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Home My WebLink About26175-Z FOR14 NO. I TO~N OF SOUTHOLD BUILDING DEPARTNENT TOM HALL SOUTHOLD, N.Y. 1197 I TEL: 765-1802 ~.~mined ................. , 19 .... Di~ a/c .................................. ~7 ~: .... :"-~ .... ~ ~.1 '/ / ~i~; .......... BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FOI:~I ................... NOTIFY: C,,LL HAIL TO: .................... Date ................ , 19 .... a. This application ~a~at be c~npletely filled in by type~iter or in ink and auhnitted to che Pidlding Insl~ctor 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan shoaing location of lot and of buildings on premises, relationship to adjoining pranises or public streeta or areas, and giving a detailed description of layout of property ramt be dr~n on the diagram which is parc of chis application. c. The work covered by this application v~y not be ctxanenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Pemit to the applicant. Such permit shall be kept on ~ premises available for inspection thmuNb~t the work. e. NO building shall be occupied or used in ~hole or in part for any purpose ~daatever until a Certificate Occupancy shall have been granted by the Building I~tor. ai~ICXTlCtq Iff ~u~_~t ~ to the Building Depmn,ent for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the To~n of Sonthold, Suffolk Cotmry, ~ York, and other applicable La~s, Ordinasces or ltegulatiorm, for the coasrmction of buildings, additions or alterations, or for r,,,o~al or demolition, as herein described. Ibc applicant agrees to comply with all applicable la~s, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on prc~aises ~ in building for necessary inspections. (Signature of applicant, or nam, if a corporation) (l~ailing arlaress of applicant) State whecher ,~pplic_~t is oaner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ...~.~..5 ~..~-.~.'.~..~ ....................... : ................................................................. ~ o~ ~ o~ pr~ses ..~...?x ?...~X~....ki~Sk-%.....~.~..\.~..~ ............................................. (as on the tax roll or latest deed) If applican~ a corporation, signature of duly authorized officer. ....... (l~ae a~! title of corporate officer) Builders License No...k..~..lM.~O.[i.k ....... Plumbers License No .......................... Electricians License No ...................... Other Tr~ao's License NO ..................... I. Location of land on ~hich proposed ~ork will be done .............................................................. ...9,...q.'-.~. .................. ~..~.%%%~.. ............... ~9~.q.~q...9.k..~,%. ...................... Bouse llc~nber Street ltanl e t County Tax ~ NO. 100{3 Section ~.~ 3.%~.~... Block....~..: .':a:.~. hot ................ Subdivision ...................................... Filed l, iap No ................ Lot ............... 2. State existing use taxi occupancy_of?remises~ and intended~ and occupanc~ of proposed construction: a. ,~st',ng ~ ,~ oe~..'k5%..X.~%~. .... k..'?l~9......~';... .......... '..,.'..., ..... :.':;.. ............. ~,. ',,,,:~ ,~ ,~ o,=~-',~ ....%..b,..~...%.... ............................. '.' .......... : ...... : ........... ~ature of work (d~ck ~hid~ applicable): ~ l]uilding .......... Addition ..~ .... Alteration .......... l~ir ............ ~,. ~al ............. ~liti~ ............ Other ~ ..... ~~; ................ Estitmt~ ~st ......... f~ .............................................. ~ ~ ......... .~to ~ ~id ~ filing this If ~11i~, ~d~r Of ~11i~ traits ............ ~r o~ ~11ing ~its ~ e~ fl~r ................ If garage, ~r of ~rs ...................................... If I~i.~ , · - . / .. ,. ~ / )- .... ~ ~ ~ NO q . . mpth . ~k~... ~ ....... Dimensi~s of ~isCi~ st~m~s, ~ ~: t~c .... ~.~- ................... · ~ i~'~}'~'"it~ ~,h ~t~ti~ o~ ~itions: ~onC "~9"~'1 .... ~ar ............... DI~ · _ . ~ ~ ~;~ ~r of Stories ....~.,~ ...... , Diumnsi~ of entire ~ ~st~ti~: ~t ..~..~ ..... ~ar ..~ .... ~ ..... ~P~ -~' ~ ......... ,~, .............. =~..~.. ~ o~,,,o~ 5.~.~ ............... I ~5 ' Si~ of lot: ~t .~ ............. ~ ''~ ................ ~pth .................... ~te of ~dla~ .~ ........... ~ of Four ~r ........................................ ~ or ~ district in ~i~ pr~i~s a~ si~t~ ............................................... : .............. ~s pro~ ~t~ti~ violate a~ ~i~ 1~, o~i~e or re,latin: ........................ Will lot ~ ~ .................... will ~ss fill ~ r~ ~m ~s: ~ .............. ~ of ~ddt~t ~ress .............................. .................................... ~ of ~tr~tor ........ · Is ~is p~r~flfin ~ f~t of a ti~l~tl~? *~ .......... ~ "[~ .... PLOT DIAGRAM I~cate clearly and distinctly all buildings, ~laether existing or proposed, and indicate all set-back dimensions property lines. Give street and block r~r or description according to deed, and show street nares and indicate lmtlmr interior or corner lot. :~...~.~.~,~-L.-.~...Y. ................... ,~ ~,ly ~,~J, ~-~ ~ ~y~ ~*~ h~ i~ ~ ~n~[. ..~~ ~ - ~ . ~ of i,~ivi~l signi,g c~tract) ~e ~, ~ i ~ ~,,e .. ~. ;'~. ~~-~ .................................................................... (~tractor, ~ent, cor~rate officer, etc.) f ~id ~r or ~rs, ~ is ~ly ~thori~ to ~rfom or h~ ~rfo~ ~ ~id ~ ~ to ~ ~ file this ~licati~; ~at all statements cmtai~ in ~is a~licat[~ are t~ to d~e ~st of his ~t~ ar~ ~lief~ a~ hat the ~ will ~ ~rfo~ in tim ~mmr ~t forth in ~e a~licatim fil~ t~- (Signature of Appticant)