I
Ap
pli
ca
tion #:
___
_ _ _
I Permit
#:
______
_
D I New Applicat
io
n
DI Renewal
APPLICATION FOR ERECTION
OF
SIGN
DI
Approved
DI Denied
Department
of
Build
ings -
Incorporat
ed
Village
of
Freeport
Application
is hereby made
pur
s
uant
to V
ill
age
of
Freeport
O
rd
in
an
ces
for
approval
of
plans and
spec
ifi
cations
of
the s
ign
s
tructure
here
in
d
esc
rib
ed, to be erected,
hun
g and maintained In acco
rd
an
ce
wit
h
the r
eq
uirements
of
the aforesaid
ordina
n
ce,
the B
uil
di
ng Code, and any
other
ordina
n
ce
or l
aw
applicable
thereto. Sign
permit
number
will
be placed In
lower
rig
ht
corner
of
sign.
Date
:-----
---
-
Wa
ll
Sign 0
Ground Sign 0 Canopy 0
Renewal
Period:--
-----
----
-
Name
of
Property
Owner:-
--
-----
---
-
----------
-
----
---
Name
of
App
li
cant:-----------
-
----
Contact#:
_ _
_________
_
Width
of
Buildi
ng
(Frontage):
---
---
- -
Length
of
Buildin
g (Depth): - -
----
--
Height
of
Buildin
g:------
----
Setback
of
Nearest
Building:
---
--------
Exact Location
of
Sign
:---------------------
-
------
--
-
Street Sign
Front
s
On
:---
----
-------
---
----
-
------
--
-
Width
of
Sign:-------
Hei
ght
of
Sign:-
--
---
-
Depth
of
Sign:--
-----
Projection
from
Building:------
-----
-
Setback
of
Sign:---
---
------
Is Sign
to
be
Illumin
ated? Yes 0 No D
(If
yes, give name, address,
and
phone
number
of
Freeport
Licensed
Electrici
an
performing
the
work:
Name
of
Electri
cian:-------
---
--
Address:
____
____
______
_ _
Sign
Hang
er's
Name:-----
--
-
--
- -
Add
r
ess:-----------
---
--
Sign
Hang
er's
Phone N
umb
er:--
----
--
Email:-------
-
----
--
---
Approval is
hereb
y given
to
the foregoing application
and
permi
ss
ion Is granted
for
the hanging
of
the
sig
n
described
herein.
This permit is
rev
oca
ble
in
case
of
any non-compliance with provisions
of
afo
r
esaid
Ordinances. Permit
expires
thr
ee
(3)
yea
r
s,
provided that
such
a
sig
n continues
to
be
maintained in compliance with
the
ordin
ances
of
the
In
co
rporated Village
of
Freeport in force at
the
time
of
ren
ewal.
Dated:
Freeport, N.Y.
_______
_
20
__
Superintendent
of
Buildings
CHECK
FOR
PERMIT
FEE
OF
$150
PER
SIGN
(PA
YADLE TO
TH
E I
NC.
VILLAGE
OF
FREE
PO
RT
MUST
ACCOMPANY
THIS
APPLICATION
A
COLO
R PHO
TO
OR
COLOR
RENDERING
FOR
ALL NEW AND RENEWAL SIGN
PERMIT
APPLI
CAT
IO
NS
DEPICT
ING
THE
ACTUAL SI
ZE
AND DESCRIPTION
OF
TH
E SIGN
•AND•
AN
UP
TO
DA
TE
PHOTO(S)
OF
THE
FRONT
AGE OF ALL STORES WITHIN 2
00
FEET
OF
SUBJECT BUSINESS IN EITHER
DIRECTION, MUST BE SUBMI
TIED
WITH
THIS
APPLICATION.
Please visit our Website
at
http://www.freeportny.com/documents/4/Signs-modl.pdf for
sa
mples of acceptable sign types
DEPARTMENT OF BUILDINGS
OF
THE
VILLAGE
OF
FREEPORT, N.Y.
PERMIT
NO.----------
FILING DATE
_________
_
The
fee paid herein shall be non-refundable. Said cost will be for the processing
of
the sign
application whether approved
or
not.
Applicant Signature
SIGN PERMIT FEES
1.
RENEWAL EVERY THREE
(3)
YEARS
...............................
$150.00
2. NEW SIGNS .
...
..
...
.
.......
..
.............
. I
•••
I
•••••••••••••••••••••••••••••
$150.00
FEE IS NON-REFUNDABLE
(COLOR PHOTOS MUST ACCOMPANY ALL SIGN RENEWALS)
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