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HomeMy WebLinkAbout8983-zFO~ NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z76~2 Date l~y 9 19.??. THIS CERTIFIE~that the building located at ....... ~.~..~.n.· ............ Street (~ Southold Map No..~X. ~e~. Block No ........... Lot No... ?~ ..... S~.. ~.~ ....... conforms substantially to the Application for Building Permit heretofore filed in ~is office dated ............ ~V. 2~.., 19. ~ pursuant to which Building Permit No.. dated .................. ~ov ~g. .... , 19 ~.~., was issued, and conforms to ~1 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~d ~..~r~.~. 9~e. f~$. ~,~n~. ...................................... The certificate is issued to ~8~,. Y~S0~ ....... ~ ........................ (owner, lessee or ten,t) of the aforesaid building. SU~Olk County ~epar~ment o~ Health ~pproval ~[ .3.. }.!~7...~. ~.'..W}!a UNDerWRITERS CERTIFICATE No.. ~.~ .... ~P~ .~...!~. ................ HOUS~ NUMBER .............. Stree~ ~in Lane 8ou~hold Building In/pector TOW;N OF :S0m'HOLD TOWN CLERK'S OFFICE SOUTHOLD, N'. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8983 Z Permission is hereby gr~nted to: .q..o.~ .~.~.~..z.... ~.9..~.~:~ ~ ~. :~f.;.~ ~..o~...~ ~:~...... ~../..c.'...?~,~'~o w~.~8ovie ................... ~.~,~.o.~. ......................................... ro ~.t.~.':?~.e.~.:~...v~.~...:~.~.~..z..'.z.~!...~.:.:'~.!~.!~.~ ...................................................................................... at premises located at ......~..0..~....~.~. ....... .~...~.~...};.~.*~.~..~.t...~!..~.9..~...t,~.l.o...~..~.. ................................................. ............................................... .Girt...L~ne .............. S.~thoifl ........................................................... pursuont to opplicotion doted ........................ ~f).~***.**~*. .............. , 19.**~...6., ond opproved by the Building Inspector. Fee $.....,~...t.~.O.. ........ Building I~spector 'l FO~M NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Officn Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4, Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare (3 certificate, C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3, Copy of certificate of occupancy $1.00 Date ........... ~ ............................. New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .......... .~,,,..~..-~... ...... .,~,C~/../..~, ..... ,,~..~., ,./~.,../..~ .................. .,.'~..,~...'..,~. ,~'. ....................... Owner Or Owners Of Propert, ..../~'7.~.'~..../~...~. .......... ~..'~...~~.."~" ................................................... Subdivision ................................... Lot No. Block No...' .......... House No......... .... .................... .... Permit No, ~ ;~'-~""~.'.,~'Date Of Permit .................... ~,pp~,can'~ .................................................................. Health Dept. Approval .... ..~..~...~.i...:'....~....?../. ............. Labor Dept. Approval ................................................ Underwriters Approval .......................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .......~,. .......................... Construction on above described building and permit meets_all Opplicable Codes and regulations. Applicant .. ~-.~ .................................................. Sworn to before me this ............. of ................ Public ............................. .TCaun,¥ (stamp or seal) C'_a 7_ 7659-. ; - THE~NEW'~yORK BOARD OF FIRE UNDERWRITERS '~ v kI ' ~, : ,- -~ i . ; BUREAU OF ELECtRICItY --- '% '.L 'L, : .; "85 JOHN STREET, NEW YORK, NEW YORK 10038 . App,,ca,o...¥a. on~,,~ 892~0~N 3 3 4 9 5 2 -~"~" :April 28,1977 : .., . . THIS CERTIFIES ~HAT' "',: . ' o~ly the electrical equip~ne~ as described bel~ and introduced by the applicant named o~ the above application ~umber in the premlses of ~ ~koVu~asov~c;~G~n ~ne,~off Bayv~ew, 8outhold, L.!. 2 Box 215 -, ,. [ ~ f/ This certificate must not be aJtered in any manner; return to t~e o¢fice of the 5oar~ i~ incorrect. Inspectors may be identitied~y 'their c~ TOWN OF SOUTHOLD r~',?/~¢~ ~/~.,2~,,/~ /~,~'/~& / ~/~ BUILDING DEPARTMENT~ ~,~ ~/~ . TOWN CLERK'S OFFICE / -['~/ - cx~mmeu .... ~......:...~ ..... .I.. .... , Iy.a~ . ,/~ I ,, , ~-~ ~.,L ~pp cotion ~0, ...~...L.~..~ .~ -- ~ ~ . ~ ~, ~ ..... ~ ....... ~ ....... Disapproved a/c .~ ...... ~:_~ ............ ~.....,/~- ~/~;.~. .................................................................................. ............................... /~ ............ A ............................. APPLICATIOH FOR~rLDING P'RMIT ~I'7 O~/~, D to ~ O ................................................ INSTRUCTIONS o. This oppiicotion must be completely filled in by ~pewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to ~ole. Fee according to schedule, b. Plot plon showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofprope~ must be drown on the diagram which is c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building ~nspector will issue o Building Permit to the applicant. Such permit sh~ll be kept on the premises ~v~ilobte for inspection ~roughout the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until shall h~ve been granted by the Building Inspector. APPLICATIO~ IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town o~ Southold, Suffolk County, New York, and other opplicob e Laws, Ordinances or Eegulotions, for the construction of buildings, additions or alterations, or for removol or demolition, os herein described. The applicant agrees to comply with o~1 applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and i~ buildings for n~esso~ inspections. Cornell Construction Corp (Signature of applicant, or name, if a corporation) Southold N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Name of owner of premises Marko Vukasovic if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. nlat tituck Electrician's License No .... .QJ~...~ ............................... Other Trade's License No ............................................... ~c>~ t D Bay Haven ~ ~ Sguthold 19 Location of land on which proposed work will be done. Mop No.: ........................................ bat No ......................... Street and Number ........... .G..~.~.....~...a..~..e. ........ s.O.~..'g..~..o.~~ .......................................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy vacant b. Intended use and occupancy one family, dwelling. 3. Nature of work (check which applicable): New BuibJm9 .....y,.~..~t¥ Repair .................. Removal ...... , ........... Demolition .................... Other Work .................................. . ,~' ............. .... (Descnp,on) o o0o + e ........................................................ 4. Estimated Cost ......................... ~....~ ........................... F e (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .(p..~.e. ................ Number of dwelling units on each floor ............................ If garage, number of cars ......... ...~.W..©. ........................................................................................................................ 6. If business, cornrnercial or mixed occupancy, spedfy nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Freest .......................... Rear ................................Depth .................... Height ........................ Number of Stories .............................................................................................................. Dimensions of same structure with allerations or c~dd~tioas: Front .................................... Rear ............................ Depth ................................Height ............................ Number of S~ories ................................ 8. Dimensions of entire new construction: Front ...... ~.8. ............... Rear ...... ~.~ ................. Depth .~.../.~ ......... Height .................... Number of Stories .....1.~ ....................................................................................................... 9. Size of lot: Front ..1..~.~ ................................................ I(cor. ......... ~.~.~ ......................... Depth ......... .1.2.~. ................ 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ...[!~.t.!...d.:~q.i~ ............................................................................... ]2. Does proposed construction via{ate any zoning Iow, ordinance or regulation: ................ .~.,.O. ................................... 13. Will lot be re-reded ........ ~...e.¢ ............. Will excess fill be removed from premises: ( ) Yes (%) No -- ~ ....... ~+1 Anderson Ave EngelI~pod Cliff N.J 1 4. Name of Owner of premises .~.~L~iO......Y. 70J~D.I~.~..O ............. Address ................................mane No ....................... Nome of Architect ........................................................... Address ................................Phone No ....................... Cornell Construction Cor~,, Southold ~4on~e of Contractor ..................................... t .................... ,~aclress ................................ Phone No ....................... PLOY DIAGRAM Locate clearly and distindly 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 end indicate whether interior or corner See Filed PLans STATE OF NEW YC~I~, ~ S S COUNTY OF ......... ~, .~. j...~..u...~..~.. ...... ..................... .~.~.,~.,......0.,O..~O.,],~k ............ ~,l~.~,fl~. ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Fie is the ................................ ~.~.i...]:.d..e...~. ............................................................................................................................... (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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .................... .2..~. day of ............... ..~..o...~. ..................... , 19.Z.6... Nolary Public,. ................ ~:~.,O. ,1. ~ .................. County (Signature of applicant) SUFI~. CO. DEPT. OF HF-AI..TH ~t[[~VlG"~ ,; , ' ~AT~NT OF INTENT · ¢0. DEPT. OF HEAL'/'H t :E. D; REF. The, sewage d~posai hnd water ~upply fertilities 2bt'this location have b~en inspected b~mthi~sid~Partm°nt and ffo~nd to ~be sat~Sf~eto~.~~ ~ Chi~e£ of General Eng ~,, : Services q 765-266g 9AM lO 4PM FOA ;~;-L' ED tNS?ECTff3NS: ,- -. 1, BEFO;,~ BACKFILLINGF " ' 3. F~N[~L %H~N JOB COMfL~TE~