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HomeMy WebLinkAbout21710-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No 5-23054 Date JUNE 20, 1994 THIS CERTIFIES that the building NEW DWELLING Location of Property 1300 JASMINE LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 3 Lot 24.11 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. 21710-8 dated OCTOBER 19, 1994 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-SO-29-MAY 17, 1994 UNDERWRITERS CERTIFICATE NO. PENDING - JUNE 20, 1994 PLUMBERS CERTIFICATION DATED JUNE 1, 1994- ARTHUR MALAUSSENA, JR. lding Inspector Rev. 1/81 FORM NO.b TOMM OF SOUTHOLD BUILDING DEPARTMENT TOMM HALL SOUTHOLD, N.T'. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ...........4.stRhrx...12............................... 19...93.... N° 21710 Z Permission Is hereby granted to: Peconic Properties. MANAGEMENT.CQRP,,,,,,,,,,,,, P.O. BOX 1143 CHTCHOGHE, NEW YORK 11935 to.........CONSTRUCT.A.OP.. FAMILY..~?s.$G..M..4w.nx>dA..WK, . . ....................................SODT. .HULDa. N.Y.,,,....,,,.......,. at premises located at...... 1300- JASN.1NE...LANE. County Tax Map No. 1000 Section .......69 Block ........3................ Lot No..24. 11................. pursuant to application dated QrX.9A r..P. 19....91 and approved by the Building Inspector. Fee 245:.QQ......... r yl •%~r~ f~Z Building Inspector Rev. 6/30/80 ? Form No. 6 TOWN OF SOUTHOLD ~Q BUILDING DEPARTMENT C TOWN HALL 765-1802 APPL CATION 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 12 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 j, c ~J, p/, New Construction...... / Old 0 Pre-existing uil ndY g........ Location of Property..l.30©, 7 \~~ry!G House No. Street Ham t Onwer or Owners of Property.(i.,,,, ice;""._"""~f' / County Tax Map No 1000, Section...6~. . .Block.. J~j .Loy SubdivisionC#~~ K 1f .Filed Map.? 7.3 . Lot. Permit No -Q 7 ZL Z:..Date /O/f Permit~~Vq~J.Y ...App1icant~ U14G~/LQj7 Health Dept. Approval,',~7/9r „ .Y~ SO a9 .,.Underwriters Approval .......v Planning Board Approval Request for: Temporary Certificate........... Final Certicate., Fee Submitted: 'l~ C~:oc• ygo~ oxn„D~. u l.0 a3oSy APPLICANT THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 r1000837 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK. NEW YORK 10038 Dote JUNE 23,1994 Application No. on file 82784693/93 N 318291 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, 1300 JASMINE ~yLANE , SECTION-II/JOB#11, SOUTHOLD, N.Y. in thefollowing location; ® Basement I Ixt Fl. ® 2nd Fl. OUT Section Block Lot was examined on JUNE 20,1994 and found to be in compliance with the National Electrical Code. FIXTURE RXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTWS ECEPTACLES SWITCHES INCANDESCENT FIVORES" OTHER AMT. K. W. AMT. K. W. MIT. R.W. MIT. K. W. MIT. H. P. 14 17 15 14 DRYERS FURNACE MOTORS FUTURE ANUANCE FEEDERS SPECIAL REC'PT TIME CLOCKS NU UNIT HEATERS MULTI-OUTLET DUdMERS AMT. K. W. Olt H. P. GAS H. P. AMT. NO. A. W. G. AMT. t-0- MS SERVICE T. AMPS. TRANS. AMT. N. P. SYSTEMS NO. OF FRY 1 F 2 DISCONNECT NO OF S E R V I C E AMT. AMP. TYPE METER 10 3W 1 s 3W 3 / 3W 3 / AW NO.Oi CC. COND. A. W G. NO. Of HI-lEG A. W. G. NO. Of NEUTRALS A. W. G. EQUI?. PER B W CC. COND. OF HI-LEG OF NEUTRAL 1 1,00 CB 1 X 1 4 1 4 OTHER APPARATUS: MOTORS:2-F H.P. G.F.C.I:-8 SMOKE DETECTOR:-1 SPUDS ELECTRIC SERVICE LIC.#192-E 175 3RD.ST. BOX 166 GiNEMt MANAGM 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 Y'p~~SUFFO( SCOTT L. HARRIS, Supervisor . o Eu ` .c Thomas Fisher Southold Town Hall Building Inspector 0 r P.O. Box 1179, 53095 Main Road Gar Fish Southold, New York 11971 Building Inspector Or = ,t 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. 07 I ~~d 7-- Owner :L~000N/G naPrTIPC w~AN46eme47-01-r (please ridty)J Plumber:. A77'E Xe '4/ =X 4r/SS EA/i4 (please print) I certify that the solder used in the water supply system contains less than 2/10 of lZ lead. lumbers Signature Sworn to before me this ~S+ day of Sl In e--. 19-9-~L. Notary Public, County Not y Public MARYANNE E. DOWIING Notary Pub to ,~ofNow Yiolk Owlilrsd in Suffolk Commission Expires Aupwt 3,1 ai9ENT~ m - J H ~ y O OUNDATION - (1st) a OUNDATION (2nd) m D Iv - o N 111116 OUCH FRAME & o pe -PLUMBING H En 4[ m n NSULATION PER N. Y. I 3 STATE ENERGY CODE m H FINAL ADDITIONAL COMMENTS: x N ~ 9 r\_ H ' O m y A .e 7 BOARD OF HEALTH FORM NO.1 3 SETS OF PLANS TOWN OFSOUTHOLD SURVEY BUILDING DEPARTMENT CIIECK _ . _ , , TOWN HALL SEPTIC FORK SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t:OT I PY ; t,...,~:,...a....:n-__• . AL L . 19 rJ~ Examined CALL ,,33 MAIL TO: Approved 19 93. Permit No.al i 7l~ . Disapproved.a/c /(Bu- no Inspector) APPLICATION FOR BUILDING PERMIT / Date 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 strce or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app. 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 e 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, o ' antes, building code, housing code, and regulations, and t. admit authorized inspectors on premises and in building for nec ssary inns ctij s* -&4&& ava (Signature of applicant, or name, if a corp6tation) 66 (Mailing address f applican State whether applicant is owner, lessee, agent architect, engineer, general contractor, electrician, plumber or builder. . . . r . Name of owner of p e ises~~..Ta-ua (as on the tax ~b11 or latest deed) If applicant is c ation, Lnature of duly auorized officer. V~ (Name d i le of corporate officer) Builder's Li ense No . Plumber's License No. c~,6.3/. P . Electrician's License No. Other Trade's License No . 1. Location of land on which proposed work will be done. House Number /Strreet Hamlet County Tax Map No. 1000 Section _ U Block Q-3 Lot .9 VI) I /J Subdivision T jc. ~!K ?-~/~.Mel Filed Map No. Lot /.1. . (Narne) 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 . t . ,3. Nature of work (check which applicable): New Building ` Repair Removal . ' ' ' ' ' ' Addition Alteration Demolition , , , , , , , , , , Other Work . 4• Estimated Cost , (Description Fee.. S. If dwelling, number of dwelling units (to be paid on filing this application) If garage, number of cars , , , , , . , • • • • 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 . Height .Rear Depth Dimensions of same structur with alterations Number of Stories • " - ~ ~ ' ' . ' ' Depth . , or additions: Front , , ~ • • • • • ' ' ~ ' ' ' " ' ' ' ' ' • • • • • - Height . Rear . . 8. Dimensions of entire new construction: Front ' ' ' • : • • Number of Stories . . . . . • ' ' • Height Rear . • Number of Stories . ' • • • . • • Depth 5. Size of lot: I•ront . 10. Date of Purchase Rear Depth . 11. Zone or use district in which ' ' ' " " ' ' • . • • • • Name of Former Owner premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded • ' . " . . 14. Name of Owner of 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 property within 300 feet of ' ' ' • Address • • . , Phgtt No. • . . *If yes, Southold Town Trustees a tidal Permit wma land?*Yes.. • " " " be re u No. PLOT DIAGRAM 4 fired. 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. ' Cf'~G~uS. ~1C3i ;~cF~r~~tJtiir{t_~ ri?It DE-SIGN ()rj CC a lRttGlts~,,?. ERKWS STATE OF NEW YORK, COUNTY OF S.S loo i~.9.~ el../~A. c. f .4 /j (Name of individual signing contract) being duly sworn, deposes and says that he is the applicant above named. / He is the ? / ;T.... 7.. f"C.. ~.G P. . / . . . (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 Fork will be performed in the manner set forth in the application filed therewith. )worn to before me this p ! .q. L day of. . 19 9 3 :otary Public, v v ~`~?~t"`-: County JOYCE M. WILKINS . ~ Notary Public. State of New York • • • . ' ' ' ' No. 4952246, Suffolk Cou (Signature of applicant) Term Expires June 12, 195 cc W v U > ;T d W a M-i NA O 4z r r y 4.U ;1y~ OR oR~? ~~9p 0Y1 2 ~ U) LL, w" Y S 2. ~Ol CL O v s V a, , C u, U C7 0 Q W r o, Ora Z) LL > cl: to $ =~'~co o ° a V. 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