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HomeMy WebLinkAbout21614-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-23050 Date JUNE 20, 1994 THIS CERTIFIES that the building NEW DWELLING Location of Property 860 JASMINE LANE SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 3 Lot 24.16 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. 21614-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 8 2ND FLOOR) The certificate is issued to PECONIC PROPERTIES MANAGEMENT CORP. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 93-SO-34-DEC. 2, 1993 UNDERWRITERS CERTIFICATE NO. PENDING - JUNE 20, 1994 PLUMBERS CERTIFICATION DATED JUNE 1, 1994 - ARTHUR MALAUSSERA, JR. flit / Aidilding nspector Rev. 1/81 FORM NO.b 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) N Dare ...el1R.~ 19..?'. 21614 Z Permission is hereby granted to: '~C91lu!..........°~J... A W. ..r.......... ..../~e....i . dr.. ta .........................41-R7 at premises located at..... . ~_l0r".art.R°....F,../ ~ County Tax Map No. 1000 Section ...........j;........ Block .........43 Lot No. .°'t..:K 4.... pursuant to application dated ..........(l,<..4 19..~?--;5 and approved by the Building Inspector. Fee S. -~.~5. Building Inspector Rev. 6/30/80 Folm No. 6 TOWN OF SOUTHOLD /JCp I f i0 J BUILDING DEPARTMENT eB" a TOWN HALL s 063 765-1802Q 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 „ New Construction. Old Or Pre-existin Bui in ~t Location of Proper ty..U~a.9r~L~!G~tt~ ClC: House ////~~JJ Street ~tlamlet Onwer or Owners of Propertyj~.../.V94~ _ &~f County Tax Map No 1000, Sect' n....P. .Block. .............Lot.... ®Q SubdivisionQLW(F~NA71Pr,V~C,,/„FilegdMap.A.731/j?~.Lot/~6 Permit No.~I~I/[..!..Date Of Permit. (.L..... .Applicant lU~.tC4.fU/.'Q~1/tJ~ 0 -50 Health Dept. Approval z2/V ,,93 ,Underwriters Approval......................... Planning Board Approval...... Request for: Temporary Certificate........... Final Certicate../.1....... Fee Submitted: $ /~e~ / C a -.a30S0 _ APPLICANT THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000837 BUREAU OF ELECTRICITY F 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date JUNE 23,1994 Application No. on file 82640593/93 N 318285 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, 860 JASMINE rG~LETAM , JOB-16, SOUTHOLD, N.Y. in thefollowinR location- ® Basement [3 Ist Pl. A 2nd F1. ATTIC/OUT Section,, Block Lot Fran examined on JUNE 20,1994 and found to be in compliance with the National Electrical Code. A%NRE RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS ECWTACLES SWITCHES INCANDESCENT FLUORESCENT OTHER AMT. K. W. MT. K. W. T. K.W. AMT. K. W. ANAT. N. P. 15 34 21 15 DRYERS FURNACE MOTORS FUTURE AMUANCE FEEDERS SFLOAL RlCTT TIME CLOCKS ULL UNIT HEATERS MULTI-OUTLET DIMMERS SS AMT. K. W. Oft N. P. GAS N. P. AMT. NO. A. W. G. AMT. AML. AMT. AMPS. TRANS. AMT. N. I. NO.OFEM YSTFEET AMi. WATTS 1 F 1 3 - 2 - SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER 1 y ]w 1 / TV ] 8 ]w ],I Aw NO. OF CG COND. A. w. G. NO. OF HI FG A. W. No. OF NEUTRALS A. W.G. NEUTRAL ROUIP. PER % OF CC. CG. OF W. 0. OF ml-uo 1 100 CB 1 X 1 4 1 4 OTHER APPARATUS: HOTORSI3-F H.P. G.F.C.It-8 SMOKE DETECTORI-2 SPUDS ELECTRIC SERVICE LIC.#192- 175 3RD.ST. BOX 166 GENERAL MANAGER ST. JAMES, NY, 11780 11 Per This certificate most not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. - - - - - - - - - - - - - - - - - - - - - - - - - INSPECTORS Yp`~ ~rF01!{~~ SCOTT L. HARRIS, Supervisor CM Thomas Fisher M x Southold Town Hall Building Inspector d l r P.O. Box 1179, 53095 Main Road Southold, New York 11971 Gar Fsh Building Inspector 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 Building Permit No. 071P51 21 Owner: PQCQNtC R pQ~e M' e4NA eiLIENTe0t-P (please rri )~/JJ~~ Plumber: .Q~y2 ^4,-,?5s 0 ¢ T (please print) I certify that the solder used in the water supply system contains less than 2/10 of IX lead. lumbers Signature) Sworn to before me this jS- day of 19 qL, Notary Public, sl l K County No ry Public MARYANNE E. 001MJN0 Notary Pubic, StKe of Now yo* N& sow= Qualified in Suffolk CouMY CwnM18e1en Expires Aupust 3, -lELD !:;S."EUTl(JN JJDATE s COMMENTS ^ - owe 3 FOUNDATION (1st) FOUNDATION) (2nd) 2. Q~ z 0 ROUGH FRAME & q~ PLUMBING d to vl 3. ? ~DiS p) INSULATION PER N. Y. STATE ENERGY CODE O1 x O C 4. 3 FINAL ~ ADDITIONAL COMMENTS: 4'i 14 v /1 N xX\~ ' U> as a y O i ' T t*1 a W • r y t O \ ~ c„ Awl, C CBOARD OF HEALTH 5 FORM NO. 1 3 SETS OF PLANS TOWN OF SOUTHOLD SURVEY _ _ . BUILDING DEPARTMENT CIIECK _ . . TOWN HALL SEPTIC FORK SOUTHOLD, N.Y. 11971 _ TEL.: 765.1802 r. DT I FY ; Examined . 19CALL . ~2 MAIL TO Approved aJ.Yy....... 19 Permit No. •°~/w /5/ . Disapproved a/c _ . ldiginspector) APPLICATION FOR BUILDING PERMIT Date..~~ 't. d • 19 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 stree 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 perm 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 c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant agrees to comply with all applicable laws„ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in building f©rinecess~ary inspections.. / (Signature of applicant, or name, if a corporation) rz~ (mailiWaddress of applicant) State whether applicant is owner, lessee,(agent, architect, engineer, general contractor, electrician, plumber o builder. Name of owner of id (as on the tax roll or latest deed) If applicant is a co gn ture of duly aut horized officer:% (Name orporate officer) Builder's License No . . Plumber's License No. Electrician's License No. • . Other Trade's License No. 1. Location of land on which proposed work will be done House Number Street Hamlet County Tax Map No. 1000 Section Block of / . Subdivision ..~•.~.4:tri'~:~:~:~~ X'~~~CL:.~ r / . Filed )clap No. Lot Q (Name) 1 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy , , , , i b. Intended use and occupancy ...~,.,~~1/J~,L,f, l-~ •3. Nature of work (check which applicable): New Building ....Y , , , Repair Removal Addition Alteration . • • • • Demolition Other Work . 4. Estimated Cost (Description Fee (to be paid on filing this application) 5. If dwelling, 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 Rear • • . • • • . ' ' • I lcight Number of Stories . ' ' • • • • • • • . • Depth . Dimensions of same structure with alterations or additions: Front • ' ' ' ' Depth . Height . Rear . 8. Dimensions of entire new construction: Front . " ' Number of Stories . Depth . Height Rear............... Depth Number of Stories . 5. Size of lot: I-ront . ' Rear . 10. Date of Purchase Depth ` 1 12. 1. Zone or use district in which premises are situated , • "Name Former Owner Does proposed construction violate any zoning law, ordinance or regulation: • • • 13. Will lot be regraded . Will excess fill be removed from premises: Yes 14. Name of Owner of premises 1 Name of Architect ' ' " ' ' ' • - • Address ............Phone No..... . Name of Contractor . • ' ' ' ' • • • • • Address Phone No...... . 15. Is this ' ' ' ' ' Address Phone No. property ithin 300 feet of a tidal wetland? *Yes. *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 wheth, interior or corner lot. UNDERWRITERS MRTIFICATE REQUIRED_ gt/S ro 'Ti T r: ,'•1~,, U}j, l ~~$qp y n q't~ R~~A is 1 € M; T CER ii OUT OF OCCUPA! " ' PLUMBER CERTIFICATION ON LEAD CONTENT BEFORE CERTIFICATE. OF OCCUPANCY SOLDER USED IN WATER SUPPLY SYSTEM CANNO7 EXCEED 2110 OF I% LEAD. STAT OF/N W YORK, COU Y F . . J % i being duly sworn -OA~ (Name of individual signing contract) deposes and says that he is the applicant above named. He is the . (Contractor, agent, corporate officer, etc.) )f 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 .vork will be performed in the manner set forth in the application filed therewith. ,wom to before me this day of. 19 :otary Public, . ljI!/~t!.'li~'`;`..- / \ - Count JO CE M. V41LKINS ~ f ~ v Notary Public, State of New Yorfc~ No. 4952246, Suffolk CounW (Signature of applicant) Term Expires June 12.19.,' N1OZ*41t- L4C14e 4414#y ss/p. E, 494 AOV s¢ //p p0. e/ V / ova I,/ ~ Sc~n~c 6919 Fase~en~ 00 ati Cr ,eo .o° ~ ti ah• g ~eo'~ SURVEY OF LOT 16 C3. 'A T SOUTHOLD Q ` TOWN OF SOUTHOLD 5 ; AP SUFFOLK COUNTY, N. Y. x 1000-70-01-Pros y Scale. 1"= 40' lei n Mar. 221993 QQ_ ~i Q E hl 11 cctti 32 V6 IS'4~3j0. C•P. Q~ J,q w i4l/ ~ P, 300 A/~/tc P~Zlr MOM FANCY OWELLNG 0Wy /i The locations of wells and cesspools shown hereon are from field observations AREA= 34,748 sq.-ft and or from data obtained from others. G Prepared In accordance with the minlmum The water supply and sewage disposal standards for dlle surveys as eslobhhed systems for this residence ww con/orm fs,,--eC by the L.I.A.L.S. and approved and adopted to the standards of The Suffolk County vaF~~,~r s % 9 OF NE{y yo ou~tb for such use by The Now York Slate Lavrd Department of Health Services. TIile Association. n J GC g aN T. ME NO rza~ ~P,f zc7~' 4 A R, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY MR3 0 N. Y.S. LIC. NO. 49618 DATE. REF. No. 9 3 S ° -3 VEYORS, P. C. (516) 7 5 -5020 El EVA noNS ARE REFERENCED P. 0. BOX 909 APPROVED TO AN ASSL*4ED DA 7t" MAIN ROAD SOUTHOLD, N. Y. 11971 *1040P 46/O' E. Mb 34 //000, ro / ~r Sonic r09~aJ Foss ?'eni . 00 .0q' ati Cr O ~Op4V 5 l !OT Q 9~ ~Gt SURVEY OF yo O~ LOT 16 0 C3 'U4P OF SOUTHOLD VILAA SECTION TWO" ,tih FLED AUG. 4. 1893 FLE NO. A-434 ry ~ A T SOUTHOLD P` TOWN OF SOUTHOLD 35.v. "5- SUFFOLK , ti f o COUNTY N. Y wo-7o-o1-P106 IX Scale: 1"- 40' -s,3 Mar. 22,1993 Aug. 17, 1993 (foundation) 2 N 32 g0 00. 0.00, ib ?4ININ w P~ 30 4)v The locations of wells and cesspools AREA= 34,748 3q. ft. shown hereon are from field observations and or from data obtained from others. Prepared in accordance with the minknum The water supply and sewage disposal standards for lllle surveys as established systems for this residence wul conform by the L.I.A.L.S. and rproved and adopted to the standards of The Suffolk County for such use by The ew York Stote Land Department of Health Services. Title Association. ? 4 p f~ 'N f t yC'~ c~ 4 ~ A i ~ 5fr yz.:. SUFFOLK COMITY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY y NO. 49618 DATE ' REF. No. PECONIC U (516) 765 - 50 ELEVATIONS ARE REFERENCED P. O. BOX 909 APPROVED TO AN AS.SIANED DA TL" MAIN ROAD SOUTHOLD, N. Y. 11971 Nips RUSSF~I 40 2~46'O' E N 1IOV P` - Il ti Scenic 6919 E os49/77 00 .Oti a2 l pT ~ ~00~ ~ tip \ah~ 5 leo 0 ON \ SUR VEY OF .p LOT 16 .U4P OF SOU7MD VV AA SECTAO v TWO" ry ?j FLED A(Arx 4, WS FIE A010. A-494 GO A T SOUTHOLD s ~P 4~• TOWN OF SOUTHOLD 35.4 = SUFFOLK COUNTY N. Y. WO- 70- 01 - Pin i hs~. W "4 oa Scale: Y'= 40' a7 ,~.3. Qw- Mar. 22f 1993 3~~~\ / •~d _ 1 Am k Aug. 17, 1993 (foundation) o „ V Nov. 19, 1993 (final) 2 , M 32 ~V SUFFCLI( COVTY DEPARRIENT OF HEALTH SERVICES ~s SINGLE FAMILY D%N1:1 I INN, ON C 800 //0. S ° JA N.D. Ref. 3 S63 No. VJfil w ~ The sewane d c;,osal and water supply ixii.t,es at tilis location /q h ve be.: sa! 5 j o ny xs1-0ed by C,:s Uepaitment aad ale Pi Z;" in compitance with tnt~e „s uuilt plans 2 C", DATE CHIEF OF GEINLRAL ENGIRT-,c& M SERVICES The locations of wells and cesspoolsg shown person are from field observations AREA= 34,748 sq. ft. and or from data obtained from others. qvc I Prepared In accordance wNh the mlfiaf MW The water s&Wy and sewage d4posad T, Or standards for tf/fe surveys as edabAtahed systems for resmence will conform S S V,t11~ ' by the L.LA.L.S and gpprowd and adovled to the standwds of The Suffok County HEp~jt~ for such use by The New York Slade Land Depwtmenl of Health Services. rAlk Aseodafian. ~P.~E OF NEIy yo ~-j 'o~N T. MptIC~ SUFFOLK CouNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONETWJCTION ONLY N. ~S LIC. NO. 49616 93 SO 34 DATE REF. No. EC u$yFi~' P. C. r516M a~ ELEVAWNIS ARE REFERENCED P. O. B APPROVED TO AN ASSU" DA TLU MAIN ROAD SOUTHOLO, N. Y. 11971 Nips RUSSF~I 4qAW P/ Fe,p.F MAC //0 .00. e~ - 31 V 1p b0 Scenic 1°I Fose~enf _ 00 !OT \ 00 00~ / vP Cl SURVEY OF •a~~0 COO ~MAPOFsou ~ ~ s,SECTION rnro- / FLED AUG. 4, 1993 FLE NO. A-434 ti Or 0 00, A T SOUTHOLD 5 ~P TOWN OF SOUTHOLD 3=~ - SUFFOLK COUNTY, N. Y. o Boa t 1000-70-01-P/06 a. 0 O Scale: 1 40' R T 5' Mar. 22,1993 3 Aug. 17, 1993 (foundation) 2 ~i / h V I V` N >S•43/p. Py gyp` Q 'ayQ$ N 80.00, 30 //000, E . 34. ''g PSM/N ~qN P,1jE The locations of wells and cesspools AREA= 34,748 sq.ft. shown hereon are from field observations and or from data obtained from others. Prepared In accordance with the minimum The water supply and sewage disposal standards for title surveys as established systems for this residence will conform by the L.I.A.L.S. and approved and adopted to the standards of The Suffolk County for such use by The New York State Land Department of Health Services. Title Association. tJ ~P `tC` 'N SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY i~ Y. S. I~CljNO. 49618 DATE kc. REF, NO. PECONIC ~§Ugjg l7`r;r1 .,C.~ (5/6) 765 - 50 ELEVATIONS ARE REFERENCED P. O. BOX 909 APPROVED TO AN ASSIAMED DATUM. MAIN ROAD SOUTHOLD, N.Y. 11971