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Home My WebLink About20801-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-22023 Date DECEMBER 14, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 250 APPLE COURT SOUTHOLD, NEW YORK House No. Street Hamlet County Tax Map No. 1000 Section 70 Block 1 Lot 6a.5 Subdivision SOUTHOLD VILLAS Filed Map No. Lot No. 12 conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 2, 1992 pursuant to which Building Permit No. 20801-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 QNE FAMILY DWELLING (1ST FLOOR ONLY) AS APPLIED FOR The certificate is issued to PECONIC PROPERTIES MANAGEMENT INC. (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 92-SO-49-NOV. 17, 1992 UNDERWRITERS CERTIFICATE NO. N-258830 - DECEMBER 2, 1992 PLUMBERS CERTIFICATION DATED OCT. 8, 1992 - ARTHUR MALAUSSENA JR. Building Inspector Rev. 1/81 FORK NO. 9 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 2080 1 Z Date ............ .................. Permission is hereby granted to: C- tK-ul-6...................................................... .......... to . ..... ..... ....... ......................................................C ................. ............................ .................. 10........ . . ....0 , .... at premises located at ... ........J.A:.:........ ...............................................................................e................................................................................. ................................................................................................................................................................. County Tax Map No. 1000 Section ..... ........ Block ....�A.......... Lot No. ............ pursuant to application dated ........... 'm. .....2..................... 191L-1 and approved by the Building Inspector. Fee awl X .....4....... ul dding:finspeciar cz Rev. 6/30/80 Form No. 6 TOWN OF SOUTHOLD A g � � YZ N' BUILDING DEPARTMENT TOWN HALL 765-1802 ° DEC f ! 1992 APPLICATION FOR.CERTIFICATE OF OCCUPANCY0'y `-, O1iB OLD 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-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 $15.00 Date . . . .November 18,. . .. .1992. . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . NEW Location of Property. . .J-5.Q. . . . �d_; �.- � '. . . . . . . . . . . . . . . . . . . .SOUTHOLD, . . . . .YORR. . . . . . . . House No. Street Hamlet Onwer or Owners of Property. . . . . . . . . . . .PECONIC.PROPERTIES.MANAGEDZENT.INC. . . . . . . . . . . : . . . . . . . . . County Tax Map No 1000, Section. . . _ . 0 . . . . . .Block. . . . I. . . . . . . . . . .Lot. . kt.$ . . . . . . . . . . . . . . . Subdivision. .t4lO.SOUTHOLD,VILLAS. . . . . . . . . . . , .Filed Map. . 9737 . . . . .Lot. . ��. . . . . . . . . . . . . . . . . Permit No.-A� d�� , , , .Date Of Permit. .JULY,9,, 1992„Applicant. .DONALD.BRACKE. . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. .. . . . . . . . . . .. . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . Fee Submitted: $. 00 . . .? •� . . . . . . . . . . . . . . . . . . . . . / oC�(J . . . . . . . . . . . . . . . � APPLICANT Cad �� 0�.3 s THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1 1000837 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 Date DECBMBE:R 02,1992 Application No.on file 73705992/92 ' N 258830 � 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 I,YBURT-SOUTHOLD VELLAS, 250 APPLO COURT, J'OD012, SOUT11OLII, N,Y. a in thefollowing location; ® Basement ❑X Ist Ft. ® 2nd Fl. OUT .Section Block Lot � was examined on NOVE MBE R 2 5 ,19 9 2 and found to be in compliance with the requirentents ql this Board. FIXTURE RECEPTACLES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS SWITCHES OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. 15 25 15 15 � DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS BELL SYSTEMS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. .AMPS. TRANS. AMT. H.P. AMT. WATTS NO.OF FEET 2 r: 1 2 12 2 w. SERVICE DISCONNECT NO.OF S E R V 1 C E METER NO.OF CC.COND. A.W.G. A.W.G. A.W.G. AMT. AMP. TYPE EOUIP l,B'2W 1�'3W 3 JB"3W 3,0'4W PER% OF CC.COND. NO.OF HI-LEG Of HI-LEG NO.OF NEUTRALS - OF NEUTRAL 1 9 1 OTHER APPARATUS: MOTORSeI—t I-I.P. SIAOKE DETECTOR t—]. — Lcertiffic.t. ELECTRIC SIaRULL'E LTC. {;192I� `P. BOY 166 GENERAL MANAGER , NY, 11730 11 Per tered 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. �c�k\F �O TEL. 765-1802 TOWN OF SOri THO]LD OFFICE OF BUILDING INSPECTOR o `r, �I 7 �7 �yilf- }•� = P.O. BOA 11/9 TOWN HALL SOUTHOLD, N.Y. 11971 C E R T I F I C A T I O N Date Q� Building Permit No. aa� Owner print) Plumber (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% . lead. (plumber 's signature) SWo�Fn to before me this ' day of (� , 19 . ;�o otary Public t>otary Public,-, l 1 2'XftNCounty . MARYANNE E. DOWLING Notary Public, State of New York No. 5000030 Quali County Commission� Expires Aug st 3 1994 765-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 15T ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION �j FRAMING [ ] FINAL REMARKS: V� DATE INSPECTOR V C'i L �o Ba 70-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE 1 -7 z INSPECTOR YC, 1_ aQ �ol � 7W-1802 BUILDING DEPT. 1 NSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL REMARKS: DATE '-I 19 INSPECTOR V CT �-- E:._ ram•+ � ?OUNDATION 1 s t ) 'OUNDATIO,d (2nd ) ;OUCH 4FA l•IE ) y o .P ING 3 . :27SULATIOPI PER N . Y. � I • , H STATE ENERGY II CODE CJ m FINAL I — _n VI ADDITIONAL COMMENTS : m J r Q ea- H O _. _ r � • d BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLAZIS . . . ... . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORH . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 r:oT I FY66.�, q CALL . . . - - - . . . . . . . . . . . Examined . . . , , 19 !L MIA I L TO : - • • - • . . . - . . Approved . . . �. ., 199?.. Permit No. a4 . . . - - - . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .q.�.. . . . . o �-.v.°. . . . . . . . (Building nspector) 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 nec ;.;r.:,nsp cti S. JI�� `:. . r . . . . . . . . . . . . . . (Signature of applicant, or r�'ame, if a corporation) (Mailaadd'ressVa��licaiit) State whether applicant is owner, lessee,. agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . .a- . . . Name of o er of premises (. '1�1. f . . . . . . . .�fi. . . . . .w LO.�r... . . . . . . . . . . . . . . . . (as on the t�or latest deed) If #Aame por /ion, signature of duly authorized officer. . . . c��v nd title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . .� .6. 3./. . . . . . . . . Electrician's License No. . 1.,�off. . . . . . . . . . . . . . Other Trade's License No. I: Location of land on which proposed work will be done. . .C` ZtX; ./!f� . . .�4d .. . . . . . . . . . .tY�. .!!` . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . I-louse Number Street Hamlet County Tax Map No. 1000 Section . . . . . ./. O. . . . . . . . . Block . . . . . . I. . . . . . . . . . Lot . . . .6. . . . . . . . . . ... . . Subdivision . . . . Y am. . . . . . . . . . . . . Filed Map No. . .9? S.7. . . . Lot .19'. /a:. . . . . . . (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 . . . X. . . .. .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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) 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 . . . . . . :. . . . . . . . Rear . . . . . . . . . . . . . . Depth Height . . . . . . . . . . . . . . . Number o"f 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?" .* 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 47. • • • . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (C ractor, 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 them ner set forth in the application filed therewith. Sworn to before me this . . . . . . . . . . . . . . . . . . . . y of. U. . . . . . ., 19 Notary Public, C . . . 5 .�. .�_ ounty' ROBERT 1.SCOTT,JR. NOTARY Pl1BLIC,Staf�of . . . . . . . . . . . . . . . . . . . . ND..4725089,Suffolk n (Signature of applicant) Term Expires May 31,19 S \ Y N�p,F Rv ✓0 s tilq F N 00- \a6. tole /6303, �EPSE ;S r°t ea- 53 s' 2 ,C Z envelope J` e/ 2¢ / 272.65' 0 N. S. 8705235' W. h' d 0 4�2 L � 53j'w Q 1- O z E JASMINE BAN SINGLE FAMILY DWELLING EXPIRES 3 YEARS FROM DATE GONLY AREA = 27,459 sq.ft. APPROVAL SURVEY OF LOT 12 "MAP OF SOUTHOLD VILLAS" FILED MAP NO. Prepared In accordance with the minimum r A T SOUTHOLD standards for title surveys as established r by the L.I.A.L.S. ..A.L.S. and approved and adopted C ze# TOWN OF SOUTHOLD for such use by The New York Slate `Land Title Association. SUFFOLK COUNTY, N. Y. The water supply and sewage disposal ` UN 1 199" 1000 - 70 - 01- P/O 0� systems for this residence will- conform i� i to the standards of The Suffolk County S Scale: r = "40 Depa eni of Health Services. kEALT115 ER T. Mc11 ch 11, 1992 4he locations of wells and cesspools shown hereon are from field observations and or from data obtained from others. LAN SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVIC �� M FOR APPROVAL OF CONSTRUCTION ONLY N.Y.S. L1C. NO. 49618 JUN 0 219 DATE_ HS. REF. NO. dt P S 4 YORS, P.C. O N�.49 9 APPROVED N.Y. 11971 87-670 12 Nip�F Rv . Mq NN ✓O ,qN �9 M N a6 Ll 2�S o ,3o�2,Op.F N ti0 53 2y.o• s, � � � 09 .ti 35 v O C j t, -t 272.65' 0 N. S. 8705235' K AP ,C 13 a v 4_ 00 o no rZ up 00 ' LANE J ASMINE AREA = 27,459 sq.ft. CERTIFIED Too THE LONG ISLANSAVINGS BANK PECONIC PROPERT IES MANAGEMENT CORP. SUR VEY OF LOT 12 "MAP OF SOUTHOLD VILLAS" FILEDJUNE 25, 992 MAP NO.9237 Prepared in accordance with the minimum A T SOUTHOLD standards for NIIe surveys as established by the L.I.A.L.S. and approved and .adopted TOWN OF SOUTHOLD for such use by The New York Slate Land Title Association. SUFFOLK 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"= 40" Department of Health Services. - Mc'il'ch 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 ONLY N.Y.S L1C. NO. 49618 DATE HS. REF. N0. CONIC -Ro EYORS, P.C. ICJ6 20 909 APPROVED D SOUTHOLD, N.Y. 11971. 87-670 12 T j Cl�f''=(�.i K: (,•.'� ; .,.; _ v' Irr1i_i i , fI�LJ tt DAT h ,aq ? iC, an:i0r Othel 1 {.'r) i s Gllli iG..iilU to i_'£ soli lOrj. �psF Chief 0 uu e?1j 0f V%Iastewater 1 a�ag°meat SF�� M,gNN � $6, 3 72 oO a NN 1� � �g6• c' F h o / N � , s' 163 03, ti0 eo kl 3°55 � s, '�� 2 �• �C 2 3. C d. 1 enyeloRe 2 72.65' / 0 N. S. 87°5235" W. \ O�p R-2S G,2 O O b S.3), o� •o 6ui tio_ �o �O Z. �25. 21 LANE J ASMINE AREA = 27,459 sq.ft. CERTIFIED TOI THE LONG ISLANSAVINGS BANK PECONIC PROPERT IES MANAGEMENT CORP. SUR VEY OF P a %.y- lj3S— LOT 12 "MAP OF SOUTHOLD VILLAS" FILEDJUNE 25, 992 MAP NO. 9237 Prepared In accordance with the minimum A T .SOUTHOL® standards for title surveys as established TOWN ®F S®UTH®L� by the L.I.A.L.S and approved and adopted for such use by The New York Slate Land O SUFF L Title Association. K COUNTY, N Y The water supply and sewage disposal 1000 - 70 - 01- PIO 06 systems for this residence will conform to the standards of The Suffolk County Stale 1"= 40 Department of Health Services. Mcvch 11, 1992 JUL Y 15, 1992 (foundation) The locations of wells and cesspools shown hereon are from fleld Oct 23,1992 (final) observations and or from data obtained from others. 4� SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY N.Y.S. LIC. NO. 49618 92SO49 DATE_ HS. REF. NO. NOV 1992 "PECONIC SUR,VE?YORS, P.C. (51.6). 765 7 5020 S.C. DEPT. O� A':O:- BOX. 90'� M:47N R0,4'p:fi APPROVED HEALTH SERVICES SOU'THOLD; N.Y. 11971 87-670 12 -