HomeMy WebLinkAbout9172-z BUILDING PERMIT
(THIS P£RMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 9172 Z
Permission is hereby granted to:
B d~c~.d...~, r.e ~h~;~ ...................................................
........... ~tt...~.~ ....... ~' ,t.,'"'~-$966' .................
~o ~..~..v.~..x..~.~.~.t.~.n..g~.~.~.t..~..~.t..~..~.n..~.~.:~.c.~Q~ ..............................................................
at premises located at ...~O~l'...lloatel ................................................................................................
................................................. ~to~.l~e! el..... ~ ¥ -Y.~ ..............................................................................
pursuant to application dated 'U .................. ~.]~-:t.]:-'"'~ ............... , 19..~7~.., ~nd approved by the
Building Inspector.
BuHaing ~nspector /
FOF~M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Disapproved a/c
......................
APPLICATION FOR BUILDING PERMIT
Date ................. ~ ................ , 19 2/) ..
INSTRUCTIONS
o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or
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 progress of 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 o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...... ...................................................................................................................................................................
Nome of owner of premises .,,~..?..~c¢..-/o ~./.,~... ,i9- ~Lc-C [¢-T ~ ~ ~ Z~ ~a/~ ~7 /°~C~('l/~d__
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of land on which proposed work will be done. Mop No.: ...~'.~..~¢..~..~.~. .............. Lot No .........................
Street and Number ..~....O..~.'Z.(~(~ ........... ~:.~ ................... .~..?..(~ .,%../:~..~.~_.~?. .....................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ....~../~...C.~....~...C."../.~. ....... .~..-...~...~..~*..~.......~...,~'....~(.....¢~.. ..........................
b. Intended use and occupancy .(. ' '~ ~
............. J..~./...~..~ ..................................................................................................
A