HomeMy WebLinkAbout21711-z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 2-24251 Date APRIL 2, 1996
THIS CERTIFIES that the building ACCESSORY
Location of Property 40 ORIOLE DR. & 240 TUTHILL RD. EXT. SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 55 Block 6 Lot 15.15
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 29, 1993 pursuant to which
Building Permit No. 21711-Z dated OCTOBER 15, 1993
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 STORAGE SHED IN REAR YARD AS APPLIED FOR.
The certificate is issued to JOHN & MAUREEN ROSLAK
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO.-N-376827 - FEBRUARY 1, 1996 -
PLUMBERS CERTIFICATION DATED N/A
CA J3 Q
Buil ing Inspe or
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) 9
19...1..3.
Date 193.
Nn 21711 Z
Permission Is hereby granted to:
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to ? Cf..:f~........ .CC sSO/1 °..........~4~
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: y~~.........,. ......f~1~f'........ ~~r
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at premises located at f eela..C!c.....!.4
County Tax Map No. 1000 Section Block .........0(4 Lot No. .~5........
pursuant to application dated ...........~~../...r........ Pl-.J. ~ 19........, and approved by the
Building Inspector.
Fee 5..
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( wilding Inspector
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Rev. 6/30/80
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--~-~•z.-'-_ Form No. 6
TOWN OF SOUTHOLD
i~.n, BUILDING DEPARTMENT
TOWN HALL Rase
- 765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY 30tc7t ho) cO 1`
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: 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 17 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 a 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 525.00, 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 - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date 7 ! fG2
New Construction..... . Old Or Pre-existing Building
Location of Property..
House No. Street Hamlet
Onwer or Owners of Property y~~j~
..w°? !~~ryj• • ~ e T• • • ° -5 4_'5~. ' • • ' • • • • '
County Tax Map No 1000, Section....) jl...... Block J......... Lot....~ J.! 1~
Subdivision ....................................Filed Yap.........../.L Lot......................
Permit NoV?1.7.I~ 7rr..Date Of Permit Applicant../.(.Qs6a&'~~
Health Dept. Approval ..........................Underwriters Approval........................
Planning Board Approval
Recuest for: Temporary Certifficate........... Final Certicate.... L1_•••
Fee Submitted: S....G~
X71 516 APPLICANT
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
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Town Hall, 53095 Main Road p Fax (516) 765-1823
P. 0. Box 91971 Telephone (516) 765-1802
Southold, New York 1
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 19, 1996
Mr. & Mrs. John Roslak
40 Oriole Drive
Southold, N.Y. 11971
To Whom This May Concern:
We are unable to complete your Certificate of occupancy
because of the following reasons:
XX An application for Certificate of occupancy is
not on file. (Enclosed)
XX No Underwriters Certificate on file.
XX The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 21711-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
=o~~gpFFO(,~~,
G
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ca
Town Hall, 53095 Main Road p i Fax (516) 765-1823
P. O. Box 1179 Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
January 3, 1996
Mr. & Mrs. John Roslak
40 Oriole Dirve
Southold, NY 11971
Re: Building Permit#21711-Z
Premises: 40 Oriole Drive, Southold
Suff. Co. Tax Map #1000-55-6-15.15
During a review of our files it was noted that the above
building permit has expired, and a Certificate of Occupancy has
never been issued.
According to the Code of the Town of Southold, Article
XXVIII 100-284, it is unlawful to occupy or use a structure
until a Certificate of Occupancy has been issued.
Please contact this office as soon as possible so that we
may clear up this matter.
Thank you for your cooperation in this matter.
Very truly yours,
SOUTHOLD TOWN BUILDING DEPT.
BOARD OF HEALTH .
FORM NO.1 ?3 SETS OF PL.1:7S
TOWN OF SOUTHOLD /SURVEY . . . .
BUILDING DEPARTMENT IIECK
TOWN HALL SEPTIC rOR%l _ _
SOUTHOLD, MY. 1197.1
TEL.: 765-1802 t:0./.la
Examined . CALL.
/ q T0:
Approved / Q~/ f~ 19 / Permit No. p.21.7ff • • .
Disapproved, a/c _ .
r
«m.~•m..e,.urim~ 1• • Sw.6..4A. rwh•d..ry.. . . r . .
C~ a Imo........ "
EL,.,..,.... o~I Spector)
?p 21 , . APPLICATION FOR BUILDING PERMIT
TOV`li: Date 19 . .
-INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with .
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 street
br areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli
cation.
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 issued a Building Permit to the applicant. Such permi
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 Occupant}
shall have been granted by the Building Inspector.
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 o;
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 tc
admit authorized inspectors on premises and in building for nee ssa inspections.
- - _ - - CAL e ~r-:
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder.
V..Cf.........................................................................
Name of owner of premises . ~Qf/... ~~i~tC C~ ?V j f <
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer. APPROVED AS NOTED
GATE: B.P. # a
F
EE. 1v BY:
(Name and title of corporate officer) NOTIFY BUILDING DEPARTMENT AT.
Builder's License No. 765-1802 8, AM TO 4 PM FOR THE
UPANCY FOLLOWING INSPECTIONS:
OCC OR TWO
- REQUIRED
Plumber's License No. . 1. FOUNDATION
Ft')R POURED RED CONCt;RE RETE
. USE. • • • ' , L . 2..ROUGH - FRAMING A PLUMBING
Electrician's License No. .y~.q y 3 INSULATION
Other Trade's License No. t 3 d . „ am BE COMPLETE FOR C.O.ION MUST
v~ ALL CONSTRUCTION SHALL MEET
I. Location of land on which prop .C w J ,Gg l 1 . . . . . . . . . Top. REQUIREMENTS OF THE N.Y.
. T..HE. .
STATE • 'b STR C7l0N' S ' ENERGY..
1 i(L c T RESPONSIBLE FOR
House Number Street tSRCON'r"tld't1CTlON'ERRORS.
AT
County Tax Map No. 1000 Section v~ Block
l , Lot...
Subdivision . N12 /Al~ vpU~...'. Filed Map No. ~o . Lo[ .
..(Name)
1 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 ,
~Plr .
.
•3, Nature of work (check which applicable): New Building L.
Repair Removal Addition Alteration
Demolition • Other Work
4. Estimated Cost (Description,
Fee .
S. If dwelling (to be paid on filing this application)
num number
of of cars dwelling unt s sJl' Number of dwelling units on each floor. . 1~!~
If garage, n !t/~
6. ! If business, commercial or mixed occupancy, specify nature and extent of each t
7. Dimensions of existing structures, if any: Front . YPc of use ....ail , • , • •
Iieigltt Number of Stories . Rear Depth .
Dimensions of same structure with alterations or additions: Front , . , , , • , • , ' ' ' ' ' '
Depth .1.... Height. Rear................
8. Dimensions of entire new construction: Front . • ' ' • • Number of Stories ,
Height Rear ...lC~.!....... Depth
Number of Stories
Size of lot: 11ront Rear
10. Date of Purchase , Depth
1 1. Zone or use district in which ' . • ' . ' . ' • • • Name of ormer Ow r • • . . ' . ' '
premises are situated , '
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded .7.'j,Ql••~
Name of owner of
premises ' Will excess 611 be removed from premises: Yes N
, Address .
Name of Architect . Phone No...... .
Name of Contractor . Address Phone No........ • • .
. Address
15,
Is this property withiri 300 feet of a . Phone No.
tidal wetland? *yes ' " '
If yes, Southold' Town Trustees Permit may be required,.. •
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions fron
property lines. Give street and block number or description according to deed, and show street names and indicate whethe
interior or corner lot.
I '
i
I
STATE OF NEW YORK, S.S
COUNTY OF
m Uke.~ti... eoSit- K
• • • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
'ie is the
(Contractor, agent, corporate officer, etc.) . • • . ' ' ' . ' ' ' ' ' ' .
)f said owner or owners, and is duly lauthorized to perform or have performed the said work and to make and file this
pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
vork will be performed in the manner set forth in the application filed therewith.
worn to before me this
Of. , 19 ?If?
'otary Public, County
LINDA J. - .
' . .
Notary Public, State te of of New Yo . . . .
No. 4822683, Suffolk Coun I (Signature of applicant)
Term Expires December 31,19'
Subdivision -"Map of Yennecott Park"
Suffolk County File No.5187
Lot49 Lot48
L N.88°57130"E. 139.501
it -
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Area = 22,02 Sif.
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SURVEY FOR
MAUREEN ROSLAK DEC 13,1990
LOT NO.12,11HIGHPOINT MEADOWS, SECTION TWO" NOV. 5, 1990
AT SOUTHOLD DATE OJULY 24, 11990
TOWN OF SOUTHOLD SCALE: 1 50'
SUFFOLK COUNTY, NEW YORK No. 90-0538
R UTAUTNORIIED ALTERATION ON ADDITION M THIS
SURVEY W A VIOLATION OF SECTION 7209 OF THE
NEW YORK STATE EDUCATION LAW
.COPIES OF THIS SURVEY NOT MEANING THE LAND
SOT VE INKED SEAL OR EO SEAL SHALL NE
C
NOT ME CON COMSIDE R[0 TO SP A VALID D ETRUE COPI
D AL
¦GUARANTEES INDICATED HEREON SMALL RUN ONLY TO
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED ~P~w•
AND CIN HIS K"LF T THE TITLE COMPANY, GWUM- CO
M
NEAREST MA IMA MLIM-YI *SOURCE OF WATER PRIATE
LOTRZ-M.1 C_ HMENTAL AGENCY AN
D LENDING INSTITUTION LISTED
M fl// CO. TARMAR DNT 1000 SECTION _',~,I KO
_ BLOCK K ~ fi _ LOT R(y~rL.l HEREON, AND TO AH TO THE ASSIGN [ES OF THE ION OM E LENDING
* Y61(1_~
WTNEOC ARE NO OWELLUMS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRARSFERAELE
OTHER THAN THOSE SHOWN NEREOM TO ADOITIOMAL INSTITUTIONS OR SUM SEOUf NT
N THE WAT(R SUPPLY AND SCOW DISPOSAL SYSTEM FOR THIS ACSIDEMM OWNERS 1. ,
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT R DISTANCES SHOWN MESON FROM PROPERTY UMES
OF HEALTH MWICtS. T
OEKISTINA STRUCTURES ARE FOR ASPECIFIC
PURPOSE AMID OT USED TO ES
APPLICANT- PROPERTY LINESRORNFORTTHEECRECTIOM OFTADLISH
III /
ADDRESS
TEL YOUNG 8t YOUNG ~ RMEAT D, NEW YAVEN ORRK'E
NOTE % MONUMENT6z STAKE
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W. YOUNG, PROFESSIONAL ENGINEER
SUFFOLK COUNTY ON MAR. 19,1990 AS FILE NO. 8911. AND LANG SURVEYOR N `IS UCENSE NO 12843
° HOWARD W. YOUNG, LAND SURVEYOR
o rTNtLOGTMGFWOLL(W),MVTICTANK(ST)BCESBPCMS")BNOWMISMON MY S. LICENSE 00 45893
° ME FROM FIELD OMW ATMN S AM OR DATA OBTMMtD FROM OTNtOS
BRANDIS A SONS INC.
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