HomeMy WebLinkAbout25707-Z FOlm NO. I
TO~I OF SOUTBOLD
BUILDING DEPARTNENT
TO~/N gALL
SOUTBOLD, N.Y. 11971
TEL: 765-1802
19.~-~" ~emit No ...........
Dis~uw '~ed a/c ................................ . ·
APPLICATION FOR BUILDING PRRHIT
INSTRUCTIONS
BOARD OF BEALTB ...............
3 SETS OF PLANS ......... ' ......
SURVEY ........................ '
CBECX .........................
SEPTIC FORH ...................
HAIL TO: ....................
'Date., .............. ,19 ....
a. This applicatim ,~mt be completely filled ~ ~ ~iter or in i~ ~ s~itC~ to ~ ~ildi~ ~cor ~
3 ~Cs of pl~, ~ plot p~ W ~le. F~ ~i~ W ~e.
b. ~oC-plm ~ l~aC~ of lot ~ of ~ld!~ m ~, ~lati~ip W ~join~ p~i~ or ~lic
sC~ts or ~s, ~ 8i~ a ~1~ ~im of l~t of p~ mint ~ &~ m ~ di~ ~i~ is ~rt of
'~is ~li~tim.
c. ~ ~ ~ ~ ~is ~li~tim my mt ~ ~..~ ~fo~ i~ of ~iMi~ ~t.
d. ~ ~ of ~ts ~i~tim, ~ ~i1~ ~tor ~11 i~ a ~ldi~ ~t to ~ ~lic~t.
~t ~1 ~.~ m ~ ~'~s ~le ~r i~tim ~t ~ ~.
e. ~ ~ldi~ ~1 ~ ~ ~ ~ in ~le ~ in ~ ~r ~ ~ ~t~r ~til a ~rtifi~te of
~ffi ~ ~ ~ w ~ ~!ldi~ ~t for ~ ia~ of a ~!ldi~ ~mlt ~t to t~
~ldi~ ~ ~i~ of ~ ~ of ~ld, ~lk ~, ~ Yo~, ~ o~r ~lt~le ~, ~i~s or
~ati~, ~ ~ ~tim of ~]gir~i~ ~iti~ ~ ~ti~, or ~ ~ ~ ~liti~, ~ ~in
~ri~. ~ ~i~t ~a ~ ~y ~ ~1 ~li~hle 1~, o~i~, ~ldi~ ~, ~i~ ~, ~
~ati~, ~ ~ ~it ~~ ~ m ~ ~ in ~ldi~ ~r ~~ti~.
......................
(Si~ of ~1i~, or ~, if a ~tim)
~ili~ ~ of ~li~t)
S~te ~r ~li~t is ~ ie~, ~t, m~hi~t, ~i~r, ~r~ ~t~tor, el~trici~, pl~r or ~i1~
...........................................................................................................
...... .................................
(~ m ~ ~ ~11 or ~t~t
If ~lic~t is a ~ti~ si~ of ~,ly m~i~ offi~r.
(~ ~ title of ~m off~)
Electrici~-~ Lio~ Nm ......................
Other l~'s Lion-me No .....................
I. h~atim of l~ en ~zich ~ Mdt rill be dine ..............................................................
............................. ...............................
~ho¥ ~l~liee~i~'5 0 q ~IATOI~ SL-geet ~1 et
~~~ ~tim .... ,~.~ ........................ ~ ....... ~--
~~ ,. , , '
~,~ ~fl~c~.~.~!~.~..~. ~ ~..~$ ...... ~, .~ ..........
a. ~,~-- ~~ ,..l.~mil~,..~,.~[h~ .........................................
~. ~_ ~ ~ ....~ra~.~... ~ ...........................
3. ~ture o~ ~ork (check ~hid~ spplb'~51e): Ne~ Building .......... /~ldition .......... Alteration ..........
Repair ............ P~,._~al ............. P~o~,l ition ............ Other ~ork .............................. ~':..
4. Esti,nted Cost - fee o .
(to be paid on filing this 8ppliemtloo)
5. If d~elling, runber of d~elllng_l.units ............ llm~r of d~lling units on e~ch floor ............
If garage, n~ber of car8 ..
. !
6. If bu~Iness, r-....,=rclal or m~KI occupancy, s~ecify nnture_3nd extent of em:h t-y~e of use .....................
Ileight .. ~. ~..I/..~. ~ l~ber of Stories
l~prn . --~-4~--.-~'~-'- ....... Beight .................... Nmi)er of Stories ..... [ ......... ' ~" ' 'j~ .....
,,i~t .../.~../.~....~.~,. ...... ~r of Stories ...~ . ,
· ;~ · z - '"i ............
II. Zooeorusedistrlct inMIich premlsesareslbJated I .~it~
....... · ~ ......................... ,~ ................
12. Does i, iol~d construction violate 8ny zoning la% ordinance or regulation: ~ ................
,~. ~l. ~ot be ~ ...... ~.:.0....: .... .. ~ill ~ss fin be
....... ~,~.. .
~me of Architect
.................................... /~ldress .............................. Phone No ..............
~ of Contractor ..... ~ .... J~ldr~
15. Is ~his property vi~hin 300 feet ota ti&l ~,~tland? * ~ .......... tO ..........
PLOT
I~cate clearly 8nd distinctly all buildings, Tabefl~er existing or ~i-opoMd, 8nd indicste rill ~et-bnck dimensions
Prc~ p~er~y lines, give street ~nd block r~her or de~oription according to ~'c~, m~d ~ street names and indicate
~ether interior or co~er lot.
~FAiIE OF EI~ YOfIK,
I~ js the ......... ~ ...............................
(~t~tor, ~nt, ~te offi~r, etc.) ......................................
of ~id ~r or ~rs, ~ is ~ly ~t~rl~ to ~rfom or hm ~r~ fl~ ~id ~ ~ to m~ ~ file this
a~licati~; ~t all stat~,~ts ~tai~ in ~is a~'llcati~ n~ t~ to ~'~s~ of his ~1~ ~ ~liefl ~
that ~ ~ viii ~ ~r~ in tim ~r ~t f~r~ ~ ~e ~li~ti~ fil~ ~.
~m to ~o~ ~ ~is L~ ~. ~0~
................... ~ay ot ..~:~1 ........ 19 // ~.01~
...: ...................... .....
L[ ) "a
CO UK"TY N.Y.
St~JRVE'YING P.C.
BOX 377
JAM..ESPO~T, L.I.. N.Y. I