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Home My WebLink About27803-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29179 Date: 01/08/03 THIS c~TIFIES that the building ADDITION Location of Property: 40 ORIOLE DR SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 55 Block 6 Lot 15.15 Subdivision Filed Map No. __ LOt No. conforms substantially to the Application for Building Permit heretofore filed in tb/s office dated APRIL 13, 2001 pursuant to which Building Permit No. 27803-Z dated OCTOBER 17, 2001 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 NEW CHIMNEY ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. ·"ne certificate is issued to MAUREEN & JOHN ROSLAK (OWNER) of the aforesaid building. SUFFOI~KCOUNTYDEPARTMENTOF~RALTHAPPROVAL ELECTRIC~J~ CERTIFICA~ NO. PLUMBERS CERTIFICATION Rev. 1/81 N/A N/A N/A Au~ho;izea ~igna~e FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUIr~ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 27803 Z Date OCTOBER 17, 2001 Permission is hereby granted to: MAUREEN & JOHN ROSLAK 40 ORIOLE DRIVE SOUTHOLD,NY 11971 for : CONSTRUCTION OF A WOOD FR3~ME CHIMNEY AS APPLIED FOR at premises located at 40 County Tax Map No. 473889 Section 055 pursuant to application dated APRIL Building Inspector. Fee $ 75.00 ORIOLE DR SOUTHOLD Block 0006 Lot No. 015.015 13, 2001 and approved by the Authorized Signature Rev. 2/19/98 COPY 3 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: Bo 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. 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 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Cormnercial $15.00 Date. New Construction: Old or Pre-existing Building: Location of Property: /-/O ~5~)tqt oc-~_"'~z ~ House No. Street Owner or Owners oferoperty: ,,~o~r3 ~- jl~q,~a-g~'~q:~,o~,._ Suffolk County Tax Map No 1000, Section Subdivision PennitNo. 2-'7 ~>O3 ~ DateofPermit. (check one) Hamlet Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Block Lot Filed Map. Lot: Applicant: Underwriters Approval: Final Certificate: (check one) ~t Signature 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION l ST [ ]ROUGHPLBG. [ ] FOUNDATION 2ND [ ,. ] I~ULATION [ ] FRAMING [ ~,~'FINAL [ ] FIREPLACE & CHIMNEY DATE ///////~///~ /~ INSPECT~~ 765-1~0Z BUILDING DEPT. INSPECTION [ ] FOUNDATIONlST [ ] FOUNDATION 2ND [ ] FRAMING ROUGH PLBG. ] INFLATION [~FINAL [ ] FIREPLACE & CHIMNEY RI'MARKS: /~ ~ // INSPECT~ 765-1~02 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I~ULATION [ ] FRAMING [//] FINAL [ ] FIREPLACE & CHIMNEY REMARKS: ,/~ ~:~ ~ /~~'~ FXgLD 'INSPECTION. R~PORT '~ ~N~OLAT~ON CODE· i' ~'A~DITIONAlr. CO. tEllS: TOWN HALL ~ '"' SOUTHOLD, NY 11971 ~ ;_~>~. !>?'i; L ' ,xo "' TEL: 765-1802 ..=- - . PERMIT NO. ' Examined ,20 Approved ,20__ Disapproved a/c DUILDIINti }'NFO,VII 1 /r~FLICA liON CHECK_LIS' Do you have or need the following, before applying Board of Health 3 sets of Building Plans Survey. Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ,200/ a. This application MUST be completely filled in by tYPewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~ b. Plot plan showing location of lot and of building~ ~n'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 Indpector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection througho.ut'the work. e. No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupan is issued 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 or Regulations, for the c'onstruction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to coinply with ali applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for neces, sary inspections. (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 Name ofownerofp~'emises '~-~'~Tf) _(~ ~' //~O'-Z4'/r-~7~L' ~ (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authori~i:d officer (Name and title of corporate oi*ficer) Builders License No. 2-{)'~{q~'~ Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which ~ro~osed work will be done: House Number S~eet Hmlet County Tax Map No. 100~ Section /~ ' ·' Block ~- ~ ~~Fr~'-~'~ ~l~;{~lZl~fO'~ ~"'~J~r0 .~ Subdivision Filed Map No. v me) State existing use and oc'~upancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ~. Nature of work (check which applicable): New Building. Repair Removal Demolition i. Estimated Cost /~ cro D "" If dwelling, number of dwelling units i If garage, number of cars ~A- Addition Alteration '>"'- Other Work Fee (Description) (to be paid on filing this application) Number of dwelling units on each floor If business, commercial or mixed occupancy, specify nature and extent of each type o fuse. Dimensions of existing structures, if any: Front Height. Number of Stories /fz_ Rear %/0 Depth DimenSions of same structure with alterations or additions: Front Depth 2~ 2? , Height x, Dimensions of entire new construction: Front H~fght Number of Stories ~'ze of lot: Front / ;'-o Rear /' )'mo Depth 0. Date of Purchase /z-t/~ O Name of Former Owner ~.~ 5t~- Rear Number of Stories /?~ Rear Depth /5"'O 1. Zone or use district in which premises are situated 2. Does proposed construction violate any zoning law, ordinance or regulation: n.5o 3. Wilt lot be re-graded ,*tM Will excess fill be removed from premises: YES O 4. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 5. Is this property within 100 feet of a tidal wetland? *YES NO · IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 6. Provide survey, to scale, with accurate foundatiOn plan and distances to property lines. 7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. TATE OF NEW YORK) SS: ;OUNTY OF ) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, ¢)He is the (Contractor, Agent, Corporate Officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; mt all statements contained in this application are true to the best of his knowledge and belief; and that the work will be erformed in the manner set forth in the application filed therewith. worn to before me this '3 day of ~ Notary l~ublic Signature of Applicant 766-1802 9 Aa TO 4 PM 'FOR THE OCCUPANCY OR t FOU~AT~O~ ,, TWO n[oum~ USE IS UNLAWFUL F~ POUn~Oc~c~ WITHOUT CERTIFICATE ~ ~ ROUGH- FRAMING & PLUMBING OF.OCCUPANCY ~ INSU~TION ., ~ FINAL ,'~ CONSTRUCTION MUST ~ · ALLOt~$T~UcTi~N I' ' ..... $HALL MEET- ITATE:GONSTnUCTION &::~ .I ' .~DE~.. NpT~OM~E'-~I of Yennecoff park "'~ SU~Y FOR MAUREEN ROSLAK Dec LOT NO. 12,"HIGHPOIHT MEADOWS,SECTION TWO'* OCT. ~7,~0