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Home My WebLink About21606-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23049 Date JUNE 20, 1994 THIS CERTIFIES that the building NEW DWELLING Location of Property 1455 JASMINE LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 3 Lot 24.8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 2, 1993 pursuant to which Building Permit No. 21606-Z dated AUGUST 24, 1993 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 ONE FAMILY DWELLING (1ST Q 2ND FLOOR) WITH ATTACHED GARAGE AND WOOD DECK The certificate is issued to PECONIC PROPERTIES MANAGEMENT CORP. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 93-SG-26- DEC. 2, 1993 UNDERWRITERS CERTIFICATE NO. PENDING - JUNE 20, 1994 PLUMBERS CERTIFICATION DATED JUNE 1, 1994 - ARTHUR MALADSSENA, JR. q2 Rfidi ing Inspector Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT COMPEEMUST TIION OF THE WORK AUTHORIZED) PREMISES UNTIL FULL KEPT ON THE Date Y/93.. 19J x... N°_ 21606 Z Permission is hereby granted to: D. ~8.....//c3 . / .1 / to rlt %.,Tz . at premises located at.. CounNTaxMapNo. 1000 Section.....la•.......... Block LotNo.. c~ and approved by the pursuant to application dated 19...I Building Inspector. Fee S• ° ~'G a'nrs4 a. . / Building Inspector Rev. 6/30/80 7a, 6 o Form No. 6 ~41 TOWN OF SOUTHOLDG BUILDING DEPARTMENT /off TOWN HALL U/J ~?X O 765-1802 r 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 Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00,, Commercial $15.00 Date ~/,/„1(, New Construction.. Old Or Pre-existing ui1 y~ Location of Property.. f T......K . . House No. Street mlet Onwer or Owners of Property.,2. 4ft4(_, i' -mow :u2y L~5fC/ , County Tax Map No 1000,JJ~~Section .....6 I• ...........Block..... ...Lot..Z X Subdivision)' .h& . ~((~~c~.. .(FiileQd Map.44../. r31. Lot..Q... .~.j.~............ Permit No..4 1.6ZL: .DatennOf Permit. ApplicantW ~/l pl(G ~l/ Health Dept. Approval /?9 /2/R.. o ..,Underwriters Approval Planning Board Approval Request for: Temporary Certificate........... Final Certicate..x Fee Submitted: $ - , a.~.~,, goad . ~ ~ 4 APPLICANT c.o ?'a3oy9 . THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 r1000837 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 Date JUNE 23,1994 Application No. on file 82640093/93 N 318280 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of SOUTHOLD VILLAS, 1455 JASMINE LANE, JOB-8, SOUTHOLD, N.Y. in thefo/lowing location; ® Basement ® 1st Fl. ® 2nd Fl. GAR/OUT Serti..II Block Lot was examined on JUNE 20,1994 and found to be in compliance with the National Electrical Code. FIXTURE KE?TAClES SWITCHES RXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS I. NDESCENT FLUOIIESCENT OTHER T. K. W. AMT. X. W. T. K.W. AMT. K. W. AMT. H.P. 33 35 29 33 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALRK'PT TIME CLOCKS YLL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K. W. OIL H. P. GAS H. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H. t. SYSTFEMS IJAT. WAli3 NO.O FEET 1 F 2 - - 2 - 1 SERVICE DISCONNKT NO. OF S E R V 1 C E AIRTER AMT. AMP. ITPE P. 1 A tW 1 9 3W 3 9 3W 3 Z AW NO. Of PER& CC. COND. Of A. COND. NO. OF HI-LEG .'W.~G NO. Of NFUTRALS Of . W.. NEUTRAL 1 150 CB 1 X 1 1 1 1 OTHER APPARATUS: MOTORS I3-F H. P. G. F.C.II-9 SMOKE DETECTOR[-1 SPUDS ELECTRIC SERVICE LIC.11192-E 175 3RD.ST. BOX 166 OWEML MANAGN ST. JAMS, NY, 11780 11 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by'$Gir credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. INSPECTORS y'" gUFFO(~ J~w~,.._.. !c G SCOTT L HARRIS, Supervisor Thomas Fisher Southold Town Hall Building Inspector P.O. Box 1179, 53095 Main Road 1 Gary Fish Southold, New York 11971 Building Inspector =-Y Fax (516) 765-1823 Telephone (516) 765-1800 Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUMOLD ' C E R T I F_1 C A T I O N DATE: Building Permit No. o~~6a6 z Owner:-ACON/e DRor001-Ti2S h4d1j4 A4eA1rC0i-p please print!) ~e Plumber: Amy 5-4-- 4,0V (please print) I certify that the solder used in the water supply system contains less than 2/10 of IZ lead. 7 lumbers Signature 4 P Sworn to before me this day of ln~ .19914. Notary Public, County N ary Public QUONftw in 800030 COMMI"lon E*m WC Mad MELD I::SF_; TIUN -11uATE 1 UMMGNT° a 3 H FOUNDATION (1st) FOUNDATI (2nd) 2. wv 4 z 1410 0 ROUGH FRAME & Irk PLUMBING H f 3. ~r INSULATION PER N. Y. STATE ENERGY CODE Q G ca 4. 4 r H O Aa /4 FINAL gg 0 z ADDITIONAL COMMENTS: m O oa ro x~ a a H O y V m ~ a • rr~- • ~ C7 1 V1 H BOARD O-F -HEALTH FORM NO. 1 3 SETS OF PL.1YS TOWN OFSOUTHOLD SURVEY BUILDING DEPARTMENT CHECK _ . TOWN HALL SEPTIC FORM SOUTHOLD, N.Y. 11971 _ TEL.: 765.1802 t: DT I FY Examined . , 19 CALL MAIL TO: Approved . IgvPermit No... .60~? . . . . . Disapproved a/c . . ( ildin Spector) APPLIC TION FOR BUILDING PERMIT • Date ((ff 19~•`• INSTRUCTIONS a. This application must be completely filled in by typewri ter or in ink and submitted to the Building Inspector, with 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 stieet< 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 herein described. The applicant agrees to comply with all applicable laws, ordina es, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for nec ssa nspectio (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 o builder Name of ow r of premises (as on the tax roll or latest deed) If a a rporation, signature of duly authorized officer. .12- y 2- 0 (Name and title of corporate officer) ui er's License No. . Plumber's License No. . Electrician's License No. . . Other Trade's License No. I. Location of land on which proposed work will be done. , !louse Number Street • Hamlet County Tax Map No. 1000 Sectiop , • • • • , Block , , . , , . • , , • . Lot . Subdivision . ~~{i•G~ , , Filed Map No. 8 (Name) Lot . 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 (2heck which applicable): New Buil ding . / , Repair Removal . , Addition Alteration . • • • • . • , • Demolition Other Work 4. Estimated Cost (Description) Fee..... 5. If dwelling, (to be paid on filing this application) o, number of dwelling units • . , Number of dwelling units on each floor , . If garage, number of cars . . 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 ...............Num of Stories Rear Depth of same structure with , , , , , , • • • • • • • . Dimensions • . Depth ions o , alterations or additions: Front Rear . . • • Height 8. Dimensions of entire new construction: ront . . . . . . . . " . Number of Stories........... Height ...............Rear............... Depth y. Size ht lot: 1ront Number of Stories . , , , . , . Dateofot- se Rear Depth 10 11. Zone or use district in which premises are situated , Name of Former Owner , , • , , , , • • • ' ' ' ' 12. Does proposed construction violate any zoning law, ordinance or regulation: • . ' 13. Will lot be regraded . Will excess fill be removed from premises: Y • .14. Name of Owner of premises es N, Name of Architect ' ' . ' ' ' • - • Address , , , , , , , , , ,phone No... _ Name of Contractor ' ' ' ' • • • Address Phone No.... , • • • 15. ' Is this property within 300 feet of a tidal 'Address ? , , , , , , , pho e`No . rmwetland, quire,,,,,, No..X • *If yes, Southold Town Trustees Permit may. be required. - ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions frorr property lines. Give street and block number or de cr' do ac ding- to deed, and show street names and indicate whether interior or corner to%t?j ~ p i ~~j° APPROVED AS NOTED. DATE: 2 3 B.P. # UNDERWRITERS CERTIFICATE FEEIcZ V f~ By, T REQUIRED NOTIFY BUILDING DEPART NT AT 765-1802" 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED = FOR POURED CONCRETE 2. ROUGH - FRANIING & PLUMBING I tab? s 4. Fit,, I_ F~ONSTRUCTION MUST BE COI` P ETE FOR C.O. ALL COii'iTRU( fiON SHALL MEET THE REQUIREMENTS OF THE MY. ,,,AT[: CONSTRUCTION & ENERGY Ci??7cS. NOT RESPONSIBLE FOR ~??tQER CERTIFICATION DESIGN OR CONSTRUCTION ERRORS &N LEAD CONTENT BEFORE. CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNOT €XCEED 2110 OF 1% LEAD. STATE OF NEW YORK, . COUNTY OF . S.S ' ' . ' ' ' ' ' ' ' ' ' ' ' ' . ' • • • • • • • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. 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 1pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the •vork will be performed in the manner set forth in the application filed therewith. Sworn to before me this l.d. G G day of 19 . \ ounty . ^CL Notary P bCc, State loKINeS Now York ' • C! No. 4952246, Suffolk Coin • . (Signature of applicant) Term Expires June 12,19 _m a o~ z O~~ti O COS ~Otl~ 2 O LL. 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