The URL can be used to link to this page

Home My WebLink About25722-Z~ TOW~ O~ ~S[/rJiOL~ FORH 80. I T0~18 OF SOUTHOLD BUILDING DEPARTMENT TO~8 HALL SOUTHOLU, N.Y. 1197 I TEL: 765-1802 ................. Diqupp~ oved a/c .................................. - '"'i iiii ' APPLICATION FOR BUILDING PEP. MIT BOARD OF REALTB ............... 3 SETS OF PLANS ......... ' ...... SURLY ........................ CHECK ......................... SEPTIC FORH ................... NOTIFY: CALL HAIL TO: .................... Date ................ ,19 .... INSTRUCTIONS a. lhis application -,mt be mmpletely filled in b~ t~3evriter or in ink and anl~titted to the Building Inspector vitt 3 sets of plsns, accurate plot plan to scale. Fee according to smSe~le. b. Plot plun ab~aing location of lot and of lmildings on pr~mlses, relatior~ip to adjoining praises or public streets or ar~-% and giving a detailed deacriptino of laynot of property mist be dr~m no the diagran ~hich is part of this application. c. ~ ~ork covered !~/ this applicatino may not be cu,,*aced before isst~mce of Building Permit. d. Upno ~,~,/al of this a~lication, the Building Inspector ~ill ia a Building Pemit to the applicant. Such pemit ~'mll be kept no ~ premises available f. or inspection throt~anot the york. e. lto building stroll be oc~zpied or used in ~ole or in part for any purpose vbatever notil a Certificate o[ APPLICATKIt IS ~ ~ to the Building r~p~;.~,,t for the issuance of a Building Permit pursuit to the l~,ilding Z(me Or~inm~ce of ti~ To~ of htimld, Suffolk Cno~LT, Ney York, and other applicable ]La~s, Ordinm~ces'or P~l~lati(ms, for tim const-mctino of buildings, ~iti(xts or alteratinos, or for ~-,~val or &~olitino, as herein described, llm ~pplieunt a~,~es to ~.,:,ly vith all ~li¢~hle la~, ordinals, building code, tx~Jsing code, and regulations, and to u~mlt anthorized inepectors no pr~mlse, and in buildf? ~s~ inspectinos. (Signature 9f applicant, or na~, if~ corpor, atino) ..~'. .... ' .a/'~...t~/..'-~.. g ~. a 1~..~.. d .... ~ ,.~.~- ,.' ........ /~... (l~ailing ~m-ess of ~hmmt) /[ ~'_~ s State vhether applicant is Omer, lessee, agent, amSitact, engineer,' general contractor, electrician, plmber or builder. (as m the tax roll or latest &eed) If applimt is a corporation, signutore of daly authorized officer. and title of corporate officer) Electrici~-s License No ...................... I. tocatim of land ~n ~hich proposed york vi11 be done ~ ~ c~ 0 House l~her Street ~e,~ et m. tino .... /..0.3. .... .... Y.. ......... ........ Subdivision ...................................... Filed ~ No ................ l~t ............... (~) 2. State oxlsting use and oceupane7 o~ $?~-ses and into~-cl use and a. F.x/sting use ~ ac~ .marcy ..... ].~ .~. ~. L .~ .~./V.~. .~. ........ ~: ~4% ',' ,:" ,'~ ~,f~:,' ~ ~ '" ~ ,' ,~:~ ............... I! b. ~r~ed use ~ m~ ............................................................................. 3. I~ture of ~ork (check ~hid~ applic~hle): ~ Building .......... Addition .......... ~terati ~ir ............ ~1 ............. ~liti~ ............ O~r ~ .................. (~ri~i~) 5. If ~lli~, mr of ~lli~ mit~ :¢...~ ..... ~r of ~lliq mits m e~ flmr ...~.. ~f ~, ~r o~ ~rs ........ ~..~ ...................... 6. If ~imss, ~:-',,~rcial or ~ ~, ~i~ m~e ~ ~tent of e~ ~ of m...~ ......... .~ ....... 7. Di~i~ of ~sci~ s~s, if ~t...~.q ........ ~ar ...~ .......... ~pth ~(.~.~... D~i~ of ~ st~ ~th alterati~ or ~iti~: ~ ...~.. ~ar ~ ~Pth .................... ~i~t .................... ~r of ~tories ............... 8. Di~i~ of enti~ ~ ~t~tim: ~t ~.~ ...... ~ar ............... ~p~ .............. t~i~ ......................... ~r of Stories ..................... O. Si~ of lot- ha,t ~ /} ~ [ ~ ~ ~ ~, /'~ ' "7 .............................. ~.. ~pm ...~. ............... ,0. ~o~ .... ~ ....... ~o,,o~r~r .~aC.Z...~.~.*.~.~ ........... I I. ~ or ~ district in ~i~ p~i~s am si~t~ . .'~ J. (~.~ :{. ~.~ ....................... 12. ~s ~o~ mt~tim violate ~ ~iq 1~, o~i~e or ~latim: . ./~ ................ I]. ~ill lot ~ ~ ...~. ..... .~ .... ~ill ms~ fill ~ ~ h~ ~s: ~ o, .............. .............. ~ of ~tr~tor ................................... ~resa ............................... ~ ~ ............... 15. Is ~is pr~~in ~ f~t of a ti~l~tl~? *~ .......... ~ .~ ..... PLOT DIAG~ I~ate cle~ly ~ disti~tly all ~ildi~, ~r ~isti~ or ptu~, ~ i~imte all ~t~ h'ou ~r~ li~s. Gi~ st~t ~ bl~ ~r or ~ripti~ ~co~i~ to ~, ~ ~ st~t ~s ~ i~imte ~r interior or m~r lot. .......................................................... being duly s~rn, deposes and says that he is tl~ applicant (lq~ne of individual signing contract) above n~d, Ile is the ................................................................................................... (Contractor, ngent, corporate officer, etc.) of said {~er or o~ers, and is duly authorized to perform or have porforn~l the said ~ork and to make and file this application; that all state~nts contained in this application ara true to the best of his knowledge and beliefl and that the wrk will be perfon~l in tl~ manner set forth in the application filed there~th. .9~rn to before me this ...... / .......... day ..... ,9..a! Notary Public d N~, ~I. IZ. ABE~ A ~rA~l.l~ ;a, Ry PUBLIC, ~late No.~l $T6008173, Suffolk Cou~tv em~ Expires June 8, 2020 (Signature of Applicant)