HomeMy WebLinkAbout8908-z TOWN OF $~UTHOLD,
TOWN CLER~('S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST B£ KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 8908 Z
Permission is hereby granted to:
Thos, Ros~Lak
......... ...c~.¢~. .................................................
~o ~.u...&z. ~... ~..n....~.L¢..x. ~.~ p. n....o..n....e...x..~.~ ~..x.~. ~..~.,.e.;~g .................................................................
at premises located at ..:LO.~..~,~..&..(~t-.....l~.~8.~[at~ ....................................................................... ;
............................................ .Tz,~ek..~,~te ....... .Cuteh~te .................................................................
pursuant to application dated .......................... ~g.....1.~ ............. , 19..q~., and approved by the
Building Inspector.
Fee $.1.~, .(~ ............
FO~M NO. 1
TO~N O~ SOUTSOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, No Y.
Examined .................................. ~.,.., i9.
Approved ................ .(.: ........... L..'~,~...., 19. Z.~,~ Permit No.....~....~.~.....~.....~....~..
Application No ................................
Disapproved ............................. ...... a/c~ ...... ~.~~~....................~.~~~ ................................. .... __ .......~.~-,~-.... ' ---
APPLICATION FOR BUILDING PERMIT
,Dote ................ ...... . ....
INSTRUCTIONS
a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets br
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application.
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 permit
shall be kept on the premises 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 granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New'York, and Other applicable Lows, Ordinances or
Regulations, for the construction of buildings, additions or aJterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
..... ...........................
(Signature of a(~/licant, or name, if a corporation)
(Address of apphcan~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........... ...........................................................................................................................................................
Nome of owner of premises ...~./..~...~m.f.q,~......3:.....~...o...5. L.~.~..~. ............................................................................................
if applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ........... ..,~.....~.'. ................................
Plumber's License No. f~J/~.
Electrician's License No. ..~.....~.. ..................................
Other Zrade's License No ..... .~....(~. ................................
........................................ ,'
1. Location of land on which proposed work will be done. Map No.: / ~ ~0 Lot ~'~o.u.~ ............ /. ........
Municipa~l~.
2. State existing use and occupancy of premises and intended use end occupancy of propased construction:
a. Exisiting use and occupancy ......... ~ ............. 7" ........................ :'""t ......... ;'"'y?~"-'% .......... ;v'4 .............. ..........
b. Intended use and occupancy ....... ./.~. · .~./~/. 4~ .y. ....... .~.....'J~...?.=L././.../~....~....... ~.~....~.....~..~...~:....~....~/.....~.. ~ .....~ ...... , ......