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Home My WebLink About26764-Z ¥ORM NO. T0~N OF SOUTHOLD BUILDING DEPARTMENT TONI~ HALL SOUTHOLD, N.Y. TEL: 765- 1802 Disapproved a/c .................................. I AU~ 292881) iilJ; (fluilding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORM ................... NOTIFY: CALL .................. MAIL TO: .................... Date ................ , 19 .... a. lhis application mtqt be cu~letely filled in by t-ype~iter or in ink and suhnitted to the Pldlding Inspector 3 sets of plans, accurate plot plan to scale. Fee according to schedule, b. Plot plan shoaing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property mast be drm~n on the diagram which is part of this application. c. The ~ork covered by this application may not be cum~nced before issuance of Building Permit. d. Utxm approval of this al~lication, the Building Inspector will issue a l~ilding Permit to the applicant. Sud~ permit shall be kept on the p&~uises available for inspection throughout the ~ork. e. NO building shall be eccupied or used in ~hole or in part for any purpose ~hatever until a Certificate of Occupancy shall have been granted by the Building Inspector. /~PLICATI(lq IS ~ ~ to the Building Depa~r~,~ut for the issuance of a lluilding Pemit pursuant to the lluilding Zo~ Ordinance of the To~u of Sonthold, Suffolk County~ Ne~ York, and other applicable La~s, Ordinances or Regulatiorm, for the construction of buildings, additions or alterations, or for removal or d~lition, as berein described. The applicant a~es to comply vith all applicable la~s, ordimaaces, building code, housing code, ar~ regulations, and to ~it authorized inspectors on pr~nises and in building for necess~qry inspections. .......... (Signature of applicant, or na~, if a corporation) .. :.. (Hailing address of applicant) State whether applicant is c~zner, lessee, ~ architect, engineer, general contractor, electrician, plunber or bui]de (as on the tax roll or latest deed) If applicant is a corporation, signature of duly anthorizedlo'~fieer; (I~,,~ aa:! title of corporate officer) i ]o Builders License No .......................... Plumbers License Ro .... ~.~'..2.3./~. ........... Electricians License No ...................... Other Trade's Liceuse No ..................... House Nt~ber Street Haralet County TaxMap ,,No. 10(X) S~ction .... ~.~2~ ....... Block .... .~..C. ..... Lot .;~.~.~ Subdivision ..................................... Vil~ ~ ~o...~.~ .......... Lot . .f~...7~~. .... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. F. xisting use and occupancy ........................ ; .................................................... h. ~re~a~d u~ ~a ocmp~:y ..... .-5..~ .~ .......................................... K'~mre of work (cBeck'~fid, applicable): Neu [~filding .......... &kiition .......... Alteration'..~j .... ]~ir ............ ~al ............. ~liti~ ............ Other ~ " ~ripti~) .~to ~ ~id ~ filing this a~li~ti~) Iff ~lli~, ~t~r of ~11i~ ~mits ......... r~r off &~lling mits ~ ead~ fi~r ...... ~ ........ If garage, ~r of ~rs ........ If I~imss, ~rclal or ~ ~, s~ci~ ~ture ~ ~tent of ead~ ~ of ~ ...................... Di~nsi~s of ~isti~ st~s, if ~: ~t...~. ........ ~ar .... //~ ....... ~pth .... ~ ........ ,~i~,~ ....... ~..~. ......... ~ o~ s~o~i~ ...................... Di~i~ of ~ st~e ~th alterati~ or ~itions: ~nt ............... ~ar ~pth .................... ~i~,t ............... .................... ~r of Stories ............... Di~nsi~ of entire ~ ~st~ti~: ~t ................ ~ar ............... ~p~ .............. l~iO~t ......................... ~r of~ Stories ..................... Si~ of lot: ~t .................... ~ar .................... ~pth ............... ..... ~). ~te of h~d,a~ ..................... ~ of Four ~r ............................. ~.. ........ I. ~ or ~ district in M~id~ pr~i~s a~ s~t~ ~. ~s ~o~ ~t~ti~ violate ~ ~i~ 1~, o~i~e or re, latin: ........................ L ~ill lot ~ ~ .................... ~ill ~ss fill ~ ~. ~s of ~r of pc~s ........................... ~ress ............... ~, ............. ~ ~ ............... ~ of .................................. ............... ........................... e~ ~. ~~4. 5. ~s this p~r~ ~flfin ~ f~t of a till ~tl~? * ~ .......... ~ .......... PLOT DIAG~ ~,~. ,.~G~. '.~0 t~t~ dearlx ~ ~i~ti~dr all ~d~, ~~~ro~, ~ i~i~t~ ~ll ~t-~ ~i~ ~r i~terior or ~r lot. T' ~ ~v- ¢.,.~,.'~p.O ~t °'~O ~ C~O' APPROVED AS NOTED ' o~~ ..x~~'C~x:~ ~Cy: ~ ¢~0'~ 765-1802 9 AM TO 4 PM FOR THE ~ -~ ~. ~ FOLLOWING INSPECTIONS: ~ 1 FOUNDATION - ~0 REQUIRED PLUMBING ALL PLUMBING ~ & WATER UNES NEED TESTING BEFORE COVERING ...... ta~ of individual Wi~ni.g contract) ................. ~ve na~d, FOR POURED CONCRETE 2 ROUGH - FRAMING & PLUMBING 3. INSULATION 4 FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O, ALL. CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR i2ESiGN OR CONSTRUCTION ERRORS duly sworn, depeses and says that he is tim appl. icaz]t the work will be perfon~y.l in tim mam~r set forth in the application ...... ..................... ~RELG~ "rk I No. 01~79505 Qualified in Suffolk Co~t~,~ ~ (Contractor, agent, corporate officer, etc.) said o.a~er or (~ners, and is duly authoriza~d to perform or have perforn~d the said work avl to mak~ and file this ~)llcatRm; that all statements contained in this applicatio~ are true Lo the best of his knowledge and beliefl and