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Home My WebLink About26765-Z -FORt4 NO. TOhrN OF SOUTHOLD BUILDING DEPARTMENT TONN HALL SOUTHOLD, N.¥. I 197 I TEl.: 766-1802 Disa~tnuved a/c .................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORM ................... NOTIFY: CALL .................. MAIL TO: .................... a. This application mtqt be cuupletely filled in by typewriter or in ink and suhnitted to the l~filding Inspector ~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule, b. Plot plan dx~ring location of lot and of buildings on premises, relationship to adjoining pr~ises or public streets or areas, trod giving a detailed description of layout of property must be drawn om the diagram which is part of this application. c. The work covered by this application rmy not be ccm~mnced before issuance of Building Permit. d. Upon app£o~al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pemnit shall be kept on the Ft~ises available for inspectio~ throughout the work. e. No building shall be occupied or used in whole or in part for any lmrpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICA~Ct~ IS ~ ~ to the Building Depm~ent for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Tcmm of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alteration, or for ~ta,oval or d~a~lition, as herein described. The applicant agrees to cxat~ly with all applicable laws, ordinances, building code, housing code, and regulations, and to afl,it anthorized inspectors on premises and in building for necessary inspections. ... < <! .......... (Signature of applicant, or na~, if a corporation) (Mailing .~l~ress of a~licant) State whether apt~licant is framer, lessee, ~ architect, engineer, general contractor, electrician, pltmber or build~ (as on the trax roll or latest d~)'~ !~:;' '::~' . If applicant is a corporation, signature of &~ly authorized '~ffi;;:~'~ ::7 :':':': "~ (Name and title of corporate officer) Builders License No .......................... Plt~nhers License No .... ~.~-..l.3./Q ........... Electricians License No ...................... Other Trad~'s License No ..................... t tion of on which win done Hame Ntmt)er Street Itanlet Cotmty Tax Map No. 1000 S~ction .... ~.~.~.] ....... Block .... .~...~... ..... Lot . ~-.~.. State existing use trod oc~ of pr~mlses and intended use and occt~pancy of proposed construction: a. Eadsting use and occupancy ........................ ; .................................................... Nnture of ~ovk (cl~-w.k ~hid~ applicable): l~ir ............ ~al ............. l~liti~ ............ Other ~ .................................. (~ripti~) Est i~mt~ ~st .................... f~ .............................................. -~to ~ ~id ~ filing this a~li~ti~) If &~lli~, ~tmr of ~lli~ traits ......... l~r of ~lling mits ~ ead~ H~r ...... ~ ........ xr ............ ................ If Imimss, ~rcial or ~ ~, s~ci~ ~ture ~ ~tent of ead~ ~ of ~ ...................... Di,~nsi~s of ~isti~ st~s, if ~y: ~t...Z~. ........ ~ar .... //~ ....... ~pth .... ~. ........ lYi~t ....... ~ .............. ~r of Stories ...................... Di~i~ of ~m st~e ~th alterati~s or ~itions: ~ont ............... ~ar ............... ~ptl~ .................... ~ij~t .................... ~r of Stories ............... Diuensi~ of entire ~ ~st~ti~: ~t ................ ~ar ............... ~p~ .............. }~i~t ......................... ~r off Stories ..................... Si~ of lot: ~t .................... ~ar .................... ~ptt~ .................... ~te of ~d~a~ ..................... ~ of Four ~r ............................. i~.. ........ ~ or ~ district in d~i~ pr~i~s a~ simt~ .............................................................. ~s ~o~ ~t~ti~ violate a~ ~i~ 1~, o~i~e or re.latin: ........................ ~ill lot ~ ~ .................... ~ill ~ss fill ~s of ~r of pc~s ........................... ~ress ............... ~ ............. ~ ~ ............... ~ of ~dt~t .................................... ~ress .............................. ~ ~ ............... .......... '.7~': ~ .,~ ........................... Is ~fis pcoter~ ~dn ~ f~t of a till ~tl~7 ~,,&~:~l~ .......... ~ .......... pr~r~ liras. Gl. st~t ~ bl~ ~r~O~°~eo~ing to interior or co~r lot. , ",r? ~,(;'? c,~ ~q~ 0D APPPOVED AS NOTED X~t 'N~*~R'~x NOTIFY BUILDING DEm"TMENT AT FOLLOWING INSPECTIONS: $3" ' '~ < " PLUMBING ALL PLUMBING ~ & WATER LINES NEED TESTING BEFORE COVERING :'^'tn c~ .~cu~<,. 7~_ /~ ,ss . .... ~ .... being tare of individual idlgniug contract) FOUNDATION - TWO REQUIRED 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 DESIGN OR CONSTRUCTION ERRORS duly s~m, delx~ses and says that he i.s tim appl. icant (Contractor, agent, corporate officer, etc.) said c~er or c~ne. rs, and is duly ~rothorized to ~rfom or h~ ~rfo~ ~m ~[d ~ m~ to ~ ~ f[le th~s ~llcati~; d~at all stat~nts c~ta[~ in ~RE ~ G~ew York No, 01GL~?gs05 Qualifi~ in Suffolk Commi~ion ~ir~ D~. 8,