HomeMy WebLinkAbout20798-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-21163 Date NOVEMBER 19, 1992
THIS CERTIFIES that the building NEW DWELLING
Location of Property 205 APPLE COURT SOUTHOLD, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 69 Block 3 Lot 20
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. 20798-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-46-NOV. 17, 1992
UNDERWRITERS CERTIFICATE NO. N-258434 - NOVEMBER 25, 1992
PLUMBERS CERTIFICATION DATED OCT. S, 1992 - ARTHUR MALANSSENA, JR
uilding Inspector
Rev. 1/81
fOB3[ N0. f
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°°-N° 207982 Date ..........~..~-s~.~q......`~ 19.9..?-
Permission is hereby grouted to: ~ ~y
.mssarc....11~......~-~....a........f
...!a~.:...,.....1.!..9..35"..........
~~I~ V
y~ y Q ~Q ~pQ
of premises located at ~..°...1........~.L.~.... ..I..........T.~IO°!6!!A!!;^!~A
.
County Tax Map No. 1000 Section .....Q.7. Block .....5~. Lot No......4.~f...........
pursuant to application doted ......~.~1~.....~ 19.~.L and approved by the
Building Inspector. \
Fee 5...1.~1.:.Si?..
....~s,~!...w
B g Inspector
Rev. 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TO[dN HALL
765-1802
APPLICATION FOR CERTIPICATS 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 Euilding - $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.,205 APPLE COURT SOUTHOLD,.NEW YORR..
House No. Street Hamlet .
Onwer or Owners of Pro ert PECONIC PROPERTIES MANAGEMENT INC.
P Y
County Tax Map No 1000, Section...69.........B1ock....3...........Lot..?~
Subdivision..![(O,SODTHOLD,VILI.AS,,,,,,,,,,,,,,,Filed Map.. 9737 .....Lot...9..................
Permit No..?07982.. ,,,,,Date Of Permit..:~Y.9,,1992 „ Applicant.,DONAI.D,BRACKEN „
Health Dept. Approval ..........................Underwriters Approval.........................
Planning Board Approval
Request for: Temporary Certificate........... Final Certicate...........
Fee Submitted: $,.,,25.OU .
~~`~•+C~C-• lI y ~ APPLICANT
~o4aI1G3
t THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1000831 BUREAU OF ELECTRICITY
83 JOHN STREET. NEW YORK, NEW YORK 10038
Date NOVBNBER 25,1992 gpp/icaHonNo.onfile 78705692/92 N 258$34
THIS CERTIFIES THAT
only the dertrlcd equipment os described below and introduced by the opplicont nomad on [he o6oue applicotion number in the premises of
~ STAPLES-SOUTHOLD VILLAS, 205 APPLE COURT, JOBi9, SOUTHOLD, N.Y. _
in thefdlowinq hscation; ®Basement ® /At FL ®Ynd F'1. OUP .Section Block Lot E
was examined on NOVEHBER 19,1992 andfound to be in complimce with the requirements of this Board.
RXTURE RXTURES RANGES COOKING DKKS OVENS DISN WASNERS EXNAUSi FANS
OUTLETS EPTACIES SWITCNES INCANDESCENT flUOI1E5CENi OTHER AMi. K.W. AMi. K.W. AMi. K.W. AMT. K.W. AMT. N.P.
t 10 26 16 10 1 g
3/ DRYERS RIRNACE MOTORS WTUR! AF?UANCE REDFRS SPKIAl I1K'Fi TIME CLOCKS uu UNIT NEA7ER5 MULTbOUTIIT DIMMERS y
AMT. N. W. Oll N. P. GA$ N. P. MAT. NO. A. W. G. AMT. AMI. AMT. AMPS. TRANS. AMT. N. P. STSTEMS AMT. WATT$
NO.OF RFi
i 2 12 ~ -
5lRVICE DISCONNECT tq. OF S E R V 1 C E ;
AMi. AMP. I WE pU
F. 1 p ]W 1 $ SW 3 F SW 3 X AW PER gCOND. Of CC. COND. NO. OF NI-lFG H '~G NO.OF NFUT[A45 Of E TGW1L
1 ]00 CB 1 % 1 4 1
OTNFR AMARATUS: '
G_F.C.I:-2
SHOKE DETECTOR:-1 3
,Ea~
SPUDS ELECTRIC SERVICE LIC.{192 E
175 3RD. ST. BO% ]66
TiENERAI MANAGER
ST. JAMES, NY, 11780 11
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 crodentials.
j COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFIGTE MNIST NOT BE LTER
S~FF~(h TEL. 7G5-1802
o~~.:.v..:;:1 Oh TOWN OF SOii7THOb.D
~ Lt=~"• OFFICE OF BUILDIP7G INSPECTOR
vt \~^c ri. P.O. BOX 1179
c?s ~ TOWN HALL
%Ol ~b0~ SOUTHULD, N.Y. 11971
C E R T I F I C A T I O N
Date l~ ~Z
Buildirq Permit No. Q ~ 9g
Owner -
(please print) .
Plumber c~
( lease rint)
31-~~
I certify that the solder used in the water supply system
contains less than 2/10 of l~ lead.
(plumber's signature)
Sworn to before me this
1~~ day of
19~. ,
~,r- tart' Public
lfotary Public, StrFtr~I~County
MARYANNE E. OOVJLING
Notary Public, State of New York
No. 5000030
Qualified in Suffolk County ~~,,fJ
Commission Expires August 3, 99~.
ao798
ass-iso2
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION 1ST ROUGH PLBG.
]FOUNDATION 2ND [ ]INSULATION
FRAMING [ ]FINAL
REMARKS: ~
DATE ~ ° 1' INSPECTOR
ao~9s ~
~i~-isoz
BUILDING DEPT.
INSPECTION
[ ]FOUNDATION iST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: ~c ~
DATE 1° ~ IN8PECTOR T
aQ~98
765-1802
BUILDING DEPT.
1 NSPECTION
[ ]FOUNDATION i5T [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING II FINAL
REMARKS: c?~' ~ e • G
DATE i `1 ~ i. INSPECTOR Y Q ~ _
Y.~
1 . II r- ~ O
„ s
'J
'OUIIDATIO"1 (1st)
'OUIJDATI011 (2nd) 2I _ ~ _
m
~k ~ I a
:OUCH FRki•!E Q& I ~
~PLUMBINO ~J
'
3. ~ I ~ y
m
:IISULATI021 PER Y. Y. I y
STATE Ei1ERCY II
CODE I ~ ,
• ~ ?
' ~
I
FZ;]AL I
• ~ o
ADDITIOPIAL COMMENTS: x
m ~J
• F
._0fiQ sod' 1"•
• M
ro ~
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a 1
BOARD OF HEALTH
FORM NO. 1 ~ $ET$ OF PL 1:75 .
TOWN OFSOUTHOLD SURVEY
BUILDING DEPARTMENT CIIECt: . .
TOWN HALL SEPTIC FORtI
SOUTHOLD, N.Y. 11971
,I(((o~~~•~ p TEL.: 765-1802 t:OTIFY: ~~S 6p,/~
Examined 1 , .I... , 199E CALL ..~7 .
J pp p MAIL T0:
APProved •A 19q?-. Permit No.~.o7. ~ .
Disapproved a/c _ .
(Bui ding Inspector)
APPLICATION FOR BUILDING PERMIT
Q
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 necessa spections./~
(Signature of applicant, or name, if a corporation)
(Mailing address f applican~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of o er of premises ~%~i.~~/.Z, 4~=~/I~KQ.4. ~f7.e~GL . . 'y,r~t~! . LQ. ~(i~l~ .
(as on he tax roll or latest deed)
If a li is c r ra 'on, signature of duly authorized officer.
me and title of corporate officer)
Builder's License No . .
Plumber's License No. ...~nb ..r`.~........ .
Electrician's License No. l.di. ~ .
Other Trade's License No .
1. Location of land on which proposed work will be done. ~o:4t,-f-u,.a-,~,~'; , ,~~{1, c1~, ,~~,u ~r~
~
House Number ~ Street Hamlet
County Tax Map No. 1000~Se~cti//on .....I.Q.......... Block Lot ....6
Subdivision ~-~a~~~:C~(!.{~~,~Q> Filed Map No. . ~ 1. ;3 .7..... Lot 9......... .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .
...........v
b. Intended use and occupancy L~/':^~`~, , , , , , , , , , , , , , ,
L
3. Nature of work (check which applicable): New Building Addition Alteration
epair 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 t
7. Dimensions of existing structures, if any: Front Rear ype of use .
Depth
Height Number of Stories .
Dimensions of same structure with alterations or additions: Front .
Rear
Depth Hei t.........
gh • • • . • Number of Stories .
8. Dimensions of entire new construction: Front Rear Depth .
Hei ht
g • • • • • • • • • Number of Stones
Size of ]ot: Front Rear Depth .
10. Date of Purchase " " " " " " " •
Name of Former Owner
1 1. 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.
ame of Contractor ..........................Address Phone 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 ]ot.
STATE OF NEW Y
COUNTY OF ~ . , , • /So.S
• • •.D•!(• ~~!3 ~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.
Sworn to befo//re me this
..........G~.~`.':...f~~day ~.V`Y 1992
~ ~ S ~~o~
Notary Public, .County / V
NOTAR~1' PUS,
~~e (Signature of applicant)
Na 4725089. Sutfo~c Cou~y
Term Expires MeY 31.19,Yd`-
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~orrsaun?~o~ vac~s~
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Propwed h oocadpro. wlM Ms mii~+wm T
s/ondlards /or NlM sww~s os s/abMdred ~ { S~~K
br N.. ~.cA.c.~ oud over and~y r.d TC3YWK QF ~fXlTt,~OILD
n
~ ATM r`~ roar sror. Caved ~ ~'(,~II~VTY HL Y. .
TM wo)sr s ~d s•waye a~.sd PLEASE NOTE . ~ . ~ _ R/b
srsMres /ar fl~e~ rsid.nce wp/ eo~nlorm Sanitary system ~s nOt to l?8
ro a» shndall o/ rh. SuNollr coun/r placed under driveYYay area. $C+~ '
hI11/?/ o/ Heafll? S~rvles.
G i~L~~~
M bcoHa?s o/ w.lls ar?d cssspods shown hereon are lravn pdd
ebservoHons and or lronr da/o obhiiled /rovR oN»rs.
~!S'l~FS~ 13~Oe- as ~ti~tA~~~~9L
wFFC~x ~n oerrvuer?i~r of nr~rn sERV~cES ~,•1,~
~ t~ m
FOR AMROVAi OF CONiTRUCTgN OILY nv i~ 1~ _ U ~ ~9 p
9 ~"'f ~''"`w 7° N.Y.S. LIC: N0. 496/8
DA QZ~ Iffi REF. NO. (a '`~aF~ ~ ~ ,
~vED y S~ Dfpr stw o, ~Y. I197/
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AREA= F0,742s¢ff.
`Eir,~
i~o°N~
i~anro savrvcs ea/w~ SURVEY OF
PECOrwc PROPElerlES MahracE~nlr LOT _9
~x~or~so~un~o~cc vluAS.•
Prepared /n accordance with the m/nlmum A T SOUTHOLD
slandards /or 1pM rurveys os ss/ab/fshsd TOWN Of SOUTHOLD
by 1M L.~A.L.S. and approved m?d adop/sd
/or such use by The New York Sla/s Land SUIFFOLK (iOUNTY, ~ Y
T/1M Asroclollon.
The wafer sup/y and sewage dkposol X000 - ~ ' ~ P~~ ~
systems /or hls resldenee wIN conform ~
to the standards of TM Suffolk Coun/y SC~~ ~ =
Deparlmenl o/ Hsallh Servh:es. MBrCIi 982
.IGC Y b5, 199? (fotM?datan)
The /ocaNons o! wells and cesspools shown hereon ore /rom lls/d
obssrvollons and or /rom data ob/oMed /rom o/hers.
0' ft
~
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES k~
®~4 ~
FOR APPROVAL OF CONSTRUCTKIN ONLY O~
.Y.S. LIC. NO. 496/8
•
DATE ws REF. N0.
S, P.C.
F~~~y
APPROVED ~
SOUTNOLD, N. Y. 1197/
87-670 9)
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AREA= r0,7428¢ff.
rrR,ET
i~oNC
i~awo savrvcs eAnlar SURVEY Of
PECOANC PROPERTIES kLINAGEAENT CORP.
~~93 S- LOT 9
o~ sournxxo vrus••
aEV~2s, >~~MO.92a~
Prepared >n accordance wllh the minimum A T SOUTHOLD
slandara's for 111/e surveys as esla~bNshed TOWN OF SOUTHOLD
by 1/a L.L.4.L.S and gpprovsd and adopted
for sucl? use by TM New York Sale Land SUFFOLK COUNTY, N. Y.
TIJN Assoc/alion.
The wo/sr supp/y and sewage d/sposal - 70 - 01 ' PLO ~
ayslems /a Jlhls rer/dsnce wpl con/orm ~s ~
to !hs s/andards of The Su//o/k County SC~@~ ~ = 30
Department o/ Health Services. tilArClY 1 ~ 199?
.ICX Y 15, 199? (fotr?dafien)
The /ocallona o/ wsUs and cetspoo/s shown hereon ore /ram /laid OCr 2$199? (fk??al)~
observations and or tram data oblaJ?wd learn others.
~FF~ORCAP~PROVA~~ CO~NSTRl~1'ON
OI~Y~V~ F1~~I~YY~
(u, "''~~~17! ~ Y.S. L/C. ND. 496/8
ogre k~ 92 SO 46 ~ iC VE P.C.
NOV i 8 1992 fio~'.~, 765 - 50201 ~ 'Y
P. ~ Q X 909 X.
nrrrtoveo S.C. DEPT. t?F ~ sovri~a Ny~~ `ils7i
' HEAiiH SERVICES n
87-670 9)