HomeMy WebLinkAbout32103-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31646
Date: 06/30/06
THIS CERTIFIES that the building ADDITION
Location of Property: 3625 DELMAR
(HOUSE NO.)
County Tax Map No. 473889 Section 125
DR
(STREET)
Block 4
LAUREL
(HAMLET)
Lot 4
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
JUNE 12, 2006 pursuant to which
Building Permit No. 32103-Z
dated
JUNE 13, 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 "AS BUILT" DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to RAYMOND & RITA HAUSLER
(OWNER)
of the aforesaid building.
N/A
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
N/A
PLUMBERS CERTIFICATION DATED
Rev. 1/81
Form No.6
/?'I) .IS O\,C S' 7
?AtJ~?- t' -1f. r: //9.;LP
,
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APPLICATION FOR CERTIFICATE OF OCCUPA~CY
TOWN OF 80UTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
This applicatiopmust'be filled in by typewriter or ink and submitted to the Building p~pa[lment with th:fgJlowing: \
- -, . '" J
A, For new building or new use: ~. _..'.x,_ .. . '.__
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 (8-9 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 I % lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations, a ceriificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
26
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" laud uses:
I. 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. ~/ ).4, - () L,
New Construction: Old or Pre-existing Building: ><-. (check one)
LocationofProperty 3(,;1.j .J>~#LlJllt~e... < .(.;tH//46L /If-" r //t? ~r
House No. Street r / Hamlet
Owner or Owners of Property: If /ly M 011/ j)> ~ t/ oS CCjt-
Suffolk County Tax Map No 1000, Section
Subdivision
Block
Lot
Filed Map.
Lot:
Permit No. 3 d- I 0 ~
Date ofPclmi!.
Applicant:
Health Dep!. Approval:
Planning Board Approval:
Underwriters Approval:
Request for:
remporary Certificate
Final Certificate:
(check one)
Fee Submitted: $
~/~~ dw~L-
. Applicant Signature
Co Z-:, \.10 ,.tto
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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.
32103 Z
Date JUNE
13, 2006
Permission is hereby granted to:
R HAUSLER & WF
PO BOX 57
LAUREL,NY 11948
for
"AS BUILT" DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR THIS PERMIT REPLACES BP 26859
at premises located at
3625 DELMAR DR
LAUREL
County Tax Map No. 473889 Section 125
Block 0004
Lot No. 004
pursuant to application dated JUNE 12, 2006 and approved by the
Building Inspector to expire on DECEMBER 13, 2007.
Fee $
300.00
~c.n-
( Authorized Signature
ORIGINAL
Rev. 5/8/02
:3 2-JO}6
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
] FOUNDATION 1 ST [] ROUGH PLBG.
] FOUNDATION 2ND [] IN~TION
] FRAMING I STRAPPING [ ~AL
] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
Co
;Jo
,
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DATE
INSPECTOR
L
FIELD INS.tECTION REPORT COMMENTS . J
DATE
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FOUNDATION (1ST) -~
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ROUGH FRAMING & ra
PLUMBING
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INSULATION PER N, Y, r;;
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STATE ENERGY CODE
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UNAUTHORIZeD AlTERATION OR ADDITION
TO THIS SURVIY 15 A VIOLATION Of
SECTION 7..C9 Cf llU NlW YCfi.K STAff
EDUCATION LAW.
eorlES Of THIS sur;v:.'f MAP NOT 8fAr.ING
IHi: LA~_O SU.-Yu:':,,':, ir..K.t;. ~IAl V~
~BOSS[D S:A! ~~:'\ll ~':i L~ l.,J,,~:t)tREO
TO U A VA~ii; I,Ut CLn.
GUArA!.1H's ,r'C'I";"d) n"I.~ON ~HML RUN
ONLY TO IrlL ~i:,:'~;,; fe" W:"':;.\!, lH( !:U';'V[Y
IS flUtAd;:;, "'.-0 u,~ H,S B.I.Mi' Il: i'He
rlTLE COMi'ANY. GOVl:"W"lN'IAl A~tNC'r AND
lINDINt> 1:,snlUllOI~ liSTLc. .U..ON, AIlD
TO THE A~SIGI,llS CF TliE LL"DING INSTI-
TUTION. (;UA:V.....lLl:S An hOT J,.M,Hb:A8Lf
TO AD;)llIONAL IhSmuTIO,,"S Ok SUI;StQUiNT
OWNUS.
NOT€:
. : MONUM€NT
SUBOIVISIONMAPFIL€OIN TH€OFFIC€
OF TH€ CL€RKOF SUFFOLK COUNTY ON
oIUN€ 22,1970ASFIL€No. 5486.
REVISIONS
YOUNG & YOUNG
400 OSTRAN-OER AVENUE, RIVERHEAO, NEW YORK
JAN. 24, 1973
MAY I, 1973-
ALDEN W. YOUNG
PROFESSIONAL ENGINEER,AND
LAND SURVEYOR. N,Y.S. LIe:. NO, 12645
HOWARD W. YOUNG
LAND SURVEYOR
N.Y.S. Lie. NO. 4:1693
SURVEY FOR:
INLAND HOMES,INC.
LOT NO.26," LAUREL COUNTRY ES"., };t:;;~~-:::;-,,:
/7 ~"-,'T-' -.'-, "
7_...."'.....~ . . \ '-'.. ",
'f ~!"("I\;'_'.". p'. .~.'" v.~.:..:\,- \.
AT
LAUREL
SOUTH OLD
SUFFOLK CO., N. Y.
TOWN OF
,
SCALE: ," = 40'
TOWN OF SOUTH OLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.netlSouthoId/
PERMIT NO.
h/u3 l/
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
~ 4 sets of Building Plans
Planning Board approval
.J. Survey
.; Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Expjratjpn
'i I I',
j, r 'I, ___
~ 1/3 , 20 () t.
. -
V/13,20~
- I)II~: 01'
".O!_\(~
, i ~
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Examined
Approved
Mail to:
Disapproved aI c
Phone J,J't - '-f :J.J y
\lill2"
p~
Building Inspector
. !
APPLICATION FOR BUILDING PERMIT
Dat#~
/.2-
20 (}6
'-
INSTRUCTIONS
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 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 South old, 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.
L
(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
Nameofownerofpremises ~/110A/U ;MJ~~ ~m 4t/.s~~
(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.
Other Trade's License No.
I. Location of land on which proposed work will be done:
3C~ ') "t>~C,u4,t.. ~W4 ( iAz/uu /N-~ lit} '/ r
House Number Street I Hamlet
County Tax Map No. 1000 Section
Subdivision
I ;?,S
Block cf
Filed Map No.
.h,
Lot rf
Lot
':"1
.,
(' .11
.':
(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
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
Alteration
4~ l:- #5 J1rJkr
(Description)
5. If dwelling, number of dwelling units
If garage, number of cars
Fee f 3CJt'}. 02-
(To be paid on filing this application)
Number of dwelling units on each floor
4. Estimated Cost
~, UJi) , ~
f
6. If business, commercial or mixed occupancy, specify nature and extent 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 Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflot: Front
Rear
Depth
10. Date of Purchase
Name of Fonner 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. Willlot be re-graded? YES_ NO_Will excess fill be removed from premises? YES_NO_
14. Names of Owner of premises 41h4& 6vr~ddress 3~ j .tJ~ J.{{qe.Phone No. O1fJ"~ ~2~
Name of Architect I 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 & 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.
being duly sworn, deposes and says that (s)he is the applicant
(Name of indivi ual signing contract) above named,
~e ~e-r
(Contractor, Agent, Corporate Officer, etc.)
~\)
s/er
(S)He is the
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~ before me thi.s,-, ( _
I d-- day of 0~ 20~
~-2J(~
I Notary Public
BARBARA H. TANDY
Notary Public. Slale Of New Vorl<
No. 01TA60BBOOl
Qualified In Suffolk County rl 'L-
Commission Expires 01/13/20!L.J
~PPl;~m
1000
OWNER
-_/
-12 j~- '1_ f' TOWN OF SOUTHOLD PROPERTY RE'-ORD CARD
2-5
11-9
--
STREET
VILLAGE
DIST. i
SUB. ~.. LOT#c.?
/ 1 :I.,::J 4-t. ,,~ <-.' ~t, ",. r I, / c:;.. z:; .t[
ACR. {'
,S,g
TYPE OF BUILDING
7!.AYl>t6KO ~. J/ntJSLE
FORMER OWNER
-;(# L 1M! [) !14th E$ :J:,,,C.
RES. .2/ (j
LAND
;rO 0
/0 oj
I/DO
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W
SEAS, VL. I FARM COMM. CB. MICS. Mkt. Value
IMP TOTAL DATE REMARKSIJ"-..,-:" ,4'" ., .,.P~1. i~-).../ T r r"/ ,/,' ,
. /1/?/7(! -.jh/C;Y /,<, Mfc:J L':"J ";:j" '"I:,i,,'" 0 oJ, J /e~J en, I,
~oo, I "fl?/'ll /)t;hfJJ/~Jrft""#'b.i',2 fZ, !Jv{,/d u..... hO(;.['('r Er c1.0.t!cJO. -:.
/000 .J 2/j/73 3/;l6h3jo~y'..r7Jf'J6{)' .J/.ccl:eJ'/<,' 76 .1"<.J / j /ld"'~( If/C,
7"'.:600 S-<,/oO"Tj,:"-/,3() Z~"
..5/06 .../ ffof'5~1:~'fl~~j
( , ,
nllable FRONTAGE ON WATER
,
Noodland FRONT AGE ON ROAD r
/36
~eodowl<lncl DEPTH 17()
,
-louse PIQt BULKHEAD
rotal
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Extension C,i,S-,.. <:16 ~..,()
.3 60
, Extension
Foundation '/)t. Both / Dinette
Porch Basement FvL'-' Floors 6:J41( K.
larc:h . Ext. Walls /"tse",wooj;> Interior Finish LR.
S 1-11 J{';' . 1,JAj..L. ;P
Breezeway Fire Place /oj 0 Heat ,j f.-> DR.
Garage 3 ,S' h" ype Roof Rooms 1st Floor , BR.
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FRONT ELEVATION
SCALE: 1/4" = 1'.0"
OCCUPANCY OR ~ !?rudf"
USE IS UNLAWFUL APPROVED AS NOTED
WITHOUT CERTIFICATgTE: d/~/(" CP# -:fd.103 y
::>F OCCUPANCY FEE: it!?) ny: I'~A-'-
NOTIFY BUILDiN3 ".:;r;iMENT AT
765-1802 8 AM 1 () 4 D\/ FOR THE
FOLLO'NING INSPEC," ;:,S:
1. FOUNDATION. iIV' REQU'RED
FOR POURED C'.J"CRETE
2. ROUGH . FRAMING & PLUMBING
3. INSULATION
4. FINAL. CONSTRUCT ON MUST
BE COMPLETE FOR .0.
ALL CONSTRUCTION S ALL MEET THE
, TH :;OJES OF NEW
PONSIBLE FOR
TlON ERRORS.
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CONC. FTG.
SECTION A-A
SCALE: 1/4" = 1'.0"
~FH (,,-ICATION OF
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LEFT ELEVATION
SCALE: 1/4" = 1'.0"
DeCK
HAUSLER, MATTITUCK, NY
PREBUILT PRIOR 2003
June 08, 2006
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June 08, 2006 SCALE
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