HomeMy WebLinkAbout26762-Z FORM NO. !
TOWN OF SOUTIt0LD
BUILDING DV-PARTMENT
TOWN HALL
SOUTItOLU, N.Y. ] ]9? !
TEL: ?65-]802
Disapproved a/c ..................................
......... '-- ....... (Building Inspector)
Mo
BOARD OF BEALTH ...............
3 SETS OF PLANS ...............
SURVEY ........................
CHECK .........................
SEPTIC FORM ...................
NOTIFY:
CALL ..................
MAIL TO: ....................
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
This application ri. mt be ct~pletely filled in by type~iter or in ink and anl~nitted to the Building Inspector
3 sets of plans, a~curate plot plan to scale. Fee a~cording to schedule,
b. Plot plan showing locatio~ of lot rand of buildings on premises, relationship to ~tjoining pr~nises or public
streets or areas, and giving a detailed deseriptio~ of layout of property mast be drawn on the diagram ~dnich is pert of
this application.
c. The work covered by this applicatio~ my not be ca,,eneed before issuance of Building Permit.
d. Upon approval of this ~la, lication, the Building Inspector will issue a Building Pemit to the applicant. Such
pemit shall be kept m the premises available for inspection throughout 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 ~ ~ to the Building Uepartnmnt for the issuar~ of a Building Permit pursuant to the
Building Zone Ordinance of the Tc~n of Suuthold, Suffolk County, New York, and other applicable Laws, Ordinances or
Rngulatiorm, for the construction of buildings, additions or alterations, or for removal or d,~lition, as herein
described. The applicant agrees to curly with all applicable lm~s, ordinances, building code, housing code, and
regulations, and to ~4~it authorized inspectors on praises and in building for necessary inspections.
... ..........
(Signature of applicant, or na~, if a corporation)
(Mailing ~laress of applicant)
State whether applicant is owner, lessee, ~ architect, engineer, general contractor, electrician, pltmber or builder
~ of c~ner of pr~mlses .. ~.z: ........................... ~-.- ~ .... Ax ...............................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly anthorized officer.
(Nage and title of corporate officer) '
Builders License No ..........................
Plumbers License No .... d.~..2.3./~. ...........
Electricians License NO ......................
Other Traders License No .....................
Location of last on which proposed ~ork will be done
House bi ~her Street Itmnlet
County TaxMap No. 1000 S~ction .... ~f?.7 ....... Block .... .~..~... ..... Lot .1..~..~..~.-...~..~...
Subdivision. ~ .................................. Filed Map No... 2~.~..7. ...... I~t . .~.~..~ ....
2. State existing use and occupancy of pr~mlses and intemded use and occupancy of proposed construction:
a. Existing use and occt~ancy ........................ ; ....................................................
b. Intended use and occupancy ..... .'~.'/../f-~ ~ .~-- .... '/~ -- ~'. ?.?f.r.4Y ..... .~..~ff. ..............................
AT GREENPORT
TOWN OF S(3UT~D
SUFFOLK C~TY, N Y. ,
CALEB'S .... LANE '
~Y.$. LIC. NO. 49618
TREE T
93 - 300 ( ~,~. ~. .~ )