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HomeMy WebLinkAbout11595-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.! 1 Q.6.7 .......... Date ....... .J.u.l.y.. 9 ................... 198.$. THIS CERTIFIES that the building ................................................ Tuckers Lane Location of Property . 9. .7 .5 ........................................ .~.o.~.!~. h. 9.I.d. ......... House No. Street Ham/et County Tax Map No. 1000 Section .. 0..5.9 ....... Block ..1..0 ........... Lot....0.1.3 ........... Subdivision ........ 1~ ...................... Filed Map No....X ..... Lot No..X ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated · .~i.a.r.c. 17~..~.~ .......... , 19 .g.~. pursuant to which Building Permit No...1.1.~.9. 5...g ............ dated ....}i.~. r. 9 .h..~. 9. ............... 19.8. ~., 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 ......... a one-car .eara,5o,. The certificate is issued to Nikola Kirlncic ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval n/a UNDERWRITERS CERTIFICATE NO. N 565533 Building Inspector Rev. 1/81 FOR~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 11595 Z Permission is hereby granted toil;. .. ..... ./..(~ ~ ~. ~' .~. ~.~..~ e...~~ ~ ~. ..... ~ .............. ~=~..~~- ~ .......... ..... ~~~....~.~.~ ....................... ~o ........ ~~.~ .~.~~ ~..~ ~.:~ ~....~ ......................... .................................................................................... ~~....~.=~c .............. ~t premises I~eted at ..~ ...... ~~....~~.; ...~ ............................................ ............................................................................................................ ~~~x....~.,~,.. co~ r~ ~op ~o. ~ooo s~t~o~ .~[~ ..... ~o~k ....... 2.~. ..... cot Uo...~/~ ......... Building Inspector. Fee $.Z.~... ............. .... / /,~u,,u, gm'"'""n-,r~ ,'--ec'or .... ; .......... Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department "" Town Hall 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 Inspec- tor with the f. ollowing; 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 installa- tions, 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph ic 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 informa- tion required to prepare/a 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 New Building ..... X. ....... Old or Pre"existing Building(X) ........... = fVacant Land - Location of Property .... ~,.~ .......... Tuo]~ez-te ~e S~tho~d Steer Hamlet Owner or Owners of Property ...~?~ County Tax Map No. 1000 Section ~9 Block ' 10 ~. . ........ .............................. Lot ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~ ..... Date of Permit . ~/~/~..Applicant .~.'.~ ~o~..~v~.~ ........ Health Dept. Approval . ........................ Labor Dept. Approval .,.. Unde~riters Approval ........................ Planning Board Approval .................. Request for Tempora~ Certificate ~ ..................... Final Ce~ificate ........ - ......... Fee Submitted $ ~00 Construction on above described building and p~[meets,all ap~cabl~odesgnd regulations, Applicant .~~ iooooel THE NEW YORK BOARD OF FIRE UNDERWRITERS  BUREAU OF ELECTRICITY June 16,19828s JOHN STREET, NEW YORK, N~V~/I~J_I~K_~O38 ~,ate ,~ppli~tio,,,~'o.o,~il~ N 565533 THIS CERTIFIES THAT o~l~ ~he ~lectc~l equiprrient asA~escrjbed belov~ and inty4~duc.e~ by~tl~e o. qpljcant named on the above application number in the premises of 1Ko£a ~:LrXrtC:LC, 'I-ucKe['B bane,~oul:ilokci~t~.~. in the/allowing location; [] Bas .....t [] ~st ri. [~ 2,d vi. garage Se,,tio, BIo,,~ tot was examined on Ju~e 7 ~ ~ ~2 and found to be in compliance with the requirements of this Board. ~L~ RECEPTACLE, SWTCHES 'INCANDESCENT FFLIu~TRE~E'NST ~:~:Y ' ~T"ANG~.t. 'C(~NG~E~KS' AMTOVE~.C 'DJI~WASK.%E."S' E~AUS' HF. tNS 3 3 3 3 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS ~PECIAL REC'PT T ME CLOCKS BELL UNIT HEATERS MULT-OUTLET [ D MMERS OTHER APPARATUS: T~is certificate m._. ,,xujt not bT~z.~s~,.xaltered in any manner; return to the office of the Board if incorrect. Inspectors may be i~,~ified by~helr crode~t' ~ V ' n~ia~s~st;~x~w~f~`a~N~/'~x~`~r~:~T~`~i~`~~~~~~ *~d COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. DATE COMMENTS ~DDITION~L COMMENTS: FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL Examined ...... , 19 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ......................................................................... .../ ............... APPLICATION FOR BUILDING PER,AlT ' INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate 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 ofproperty must be drawn on the diagram which is part of th s application. c. The work covered by th!s application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such pern~it shall be 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 Occupoi,cy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 buildings for necessary inspections. Ronnie's Home Improvements ......... ;"i,s gnature ......................... of applicant,* ...... ' ........ or name,'"'"'"';,f.a ....................... corporation)* ..... "' 6~. Jernick Lane ............................... ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. General Contractor Nome of owner, of premises Nikola Kirincic If applicant is a corporate, signature of duly authorized officer. Builder's License No .... .2.~?. .......................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Subdivision Location of land on which proposed work will be done. Mcp No.: ....... :': ............................... Lot No ......................... Street and Number 9T~. Tuckers Lane Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy One family dwelli~ b. Intended use and occupancy .."?...f&.;?.~'..'..,...L ..-:'.. f. ~ ' . ' County Tax Map No. Dist. 1000 Section ~9 Block 10 Lot i~ 3. Nature of work (check which applicable): New Building....~ ............. Addition .................. Alteration ................. Repair .................. Removal .................. Demolitior. .................... Other Work ' . .... (Description) 4. Estimated Cost .... .$. . . ~ ~.0. .0. ... .0. .0. ...................................... Fee ........ /..~.....~.. ..... f...~/..:. ................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .... ..O~...e. .................. Number of dwelling units on each floor ............................ If garage, number of cars O~e 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 ........J...h: ................. Depth ..... .;~..h. .............. Height ..... 9...~...~.? ...... Number of Stories .... ~.e~ ....................................................................................................... 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 ..... ~.k..o.~..~.~.~.a.,~.c. .................Address .e~5..~.U.C~l~Z~.~,.n___~_e Phone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor ..~..o..~..~.~..e...~.o..~.~.q ............................... Address I~./+~..~Taz'~c,~.Ln~ Phone No. ~5.':5~.~..2. ....... 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,,~OR~_,,,.- ~& ISS ............ · ..¥.-~.~..~..t..~.. .......... ~...v.l~..~.~.~-~.~-.t~. ................ being duly sworn, deposes and says thor he is the applican~ (Name of individuol signing contract0 above homed. He is the ....................................... ~ ....... ~ .................................................................................... ' X~ont~agent, corporate officer, etc.) ........................ of said owner or owners, and is duly au-fh'~ffzed to oerform or have performed the said work and to make and file this application; that all statements contained in th'is application are true to the best of his knowledge end belief; and thor the work will be performed in the manner set forth in the apl;~l~ation filed therewith. Sworn to before me this__/ ~ , .... ...... day of ............... ........ . No, Pub,c,. .............. : .......... Coun ........ ...................... ......... : NOTARY PUBLIC, State of New No. 52-8125850, Suffolk C~nty - .....xqlres March 30, ]9.~;~., \ . f FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No .......... ~ ............... · ..... .... PLEASE TAKE NOTICE that your application dated . .~..~...~.~ ...... ,19..~..O~.. Location of Property ~lou,e No. Strut Hmmlet Cou~y Tax'Map No. lO00 Section . .~..~.~'. ..... BloCk .. ~..~. ........ Lot (~./..~.. ........ Subdivision .... :~7~..-~ ........ Filed Map No ................. LOt No. -- -- is retum=d herewith and disapproved on the following .grounds ~~. ,,~e~ ......... " ·.u ,,.~..,..~-'~d~g'I::-':x:- ....... :' RV lj80 OlD & NEW CONSTRUCTION ~ ~'-~ CUSTOM HOMES ~ R J, MOR IZZO SOUTHIO LD. N.Y.