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Home My WebLink About10400-z ]FOI~M NO. 2 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 10400 Z Permission is hereby granted to: , .../~...~.~ ................... ¢ ...... :.~ ....... ..~ .......... (z ........ ~ ...... ¢..~ .......... o, premises ,oco~ o, ~~....~..~ :...~ ........ pursuant to application dated ....... /..~ ............ , 19. and approved by the Building Inspector. Fee $..../~..,.T. ......... / Building Inspector FORM NO. 6 TOWN OF $OUTHOLD 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 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 property 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 buildin~gs. 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/' $ :15.0 0 3. Copy of certificate of occupancy $1.00 / 4oVacant Land C.O. $5.00 Date ....... .ApF.i.1' .2.9,..1.9.8.5 ..... New Building .... ~ ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property 3595 ,~eebe D.~ive Cutchoc~ue House No. Street Ham/et Owner or Owners of Property .... .H.e.r,b?.r.t..T:..0.o.n,k.l.i.n, .a .n .d . .F .r .a .n .c ? ,s , ,E:, .C.o,n,k,l,i,n,,, ,h,i,s. ,w.i.f.e ..... County Tax Map No. 1000 Section ...... ,1.0,3:,0.0... Block ...o. 9...o. 0. .......Lot .... .0.1,0;.0.0.0 ..... Subd,vision ......... ~ .............. ~/~[~..Filed Map No ........... Lot No .............. Permit No... ,1.0.4.0.0..Z. Date of Permit . ,9./.1.217.9..Applicant . .R.i.c.h.a.r.d, .J....C,r.o.n.: .a.s..a.t.t.¥; ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted $, . . .5.-QQ ...................... Construction on above described building and p3~m¢t~r~a~/p~ic~le~:Je~t'--~ns. Rev. 10-10-78 =i I FOBM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exommed ...~ ................... , Approved ,~.....J...~...~.,'. ............ , 17.~...~... Permit No..~.~......~'...~.'...C~..~, .... Disapproved a/c ................. ::~.~ .............................................. ..~/. ................. App, ica,on No. ZL'~.~.~ ............ APPLICATION FOR BUILDING PERMIT Date ..... INSTRUCTION$ a This application must be completely filled in by typewriter o¢ in in,k and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat plan to ~cale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets at areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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. .................... .... (Address of appl~'~'~l~ ......... ~,-... If applicant is a corporate, signature of duly authorized officer. (Name and title of corpor~r) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade s License No ............................................... Location of land on which proposed work wi~ be done, Map N : .................... ~ ........ ~.... Lo~ No..~ ................... Street and Numbe~4T....~...~...(~.~....J).~/~ ............. State existing use and occupancy of premises and imended use and occupancy of propped construction: ......... ................................................................ ..d ..... ............................ I[/ 3. Nature of work (check which a'pplicab[e): New Building .................. Addition ...... ........ AIteration_,...~ ........ ., Repal~ .................. Removal Demolition ................... Other Wa rk .~...L. i~....~... ,,,/~../,,~. -'~. .... (De~crlption) :7.. '- !''' " 4. Estimated Cost ....................... ; .................................... Fee ................. '...~..'.~ .................................................. (to be paid on filing this application) 5, If dwelling, number of dwellin~ units ..... ~ ......... Number of dwelling un,ts on each floor ............................ If garage, number of c~rs ....... ~ .............................. ., ........................................................... .,....; ............ ; .................... ,.., 6. If business, commercial or mixed occupancy, specify nature and e~tent of each type of use~: ....................... 7, Dimensions of ex~sting structures, if any: Front ............................ Rear ................................ Deptl~ .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure [with alterations or a~d~tions: Front .................................... Rear ......................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............ '.'. ....... Rear ........... Depth ........... Height ................ Number ]of Stories ..~J ................................................................................... ~ ...... ,~. 9 Size of lot: Front ........ /..~ ................................. Rear ..... ~ ................................. Depth ,Z~2..,.Z~ ..... Date of Purchase .................. J ..................................... N~me of Former Qwner ........................................................ 1 I. Zone or use district in which ~remises are situated ....... ~Z~~ ........... ~ .................................. 12. Does'proposed construction violate any zoning law, ordinance or regulation: ......... ~.~ .................................. 13. Will lot be regraded. .......... ,. , ~z/, ~ -Z~~' ........ Will excess fill be r~moved from prem,ses:( ) Yes ~No 14. Name of Owner of premises~.~~.~.~/~ress Phone No. Name of Architect ........... ~.S. ........................................... Address ............................... Phone No ....................... Name of Contractor .~¢~ ................. Address ~'~Z,. Phone No. ~~ ~ ~-- PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ar proposed, and indicate all set-~ck dimensions from property lines. Give street and bl~ck number or description according to deed, and show street names and indicate whelher interior or corner lot ~~ STATE OF NE (N,me o~ mdividu*l sion~n~ contr~cf) '~ ' ' o'bove named. __ ~ /' ~ ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dbly authorized to perform or have p¢rformed the said work ~nd to make and file this application; that aH statements contained in this applicatiqn qr~ true to the best of ~nowledge and belief; and tha~ the work will be performed in,the manner set forth in ~he application fil~jt~wi~ ~, ~ ~ ~ _ Sworn to before me this NOTARY PUBLIC, ~t~te ~t N~w York le~ E~res March ~, 19,~ I