HomeMy WebLinkAbout25704-Z -FORH NO. I
TOglq OF SOUTBOLD
BUILDING DEPARTI~NT
~ !~1.1.
SOUTHOLD, lq. Y. ! ! 97 !
TEL: 765-1802
CHECK .........................
SEPTIC FOI~ ...................
NOTIFY:
CALL ..................
IqAIL TO: ....................
-- tOC' :!Iil APPLICATION FOR BUILDING PERHIT
* -- -r.~,~-.'~?P-'--iT. -- INSTRUCTIONS ..... ] 9 ....
l TOWN QF SOUTHOLo
a. This applicatiou --t ~e c~letely filled in b~ tTpa~riter or in ink and su~itted to the Buitdir~ Inspector u
3 sets of pl~, ~-,~--a~e plot plan ~o scale. Fee ~'~rdin~ to sd~tule.
b. Plot pla~ ~-~ location of lot md of buildings on ~i~-~.:ses, relationship to adjoinir~ pr~nlses or public
s~reeta or areas, ~ 8ivin~ a deudled de~,iption of la~ut of pc~rty mint be dr~m on the dia~rsn vhic~ is part of
this ~lication.
c. The ~ covm~ b~ this applicatio, m7 not be c~,~nced before issu~ce of Buildin~ Permit.
d. Upon ~,~,,,,al of this ~licatioa, the Buildi~ Inspector will issue a Buildin~ Pemit to the applicant. Such
pamit shall be k~pt on the praises available for inspection throul~ut tbe ~rk.
e. No beildir~ ~ha11 be occupied or used in ~t~ole or in part for an~ purpose vhatever until a Certificate of
Occupan~ droll beve ~a~ ~,~,ted b~ the Buildin~ Inspector.
APPLICATI~I IS ~ ~ ~o the Buildin~ D=~;..~,,t for the ism of a Buildir~ Permit pursuant to the
l~ildlr~ Zoue Ordln~ce of ~e Tam of Sonthold, Suffolk Coun~ Ne~ York, and other applicable Ls~s, Ordinances'or
Re~tlatiorm, for the construction of buildir-3% ~4~itions or alterations, or for ,~,~1 or d-,~lition, as herein
~-~ribed. The ~ppli~t ~s ~o *..:.ly with all a~lieshle 1~, ordimmces, buildin~ code, beusi~ code, and
regulations, and ~o ~%~it authorized inspectors on pr,~ses and in buildin~ for eecessar~ inspections.
(Signature of a~lic~t, or na~, if a corporation)
... £~....~.¢~..//. ~4...~<.4..~...~.../../.~'7...
(Hailir~ ~M~ess of ~licmt)
State ~i~ether ~lic~t is o~a~r, lessee,l , architect, en~ineer,'meral co~tractor, electrici~, plmber or ~uil.~k
~- o, ,~ o, ~.~--..~.~.~... Z ~e:....~.~...~/.~.. ~ ..............................
(as ~u the tax roll or lateet deed) ...................
If applicant is _co!l~tiou,a sig~atm*e of ~uly ~thorized officer.
& ...............................
'i and titl~ ~f offleer)
corpomt~
Electricians Lir~,~e No ......................
Other Tr~s License NO .....................
P~use I% ~F~r Stieet li~.let
~ ~= ~ No. I~ ~tion .... ~.o. ........ El~ .... .o..~. ....... ~ .~.~.?./.~.~
~.~on .£e.r~.~ .P...~..~e..: .............. ~ ~ ~. zg.~/:~.. ~ ..d~.r.~g.
................................. ~9'~3;=tZ~,~ r o:o~r ....... : ....
_ 7.. ...............
3. Pature of ~ork (check ~i~id~ applie~hle): ~ Buildiug .... ~klition .......... ~terati~ ..........
~ir ............ ~1 ............. ~liti~ ............ O~mr
Esti~t~ ~st
(to ~ ~id ~ Hli~ this ~li~ti~)
5. I~ ~lli~, ~r of ~lli~ ~mlts ....~ ...... ~r of ~lli~ ~its ~ e~ fl~r ..... ~ ..........
I~ ~r~e, ~r of ~rs ...
6. If ~imss, ~reial or ~ ~, ~i~ m~e ~ ~tent of e~ ~ of ~ ......................
~. Di~nsi~s of ~sti~ st~s, if ~: ~t ...... . .......... ~ ............... ~pth .................
I~i~t ......................... ,.~r of Stories ......................
Di~i~ o~ ~ st~ ~th alterati~ or ~iti~s: ~t ............... ~ar ...............
~pth .................... ~i~t .................... ~r of Stories ...............
~.0i~si~ o~ ~i~e ~ ~i~: ~ ...Zl;~ ....... ~ .../.~.~. ..... ~...3:~ ......
~i~t ...... ].~. ............... ~r of Stories ..... ~ ...............
9. Si~ of lot: ~t .................... ~ .................... ~p~ ....................
I0. ~te of ~d~ ..................... ~ of Four ~r ........................................
I I. ~ or ~ district in ~i~ p~i~s a~ s~t~ ..............................................................
12. ~s ~o~ ~t~ti~ violate ~ ~i~ 1~, o~i~ or ~lati~: ........................
13. ~ill lot ~ ~ .................... ~ill ~ fill ~
14. ~s o~ ~r o~ ~s ........................... ~ss .............................. ~ ~ ..............
~ o~ ~i~ ...~g~.~ .... (~.~4 ........... ~ ..~ .......................... ~ ~ ~ ~ ..............
15. ls fids p,~ ~in ~ f~t of a ti~l wtl~? * ~ .......... ~ ..........
PLOT §IAGRAH
[~cate clearly ~nd distinctly all Imildi~gs, ~ether existing or ~, ~ i~i~te all ~t~ d~nsi~
P, 9~ ~r~ li~s. Gi~ st~t ~ bl~ ~r or &~ripti~ ~i~ to ~, ~ ~ st~t ~s ~ i~i~te
~r interior or ~r lot.
~¥A1E ~ ~i~
,~S
OYdN F/ L~ .......................
(~ ....... Of 1~IV1~;''~'~ ...... S~a~;' ' ................................. ~tr~t) ~i~ duly ~m, ~s a~ ~ys ~t ~ is ~m a~li~t
~ is the
(~tr~tor,
~f ~id ~r or ~r~, ~ i~ ~ly ~t~ri~ to ~rfom or ~ ~rfo~ ~ ~i~ m~ ~ to ~ ~ file this
a~llcati~;
that ~ m~ viii ~ ~rfo~ in ti~ ~r ~t ~rth in ~e ~llmtim fil~ ~.
~m to ~fore
....... .....