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Home My WebLink About33979-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~dlTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33721 I~ate: 05/19/09 HIS CERTIFIES that the building INGROUND SWIPING POOL Location of P~erty: 1485 ORIOLE DR SOUTHOLD (HOUSE NO.) (STREET) (RAMLET) Colulty Tax ~ap No. 473889 Section 55 Block 6 I~t 15.30 Subdivision Filed Map No. Lot NO. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 2, 2008 pursuant to which Building Permit No. 33979-Z dated JUNE 13, 2008 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 IN GROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to DAWN & CHESTER GRZEGORCZYK (OWNER) of the aforesaid building. $[~FFOI~K C~)I~I~fDEP~/~q~TOF ~"~PPRfFq~J~ N/A ELEC'IR~ICAL C~KTIFICA~ NO. 8953 07/29/08 PL~ ~KTIFICATION DA'r~3 N/A Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OFO£ BLDG. DEPI. :~-~-~X~WN OF SOUTHOtD This application must be filled in by typewriter or ink and submitted to thc Building Depaxtment 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 installatiun fi:om Board o f Firo Underwriters. 4. Sworn statement from plumber certifying that thc solder used in system contains less than 2/10 of 1% lead. 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 requimments~ B. For existing buildings (prior to April 9, 1957} non-conforming uses, or buildings and "pre-existing" land uses: l. Accurate survey of property showing all property lines, streets, building and.unusual natural or topographic features. 2. A properly completed application and eousent to inspect signed by the apphcant. 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 dwelllng $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 Occupansy - Residential $15.00, Commereial $15.00 Date. New Construction: Old or Pre-existing Building: Location of Property: \ ~3~.~% (~( ~C)ke ~ House No. Street Owner or Owners of Property: Suffolk County Tax Map No 1000, Section ~ Block Subdivision ? rmit Health Dept. Approval: Date of Permit. Filed Map. Applicant: Underwriters Approval: (check one) Hamlet Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Final Certificate: (checkonc) - Applicant Sign~u~e~ (~ SUE FOI K BUR AU ~ 40 Nottingham Ddve. Middle Island. NY 11953 Telephone: 631 495 8136 · Fax: 631 980 6455 · E-Mail: SBEIGS@gmail.com Applicant: Rough In Inspection Date: Application No.: Suffolk County Tax Map No:: CERTIFICATE OF ELECTRICAL COMPLIANCE Raymond Electrical Certificate No.: 8953 July 29,2008 Final Inspection Date: July 29,2008 8953 Building Permit No.: 1000 55 6 15.3 This Certificate of Electrical Compliance is limited to the inspection and compliance of electrical equipment and/or work described below, installed by the applicant named above, located at the premise of and not after the final inspection date above: Owner: Chester and Dawn Grzegorczwk Site Location: 3.485 Oriole Dr., Southold, NY 3.3.971 Owner's Address (if different): [] Residential [~ Commercial [] Addition Single Phase Three Phase Main Panel Sub Pardi 4ckt GFCI Breaker 1 [] Indoor [] Basement [] Service El Shed [] Outdoor [] Firat Floor [] Pool [] Hottub [] Renovation [] Second Floor [] Attic [] Garage [] Survey Other: INVENTORY Heat 1-gas Duplex Recpt Geilin9 Fixture HID Fixtures Hot Water GFCI Recpt 1 Wall Fixture Smoke AC Cond Single Recpt R~cessed Fixture CO Detscl Appliances Dp/er Recpt Emergency Time Clock 1 ii" The electrical work and/or equipment described above were inspected and appear to be in compliance !'J" with local, state and national electrical code requirements and this office. '.~,~ Applicant: Raymond Electrical License No.: 5141ME ~i inspected By: Gene Surdi Date Of Certificate: Aug 01 2008 · Signature: 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. 33979 Z Date JUNE 13, 2008 Permission is hereby granted to: DAWN GRZEGORCZYK 1485 ORIOLE DR SOUTHOLD,NY 11971 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL IN THE REAR YARD, FENCED TO CODE at premises located at 1485 ORIOLE DR County Tax ~4ap No. 473889 Section 055 Block pursuant to application dated JUNE 2, 2008 Building Inspector to exl~ire on DECEMBER 13, SOUTHOLD 0006 Lot No. 015.030 and approved by the 2009. Fee $ 250.00 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS/UL'~TION [ ] FRAMING / STRAPPING [~/]"~INAL~'-'~ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION DATE INSPECTOR~~/~ I' COMI~NTS 'FI~ELD INSltECTION REPORT ,i DATE FOI~ATION (1ST) FOUNCATION (2ND) ROUG~ F~G & ~N'SL~ATION PER N. Y -- STATE ENERGY CODE ~DITION~ COUNTS BUILDING I)EPARTMENT TOWN HALL SOUTIclOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ PERMIT NO. Exainined $/~?, Approved ~//~ 20~ I)isap?roved a/c / / Building Inspector Do you lnave or need the following, before applyiag? Board of Health 4 sets of Building Plans Plarming Board approval Smwey Check Septic Form N.Y S D E.C ~qq. g ~0o APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ,-6'/,0-0 20 05 a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocation of lot and of buildings on premises, relationship to adjoining premises or public streets or a~eas, and waterways, c. The work covered by this application may not be commenced before issuance of Bnilding Permit. cl. Upon approval of this application, the Building inspector will issue a Budding Permit to the applicant. Such a pema~t shall be kept on the pren~dses available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any pul-pose what so ever until the Building Inspector ~ssues a Certiicate of Occupancy. f. Eve~T 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 tine property have been enacted in the interim, the Building L~spector may authorize, in writing, the extension of the permit for an addition six months. Therea~er, a new pemfit shall be required. APPLICATION IS HEREBY MADE to the Building Depatlment 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, ~uilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. '~/~~' name, ifa corporation) (S~gnatare of apphcant m "IMMEDIATELY".. ENCLOSE POOL TO GO~E ALLCONSTRUC~ig~SHALL~\ p_.k~"L'hfl ~.F.~/94- }.~ iI'Y/B uPON COMPLETION BEFORE "WATEr' MEET THE REQUIRDJEi"FrS OF THE (Mailing address of applicant) COOfiS OF NEW ~ OFiK STATE. State whetlner applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~_~. {a~'~'-~ ll~' applicant is a co~oration, signature oF duly autho~z~d ~DER~RS CERTIFICA~ (Name and title of co~orate officer) ~RE~IRD Builders License No. r--~\l-4l ~ Plmnbers License No.. Electricians License No._ _ Other Trade's License No. ~'tD72~-}'/=- -~ d ' A~' ~-a,. ~ eD Ao hO[ED (As on th~tax roll 0¢~Z5.._' ~y.'.}. ~- ~ NOTIFY BUILO'YG ~_¢,RTMENT AT 795d802 8AM TO 4FM FOR THE FOLLO'.'",HG INS~:CCTI,3 ~S: L FOU~:DATION - %(0 REQUIRED ~ ~1 I m ~ ~ i~x/ FO;: 7O'.'P=n CONCRETE ~r~l~l OR 2. ROUGH - FRAM',NG & PLUMBING ........ U 4. co s uc¢ o. ~ UNI AWF L a. INSULATION · n~ ~ ~ ~--~,~ ~E COMPLETE FOg C.O. ~VlI~UI ~/I~Ib/",ALL CONSTRUCTION SHALL MEET THE I. Location of land on which prop_osed F OC mANCY~. REQUIRgMENTS OFTHECODESOF NEW &b~O~E. NOT RESPONSIBLE FOR i~d 0riol~ ~r' Ho~se Number Street O~l~R CONSTRUOTION ERRORS. 15.5o County Tax Map No. 1000 Section ~ '~:~m~A~ ~:., ,.,~,~.~ ~, ~ ~., ~ Lot ~ wAm~ ~ :.. ~='"~}ed' Map NoR~AIN ST~ D,~ Subdivision ~ no,~f ~ (Na~)i OF THE TOWN COD~ State existing use and occupancy of premises and invaded use and occupancy of proposed constructien: a. Existing use and occupancy_ ,~lq~\(' ~m[Ic( '~/.tc~6ig(/C~ b. Intended use and occupancy ~t~o)~e~.m,'lc~ ~.t_~'t~a_d~ u.3 I 11'l~'rt'~rlA 7~o } 3 Nature of work (check wlnich applicable): New Building Repair Removal Estimated Cost ~k[~.l~0" If dwelling, nm'nber of dwelling units If garage, number of cars Fee Demolition Addition Other Work,~t>rs (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and exte~t of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth_ Height Number of Stories Rear Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Sizeoflot: Front Rear _Depth 10. Date of Purchase Name of Former Owner / 1. Zone or use district in which premises are situated I2. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES ~ NO Will excess fill be removed from premises. YES NO 14. Names of Owner of premise~hiC~ex ~rzeo~orc z~F'Address 1~4?,6 0c;oie ~,. PhoneNo. Name of Architect~~ ~ Address ~~d ~ PhoneNo 3a~-~105 NameofContract~aM~flddc~ Address ~21 ~2S~ PhoneNo. qqq-¢,oo 15 a. Is this propeay within 100 feet of a tidal wetland or a freshwater wetland? *YES NO ~ * IF YES, SOUTHOLD TO~ TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES~ NO ~' * IF YES, D.E.C. PERMITS MAY BE 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: COL~TY OF (Name of individual signing contract) above named, (S)He is tl e (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly author/zed to perform or have performed the said work and to make and file this application: that all statements contained in this application are tree to the best oflqs knowledge and belief; and that the work wig be performed in the maturer set forth in the application filed therewith. Notar¢'~blic ~5 TOWN OF SOUTHOLD PROPERTY RECORD CARD ",/N ER //" ' '" VILLAGE STREET .,, ?/ ,~_¢? ~; ACR. TYPE OF BLD. LAND I IMP. TOTAL DATE I REMARKS D'ST.1 SUB. LOT ~..'~ FRONTAGE ON WATER FRONTAGE ONROAD DEPTH BULKHEAD TILLABLE WOODLAND MEADOWLAND HOUSE/LOT TOTAL 55~6-15.30 10/02 COLOR "~-~dg- ~OK~ lj'7_~. ~.~) ~,.~5 Foundation (;~ Bath ~ ~ Dine"e /~'~"m" ~ ~ ~p ~' ~ ~,~ ~¢ Basement ~'SL,. Floors Kit Ex~si°n ~ ~ ~ ~ /~ 2, ~0 ~ Ext' Walls ~l~r;~C?~~I Interior Finish L.R. Extension Fire Place ,~ Heat D.R. Patio Woodstove Br~zeway Rooms 1st Floor Garage ~¢XaT-->¢~? ~7¢ 1¢50 Driveway Rooms 2nd Floor O.B.. I ~ool Erosion, Sedimentation and Storm-water Run-off Control Plan ASSESSMENT FORM Yes EXEMPTIONS: A. Does this project meet the minimum standards for classification as an Agricultural Project. Note: If you answered Yes to any of the above, a Storm-water, Grading, Drainage & Erosion Control Plan is not required. ACTIONS REQUIRING. THE. SUBMISSION OF A STOPdVI;WATER~ GRADING~ DRAINAGE & EROSION CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. Item Number: (A Check Mark 6/ ) for each question is required for complete application) Yes No Will this project retain all Storm-Water Run-off generated on Site? ' (This will include all mn-off created by site clearing and/or construction activities as well as all Site Improvements and the permanent creation of impervious surfaces.) 2. Will this project require any land filling, grading or excavation where there is a change to the I--'"3 natural existing grade involving more than 200 cubic yards of material within any parcel?I~l 3. Will this application require land disturbing actixfties encompassing an area of five thousand (5,000) square feet of ground surface or more? 4 Is there a Natural Water course mrmmg through the site or is this project ~dthin One hundred (100) feet of wetlands or a beach? I~ 5. Will there be site preparation on slopes which exceed fifteen (15) feet of vertical rise to r~ One hundred (100) feet of horizontal distance? 6. Will driveways, parking areas or other impervious surfaces direct Storm-Water Run-off into and/or in the dire~ion of a Town Right-of-Way? 7. Will this application require'the placement of material, removal of vegetation and/or the ~ ..~ construction of any item witl~in the Town Right-of-Way or road shoulder area? (This item does not include the installation of driveway aprons.) 8. Will there be site preparation within the one hundred (100) year floodplain of any watercourse? Note: If any answer to questions ~ne through eight is answered with a check mark in the Box, a Storm-water, Grading, Drainage 8, Erosion Control Plan is required and must be submitted for review prior to issuance of any building permit. STATE OF NEW YORK, f ~--_ ,. ,/__COUNTY OF ........ '~}'~'~ ~.g~7 SS (Name of individual signing Document) And that He/She is the (~'~[q~a~)(~'i (Owner, Contractor, Agent, Coqmrate Officer, etc.) Owner and/or representative of the Owner or Owner's, and is duly authorized to perform or have performed file said work and to make and file this application; that all statemeots contained in this application a~e true to the best of his knowledge and belier; and that the work sill be perfon'aed h~ the maturer set fo~Lh in tile application filed herewith. Sworn to befoIe me this .................... - Notary Public: ........ .. ~., ($~gnature o~ Applicaot) ISURVEY ;HAP OF SEC_.,TI ON T?,IO iFIL:FO f,,IAROH Iq, Iq, lO, FIL:F No. : SITUATtE: :~xPUTI--IOLP TOINN...~2UTHOLD ~f::,UFFOLF-. COUNTY, NT SCT:¢ SUP--VETEO JULY 26, 2000 i Ab'I~N~'~I~: 11-14-2000, FND LO6, 12-0S-00 FINAL 12 OF LOT ~ ' HI®HPOINT MEAPOHS, IqqO : C,E~TIFIEE) TO: C, idESTE~ ! ULST~I~. SAVINGS BANI(. SOE~HS P-El= ~ RIO-O00lql 20 N E ,5 u NOTES O PIPE FOUND AP-.EA = 22,22q SF O~ 051 AOF~ES GRAPHIC SC, ALE JOHN 6 EAST MAIN STREET RIVERHEAD, N.Y. 11901 369-8288 Fax 369-828'1 N.Y.S. [,lC NO. 50202 REF.\\Hp server\d\PROS\20-219c.pro 1'-8 O, t-~ ,,,/ >_ , , > Z ~ ~TO RE~S ~ o ~ :~, ~ PLUMBING SCHEHA~C TO WAS~ ' GRADE P~N ~o~o FOAM ~ POURED C ' BETWEEN UNER ~ 21X40 ME AND CONCRETE FORM TIES ~ ~Y~. ~ = VINYL LINER ~ :~ ~ ~ ~ 2" TO 4" SAND 7 % · ~ ' ~(q~ = WALL SE ION 1. S~UC~RE IS DESIGNED FOR USE BELOW GRADE AND ONLY IN AREAS WHERE ~E GROUND WATER TABLE IS A ~INI~UM OF 4'-8" BELOW ~E PROPOSED FINISHED GRADE. SE ON~ z BACKFILL ~TH CLEAN EAR~, FREE OF ROOTS AND DEBRIS. DO NOT ALLOW THE HEIGHT OF BACKFILL TO EXCEED THE HEIGHT OF THE WATER IN THE POOL BY MORE ~AN 8" 6-12-05 ~. WALKS TO BE S~OOTH, NON SKID T~E, SLOPED AWAY FROM POOL. 4. WA~R DISPOSAL SHALL BE LIBI~D TO OWNERS PROPER~ TO SUIT LOCAL CONDITIONS.