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Home My WebLink About20792-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21156 Date NOVEMBER 18, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 665 JASMINE LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 69 Block a Lot 14- Subdivision SOUTHOLD VILLAS Filed Map No. Lot No.. 3 conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 2, 1992 pursuant to which Building Permit No. 20792-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 STORY ONE FAMILY DWELLING The certificate is issued to PECONIC PROPERTIES MANAGEMENT INC. (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-40-NOV. 17, 1992 UNDERWRITERS CERTIFICATE NO. N-256230 - NOVEMBER 9, 1992 PLUMBERS CERTIFICATION DATED OCT. 8, 1992 - ARTHUR MALANSSENA, JR. Building Inspector Rev. 1/81 FORK NO. a 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) NON 00 2079 2Z Date ...........ya. . ....... .................... Permission is hereby granted to: ..... ....... ....... ....... q114 C— ....!JA.... ................................................ ................ .. ... .... .... I ......... 0 ....M.R-. Row. ...... ............................................................................... ................. at premises located at L.��.......I. ................................................................................................................................................................. ................................................................................................................................................................. County Tax Map No. 1000 Section ......... Block .....QA.......... Lot No. ......Q.�.......... pursuant to application dated ...... .... ..........................1 19.7.-'", and approved by the Building Inspector. Fee ......... Building 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 OR 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 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 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . . �?;SJASMINE . LANE. . . . . . . . . . . . . . . . .SOUTHOLD, .NEW.YORK. . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . . . . . . . . , ,PECONICPROPERTIES . . . . . . . . . . . . . . . .MANAGEMENT.INC: . . . . . . . . . . . . . . . . . . . . 64 County Tax Map No 1000, Section. . . . .9. . . . . . . . .Block. . . . 3. . . . . . . . . . .Lot. . 1. . . . . . . . . . . . . . . . . . . M/O Subdivision. . . . . . S . . . . . D VILLAS . . . . . . . . . . .Filed Map. . . 9737 . . . . .Lot.13. . . . . . . . . . . . . . . . . . . Permit No. . . .Date Of Permit. .:YnY.9,. j99?. .Applicant. ,99N4D,BRACKEN. . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . ..Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . .. . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . 4FinaCerticate. . . . . . . . . . . Fee Submitted: $. . „N..00. . . . . . . . . . . . . . . . . . . . . . . ..��. . . . . . . . . . . . . . . . . . . . . . . . . . . APPLICANT THE NEW YORK BOARD OF .FIRE UNDERWRITERS FACF, 1 1000837 BUREAU OF ELECTRICITY" F 85 JOHN STREET, NEW YORK, NEW YORK 10038 1�OVERBOR 09 1,992 78�-42092192 H 256230 Date r Application No.on file *y �I THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of EDWARD Si DONNA DUNNC , 665 JASM11d0 TANK , JOB P,3, SOUTIfOL i, N.Y. v in the following location; X Basement ® 1st Ft. ❑ 2nd Fl. OUT Section Block Lot was examined on 1`I(J lr�i t1s� R 0 2 ,1.9 9 u and found to be in compliance with the requirements of this Board. FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. I K.W. AMT. K.W. AMT. K.W. AMT. H.P. 13 30 14, 3.3 is DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS w SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET AMT. WATTS Yi 2 F 6 2 SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER I�,YW I 3W 3 0 3W 3,B"4W NO.OF CC.COND: A.W.G. NO.OF HI-LEG A.W.G. NO.OF NEUTRALS A.W.G. EQUIP. PER 0 OF CC.COND. OF HI-LEG OF NEUTRAL 1 :100 CL 1 X 1. 4 1 a OTHER APPARATUS: SMOKE DETECTOR;-1 m SPUDS ELECTRIC SERVICE I,TC. t 192_E � 175 RD.ST. BOX 166 ' GENERAL MANAGER ST, JAMES, NY, 51780 Per at 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. DEPARTMENT. TH15 COPY OF CERTIFICATE MUSTNUT BE s ALTERED IN ANY MANNER. ? it TEL. 765-1802 TOWN OF SOUTHOLD OFFICE OF BUILDIidG INSPECTOR o , P.O. BOX 1179 TOWN HALL SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date Building Permit No. Owner (please print) Plumber (please print) zz I-P I certify that the solder used in the water supply sysEem contains less than 2/10 of lo ' lead. (plumber ' s signature) Sworn to before me this2:L ' day of `�11� , 19 z otary Public 110tary Public, S 1•� County MARYANNE E.DOWLING Notary Public,State of New York No. 5000030 Qualified in Suffolk County Commission Expires August 3, 199� ao �9i � 765-3802 BUILDING DEFT. INSPECTION Q�] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: OIC �U 1�C1., ,n A2�Tw�1 DATE -7 9 z INSPECTOR ®-7 9 70-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. j� FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: I DATE -7 so 9 �- INSPECTOR J 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ) ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING [ ) FINAL REMARKS: DATE � e � L. INSPECTOR Y B L ao-7 4 �� rss-isoz BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [�] ROUGH PLBG. [ ] FOUNDATION 2ND INSULATION [ ) FRAMING [ ] FINAL REMARK8:Q&,,.�� ?� L_i n fil, DATE —INSPECTOR �L M-iso2 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ J FRAMING K] FINAL REMARKS: C., o . DATE �� - INSPECTOR :.::_i::i :;i;:•fiIENT^ 1 . '7 Jy m �► . _ O H � ?OUIIDATIO:V -, ( 1st ) -3 -0_ NJJll 'OUNDATIO11' f 2nd ) I O TOUGH FRAIME & . v'1 •PLUMBIVG 3 . I cn H Li 9J m _IISULATIOPI PER N. Y. . y STATE ENERGY II CODE I T --------------- FINAL ADDITIONAL COMMENTS : m o � ca En 1 -o c BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . _ _ . . . . ... . . . . . BUILDING DEPARTMENT CHECK . . . . . . _ . _ . . . . . . . . . . . TOWN HALL SEPTIC FORK . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 �� G0! qCALL / .7. . . . . . . . Examined . HAIL TO: Approved . . 7 . . . ., 19q Permit No. . . . . . . . _ . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT , DateJt1le—liv . J . . . . . ., 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 bd 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 ne s ary�ti s. (Signature of applicant, or name, iia corporation) .4.�/�� . ./. . . . . . . .. . (Mailing address of applie'ant) . State whether applicant is owner,, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. le . . . . . . . . . . . . . !/� "_Zl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - Name of ow er o p ises �✓�2�J�. . . : . . . . . . . . . . . . . . . . . . . . . . . . . (as on the ax roll or latest deed) If app an cop a on, ignature of duly auth ' ed officer. . . . . . . . . .�N e nd title of corporate officer) Buij er s License No. . . . . . . . . ./. . . . . . . . . . . . . . . . Plumber's License No. . . . . .c� i� .J. R . . . . . . . Electrician's License No. . ./. .9. a .4... . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . ... � 1. Location of land on which proposed work will be done. . . . . . :�:(ZQ�.�� if�—�/ . . /V. . . . . . . . . . 0 .�!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. I-louse Number Street t S r Hamlet / County Tax Map No. 10000 Section . . . . ..70. . . . . . . . . Block . . . . D/ . . . . . . . . . . Lot . . . . �?. . . . . . Subdivision . Gc � ��. . . . . . . . . Filed Map No. , 9. /.�./, , , . Lot . �3. . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use an , , . , ;d occupancy . . . . , , . `rc.• :`� . ... . ... . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . ... . . . . . . Other Work . . . . . . . . . . . . . . . (Description) 4. Estimated Cost . d � �. . . . . . . . . . . . . . . . . ... . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) S. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . Ifgarage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each.t' of use 7. Dimensions of existing structures,if any: Front . . . . . . ... . . . . . Rear . . . Depth . Height . . . . . . . . . . . . . . . . . . . . . . . . g . . . Number o.f Stones . . . . . . . . . . . ... . . . Dimensions 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 . . . . . 11. 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 . . . . . . . . . . . . .Pho e 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 lot. STATE OF NEW Y COUNTY OF S.S • • dam• . eRxC*,e- • • • • • . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ntractor, 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 r . . . . . . . . . . . . . . . . . .day o . . J J L. . . . . :, 19Q Notary Public, . . County �+ 1.SCO1 T,JR. ROBE S 4 ,J . NOTARY PUBLIC,State " " " " " " " ' UBLIC,State of N.Y, No.4725089,Suffolk Cou . . . • . (Signature of applicant) Suffolk C'oeu Term Expires May 31.19 r ' J,4SMl/VE / ,oroP wiM 25 �A/�E PLEASE MOTE Sanitary system is not to be s,�5.437 placed under driveway are&. ei 5500, , O ds N ,Q 0 h /0, � Q V 0 •� (6 rw Z e CO'VS"N4 T Ov, �5 10N V �S'43• 3 /8 4�•h' W. EASE'yEiV p O T �0 ti N 2 O /V/8-1e.?O.W e/23 P111. /2z 61-16- N/p/F Ft pw _ ER HILL BU/LD/lVG CORPORA T/ON SINGLE FAMILY DWELLING ONLY AREA = 14,202 sq.ft. EXPIRES .3 YEARS FROM DATE OFAPPROVAL 0 9 3 s SUR VEY OF LOT 3 "MAP OF SOUTHOLD VILLAS" FILED MAP NO. Prepared In accordance with the minimum A T SOUTHOLD standards for 11l/e surveys as established by the L.I.A.L.S and approved and adopted TOWN OF SOUTHOLD for such use by The Now York Stole Land SUFFOLK COUNTY N. Y, Title Association. r The water supply and sewage disposal 1000 — 70 — 01- P/O 06 systems for this and will conform SCale: I"= 30� to the standards of The Suffolk County De a tment of� Health ervices. March 11, 1992 lt) The locations of wells and cesspools shown hereon are from field observations and or from data obtained from others. �f S't IFS •3�0 0-- as o �_ �.�►�� SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY b . N.Y.S L1C. NO. 496/8 .W 02AW q 5 o- o �Y,fig DATE HS. REF. NO. 1992 N 6' S Y ORS, P.C. SC 9 APPROVED 81*48 Sic r OP v SO N.Y. 11971 J43M/yF 25 5,600, O � - C o h ,o. u° 2�,c v � e�5 C�NSERVAT/ON 0 /V.7S.g3/op +� V /8 4/'fY, W EASE,yENT 00 ti C• 2 Cl 6/./6' lV/O/F .FL0wE R � HILL BU/LD/IVG CORPORA T/ON a�d 44 AREA = 14,202 sq.ft. CERTIFIED We SURVEY OF THE LONG ISLAND SAVINGS BANK PECONIC PROPERTIES MANAGEMENT CORP. LOT 3 "MAP OF SOUTHOLD VILLAS" FILED JUNE 25, 1992MAP NO 9237 Prepared In accordance with the minimum A T SOUTHOLD standards for title surveys as established by the L.I.A.L.S and approved and adopted TOWN OF SOUTHOLD for such use by The New York State Land SUFFOLK COUNTY N. Y. Title Association. The water supply and sewage disposal 1000 — '0 _ 01_ P00 06 systems for this residence will conform SCale 1 r' — 30 to the standards of The Suffolk County Department of Health Services. Mj cvCh 11, 1992 JUL Y 15, 1992 (foundation) The locations of wells and cesspools shown hereon are from field observations and or from data obtained from others. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLYP. Y.S. LIC. NO. 49618 DATE_ HS. REF. NO. O TI"UR RS, P.C. MA � APPROVED SOUTHO D, N.Y. 11971 27 - (o70 ( 3 ) M/ " l li\T`� Uri rt ill S 1 .,L i i A�F Sl�,u l S RTE ----- N.S. A, r r ..a UPPI uCl�f li;S �Qi i..iJ Ti?e y ^;%ge aCt ^I 8•.?J rd i(,i s n r .err �`i.�: a.-.ar d V / �je I is i ii:i �?"aiifli rltun /�l ,4 loc?tfln ha c. e a lli faU ,� �a b..- s£tisi f oiy. oth lei G�2S!�{}2f �^p• 5S00, Chief og BUI' aU G' 2'Nate 'i„`aragPf"ent / ST GP/ Q9 C! ,, 36.o �W v ,h h C��SERV4 TIph V /8,ql,w .ki e4SEAIENT 4p R 2 c N,/8ry2.20-W. NrOiF .FLOW _ ER HILL BUILDING . CORPORA T/ON AREA = 14,202 Sq.ft. CERTIFIED TOR SURVEY OF THE LONG ISLAND SAVINGS BANK PECONIC PROPERTIES MANAGEMENT CORP. LOT 3 o. f //�/� 9` "MAP OF SOUTHOLD V/LL:AS" FILED JUNE 25, 1992MAP NO.9237 Prepared In accordance with the minimum A T SOUTHOLD standards for fille surveys as established by the L.I.A.L.S and approved and adopted TOWN OF SOUTHOLD for such use by The Now York Slate Land SUFFOLK COUNTY N. Y. Title Association. The water supply and sewage dlsposoi 1000 — 70 — 01— P/O 06 systems for this residence will conform SCale: I""= 30� to the standards of The Suffolk County Department of Health Services. March 11. 1992 JUL Y 15, 1992 (foundation) The locations of wells and cesspools shown hereon are from field Oct 24,1992 (final) observations and or from data obtained from others. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY r ' Y.S. LIC. NO. 49618 92 SO 40 NOV is DR DATE -IS. REF. NO. N1C aSffJRVE S, P.C. &C.DEPT. OF P. � APPROVED %EXTH SERVICES MAl SOUTH O , N.Y. 11971 2-7 - 6_70 ( 3 )