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Home My WebLink About20793-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21159 Date NOVEMBER 19, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 775 JASMIN LANE SOUTHOLD, N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 3 Lot 15 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. 2.0793-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. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-41- NOV. 17, 1992 UNDERWRITERS CERTIFICATE NO. N-258493 - NOV. 1992 PLUMBERS CERTIFICATION DATED OCT. 8, 1992 - ARTHUR MALANSSENA JR. r57 uilding Inspector Rev. 1/81 FORM NO. 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) NN9 20793 Z Date ............... . . .... .................... -- Permission is hereby granted to: .?Aat R. II ....�........�4.3�................................................... ...... .....to ............ . ........ ... :.... ..... .....� !....a.............. .....4 ... CIO ........................................................ ........................ at premises located at ......... .. . ........ .. ................ ................. .......... ............ ... �. , ....... . .................. ... ......... . ..... .. ............................... ................................................................................................................................................................. ................................................................................................................................................................. County Tax Map No. 1000 Section ....0 ........ Block ...... O.......... Lot No. ...4&............. pursuant to application dated ......... . . . . ...�-.......................... 19.q.z:, and approved by the Building Inspector. Fee $...� �:� ..... .. ...... .ing In.... i dspector Rev. 6/30/80 Form No. 6 .. J 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. . :; l, Ps , , , . .JASMIN� . . . . . . . . . . . . . . . . . . . . .SOUTHOLD: .NEW.YORK. . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . . . . . . . . . .PECONIC.PROPERTIES.MANAGEMENT.INC: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . .0 . . . . . . . .Block. . .,'A.. . .. . . . . . . . .Lot. . . .1,5. . . . . . . . . . . . . . . . Subdivision. . . Yt. . .. . . . . . . . . . . . . . . VILLAS . .Filed Map. . . 9737 . . . . .Lot. . .W . . . . . . . . . . . . . . . . . Permit 140.x.Q. Fq . . . . .Date Of Permit. Applicant. .DONALD.BRACKEN. . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . ..Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: . . . . .. . . . . . . . . . . . . . . .. 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . APPLICANT Cam a ,I� .._ .. . . THE NEW YORK BOARD OF FIRE UNDERWRITERS - PAGE 1 1000837 BUREAU OF ELECTRICITY F_ 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date 110VEMBER 30,1992 Application No.on file 7870 t 192/92 N 258493 „ 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 t UATERROUSE-SOUTHOLD VILLA, 775 JA3P[Itll] LIANE , J013#4, SOUTROLD, N.Y. in thefollowing location; ❑S Basement ® lst Ft. 0 2nd Fl. OUT .Section Block Lot was examined on i30 VE�iB 1 1 9 ,L 9 9 2 and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCENT1.FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. I H.P. 10 25 13 10 1. Y DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS OIL H.P. GAS H.P. AMT. NO. A.W.G. T. AMP. AMT. AMPS. TRANS. AMT. H.P. NO.OF FEET SYSTEMS AMT. WATTS 2 - SERVICE DISCONNECT NO.OF S E R V I C E METER NO.OF CC.COND. A.W.G. A.W.G. A.W.G. _ AMT. AMP. TYPE EQUIP 1,9'2W 7,B 3W 3 A'3W 3.0 4W PER A' OF CC.COND. NO.OF HIAEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL 1 1.00 CB 1 X 1 4 1 4 OTHER APPARATUS: C,.F.C. 1 2 SROKE DETl;CTOR:-1 SPUDS ELECTRIC SERVICE L' IC,tL192 E ' 175 3RD.ST. FOX 166 GENERAL MANAGER ST. JARES, 11Y, 11730 i1 { Per 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. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TEL. 765-1802 TOWN OF SOUTHO]LD OFFICE OF BUILDIi1G INSPECTOR P.O. BOX 1179 TOWN HALL SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date lt---o Building Permit No. o ' Y3 Owner (please print) P1Lr,,beri2 ��Y*645�vs � (please print) CZ63�-�> I certify that the solder used in the water supply system contains less than 2/10 of 1% ' lead. (plumber ' s signature) Swo n to before me this ' Kday of 19 L No��bdlic 110tary Public, County . MARYANNE E. DOWLING Notary Public, State of New York No. 5000030 Qualified in.Suffolk County Commission Expires August 3, 199� ao -7q 3 � 7ss-1so2 BUILDING DEFT. INSPECTION [ ] FOUNDATION 15T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING pQ FINAL REMARKS: � �. C.d• DATE j' 18 4 �-- INSPECTOR �# a o+jl '� � 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION SST [ ] ROUGH PLBG. [ � FOUNDATION 2ND [)(] INSULATION [ ] FRAMING [ ] FINAL REMARKS: o-Pe 1"- ,R DATE `l a� 9 a. INSPECTOR 9L ors-isox BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST [k] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION (x] FRAMING ( ] FINAL REMARKS: DATE `� �� `1 z INSPECTOR 1c:LJ HD E NT.". _ n' J-' 1 . —7 FOUNDATION ( 1 s t ) 'OUNDATION ( 2nd ) car o ;OUG.H FRALME & I 11 Eli-PLUMBING -' l 3 . cn ►3 =IlSULATIOPI PER N. Y. I - • • ►a STATE ENERGY II CODE I ? flial9i . c9 . FINAL I _ ADDITIONAL COMMENTS : • ' x _ H Q�,t.�� C •o. i — > P_p r �� '� ° V" BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . ... . . . . TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . _ . _ . . . . . . . . . . . TOWN HALL SEPTIC FORM _ . _ . . .. . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 NGTIFY CALL . . . �G� o Y . . . . Examined . . , ,�, , , 19 MAIL TO : ApprovedYjllal . . . . . . ., 19�Z Permit No.a4�9.5�� . • . . . : _ . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . ., 19 9� 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 nec ry inspections. : . . . �2 . . . . . . . . . . : . . . . . . (Signature of applicant, or name, if a corporation) � . . . . . . (Mailing address of aolicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . Name of er of raises .. �� . . . . . . . �taxoll %�!! .�.�/ :. . . . . . . . . . . . . . . . . . . (as on the latest deed) . If pl'c is a o ati , signa ure of duly aq1horized officer. ( a e and title of corporate officer) uil er's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . 4; K 3 f .P . . . . . . . . Electrician's License No. . . . . . . . . . . . . Other Trade's License No. 1. Location of land on which proposed work will be done. . . . . . ..A,-6vt. . . . . . . . . . . .( � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-louse Number Street Hamlet County Tax Map No. 1000 Section . . . ./. .�. . . . . . . . . . . Block . . . . .�. �. . . . . . . . . . Lot . . . . . . . . . . . . . . . . . r � ��o�. . . . . . . . . . . I. 7 .% . . . . . . . . . Subdivision Filed Map No. Lot .�. . (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 and occupancy . . . . . . . . .'. . : . . . , . . . . . . . , , . 3. Nature of work (check which applicable): New Building . . . :4.. . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . ... . . . . . . . . Other Work . . . . . . . . . . . . . . . (Description) 4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) S. 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 type of use . . . . • _ . 7. Dimensions of existing structures,if any: Front . . . . . ... . . . . . . . e.Rear . . . . . . . . . . . . . . Depth Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . _ Dimensions of same structure with alterations or additions: Front Rear . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . .: . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . 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 . . . . . . . . . . . . .PhQr}e No. . . . . . . . . . 15. Is this property within 300 feet of a tidal wetland?' *Yes. • No 1` � � � � • � • . . . .. . . . . . . . *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 YORK COUNTY OF S.S • • ��• •4•U• • •�WACle4 • • • • • . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name.of individual signing contract) above named. I_ Heis the . . . . . . . . . . . . . . . . . . . . . bX-t-.C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 beforVet.h . . . . . . . . . . . . . .day . . 0 L x. . . . . ., 19 .`P2 �1 S4 Notary Public, . . . . . . . . . _. . . . . ::.amount /4 BERT 1.SCOTT,JIRL . . . . . . . . . . . . NOTARY PUBLIC,State of N.Y.` (Signature of applicant) No.4725089,Suffolk Cou Term Expires May 31,39 s _ J'4SM//�/F PLEASi` t�ij'i E Sanitary system is not to be . placed under driveway area. PIZ, f. O y 75 00, O 55 00' • a O 0/01 J h c ti ` Avg .'� top 70 of C /V/O/F �s 00 F�pwER AM, . CORP AREA 12,000 sq.ft pirtu7 /I j SURVEY OF SIN L£ 1: NMiL DWELUNG ONLY .SOT 4• EXPIRES 3 YEARS FROM DATE OFAPPROYAL „MAP of souTHoLD vxLAs" FLED MAP No. Prepored /n accordance. with the minlmum A T SOUTHOLD standards for Ntle "surveys -as established by the L.t.A.L.S. and approved and adopted TOWN`OF SOUTHOLD for such use •by 'The:.New York Slote Land Y N. Title Association. SUFFOLK COUNT Y. The water su ply and sewage disposal 1000 — 70 01- P/o Oe systems for this resldence' will conform i< to- a standards of The Suffolk Counly $Cale: 1" = 30 D p -tment�of Health Services." March "11, 1992 T e locallons" of wells and. aesspoo/s. shown hereon are from field observatlons and or from data obtolned from..others. �, t E:yp -LAUDEnvy. i� � SUFFOLK COUNTY DEPARTMENT: OF HEALTH SERVICES �, , META FOR APPROVAL OF-CONSTRUCTION ONLY PAY 2s- 1992 � ,� � °` AY.S. L/C. N0: 49618 . DATJ AREF. NO ' S0_`� EC '1121 ,u ORS P.C. S•O, UFPT. CFHEA I Trl S2.VICES E APPROV - N Y. 11971 lqN P,z /p E 5 � 00 7S pp, pp. O 1 27 c CQ /o, Q v 0 Q . V 1 v 0 h p � Pi 27 O ,h N � r %p•�, C N/`o/F F 75 00. Bowe v A Q BU BU a CORP AREA 12 000 s .ft. ! 1 u CERTIFIED TO• SUR VEY OF THE LONG ISLAND SAVINGS BANK PECONIC PROPERTIES MANAGEMENT CORP.. LOT /J"MAP OF D'�'SOUMOI VILLAS" Prepared In accordance with' the minimum F/LEDJUNE25, 1992MAP N0.9237 standards for tlNe surveys as established A T SOUTHOLD by the L.I.A.L.S and approved and adopted TOWN OF SOU THOLD for such use by The New York Stale Land Title Association. SUFFOLK COUNTY, N. Y• The water suppply and sewage disposal 1000 — 70 — 01- P/O 06 systems for lhls res/dence will conform to the standards of The Suffolk County SCal@: 1��= 30 Department of Health Services. March 11, 1992 The locations of wells and cesspools shown hereon.are from field JUL Y 15, 1992(foundation) observations and or from data obtained from others. SUFFOLK COUNTY FOR APPROVAL OF CONSTRUCTION HEALTH ONLYSERVICES - D=5 � WF''= N.Y.S L/C. NO. 49616 DATES. REF. NO. CQ, I =` E RS P.C. 6) .5 —q APPROVEDILL ® '" 11971 �-1- 6-10 (4 ) SUFFOLK CUUM'Y DUAilk7li'CfE-114"F 0F SFE.Ilftftflr�s t§2AWLY �>%�'-R- lW; 0 Thp� iocaticm t,.ave 0'1flef age iclif's md X,u-d t'o -a -1-4,94fpVe f 0 cur-eau Of Wlas'ie.viater !,•ilanagemEml '13 70 1-4)VIF O ",500O , 0 4-1 5soo, 00,1 01 - 17C"'.5e 35..3. �Q O 0, NZ W 0 �Q O o �v c7 CO 'V 0 'SZ;5'V4 N. 370. C6 A'/o/ .00, ok, CORP AREA 12,000 sq.f t CERTIFIED TO, SURVEY OF THE LONG ISLAND SAVINGS BANK pECONIC PROPERTIES MANAGEMENT CORP. LOT 4 �0,6, /S f // Z13 V� q 3 "MAP OF SOUTHOLD VILLAS" Prepared In accordance with the minimum FILED JUKE 25, 1992MAP NO.9237 standards for title surveys as established A T SOUTHOLD by the L.I.A.L.S. and approved and adopted TOWN OF SOU THOL D for such use by The Now York Slate Land Title Association. SUFFOLK COUNTY, N. Y. The water supply and sewage disposal 1000 - 707 01- P10 06 systems for this residence will conform to the standards of The Suffolk County SCale: 1" = 30-' Department of Health Services. Mcvch 11, 1992 JUL Y 15, 1992 (foundation) The locations of wells and cesspools shown hereon are from field Oct. 23,1992 (final) observations and or from data obtained from others. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Y.- FOR APPROVAL OF CONSTRUCTION ONLY Y.S. LIC. NO. 49618 92S041 VS 1, :, .11 DATE --HS. REF. NO. CONl Vtr( RSI P.C. 6�1.til '65 '4�0 . -2. , 5 02.6 APPROVED V;�101 sou Y. 11971 �00 (4 )