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Home My WebLink About21601-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22787 Date DECEMBER 15, 1993 THIS CERTIFIES that the building NEW DWELLING Location of Property 895 JASMINE LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 3 Lot 24.1 Subdivision SOUTHOLD VILLAS SEC #2 Map No. Lot No. 1 conforms substantially to the Application for Building Permit heretofore filed in this office dated AUGUST 2, 1993 pursuant to which Building Permit No. 21601-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 FLOOR ONLY) AS APPLIED FOR. The certificate is issued to PECONIC PROPERTIES MANAGEMENT CORP. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL-93-SO-19-DEC. 2, 1993 UNDERWRITERS CERTIFICATE NO. PENDING - DECEMBER 14, 1993 PLUMBERS CERTIFICATION DATED NOV. 21, 1993-ARTHUR MALAUSSENA JR. Building Inspector Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWNN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N2 21601 Z Date /.T 19. Permission is hereby gra ted to: . . ~is3 ~.f.~ to.. ..a..... . ........................................AA......................................................../................................................................ at premises located at..4n;9 chi...~F. CountyTax Map No. 1000 Section 6,.Y Block '...a.... Lot No..... A5.` I........ pursuant to application dated .........(0 19... and approved by the Building Inspector. Fee $ ...1..J~ Building Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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, CLo~mme gcial $15.00 Date . 9.3 New Construction... X.. rOlld Or Pre-existing Build' g...... . Location of Property... U./. House No. Street Hamle Onwer or Owners of Property. . . County Tax Map No 1000, Section J~. Block.... ......[....Lot... /a. 7 Subdivision. . ......'kOFiil~Jed Map.z. ~3=0t. Permit No.Date Of Permit.y/RX1.7.3..Applicant Health Dept. Approval.../. J O / ( ,,,,,,...Underwriters Approval..` Planning Board Approval. Request for: Temporary Certificate........... Final EiANT Fee Submitted: $ 12 11 C O~ a k-) W I IC INSPECTORS ~~gUf FO(,~-c ~~O 4Gy c ~ SCOTT I.. HARRIS, Supervisor ti i. x Southold Town Hall Thomas Fisher Building Inspector P.O. Box 1179, 53095 Main Road Southold, New York 11971 Gary Building Fish Fax (516) 765-1823 Telephone (516) 765-1800 Robert Fisher Assistant Fire Inspector OFFICE OF BUILDING INSPECTOR Telephone (516) 765-1802 TOWN OF SOUTHOLD C E R T I F I C A T I O N DATE: 3 Building Permit No. 1~ /120 / Owner: P Fif0/4/C ID02a A> 4N,4,Ml Nr- CORP. (please printt))j Plumber: i7f(/2 1~/~y/~~SEiy¢ (please print) I certify that the solder used in the water supply system contains less than 2/10 of li lead*(Flumbe~ t ure Swo~~rn to before me this / 4A day of~V0 19 . Notary -Public, County )j la lp No ry Public MARYANNE E. DOWLING Notary Public. State of New York No.50OD030 Qualified in Suffolk County i I Commission Expires August 3,189:.1. lELD S:'ECT1O:i (fbATE COMMENTS 1. O m \ x ~ y FOUNDATION (1st) 3 FOUNDATION ( 2nd L 2. z 0 ROUGH FRAME & Q O~ PLUMBING Gy H INSULATION PER N. Y. 3 N STATE ENERGY CODE x a 4. !aLo. HE Vy &4-1- FINAL O 2 ADDITIONAL COMMENTS: e • x H O\ 2 a H x t7 ' U' m ~ H BOARD OF HEALTH FORM NO. 1 3 SETS OF PLANS , • . • • . TOWN OFSOUTHOLD SURVEY BUILDING DEPARTMENT CHECK _ TOWN HALL SEPTIC FORM _ SOUTHOLD, N.Y. 11971 - - TEL.: 765-1802 t:OT I FY ; Examined 199 CALL . ' MAIL TO. Approved ,1 Permit No._.......... Disapproved. a/c (IIu' ding ifpactor) APPLICATION FOR BUILDING PERMIT Date 1991: INSTRUCTIONS a. This application must be completely filled in by typewriter Orin 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 sti' or areas, and giving a detailed description of layout of property must be drawn on the diagram. which is part of this appl 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 permi 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 Occupant 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or den:4ition, as herein described The applicant agrees to comply with all applicable laws dinances, building code, housing mdg, and regulations, and tc admit authorized inspectors on premises and in buildin fo ecessary i pet ns. 4 ~k ignature of applicant, or name, if a corporaalon) Ms_ (Mailing address of a licant) State whether applicant is owner, lessee, agen architect, engineer, general contractor, electrician, plumber or uild . • P. . Name of owner of p ises (as on the tax roll or lat deed) If applicant is a atio ,signature of duly authorized officer. n (Na e d title of corporate officer) Builder's License No. . Plumber's License No. 3./ - Electrician's License No. . 1 a t Other Trade's License No. 1. Location of land on which proposed work will be done. ~J < C , c.... ,/a~c ~ ~q!.. _ . use Nu Do mber 'e/ Street Hamlet County Tax Map No. 100 SScctio Block , j ~ Subdivision . ~Y"~/ a Lot.. -~~-Q-..... Filed Map No. / . (N .3 . Lot (Name) 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 01 +slez •3. Nature of work (check which applicable): New Building Addition . Repair Removal . , • • • ' ' Alteration • • • • • Demolition Other Work . . . . . 4. Estimated Cost (Descriptior Fee..... 5. If dwellinog (to be paid on filing this application) If garage, n, number mber of of cars g units Numbcr of dwelling units on each floor . 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 Depth..... .Height... Rear..... 8. Dimensions of entire new construction ' ' ' . ' ' Number of Stories . Hein Front 5. oht Number of Stories ,Rear ...............Depth Size of lot: 1•ront • • • • • • - . 10 . . Date of Purchase Rear................ Depth 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 _ • • - • • • • ' 14. Name of Owner a premises ' ' ' ' ' ' . • • Will excess fill be removed from premises: Yes r Name of Architect Address ............Phone No. Name of Contractor . ' ' ' ' ' ' ' • • • • • Address Phone No. • . • . 15. Is this ........................Address .Pho No..•....... . property within 300 feet of a tidal wetland? *Yes......... :K. *If yes, Southold Town Trustees Permit may be required.~~'•'• No. " " PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions fror property lines. Give street and block number or description according to deed, and show street names and indicate whethc interior or corner lot. APPROVED AS NOTED BATE-1; N 14 s B.P a L- I1NnrPWRf=CERTIFICATE FE E: FY 'QV 8Y: REQUIRED ~ n1oTWFY BUlE.7!~;G OE~4R ENT• AT - eFiS "s~302 c' Ar,,A TO 4 PIVI FUR THE rI{it,t _ "Ndr REQUIRED p, gjREp (C(_`NCr _ r s 7 r Ne a"' I e_ & PLUA?BIND a k;p~ sou ~.t_ir~i•~7SVR~isST SHALL !V1EEi Y OF i~~T CitJ}!:N1• O"r THE N.`~- , f R ENERGY . per 70N RESPO NSWELE FOR Ol?.' :efORE } r_;,rIjFrRUCTQ N ERROR',— CE, JPANCY ^?ATER S" ;ANNOT EX , %LEAD. STATE OF NEW YORK, COUNTY OF . S.S (Name of individual signing contract) being duly sworn, deposes and says that he is the applicant 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 tom ippiication; 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. Make and file this iworn to before me this ~G• • ...day of .,.19 . . :otary Public, W ' County JOYCE M. 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