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Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

State

Is Agent/Contractor same as Owner?

Cell Phone #

City

Replacement of less than 50 linear feet of deck surfce material. *

Cell Phone #

Email

City

Village of
Ocean Beach

Mailing Address

Electrician/Plumber Information

Less than 50 square feet of soffit and/or fascia material and new molding. *

ZIP

Work Phone #

Plumbing repair from stop valve forward. *

Begin typing address and select from the populated dropdown

Ordinary Repair and Maintenance Permit

Last Name *

Repair of less than 16 feet of fence. *

Owner Information

Lot

Property Address

ZIP

Name

Suffolk County Home Improvement Contractor License #

P.O. Box 457
Ocean Beach, NY 11770
(631) 583-5940
https://www.villageofoceanbeach.org/

Mailing Address *

Less than 200sf of flooring. *

State *

Cell Phone #

Contractor Information based on required or not

Does work require Agent/Contractor? *

Applicant Signature *

Block

Email

Email *

Does work require Electrician/Plumber? *

Installation of gutters. *

Contractor Required or Not

Work Phone #

Less than 50 square feet of side wall material. *

Work Phone #

Property Information

Home Phone #

City *

Name

Please check either yes or no for each box.

Signature

Remarks

First Name *

Mailing Address

ZIP *

Agent/Contractor Information

State

Less than 50 square feet of roof material. *

Is Electrician/Plumber same as Owner? *

Proposed Work Information