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Home My WebLink About25698-Z -FORI~ NO. 1 TONN OF SOUTHOLD BUILDING DEPARTHENT TO~i P~,LL SOUTHOLD, N.Y. 1197 ! TEL: 765-1802 Disat4,,,.,,tad a/c ................................ .. BOARD OF HEALTH ............... 3 SETS OF PLANS ......... ...... SURVEY ........................ CHECK ......................... SEPTIC FORH ................... NOTIFY: CALL .................. ttAIL TO: .................... APPLICATION FOR BUILDING PEP, HIT INSTRUCTIONS a. This ~vlication mint be cu~letely filled in by typewriter or in ink and sul~ittad to the Building Inspector ~ 3 sets of plans, accurate plot plan to scale. Fee ~ording to schedule. b. Plot plan shas4ng location of lot md of buildings on p,~..ises, relationship to adjoining pr~nlses or public streets or areas, n~d ~iving a detailed description of la. ut of pt-ope,'ty mint be dra~ on the diagram vhich is part of this ~lication. c. The ~ covered by this application my not be ca,,,,,:nced before issuance of Building Permit. d. Upon ~,o~al of this =wlication, the Building Inspector vi11 issue a Building Permit to the applicant. Such pamit shall be.kept on the premises available ~or inspection throughout tt~ york. e. No building shall be oc~ied or used in vt~ole or in part for any purpose ~atever until a Certificate of ~_.ICATI~I IS ~ ~ to the Building ~,~...M,t for the issuance of a Building Permit pursuant to the Building Zooe Ordln~ce of tl~ Tcsm of S~uthold, Saffolk County, New York, and other al~pli~-ahle La~s, Ordim~ces'or Rngulations, for the construction of buildings, ~4ditions or al£erations, or for t~t,eal or d~mlition, as herein a~-~cribad. The ~plicant agrees to ,v?ly vith all =~vlieahle la~, ordinances, building code, housing code, and regulations, and to atilt mthorizad inspectors on praises and in building for necessary inspections. (Sigtmt-u~ of t~plicant, or m. if a corporation) OIMling ~h'~ss of .~i,lieant) ~ · State ~ether .~.~licant is mr, le~, iteet, c~in~r, 8~t~ral contractor, electrician, plmt~er or build~ .- o, ,,~r o, ~.~ses ~..~.,rrx....~...,e/x... ~e..,~...,.~ .... ~.. ................................................ (as on the tax roll or latest deed) If appli¢~t is a cotp~ti~, sigrmture of chly anthorized officer. .... .............. (l, lg~ and titl~of oa.y.,~a~e officer) ~leetrici~s Licease No ...................... Other Tr~o~s License No ..................... ..~ ........................................... ."t$5,~.Oz.a..~ ; O_~..~.~ .................................... ltouse 1~ ~her St~c~t / ~l~alet County Tax l~p No. i000 .Section .... .~0. ........ Block ....~. .......... Lo; ..~. ..... .-:..~ ...................................... nI,~ ~,,, No. Z../z...Z. .... ,~, ...7. .......... (~.~) 2. State existing use and oca.ma,~ of praises and inton~ use and occupan~ of proposed construction: a. F. xisting use ~,~ occupm~ ........... ~ ....... -ff'~-'~'~~,;: :i'-: .~.r..[ ......... : ........... .... ~/ u/u,,z s,,v~/'"',4'*',~/ r'~,~Jo- ' b. Int~l use ~a occupancy ....... / ...................... .(~l .....,f . . ; .................. 3. K~t,re of ~ork (check ~hid~ applicable): Ne~ Building .... .~.... t~dition .......... ~terati~ . ' ~ir ............ ~1 ............. ~liti~ ............ Otber ~ .................................. ~ ~ ~ripti~) ~. ~sti,~t~ ~st..~.~. ~:~.~ ....... f~ .............................................. (to ~ ~id ~ fili~ this a~li~ti~) 5. If ~lli~, ~r of ~lllq ~its ....~ ...... ~r of ~lllq ~its ~ e~ fl~r ................ 6. If ~i~ss, ~rcial or ~ ~, ~i~ ~e ~ ~tent of e~ ~ of ~ ...................... ?. Di~nsi~s of ~isti~ st~s, if ~: ff~t ................ ~ ............... ~pth ................. I~i~t ......................... ,. ~r of Storles ...................... Di~i~ of ~ st~e ~th alterati~ or ~iti~s: ~t ............... ~ar ............... ~pth .................... ~i~t .................... ~r of Stories ............... ~.~i~i~ o~ ~.d~ ~ ~~: ~ .... ~/.~ ....... ~ .... ~/,~ ..... ~p~ .... .~77/. .... }~i~t .......... [.~ ........... ~r of Stories ..................... 9. Si~ of lot: ~t .................... ~ .................... ~pth ............... ..... lO. ~te of ~dm~ ..................... ~ of Four ~r ........................................ I I. ~ or ~ district in ~i~ p~i~s a~ s~mt~ .............................................................. 12. ~s ~o~ ~t~tim violate ~ ~iq 1~, o~i~ or ~latim: ........................ ~3. ~ill lot ~ ~ .................... ~ill ~ fill ~ '~,~ ~ ~s: ~ ~ 14. ~s of ~r of ~s ' ~ress .............................. ~ ~ .............. .................................. ~se ......................... ~ ~ .............. ~ o~ ~o~ .~.~q~ ......... ~ ~.~. ...... ~ ....... ~ ~ ........... 15. Is this p~o~ ~in ~ f~t of a till ~tl~ * ~ .......... ~ .......... PLOT DIAGRAH I~cate clearly and distiactly all I~ildings, ~ether existing or ~, ~ i~i~te ~1 ~t~ di~i~ ~ p~r~ li~s. Gi~ s~t ~ bl~ ~r or &~ripti~ ~i~ to ~, ~ ~ st~t ~s ~ i~i~te ~r interior or ~r lo~. ........................................................ duly s~m, deposes and says that he is tim applicant (l~e of individual signi[~g contract) (Contractor, ~nt, corporate officer, etc.) said o,~er or o, mers, ~d is duly ~uthorised to perform or hav~ perforu~l the said ~rk and to m~e and file this ~pplication; that all stst~rents contained in this ~PPlicatlon are true to the best of his knowledge ~nd beliefi and ~hat the ~)rk will be performed in ti~ menner set forth in the applicatioa filed there~th. ~m to before me this ELIZABETH A STATHIS NOTARY PUaUC, State of New No. ~01 ST6008173, Suffolk _C o u_u_u_u_u_u_u_u_u_~t y term ~xoires June 8.20~~o (Signature of ^pptic~t)