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Home My WebLink About26061-Z FOR~ NO. I TONN OF SOUTHOLD BUILDING DEPARTMENT TO. HALL SOUT~OLD, N.Y. TRL: 765-1802 11971 Disapproved a/c .................................. BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORM ................... NOTIFY: CALL .................. MAIL TO: .................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................ ,19 .... INSTRUCTIONS ~letely filled inbytypewriter or in ink andsutmittedtotbeBuildingInspectorwit 3 sets of plans, a~curate plot plan to scale. Fee a~cording to schedule. b. Plot plan showing location of lot and of lmildings on premises, relationship to adjoining pr~nises or public streets or areas, and giving a detailed description of layout of property unst be drm~a on the diagran which is part of this application. c. The work covered by this application ~ay not be co~uenced before issuance of Building Permit. d. Upon aptera/al of this application, the I~ilding Inspector will issue a B~ilding Permit to the applicant. Such permit shall be kept on the premises available for inspection throngho~t the work. 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 ~:U~t MMlg to the Building Departs,mt for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Sonthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for r~,oval or demolition, as herein described. The applicant agrees to ccmply with all applicable laws, ordin~cas, Imilding code, housing code, and regulations, and to ~lm~t mthorized inspectors on premises and in building for necessary inspections. (Signature of applicant, ~r nam, if a corporation) //.ff.... (Mailing ~taress of applicant)e' State whether applicant is ~aner, lessee, agent, architect, engineer, general coutractor, electrician, plunber or builder. ........ w~.~ ./ ..................................................................................................... (as on the tax roll or latest~deed) .............................................. / If appli .clmat is a corpor, a.ti~, signature of duly authorized officer. (~ ~ title ortho.ate offi;;;i ................... Builders License No .......................... Plm~ers License No .... ~ ~. .ff. ?. . ./. .......... Rlectrici~s Licen~ No..../~..~..~. ......... Other Trmrio's License No ..................... 1. ~tion of ~ on whi~ ~ work ~ll be ~ ....... ~..:...:./..C. ~vz , ...................... ', ..................... ...~~. ~.~. .... ~d~.. ze~ ./.. ........................... ~.~.~...<~ Cotmty Tax Map No. 1000 Section ..~..6),.d ........ Block ...... /. ........ Lot ..... ~.'....k/.7 s~i.~on ..././/r/ex.~.z<../..../..~.<<. ............ F~l~ ~ No ................ ~t .y./7.:.~. ~. (Nam) ' " 2. State oxqscing use and necupmmy of premises and intended use and occupancy of proposed construction: a. Facisting tree and neeupaney ............ {~.TA~ ,,, *~'~-^t', ~ ............................... - ' . ': ;,~ ' "~t -' ~ · -'? ".'~ · · .~ ........ ~ / / j . .,. il~bV~-,Mo,~,, :,.~ ..',. ,c~ b. Intended use and occupancy ........................................... .~Oiis~ '~.,~.~',. 1.~i¢** t~'~o:l. ......... I~nmre of ~ork (ct~ck ~id~ applir~hle): Ne~ Building .......... ~ldi~ion .......... Alteration ..~ ....... Repair ............ l~nval ............. Demolition ............ Otber Work .................................. (Description) Estitmted Cost ......................... fee .............................................. (to be paid on filing this application) If duelling, nuttier of d~elllng units ............ Ntxnber of d~elllng units on each floor ................ If garage, ~ber of cars ...................................... If Ixminess, cumercial or mi~z<l occupancy, specify rmture and extent of each type of use ...................... Dimensioos of existing structures, if any: Front ................ Rear ............... Depth ................. Ileight ......................... lx~r of Stories ...................... Dimensions of s.~ structure wlth alteratiotm or additions: Front ............... Rear ............... Depth .................... Height .................... h~tmr of Stories ................ Di,,ensions of entire ne~ construction: Front .//~. ........... Rear ../,/.~. ......... Depth .. 5~-.ff ........ tleight ...... /.~. ................ txttnber of Stories ....... /. ............ Size of lot: Front .................... Rear .................... DePth .................... Date of Purchase ..................... Ix~ of Former O~ner ........................................ Zone or use district in ~t, ich praises are situated ...... Z~l~.~¢. ~- ....................................... Does proposed construction violate any zoning 1~, ordinance or regulation: ............ '. ..... ...... Will lot be regraded .................... Will~en~ess fill be r~m~ed,~ -~ ---- t,,frc~ premises: ~_S NO of Contractor Is this property within 300 feet of a tidal wetland? * ~ES .......... hO .. ~ ....... · IF YES, S(II1BtlD ~ 'r~l'l~.c~ ~ HAY 1~ PLOT DI AGRAH locate dearly and dlstinctly all buildings, ~&ether existing or proposed, and indicate all set-back dimensions property lines. Gi~ street mad block r~r or description according to deed, and ~ street t~res ~ indicate etlmr interior or corner lot. FA'IE (~ N[~ IIN[~ (~ ....................... ......................................................... being duly s~m, deposes and says that he is tim applicant 5Lsne of ilviividual signing contract) bore na~d, e is the ................................................................................................... (Contractor, agent, corporate officer, etc.) f .maid o~mer or t~mers, ar~l is duly authori~! to perform or have performed tl~ said ~rk md to make and file this pplicatlon; that all statu,ents contained in this application are true to the best of his koo~l~ and beiiefi and hat the ~x~rk will be perfonmd in tim maturer set forth in the application film there*fith. EUZABt=TH A STATHI$ NOTARY PUBUC, State of New No. 01ST8008173, Suffolk Term Expires June 8,