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Home My WebLink About21706-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCuumANCY No Z-23051 Date JUNE 20, 1994 THIS CERTIFIES that the building NEW DW~W.ING Location of Propert~ 1305 JASMINE LANE BOu'£HOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 3 Lot 24.6 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated O~TOBER 12, 1993 ~ursuant to which Building Permit No. 21706-Z dated O~TOBER 19, 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 DW~.ING (1ST & 2ND FLOORS) The certificate is issued to of the aforesaid building. PECONICPROPERTIES MANAgemENT SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 93-SO-24- MAY 18, 1994 UNDERWRITERS CERTIFICATE NO. pENDING - J~NE 20, 1994 PLUMBERS CERTIFICATION DATED JDNE 1~ 1994 - A~£~UaM~J~AUBBEMA~ JR. /~ B~I ding InSpeCtor Rev. 1/81 FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPAETMENT TOWN HALL SOUTHOLD, N.Y. No 21706 Z BUILDING PERMIT (THIS PERMiT MUST BE KEPT ON THE PREMISES UN11L FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: .... ~.c..o.~.~..c....?.T..o.~ ~ ~.s.....~...~.a.~?..~...c. ~... .............. P.O. Box 1143 .... .c.~.o..~.:...~...~,.......!.!,9.,,~.,s. ........................................ CONSTIIUCT A ONg FANILY I)~LLING AS APPLIgD FOR. at premises located at..... !..3..0..5....J'..a....s~..".~..~..e.....R~...a..~. ......................... .S..o..u. ~.h..o..1...~. ,....~...~... ................................. CountyTax Map No. 1000 Section ...... ..6..9. .............. Block ...... ] .................. LotNo ........ .2../f....6.. ............ pursuant to application dated ...... ..O..c.~.o..b..e.~...!.2..~ ............................. 19.....9..3. ........ and approved bythe Building Inspector. Fee $ .......2. ~..5. :.9..0. ...... ...................... Rev. 6/30/80 /Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ~-~~TION FOR CERTIFICATE OF OCCUPANCY 105 o This application must be filled in by typewriter OR ink and submitted to inspector with ~he 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and Vpre-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 ,nn,/ New Construction...z ... Old Or Pre exlstl Date .~r../. /./../..~.~.. ..... Location of Property..../.~..~. ~.~... ~rL~UL~L~ ~ ~7~,', Ho .... ~7--'-'"'''''''~ .......................... ~' ~'" fY" ....... use Nom~ m Street Hamlet Onwer or Owners of Property.~.~.~~~.~~~~ .... ...... j .F .......... County Tax Map No 1000, Section...~.~. ..... Block .... ~.~ ....... ........... Ptann~ng Board Approval ........ Request for: Temporary CertSficate ........... F~nal CerrScate,~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 1(~837 BUREAU OF ELECTRICITY ~- 88 JOHN STREET. NEW YORK, NEW YORK 10038 Date JU~'E 23,1994 Application No. onfil~ 82784293/93 N 318284 THIS CE~IFIES THAT SOUTHOLD VILLAS, 1305 JASMINE LANE, SECTION-II/JOB#6, SOUTHOLD, N.Y. in thefollowlng location; [] B~sen~ent [] Ist FI. [] 2nd FI. ATTIC/OUT ,%.ion Block ~vos examined o. J~ 20,1994 and found to be in compliance with the National Electrical Code. Lot 5 37 47 52 ,2,"?.w. .,..,,,,cE.,,,,o.o.,s .,u.A-..,,,.,=. 1 F i 1 4 - 1 20 R V I C OF CC. CO~D. 2/0 NO. OF HI-LEG MULTI-OUT~T SYSTEMS NO. OF FEET EXHAUST FANS 2/0 SPUDS ~r.RCTRIC SERVICE 175 3RD.ST. BOX 166 ST. JAMES, NY, 11780 LIC.#192-E Per , This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by theW'~'r~dentials. ALTERED IN ANY MANNER. INSPECTORS Thomas Fisher Building Inspector Gary Fish Building Inspector Robert Fisher Assistant Fire Inspector Telephone (516) 765-1802 ,St '( )TI'I, I IAI{I(IS, Southold Town Hall P.O. Box 1179, 53095 Main Road Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD CERTIFICATION I AIl,% . ,,uilding,,e it No. (please p3iu[) Pl~ber: ~ ff~~~ (please print) // I certify that the solder used in the water supply system contains less than 2/10 of IZ lead. umbers Signature) Sworn to before me this .,1~4 day of__~Zm~____~, "9q Notary Public, ~lJW(~l K County MARYANNE E. DOWUNG Notary Public, State of New ¥o~ No. 5000030 - Qualified n Suffolk County ' Corem ssion Expires August 3, '~99_~ 7LS-XSOd~ INSPEC )N FOUNDATION '"ST [~j' ROUGH PLBG. ] F/O~NDATION AND [ ] INSULATION / [//~FRAMING [ ] FINAL BUILDING DF. PT. INSPECTION/~~~ .] FO/JUNDATION.~ 2ND [ ] INSULATION FRAMING [ ] FINAL ~OU~;DATION fOUMDATIO:~ (1st) (2nd) ~UGH FRAME & -?LUMBING ~I~SULATIOM PER N. Y. STATE E~JERGY CODE FI:;AL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL E'xamlned. ~.~l~ ..... '~} 'l 9 .~-~ Approved.'~'~.I.eLL ¢ ......... 19 ~ eem~it No.oTl)~0(o..~'.. Disapproved a/c ..................................... $OUTHOLD, N.Y. 11971 . (,BuildC, rfig Inspector) APPLICATION FOR BUILDING'PERMIT · INSTRUCTIONS B6ARD OF HEALTH 3 SETS OF PLA'~S SURVEY CIIECK .... t;OTl FY; I'IA I L Date .,/~ ....... 19 .~.. 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 btiildings on premises, relationship to adjoining premises or public sti'eet or areas, and giving a detailed description of layout of property mu~t 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 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 Occupan% 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 thc Building Zone Ordinance of the Town of Southold, .Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for thc construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws,~f~l~ances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in building ~,6r ~eqtessary.inj(hectio'fis. · c- '~O,( (Si.~gnatur~ of applicant, or name, if a corpora~on) . ,..././...<z., · ' (Mailing address of 6~pplicant) (.J State whether applicant is owner, l~ssee architect, engineer, generai 'contractor, electrician, plumber o ...................... 'YO ...... .'",~ ......... : ..... · .............. ".-~;; ........ . .... ' ..... Name ~eeJawner ° f premises ~'~'-'~' ' '~'~' '~~~ -/.~- · ·' ...... ' /,cZ / ~/ (as on the tax roll or(/atest deed) If.~_ ~ .~:oration, signature o~,~, authorized oyficer. t/l meand title of co orate' !officer) Plumber's License No ............. · Eleetric,an's License No.../' ]P.. :'..Z.i ........ Other Trade's License No ................... 1. Location of land on which proposed work will be done .................................................. House Number O ........ ~;r~;; .................... Hamlet Subdivision '~.~...~.~ ' Filed Map No...ZtJ. '~..(2(~...~... Lot ...~. ..... (N:lme) 2:~!State "' * .~ cx~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing Use and occupancy ................................../'Q -- .,~ ~ //.¢ '~ ................................... -3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration Rep~/,r .............. Removal .............. Demolition .... : ......... Other Work ............. · . . (Description) 4. Estimated Cost ............. : ........... Fee ..... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... 2 ........ Number of dwelling units on each floor ...... . If garage, number of cars ................ ' ........ 6. If business, commercial or mixed occupancy spec fy nature and extent of.each type of use .......... 7. Dimensions of existing structures, if any: Front ............... Rear .............. De 1 teight ......... umber of Stories ... ...... · pth ... 'N .... Dimensions of shme structure with alterations or additions: Front ' ' Depth .... } .................. He t ........... · ......... ... Number of Stories ....... 8. Dimensions of entire new construction: Front .............. : Rear ............... De '. ' j ' ' Height ............... Number of Stories ....... pth . .. Size of lot: Front ......... .. Rear ................. Depth "~ ..... Date of Purchase ..................... .................... · ........ . Name of Former Owner Zone or use district in which premises situated ............................. are · Does proposed construction violate any zoning law, ordinahce or regulation. ................ Will lot be regraded ...... ' ' ' "' ....... " .................... Will excess fill be removed from premises: Yes ' ' Name of Owner of premises ........... , ........ Address ·: ...... .......... Phone No ...... ... Name of Architect ....................... ". ·.. Address ........ ' ........... 'Phone No ................. Name of Contractor ..... · · .' ....~'. ............ Address ............ ; ...... Pho, n~. No .......... ; .' ...... 15.' Is this property within 300 feet of a tidal wetland? *Yes ........ No.~ ..... · 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 10. 11. .12. 13. 14. ALL CO~'}STa~CTIOh[ SHALL ~,IEET ;THE REOUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY COO'ES. NO~ RESPONSIBLE FOR DESIGN OR CON~TRUCTION ERRORS STATE OF NEW YORK, COUNTY OF ................. S.S ·-,~ ~'./.q J4.'~-/J.. ,/~.~./~ ~.~. ~./.k/.. being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) above named. ...... . ....... (Contractor, agent, cor'porate officer, etc.) '" ' ' ~f said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this ~pplication: that all statements contained ~ this application are true to the best of his knowledge and belief; and that the . ork w~l be perfo~ed ~n the manner set forth ~n the apphcatmn fil~rewith. ' ~wom to before me this .......... /A. .... ~o'ta~ Public ' ................. Term ~pir~ Ju~ OWNER TOWN OF SOUTHOLD PROPERTY RECORD CARD '~ '~ [ "~T-REET t '~ 0 ..~ F~Ii'~GE LAND IMP. TOTAL ""700 ACR. TYPE OF BLD. ~ DATE REMARKS I FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD TILLABLE WOODLAND .EAOOWL^NO TRIM ~'!. Bldg. i~:~' Extension Extension Extension Patio ..: Porch Deck.: Breezewa' Foundation Pc CB FULL Basement CRAWL SLAB Ext. Wails Fire Place Dormer Fin. B. Attic Rooms 1st Floor Driveway Rooms 2nd Floor The waler supply and sewage disposal sysleros tar this residence will conform lo the slanderSs of The Suffolk Counly D~rtmenl of Heo#h Services. The Iocalion~ of wells and cesspools shown hereon m'e from field observa/ions and or from dele o~foined from a/hers. I.~I~LK COUNTY DF. PARTME. NT OF HEALTH SERVICES FOR ,M~h~3VAL OF CON$TRUCTION ONLY APPROVED zor (~ Zor (~) 'v/°/~ ,~z o~,,~ /'att t~taINt' ~ zor (~ ~'¢. ~EPT. OF HEALTH SERVICES AREA = 2~ 175 sq ft. Prepared in accordance with the minimum slandords for t/lie surveys as established the L.I.A.L.$. and approved and adepled ~[r such use by The New York Slate Land T/lie Association° SURVEY OF LOT OF ~OU1HOLD VlI. AE~ SECTION TWO" A T SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. 1000 - 70 - O!- PlO 6 Scale.. 1" = 40' Mar. 15, 1993 The woter supply end sewoge disposal syslems for this residence will conform to lfle slondords of The Suffolk County Deportment of Heollh Services. The /ocolions of we/is end cesspools shown hereon ore from field observolions end or /rom dole oflteined from others. ~K COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE HS. REF. NO. 93 SO 24 APPROV~D SURVEY OF LOT 6 "MAP OF SOUTHOLD VILLA,,~ SEC710N TWO" ~ A~ 4, ~ F~E ~. A-434 A T SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNT~ N ~ 1000 - 69 - 03 - 24.6 Sc~e:l"=40' ~ ~ Mar. 15, 1993 / ,~ Oct. 21, 1993 (foundation) / Nov. 15, 1993(addition) ' / _.~ May 11, ~994 (fi.~) CERTIFIED TO, ~ DONALD e. 8RACK~,% ~. THE L ONE ISLAND .~ VI~S BANK CHICA~O TITLE INS,~A,~CE COMPANY , AREA = 2~ 175 sq ft. Prepored iff occordgflc'e w/Ih tile minimum ~~~/ N.Y.S. LIC. NO. 49618 slondords for t/tie surveys os esteblisfled forby the L.I.A.L.S. ~d ~proved end odopted ELEWT~ ARE REFERENCEfl SURVEYORS~ P.C. such use fl~ T~ ~w Yor~ Stole Lend TO AN A~D D~T~ (516) 765 - 5020 T/lie Associolion. P. O. BOX 909 MAIN ROAD . ~/9/9~ CERTIFIED SOUTHOLD~ N.Y. 11971 94-155 J t ¥