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Home My WebLink About25936-Z1999 FORH NO. TONN OF SQUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1197! TEL: 765-1802 ~.~,nined ................. , 19 .... A r ed ..... ...... , Pe t NO ................. Disapproved a/c .................................. (Building Inspect) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF BEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORM ~ .................. NOTIFY: PAIL TO: .................... Date ................ ,19 .... a. 'Ibis a~plication rmrqt be c~pletely filled in by typooriter or in ink and suhnitted to the Building Inspector ~i 3 sets of plans, accurate plot plan to scale. Fee according to seheduIe. b. Plot plan i~5owing location of lot and of buildings on premises, relationship to adjoining pronises or public streets or areas, and giving a detailed description of layout of property unst be dr~an on the dingran dnich is part of this application. c. qa~e ~ork covered by this application may not be co,nenced 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 the premises available for inspection throusJ~t the ~)rk. 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. APPLICATIC~I IS ~ PAtE to tho Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the To~n of Sonthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulatioc~s, for the construction of buildings, additions or alterations, or for r~oval or demolition, as herein described. The applicant agrees to o:,,-.,ly with all applicable laws, ordinances, building code, honsing code, and regulations, and to ~tmit ~athorized inspectors on pr~nlses and in building for necessary inspections. (Signature of applicant, or [la~e, if a corporation) (Mailing address of applicant) State ~ether apphcant is a~er, les~s~e~ .age~..~,~ar~chxtect, engineer, general coutractor, electrician, plmber or builder ~ _ .... ~":. .~-.=..--...,-..------'., :i2'2 ..... .'i'~'~J-~,~~;q! .................................. If applicant is a corporation, signature of duly authorized officer. (Nam and title of corporate officer) Builders License No .......................... Plumbers License No .......................... Electricians License No ...................... Other Tr~lo's License NO ..................... I. Location of land on which proposed ~rk will be done .............................................................. ....L. ............................... .$..¢. ....................... House Number Street Hmalet c ty ,ooo s t on ....O. 6..q ,io .0.3. i,,t q 2. State existing use and occupancy of premises and into_~ioO use and oc~ of proposed construction: a. Existing use and occupancy .............. ¢ ............ lh"o¥ iqe~; ~6 ~? ¢%¢, .~ ~.,',, :;w 'f ¢¢R?~ .......... b. Iute~A~a nse and occupancy ...... ]. -R~ture of ~ork (d~k ~id~ applicable): Ne~ I~ilding .......... /~ldition .......... M~eral;ion Repair ............ l~a~val ............. Demolition ............ Otl~r ~. Esti~mt~ ~st ~O0 ~ ~ripti~) .(to ~ ~id m fili~ this a~li~tim) i. If ~lli~, ~r of ~lli~ ~mits .... ~ ....... ~r of ~lling ~its m e~ flmr ...... ~. ......... If ~r~e, ~r of ~rs ~.~. L If ~i~ss, ~mercial or ~ ~, ~i~ ~ture ~ ~tent o~ ead~ ~ of ~...~ .............. tbiO~t ......................... ~r o[ Stories ....... Di~i~ of ~ st~e ~th alteratlms or ~itions: ~mt ..... ~pth ..... ~ J .......... ~i~t .................... ~r o~ Stories ..... ~ ....... ' ............ Bi~nsi~ of entire ~ ~st~tim: ~t . ~ lbi~t ......................... ~r of Stories ...... ~ ............ L Si~ of lot: ~t ........... ~ar - -, [ ............................. ~pm .................... I0. ~te of ~dm~ ..... ~t~. ........ ~ of Po~r ~r ........ ~1. ~ or ~ district in ~i~ p~i~s a~ si~t~ 12. ~s ~o~ ~t~ti~ violate a~ ~i~ 1~, oMi~e or re~latim: 13. ~ill lot ~ ~ ....... ~.0. ......... ~ill ~ss fill 14. ~s of ~r of ~s ........................... ~ress ~ of ~ddt~t .................................... ~ress ~ of ~tr~tor ................................... ~ress ............................... ~ ~ ............... 15. Is fids p~r~ ~fldn ~ f~t of a ti&l ~tl~? * PLOT DIAGRAH locate clearly and distinctly all buildings, ~ohetimr existing or proposed, and indicate all set-back dlmmsions Prc~ property lines. Give street and block r,~ber or description according to deed, and ~ street nares and .indicate ~mtber interior or corner lot. UHDEm~ITEII~ eERTIFICATE OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY ... g -) A, PPRqVED AS NOTED DATE: _~l' w_~ B.P. ~ FEe: 5-~~-- BY: NOTIFY BUILDING DLe~ARTrv~NT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1 FOUNDATION - TWO REQUIRED ------~. FOR POURED CONCRETE ~ -= .... -~"-- z .OUCH. F.Am~NG & ~LOUmNG /' "IMMEDIATELY". ~ s ~nsuu~t~on { ~llO01-'lO~ ~ 4: FINAL - CONS'RUCTION MUST ~,, ~1~31~~ '~ BE COMPLETE FOR C.O. ~ ~OR~'II~'~R~ /ALL CONSTRUCTION SHALL MEET "~, · ~ THE REQUIREMENTS OF THE NY. ~ ' ~ ~ STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS duly s~orn, deposes and says that he is the applicant is the (Contractor, agent, corporate officer, etc.) said owner or o~ners, and is duly authori~t to ~rfom or h~ ~rfo~ H~ ~id ~ m~ Lo m~ ~ file this ~licati~g ~at all stat~nts cmta[~ in ~[s a~licati~ are t~ to ~e ~st of his ~1~ a~ ~l. ief~ a~ Lllat the ~ will ~ ~rfo~ in tim ~m~r ~t forth in H~e a~l. icati~ fil~ t~. __ _ ?~LIZABEI'H A STA THIS L~3~'_ ARY _P_U_BUC. State of Nee N~-_01ST_6008173, Suffolk Coun~ :.....-~----=. (Signature of ^pplicant)