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Home My WebLink About20794-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21160 Date NOVEMBER 19, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 875 JASMINE LANE SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 69 Block 3 Lot 16 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. 20794-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-42-NOV. 17, 1992 UNDERWRITERS CERTIFICATE NO. N-258492 -'NOV. 1992 PLUMBERS CERTIFICATION DATED OCT. 8, 1992 - ARTHUR MALANSSENA, JR. Al e Ut QIJI u ding Inspector Rev. 1/81 FORM NO. P 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) MM 2 0 7 9 4 Z Date .......... ... . .....17.................... 192.)— Permission is hereby granted to: .. ................................................ .............. to .....C.>^.-q 11... ........ . . ... ...................................................................................... �............:.:...::. � atpremises located at ..2a.:w......lqli�.�. ... ......... ............ ................................................................................................................................................................. ................................................................................................................................................................. County Tax Map No. 1000 Section ........QDJP.... Block .....0.1........ Lot No. ........... pursuant to application dated ........... ..................... 19.9.E—, and approved by the Building Inspector. Fee $ . ...... .... ..a .. .......Y.............. Buil inag Inspector Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO[dN 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: I. 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-al 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.18: .1992. . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . . .875.JASMINE.LANE . . . . . . . . . . . . . . . . . . . . . . . . .SOUTHOLD, .NEW.YORK. . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . . . . . . . . , ,PECONIC.PROPERTIES.MANAGEMENT.INC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. . . _69. . . . . . . .Block. . . . .3. . . . . . . . . .Lot. . . . 1 . . . . . . . . . . . . . . . . . Subdivision. .MlO.SOUTHOLD,VILLAS. . . . . . . . . . . . . . .Filed Map. . 9737 . . . . .Lot. . . .5. . . . . . . . . . . . . . . . . Permit No. . :.'"?. . . . . . . . . . .Date Of Permit. .:nY.9a, 1992. .Applicant. ,DON4D.BR4CREN. . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . ... . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. . . .25•0U . , , . . . . . . , , , . . , , , , �.. . . . . . . APPLICANT TEL. 765-1802 TORN OF SOUTH OLD s OFFICE OF BUILDING INSPECTOR yE '� r P.O. BOX 1179 O s TOWN HALL SOUTHOLD, N.Y. 11971 . C E R T I F I C A T I O N Date � � Building Permit Owner (please print) Plumber Ards aG4� (please print) 3/-P) I certify that the solder used in the water supply system contains less than 2/10 of 1% . lead. 7 (plumber 's signature) Sworn to before me this ' day of , 19 o Notary Public tlotary Public, County . MARYANNE E.DOWLING Notary public,5 ate of New York No. Qualified in Suffolk County Commission Expires August 3,199A THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 [was 837 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 ate 1'101fF'MBER 30,1992 Application No.on file 78705292./92 N 258492 THISCERTIFIES THAT �4e electrical equipment as described below and introduced by the applicant named on the above application number in the premises of r C'.ROCC-�iOUTPlOLD VT.LL, 875 �1c�vL`dINEiLr11e� , JOLi5 , S�?4I9'#iOLF), ia.i�. ollowing location; Basement Lst Fl. El 2nd Ft. OUT Section Block Lot mined on CJOV 1;I't8 E R 14 ,14 9 2 and found to be in compliance with the requirements qj this Board. RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS INCANDESCENT_FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 8 25 14 8 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS 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 r, 1 2 12 2 SERVICE DISCONNECT NO.OF S E R V I C E - `! METER AMT. AMP. TYPE EQUIP 1.o 2W 1,0'3W 3,0'3W 3,0'4W NO.OPER�COND. OF CC.COND. NO.OF HIAEG OF HI-LEG NO.OF NEUTRALS OF NEUTRAL 1 1.50 C13 1 a 1 1 1 1 OTHER APPARATUS: .F.C ,I: -2 cc,'IOKE DETECTOR: -1 SPUDS ELECTRIC SERVICE LIC.#192 E 1.75 3RD.ST. BOX 166 GENERAL MANAGER ST. JARES, 11Y, 11780 1.1 V 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. ao '79 � 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 15T [kJ ROUGH PLBG. ] FOUNDATION 2ND [ ] INSULATION [� FRAMING [ ] FINAL REMARKS: �2 DATE �'I �`I 9 i- INSPECTORS 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 15T [ ] ROUGH PLBG. [ ] FOUNDATION 2ND INSULATION ( ] FRAMING [ ] FINAL REMARKS: o IZ DATE �' a� `l'- INSPECTOR Y-9� 794 70-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ FINAL REMARKS: 04 �. C, o . DATE `� 9 `$c;l- INSPECTOR Y C Ind w _ C=7 0 • I H � H?OUIIDATIO:V � i st ) I _.r -- c 'OUNDATION ( 2nd ) Zj o oG ` �' �' " TOUGH FRAME & r, •PLUMBING 3 . IIN9 laa �L_ H � :NSULRTIOPI PER N . Y. oil • • y STATE ENERGY II . CODE I ? I � H FINAL I 1 ADDITIONAL COMMENTS : m � AA may„ ----- —_ x -------------- i •� N v- f o m ^a _ BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . TOWN OFSOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . _ . . . . . . . . . . . . . TOWN HALL SEPTIC FORtl _ . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.. 765-1802 t:Di Z FY O 6 S /'O Yl . 9 . . CALL . . ! . 7. . . . . . . . . . . . . . Examined . . . ,, 19 J.2-- MA I L TO : Approved / . .�. . . ., 19q'4- Permit No. . . . . . . . . . . . . . . . . . . .. . . . . . . . _ . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 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 n sary in p c jons. (Signature of a m( g applicant,b pp i , or name, if a corporation) (Mailingaddress f aPPli �t State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . .�,fcck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of o er of mL 'l . .u! .Ci?!�-� . . . . . . . . . . . . . . . . . . . . . . . . . (as on t tax roll or latest deed) If a li is a,c atre of dull a horized officer. ' . . . . . . ... . . . . . . . . . . : . . . . . :f�'. . . . . . e and title of corporate officer) uil er's License No. . . . . . . . . . . .a. . . . . . . . . . . . . . . Plumber's License No. . . . �. !?.J./. . P . . . . . . . Electrician's License No. . . 7 a . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . ... 1. Location of land on which proposed work will be done. ,� , , , , , , ,� . .09. . . . . . . . . . .� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-louse Number Street Hamlet / County Tax Map No. 1000 Section . . . . . .70. . . . . . . . . Block . . . . . . /. . . . . . . . . Lot . . . . . . . . . . . . . ... . . Subdivision . . V.�b?. . . . . . . . Filed Map No. .9. . . . 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 . . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . . . . 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 type of use . . . . . . . . . . ... . . . . . . . . . 7. Dimensions of existing structures,if any: Front . . . . . . . . : . . .: . . Rear . . . . . . . Depth Height . . . . . ... . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . .Phone No. . . • . . . 15. Is this property within 300 feet of a tidal wetland? *Yes, )(. *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. a STATE OF NEW YOAK„� `� S.S COUNTY OF . . . . . . . . • • N Q' 4< 4�'• •� � • • • • • • • • • • . . . . . . . . . . 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 before me this . . . . . .. .. . . . .day �.t/�.y. . . . . ., 19 N � Notary Public, . . . . . . . County.\. ROBERT I.SCOTT,JR. � . . . . . . . . . . ��2G�✓ NOTARY PUBLIC,State Y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No.4725089,Suffolk Cou (Signature of applicant) Term Expires May.31,19 PLEASE NOTE Sanitary system is not to be eC 2 placed under driveway area. _�— 9 ✓gsM�N _ e/STs•4`3%0"tc °. oho r 29 h J ` O In 'S pp, e/z' M 3 P>c /30 00 O 0 3g Q V O V W /s, o o t4; p C � C01ySzC1? `,4 T/pN +� h P/za �ASVEiyT � N/Q/F elZ; F�Q�ER TS 00, \ CORP AREA= 12,000 sq•ft. 4" � l 93 � SURVEY OF SING TAMILY DWELLING o:��.Y LOT 5 EXPIRES �iiV'��_DAT4 0� WROV�i u. J„ LJ ViLL/'1v7// MAP OF SOUTHOLD AP FILED MAP NO. Prepared In accordance with the minimum A T SOUTHOLD standards for Htle surveys as established by the L.I.A.L.S and approved land adopted TOWN OF SOUTHOLD for such use by The New York Stale Land Title Association. SUFFOLK.COUNTY N. Y _ r The water supply and sewage disposal 1000 — 70 — 01— PIO 06 systems for Ih1s residence w111 conform SCaI�� 1��= .30/ to the standards of The Suffolk Counly D menl of Health Services. Mcvch 11, 1992 The locations of wells and cesspools shown hereon are from field observations and or from data obtalned from others. rdM1 ,r- SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY �' ;�g2 '"' ' N.Y.S. L1C. NO. 49618 Q � DATE 02 =S. REF. NO. -`a S0 � �` �� EC�1�llC'�_$�l E ORS, P.0 APPROVED SO n N.Y. 11971 ✓Ash/NF �� 2, s.�S'43 LgNF e�29 %0+F 00 7S 00, z7 hl 00 OO N v ,Q /o, I.- O V v W �s. O 2 ,Q b Z ti oNSERV4 T/pN10 e�2a �AS�FNT N. N/O//c C FZQ�FR ,S 00, BUS e �povG CORP AREA= 12,000 sq.ft. CERTIFIED TO, SUR VEY OF THE LONG ISLAND SAVINGS BANK LOT PECON/C PROPERTIES MANAGEMENT CORP. 5 "MAP OF SOUTHOLD VILLAS" FILED DUNE 25, 1992MAP NO. 9237 Prepared In accordance w/lh the minimum A T SOUTHOLD for file. surveys, as established by the L.I.A.L.S. and approved and adopled TOWN OF SOUTHOLD for such use by The New York Slate Land Title Association. SUFF OLK COUNTY N. Y.- The water supply and sewage disposal 1000 — 70 — 01— P/O 06 systems for this residence will conform to the standards of The Suffolk County Scale 1 30' Department of Health Services. Ma/'Cf1 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 DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLYIM N.Y.S. LIC. NO. 49618 DATE --MS. REF. N0. CC�NI ,A RS, P.C. O APPROVED SO .Y. 1197/ L rt 17' The vva ge i 2rl(i -)KOS V J," !- L.:j t' r '2 E E ot agrj2i- t ald 1, 10 j)* L is L�01i e C, Chieff &TUrcau ;1IT'lastawater S4 10,VeS'S Z,4)Ve '13 7,? 09 E. "Sao, 0 130.00 y 16 5 00, ti LAI /0, 11*4 O Q 0 CIO Q4 R AlZol C07 owe ?Soo, CORP AREA= 12,000 sq ft. CERTIFIED TO, SURVEY OF THE LONG ISLAND SAVINGS BANK PECoNIc PROPERTIES MANAGEMENT CORP. LOT 5 //q . "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 Title Association. SUFFOLK COUNTY. N. Y. The water supply and sewage disposal 1000 - 70 - 01- P10 06 systems for this residence will conform to the standards of The Suffolk County SCale: I"" = 30 Department of Health Services. Marcia 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 0 Y.S. LIC. NO. 49618 - S NPA DATE 92S042 --HS. REF. NO. C04 RSr P.C. 65 -155 V 0 APPROVED S.P4."UL sou N.Y. 11971