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Home My WebLink About26763-Z FORM NO. I TOM OF SOUTHOLD BUILDING DEPARTI~NT TOWN HALL SOUTHOLD, N.Y. 1197 I TEL: 765-1802 Disapproved a/~ .................................. AUG 2 9 i · ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORM.. .................. NOTIFY: CALL .................. MAIL TO: .................... INSTRUCTIONS Date ................ , ]9 .... a. This application ~,tqt be caupletely filled in by typewriter or in ink and submitted to the Pxdlding Inspector 3 sets of plans, accurate plot plan to scale. Fee according to schedule, b. Plot plan sho~ing locatiom of lot and of buildings on pr~nlses, relationship to ~djoining pr~nises or public streets or areas, mhd giving a detailed description of l~at of property must be drawn om the diagr~ which is part of this applic~tioo. c. The work covered by this applicatico may not be co~nenced before issuance of Building Pemit. d. Upoo apptu~al of this application, the l~ilding Inspector ~ill issue a Boilding Pemit to the ~pplicant. S~ch permit shall be lo,pt co the pr~ises 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 gr~nted by the Building Inspector. AFFLICATICt~ IS ~ MA~E to the Building Depaxr~mnt for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Sc~thold, Suffolk County, New York, and other applicable Laws, Ordinamces or Rmgulations, for the construction of buildings, m~ktitio~s or alterations, or for r~oval or dem01itioo, as herein described. T~e applic~t ~tees to c~,,~ly with all applicable l~s, ordinances, l~ilding coc~, housing code, and regulations, amd to ~l~{t authorized inspectors on premises and in building for necessary inspections. ... ......... (Signature of ap~lleant, or na~, if a corporation) (Mailing ~-~lareas of ,~t~,lic~nt) State whether applicant is ~r, lessee, ~ architect, engineer, general contractor, electrician, plmber or builde (as co the tax roll or latest deed) If aM~lic~nt is a corporation, signature of duly authorized officer. (1~,,~ and title of corporate officer) ' Builders License No .......................... Plumbers License No .... 3.~-. 2.~.~. ........... Electricians License No ...................... Other Tr~-k~'s Lice~e No ..................... Ix)cation of l~d on which proposed work will be dome. ~-- Fature of work (ct~k whirl, applicable): Ne~ Dailding....../ ...... hddition ........ Alteration .......... l{epai r ............ Removal ............. l)~rol ition ............ Other l/ork .................................. .(Description) Est i,r~ted Cost ....... /f( .~.... ..... fee .............................................. -.(to be paid on filing this applicatioo) If &~lling. nu,t)er of dwelling units .... .~. ..... tk~ber of &*elling units oo each floor ...... ff. ........ If garage, nt~/Oer of cars ............ /~4../-?.~-.. ................ If Dss'ness, cannercial or mixed occupancy, specify nature and extent of earl, type of use ...................... Dimensions of existing stn~ctures, if any: Froot..././.d. ........ Rear .... //~. ....... Depth .... ~'Z ........ ....... ......... of Stories ...................... Oirrenaioos of sara structure with alterations or additions: Front ............... Rear ............... Depth .................... Be,O,t .................... limber of Stories ............... Dimensions of entire new construction: Front ................ Rear ............... Depth .............. Ileight ......................... hkxnber of! Stories ..................... Size of lot: Fro, t .................... Rear .................... Depth .................... Date of Purchase ..................... blare of Fomer Owner ............................. ~.. ........ Zone or use district in ~i~ich premises are situated .............................................................. Does proposed coo. stmctioo violate any zoning 1~, ordinance or regulatioo: ........................ Will lot be regraded .................... Will excess fill be removed frem pre-dses: ~ ltd t4arcs of (~r of p~,ises ........................... ~Idress ............... : .............. l~ tlo ............... tlane o~ architect .................................... /~klress .............................. Fnone Ilo ............... Is ~* _XES .......... NO .......... fids property within 300 feet of a tidal wetland? * . PLOT DIAGP~M~ I~cate clearly and distinctly all lyaildinga,':,~.~e~'~'~s$~l,'~ ~proposed, and indicate all set-back dinensions proparty lines. Cive street and block nt~berj~5~.~le~il~b~c~lhg to deed, and sho~ street nares and indicate ~ether interior or corner lot ,~l.., .\S o~ %%u'~% ~3~ e.~, 765-1802 9 AM TO 4 PM FOR THE '~% ~'%' ,d'x- _ %x3* '¢.~? FOLLOWING INSPECTIONS: ',.?',~:.' ~,~x~,% '/- .. 1 FOUNDATION . TWO REQUIRED ~c ~' 2. ROUGH - FRAMING & PLUMBING ~ ~,: ~',¥~o 3. INSULATION PLUMBING ALL PLUMBING WAb'~ & WATER LINES NEED AlE Olr I~t~ ~K, TEST NG BEFORE COVERING ...... ...... ~me of individual Idigning contract) 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y, '~TATE CONSTRUCTION & ENERGY -:r;OES. NOT RESPONSIBLE FOR ,cSiGN OR CONSTRUCTION ERRORS duly sworn, deposes and says tlmt he is the appl. ic~,t (Co, tractor, agent, corporate officer, etc.) said c~er or owners, and is duly authoriza~d to perfonn or have performed Om ~id ~ m~ to ~ ~ file this ~)licati~q 6mt all stat~nts c~tai~ in ~is a~licati~ are t~ to the ~st of his ~1~ and ~liefi a~ I ~ [c~t) ' ~mmi~ion ~ires D~. ~, ~