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Home My WebLink About22053-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23274 Date OCTOBER 11, 1994 THIS CERTIFIES that the building ADDITION Location of Property 2645 DELMAR DRIVE LAUREL, NY House No. Street Hamlet County Tax Map No. 1000 Section 127 Block 4 Lot 2 Subdivision Filed Map No. Lot No.' conforms substantially to the Application for Building Permit heretofore filed in this office dated APRIL 25, 1994 pursuant to which Building Permit No. 22053-Z dated MAY 11, 1994 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 A DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING "AS BUILT" AS APPLIED FOR. The certificate is issued to MAHLON & KIM RUSSELL (owner, lessee or tenant) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE NO. N/A PLUMBERS CERTIFICATION DATED N/A r B d'd inspector Rev. 1/81 FORM N0.3 TOWN OF 3OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)/ 19. Date N® 22053 Z Permission Is hereby granted to; / n A.~'~.!-a. Sflr(..1 : J qA ........,/.V/~ ..:....eiI„e to. e- fJ`...,...?,.... /m./.r.. Wis.........,.... at premises located at........... T. •..a..~.. .........................................................rte`"`............................................................................... County Tax Map No. 1000 Sectlon e?.......... Block-- rV~......... Lot No..., pursuant to application dated G....... 19... 91 and approved by the Building Inspector. Fee $ ..7 ilding Inspector Rev, 6/30/80 Form No. 6 TOWN OF SOUTHOLD g d~. BUILDING DEPARTMENT TOWN HALL OCT`'~~~ 765-1802 a,. DEPT APPLICATION FOR CERTIFICATE OF OCCUPANCY'- 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 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 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 $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 Buildine - $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 ...f/ New Construction........... Old Or Pre-existing Building /J yJ FTr~ Location of ..1 Sot VLr ~hK!` . House No. n Street Hamlet Onwer or owners of Property. M!!-Wp . r...`~ ~ ....1~.:... v SS << County Tax Map No 1000, Section. .I.~ .......Block.. ?.Lt .........Lot.. O.`'4 Subdivision L'kYo--p ..&L4AN, -~!-S ......Filed Map. .cc ....Lot... Permit No.oq ` '3>. - Date Of Permit'?.. 11. .....Applicant.' 1. ~8 fJ„ P ~ Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final C ticate........ Fee Submitted: ~ ae ~i9~c~~r~? 1~ . _ APPLICANT 765.1802 BUILDING DEPT. INSPECTION [ j FOUNDATION 1ST [ j ROUGH PLBG. j FOUNDATION 2ND rT INSULATION [ l FRAMING ( FINAL REMARKS: I DATE INSPECTOR o Town Hall, 53095 Main Road 9~o~g~FFOI = Fax (516) 765-1823 P. O. Box 1179 W- Telephone (516) 765-1802 Southold, New York 11971 y 0! poi ~ ~a OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 3, 1994 Mr. Mahlon Russell 2645 Delmar Drive Laur (TF La urel, NY 11948 ;r nr 1994 s Ah nLn y.. 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) 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 # 22053-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. COMMENTS II a ' M rOUNDATION (1st) a(~ c FOUNDATION (2nd) 2.• • o ROUGH FRAME -PLUMBING i N ~I y 3. I ~ INSULATION PER N. Y. STATE ENERGY II~ CODE r 4. FIIJAL 5 I ADDITIONAL COMMENTS: m • a H 1 m a r \ H C\ m snafi , rw O O ~ aF a m ~ z~a~~ _ W O W ? z Y W w w U, z m IL F off-] 11 ~ LL y O ~ ~ `a 4. i ~3 a aaz0 °g =0 Oz0 r V d az c5 o Ul [1 °n r ~moo5 . oz y®o c-~-aw n O T Y U ~W S Z tW~mZ i^ U ,~t o p p L=L, v. 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' ti ° iii`-d • - - 1 _i \ai ~ , y Z N /',o Iir m v+ 00.091 101 02 ~ m 0 ~ N N u N ~ a a~ o_ o M y,V 6262 nD/nQCti C nA/ :77 / / I t pS'aFF0L/( y o ~ Town Hall, 53095 Main Road °y Z Fax (516) 765-1823 P. O. Box 1179 - .F Telephone (516) 765-1802 Southold, New York 11971 OFFICE OF THE BUILDING INSPECTOR TOWN OF SOUTHOLD October 3, 1994 Mr. Mahlon Russell 2645 Delmar Drive o pp Laurel, NY 11948 nr.T X094 j') 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) 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 # 22053-Z Please contact our office on this matter. Thank you for cooperation. SOUTHOLD TOWN BUILDING DEPT. FOR MNO.1 3 SETS OF PLANS TOWN OFSOUTHOLD SURVEY BUILDING DEPARTMENT CIIECK . . STOW114(1~10)EUT~OLD BOARD OF HEALTH TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t:aTIFY: ~ 11~, CALL ? Examined . 19 . MAIL TO Approved ....J , 19/2, Permit No. Disapproved a/c g Inspector) APPLICATION FOR BUILDING PERMIT L Date 19 7V INSTRUCTIONS 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 buildings on premises, relationship to adjoining premises or public streets or 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 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. 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 here' described. The applicant agrees to comply with all applicable laws, ordinances, bu' ding ode, hous' g. c e.,. and. re ul. tio.n.s.,. and to admit authorized inspectors on premises and in building for necessary in ectio (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. Q . . Name of owner of premises . /A ....Q:.. ~ F . . . . . . . . . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..0 Plumber's License No . Electrician's License No . Other Trade's License No . 1. Location of land on which proposed work will be done . a~Lt~ ..............A~-c.r~! ..:Vl,ue . ...........!~..~:.....N........9~~ House Number Street I Hamlet County Tax Map No. 1000 Section Block ...I I Lot.... Subdivision Filed Map NJo. Lot............... (Name) 2. 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 z 3. Nature of work (check which a plicable): New Building Addition Alfer i . . ih Repair oval . Demolition Other Work . C~O C. .C on) . . 4. Estimated Cost .....moo. Fee . (to be paid on filing thU]dPpfl6airn")" 5. If dwelling, number of dwelling'units Number of dwelling units on each floor If garage, number of cars i . mixed 6. If business, occupancy, specify nature and extent of each type of use 7. Dimnsons of existing lstructur I s, if any: Front Rear Depth Height Number ofStories Dimensions of same structure with alterations or additions: Front Rear . Depth Height Number of Stories . 8. Dimensions of entire new construction: Front . Rear Depth Height Number ofStories . Size of lot: Front . . . . . . . . Rear Depth 10, Date of Purchase Zone or use distract in which , , • • • • ' . • • • Name of Former Owner . are situated 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. Will lot be regraded Will excess fill be removed from premises: Yes No of Architect . • • . • • • • . • • • • • Address Phone No............... . 14. Name of Owner Architect premises . Address Phone No............... . Name Name of Contraactor......................... Address Phoppe~' No............... . 15. Is this property within 300 feet of a tidal wetland? *Yes........ No..2C..... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ai, 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. i! I i STATE OF NEWS COUNT//~F . • • • • • • . l • • N... • 2 C. ( I.......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ,e He is the ................C)wIr (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 manneriset forth in the application filed therewith. Sworn to before me this , day of .I', ~.1..., 1.1~ / Notary Publi County CLAIRE L GLLEW, Notary Public, State of Now York • No. 4879505' (Signature of applicant) Qualified in Suffolk County Commission Expires December 8, IS