAL ATION
FRAMING
[ ] FIREPLACE & CHI NEY
REMARKS:
(ot1
DATE /4�)t INSPE
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATI N
[ ] FRAMING
[ ] FIREPLACE & CHIMNEY
REMARK
DATE INSPECT
_ t
,D INSPECTION REPORT DATE
=xaxsax==xxxxx:ac—xxsax�II m--- _sxxs COMMENTS
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(DATION OST)
2),IDATION (2ND) -------------
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PLUMBING
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RATION PER N. Y. n N to
;TATE ENERGY I ii
CODE
u
=x=xxaxxxxxxxsxxxx ---xxxx�=a=asxx==xx==xxxxxxxx�xx.= xxxxxxxx=xxxcxaxxaxxx=x (/
oc� Z44 �'�"�
I� II J hi 1 H
FINAL
ADDITIONAL COMMENTS:
_ f
farb .v77 AAAty&d .04,4Ts !'a /e .-rate/l/a+we i,4
if 0eo tJ/�d� 3sT04eac5 Zo.+�.,. ii- Q / Li
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BOARD OF HEALTH
FORM NO. 1 3 SETS OF PLANS
TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . .. . . . . . . . .
BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971 DEC . . . . . . . .. . . . . . .... . . . .
S
TEL: 765-1802 TRUSTEE . . . . . . . . . . . . . . . . .
NOTIFY: - T,�cl !al CALL . t, l
Examined...���& 20 6.9 MAIL TO: . . . . . . . . . . . . . . . . . . . .
Approved...1A11.?.......I QUO. Permit No. .... .....
Disapproveda/c .................................. ...................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date. . . %30 . . . . . . . . 2G,X.
1— ----, INSTRUCTIONS
a. 'This application must ^'completely filled in by typewriter or in ink and submmitted to the Building Inspector wi
3 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 giving a detailed description of layout of property mist be drawn on the diagram which is part of
this application.
c. the work covered by this application may not be ccnmenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such
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 whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
AP11LICATION IS BEREBY 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.
de .� ...Com.... . . .......................
(Signature of applicant, or nacre, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
ye. ..u .! e...............................................................................................
Name of owner of premises ... Ct Ill e I ^I,,.�/��G�I no.. BTW. .. ......................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.�..C ...e,�. ... '�.... D L✓r✓e!............
(Name and title of corporate officer)
Builders License No. .4.90.�!
Plumbers License No. .........................
Electricians License No. .....................
Other Trade's License No. ....................
I. Location of land on which proposed work will be done..............................................................
13 95 f-I dl f. Vi-, ✓e S'o t� ..................
................•-•--.............f�........................... .........
House Number Street Hamlet
County Tax Map No. 1000 Section ...... �....... Block ......T........ .1 �. .A. .
.. �. �j�.�
Subdivision )5...� f1e�i�Ql1�S.... Filed Map No. ............... Lot ....a .......
(Name)
2. State existing use and occupancy of premises andintendeduse and occupancy of proposed construction:
a. Existing use and occupancy .....� !�!°�.4! J.....h.U.uC�-e.......................................
b. Intended use and occupancy ..........e«r., s? .............r..,.,.......,.,..........
J
OA
3. yature of work (check which applicable): New Building .......... Addition ..Y....... Alteration ..........
Repair ............ Removal ............. Demolition ............ Other Work .................................. .
(Description)
4. Estimated Cost .X1,oUv.......... fee ..............................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ............ Number of dwelling habits on each floor ................
Ifgarage, number of cars .....C...............................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use......................
7. Dimensions of existing structures, if any: Front....3 L.. ... Rear ...all.. .... Depth ......80...........
GI
height ....... .. ........ Number of Stories ...... ..............
�/ r N
Dimensions of sae structure with alterations or additions: Front ...... Rear ...I.7 . j�...
Depth / ...... Height ....... $......... Number of Stories .... .
P2...
� r � r
B. Dimensions of entire new construction: Front ....�.. . .... Rear .....4�:....... Depth ......
lieiglht ........�.h! .............. Number of Stories ......I.............. /
9. Size of lot: Front .... Rear .....lX '.91,.... Depth ... �
10. Date of Purchase ..................... Name of Former Owner ........................................
II. Zane or use district in which premises are situated ..............................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ..&.................
13. Will lot be regraded .....1.V Q.......... Will excess fill be removed from premises: NO
/-d
14. Names of Owner of premises .0M.O.'AW.M.fi7 q#'Address Z� .l..�1[C.I �C,�n.S6Lt{i7b Phone No.WJ6..
Name of Architect ........................ Address ........................ Phone No. ............
&LWre of Contractor l le,�f UC1I121r.............. Address �r�5.Ak)ip h/J`' .1ir2.�u.�uhe No.
15. is this property within 300 feet of a tidal wetland? * 'YES .......... NJ ....Y.....
*IF YES, SOEM D Ta4N Tf31SIPL'S PE[AIIT MAY BE W!gnRED.
PLOT DIAGRAM
locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
from property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
owl(
I ,
srAlE (x. raWY(W,,
(XMIY OP ...2(�Q-A0 j K........... �S
............................being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named,
Ile is tl re ... !!. 1� . u I)c%e-If.... ..................................
(Contractor, .gent, 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 wi11 be performed in the manner set- forth in the application filed therewith.
Sworn to before me this
S.6..... of 14� 6L
00.I� .,/.:.Notary Rhbl �:ir ELIZABETH A STA ...... ... .....................
ARYPUBUC,State ofNewYotk (Signature of Applicant)
No.01 ST6006173,Suffolk County
Tenn Expires June 6,2002-
q,/
�'
-� APPROVED AS NOTED I
r
___f DATE:
.i i � FEE' rh BY: "
( NOTIFY BUILDING DEPARTMENT AT z
F-' f__— DO NOT PROCEED WITH 765-1802 9 AM TO 4 PM FOR THE
FRAMING UNTIL SURVEY °FouNlo FNG OUNDATION
INSPECTIONS:
REQUIRED
D m P n
-' OF FOUNDATION LOCATION FOR POURED CONCRETE
! i HAS BEEN APPROVED. 2 ROUGH - FRAMING & PLUMBING
3 INSULATION
4 FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C-0.
ALl CONSTRUCTION SHALL MEET
- ""-- - THE REQUIREMENTS OF THE N.Y.
�, S1ATE CONSTRUCTION & ENERGY
_.
I CODES NOT RESPONSIBLE FOR 4 w
DESIGN OR CONSTRUCTION ERRORS ,
OCCUPANCY OR �I
USE IS UNLAWFUL��JIYFIOUTCa:PMFK ,1,- -
I � o
PROVIDE OPENINGS FOR
EMERGENCY ESCAPE AS
REQUIRED BY PART. 714 OF o
I N.Y. STATE BUILDING CODE. w
x x
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PROVIDESMORE-DETECTING x ALARM IDEVICES O
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AS TO PART.721.1 Q > G
N.Y.S BUILDING CODE.
z z
UNDER RIETERS QU RED CERTIFICATE
It 'I
PROVIDE NR. FIRE �` QQ
RATED SEPARATION TO (,2
PART. 717.3 (f) (1) OF `a111
N.Y. STATE BUILDING CODE.
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N.Y. STATE BUILDING CODE.
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