HomeMy WebLinkAbout32951-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32400 Date: 06/13/07
THIS CERTIFIES that the building DECK ADDITION
Location of Property: 3055 DELMAR
(HOUSE NO.)
County Tax Map No. 473889 Section 125
DR
(STREET)
Block 4
LAUREL
(HAMLET)
Lot 8
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
APRIL 20, 2007 pursuant to which
Building Permit No. 32951-Z
dated
APRIL 26, 2007
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 SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to ROBERT & MARIE COLWELL
(OWNER)
of the aforesaid building.
N/A
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO_
N/A
PLUMBERS CERTIFICATION DATED
~ (J, 'J/J.
~/-
uthorized Signat~re
Rev. 1/81
~d<
Form No.6
TOWN OF 80UTHOLD
BUILDING DEPARTMENT ' I" ;$" II" In I"
. TOWN HALL t~- lS ~'. i. '\/"
765-1802 J r--- --~.
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APPLICATION FOR CERTIFICATE OF OCCUPAN I _'_.---:;'- ~ I
This application must be filled in by typewriter or ink and submitted to the Building Departme~,w,i\l1~flli~ng:
A. For new building or new use:
I. 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 2/1 0 of I % 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:
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.
New Construction: Old or Pre-existing Building: (check one)
Location of Property: '3055. lY~C'\Y1r lJyivt:
House No. Street
Owner or Owners of Property~r.}cyr-4- ~ ff\rt ne Crl ~ \
Suffolk County Tax Map No 1000, Section 1d.5 Block Lf
LQur....~\
Hamlet
Lot 'X
Subdivision
Permit No. '3 2<) S' I~ Date ofpermit. tf.;)l, -OJ
Filed Map.
Applicant:
Lot:
Health Dept. Approval:
Underwriters Approval:
Planning Board Approval:
Final Certificate~
Request for:
Temporary Certificate
( check one)
Fee Submitted: $
dS,Ol)
~q(
~ C~U.&O
Applicant Signature
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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-32401 Date: 06/13/07
THIS CERTIFIES that the building HOT TUB
Location of Property: 3055 DELMAR
(HOUSE NO.)
County Tax Map No. 473889 Section 125
DR
(STREET)
Block 4
LAUREL
(HAMLET)
Lot 8
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
APRIL 20, 2007 pursuant to which
Building Permit No. 32951-Z
dated
APRIL 26, 2007
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" HOT TUB ADDITION TO AN EXISTING SINGLE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to ROBERT & MARIE COLWELL
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE NO.
3033859
05/31/07
PLUMBERS CERTIFICATION DATED
N/A
~~~
Authorlzed Slgnature
Rev. 1/81
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
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 2/1 0 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
@ 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)
Locationofproperty: '"2::(:)55 ~\ffY1 r ~Ve..
House No. Street
Owner or Owners ofpropertYfuyYr+- ~ ~lt: C.r\ v-Y..\ \
Suffolk County Tax Map No 1000, Section _I ';).. c;- Block If
( flUId
Hamlet
Lot g
Subdivision
Filed Map.
Date of Permit. Jf 1.),10 I () '7 Applicant:
Lot:
Permit No. ~;). '15 J
Health Dept. Approval:
Underwriters Approval:
Planning Board Approval:
Request for:
Temporary Certificate
Final Certificate: .~
(check one)
Fee Submitted: $ :;;r; . DO
~ 7 l"l.N6
~1\'.lQC~
pplicant Signature
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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.
32951 Z
Date APRIL
26, 2007
Permission is hereby granted to:
ROBERT COLWELL
PO BOX 546
MATTITUCK,NY 11952
for
"AS BUILT" DECK & HOT TUB AS APPLIED FOR
at premises located at
3055 DELMAR DR
LAUREL
County Tax Map No. 473889 Section 125
Block 0004
Lot No. 008
pursuant to application dated APRIL 20, 2007 and approved by the
Building Inspector to expire on OCTOBER 26, 2008.
Fee $
650.00
I!~ (~
I Authorized Signature
ORIGINAL
Rev. 5/8/02
7.
8.
~vJcn :#3/
JJ.o~Y -2
Erosion, Sedimentation and Storm-water Run-off Control Plan ASSESSMENT FORM
Yes No
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 REOUlRING THE SUBMISSION OF A STORM-WATER, GRADING, DRAINAGE & EROSION
CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE. OF NEW YORK.
Item Number: (A Check Mark (J) for each question is required for complete application)
Yes
No
I.
Will this project retain all Storm-Water Run-off generated on Site?
(This will include all run-off created by site. clearing and/or construction activities as well as all
Site Improvements and the permanent creation of impervious surfaces.)
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2.
Will this project require any land filling, grading or excavation where there is a change to the
natural existing grade involving more than 200 cubic yards of material within any parcel?
3.
Will this application require land disturbing activities encompassing an area
of five thousand (5,000) square feet of ground surface or more?
4.
Is there a Natural Water course running through the site or is this project within
One hundred (100) feet of wetlands or a beach?
5.
Will there be site preparation on slopes which exceed fifteen (15) feet of vertical rise to
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 direction ofa Town Right-of-Way?
Will this application require the placement of material, removal of vegetation and/or the
construction of any item within the Town Right-of-Way or road shoulder area?
. (This Kem does not include the installation of driveway aprons.)
Will there be site preparation within the one hundred (100) year floodplain of any watercourse?
Note: If any answer to questions one through eight is answered with a check mark in the Box, a Storm-water, Grading,
Drainage & Erosion Control Plan is required and must be submitted for review prior to Issuance of any building permit.
-------------------------------------------------------------------
STATE OF NEW YORK,
COUNTY OF. ....... .......... . S8
That I. ..R.Q.6..'(r.:.f.........?.tf..t.JUr...t............ ..... being duly sworn, deposes and says that he/she is the applicant for Permit,
(Name of individual signing Document)
And that He/She is the ........... ......(O;,;;;!ce;:.;:;:t~;:c~;;,~;~;;offi;;;,;t;i.............. ............
Owner and/or representative of the Owner or Owner's, 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 belier; and that the
work sill be performed in the manner set forth in the application filed herewith.
Sworn to before me this; ~I '- -zoO r-
........ ......t.l...... .. .... ..day of. ..... NOTARY'~,=-~"''''
No.01818152lil51
Notary Public: ... .... ...................~~~'~6.20J..()
c.....a.1t8sioil ......- ,
l!I.l!I
i BY THIS CERTIFICATE OF COMPLIANCE THE ~
~ NEW YORK BOARD OF FIRE UNDERWRITERS ~
~ BUREAU OF ELECTRICITY ~
~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~
~ CERTIFIES THAT ~
~ ~
~ Upon the application of upon premises owned by ~
~ ~
~ JOHN LUDEMANN ROBERT COLWELL ~
~ PO BOX 621 3055 DELMAR DR ~
~ NEW SUFFOLK, NY 11956 LAUREL, NY 11948 ~
~ ~
~ Located at 3055 DELMAR DR LAUREL, NY 11948 ~
~ ~
~ Application Number: 3033859 Certificate Number: 3033859 ~
~ Section: Block: Lot: Building Permit: BDC: ns11 ~
~ ~
~ Described as a occupancy, wherein the premises electrical system consisting of ~
~ electrical devices and wiring, described below, located in/on the premises at: ~
~ Outside, Pool/Spa, ~
~ A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ~
~ herein, was conducted in accordance with the requirements of the applicable code and/or standard ~
~ promulgated by the State of New York, Department of State Code Enforcement and Administration, or other ~
~ authority having jurisdiction, and found to be in compliance therewith on the 31st Day of May, 2007. ~
mJ Name OTY Rate RatinlZ Circuit ~ rel
~~~ ~
~ supply power to self contained ~
~ hot tub and above ground pool ~
~~~~ ~
mJ Disconnect I 0 60a Pool/ Spa mJ
~ GFCI Circuit Breaker 1 0 40a Pool/ Spa ~
~ Receptacle 1 0 GFCI ~
~ Switch 1 0 General Purpose ~
~ (Swimming Pool): This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have ~
iaI frequent test and/or repairs made by a qualified person. iID
~ ~
~ ~
~ ~
~ ~
~ ~~ ~
~ ~
~ I of I ~
~ ~
I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING M FINAL k "
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: ;O~ ~ if-
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DATE 6--; /07
INSPECTOR ~ ~
3;L~SI Z-
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
] FOUNDATION 1 ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ] INSULATION
] FRAMING I STRAPPING rP<f: FINAL
] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: W t/-- /fj:f T ~ tN- DK J
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'E:' - CRJ0C, ~&, I
5-/..>-07 INSPECTOR ~~
DATE
FIELD'INSPECTION REPORT DATE I
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COMMENTS
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FOUNDATION (lST)
FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBING _
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INSULATIONPERN. Y.
STATE ENERGY CODE
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ADDITIONAL COMMENTS ./ n xr..L..7
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PERMIT NO.
.3ri--85I-c
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans ~'
Planning ~d approval
Survey
CheebJI-cJyf 5 .
Septic Form
NYS,DEC
Trustees
Contact:
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
Examined
1~'20tl
,20&
Approved
Disapproved ale
Mail to:
Phone: ? ?, <f - :J 0 , I
I
Expiration
, D~,20JlL
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I Building Inspector
'PR2020er
-'
APPLICATION FOR BUILDING PERMIT
Date /).1 fI J
,
2~
,20 tfl7
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 oflot 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, admit
authorized inspectors on premises and in building for necessary inspections,
JA fF {VIlfln C/-(.
(Mailing address of applicant
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
:; M,,-rl-G- Co / w<;./ /
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
j).;~,.. f
.
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Name of owner of premises
(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:
'3 t> 5"7 t?et/Y1'u'" /}rtvt:.-
House Number Street
tPf//'C I
Hamlet
County Tax Map No, 1000 Section /2 'r
Subdivision
Block 4
Filed Map No,
Lot g
Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy 1<<:5/111.:"1 c-c
b. Intended use and occupancy
I< e.'5I'/ t'", ?.<:.
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition Alteration
Other Work tt'p&f /'~'/.Ie>,.,
(Description)
4. Estimated Cost
Fee
5. If dwelling, number of dwelling units I
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
tit)
A/ / Jl-
Depth ~4, 3
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front 4- 0
Height ~ I' Number of Stories
Rear
I
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
Rekr'<
8. Dimensions of entire new construction: Front If 0
Height Number of Stories
Rear 4 t?
Depth 3$, 4
9. Size oflot: Front
1/.7
Rear I tfo
Depth_I ft1J 3~
10. Date of Purchase
Name of Former Owner
II. Zone or use district in which premises are situated
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12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO ~
13. Will lot be re-graded? YES_NO L Will excess fill be removed from premises? YES_NO ~
14. Names of Owner of premises cJwd/ Address 3""" tJ~/M"r Phone No. 2.'f% - 7.2 4-3
Name of Architect lJlvJ PJ",""IIH e,,~ -f Address PhoneNo 7JII-.p~//
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 1
* 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 )
!?t? I~; I- tt/~IJ"C// f being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
/J-'J elJ f
(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 thO
f8 day
It- 20~
X-~
JOHN E. S11.l/oIPF
NOTARY PIJBIJC, __1:4 f!Qw_
No.01STl11Ul61
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