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HomeMy WebLinkAbout20794-Z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21160 Date NOVEMBER 19, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 875 JASMINE LANE SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 3 Lot 16 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 2, 1992 pursuant to which Building Permit No. 20794-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 FAMILY DWELLING (FIRST FLOOR ONLY) The certificate is issued to PECONIC PROPERTIES MANAGEMENT INC. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-42-NOV. 17, 1992 UNDERWRITERS CERTIFICATE NO. N-258492 - NOV. 1992 PLUMBERS CERTIFICATION DATED OCT. 8, 1992 - ARTHUR MALANSSENA, JR. `~Ut u ding Inspector Rev. 1/81 meat xa s TOWN OF SOUTHOLD lUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N00-N° 2079~Z Date 194.x. Permission is hereby granted to: `-3ok...i.>. ~ of premises located at .~..Z, .,~......~A!sArY.~~ ..o-SrA!GK.L~'1~,..~............ . County Tax Map No. 1000 Section ........~1.a....gqBlock Lot No....~..P........... pursuant to application dated .....J 19.~.+Z.r, and approved by the Building Inspector. Fee S...I.~.1.:.~~. .~1.~'.~! • ..!fit... . r?r.4r~. ~r~ Buil ng 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 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ..,,November 18:.1992 New Construction........... Old Or Pre-existing Building Location of Property...,$~S.JASMINE LANE SOUTHOLD, NEfl YORK..... House No. Street Hamlet Onwer or Owners of Property...........,PECONIC.PROPERTIES.lfANAGENENT INC . County Tax Map No 1000, Section....69........Block.....3..........Lot....16 Subdivision..ti(O.SODTHOLD,VILLAS,,,,,,,,,,,,,,,Filed Map.. 9737 .....Lot....s................. Permit No...,20794Z_ ..,,Date Of Permit..:~Y.9~.1992 „ Applicant..~NALD.BEACREN..... . Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for; Temporary Certificate........... Final Certicate........... Fee Submitted: $....?S.UO P~~ _ 4 al/~ Z7 APPLICANT c~~FF~(~-~, TEL. 765-1802 o~~~: l Old TORN OF SOiJT~Od.D < OFFICE OF BUILDING INSPECTOR ~ P.O. BOX 1179 cA"i ~ TOWN HALL SOUTHULD, N.Y. 11971 C E R T I F I C A T I O N Date Q L Buildiry Permit No. Q % / ~ z- Owner (Pleas~ej~ print) Plumber~~~~,77F/~ O'//~rAcvg,FN'4f (please print) ~z~ 3/ -off I certify that the solder used in the water supply system contains less than 2/10 of l~ lead. t~L'u~r-fG` (plumber's signature) Sworn to before me this day of 19~. Notary Public Notary Public, County MARYANNE E. DOWLJNG Notary PuNloc 55000030New York Qualified in Suffolk County 1 I Commission Expires Augusl 3, 19 } Laeas37 THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 a ~ BUREAU OF ELECTRICITY f EIS JOHN STREET. NEW YORK, NEW YORK 10038 Y is Dote NOVEMBER 30,1992 gpplirationNo.onfile 7A705292/92 N 25A492 ? THIS CERTIFIES THAT _ only the electrical equipment oa described below and introduced by the applicant homed on the oboue opplicatfon number in the premises of E SANTA CROC,E-SOUTHOLD VILL, 875 JASMINE LANE, JOBtS, SOUTNOLD, N. Y. mm ~ry ryry--~~ r in [hefollowinp location, L"J Basement L'J tat Fl. LJ 2nd FI. ffLT Sertion Block Lot NOVENBBR 19,1992 una examined on andfound m be in cornplianre with the rrquirement.q q(this Board. iIXTURF RKTURES RANGES COOKING DKK$ OVENS qSN WASHERS EKHAUSi FANS ~TLE7, $ lCEPTACLFS SWITCHES INUNDESCENi. FlU0RE5CENT OTHER AMT. K.W. AMi. N.W. AMi. KW. AMi. K.W. MIT. N.P. } 8 ~5 14 A 1 F DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SIFCIAL REC'PT 71MF CLOCKS gEll UNIT HEATERS MULTLOUTIET DIMMERS = AMr. K. W. Oll H. P. GAS N. P. AMT. NO. A. W. G. AMi. AMP. AMT. AMPS. TRANS. AMi. X p SYSTEMS AMi WATiS NO.OF iEET 1 £ 17 2 - 5lRVICE gSCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER 1,a TM 1 ,e ]W 3,a lW 3$ AW NO. Of CC COND. A W G. NO. Of XI-LEG A' W' G. NO. Of NEUTgAIa A. W. G EQUIP. PER $ Of CC. COND. CK XI-LEG OF NEVTNAI 1 150 C8 1 R 1 1 1 1 OTHER A??ARATUS: v.P.C,I:-2 SMOKE DETECTORI-1. d t i z 3 i p~Q / ~ ` SPUDS ELECTRIC SERVICE LIC.4192 E G/~%~ 175 3RD. ST. BOR 166 GEFEERAI MANAGER ST. JAMES, NY, i178a 11 ~ Per G t 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. ~ f COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. aQ79~ ass-ice BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION 1ST [~C] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION FRAMING [ ]FINAL REMARKS: ~ q-o ti 7 ~ DATE ~~1 ~`I 9 i INSPECTOR Y ao'~~y ~ 765-1802 BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [)FOUNDATION 2ND INSULATION [ ]FRAMING [ ] F(~INAL REMARKS: 012 `a-o Cf"~~i DATE ~ ~ ~ 1- INSPECTOR Y$~ ao~9'~~ 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION iST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING FINAL REMARKS: D-1~ C. o . DATE ~ 9 INSPECTOR V ~ L, `1cLJ i.: -J:i il:Jn:.. I~ ii:1i9LNT.: 1. ail 211 _ m _ o a J H ~OUIlDATIO'J (1st) I -a ~ 'OUIJDATI011 (2nd) 7 c* . I o~ ;OUCH FRki~fE & I ~ ~ p` ~PLUMBI,IG R 3 , y m 9a ~ :17SULATI011 PER N. Y. I y STATE E;IERCY II ~ CODs I ~ , I , Il °I p 1b m H . I _ 1 FZ;IAL I - . b~ I ~ o~. ADDITIOIIAL COMMEIITS: m~~9 s 7 ~~~Q2-' U ~ ~ a 0. ~ ~ ~ m ' x '9 ~ 1 ~ > C H F~ -0 ° ' ° 'F r - ~ ~ N ~ o . ~ o m ~ -.c _ ~ N ' BOdFD OF HEALTH FORMN0.1 J SETS OF PL\775 TOWN OF SOUTHOLD SURVEY BUILDING DEPARTMENT C11ECf: • • • • • • . • - • • • • • • • • - TOWN HALL SEPTIC FOR:1 . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 r:oTIFY: ~6S 6at/~ n CALL Examined , ."v - . ~ , , , lg q.L h1n I L TO Approved / ..9... , 19g~. Permit No. 0~0~,9,~{..~ . . Disapproved a/c . ~w. a'`...... ...F........ (Bui ding Inspector) APPLICATION FOR BUILDING PERMIT Date C~~Zt~.. d~......, 19 ~ INSTRUCTIONS UU 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 n sary in p c ons. (Signature of applicant, or name, if a corporation) (Mailing address f applicant State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of o~er of miser •~,~F~ ~ ~2P~(~ (as on t tax roll or latest deed) [f a li ~s a atio , si nature of dul a horized officer. ' d~eAg y ........~2~:..... e and title of corporate officer) uil er's License No . . Plumber's License No. a.p!?.~.~. P . Electrician's License No. ~ £ . Other Trade's License No . 1. Location of land whi h proposed work will be done. ....~~~e:~J.'-. , , G,, r........:....~/.° i-louse Number Street Hamlet County Tax Map N,o,. 1000 S~ec~ti~on~.././../.vJ.4,., Block ~.p....... Lot Q . Subdivision ...~SL~'~%ay~~' :'x V-G~-,~.1~........ Filed Map No. ~ 3 ~7... Lot ~ . (Name) 2. Stale existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . b. Intended use and occupancy 3. Nature of work (check which applicable): New Building X Addition Alteration . Repair Removal Demolition Other Work . (Description) 4. Estimated Cost Fee...................................... (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 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 De th p Height Number of Stories . 9. Size of lot: Front Rear . Depth 10. Date of Purchase .Name of Former Owner Zone or use district in which premises are situated . Does proposed construction violate any zoning law, ordinance or regulation: . 3. 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 Phone No............... . 15. Is this property within 300 feet of a tidal wetland? *yes,,,,,,,, Nc.~ *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 YOBK., S.S COUNTY OF . ~oN,Q~ ~ O/, ~?/s1 ~!~t'~'/Y , being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, 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 ..........6~ ..day ..~.tl~.`~........., 19 Q~ Notary Public, ~ , C ROBERT I. SCOTT, JR. \ NOTARY PUBLIC, State .Y " ' . T rn47EupI~res9~May31 19a- (Signature of applicant) PLEASE NOTE Sanitary system is not to be _ N _ ~ w/, y placed under driveway area. ~ t, ~ hJ 8 h '~Q°' s isc ~ ~`3°•uo =ry,ti,w b~ / / io. i~ O ~ ~ O Q b o C b ~ ~ z ~ 4~'''~~av s~ a` Nri y tits AREA= 12000/i4~ ~G% ~~~-~'Lf~- ~lJ ~~~~~4~GrLPu~~~ iry~ i~ 93r sc~rvEY o,F siwc~. R~~ o~r~r.~t:r~. ~w LOT 5 3 1 ''X1AP QF ~a0U~1~01LD ViLA3" ISr~D A/AP /rK7t .r Jn. ~ AT SOUTHIOrLf ' ~ e~ r°~: n~ r°"~°~r ~ TOYIrM OAF ~Ot/TJMOwi.O r,~. ,~oo,~wn. S~LM~'fC~LK COGrNTY AI Y Tn~ wabr aM «wa~ iipwsar >a00 - 7b - 01- P/~O , o'i~~rr»"`sa~ r c ~ Sc+~s~ r~ = 3©~ Haan srveo... Arch ~ 188'1 The /ocalha?s of wMts and cw~ork aMMw nwen ao hom J~nd oburvoNons aid or !roan dole o1JMb+d h~ olArrs. ~~r !S IFS `3 Do. ae ~`F~,,':., °~/~Ar~ASv BUFfCU( COUITY 0@ART11LtlT MpLTM ~M~AOts ~ . nner~, 9L Fat ~ovAl of cawetw~CrgN arLr ~ MdY 2S 1992 N.Y.S. tlC. NO. 496/8 DATE ~ Q? 4~f~e arff. NO. ~ S O - ~ ~ ~V ~i OiR$ P.C. . fl«~Ti! V ,I~~ ° n Aa'?gOVF~ N.Y. JJ971 _N_ s ~,?•,~3jO~ Aw ~ Y9 ~ ~C 00 ~ ~s ~0' i ~ ~0 o, /3p ~ j0~,Y ~ O tip`` ~ R'392? ~o~ °~~.s o ~ L ~ o,ryy 3y o . ,Q /0. ,J ~e Q~ 0 ,t 6 ~ ~ ~ ~ :n~ ° ~ Q ~ eY~ FA~ 0 N, ~3.,43jo ~ AREA=_ 12,000 s¢ft ~ CERTAFED TO' niE Lonrc /st~hv s~v~ss ann~r SUI?VEY OF PECOV~IiC PROrERT~s ~wsev~Nr eoraP LOT 5 o~~n~ao viwsN Prspwed /n accordancs w/lh hye n~hfmwn ~~A1E~ ~T~t/I+~P~ X97 slawdar~ /or NNe s+awys os es/a6NsMd vW i rMf~/ by !h. L.u.L.s .,,d ~ppr rd and ld TOV~IV OF for such uc. by Th. Mew °rok S1a1~.od Load rna As~sac/aaw,. SUFfCKK CCIGIVTY, l1l Y. The woha syop/y and sewo9e df~posa/ X00 - 7ff1- 01- Pfd OQ sys/evns !or Ibhlles res/Oencs w~' conlorn? to the standards o/ The Su/lodlr County SCi~O: r~ ~ D.pas/menl o/ Hed/h Servkes. ~Ch The /ocollons o/ wslk ahd cesspools shown hereon are h'om lls/d .lam Y 15, A992 (fglArld!' tkfilf) observations and or lrom data obla~ined h•om others. st~FOLK couwrY DEPARr?~r of riEALrH sERVK~s ~O ~ANDSG FOR APPROVAL OF CON6TRUCTION q,EY S. MEEK 9` FL o N. Y.S LIC. NO. 496/8 DATE _ uc REF ~ C S, P. C. APPROVED 1ko~Q3 O QI SO . Y. 1197/ ~V ~01 'L rri ,~1~' ' 'y Y . ; _ ~.Q~ _s p~~ _ Oi^ei ~ r., . , 6 ~ _ _ C ~IL'I OI 'J fb J C` ti%SSu.bVG _CC I~(alll'I~+C iPC.I~ •s_- -N- JgSM~NE spa ~ ~'4~ 9 O ~ ~ 15 00 3~ ip ~ ~ ~ p '°•3 a _ ~ 0~ i ti 23 fy ~ ~s3 _ ion., ,5so. ~ ti~ O 2 _ a5 3 ~ ~o ~ ~ / I v ~s• ~ O Q O ~ .W ~ h h 0 ry C~V'' ~ ~ .3 v eqT 'A ~0 NTS 43jO ~/f D ~O~ ~SOO ~ Q,_ ~/~~rr,C-i C~ AREA= 12,000 sq. ft. CERTIFIED TOE SURVEY OF Th1E LONG /BLAND sA VANGS BANK LOT 5 _ PECOI~NC PROPERTIIES A/ANAGEMIENT CORP. ~ fcs'o~ %3 ~ .mac-~®" g ~ 'FLED JCA'VE 25~ ~ AIO 9237 Prepared Jn accordance wllh the m/nlmum A T SOUTHOLD standards /or lllJe surveys as es/abllshsd by /hs L.I.A.L.S. and approved and adopted TOWN OF SOUTHOLD for such use by Ths ew York Slo1e Lond SUFFOLK COUNTY N. Y. T111e AssocloNon. ~ The water supply and sewage dJsposal ~ - - P~~ ~ systems /or this resJdence wJll conlorm c+C~Br 1 = 30 r to the standards o/ The Sullo/k County ~7 Ospoilmenl of HeaUh Services. March 11, 1992 JULY 15, 1992 (foundation) The /ocaNons o/ wells and cesspools shown hereon are /ram /Je/d Oct. 24,1992 (f%n81~ observations and or tram data ob/olned tram others. _ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES '~~r FOR APPROVAL OF CONSTRUCTION ONLY ' ~ .Y.S. L/C. N0. 496/8 DATE NS. REF. NO. 92 42 ~ 1$ ~ RS, P. C. ,~65 -~5 DE~~y~~ o ,,,..a1 APPROVED .,SNt111 SOU R N. Y. 1/971 1~" g ~ - l~~ O ~ 5 )