HomeMy WebLinkAbout30871-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30794
THIS CERTIFIES that the building ACCESSORY
Date: 02/25/05
Location of Property: 865 WHITE EAGLE DR LAUREL
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 127 Block 9 Lot 23
Subdivision
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 28, 2004 pursuant to which
Building Permit No. 30871-Z dated DECEMBER 29, 2004
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 HOT TUB AS APPLIED FOR "AS BUILT".
The certificate is issued to DONN-PAUL DELANE
(OWNER)
of the aforesaid building.
SUFFOLK COUN'T'Y DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 6080 11/02/04
PLUMBERS CERTIFICATION DATED
Rev. 1/81
N/A
i
Authorized Signature
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30793
THIS CERTIFIES that the building ADDITION
Date: 02/25/05
Location of Property: 865 WHITE EAGLE DR LAUREL
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473689 Section 127 Block 9 Lot 23
Subdivision
Filed Map No. Lot No_
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 28, 2004 pursuant to which
Building Permit No. 30871-Z dated DECEMBER 29, 2004
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 EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR "AS
The certificate is issued to DONN-PAUL DELANE
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED
uthorized Signature
Rev. 1/81
. Form No. 6
.TOWN OF SOUTHOLD
BUILDING DEPARTMENT FEB 2 5 f
TORN HALL V
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by tyl)ev.Titer or ink and submitted to the Building Department with the folio .,ing
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.
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 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
I. 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
Date.
New Construction: Old or Pre-existing Building: VZ (check one)
p/
Location of Property: _ O (OS wh i k )SQq l e �W , L Q u re -
House No. Street Hamlet
Al
Owner or Owners of Property: L nrl - f Qt -1 `( T LO -1't 1(�,
Suffolk County Tax Map No 1000, Section / CZ % Block O U O 9 Lot ea 3
Subdivision �D �C��J 1 Vl V i e A-) FS r ce-t -S Filed Map. 7776
%76 Lot: 0?3
Permit No. 3 D 2") I Z Date of Permit. 2-9 OL( Applicant: Uon n — —pa a4 Qf?
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ 5-6
�-Q-E` • �P i 7.7
Cc C),? y
/ (c,o)
Final Certificate: V (check one)
A-_ pa's
Applicant Signature
Form No.6
TOWN OF SOUTHOLD
BLIILDING DEPARTMENT FE$ 2 §
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by h,'pewriter or ink and submitted to the Building Department with the follmk ing:
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.
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 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, Commercial $15.00
Date.
New Construction: /� Old or Pre-existing Building: (check one)
pt0
Location of Property: O wjh l #— FaQ 1 e b'.
House No. Street Hamlet
Owner or Owners of Property: b 17 f'1 — a U_ I �rk L —, t >✓
Suffolk County Tax Map No 1000, Section / a % Block &)6,9 Lot Qo� .3
Subdivision t 50 �C� %1 h'/ V l Filed Map. 7770 Lot o?_,�
Permit No. 3 U 7 Z Date of Pernut. Z 9 d`f' Applicant: �0✓) ! — Q.� L/ i Qin
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate
Fee Submitted: $ �(U
CO -?- 30,293
Final Certificate:
/ (,f .o )
(check one)
Applicant 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. 30871 Z Date DECEMBER 29, 2004
Permission is hereby granted to:
DONN-PAUL DELANE
865 WHITE EAGLE DR
LAUREL,NY 11948
for :
INSTALLATION 0f' AN "AS BUILT" DECK AND HOT TUB AS APPLIED FOR
at premises located at
865
WHITE
EAGLE DR
LAUREL
County Tax Map No. 473889
Section
127
Block 0009
Lot No. 023
pursuant to application dated DECEMBER 28, 2004 and approved by the
Building Inspector to expire on JUNE 29, 2006.
Fee $ 600.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
Nassau Suffolk Electrical Inspections, Inc.
5A Canal Street • Center Moriches, New York 11934 • Tel: 631-878-3500 • Fax: 631-878-3764
Application: 6080 Date: 11/2/04
Issued to: DeLane
Address: 865 White Eagle Dr
Village: Laurel By: Delane Electric License#:4354-E
was examined and approved up to the above date and was in compliance with the NEC
Attic 1st f=loor Residentiai❑x P10d Det Garage
Basernent 2nd floor C nTlerdal Hot Tubes Addition
This certificate must not be altered
in any manner
Switches Receptacles Fixtures G.F.I. Range Hood Whirlpool
Fans Dishwasher Washer/Amps Dryer/Amps
Oven
Carbon
Range/Amps
Monoxide
Furnace
Oil
Gas
Heat Zones
Smoke
Bell
Detectors
Transformers
Meter
Amps
Phase
Motors
Other Equipment:
1 -Outdoor Hot Tub -50A
1-GFCI Disconnect
Out,Res
-307 "7IZ 765.1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION IST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING KFINAL
[ ] FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
REMARKS:
DATE INSPECTOR
FIELD INSPECTION REPORT
I DATE
COMMENTS
FOUNDATION (1ST)
------------ b---------------------
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FOUNDATION (2ND)
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ROUGH FRAMING &
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INSULATION PER N. Y.
STATE ENERGY CODE
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FINAL
ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/ PERMIT NO. i'f�,
Examined , 20 GY {
Approved 20 L>�
Disapproved a/c
Expiration L , 20 oc-
BUILDING PERMIT APPLICATION CHECKLIST
Building Inspector
Do you have or need the following, before applying?
Board of Health
3 sets of Building Plans !-
Planning 116
ard approval
Survey V/
Checko I
Septic Form
N.Y.S.D.E.C.
Contact:
Mail to: ra L A4
Phone( 8)70 -7l y00
{' 2 8 2004
APPLICATION FOR BUILDING PERMIT
Date 20�
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.
V 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 permit 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. �c.Q
(Signature of applicant or name, if a corporation)
C /1t,' 1 i 1 � c ��t'a✓1
(Mailing address of applicant
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises y� _ �AU U� LJ_ J
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No. 437c(
Other Trade's License No.
1. Location of land on which proposed work will be done:
1.
House Number Street
Hamlet
County Tax Map No. 1000. -Section—-o1—Block q Lot 93
Subdivision aQ Id eYl V leAL E3C aL eS Filed Map No. `1-1-1 In Lot ') 3
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 5
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Workq
rlw.. P�l� 0 k1��(Descnption)
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. I£ business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
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 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 PC-- , ,
12. 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—A,`
14. Nantes of Ownci of premises address Phone No.
Name of Architect 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
* IF YES, SOUTHOLD TOWN TRUSTEES a D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO__te!--
* 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:
COUNTY OF S VI�YP
1Y� being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) 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 me this
.;IP" day of v( 20DI
—
Notary Public
UELW Y. MOM
NOWy hilt, &W 01 No Yak
Na+909712
OA" N 9ullok owdy
cwmb" eon Oct. 19, a�
Signature of Applicant
LOT AREA= 40,112 sq. ft.
I
603.00'
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WHITE EAGLE DRIVE
S 32'33'42"E 184.00'
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N 32'33'42"W 184.00'
LRd'.'L•::aYd:77Ia:77:77:� : � y>rd:�
Tiie existence of right of ways and or easements
of record, if any, not shown are not euarantPP.t
Im orram in oubwq" rrRr NMWOr nor 7 E awmuo lo M
PR0Pr11Y LOO AAE FOR A !1101M FUN OE AO OE Mr 71406OE AE NOT
adaoen TO OM TK OIrC1 OF f1010M 111911111110 rales FOEA FIRIM
RAMIRIO ARM AYOOI 10 OIAOarI OA .MY 071E1 mmORMW
1O1NOFRO® Ah WW ON A03491 70 71E allR1EY E A g01,aW 0► O6'IIOr
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TE OOMMY W1 WIN OOMIq 704E We fEETOMI OO® ML OR
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CERTIFIED ONLY TO:
DONN —PAUL and PATRICIA DE LANE
f'(,,_,xdc F _T
N.Y. LK:: No. 048992
HAROLD F. TRANCHON JR. PENN. LIC. No. 21155–E
5
JOB No. 02-107 FILE No. GOLDEN VIEW ESTATES
SURVEYED FOR
LOT NUMBER 23
MAP OF GOLDEN VIEW ESTATES
SITUATED AT LAUREL
TOWN OF SOUTHOLD – SUFFOLK COUNTY N.Y.
SCALE 1' = 40' DATE 3-21-2002
FILED MAP No. 7770 DATE 8-30-1984
TAX MAP No. (REF oNLY) 1000-127-9-23 DISK 500
HAROLD F. TRANCHON JR. P.C.
LAND SURVEYOR
1866 WADING RIVER–MANOR RD. WADING RIVER,
NEW YORK, 1T792
631-929-4695
m
EXI5TI1gG HOUSE---
---------------
-----------------------------------------
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ZK8 LEDCER
----- �'. SOL -ED TO 9LDG. U
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ANCHORED TC
12"XI^" C014C. FTG. n 1
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BJDXB_SII -----
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ANCHORED To
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_rn _2x8 GIRDER I_, 1 I101,
FOUNDATION PLAN
14
t,,,O le e- /ham ' /cYv-e_V vp ,-e perej,
DECK BUILT PRIOI, 2003
FLOOR PLAN ISUNDERWRIELWInEDATIFICATEI
565 WHITE EAGLE
Fc-.
I of 2 October 14, 2004
FE
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F
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3
IPANCY OR
S UNLAWFUL
JUT CERTIFICATE
3CUPANCY
APPROVED AS NOTED
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-
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JI,6T',_, TION ERF
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I/4" = Ib'
REAR ELEVATION
GIRDER/HEADEF
POSTICOLUMN
(POST-TO-GIRDER/HEADER CONNECTION
IACATION
USP NUMBER
DESCRIPTION
APPLICATION
1414 SOLIIJ COLUMN
PBS44 / PBSLh4 / KCh4
POST CHP ANCHOR
APPLY TU FACI-I COLUMN
GxG SOLID COLUMN
PBBGG / PBSECG / KC66
POST CAP AItlCHOR
APPLY TD EACH COLUMN
HOLLUW CUWMN
SIMPSDN STRR1/2
HC ANCHOR
APPLY TO EACH COLUMN
_PMU ER
LEE TO HOUSE -
I", EIA GALV,
5 Wi WASHERS
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FLASHING TUCKED UIJDER
/ TOP PIECE OF SIDING AND
j LAPPED OVER FIRST CONTIN
/ PIECE OF SIDING BELOW
/ b2" DIA. LAG BOLTS W/ WASHERS
/
CONNECTED TO BLOC CW, 16" OC
FLOOR FRAMING '
�r 2x JOISTS
BLOCKING
FOR"JOIST RANGER
LAG UOLTS p
RIMJOIST/RDS
DECK/PORCH LEDGER CONNECTION
LEFT ELEVATION
4" MAX
11�A�
RIGHT ELEVATDON
4" DIA MAXIMUIN
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STAIR FRAILINS
DECK RUILT PRION 2003
T' DI.
4"MAX