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HomeMy WebLinkAbout21709-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 5-23053 Date JUNE 20, 1994 THIS CERTIFIES that the building NEW DWELLING Location of Property 1380 JASMINE LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 3 Lot 24.10 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. 21709-8 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) The certificate is issued to PECONIC PROPERTIES MANAGEMENT CORP. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 93-S0-28-MAY 17, 1994 UNDERWRITERS CERTIFICATE NO. PENDING - JUNE 20, 1994 PLUMBERS CERTIFICATION DATED JUNE 1, 1994-ARTHUR MALAUSSENA, JR. D B ding Ins ector Rev. 1/81 FORM NO.S 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° 21709 Z Date t0bRa...1A.. 19...93.... Permission is hereby granted to: Peconic.. Propert ies„Management„Corp,. P.O. Boa 1143 Cutchogue, H.Y. 11935 to CONSTRUCT A ONE FAMILY DWELLING AS APPLIED FOR. . LANG .....................S.UU.7:sQT.Re..N..X........................................ at premises located at.... 1380, JASMINE.. County Tax Map No. 1000 Sectlon ......69 Block 3.................. Lot No...... ZIA .10............. pursuant to application dated ........October., ?x 19... 9.8......., and approved by the Building Inspector. Fee $........245.00..... Building Inspector Rev. 6/30/80 Form No. 6 p ~Si(1~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATOR 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 X Date, New Construction.... Old Or Pre-existing Binl_9 g.......... Al ~j Location of Property../. Q d House No... Street Hamlet'............ Onwer or Owners of Property ~y County Tax Map No 1000, Section...... Block.. A~ .Lot.. . Subdivisionde'V SS .Y~ 4ii*.. 4G_r.-Fil~edd Mapf:~..L/7.d?.L/ z...Lot..~~ Permit No. L Date/~Of Permit.! ~/p/J/1(.? ...Applicant Health Dept. Approval//7""/J.~„ ~USD ~O ...Underwriters Approval Planning Board Approval Request for: Temporary Certificate........... Final Certicate..~..... Fee Submitted: $ . ~C'47tGC 6:~2 Gr? F 44 Od-I 'tzl - ~q ?-013053 z APPLICANT INSPECTORS SIFFO(k Yp~ c© SCOTT L. HARRIS, Supervisor 0 Thomas Fisher r" r 6` r' z Southold Town Hall P.O. Box 1179 53095 Main Road Building Inspector Gary Fish''~j~' Southold, New York 11971 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 ~J J ~7 p DATE: Building Permit No. Owner:- pecoH/C RAdpet-Tes l4,1Q6eme14T eot-P (pl/Jease pri t) Plumber: (please print) I certify that the solder used in the water supply system contains less than 2/10 of IX lead. Plumbers Signature Sworn to before -m~e^this ~ S+ day of v l lrlp_ 19qL4. Notary Public, SL6P County N ary Public MARYANNE E. Do1NLJN(i Notary Public. St Now yqk No.6000030 Qualified in Suffolk County Commission Expires Auuust S. 1 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 82784593/93 N 318290 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the abode application number in the premises of SOUTHOLD VILLAS, 1380 JASMINE LANE, SECTION-II/JOB#7, SOUTHOLD, N.Y. in thefollowing location; IN Basement ® Ist Fl. ® 2nd Ft. OUT Section Black Lot was examined on JUNE 20 , 1994 and found to be in compliance with the National Electrical Code. FIXTURE KFPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS OUTLETS INCANDESCEM FWORESCENr OTHER AMT. K, W. AMT. K. W. T. K.W. AMT. A. W. AMT. H. P. 13 17 15 13 1 8.6 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS SELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. K. W. On H. P. GAS H. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H. P. SYSTEMS AMT. WATTS NO.Of FEET 1 F 2 - SERVICE DISCONNECT NO OF S E R V 1 C E AMT. AMP. TxvE METER 1 X 3 1 X 3w 3 X 3W 3 Ar4W NO. Of CC COND. A. W. G. NO. OF M4lEG A. W. G. F40. OF NEUTRALS A. W a EOUI?. PER A OF CC. COND. OF HI-lEG OF 4l11RAl 1 100 CB 1 X 1 4 1 4 OTHER APPARATUS: MOTORSt2-F H.P. G.F.C.It-7 SMOKE DETECTORt-1 SPUDS ELECTRIC SERVICE LIC.#192E 175 3RD.ST. BOX 166 GOMM 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. ~o OUHDATION (1st) (t! CA GUNDATION (2nd) m o OUCH FRAME & o -PLUMBING c/ Qi N y ~ p • i n 1 IISULATION PER N. Y. I y STATE ENERGY ~I CODE VI FINAL ADDITIONAL COMMENTS- m . a ` G ~d 4 e x • H a ~O N • O y _ a - rn o • v 01 BOARD OF HEALTH FORM NO. 1 7 SETS OF PLANS • _ _ TOWN OF SOUTHOLD SURVEY • • • • - - - - • • , t, BUILDING DEPARTMENT CHECK: i TOWN HALL SEPTIC FO R:1 SOUTHOLD, N.Y. 11971 L--T'?', TEL.: 765-1802 N I FY ' Examined ..i.o~~-f........ 19.93 CALL - PIA IL TO: Approved 19 . Permit N0.o?l2V.g-Z- • . Disapproved a/c _ . (Building I s ector) APPLICATION FOR BUILDING PERMIT Date . /P. 19/ 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 st'ree 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 Occupanc 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 demolition, as herein described The applicant agrees to comply with all applicable laws, o i nces, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in building fo nq ssary i s ct• s. (Signature of applicant, or name, if a cai oration) ' 1../-/, t Z .1/.9s . (Mailing address of ap icant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . ~ Name of o*nr ses -47~r4P..r . ~ . as on the ( tax r or 1 If applican io signature of duly a horize d officer. le of corporate officer) Buildeo. Plumber's License No. Electrician's License No. Other Trade's License No. . 1. Location of land on which proposed work will be done. ~ j3$Q..... Gam.. ? House Number Street Hamlet ' County Tax Map No. 1000 Section , . 0_3 Q . . . . . . . Block Lot. a.~i,( Subdivision . do--f j........... Filed Map No. Lot . f1. y3.7, .40 (Name) 1 State existinc use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy . _.,..as~iiit -3. Nature of work (check which applicable): New Building I • Repair Removal ' • ' ' ' ' Addition Alteration • • • • • Demolition Other Work . 4• Estimated Cost (Description Fee 5. If dwelling, number of dwelling (to be paid on filing this application) If garage, number of cars ° units Number 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 . 1160-lit Num Rear Depth • . Dimensions of same structure hr of Stories alterations ies *Ji, 'n*s*: . • . • ' ' • Depth or adtions: Front . , , , , , , • , • . • • • ' ' ' • ' ' ' ' Height . • - • • • Rear . 8. Dimensions of entire new Construction • • • ' • • • ' • ' Number of Stories . Height : Front Rear........ • - Number of Stories . Depth • . y. Size of lot: I•ront 10. Date of Purchase Rear............... :.Depth . .L 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: Yes * r 14. Name of Owner of premises Name of Architect • - ' ' • ' • ' ' • • • Address Phone No. Name of Contractor . - • • • ' ' • ' ' ' ' • • Address Phone No... . • • . • . . . • 15. Is this . • • • • , , , • - , Address . Ph ne No. property within 300 feet of a tidal wetland, *Yes.. *If yes, Southold Town Trustees Permit may be NO' ^ " required. • 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. • 8' i4 e T F # C 1 V~ Q STATE OF NEW YORK, COUNTY OF S.S %Jo ~~/',n L.d R ~l~ G.IC tf !V (Name of individual signing contract) being duly sworn, deposes and says that he is the applicant above named. He is the ~ o /~I• 7-1c /4 G ~ w (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 .pplication; 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 i 7-7 19 ,day ,otary Public, • • , • . • • _ • -C • ~r.. ount JOYCE M. WILKINS • • . Notary Public, State of New York No. 4952246, Suffolk County (Signature of applicant) Term Expires June 12, 19 f - • /F r V1k4 ~~b Y Fz uW ~ ~p4` 4 ~ ~ a~ 2 r y~, O W W y?1 ' ,CQO J o :l=:r (0mcc O C p ~Y o u• dy°~ W~QO cot. in- O JZ lL v J~I~O~~ wog_~, ~moJ OOH O~2a~~ aso r`^~l' o3`bO' "bay O OL ° mbV) o a~~ o as b vi Z O cn b o ahcZ _ ~4 y to = ~ al O 7 to: v, O COQ ubi V 3 y y m yJ' N b t to t b~ 4 O.a~ y b Cc) Wo %V C4 • 6 O R.2 9 2~. • ~9y0 C g s9~ 0~ ~ ~ > Ls3 CD a2 \G W i Q\m ~ 3 c u / O c2 LLJ f -W °sa 0 °O•~s •9c S Vl O w Q) h0ti Ilya °y~ h h ID -:91'°~ 0,0a1 Ell* 0 elm C6 rw~ C ~ / p0, omo T 4Z G 44 OD U) aD m W U ~ `I w 2 W =.j ~ = g r J% ~~P O f~ L~U OD Z Z f~ o LL v y 2y~ _ W N J- <U. to ~o kQ to (j _j z & oa ~(pOZ~ ICo t~ U z 1 D a. (n v Q J O 4z LL Z NO :3 oE= O•~ N.c I ~'(hv~`~ ooa •Er~ ~4 4~c - Q M OCa 1, U 03` to C4 N ~ N 01 y J J ~7 jJ O \ I :,nom v r^ 'K V V e U~~ o o~ m am v, U O W7~i 1. a IL Q~po cn Z 0 ~'mp; LJ s~ • C~3 O N C J w. a FZ. 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