HomeMy WebLinkAbout15919-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
15919
Z
Permission is hereby granted to:
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, ....~~....~..:.~..: .!..!.~..~.~ ......
.................................... i'":;"'~'""~"~-~:":c.-:';""-~ ........... ~"~:'_ ';_ '
at premises located at ~..J...~. .............
I 1 / ~ ....... ..O...~ ....... Lot No ......~..~.:.,?.,I ......
County Tax Map No. 1000 Section ................... Block
pursuont to application dated ....... ! .............. , 19~..'~., c~nd approved by the
Building Inspector.
Rev. 6/30/80
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined , .~Z~.. I..--/. 0.,
19~
.2
Disapproved a/c .....................................
....................
(Buildzng Inspector)
APPLICATION FOR BUILDING PERMIT
Received ........... ,19...
Date ................... 19...
\ INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
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 street-
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Braiding lnspecior will issued a Building Permit to the applicant. Such permi
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 Occupanc:.
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Bmldmg Department for the issuance of a Building Permit pursuant to th.
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable laws, Ordinances o,
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 laws, ordinances, building code, housing code, and regulations, and tr
admit authorized inspectors on premises and in building for necessary inspections.
'I'WIN FORK FENCE COMPANY (S~gnatt~WfN'~alatN~n~li[l~l'~orporation)
PO ,Box 476 . North [load ~3 Box 476 - North Eg.a~t ....
Matt~tuck, NY 11952 Matt tuck, NY 11952
State whether applicant m owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Agent
, Hr. & Mrs. Lowell
Name of owner of premises '
(as on the tax roll
If ag!.dmgnt m a corporation, signatUre of duly authorized officer.
.... ' ...................
(Name and title of corporate officer)
508
Budder's License No .........................
Plumber's License No .........................
Electrician's L~cense No .......................
Other Trade's license No
I. Location of land on wlfich proposed work will be done.
I ~ O0 ~ Ma. rra~ooka Lane ~ Ymtt£tucg
Itouse Number Street Ifamlet
115 3.00 018.001
County Tax Map No. 1000 Seclion ...... . ..... . ,.... Block ..... ...... ....... Lot ..................
Subdivision .................................... Fded Map No ............... Lot ...............
l(Name)
2 State ex~sting nse and occupancy of premises and intended use and occupancy of proposed constructmn:
S~ngle Family Dwelling
· ' ' and occupancy
11, J:XlStlll§ tl5¢ ....................................................................
b. Intcudcd us~. and occupancy