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Home My WebLink About10369-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PltEMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10369 Z Building Inspector. Fee $..~...~..~.....~.. ..... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY t 61986 BLDG. OEP'L TOWN OF ~OU"'k~O[D Instructions A. This application must be filled in typewriter OR ink, and submitted ~ ~ to the Building Inspec- tor 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 featu res. 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 p~:operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 p?e-e~i~ting dwelling ' $[5.00 3. Copy of certificate of occupancy $1.00 4.Vacan~a Land C.O. $5.00 5. Updated C.O. $15.0 0 Date...~/./.~'vd'~J>~,~ ............. New Cons tpuction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ., ' .~:(..? ........................................... House No. Street Ham/et Owner or Owners of Property .../.~./*J~,/,~. ~ ~.T..,Z..~./. ,,~9./~'~/~?,,-,~, ...... County Tax Map No. 1000 Section .. ?. ~ .? ...... Block ... ~ .~ ........ Lot ..... ~ .~ .... Subdivision ................................. Filed Map No ........... Lot No .............. /; Permit No.. , ate of Permit .... pphcant .................................. Health Dept. Approval ........................ 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 applicable codes and regulations. Rev. 10-10-78 Ai) DITIOt, JAL TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOI~. TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 August 12, 1980 William Konkel 740~ Main Road Laurel, N.Y. Dear Mr. Konkel: : This is to advise you that the job under Building Permit No. 10369Z issued to W. Konkel on . August 28, 1979for chimney . "' appears to be completed as o£ our last inspection. Before you can legally use or occupy this structure a Certificate of Occupancy must be issued. Please fill out the enclosed form and return same to the above office. There is a fee of $5.00 for a Certificate of Occupancy Thank you for your prompt attention. Very truly yours, GEORGE H. FISHER Sr. Building Inspector enol. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 . . ~ Examined . ..~< ~..., 19 . .... Approved ....... , lP. Permit No .... ~.~.... Disapproved a/~ ..... -:-~..~:......--~-'~-----------~. ....... ~ .......... / ..~. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. 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 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 issue a Building Permit to the applicant. Such permit 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 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 buildings for necessary inspections. . , (Signature of applicant, or name, if a corporaBon) ..... ' .....' i~laili~ ~;e'ss of applicant) ~ State whether applicant ~s~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... .~.'.c..~...~. ............. Plumber's License No ......................... Electrician's License No ...................... 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 ... ~ .~..Z.. .......... Block ...O..~. ............ Lot..~..~.2'._ ............. Subdivision .................................... Filed Map No ............... Lot ............... (Name) 2. State exishng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ~.~. · .~.~/~!.l'.-~. 7" · ~"~'~['' "~' '~"'~' · '~' · ............................. .5. ?. / . ..¢..-, .c,, ,, b. Intended u~e and occupancy . , I~N~7 ......... 3. Nature of work (check which aplSlicable): New Building .......... Addition .......... Altera~,on,,~,~ ......... Repair .............. Remoyal .............. Demolition .............. Other Work .LT~i 4. Estimated Cost Fee ........................... i ; (to be paid on filing this application) 5. If dwelling, number of dwelling hnits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... ~ .................................................................. 6. If business, commercial or mixedi occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, 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 o~ use district in which premises are situated ................................. .) ................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... //-,J.~ ................. 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 ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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. ~ ~] 8TATL OF NEW/YO~ j,~ '~ ~ --, being duly sworn, deposes and says that he is the applicant (Name of individual sigmng contract) above named. He is the ...................... : ................................................................... ~ (Contractor, agent, corporate officer, etc.) d ' of said owner or owners, and is uly 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 mannei set forth in the application filed therewith. Sworn to before me this ............ ..... ....... jUD ' '- -I Ne~ york ~ ~Ol~ai'Y public, S'{ate o ................. , ~9~ suffolk coun_tY~ (Signature of applicant) NO, 52-0~ .' ~arch 30, ~-~ [ CornmSssler~ E:xpl~es ,"