HomeMy WebLinkAbout20797-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22026 Date DECEMBER 14, 1992
THIS CERTIFIES that the building NEW DWELLING
Location of Property I55 APPLE COURT SOUTHOLD, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 69 Block 3 Lot 19
Subdivision SOUTHOLD VILLAS Filed Map No. Lot No. 8
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 2, 1992 pursuant to which
Building Permit No. 20797-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 (1ST & 2ND FLOORS) WITH ATTACHED DECR.
The certificate is issued to PECONIC PROPERTIES MANAGEMENT INC.
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-45- NOV. 17, 1992
UNDERWRITERS CERTIFICATE N0. N-258834 - DECEMBER 2, 1992
PLUMBERS CERTIFICATION DATED OCT. 8, 1992 - ARTHUR MALAUSSENA JR.
.
ilding Inspector
Rev. 1/81
1R0>s![ N0. ~
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~11T° 20792 Z Date 19.9..3-
Permission is hereby gron1ted to:
.e~:A
.c ~.,.........9.:~~'........
ro .1.!:t~-...a.....,),nA...`~,A,:,:ne;..Q:t.~.~~:4rY.~!:..~..~.....c.~.~Q,~4A,:fX.....
at premises located at`w~~...:i..~(.~.~:[....~.*.~!::!...........S.~.A:^:^I,:~I~At~Q~...
.......................................................~.1...U.....................................................................................................
.
County Tox Map No. 1000 Section 01 BI«k Lot No....Q..~............
pursuant to application doted .......~...a~sr 194, and approved by the
Building Inspector.
Fee 5~••~1.1x.~
.
.t~~~
Ing Inspector
s~.•e.~ `~.t~
Rev. 6/30/80
~""~'"'~ai:~~:~°.-_.. Form No. 6
~j 3~ TOWN OF SOUTHOLD
i-:rrv Il'` ~ 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...~ss ......................SOUTHOLD: NEW YORK. .
House No. Street Hamlet
Onwer or Owners of Property..........,,PECONIC PROPERTIES MANAGEMENT.INC.
.
County Tax Map No 1000, Section..._~.9.......B1ock.....3..........Lot.. ~.1
Subdivision..M(O.SOITI'HOLD,VILLAS „ Filed Map.. 9737,,.,,Lot...c~
Permit Non~~.~.i.~j.i.~....Date Of Permit..:~Y.9,,1992.,Applicant..~NALD,BRACKEN,...........
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... F' a Certicate...........
Fee Submitted: 25.UU.. . /
~1zc ysaGy ....~.1~~....w....~~....
C~ ~aa~~Y APPLICANT
i~
THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE I
I.a0083? BUREAU OF ELECTRICrTY
85 JOHN STREET. NEW YORK, NEW YORK 10038
Date DECEHf1ER 02,1992 Application No. on file 78705582;92 N 258839
THIS CERTIFIES THAT
only the electrical equipment as descrihed hebty and introduced by the applicant named on the shove application numher in the premises of
JF,NKINS SUUTHOLO VILLAS, 55 APPLE COURT, J08#8, SOUTHOLD, H.Y.
in thefollotcinA location; ®Baaement ® /st F'l. ?X 2nd F'!. OUT .Sertian Block Lut
ana examined on NOUEHBER 25,1942 and found to hr in cunrpliance ra•ith the requirements of this Board.
fIXTURE ECEPTACUiS SWITCHES RXTURES RANGES COOKING DECRS OVENS DISHWASHERS EXHAUST FANS
OUTLETS MUNDFSCENiFWORESCENi OTHER AMi. K.W. AMi. N.W. AMi. K.W. AMi. K.W. AMi. N.P.
Ie s6 !9 f.x
DRYERS FURNACE MOTORS iUTURF APPLIANCE FEEDERS SPECIAL RFC'/T TIME CLOCKS YLL UNI7 HEATERS MULTI.OUTLFT DIMMERS
SYSTEMS
AMi. K. W. Oll N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMi, gMPS. TRANS. AMT. N. P. NO. OF FEET AMT. WAiiS
3 P - ~
SlRVIOE DISCONNlCT NO.OF 5 E R V I C E
AMi. AMP. ME MITER 1 R [W I P TW 3 d ~W l,e' ~W NO. OF CC. COND. A. W. G. NO. Of HI-LEG A. W. G. NO. OF NEUTRAIR A. W. G.
EQUIP. PER d Of CC. COND. OF NI-LEG Of NEUTRAL
1 200 CA 1 X t '/0 2/0
OTHER APPARATUS:
HnTORS:I-P H.P.
F.P.C.I: 3
SNOKE DETECTOR:-.
SPUDS ELECTRLC SERUi:CE LIC.{192E G~~~
/
?75 3RO.ST. EiOX 166
GiNERAI MANAGER
iT. JAHf;S, NY, 11760 il.
Per '
This certificate must not be altered in any manner; return to the office of the Board if incorretl. Inspectors may be identified by their credentials.
• ANY MANNER.
Oc~~F F TEL. 765-1802
o~, -v..,., TOWN OF SOtJT~Oi.D
~ < OFFICE OF BUILDII•]C INSPECTOR
o
zit> ~~t rn P.O. BOX 1179
p cs~ 'z' TO~VNHALL
• i~01 ~.~Q~ SOUTHOLD, N.Y. 11971
C E R T I F I C A T I O N
Date ~ y7
Buildirq Permit No. (J ~ 9 / Z
owner
(please print)
Plumber ~27~r,~ /`/A~Au~~En~F~
(pl ase print)
~Z6 3/-P)
I certify that the solder used in the water supply system
contains less than 2/10 of la lead.
(plumber's signature)
Spwor~n to before me this
_
-cL_day of r~_(1~~
R
19~,
~ M otary Public
tlotary Public,.
Sl_ti'~Q .
County
MARYANNE E. DOWLlNG
Notary Public, State of New yo,~
No. 5000030
CommOissio~n~ F ~~rSuffolk County
a es August 3, 19Q
ao ?~7~
765-1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION 1ST ~j ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING FINAAL
REMARKS: ~ P~7 )~e
DATE I ~ S 2 INSPECTOR -~~y
~~~9~ ~
T6.i' -1802
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ~ INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~"v
DATE " ~ ~ 9 INSPECTOR ~L
ao~9~
X68-isoi
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST [ ]ROUGH PLBG.
]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING c FINAL
REMARKB: t-~C. Y_.e,.~- C .0 ,
DATE I 9 z. IN8PECTOR ~L~_
r lc.! O iL:.':: _:~::i iID:.: _ I~ iiCii9l.NT.^. .
1. I ~ N
_ - J
'OUtIDATIOV (1st) I y J
' ~
c
'OUtIDATIO;I (2nd) 7 ~
m
• I
I o
;OUCH FRki•fE
N ~
•PLUMHI,IG~ p
•
m
=JJSULATI0;1 PER Y, Y,
H
STATE Ei7ERGY II
CODs
I ~
1 ~
!in O. _~r
• M/~
I M?
FI;)AL I
b
ADDITIOJIAL COMMEPJTS: m~-v
J w- t,,_ _
H ~
~ 9
~ C,O. y
.o
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~?-a dv~ 0. f Q X ,ZS~ ~;fr _ ~p-v~ ~n~ n ~ 4 ~.~.cjl~,,~,T, ' fig
t+f
' BOA6D OF HEALTH
FORM NO. 1 ~ SETS OF PL \t1S .
TOWN OF SOUTHOLD SURVEY . . . .
BUILDING DEPARTMENT CIIECI: • • • • • • • •
TOWN HALL SEPTIC FOR:I
SOUTHOLD, N.Y. 11971
TEL: 765-1802 t:DTIFY; •?6S- 6~~~
CALL J
Ci . .
Examined ]9q?- tfAIL TO:
Approved I„~... , 19`~~ Permit No.v?o7g~.~ .
Disapproved a/c
c......
.
.F.4?'...
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
q
Date ~ ..d~......, 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 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, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for nec sa inspectio s.
(Signature of applicant, or ame, if a corporation)
(Mailing akldress of a~licant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
~
Name of er o remises . !~'..~vd~?.EcP^%.(~! o h~~!~. o:. `::.d?~ .
~ ~ ~atest deed)
If pl' is a r orat'n~~, signature of duly a thorized officer.
( ame and title of corporate officer)
Builder's License No . .
Plumber's License No. ....~/~R.~l./...~ .
Electrician's License No. ~ .
Other Trade's License No . .
1. Location of ]and on which proposed work will be done. ..~J-v:4.4~~e~-:'~..~~~..~c~.%... ~J~(.~(.~....... .
r
....~0.-~~-E'~t,a :CPS . .
Ilouse Number ~ Street Hamlet /
County Tax Map (N~o. 1000 Section~~..Q./. Q......... Block ~lQ..r~...... Lot o..Q..........
Subdivision 1~1'L+~. !'-~~-~!~-Cam:......... Filed Map No. 1./..3. ~ Lot . #..U........ .
(Name)
2. S[a[e existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . , .
b. Intended use and occupancy / /`.l~!~G4.C 9
..~.L1'~......~
~3. Nature of work (check which applicable): New Building 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 cazs . .
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 .
Dimensions of entire new construction: Front Rear De th
Height P
• • • • Number of Stories .
9. Size of lot: Front ' • ' • ' ' ' • ' •
......Rear Depth
10. Date of Purchase ' ' ' ' ' '
Name of Former 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 Phgne 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 cleazly 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 RIB S.S
COUNTY OF
~ t1.4.:tl . , ,~~,QG/1, ~N , , , , , , , , • , , • • , • , , 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
..day ~v~y........, 19'.2
Notary Public, .~i\~~ . Cou~nty~~
NOTARY PUBU of N.x .
No.4M5089, Sufidlc (Signature of applicant)
Term Expires May 31,19
~ ~ .
Ptsy~
~ 15 not to 1~e
aR:~ ti x 9 5~~~
under driveway area•
~ cA ~ 40
N
s
Jo.
0 61~
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wp b 0 / P
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6~ yM
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~ ~ ~~E'L~:IN~ ONLY
~1f~E~4 = 1U, s¢ft
~ ~
Proas wecerdnQ. r~? wn. ~ T
sJ..d~ral~ J.r Jpb + a ar1~61~M.d
~r a?. L.LA.L.~ .nd wd anal ad TC31MyV ~ SC~JD
i~
~ r~. n`~°r«t sr.~°~.°aAa St~~.hC C:C~(J~tT Y Y.
TM wafer eyvp/~ and sew~e alkposaJ ~0. " ~ - Gt - ~/b
`Nardarr :
~"`j ~ r~~l
G~~~G°C~~;czc~2~t/ ~
~/oeeMons o/ wmNr arN +hown bereen ate ham /lsld `
oiaa?roMw~s aul of k~vn? ela/o~iblaMed /ram oUiers.
i a, a J''%~~°,~, a
i1JFF~K OP ~~EIIVICEB y , ~ ~ •3~~ ONF'`~~ G
r/w~~ Q~L~ 'yAY2~ ~~r a N.Y.S LIC. N0. 4961@
~~y~y~ ~ ,
DI?T[!N'- ,u III. N0. g 1992 OV7S. P.C.
~R11D1?[9 y~(H S~~.b L~~ r J~ Y. 1197!
~S
87- (8,?
~
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s
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e rye ~~go~ e`r
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r$ v ~ v
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C, 039
J,gSc LA/VIE ~N1
AREA = 10,153 sq. tt.
SURVEY Ole
CERJ>FED TO' ~ O T V
P~con°~Pl~"rr1 rye a
~nrr cols `KA14P#SO~(JTtK71LQ V~LAS"
f1ED.~E ~ >~A~IP MO.
Pr.~ard n, accadawce wl/h n?. m,Wmum A T SOUTMOK.D
s
a~?~ la sw~~s a ..,o
~ TOWN OF SOUTMOiCD
0 p» L.I.A.L.S. and~p oval au?d led
tar .~,on ue. ny Th. New York sl.a and SUFFOLK COtJ1V T Y l1 L Y.
1711. AseockNon.
TAe wo/er supply and aewoge aY;pord - ~ -
iyiHrns /or 1hk reslde~?ce wMl coin/orm ~ r
l0 1M slandads of The Sulla~Yt County SCi~~ 1' .~0
Department of hleaYlh Serrkes. ~Ch ~9Z
.lU[ Y 15, (fou~arr~onl
Ths /ocopons o/ wept and cettpook sl?own hereon ore h•om /b/d
a~bservadlons and or hom data oblaJrrsd lrom o/hus.
~~p LA,ypy S
a~ouc ~n oer~neNT of rrr sEnv~s v~~ y' ~ ,
IOR ArM10VAl OF CONtTRIJCOM.Y % ~ N.Y.S Lh: NO. 496/8
r
v~'rE wA No. ~ YORS, P.C.
~1 765 0
¢ se 9
erPAOVEO Eyk"!
S , Y. 11971
87--870 (8)
Sl1fEClX GGU~,ti'Y u`FAP.IMF.Ni GF itiF/i~1N Sf:F'dCCcS
~V~6/ Y ~ `tt.. ~"Y.:Y
Thy y u ~ ~ 'iti
lor,:,'io F ~ .,d,'oc
0.11Cf d ~ I~tf i . l ~ Nj.:. u {z , ;:Y,'
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s
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® 61 Fe.
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a$ 1
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JASM//~/E LANE
AREA = 10,153 sq. ft
SURVETY OQF
CE747~~ TOE ~ O / v
TFE LONG ISLAND SAVNVGS BANK
PECOANC PROPERTIES MANAGEINENT CORP. ~K41P OF SO!lTMQI.D VLLAS"
o ~ ~ y3 Gu~A. ii93s~ F[ED.AIA~E~2.~^'~~2AuM~P~ MO. s2s7
Prepared M accordance wlJh /hs minimum ~ A T Jam/ / r/VS-D
s/andords /a 1llb surveys os esla~bNaMd
by !h. L.LA.L.S. and approved and adapted TOWN OF SO(/TMOLD
for such us. ay Th. New York Slob Land SU4FFOLK COLJ~VTY, NL Y.
Tllle Assoclalton.
The wa/or supply acrd sewoge disposal _ ~ _ _ Pro ~
sys/ems for iris rsskbncs wAl conlorm $Cida~ 1a~ 30~
l0 1M standards of The Sulloik County
Department of Heo/lh Ssrvkes. ~Ch 1~.QZ
JUL Y NS, 192 (fourdatiord
The /ocallons of wells and eesspoola shown hereon are lrom lle/d OCf. ?4, 1992 (find)
oaservalions and or Iron dalo obtained /rom others.
4_ 4:
~
SUFFOLK COUNTY OEPART?ENT OF HEALTH SERVICES sstt~~..ff ~
FOR APPROVAL OF CONSTRUCTION ONLY p~p~~g~y~~
N~!~ ++~s LL1I ~ .Y.S. LIC. NO. 496/8
92 SO 45 Iii1~1(_[{~ _
DATE r+-S. REF. No. O S, P.C.
NOY ! 3 1942 ;
~ O
APPROVED S.C. DEPT, OF SOUT , N. Y. 1197/
• 87-670 (8)