HomeMy WebLinkAbout20792-Z _
- FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-21156 Date NOVEMBER 18, 1992
THIS CERTIFIES that the building NEW DWELLING
Location of Property 665 JASMINE LANE SOUTHOLD, N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 69 Block 3 Lot 14
Subdivision SOUTHOLD VILLAS Filed Map No. Lot No. 3
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 2, 1992 pursuant to which
Building Permit No. 20792-Z dated JULY 9, 1992
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 STORY ONE FAMILY DWELLING
The certificate is issued to PECONIC PROPERTIES MANAGEMENT INC.
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-40-NOV. 17, 1992
UNDERWRITERS CERTIFICATE N0. N-256230 - NOVEMBER 9, 1992
PLUMBERS CERTIFICATION DATED OCT. 8, 1992 - ARTHUR MALANSSENA, JR.
amt
Building Inspector
Rev. 1/81
roses xa 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°-I~1° 20792 Z Date 19.~.z-
Permission is hereby granted to:
~,.....u.:.~.:....!..!9:~~..........
of premises located at .~o~........Sl.rfa!!':kl:M,r~..... ..!h:!^!1.........c~~tr.4~,.tJ!?r;.Q4~r...........3......
.
County Tox Map No. 1000 Section ....Sal~.....QQ.... Block .....t,?.~.......... Lot No.......Q.~P...........
pursuant to application dated ......~......t 19.q.1.:, and approved by the
Building In~s~pector.
Fee s.'~~1'.....
Building Inspector
~
Rev. 6/30/80
Form No. 6
,
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OP, 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 17 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
S. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date ,,,,November 18,.1992
New Construction.........!(.. Old Or Pre-existing Building
Location of Property...6 Y 5...,,.JASMINE •...LANE .................SOUTHOLD: NEW YORK........
House No. Street Hamlet
Onwer or Owners of Property...........,PECONIC.PROPERTIES MANAGEMENT_INC:
. .
County Tax Map No 1000, Section...b.~.........Block....3...........Lot..14
Subdivision...Ii~O SOUTHOLD VILLAS ,,,,Filed Map... 9737.....Lot. 3
Permit No..eK.Q79aZ.~J...Date Of Permit..:~Y.9,,1992„Applicant.,DONALD,BRACREN.......
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for; Temporary Certificate........... Fina Certicate...........
Fee Submitted: $,,,~-00........ / ~ p~ /
e O ~a~ ~5 ~ APPLICANT
_ _ _
THE NEW YORK BOARD OF .FIRE UNDERWRITERS FACE 1
1000837 BUREAU OF ELECTRICT'
85 JOHN STREET, NEW YORK, NEW YORK 10038
pole NOVBNBBR 09,1992 gpplicatianNo.onjile 78442092(92 N 256230
THIS CERTIFIES THAT
only the slectrled equipment a daseri6ed 6ebso and introduced by the oppNcont nomsd on the a6oee epplicetion number in the premises of
BD/fARD & DONNA DUNNB, 665 JASHINB LAMB, JOB 33, SOUTHOLD, N.Y.
in thefolloteinR location; ®Besement ® Ist Fl. ? Ynd Fl. ODT Section Block Lot
Fmse+omined on NOVBHBBR 02,1992 andfoundmbe in cornplionce uith ehe reyuiremend Gf this BrASrd.
RXTURE RXTUREf RANOlS COOKING DECKS OVENS DISH WASHERS !%MAUST FANS
OUileit ACIRS SWITOIES IN[ANDESCEM ~ FLUOIIESCtM OTHER AMT. K. W. IMT. K. W. AMT. K.W. AMT. K. W. AMT. X. P.
13 30 14 13 1 1.2
DRYERS RlRNACE MOTORS IUTUM ANLANCE IEEDYtS SelCIAI MC'?T TUAE ClOCK3 EiLL UNIT NEAT!!S AWLTI.OUTIlT DIMMBRS
MAT. K. W. dl N. P. GAS R. P. AMT. NO. A. W. G. AMT. AMP. AMT. AMPt. TRANS. NAT. M. P. ~ ~i MIT. WATR
Z F 2 - - 2 -
SERVICE DISCONNECT NO.OF S E R V 1 C E
AMi. AMV, IYPE MRTRR 1 / tW 1 R ]W S A SW S / IW ~ CC. COND. A. W.O. NO. OF NI.LEG A. W. C'' q0. W NEUlRAlS A. W. G.
EOU11. PER a OF CC. COND. p MiEG d: NEUTRAL I
1 100 CB 1 % 1 4 1 4 i
Oi11RR ARPARATUS:
G. F,C.II-3
SNOBB DBTBCTORe-1
SFUDB BLBCTRIC 9BRVIC6 LIC./192-B
"175 3RD. ST, BO% 166
ownu MANAO!
ST. JAHB3, NY, 11780 11 ~
Per ~ f
i
This certificaN must not be altsrod in any manner; return to the office of tha Board if incorrect. Inspectors may be identified by tMir crRMettkb. -
• 7
S~EFpLf TEL.7ss-lso2
~4.v TOWN OF SOriTT~Od.D
! 1
mot:'.. r: .
OFFICE OF BUILDII~IG INSPECTOR
~ ~>r r;=r P.O. BOX 1179
c?. ~ TONN HALL
%Ol SOUTHULD, N.Y. 11971
C E R T I F I C A T I O N
Date g
Buildirq Permit No. Q~ ~~a .Z
Owner
(pleas~~e// print)
Plusher /~i(gG~jt/35E~-~~p
(please print]
2G~1-P
I certify that the solder used in the water supply system
contains less than 2/10 of l~ lead.
Vim-
(plumber's signature)
Swo'r1n to before me this
~"f!~l day of '~+-4p~R
19~,
otary Public
Notary Public, County
MARYANNE E. OOWUNG
Notary Public, State of New Ya*
No. 5000030
Qualified in Suffolk County
CommissVon Expires August 3, 9
ao79i ~
~r~-zsoz
BUILDING DEPT.
INSPECTION
~j FOUNDATION iST [ )ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING (]FINAL
REMARKB: ~sr' Ve..~••.Xa~i:u.., t~-k .
01C ~'o ~ Lw.,.,~ If ~l~-NI
~Nd
DATE ~ i~ 9 z. IN8PECTOR Y . G . L
ao~9i~-
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ ]FINAL nn
REMARKS: ~ 1C2~_~ r~-I~
d 3.~-c.t ueu~ ca.~..aQ 1 ~ g ~
DATE ~ 9 IN8PECTOR 1/ . ~i . L.
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ( )ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
FRAMING [ ]FINIIAL
REMARKS: 0~
DATE a L IN8PECTOR
ao~q~~
T6S-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST ROUGH PLBG.
]FOUNDATION 2ND [D~ INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~~M
n,l.~i.nr~
o ~ o
DATE I ~ ~ q z INSPECTOR ~ L
--T-~- - _
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST [ )ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING FINAL
REMARKS: ~ C o
DATE ~ ~ 1 ~ ,~i -INSPECTOR
- ~ 11 "~.1
r'1. J I~~n-= I~ i1:-(i9ENT~ ~
• _ ~ ~ ~
?OUIIDATIO:J (1st) I -a
I
'OUtJDATION (2nd) 7 1 _ N \
I m b
9q 13 -
I
:OUCH FRki-JE ~ ~
-PLUMBING
3, I y
1JSULATI0;1 PER N, y, I y
9 q m
STATE EJIERGY II
CODE I ,
I
, " ~ e o . .-.1 m ~
H I,~
• I ~UU
FI;1AL I -,~'l
c
n ~ AD/D~ITIOPJAL COMMENTS: ~m~
~
/1 n n n~ l / AIA y7I nl/~/-1 O QA ~J ~ ,(w O
A
m
x
' -n
M
a Ca
H
F~ ~
~~~p O
C.o. a
r
. - y r
_ ~
~ C
m ~
-v
.-i
- O ~
' BOAFD OF HEALTH
FORMN0.1 ~ SETS OF PL.\t7S
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CIIECI: . .
TOWN HALL SEPTIC FOR:1
SOUTHOLD, N.Y. 11971
TEL.:765-1802 t:OTIFY; - 6~y/
p CALL
Examined 199?-- hlAIL TO:
Approved . 9....., 19q Permit No.. a 07.~e+~ ~ . .
Disapproved a/c .
(Building 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 3
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 streets
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 pazt 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, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for nes ary ~inpsp/~~ct~i,9(J~s. vp ~ ~
(Signature of applicant, or name, if a corporation)
~ ~ ~
(Mailing addr ss of applif~ant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
<~..c~.cu:~........
/ ,
Name of ow er p 'ses ,t~..~l'-.0."~;r:~.C:.lLl~~..~i~.... ~ C-e'. dom .
(as on
thuoll or latest deed)
If app an cop a on, i~gn/a-tu~re of duly authorized officer.
N e nd title of corporate officer)
Bui er License No . .
Plumber's License No. .....a~ rh 3.l .
Electrician's License No. ..j 9 a .
Other Trade's License No .
n -
1. Location of land on which proposed work will be done. ~1.o-c4~tiLd ~U'i .~~~-~i /10'
r~
~p-~;lX.~..l./.f~.-
1.
Itouse Number Street Hamlet
County Tax Map No. 1000 Section ~Q......... Block ~~...p........ Lot ~ .
Subdivision . :.l/~~C~-'......... Filed Map No. , - Lot . .
(Name)
2. 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 RS., `
/ ?~/~Zty~
3. Nature of work (check which applicable): New Building Addition Alteration .
Repair Removal Demolition Other Work .
(Description)
4. Estimated Cost.~.4.ti~tn?'s?.....•,.,.•.•••••••.••„••Fee.o~.~~•
(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 • • • • •
Depth
Height Number of Stories .
Dimensions of same structure with alterations or additions: Front Rear .
Depth Height ......................Number of Stories .
8. Dimensions of entire new construction: Front • ~ ' ' ' ' ' ' '
Rear Depth
Height Number of Stories
Size of lot: Front Rear Depth
10. Date of Purchase " " " " " • ' • •
........:.............NameofFotmer Owner
1 I. 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 No
14. Name of Owner of premises ....................Address ...................Phone No............... .
Name of Architect ...........................Address ...................Phone No............... .
Name of Contractor • Address Pho a 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.
STATE OF NEW Y R~(., S.S
COU/N~TY OF '1'RI1~,.... .
• • • • • • ~~n~G•+`•r ~/Y• • • • • • • . • being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the
ntractor, agent, corporate officer, etc.)
of 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
work will be performed in the manner set forth in the application filed therewith.
Swom to before me this
...da o(1 J ~ ~f
S„
Notary Public, - Count
Y
g~amp~[[ NOTRY PUBLIC, State of KY
11C d x Na 47259 Suifop~ Cou~r~ (Signature of applicant)
~ Term Expires Myr 31,192iE
-°~7 ~i~ W
~M.
% 25 Lq
PIEASE NOi'E
Sanitary system is not to be
es ~s 43ryo~ ~ placed under driveway area.
-N` 25 ssoo,
~ ~
O / ~ ~a N
~ 3 ~ ~a ~Np
/ ~ ~
~i
3y-
Pro
h`o<.s
e
ti ~
h
~Q O
~o,
C
V
O ~ ~
c
b
h
~ ~ O
eir5 Tav V
^'~s.~yo w 0 41
/g q/, .
~g ~r p
2~ ~
ROI~R ~
c°r~i°+orQA
~av
SiNt31.E FAMILY OWEU.fNG ONLY....
/AREA .14,202 sµ ft. gyp- /7 f XPIRES 3 YEAR$ DATA O~APPROVAL
G(
-e'C~u~ ~ic
~o~zo ~~e~u~rX Ge~
0 ~
C~.l<.~,c~e ~ ~ - 9 3 s~ SURVEY OF
LOT 3
or<so~urria?.~ vrus~•
aav ~~1~ ~~a.
Prepared !n accordance w/th /M Mn/mum A T SOUTHOLD
slanabrds /or lllhi surveys as sslabUshsd ~v ~ t~1
by hle L.bA.L.S. and approved au?d adop/sd TOWN OF SOUTMOLD
/or such use by The New York S/ah Land
T!!h Asroclallon. SUFFOLK COUNTY, K Y.
The wo/er supply and sewage dhposol - ~ - -pro ~
sys/sms /or h!a res/dencs wlN con/arm ~i a ~
to / standards o/ TM Su//olk County SC~/ T 30
D lmenl onf ~H/sollh ervicss^. / ~l~'Ch ~82
//LZ~cI~ ~~f Cam/
The /ocaNons of wetls avid cesspools shown hereon are /ram /k/d
observallons and or /ram data ablaJnsd liom o/hsrt.
~/S'I~S '3Yoo- aao /G~'f~~,r~°~~ 5`~o SAMAS~'9~ "
SUFFOLK COUNTY DEPARTMENT OF NEALTM 8ERVICES ~vwy,~~ 2 ?
FOR APPROVAL OF CgiSTRUCTION ONLY ° a.,4 C,~ ~
DATe'~ 02~ wr q 0- o Mqy zs ~ ~ N.Y.S LIC. No. 496/8
199? u' S YORS, P.C.
O
~ 9
APPROVeD ~ NfALT ~£Pr Or e SO , N. Y. ll9Tl
H S£RVI~ ~ -
zs ~A~c
l P•~ ~
es ~S~43Yp~ ~
p zs / SS;p Uzi
6 / p
~ r~
(p 0 / iANiT
~ I ~C
~l '"'-a°o_
I
_~za ~
4H ~0~ I
O p h
~O•
HOC
YG. >
`6.0.
/ `
O l 35. ~
C
G
w ~ oa
O ~
y ~
O
e/zg '4~V ~l
N'S 4/ W EAT
°g 0
h
B?./6' 'p/xs
fZO~ ~
co~A~
~Nd
AREA = 14,20? sq. ft 11~0< Z Nom,
cERraFrEO ro' SURIfEY OF
TF~ LONG /SLAIID SAVNYGS BANK
PECOl~C PRAPERTiES MANAGEMENT CORP. LOT 3
o,~ saunran vuAS~~
Prspasd /n accordance wllh /M mbdmum A T S~s s7Va.D
standards for tUka surveys as sslabdshed
by a?. L.tA.L.s. and approved and odoo?ed TOWN OF SO!/TNOLD
for such urs by The New York Sale Land S(~'FOLK CO(~0111TY N. Y.
T/lk Assoc/ollon. ~
Ths wa/er supply and sewage a~aposol ~ ~ ~ - Pt~ ~
syslevns /or h/s residence wIN con/wm SCiI/O~ lii = 3~~
to Jhe slond~ds o/ Ths Suilolk County
OsporJmen! o/ Headh Services. March ~
.AL[ Y 13, 18s2 ffa.~al.tia?1
The locations o/ we!!s and cesspools shown hereon ore liom /ls/d
observolkns and or Iron do/o ob/akred Iron o/hers.
~0 LANpS,
BUFFOL.K COUNTY DEPARTMENT OF HEALTH SERVK~S O ~L'
FOR APPROVAL OF CC416TRUCTKMI ONLY ~
.Y.S. tlC. NO. 496!8
~f~t%
DATE REF. NO. S, P.C.
.O
. MA
APPROVED SOUTH , N. Y. 1197/
g~-boo (3f
~'4~ acv r`~ ~~2 ~ S11_~1~
i
U .
_ia+
3j E i of ~ . ~ ~ r,
o s, ~r _ ~ s~~:~
o ~ ,p~, i w~~r
~ i 5. o
p ~N-'°.
tir ^ ~
~ 3
N
2`.j. ~r
m y
` ~ ~ b ``~`o```
~ ~
26.3
I ~ `6.0,
I/ ` v
O / dg 1
W
0
;h
b q rr~w
2 N C """ARV vJ
N73' 43%O• 3 `V
/g 4/ • M'~ O • EAT y0
g ~o
~ry a
N./B'/220'W.
6/./G•
F[OIN~ J'#[ ~
coA ~
AREA = 14,202 sq. ft.
CERTIFIED TOE SURVEY OF
THE LONG ISLAND SAVINGS BANK
PECOMC PRAPER~TIES MANAGEMENT CORP. / O
n //93s'~ 'yti/,gP Of SOUTFIO~LD VLLAS"
fIED.RAtiE2a, 19,~rtA41P M0.92s~
Prepared In accordance wllh the minimum A T SOUTHOLD
s/andards for 1llie survsys as salabUshsd
by lhs L.I.A.L.S. and approved and adopted TO WN OF SOUTHOLD
for such use by Ths ew York Stale Land SUFFOLK COUNTY N. Y.
Tllie Assoclallon. ~
The water supply and sewage disposal - ~ - P~~ ~
sys/ems for !h!s res/dsncs will conlam .SC8~9~ iii= 30r
/o the standards of The Su/lolk County
Dsporlmenl of Hsaph Services. M8/(;h ~~Q
.QX Y 15, 1992 (fpur?dafioon)
The loca!lons o/ weUa and cesspools shown hereon ore Iron lleld OCt 24, 1992(fN181)
observallons and or lrom data obloined lrom olhsrs.
SUFFF~OR AP
ROVA~OF CON~STRUCTIONL~YSERVICES I~~V/ ' -j~
~ Y.S. LIC. N0. 496/8
I
92 SO 40 NpV 1S 1992 ~k'
DATE wS. REF. N0. ~ V / S, P. C.
/ _8
SERVICES P. ~ V
APPROVED SOUTH , .Y. 1197/
g ~ - (~~0 ~ 31