HomeMy WebLinkAbout33928-ZFORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
SOUthOld, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33060 Date: 05/29/08
THIS CERTIFIES that the building
Location of Property: 1485 ORIOLE DR SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Nap No. 473889 Section 55 Block 6 Lot 15.30
Subdivision Filed Nap No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in Fhis office dated MAY 22, 2008 pursuant to which
Building Permit No. 33928-Z dated MAY 22, 2006
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 DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to DAWN GRZEGORCZYK
of the aforesaid building.
(OWNER)
SUFFOL& COUNTY DEPARTl~N'P OP HEALTH APPROVAi, N/A
ELECTRICAL CERTIFICATE NO. N/A
PLDFIDSRS CERTIFICATION DATED N/A
A O lied Signa ure
Rev. 1/81
~~ I /
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 1 % lead.
S. 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 Apri19, 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 [o [he 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, Commercial $15.00 -.~~QQ ~°~,~
,Da/te. ~`C~~ ~...J.~
New Construction: ' ` Old or Pre-existing Building: / (check one)
Location of Property: l `~~ ~ ~U~-P ~S~ ~~~ `~'
Hou~se-No. `,~ - `St`reet + Hamlet
Owner or Owners of Property:-(~~' 'c' ~t `~'~~ l' j~¢~fL~x ~+~6-~
Suffolk County Tax Map No 1000, Section SJ~ Block ~ Lot ~ ~ . 3 ~j
Subdivision Filed Map. Lot:
f'
Permit No. ~ 3q ~ Date of Permit ~~ ~ Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate
rr~~ ~O
Fee Submitted: $ o~ ~J
~3~b1~ b
(?.~ c~~l `~13~t I
Final Certificate: _~ (check one)
Applicant Signature
-- ;
L_`C_~ !' - ~ ~ -~; - `'~, JL~ TOWN OF SOUTHOLD PROPERTY RECORD CARD /~~ ~-'
-- - - - ---
OWNER
STREET
VILLAGE
DIST. --
SUB. LOT ZT'~
T~~~ ~
~~,
- ~; iolE. ~~tve.. ~cu`Ffn~~l~ ~~
- ~ ~~ s ~~ h
ACR. `5i~ REMARKS t, ~
~~ ;~- //~ ~? ~.5 ~CIr7~~n_ls~Qr~:~ 7L+jtcl~;2 G~ ~ /250
TYPE OF BLD.
l ~ ~ i ` PROP. CLASS
LAND IMP. TOTAL DATE
1~ C ;, I`~~ ~ 23 ~/
N ~ '~~
~~c~ fir`=f yoo 2:~ ~~
~'? R. E~! 8c9-a 3
-
~ ~ Z 2 f) ~ 3 r~ ----
~ ~O ~~ ~ ~ r ~ ,-' 6-a 3 ~ 0
FRONTAGE ON WATER TILLABLE
FRONTAGE ON ROAD WOODLAND
DEPTH MEADOWLAND
BULKHEAD HOUSE/LOT ~~'
TOTAL '~
COLOR
55-6-1530 10/02
~~ ~°`%%
TRIM ~' _
~ ~''
M dg. ~, ~ X ~ - !~ - J" ~ Foundation a Bath 2 / ~' Dinette
Extensi n
~ ~, ~6
~
~ (o `
Basement FU
~~
SLAB
Floors
Kit.
Ex nsion P ~ _
O 2 S~ ~ Ext. Walls •°~~'~w+i{ is Interior Finish L.R.
Extension Fire Place ~ J Heat D.R.
Patio Woodstove BR.
orch X 3 3 ~{" ~ ~p ~ 2 Dormer
Deck Attic ~,~ j
Breezeway Rooms 1st Floor
Garage ~ X a __ 6 [f- ?5 a ~ ~~ Driveway Rooms 2nd Floor
O.B.
Pool
1 ~Z
~~ ~. ~ x2 ~..-c~~-- i 298 __.
-~i a
SUR1/EY OF LOT 27
MAP OF HIGHPOINT MEADOWS,
SECTION TWO
PILED MARCH Iq, IggO, PILE No. IggO
SITUATE: SOUTHOLD
TOWN: SOUTHOLD
SUFPOLiG COUNTY, NY
SURVEYED JJLY 26, 2000
SUFFOLK COUNTY TAX a I~yfrIIW~~~p_
1000-55-6-15.3® N~~I''I ~~. 11.1 nJv
OW- ItK
Lor ~e~Ia wn
az
Iii
CERTIFIED TO: 70
DAWN GRZEGORGZYK SCENIC , N~a'16~~~E /
CHESTER GRZEGORGZYK 1 V
EhSEMENt ti.,. 31~~~0
IC'.L IUC. ~ ~~
f+'urn PJe,d Map `~ o~
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NOTES:
0
PIPE FOUND
AREA = 22,229 SF OR 0.51 ACRES
GRAPHIC SCALE I"=30'
:
it jP'Or 'flu' 9~N{. ^°'"'°.~.~~~L..7
*,~ ENO. ~' 1~1,4~~t y^f ? ~ ~; M:x~
JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y. 11901 REF.\Vip serverld\FROS\20-219.pra
369-8288 Fax 369-8287
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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. 33928 Z Date MAY 22, 2008
Permission is hereby granted to:
DAWN GRZEGORCZYK
1485 ORIOLE DR
SOUTHOLD,NY 11971
for
REAR DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR. REPLACES EXPIRED BP # 29584
at premises located at 1485 ORIOLE DR SOUTHOLD
County Tax Map No. 473889 Section 055 Block 0006 Lot No. 015.030
pursuant to application dated MAY 22, 2008 and approved by the
Building Inspector to expire on NOVEMBER 22, 2009.
Fee $ 150.00
ORIGINAL
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)
PERMIT NO. 29584 Z Date JULY 18, 2003
Permission is hereby granted to:
DAWN SWIATOCHA
1485 ORIOLE DR
SOUTHOLD,NY 11971
for
REAR DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELL
APPLIED FOR
at premises located at 1485 ORIOLE DR
SOUTHOLD
County Tax Map No. 473889 Section 055 Block 0006 Lot No. 015.030
pursuant to application dated JULY 16, 2003 and approved by the
Building Inspector to expire on JANUARY 18, 2005.
Fee $ 150.00
Rev. 5/8/02
~" , -~
r
Authors Signature
ORIGINAL
33~~~~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
1 NSPECTION
[ ]FOUNDATION 1ST
[ ]FOUNDATION 2ND
[ ]FRAMING /STRAPPING
[ ] FIREPLACE ~ CHIMNEY
[ ]FIRE RESISTANT C~TRUC1
REMARKS:
[ ] ROUG LBG.
[ ] 1 ULATION
FINAL
[ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT PENETRATION
DATE 5 J ~~ ~s~ INSPECTOR
a9~b y ~
T65-1802
BUILDING DEPT.
I SECTION
[ ]/F NDATION 1ST [ ]ROUGH PLBG.
[ "f FOUNDATION 2ND [ ]INSULATION
[ ] FRAMING [ ]FINAL
[ ] FIREPLACE ~ CHIMNEY
l
~;
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined ~ ~~ Y , 2p ~
Approved ~b' , 20~_
Disapproved a/c
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
~3 sets of Building Plans
Planning Boazd approval
r~ --=Survey
PERMIT NO. a `~• )t~ ~(~ cheek
Septic Form
N.Y.S.D.E.C.
Contact:
Mail
Expiration i ~ y , 20 ~~
spe ~~ 0~2 ~~ t
___.. _
__._,' 1~~, ~c~~d .
FOR
~~
~~q~ ~
17 2003
"~ ate , 20~_~
l INSTRUCTIONS ---a
-___ ~,~ n
a. This application MUST be completely filled in by typewriter or in an 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 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 pernit 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 of a h nt r n f a corporation)
L~`~C~~.c~la < ~~ ~e ~~hU\cl.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
~~e ~
Name of owner of premises C~~~~ p-(\~ ~_~C3.u'~(1
(As on the tax roll or latest
If applicant is a corporation, signature of duly authorized officer
(lvame and tttle of corporate officer)
Builders License No.
Plumbers License No.
Electricians License 1;
Other Trade's License No.
of land on
House Number Street
C~ ~~ _
will be done: ~\~
C ~ ..se
Hamlet
County Tax Map No. 1000 Section ~JS Block ~o
Subdivision F'1 d M N
(Name)
t e ap o.
~S . ~
Lot
2. State existing use and occupancy of premlises and intended use and occupant of p sed construction:
a. Existing use and occupancy ~y~~2 C~(~ ~ Qxr ~ ~ ~,t ~ ~.~-J-e ~~~~ (1~
b. Intended use and occupancy ~~~pC ~
3. Nature of work (check which applicable): New Building Addition_~_ Alteration
Repair Removal Demolition Other Work
6 ~ aQ (Description)
4. Estimated Cost ~~~ Fee
~ (To be paid on filing this application)
5. If dwelling, number of dwelling units Number 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.
Dimensions of existing structures, if any: Front
Height Number of Stories
Depth
Dimensions of same structure with alterations or additions: Front Rear
Depth Height 55~~ Number of Stories ~'
8. Dimensions of entire new construction: Front ~C.~ Rear ~ Depth ,`\l
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_ NCY\ Will excess fill be removed from premises? YES_ NO
~• V~`sEQfi t~OA(l ~y~ r~,~.G14 ~,~ ~ ~ ~ 1-T
14. Names of Owner of
No. ~~oS-
Name of Architect v ~ 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 7~-'
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY ~E REQUIRED.
b. Is this property within 300 feet of a tidal wetland? *YES NO `ICS
* IF YES, D.E.C. PERMITS MAYBE 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.
STATE OF NEW YORK)
SS:
COUNTY OF Si~~ )
.__J~t+-fin Cj«~6CC~-t~K being duly sworn, deposes and says tha (s)h is the applicant
(Name of individual srgning tract) 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 knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before met s
/~ day of 20~
Notary Public
Signat e o A plic
;: ~'. COADY
tis~°i rinP.iC, Stot® of New Yc~:
Qu~iCied In Su9ogc Copaty
No. 4937975 ~
'Mnmbsl2n F.xpha July 11; fl,,.,~~
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
October 17th, 2007
Dawn Swiatocha
1485 Oriole Drive
Southold, N.Y. 11971
RE: 1485 Oriole Street. (Rear Deck)
SCTM # 55.-6-15.30
Dear Ms. Swiatocha,
1st NOTICE
Fax (631) 765-9502
Telephone(63l)765-1802
Please be advised that your Building Permit # 29584 issued July 18th, 2003 has expired,
According to the
Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of
the structure.
To renew your Building Permit please submit a fee of $150.00: at that time we can
schedule an inspection by one of
Our Building Inspector's.
If you have any questions please call us at 631-765-1802
,~; ~ OF SOUIyo~
~#~~ #
•
,O
~~y00UMV ,~",~'
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Respectfully,
Southold Town Building Dept.
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
,~~OF SOUTyo~
~#~~' ~
~ • ~O
Ol~Ct7U~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
2nd NOTICE
May2lst, 2008
Down Grzegorcryk
1485 Oriole Drive
Southold, N.Y. 11971
RED 1485 Oriole Drive (Rear Deck Addition)
SCTM # 55.-6-15.30
Dear Ms. Grzegorcryk,
Fax (631)765-9502
Telephone (631) 765-1802
Please be advised that your Building Permit #29584 issued July 18th, 2003 has
expired. According to the Code of the Town of Southold, n Certificnte of
Occupancy must be issued prior to use of the structure.
To renew your Building Permit, please submit n fee of $150.00; at that time we cnn
schedule an inspection by one of our Building Inspector's.
If you have nny questions, plense cnll us nt 631-765-1802.
Respectfully,
SOUTHOLD TOWN BUILDING DEPT.