HomeMy WebLinkAbout30134-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
.Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-30062 Date: 03/,03/04
THIS. CERTIFIES. that the building ALTERATION
"Location of Property: 1065 JASMINE LA SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 69 Block 3 Lot 24 .3
Subdivision Filed Map No. Lot No-
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 1, 2004 pursuant to which
Building Permit No. 30134-Z dated MARCH 3, 2004
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 2ND FLOOR ALTERATION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED
FOR.
The certificate is issued to SUSAN A CALLAHAN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1191485 01/23,/04
PLUMBERS CERTIFICATION DATED 04/22/96 MAFO'S PLUMB.& HEATING
Authorized Sign -re
Rev. 1/81
FORM NO. 3
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)
P"ERki'V14b, 30134 Z Date MARCH 3 , 2004
Permission is hereby granted to :
SUSAN A CALLAHAN
1065 JASMINE LANE
r SOUTHOLD,NY 11971
s for
i
j- CONSTRUCT 2ND FLOOR ALTERATION TO EXISTING SINGLE FAMILY
DWELLING AS APPLIED FOR. (THIS REPLACES BP #23638-Z)
at premises located at 1065 JASMINE LA SOUTHOLD
County Tax Map No. 473889 Section 069 Block 0003 Lot No. 024 . 003
pursuant to application dated MARCH 1, 2004 and approved by the
Building Inspector to expire on SEPTEMBER 3 , 2005 .
Fee $ 75 . 00
rized gnatu
ORIGINAL
Rev. 5/8/02
MEN N0.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
I
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
i
i
N° 23638 Z Date ......... /..................... 19/..(�
A;W-7�6
Permission is hereby granted to:
............ . ...14..... .
....... .y�.........................
to
.....1d ......... ....
at premises located at .................. 2,6. .........................
.... o .. � ..., ...Y..................................
.................................................................................................................................................................
County Tax Map No. 1000 Section .......... ./ ...... Block .......... ........z�Lot No. .....�..J. ...�.
pursuant to application dated .................v. .....P.�f..., 19.l�A./, and approved by the
Building Inspector.
Fee $...��..`z
.. ..... .. .........
uil in g Inspector
Rev. 6/30/80
1X5 J Form No.6
TORN OF SOUPHOLD
BUILDINGDEPARTMENT MAR ' f Ms,a
TOWN HAIL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. 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 1%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% 1957 non-conforming uses,or buildings and"pre-existing"land uses:
1. Accurate survey of property showing all property limes, streets,building and unusual natural or topographic
features.
2. Aproperly completed application and 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$25110,
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- $100.00
3. Copy of Certificate of,Occupancy-$.25 /
4. Updated Certificate of Occupancy- $50.00 /
5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00
Date. C�
New Construction: Old or Pre-existing Building: (check one) /
Location of Property: /0 59._ "ry
House No. Street Hamlet
Owner or Owners of Property: �� �_. 41,-, �
Suffolk County Tax Map No 1000, Section Block Lot �2��
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant: ��L ax Z a
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
i '
i.
i
Applicant Signature
j (3vQ e.. 6 s6 G
Co z -Ra'OG 2
�[J7[.(7rflr�7I717I'7cr �nnrrarrt�r�r�Irarar�r,�nnrm�arl�r.1'rJZlrJr.PrJr�rJ�r1� .nnnrs ., a
BY THIS CERTIFICATE OF COMPLIANCE THE 5
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 BUREAU OF ELECTRICITY 5
40 FULTON STREET — NEW YORK, NY 10038
5 CERTIFIES THAT S
Upon the application of upon premises owned by CEJ
' 5
JOHN CALLAHAN JOHN CALLAHAN 5
1065 JASMINE LANE 1065 JASMINE LANE 5
SOUTHOLD, NY 11971 SOUTHOLD, NY 11971
5 Located at 1065JASMINE LANE SOUTHOLD, NY 11971 5
11Y911485`
- 5 •alTpficatiolT)'rmbere Certificate Number: 1191485 5
5 Section: Block: Lot: Building Permit: BDC: nsl l 5
Described as a Residential occupancy,wherein the premises electrical system consisting of 5,
5 electrical devices and wiring,described below, located in/on the premises at:
Second Floor,
,5 5
was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below,was 5
found to be in compliance therewith on the 23rd Day of January,2004.
Name OTY Rate Ratine Circuit Tvoe Amount5
Miscellaneous
5 FINNISH SECOND FLOOR $0.0
AS BUILT 1996 $0.0c 5
Alarm and Emergency Equipment 5
Sensor 4 0 Smoke $3.0 5
Wiring and Devices Lel
Receptacle ep 1$- 0 -- --- Genera P trpose $4.50
Switch 9 0 General Purpose $2.25 5
Fixture 5 0 Incandescent $1.00 5
Paddle Fan 3 0 $6.001
Receptacle 1 0 GFCI $1.00 5
Invoice Total $50•.0 7
A visual inspection,of the delineated electrical installation,determined that an obvious hazard is not present and the installation is believed to be
in comforrnance with the applicable reference standard for the estimated period of construction of the premises wiring system. 5
seal
5
5
5
1 of 1
This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
cP�P�Pr�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�rJ�cP�P�PrJFL3rfffr .....................Pr�rlcPrJ�rJ�rl�P�Pr�c1rJ�rJ�rPc1�G Ir��trJ��Pctr�P�l� Ell
Town Hall, 53095 Main Road
Fax(516)765-1823
P. O. Box 1179 �: �' �' Telephone(516).765 1802
Southold, New York 11971 !
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I C A T I O N
DATE
Building Permit No.
Owner: CA-/—L >- A4
(please print)
Plumber: R hAk f) r7l
(please p nt)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
?y
(Plumbm6rs Si tire)
P
I� Sworn to before me this
4 _day of Aord / 19q,(.
it Notary Public, ��L County
NOTARY PUBLIC;State of New
No. 30-4729515 `.'�11 F'_
oommisslon Expires July 31,.19 .
MAFO ' S
PLUMBING & HEATING INC.
744-7591
Mr. Bufas•
Town of Southold Inspector
job site:
Callahan
1065 Jasimne
Southold,N.Y.
I am the plumber for this job. I spoke with, you on
4/25/96 in reference to the Wast Line and gent to be filled.
You agreed that if I tested the Trunk Line that would be good
enough. The Tub was filled and emptied 6 times . For the
Bowl I bucketed 4 -5 gallons buckets. All tested fine.
f
Thank you.
l
-n
Anthony Mar glio
Plumber
7W-1802 /
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ROUGH PLBG.
[ ]ZRAMINGAl.
' DATION 2ND [ ] INSULATION
[
[ ] FIREPLAC€ A CHIM � ""T �
REMARKS:
DA E
7 INSPE
"" � Y?�',If
765-1802
BUILDING DEPT.
INSPECT71UGH
[ I FOUNDATION IST [ PLBG.
FOUNDATION2ND [ ATION
[ j FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
r [ ] FOUNDATION 2ND [ ] SULATION
] FRAMING ] FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
DATE INSPECT
:.L27 l. .�i:°AA...�l}�a) �.�a i.'.
y
r_no�
�FOt tADATION �(�ast)
I ROUIJDATIOtI (2nd ) mC
OUCH FRAME
�Larr$aXG
CA. .
JSULATIDPT PER H. Y. 00,
STATE ENERGY
CODE
tv
FINAL77
/yam ADDITTONAL. CdZJaIF)1TS : x • `
aSi
� N
9
`�G.m'•-Ah1 .::F.iA— J• ,s �.S x'4'>�•a ,acl . .f " _. �..
BOARD OF HEALTH . . . . . . .
+ (n aq, ONMOl FORM NO. 1 3 SETS OF PLANS . . . . . . . . .
• •�� `Jt718 SURVEY • • - • - .
TOWN OF SOUTHOLD CIIECK
BUILDING DEPARTMENT
. . . . . .
Nnr ICI TOWN HALL SEPTIC FORM _ . . . . . . .
s SOUTHOLD, N.Y. 11971
TEL.. 765-1802 t:oc I F1F /.S_ J �6 n
CALL 'P o�
Examined �,��� .:,�� l MAIL TO:
. . . - -
Approved . .V�-� �,/ . ., 19 /Permit No. /�7. . . . . . . _ . . . . . .
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r
(Building Inspector)
AP L ATION FOR BUILDING PERMIT
'
Date . 6 .02..7 . . . . .,
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
shrµl 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 cod a d re ulations, and to
admit authorized inspectors on premises and in building for necessaections. �
(Signature of applicant, or name,if a corporation)
Jt.5.*9!eig- - 4.PA?_ - - - yc.9.1�4W
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
. . . . . . . . . . . . . . . . -. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of owner of premises . . . . . Sie-S. /L. . • •/"a• • � •� - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latest deed)
If applicant is a corporation,signature of duly authorized officer. APP 10 D AS NOTED
Y,, DATE: 7 �w B.P.
. . . . . . . . . . A . . . . . . . . . . . . . . . . FEE- BY
(Name and title of corporate officer) NOTIFY BUILDING DEP
ENT AT"
l/V�' ir 765-1802 9 AM TO FOR THE
Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . 10 OO VIN INSPECTIONS:
Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . FOR POUR TWO REQUIRI=f#
ED CONCRETE
2. ROUGH - FRAMING & PWM61tp,
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . 3. INSULATION
4_ FINAL - C04t'S7'RUDii011 WSJ` {
Other Trade's License No. . . . . . . . . . . . . . .. . . . . . . BE COMPLETE FOR C O,
ALL CONSTWjCTON 94J41. �
1. Location of land on which proposed work will be done.
s' 4r_ . . . . . . . . . THE REOU EWSQF
' A
. . . . . . . /�e . . n . . . . . . . . . . . . . . . .
House Number Street - Ha � �
County Tax Map No. 1000 Section . . . . . .'45� • •(SJ. . . Block . . . . .3. . . . . . . . . . Lot . . . .A3. . . . . . . . .
Subdivision . .�Oc h�'� ". .�i1� . . . . . . . . . . . . . . Filed Map No. . . . . . Lot . J . . . . . . . . .
(Name)
2. State existing use and occupancy of premises an ntend d use and occupancy of proposed construction:
a. Existing use and occupancy . . C• • • • • • • • • • • • • . • • • . . . . . . . . . . . • • • • • • •
b. Intended use and occupancy �. . . . . . . .
3. Nature of work (check which applicable): New Building . . . . Alteration . . . . . . . .
Repair . . . . . . . • • • . - . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . ... .
.. . /"_V (Description)
4. Estimated Cost . . .6.Cav . :. .7.c�c? . . . . . . . . . . . . . . . . . . . . Fee .� �'_.. . . . . . . . . . . . . . . .
(to be paid on filing this application)
S. If dwelling, number of dwelling units
�Y • . . . . . . . Number of dwelling units on each floor . .Alle. . . . . . . . . .
. . . .
Ifgarage,number of cars . . . . . . /�1�/� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. If business,commercial or mixed occupancy,,specify nature and extent of each type of use . . . . . . . .4/. . . . .
7. Dimensions of existing structures,if any: Front,,,'1r- . ,A).v. . . . Rear . . . . . . . . Dep' icy 0. .'. .,Z.s;.3.
Height . . . . . . . . . . . . . . . Number of Stories . .CP2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front 1s . . . . Rear of a . . . . -*1:0., .
Depth . . 7,& . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . Number of Stories . ..-r?,. . . . . . . . . . . . . . . . . .
8. Dimensions of entire new construction: Front Rear . .lf.`. ;. • • . . . . . Depth . . . . . . . . . . . . . . .
Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Size of lot: Front . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . .
10. Date of Purchase . , e�Cpn�. . 9.�`�. .l. Y. . . . . . Name of ormer Owner . . �. . ��.4�Y7S. . . . . .
11. Zone or use district in which premises are situated . .,SL-, dl . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . .
12. Does proposed construction violate any zoning law,ordinance or regulation: /-�. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Will lot be regraded . . AIP . . . . . . . . Will excess fill be removed from premises: Yes
14. Name of Owner of premisesS'_e6rsv.z_Aa/�rcrr.�c Address IQ.-'! /c&Phone No.Sl6:T4s:/. 7 . .
Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . .
Name of Contractor . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . '
ddress . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . .
15. Is this property within 300 feet of a tidal wetland? *Yes. . . . . . No,}G. . . . . .
*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 frim
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
R
f
STATE OF NEW Y S
�CO NTY OF . . . .. . . . . . . .L. . .
.�j�j'7�!! . ` . ./.f'!r'�!� being duly sworn, deposes and says that he-is the applicant
(Name of individual signing contract)
above named.
171eis the . . . . . . . . . . . . . . . . . O%_0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . .
(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 before me this
. . . . . . . . 2 � . . . ay of . . .V . . . . . . ., 191
SAD
Nota Public, . . . . . . . . . . County
ry . . . . . . . .
ROBERT 1' g applicant.WIRRY PUBLICS to of tLx (Signature of app )
Ter �Mfy 31.19
.i.,�x'Gr`!�� ; ., :,� r; p =J s.EJ,. a+.'i � :.A. ,� < ,.�.. S rQ.��}ze ._.r',. �� v f;b` �; ':f.!x aeU, y, Y'o ••�;y; A .U''; �, _.. _. - y�R:. Y
!T+{. �'e r�y� �'T' ���J � r�,` �` x x.y "�. .t.. •3f4,
x't •f `• ""'°—}..•, r +'`' '.._ i.n wsti !y J '-` �'r' x^ <�,•y Y I""'•u'ty.,a + :t. �.P i.q t .sr y-y
l a1 � '.� �N `� 't �3 't}'t4 p!. • •,�.,"j ,t�r .•�4 4� � S • ,. ,t r '.j. ��� ♦:.��
i •r...__ C` I'�y:� 'y�r'* n� ,!. �r.'f.V}1 a .w,,jM.,.pk "^'��.', rs1v �'. '�. •a � y� ,,r�•.0 .•`t� ),s. :� 3� +<�S; r,a� 1 , "t'� .�:q'
,
b d b <
7!., The locations o/ wells and cesspools .
fix„ , - ., r iw}t ., v •i' '.;t h yr: rx/ shown hereon are from field observollons
z: . ^t• k .r3:: _- i nd of from data obtained from others.
.i .r•, t. ., a ( a..x 'ov
♦i -i y s y�, d�,'' ? •.� •.e-. x b ':: ..�x' .df..f,4 ,�,o-�..�+i..•.` e>. M :. .;y�
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SUFFOLK COUNTY DEPARTMENT.r : ,� �,� ,�, r } �, t;',,�. �} �• y�2,;� RTMENT OF HEALTH SERVICES
SINGLE FA�11�1 DWELL��I�7 ONLY
S`; tf+ �v rktt. �a: rk Jy: t �:y . s r y{{, r ;1 t e'•t L APPf0Y01 t1 tlstNCted 1YorKE
e y.4i F �,ie�,� 42•'•'�N^ } t. , '; ,� �• B ' R2, •.{ j
m. ,,.,. '� : , �, '�' 1 �. �..,. H.D. R t
'°i - S ta► �� � '.. t ! §�, 3s ,Ec�3o + d 4':+n ::.. ., ..,
N 'o The sewage disposal and water supply facilities at this location
�i a+ have been satisfactorily Inspected by this Department and are
.y z.�, b"} ar.. {4'f� in compliance.loth these as-built plans .
v <�
0 �s t<, 3 * ? n tT7 � M f1FJ' 19� 0.. 1b0►Cb� I.G.
121.
DATE
X00 _ ,, � x ,� I ' •..r , } CHIEF OF GENERAL
`1a• ENGINEERING SERVICES
� ;• � 'S �,.,.
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.�949s. : ,' SURVEY OF
Y,�R :, LOT 3
h ? s 0.
"MAP OF SOUTHOLD VALLAS,SECTION TWO"
l OT i`� sa• �s 39 (� { FLED AUG,4,1998 FLE NO. A-484
A T SOUTHOLD
loT TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
zo
1000- 70- Of-P/0 6
tin Scale: 1"= 40
!�, O
Mar, 15, 1993
+ zs• ,� , Aug. 17, 1993 (foundation)
Eo titiy Nov. 19, 1993(final)
s•� . _ •� s
l H 75�43�0.
N/plc Flo 10--00,
ill BU/l AREA - 18,;77,94; ft. ; . 1 G�V�
CORP �'�� 1 of P��of NEIy y
stlFFouc cou+rY ntpnrtrtrtE►ir of ttEALTH scrtvtcEs The water supply and sewage dispo of pEQtRA\CES S��o�.+r.
FottOLMTYAPPROVAL of TWNTRUcrlorr TH Prepared in accordance with the minimum S• SE
standards for title surveys as established systems /or this residence will con/rim \ZN a,a
by the L.I.A.L.S and approved and adopted to the standards of The Suffolk County N. L/C. NO. 496/8
93 SO 21 p Department of Health Services.
2 �� „� REF.�, for such use by The New York Slate Land r,'. PE OR P.C.
Tills Association. 15/ 4 - 0 0
?' r}. . P. 0 •• 96718°
ELEVATIONS ARE REFERENCED MAINS�
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