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HomeMy WebLinkAbout21707-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 5-23052 Date JUNE 20, 1994 THIS CERTIFIES that the building NEW DWELLING Location of Property 1385 JASMINE LANE SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 3 Lot 24.7 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 12, 1993 pursuant to which Building Permit No. 21707-5 dated OCTOBER 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 DWELLING (1ST FLOOR ONLY) WITH ATTACHED GARAGE The certificate is issued to PECONIC PROPERTIES MANAGEMENT CORP. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL-93-SO-25-MAY 17, 1994 UNDERWRITERS CERTIFICATE NO. PENDING - JUNE 20, 1994 PLUMBERS CERTIFICATION DATED JUNE 1, 1994 - ARTHUR MALAUSSENA, JR. B ding Inspector Rev. 1/81 FORM NO.3 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) Date U..tobP.s..19................................. 19....93... N° 21707 Z Permission is hereby granted to: Peconic Pro rtie Management, Corp,;,,,,,,,,,,,,,,, P.O. Boa 1143 Cutchogue, N.Y. 11935 to............ CONS.T..RV.gT..k0#1 , FAY41LT..' UjNrj..A$..,AP1P%jNA..k0R at premises located at....1385„JASitII;)B...LAS S9DTaoLn.,.. County Tax Map No. 1000 Section ........6.9 Block .......3................. Lot No..... 24-2................ pursuant to application dated October. 12.r 19...93........, and approved by the Building Inspector. Fee $.........245,.00... B A ilding Inspector Rev. 6/30/80 CC// Form No. 6 7~~ ~ TOWN OF SOUTHOLD~- BUILDING DEPARTMENT C4 TOWN HALL 7 3 r O 77 I 76s-lsoz APPLICATION OR 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 - . / 7~~99.. New Construction V/.. ..65- Old Or Pre-existing B '1 ndi g........ Location of Property...... House Street Hamle~ Onwer or Owners of Property County Tax Map No 1000, Section ...09 1 Block...QY..~.l......Lot.. Subdivision7et,?.'e4 ..y~ ..Filed Map. A.% Lot................. Pe a!.!a .X. 0019.3.. 4, ,vnrmit No. .Date//O~f/ Perrmit. .Applican Health Dept. Approval. ~~/7(,,,,!;3!S,007 ,,..Underwriters Approval Planning Board Approval Request for: Temporary Certificate........... Final Certicate../X Fee Submitted: $ 0 '44~ 6 p o:~ a 3 6 5 APPLICANT THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1OW837 BUREAU OF ELECTRICITY 7 85 JOHN STREET. NEW YORK. NEW YORK 10038 Date JUNE 23,1994 Application No. on file 82784393/93 N 318282 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, 1385 JASMINE LANE, SECTION-II/JOBM7, SOUTHOLD, N.Y. in tkefollowing location; ® Basement ® Ixt FL A 2nd Fl. GAR/OUT Section Block Lot wm examined on JUNE 20 , 1994 and found to be in compliance with the National Electrical Code. FIXTURE KE?iACIES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K, W. AMT. K. w. AMT. R.W. AMT. K. W. AMT. H. P. 17 20 17 17 DRYERS FURNACE MOTORS FUTURE AFPUANC! RIDERS SPECIAL REC'FT TIME CLOCKS WILL UNIT HEATERS MUlil-0UTLET DIMMERS AMT. K. W. dl H. P. GAS H. P. AMT. NO. A. W. G. AMT. AMP. NAT. AMPS. TRANS. AMT. N. P. SYSTEMS AMT. WATTS NO. OF FEET 1 F 1 2 - 2 - SERVICE DISCONNECT NO-OF S E R V 1 C E NAT. AMP. TppE MITER 11 tW 1 / ]W 3 A ]W ] f AW NO. Of CG COND. A. w. 0. NO. OF HI-lEG A. W. G. NO. W NEUTRALS A. W. G. FOUL. PER a OF CC. COND. OF HI-LEG OF NEUTRAL 1 100 CB 1 X 1 4 1 4 OTHER APPARATUS: MOTORSI2-F H.P. G.F.C.I:-8 SMOKE DETECTORS-1 SPUDS ELECTRIC SERVICE LIC.N192E 175 3RD.ST. BOX 166 GENERAS MANAGER ST. JAMES, 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 their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. INSPECTORS„ _ ?~4SUFF0( SCOTT L. HARRIS, Supervisor CD c Thomas Fisher S~ Southold Town Hall o s%' i '`"<r s Building Inspector P.O. Box 1179, 53095 Main Road «sa <::J~" `r , Gary Fish ~p'c Southold, New York 11971 Building Inspector : Y y Fax (516) 765-1823 ~u 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. 0wner:PecoN/c pRopef-TIRS P4#41542 weNr(-ffFp (please print) Plumber: (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1Z lead. Plumbers Signature) p. Sworn to before me this 15? day of ~1 I 1 n Q - 19~. Notary Public, '~Lk9rm~ County n n N ary Public { s' x MARYANNE E. D01NUNG f Notary Public, State of New Yak No.6000030 Qualified in Suffolk Coun 88 y ' Commission Expires August 3. f.f~ . _ II I= o 140Ul1DATION (1st) I m I I c :OUNDATION (2nd) rm b I - `o ?OUCH FRAME & cl4 -PLUMBING • GDYr j. H tJ m Lb I m rNSULATION PER N. Y. STATE ENERGY CODE I r o m Gd •a FINAL ADDITIONAL COMMENTS: /:;z / ~-O Q -474 • X b H m J ' - a cl BOARD OF HEALTH FORM NO.1 J SETS OF PLANS TOWN OF SOUTHOLD SURVEY BUILDING DEPARTMENT CIIECK TOWN HALL SEPTIC FORK W----.- SOUTHOLD, N.Y. 11971 +V.1- Cc, .a TEL.: 765-1802 t:oTIFY; Examined ..j4 t9........ , 19. CALL . MA IL T0: Approved O / 19.Permit No. V120 ' ' . . Disapproved a/c ui ing Inspector) APPLICATION FOR BUILDING PERMIT f / Date ..6 •~/1.A......... 19P -.INSTRUCTIONS a. This application must be completely filled in by typewriter 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 street., 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, o t nces, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building fo n msary Ain:rcti n v......... C9 . (Signature of applicant, or name, if a corpo tion) (Mailing ad ess of applicti}tt) State whether applicant is owner, lessee, gent architect, engineer, general contractor, electrician, plumber or uilder Name of owner f remises ,e,LIG2G.. f~!b as on the tax rUL or latest deed If applican s ratioLssi.gnatu re. of duly a onzed officer. . V (Na a title of corporate officer) Builder's tcense No . Plumber's License No. Electrician's License No. a Lam..... , . Other Trade's License No . 1. Location of land on which proposed work will be done. i.3.~..........`~o............................ House Number Street Hamlet County Tax Map No. 1000 Scctio : L7 Block Lot .~1~ 7 Subdivision S y Filed Map No. . A • V3Y... Lot . (Name) 1 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Intended use and occupancy ./J [1Z 3. Nature of work (check which applicable): New Building Repair Removal Addition Alteration Demolition Other Work . 4. Estimated Cost . (Description) . Fee 5. If dwelling, number of dwelling g (to be paid on filing this application) units Number of dwelling units on each floor , If garage, number of cars 6. If business, commercial or mired occupancy, specify nature and extent * * , , each type of use . • • • • • . 7, Dimensions of existing structures, if any: Front Rear • . . . ' . ' ' ' ' . lfeight Depth ..Number of Stories . Dimensions of same structure with alterations or additions: Front . ' ' ' . ' ' ' ' ' ' • ' Depth , Height . Number of Stories Rear • • • . • . 8. Dimensions of entire new construction: Front . Height .........Rear Depth •••....NumberofStories........ 5. Size of lot: l-ront . . Rear................. .....10. Date of Purchase • • • • Depth . Name of Former Owner 11. Zone or use district in which premises are situated . 12. Does proposed construction violate any zoning law, ordinance or regulation: . 13, Will lot be regraded Will excess fill be removed from premises: Yes N( 14. Name of owner of premises Address Name of Architect • • • • • • • . • • • Phone No.......... . Name of Contractor . ' ' ' ' ' ' • • • • • Address ...................Phone No...... , ~f . 15. Is this property within 300 feet of a tidaldwetland? Ph Y No........., Yes....... No.lti *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. o`Ar ~Qk,/IB VFP Af CRs~xF?J~~~ _C~~~, _ r 1~ ~Gr ~urS Y~ iin: r, tjr FOR T!!f c er}?; !"siuCi4)F S.r., ,c, 1t7Ef4kEC fait}i.)~r 6d _ Er`~i4~~'fjkf~ x~ ~I_LI{'f ~ad~C Fi. ,aL - 97~5~'naCTiC)N MUST BF COts©LETE FOR C,-0 EET ALL CONSTRUCT*I+ SHALL Nic THE REOUIREMENTS OF THE N.Y. 3TfiTE CONSTRUCTION & ENERGY CODES. NOT RESPONS113LE FOR f)ES1GN OR CONSTRUCTION ERRORS STATE OF NEW YORK, COUNTY OF S'S • • • •op.XV49.Z.a/ being duly sworn, deposes and says Iliat he is the applicant (Name of individual signing contract) above named. He is the e..6 !V r/v (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 ipplication; 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. iworn to before me this . .day of :otary Public, County j CE M. WILKINS Notary Public, State of New York . No. 4952248,SutfolkCoun& (Signature of a licant' Term Expires June 112.19.20 PP The /ocallons of we* and cos~ SLIFFOI.K COMITV DEPARTMENT OF HEALTH sERWICEs shown hereon are from field observations FOR APPROVAL OF CO MOCTION ONLY and or from dak obtained from others. 37. E, R 3 01993 REF. No. 9 b sn -as' R L-21-98' -I APPROVED ieto r g~~ssey0 e' VO 3to J N yep Y e l cool p 3S o~ SURVEY OF 'NAP OF SOUTI oW ~ now TWO" A T SOUTHOLD TO WN OF SOUTHOLD SUFFOLK COLNT Y N. Y. or t~OR s VW- 70of-P/°d O C c Scab: I"= 40' [oT O b~°' Mw 15.1993 O MM FAM&V DMIUM ONLY C4 EXPM TIM YEARS FROM DATE OF AP Y °•ni~\ p~ OF NE ' AREA = 23,475 sq. ft. f N) E°~t,~•nr MAR 1.MfTQy~9,f 24 11"3 S 4370"K s!s Noas'7 N/Q~ 60 .00, S.C. DEPT. OF HEALTH SERVICES o`N Qt$z;,~ The water p~ stly avid sewage aYaposal N. Y. L NO. 49618 A systems for IJ r reslaVnce w7l arnv/orm 4 Prepared in accordance with the minimum to the s/arMdorak of TM SulfoAt Cotav! standards for fills surveys as eslabpshed 1 YORS, P.C. ~ep £L£var ~v CQQ}O by the L.I.A.L.S. and approved and adopted alm~l of HeaNh Serrkes• f5J6 020 TO ANA DATt& for such use by The New York Stole Land P. O. BOX 909 TIlle Association. MAIN ROAD SOUTHOLD, N.Y. 11971 The /OCaI%On5 01 Wells and CBSSPOOIS - SUFFOLK Cg1NTY DEPARTMENT OF HEALTH SERVICES \ shown hereon are from field observations FOR APPROVAL OF CONSTRUCTION ONLY and or from data obtained from others. 37 w ~ DATE ,ac REF. NO, 93SO25 R-50.00 L-21-98' s s ?,9 c~ 3>S BUFF No NTY DEPARTMENT OF iH SERVICEB vi3eSe NI~/w' FAMILY DWELMG G MVED ~?p ; ro 6" 'O' F , YF i?PP oval of Caswcle~s W i NO 3.0 ~1 H.B. mct. 3 S ~ ~ t TM sswepes cltak_, , .r N yo a 1tNs locttxN tnara s =r. p~: Yed an ks ow9W by UYs Dqm. *nt or other agenebS d ` and found to be 3alWlaac~ttory. 9 'J St YQ I~ M Y J q Zp ~ A. Ocsta, P.E., CNd 2'y \ • ° OMtos of Walsr and Weetswe W Y J J ,o~~ SURVEY OF LOT 7 RW AUa 4,111119 RENO A-I84 A T SOUTHOLD a TOWN OF SOUTHOLD ~Or G~aQ s SUFFOLK COUNTY, N. Y. 1000 - 69 - 09 - 24.7 Scale: 1" = 40' Zol' 0 " Mar. 15, 1993 Oct. 24 1993 (fotmdation) h Zor May 11, 1994 (Final) o / 2~~ p Q~ ~f1A ,a,cs SQ•nro \ pay `S ~.`'1°S ~ i, ,v , g3. E°••''•,,, y~` ' AREA - 23,475 99 . ft. T. 4^los N.\ js s ~a1 09 ~Q~Vj 4.45 490.00, 0 The water supply and sewage disposal s N.Y.S. LIC. NO. 49618 Prepared in accordance with the minimum systems for this residence wlll conform p standards for title surveys as established to the standards of The Suffolk County I'EC S RVEYORS, P.C. ELEVATIONS ARE REFERENCED CgpP by the L.I.A.L.S. and aproved and adopted Department of Health Services. (516) 765 - 5020 To AN ASSUMED DATLM for such use by The Nepw York Stale Land P. 0. BOX 909 Title Association. MAIN ROAD SOUTHOLD, N.Y. 11971 94 - 156