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Home My WebLink About22662-zFORM NO. 4 TOWN OF SOUTBOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. CERTIFICATE OF OCCUPANCY No Z-24956 Date MARCH 26, 1997 THIS CERTIFIES that the building Location of Property 420 JASMINLANE House No. County Tax Map No. 1000 Section 70 Subdivision ADDITION BOUTHOLD, N.Y. Street Hamlet Block 1 Lot 6.9 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MARCH 17, 1995 pursuant to which Building Permit No. 22662-Z dated APRIL 5, 1995 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 GARAGE ADDITION TO EXISTING ON~ FAMILY DWELLING AS APPLIED FOR The certificate is issued to WILLIAM H. GAFFGA (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED N/A H-047980 -- DECEMBER 1, 1995 N/A Rev. 1/81 FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 22662 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) at premises located at ................... ~.ff:'/~...~ .......... ...................................................... ............................ CounlyTaxMapNo. 1000 Section ......... ...~.....~.. ...... Block ............ ./.. ........... LotNo. ~''' 9' pursuant to application dated ................ ~/~....~.....~.....~.......~..7.., 1 9...~..~and approved bythe Building Inspector. Rev, 6/30/80 A. Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-I802 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 Unde~rwriters. 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 certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of cdmpleted site plan requirements. . B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and '3pre-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-existin~ Buildin~ - $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 ..~C~...~.~. ........................~ New Construction. .. Old Or Pre-existing Building ................. Location of Property .... .~.~O. ................ ~.~.,.z~..~....~..,~..~. ......... ~9..0~...O~.. ........... House No. Street Hamlet Onwer or Owners of Property ..... ....... . ........ ............... ............ County T= 1000. Seetion....?.O ....... Block. not Subdivision ~. O.q ~J~.~. ?.1~ ~ Map..~.~ ..... /6 ............... ................. ~iled ..... Lot ...... Date Of Permit ............................... Health Dept Approval Underwriters Approval ........ Planning Board Approval ........................ Request for: Temporary Certificate ........... Final Certicate...~....... INSULATION I~R N. Y. STATE ENERGY' CODE II ADDITIONAL CO~S: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGHPLBG. [ ] FOUNDATION2ND [ ]INSULATION [ ] FRAMING [ ~FINAL [ ] FIREPLACE & CHIMNEY DATE ~/~hl INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FO/UNDATION 2ND [ FRAMING [ REMARKS: [ ] FIREPLACE & CHIMNEY ] ROUGH PLBG. ] INSULATION ] FINAL INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [~FOUNDATION 1ST [ [ ] FOUNDATION 2ND [ [ ] FRAMING [ []FIREPLACE&CHIMNEY ] ROUGH PLBG. ] INSULATION ] FINAL DATE INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS ~Ac.,~ ~. 8057634 I , l~5 JOHN STREET, NEW YORK, NEW YORK tOO38 -- DECEHB~R 01,1995 1070159~/95 H 0~79~0 WILLIAM H.GAFFGA II, 420 JASMINP~ I~NE, SOUTHOLD, N,Y~ in the followlng location; ~ ?asetnenr ~ Ist Fl. [] 2nd FL GAR ,%etlon Block Lot ~s examined on NO~}~B~R 27t 1995 and found to be in compliance ~ith the National Elect~c~l Code. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE OUTLETS SWITCHES FLUORESCI~NT OTHER 2 6 DRYERS E R I C ,~o. o%cc ¢o.D... A. ,,,. ~. OF HIA. EG NO, OF NEUTRALS A. WG OF NEUTRAL P,O. BO~ 1'332 SOUTHOLD, try, 1 J. 9'7 ! GENIAL ~AO~R 11 P~r This certificate must not be altered in any manner; return to the office of the Boa~d if i.corred. Inspectors ~y be i~nfified by t~ir cmdentlals. COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST,,NOT BE ALTERED IN ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BU!LDINO DEPARTM ENT~ TOWN HALL SOUTHOLD. N.Y. 11971 BOARD'OF HEALTH ........ 3 SETS OF PLANS ........ SURV£Y ................. CI1ECK .. :.::.:.:. ~ ,.,~ .~-- / TEL.: 765-1802 . NO?IFy' . . Date .. .. INSTRUCTIONS a, T~s apphcatzon must be completely Qlled in by ~pewdter or Jn ink and submitted to the BulldOg Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot pl~ show~g location of lot and of ~uild~gs on premises, relationship to adjoining premises or pubUc street or a~eas, and giv~g a det~led description of layout of property muJt be drawn on the diagram which Js pa~ of this app[ c~tJ0n. c. ' The work covered by t~s applkation may ngt be commenced before issuance of BuQding Pe~it. ~. Upon approval o[this application, the Building Inspector will issued a BuQd~g Pe~it to the applicant. Such sh~ be kept on the premises available For ~spection throughout the work. c. No build:ng shall be occupied or us:d in wlole o: in p~t fo~ any purpose whatever until a Ce~JQcate of Occup~c- shall have been granted ?y ~e Building Inspector. APPLICATION IS HEREBY ~ADE to the Bufld~g Dep~meJt For the issuance of a B~ldJng Pe~it pu~uant to th Building Zone Ordinance of the Town of Southold, .Suffolk County, New York, ~d other appHcable Laws, O:d~ces o Regulations, for the const~ctJon of bulldogs, additions'or alterations, or For removal or demolition, as here~ desc:Bed The applicant agrees to comply with all appHcable taws, ordinances, bu~d~g cod~, housing cod~, and regulations, and admit authorized ~spect~ on premises and ~ b uild~g for n ecessa~~ ~~ . - ' ......... pp icant, or name, if a corporation) (Mailing address of applicant) State whether applicant :s owner, lessee, agent, architect, engineer, generaJ 'contractor, electrician, plumber or builder. ........... ...... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (N dtitl f rip ffi ) "" amean eo co orateo cer Builder's Lic No ' ense ........ . Humber's License No .... Electrician's License No Other Trade's License No ...................... I. Location of land on which proposed work will be'done ...................... : .................. · ' ' House Number Street Hamlet Couhty Tax Map No. I000 Section . . . i.?.O. .... . ..... ~lock . ' Lot .... t .......... Subdivision ~OOmo~h .~l:~ ....... '. Filed Map No. .~,~,:, Lot /~. ........ ' ....... (~'ai~e)" ' ' ................. 2. Stare existing use and occupancy of premises and intended use and occupancy o~proposed construction: E - a. xisting use and occupancy .................................. ,~fL,'.~l{~2'~%'J'~"~~;¥~ ................... ;~ ~)l~,~;~j~', .~3 ................ '3. Nature of work (check wl~ich ipplicable): New Building ......... ; Addition . . Alteration .... ; ..... Repair .............. Removal .............. , Demolition .... , ........ Other Work ...- .......... 4. Estimated Cost ..... . ... Fee ........... , . i (to be paid on filing this application) 5. If dwelhng, number of dwellin~ Units". ~ ............ . Number 6f dwelling units on each floor ......... J If garage, number of cars .g.~ ~..~.eO) ." ... ~ " ' ........ ,, I..f. bus~n.ess, co,mmercml or m!xgd occupancy, speedy nature and extent of.each type &use ............ ~. ~mens~ons of existing structures, if any. Front..-~.~,,.~. ' r~ ~ 5-;, ~ , . pth .............. Height Number of Stories ~ .~.' .r.O f.-~. ' Dimensions of shme structure ' · ' ' O~..~ : w~th alterauons or add~tlons: Front Rear Depth ' ~ ...... ' ............... i Height . Number of Stories ' ' ~, ' .... 8 Di i f " ' mens ons o entire new construction: Front ......... , ....... ~ ear...,, o,. ' De Hight ' Numbe of Stori ...... I ..... ' ........... · e ............... r es ........ 9 Size oflot: Front ...... ~" ' '~ ' "~ ....... ' ' ' Rear Depth ................... 10 Dar of Pu has (z,,lt.,.Tl.q,g, Name of Former Owner ~f-gq.,fflq--. ........... 11. Zone or use district in which .premises are situated ...... ,~.'P~l/3.~.'r/O~ ................... '' . 12. Does proposed construction v ate any zoning law, ordinance or regulation: ............ 13. Will 16t be re reded ,o~ .................. g ...... , .................... Will excess fill be removed from premises: Yes (~ 14. Name of Owner of premises i ...... ~ .... Address . . Phone No. . Name of Architect ......... ........ , .... ~. ~'.... Address Phone No . · Name of Contractor ........ i ....... Address ' , , ............................. Phone No ................ 15. 19~this property within 1300 feet of a tidal ~wetland? *Yes ........ No...~..... · If yes,'Southold T. own. . Trustees Permit may.be required. PLOT DIAGRAM : Locate dearly and distinctly ali buildings, ~heth~r existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc or description according to deed, and show street names and indicate %hether interior or corner lot. '. ~/ ~. . STAVE OF N wyo ,x,, COUN'Ey OF....~...sS-p.X~. ...... ..... .w. (N e of'ndividualsigni~g contract) ~bove named .... being duly s~yorn, depose9 and says that he is the applicant (Contractor, agent, cooorate officer, etc.) said owner or owners, and is dulyi authorized to perform or have performed the said work and to make and file this ~pplication; that all statements contel!ned in this'application are frue to the best of his knowledge and belief; and that the ~ork will be performed in the manner?et forth in the application filed therewith. ' ;worn to before me this Z02- 7~ ZOF ~. 00, JA SM/NE LANE t?--37/.46'. /- =111.9~' CERTIFIED TO' WILLIAM GAFFGA THE BANK OF NEW YORK SUPERIOR ABSTRACT CORPORA TION TRW-S-~4Z, 9$8-1~ Prepared in accordance wilh lhe minimum slondords tar lille surveys as estabflshed by lhe L.LA.L.S. and approved and odopt~d tar such use by The New York Slale Land Tfile Assoclolion. The waler supply and sewage disposal syslems for this residence will contorm lo lhe slandards of The Sullolk Counly Duporlment of Health Services. The iocafions ut wells and cesspools shown hereon are from field obsorvqfions and or /rom dala obtained /rom others. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY 92 SO 53 DATE ,. HS. REF. NO. AREA= 14,278 sq. ft. SURVEY 0 LOT "MAP OF SOUTHOL£ FILED JUNE 25, 1992 ~! A T SOUTHC TO WN OF SOU, SUFFOLK COUN 1000 - 70 - OIL 6, March 11,1 191 JUL Y 15, 199~ (f~ Oct. 23,1~2 (f~ (/y,O ~c .S', ~ -05 .:',-