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Home My WebLink About20804-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-21157 Date NOVEMBER 18, 1992 THIS CERTIFIES that the building NEW DWELLING Location of Property 420 JASMINE LANE SOUTHOLD, NEV YORK House No. Street Hamlet County Tax Map No. 1000 Section 70 Block 1 Lot 6.9 Subdivision SOUTHOLD VILLAS Filed Map No. 9737 Lot No. 16 conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 2, 1992 pursuant to which Building Permit No. 20804-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-53-NOV. 17, 1992 UNDERWRITERS CERTIFICATE NO. N-256232 - NOVEMBER 9, 1992 PLUMBERS CERTIFICATION DATED OCT. 8, 1992- ARTHUR MALAUSSENA, JR. uilding Inspector Rev. 1/81 FORM NO. s 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) N°N® 2080 4 Z Date .............. . .... .....9................ Permission is hereby granted to: 11 3, ... .. ,,... .. ....a.�. 3 .......... to ... q........... ...........�..... ........ � .... . ..�.... at. premises located at ..LlZu?......... ........ ........9.:...:........ ................Ic ........:... .......... Jk) ................................................................................................................................................................. ................................................................................................................................................................. County Tax Map No. 1000 Section ...... ..... Block ....®.)........... Lot No. �............ pursuant to application dated ............. .. 1...................1 19%1--,, and approved by the Building Inspector. Fee $...�. :. ... CL Building Inspector So�.c.�4i.�IGOI �d�p-d 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.18: .1992. . . . . . . . . . . . . . . . . . . . New Construction. . . . . . . . . . . Old Or Pre-existing Building. . . . . . . . . . . . . . . . . Location of Property. . . .y o. . . . . .JASMINE . . . .�E. . . . . . . . . . . . . . . . .SOUTHOLD,: .NEW.YORK. . . . . . . . House No. Street Hamlet Onwer or Owners of Property.. . . . . . . . . . ,PECONIC.PROPERTIES.MANAGEMENT.INC. . . . . . . . . . . . . . . . . . . . . County Tax Map No 1000, Section. .??. . . . . . . . . .Block. . . . . ... . . . . . . . .Lot. .�.,.9. . . . . . . . . . . . . . . . Subdivision. . . M)n SOUTHOLD VILLAS . . . . . . . . . . .Filed Map. . . 9737. . . . .Lot. . . . . . . . . . . . . . . . . . . Permit No.a .d fr d v.-? . . . . .Date Of Permit. .JULY.9,. 1992. .Applicant. ,DONALD.BMA KEN. . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . .•.Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . .. . . . . .. . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate. . . . . . . . . . . aS Fee Submitted: $, , ,I,-00. . . . . . . . . . . . . . . . . . . . . 613 9 . . . . . . . . . . . . . . . APPLICANT CO 0 5� THE NEW YORK BOARD OF FIRE UNDERWRITERS 1'd0F5$ 31 BUREAU OF ELECTRICITY F 85 JOHN STREET, NEW YORK, NEW YORK 10038 y rs Date NOVEMBER 09 ,1992 Application No.onfile 70W442192/92 iI 2562 2 � THIS CERTIFIES THAT only the electrical equipment as described below and introduced&y the applicant named on the above application number in the premises of r VILLIAN GAFFCA, 420 SASHINE LANE , JOB 0163 , SOU 1'1I01;I} , N.Y. in thefollowinglocation., 7 Basement EZ lst Ft. 21 2nd Fl. OUT Section Block Lot was examined on N 0VENB E R 0 2 , 19 9 2 and found to be in compliance with the requirements of this Board. FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT1 FLUORESCENT OTHER AMT. I K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P. ti 11 25 1.5 11 1 1.2 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS I 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 x 4' SERVICE DISCONNECT NO.OF S E R V I C E AMT. AMP. TYPE METER 1,8•2W 1,9 3W 30 3W 3,0'4W NO.OF CC.COND. A.W.G. NO.OF HI-LEG A•W G. NO.OF NEUTRALS A.W.G. EQUIP. PER Z OF CC.COND. OF HI-LEG OF NEUTRAL 1 150 CB 1 x OTHER APPARATUS: GY.F .C. I. -2 S ROKE DETECTOR:-1 a SPUDS ELECL'RIC SERVICE L1C.#}192-E 175 9RD.19T. BOX 166 GENERAL MANAGER ST. JAMES, NY, 117B0 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. ce COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TEL. 765-1802 O TOWN OF SOUTHOLD 'ma c OFFICE OF BUILDING 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 Building Permit No. r o Owner (pit--a-Se 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 n to before me this ' day of 19 . otary Public Notary Public, --County MARYANNE E. DOWLING Notary Public,State of New York No. 5000030 Qualified in Suffolk County Commission Expires August 3, 199-1 . T65-1802 BUILDING DEFT. INSPECTION [ ] FOUNDATION 1ST ( ) ROUGH PLBG. [ ) FOUNDATION 2ND [ ] INSULATION [ ] FRAMING FINAL REMARKS: DATE �� 1 q '- INSPECTOR '2 a O '— 00 FOUNDATION ( 1st ) I � Zk ' I lJ1 I _ c 'OUIIDATIOid ( 2nd ) TOUGH FRAME & I O -PLUMBING IF fi �I y =IISULATION PER N . Y. I `� "3 STATE ENERGY II CODE I , ` • u Il �i.. .O . •._�r- to m y �--. FINAL I � ADDITIONAL COMMENTS - m� 3 o. w rn X-L4% LH - ` o .. ' . • r vrl '1 1 BOARD OF HEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . _ _ . . . . . . . . . . . . BUILDING DEPARTMENT CIIGCK . . . . . . _ . . . . . . . . . . . . . TOWN HALL SEPTIC FORH . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 ��5 TEL.. 765-1802 r:oT Z FY �/ p CALL Examined . . . 46. 1, , , . 19 �L-- MAIL TO : • • . Approved . . . . .1 . . . ., IR4t Permit No. R9.8 � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 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, ordina es, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for nec s ins inspect ns. (Signature of applicant, or name, if a corporation) r' (Mailing address df applicaiYt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of o r of mises .,( i�QZI,{�.° .� �. . . . . . . . . . . . .�. . ": . . . . . . . . . . . . . . . . . . . . . . . . . . . . as on the ax roll or latest deed) If a pl' is c rp rayon, signature of duly authorized officer. . . . . . . . . . . . . . . . . ( me and title of corporate officer) i Builder's License No. . . . . . . . . . . . . . .//. . . . . . . . . . . Plumber's License No. . . . . .� .6 I. / . . . . . . . Electrician's License No. . . f�V. 111L. . . . . . . . . . . . Other Trade's License No. . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . .70. . . . . . . . . Block . . . . . . . . . . . . . . . Lot . . . . 6 . . . . . . . . . . . . Subdivision . � ° ,� . . . . . . . . . . . . Filed Map No. ! J�. , . . . 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) 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 of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . Rear Depth . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . .Phone No. . . . . . 15. Is this property within 300 feet of a tidal wetland? *yes„ No. ,,X . *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 �R , COUNTY OF . . . . .Q• .t4. . . . . S.S . . . . �jv.,4.4'. . . . ]_ ,RAokf-/V. . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . . . . . . y1of. . .�v�Y. . . . ., 19 4? Notary Public, . . . . . . unty A . . � j ROBERT 1.SCOTT, IR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NOTARY PUBLIC,State of Kv (Signature of applicant) No.4725089,Suffolk Cou � Term Expires May 31,19 PLEAsL i Sanitary system is not to be placed under driveway area. ZOP 13 S )3, Ei 23 2p 30 H Ol 14 8g 00, 00 ZOT a¢ \ 16 op 0 �s CL Cl LOP 1S fro P - (V ` h s e N� .�01 > O O ti Q o OA, v aQ c -- -- Q /P 2 i L=ill.96' �77 OO�O� \ fcr :3/9 79. 260 00, n'`z L=103.54' JA SM/NE LANE AREA= 14,278 sq.ft. SINGLE 'FAWLY DWE' LLi0G_'ONL.Y�� - SURVEY OF EXPIRES 3 YEARS FROM DATE OF APPROVAL LOT 16 "MAP OF SOUTHOLD VILLAS" FILED MAP NO. Prepared /n 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 , N. Y.T!lle Association. SUFFOLK COUNTY The water supply and sewage disposal 1000 — 70 — 01— PIO 08 systems for this resldence w11/ conform i to the standards of The Suffolk County .Scale. .1ii = 30 D arlmenl o/ Health Servl es. March 11, 1992 The locations of wells and cesspools shown hereon are from fleld observations and or from data obtained from o/hers. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ` t:�! �V� FOR APPROVAL OF CONSTRUCTION ONLY N.Y.S. LIC. NO. 49618 DATE S. REF. NO. " SUV, YDRS, P.C.. 7ijfir ` ` 1 4 6� 9 APPROVED SO , N.). 11971 87-670 001 nor s T3�2o3 4 N `Or Ei 23 O F 1� 8g 00, 4 a �n�• for ¢ rs o ti zOT .� 1� 195 p ConL. r, ' N �avndafian N .. /9.7 Q �1b O.Q, O I L-///.96' At 00 00 -3/9 7g, Q' f 2_—,1 26p 00 a L=103.54, zo + ./,q:SUINE LANE • el i9.5"� AREA= 14,278 sq.ft. CERTIFIED. TO: THE LONG:ISLAND SA VINGS BANK PECONIC:PROPERTIES MANAGEMENT CORP. SURVEY OF LOT 16 "MAP OF SOUTHOLD VILLAS" FX EDJUNE 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 SOU THOLD for such use by The New York Slate Land Title Association. SUFFOLK COUNT Y, N. Y. The water. supply and sewage dlsposol 1000 — 70 — 01— P/0 06 systems for this residence WN, conform S'Ca/�r 1ii= 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 observations and or from data oblalned from others. VW a SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Pt�� FOR APPROVAL OF CONSTRUCTION ONLY 0 '� ; :'; N.Y.S. L/C. NO. 49618 DATE --HS. REF. NO. `1' SU YORS, P.C. 9 APPROVED SO , N.Y. 11971 87-670 (16) —LT-H RV W,ES OF DRA ILY ILY S',J�C,tE HAN . 3 LW7E LID—" S U L,-.4 Wient and/Or ;'teen in S �i ioul-id 10 Y -W.,tQeNent O� Chief uraau 07- 13 0 F. r. 8100, 07- 0, O (r Cl 35 O 6 /95 0.5/Y 12e), lb .,(3 NN ti A, R=371.46' L=///.96' ?,-.00, 00-8, R-319.;,q, -160.00, - L=l 03.54, JA SA ANE ' LANE AREA= 14,278 sq.ft CER TIFIED TO, THE LONG ISLAND SAVINGS BANK pECONIC PROPERTIES MANAGEMENT CORP. SUR VEY OF o '7Z LOT 16 "MAP OF SOUTHOLD VILLAS" FILED JUNE 25, 1992 MAP NO. 9237 Prepared In accordance with the m1n1mum A T SOUTHOLD standards for fitle 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 SUFFOLK COUNTY, N. Y. Title Association. 1000 - 70 - 01- PIO 06 The water supply and sewage disposal systems for this residence w111, conform Scale: .r'= 30' to the standards of The 'Suffolk County Department of Health Services. Mevch 11, 1992 JUL Y 15, 1992 (foundation) The locations of wells and cesspools shown hereon are from field Oc,7 1992 (final) observations and or from data obtained from others. R Iff rM 1CM SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY N.Y.S. L 1C. NO. 49618 92SO53 Nov 1992 A0 DATE ---HS. REF. NO. PEC6Mi�3"�----S.U'.R,.V'E�Y"ORSj P.C. (516,V 76'- 5020 S.C. DEFT. OF P. 0. BOX 909 HEALTH SERVICES MAIN ROAD APPROVED SOUTHOLD, N.Y. 11971 87-670 (16)