HomeMy WebLinkAbout5084-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUT~OLD, N. Y.
BUILDING PERMIT
Cfi-IlS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
cOMPLETlg~I~ OF 'tHE WORK AUTHORIZED)
N? 5081 z
Permission is hereby granted to:
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pursuc~n.t to application dated .............................. ?~J.....~ ............. , 19..~[11~., and approved by the
Building Inspector. ~ ~ ~¢bleef, te aeeess &~ &p~z~ve{t by ~ ll)]~ea:ts~
Bui ding Inspector
~OUTHOLD, N. Y.
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INSTRUCTIONS
a. This application must be completely filled In by typewriter or in ink und submitted in duplicate to the Bu,ldin
Inspector,
b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets c
areas, and giving a detailed description of layout of property must be drawn on the diagram which Is part of ~hle appllcatio,
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permi
shall be kept on the premises available for inspection throughout the progress of the work,
e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupant
shall have been granted by the Building inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit purauant to th
Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, ~,nd other applicable Laws, Ordinances o
Regulations, for the construction of buildings, additions or alterations or for removal or demolition, as herein descrlbr.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and ragu arians.
(Signature cf applicant, or name, If a corporation)
(Addres~ of ~ppllcant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor~ electrician, plumber or buildm
If applicant Is a corporate, signature of duly authorized officer,
(Nome and title 'of corporate officer}
1. Location of land on which proposed work will be done Map No.: ,.a ......... ..................... ,.x Lot No.: ...,~ ................
Street and Number .... ,~.,!,,,O.,L.,,(~,,,,: ......... EZ.~,. ........ ~,~,~,, .,.~,,,.,';?,,,,~,,, .......... ,,,~.,,'~,.~.,~.,..~,.,', ,~..
Municipality
2. State existing use and occupancy of premises and Intended use and occupancy of proposed construction:
a, Existing use end occupancy