HomeMy WebLinkAbout21461-Z I~O~.M NO. ~
TOWN OF SOUTHOLD
I~UILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°-N? 21q61Z
Date ..~ ........................................... ,
...~:. ....................... ~ ............ ~...~.~.~ ...................................................................
~--....~A;-~."~ ............. ~~-~.~~~ ......... ~'.'~ .............
County Tax Mop No. 1000 Section ......... ../....~....?T.. Block .............. ...~...... Lot No ..........~......?.. .......
pursuant to application dated ...~.....~.. ......................................... , 19...~, and approved by
the
Building Inspector. ;z,/~s~ ~' ~
Rev. 6/30/80
FORM NO, 1
TOWN OF $OUTHOLD
BUILDING DEPARTAd ENT
TO!NN HALL
SOUTHOLD, N.Y. 11971
- / TEL.: 765-1802
Examined -~/.~.; . ...... 19 ?.~
Approved ~.~ii .....
19 ff.~., permit No. --~ / 9/~/' '~
Disapproved a/c ................. '
.... ....................
~& , APPLICATION FOR BUILDING PERMIT
'~(e ~'" INSTRUbTIONS
I10ARO OF HEALTIt . . ~ .....
3 SETS OF ?LA:;S ..~. ......
SURV£¥ ....... ~ ........
CIIECK ..............
HAIL TO:
Date ... - '/ .... 19'v
a. This application must be completely filled in by typewriter orin ink and submitted 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 st~'eets
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 Building Inspector will issued 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 whatev~er 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 Laws, Ordinances or
Regulations, for the. construction,of'~buildmgs, add~tmns or alterations, or for removal or demolition, as herein described.
The applicant agrees ~to comply with'all applicable laws, ordinances, building coge, housing.go'de, and regulations, and to
admit authorized inspectors on p~emise,s and in building for necessary inspecti~ns~.ff~/~, fi//' ~ .
.. ..
. , .~ ....... ;5,:..,~'./:'..~.'..~:? ....... : .. ..................
-- · (Signat'~' ure of applidant, or name, if a corporation)
(Mailing azidiess of~;~ii~,~t') .... /''' ' '
State whether applicant is owner, lessee, agent, architect, engineer, general ·contractor, electrician, plumber or builder.
......... ............. ; .......................... .......................
N~me o f owner o f premises ...ff,.~d.-<...~% ,~.. Z ./< .-~.~., .¢Z?..~.-A.. ~...~... 4 .~.-~....."-f'~/....~.~....-?,re~'...-~.~....~. (as on the tax roll or latest deed)
If applicant is a corporation, signature or duly authorized officer,
(Name and title of corporate officer)
Broider s Lmense No..//-~: ...... ~ .....
, ..... ..........
Plumber s License No.
Electrician's License No. ~,/~ ..... . .....
Other Trade's License No~,,~./~..~..,':~,)~
1. Location of land on which proposed work will be done ..................................................
2:¢. .......... & ,
Ilouse Num bar Street Hamlet '"
Cou'nty Tax Map No. 1000 Section ..../..~..q~..". ...... Block .... .~...3. ' Lot..~..?..c,.~..: ........
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2: State existing use and occupancy o£ premises an ,I intended use and occupancy of proposed construction:
a. Existing use and occupancy ........ ~.."-J~...~-~. .6-~T~7~ ..........
. / · 0 , '
"// . 0 ~'_ .,~ "..- .o ,~-.