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HomeMy WebLinkAbout20804-Z FORM N0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21157 Date NOVEMBER 18, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 420 JASMINE LANE SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 70 Block I Lot 6.9 Subdivision SOUTHOLD VILLAS Filed Map No. 9737 Lot No. 16 conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 2, 1992 pursuant to which Building Permit No. 20804-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-53-NOV. 17, 1992 UNDERWRITERS CERTIFICATE NO. N-256232 - NOVEMBER 9, 1992 PLUMBERS CERTIFICATION DATED OCT. 8, 1992- ARTHUR MALAUSSENA, JR. ~ Y rs, ati uilding Inspector Rev. 1/81 > OHM 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) N00-N° 208042 Date ..........~.....9 19.4 Permission is hereby granted to: ~j - `~4s.. ~.1..`.1..3:...UU to A...........:a. Z:>~t...`~ L]r„rk,r,,~...~.,sA~R~fr~....cine....~ I . at premises located at ..Z..Q.SIQ .............rp.:4/.l.!:!"~.^.?C... County Tax Mop No. 1000 Section .....Q~~....... Block ....0..~........... Lot No....Q..~............ pursuant to application dated .........~.etA)I.(,I...L 19.7.~.wy and approved by the Building Inspector. Fee 5...~.1..1:.~~... ~.~.~Arx...... Building Inspector ~.{~tQ Y ,~.~IGB-d 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. S. 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........u..~1. Old Or Pre-existing Building Location of Property....? A ..,,,.JASMINE LANE SOUTHOLD: NEW YORK...., . House No. Street Hamlet Onwer or Owners of Property..........,,PECONIC PROPERTIES MANAGEMENT.INC: . . County Tax Map No 1000, Section..~~..........Block....~...........Lot..~ii.' M/0 SOOTHOLD VILLAS p 9737 Subdivision... ................Filed Ma .....Lot...1~ Permit No.~~~~y.~......Date Of Permit..:~Y.9~, 1992„Applicant„DONAI.D,BRACKEN„.......... Health Dept. Approval ..........................Underwriters Approval......................... Planning Board Approval Request for: Temporary Certificate........... Final Certicate........... as Fee Submitted: $...~;00 ~~~!2^~~.~ ~J~.R~G ~`5~9 I APPLICANT... Co~a115~ . THE NEW YORK BOARD OF FIRE UNDERWRITERS FAGS ~0a}trykl~~r BUREAU OF ELECTRICITY 8S JOHN STREET. NEW YORK, NEW YORK 10038 Date NOVEHBER 0~r19rT2 APPlicationNo.onfife 7544219?/92 A 2567.32 THIS CERTIFIES THAT only the electricol equipment as descrihed hebw and introduced 6y the applicant named on the ohmre applicotion numher in the premises of WTGLt,~H GAF FGA, 420 JASHINB LA~H6, J68 Ql~., 80if1'f{JLq, N.X. in thefollouinq location: ®Bosement ® lxt Ff.? 2nd tY, U1JT .Section Block La[ uws examined on NOVEK6ER 02,1992 and found mbe in cmnpliance with the rrquirementx q(this Board. t NKTURE KE?TAC'LES SWITCHES FI%TURES RANGES COOKING DKKS OVENS DISH WASHERS E%NAUST FANS OUTLETS INCANDESCENT-NUp1ESCENT OTHER MAT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. N.R. 11 '5 15 11 1 1.2 DRYERS FURNACE MOTORS FUTURE A??UANCE FEEDERS S?ECIAI RK'?i TIME CLOCKS YLL UNI7 HEATERS MUITI-OUTLET DIMMERS SYSTEMS AMT. K, w. al H, v. GAS N. P. AMT. NO. A. w. 0. AMT. AMR. AMT. gMRS. TRANS. AMT N. P. NO. OF FEET AMT. WATTS > g 5lRVICE DISCONNECT trO.Of 5 E R V I C E AMT. AMR. TYRE MITER 1 g 7W 1 / 3W ~ 6 3W 3 $ .IW NO. OF CC COND. A. W. G. NO. OF NIiEG A' W. G' NO. OR NEUTRAIE A. W O EQUI?. RER d OF CC. COND. d NbIEG Of NEIIiNAL 1 150 Cfi 1 { 1 1 t I OTHER APPARATUS: G.P.C.I:-2 r ~iOEE DETECTOk: 1 x ~I SFUDS EIrECtRFC SERVtCE C.; C.A192-E 175 3RD.ST. NQ% 166 OENERAI MANAGER sm. anHES, uY, 117ae 11 Prr F r 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. CO Y F I DE ARTM T. IS C E I 1 S NO BE ALTE ED IN ANY MANNER. c~VtiF~(J'` TEL. 765-1802 o~~ } Ole TOWN OF SOi(JT~Od.D ~ ' " ~ OFFICE OF BUILDII•IG INSPECTOR ~ fi"' Si> '~~t; .irn P.O. BOX 1179 c??~ < TOWN HALL %Ol ~ ~.~Q~ SOUTHULD, N.Y. 11971 C E R T I F I C A T I O N Date 4 Z Building Permit No. ~ ~ / L Owner ' (please print) Plusher /P~LfQ ~~LAGSS,Ep/~~ (please print) C2~ 3/- p~ I certify that the solder used in the water supply system contains less than 2/10 of l~ lead. (plumber's signature) Swo n to before me this day of . 19~. I otary Public llotary Public, County MARVANNE E. DOWIJNO Notary Public, Stale of New York No 5000030 Qualified in Suffolk County Commission 6;pues August 3, 199' . T . 765-1802 BUILDING DEPT. 1 NSPECTION [ ]FOUNDATION i5T ( ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING FINAL REMARKS: e-~ C . o . DATE ~ INSPECTOR ~ L I~ I~ .:~C~(i•1l.NTS N 1. m O a _ H w ?OUIJDATION I O 1st) - - 'OUIJDATI0;1 (2nd) aU ~ ~ ;OUCH FRAi~fE & 6 ~ ~ PLUMBING 1. b 2~ ti H 7 =17SULATI0;1 PER N, Y, I H STATE E;IERGY I~ ~ CODs I r r 11 a.. r A m H I 6 FI;IAL I ~ p • I M1 O n(~ ADDITIOPIAL COMMENTS: m~ ' ~.u.. x ~ M \ ~ 0 b D • H ~ O • r / • - ~ y m ~ N • O f BOAFD OF HEALTH FORMNO.1 J SETS OF PLAttS TOWN OF SOUTHOLD SURVEY . . . BUILDING DEPARTMENT CIIECI: • • • • ' - _ ' ' • TOWN HALL SEPTIC FORtI . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t:OTIFY; • ~6s ~Q~~ Q CALL Examined..`/.,. ,p/,,,, 19 !.L MAIL T0: Approved . ly...1...., 199!1- Permit No.:`.1.0g~.~.~ ~ . . Disapproved a/c ..................................L tom.......... a'r"~ , (Building Inspector) APPLICATION FOR BUILDING PERMIT . Date ..r .0~......., 199 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 Petmit. 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, ordina es, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for nec s inspect' ns. - (Signature of applicant, or name, if a corporation) (Mailing address cYf applicartt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of o r of mises .l!/.-L'~~ .t(~/d-O~Q!~rC~. r!'t~':'Y,~7: ~ . (as on th~tax roll or latest deed) If a pl' is c r ra on, signature of duly authorized officer. i C/riL . ( me and title of corporate officer) Builder's License No . . Plumber's License No. .....~i .6 ~r~ . Electrician's License No. ~7.a. ,4........... . Other Trade's License No . 1. Location of land on which proposed work will be done. ~l; a-;~ , ; ,~/j,-~!-f . Itouse Number ~ hStreet Hamlet County Tax Map((~~No. 1000 S~~e//c//tion /.0......... Block ~ ~....n.....+-.,. Lot . Subdivision ..e.h:*.~~<4~td'i. Filed Map No. 7.~:3./ Lot ~ ~I? . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......./.......n....~J...-.~J . b. Intended use and occupancy ,/~!~?'e.~~ E'`~,[.. ; !~4'~C~i~-0~ . VV Q . L~J 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 . unensions 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 9. Size of lot: Front Rear ~ • ~ • • • Depth 10. Date of Purchase ...............:.............Name of Former Owner I. Zone or use district in which premises are situated _ 12. Does proposed construction violate any zoning law, ordinance or regulation: . 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••„ No.,X *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 XA , COUNTY\ OF 5? S.~S® y ~ I.J Q~/y.~.~.... ..~~~,rQGf•~. ~i`C being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the U (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 .........rO.~........ y of.... w~Y.. ]9 q.Z Notary Public, ROBERT 1. SfATi, JR. . G~~: `~R~:C.~, . . NOTARY PUBLIC, State of KC ~ (Signature of a No. 4725089, Suffolk Coep~~ pplicant) Term Expires May 31,19 Y1' ~ , PLEN~~ i E Sanitary system is not to be placed under driveway area. i lp~. 13 s. ~O Ei ~3'32030~f. I ~I T ~4 e4 00, 00 My C\ \(p ~Q 24 i T ~s . ~ \ 0 ti O a ` T 11 N ~ ,S lOT 1s o I `jam. (V r fJ 5 C N I I .Q~ ~ 35 ~ I O ~ ~ rt \ ~ ~ ~ ~ ~ ! 8=37/.46' . Q P wq ~ R'3/g fig, \ L =103.54' ~ z~, , JA SM/lVE LANE eli9s' AREA= 14,278 sq. ft. o~ ii~~ SINGLE I=AMlLY DWELLING ONLY SURVEY OF EXPIRES ~ YEARS FROM DATEOFAPPROWAI LOT 16 "MAP OF SOUTHOLD VLLAS" FLED MAP MO. Prepared /n accordance w!!h the minlmum. - A T SOUTHOLD slandords /or 1!1le surveys as eslab/Ished by the L.I.A.L.S. and approved and odopled TOWN OF SOUTHOLD for such use by The ew York Sloe Lond SUFFOLK COUNTY, N. Y. T/IIe Assoclallon. The wo/er supp/y and sewage dlsposo/ ~ - 7U - ~l - PLO ~ systems for 1hls residence w11/ con/arm ii i to the slandords of The Su/Io1k County SCa/e: 1 = 30 D orlmenl of Heo/lh Servi es. MA~Ch 11, 1992 The /oco!lons o/ wells and cesspoo/s shown hereon are from !let obsarvollons and or tram data obtained tram others. ~~i r/s SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES °i~ ~'MFp~~ryG FOR APPROVAL OF CONSTRUCTION ONLY F ~L c~ ~`~Y~'8 /9 ~ ~ N.Y.S. L/C. NO. 49618 ~~~q~yp~ lot SO`.~ 9? DATE ~p-.Y.LI~iS. REF. NO. 3 ~ S YORS P. C. H~~^ /?i:-~r N 65 - O ~ u~., APPROVED art' S , N. Y. 1/97/ ' 87-670 (16) SOT O . ~ ~O Ei 3 ,3•~30~ ~ N T ® 6g 00 \ ~OT O 24 0 `Y \ /S 'Ati /o ® ~ CO/JG ~ ~ ~s d N ~pN~1L~Q.~JOI~ ti ~ /9.~ " m ~s'3 /Za' I ~ ~g \ ei z2 i R'37/.46'. ~ i s L'll/.96' N.77"GO p0 fir R'3~y~ T9' 260.00 Q x'103.54' Pi 20 t SAS LAl1~' C/ /9.5' AREA=14,278 i¢ft _ ~d ~ CEIQTiI~'D TO+ TtE LOrM6 ISLAND SA V/MGS BANC PECOJwc Pr~oPExr~s wa~iwFnJr corm' $URVfY OF LOS' 16 or~sov~r~aco wws-- ~~C~ Prepatid h accordance wdh 1M naFibnten A'" ~7`~T~rD efar~ards /or HAfe savers os es/a6McMd a aka by Th: nxw Yount ~ioN Lace TOWN ~ SOIJTHO[© n>w. AsatliMan. $UP~FOLK CO~ANTY,IIL Y. The water and sewoye aOrsOosal ~0 - ~ - 01- P/b Od srsrarns ter /i1Tc- residence wrl. eo~am ~r rr s 3~ r Jo 1l?e standards or Trw Su/talk Cow?Ir Daparlmenr or warn Servrces. ~/i JG[ Y 1'~, iD9? (leun~artiad The bcallons o/ welts and eesspook shown hereon aie /?om rJs/d abservorbns and or from dala o~brahred /tom oN?srs. . LAfdb S!s ~.t~ 9L ~F~OR ~V ~CF CO~NtTT11U~CTON ONLYES G~`~~ at ` ~ ~ N.Y.S LIC. N0. 496/9 r,:; o~~ ~ raF. rw. E YOORS+ P.C. 7 a y 9 N+rwo~ SO , N. Y. 1/971 87 67~ ~16~ a ti~~LN SEhJICES U ~ ~ s I~.f4 . ~.~F .a . -~t _ - ~ r~~~~.'18~ fOf tflf$ i~, ~ :'~i'i.811~SO~~Uf ' i ~ ~ ~ i5'~~~+.cr9. ,4~~-- W ,~f if Barrtiu o~ Way?ev+ster~'!!a~`iag`etn2nt ~OT O ~ 9 ,3•?pap' E. • r OT 14 sy po \ OT 0 a DoT r' ~ ' . /S ~O OT >S 3s 3 _ ` ` ` 2s~y f~.. ° j ~ ~s H hse ~ • ~ i5.3 2s.o < r1p- ~ O O AAA ^."J q ~ ~qVy ry ry . V x O 2 ~ J ~ m ; R=37/.46' . \ ~ ~ L =l/1.96' N DO pp. R°3/9, ~ ~ 260 pp, Q wQf )g ~ cr ql \ L =103.54' JASM//~/E- ~ LANE /IKEA- u,2~s aq.ft. CERT~"lED TO+ Thy LONG ISLAND SAVNVGS BANM! PECOAVC PROPERrI~s MANaGEA~Nr coRP. SURVEY OF LOT 16 o~ sswnyacv vrus„ Rav.~~/~V~'~~Ma Prepaed in occordorres wl/h hle mJnbrNUn 14 r SwT~M.D sla?dords /or i!//~ swwys as erlaibNsMd by di. L.AA.L.S. aHl gpprov.d and oeo~lsd TOWN D~ SOUTHOLD ° . Iw ,uch use by The New York Slate and $(/FFO~L.K C~TY /1~ Y Tll/e AssoclolJon. r The we/ei supply and sewage dtspoaal p~ - ~ - ~ ~ sysJavns /or h/a resldencs wN/ conlorm $C~: - 30 ~ to /M s/endords of The Sullolk County Department of Hsallh Ssrv/css. ~Cf1 ~ ~2 JCS[ Y 1~i, wi9~? (fdN~dit/on1 The locallons of wells and cesapoo/s shown herson ore /iom lls/d Oet.,23,~92 (III observations and or lrom da/a ob/olnsd lrom o/hsrs. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ~ ` FOR APPROVAL OF CONSTRUCTKMI ONLY ~ : 1992 i i~•~, - ~ Y.S. LIC. NO. 496/8 DATE wa REF. N0. 92 SO 53 P ORS, P.C. f5/61 - O S.C.OEPT.OF P. O. BO 909 HEALTH SERYICES MAIN ROAD • SOUTHOLD, N. Y. 1197/ 87-670 (16)