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Home My WebLink About22351-zFORM NO.3 TOWN OF $OUTHOLD I~UILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N~ 22351 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) / Date ......~.~/~ ............................................. Z / Permission Is hereby granted to: / .-. -- CounlyTax Map No. 1000 Section ....... ././....~, ....... Block ........... ~.. ........... LotNo. ,..'~.¢~. ................. Building Inspector. Fee ~....0..~...~. .......... and approved by the Rev. 6/30/80 ; {/,4 ....... ~ TOW-~ORMNO'IN 3 SETS OF PCA~S .......... [ OF SOUTHOLD SURVEY ................... ' BUILDING DEPARTMENT CHEC~ ....... TOWN HALL S~PTIC ~ORH .............. ~ BLDG. DEP~ ;; SOUTHOLD, N.Y. 11971 Exam]ned ............. ,~..z ~- ~ ~;27 lC'- MAIL TO: 765-1802 9 AM TO ~ PM FOR THE ~(Bu~ifl~ [~s~ecto~) ., ~ FOLLOWING INSPECTIONS: APPLICATION FOR BUILDING PERMIT 1, FOUNDATION - '~O FOR POURED CONCRETE -' Date . ~.9~ ,, ~., ......... 19 2. ROUGH - FRAMING & PLUM~ NG 3. INSULATION~ 'INSTRUCTIONS a._.~0~~*be completely filled in by Wpew~ter or in ink ~d submitted to the Build~g Inspector, with 3 ~a of build~gs on premises, r~lationship to adjoining premises or pubn~ or aL~b~i~J~~n of layout of property must b~ drawn on the diag~m which is pa~ of this appn- ~. 8~e wor~ cowr~ a~tion may not be ~ommenc~d b~fore issuan~ of Bu~ding Pemit. d. Upon approval of this application, th~ Building Inspector will issued a Bufld~g Pe~it to the appelant. Such p~it sh~l be k~pt on the pr~mises ava~abl~ for ~spection throughout the work. ~. No building shall b~ occupied or used in whole or in p~t for any purpose whatever until a Ce~ificat~ of O~cup~y shall haw b~en granted by the Building Inspector. APPLICATION IS HEREBY ~ADE to th~ Build~g Dep~ment for th~ issuan~ of a B~lding P~it pursuant to Building Zon~ Ord~an~ of th~ Town of 8outhold, Suffolk County, N~w York, ~d other app~cabl~ ~ws, Ord~es or R~gulations, for the ~onstm~tion of bu~d~gs~ additions or ~lt~ration% or for r~moval or demoli~on, as k~r~ d~scdbed. Th~ app~cant agrees to comply with a~ app~cable laws, ordinances, bufld~g code, housing cod~, and reg~ations, and to admit authorized ~sp~to~ on pr~mises ~d ~ build~g for nec~ssa~ inspe~ons. (Signature of applicant, or name, if a corporation) Box 1459 Ma~ti%uck, N.Y..~.~. L (~aflin~ address of State ~hether applicant is owner, ~ess~, ag~n~, architect, engineer, ~enera~ contractor, ~¢c~ric~an, plumber or builder. owner Name of owner of premises ........ Love. L~ne · Acq,uis.iq~ion. corp ................................... ~as on the tax roll or latest deed) If ap, plicant is a corporation, sign~.Lure of duly authoriz, e.d officer. (Nam~Jand title ofco~pordte officer) ' Builder s License No .......................... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ........ Sa'u~zh. tlasL, o. zde. first. ~.nd. M~'~in. s.t House Number Street Hamlet County Tax Map No. 1000 Section ..... ~17 ......... Block .... 8 ............. Lot. lB ................ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy.of proposed construction: a. Existing use and occupancy .... .V. acan:o ......................................................... b. Intended use and occupancy ........ Bo.a~. · s.t.¢r.aqe ............................................. 3. Nature of work (check which ' ' apphcable): New Building .......... Addition .......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work..E. eo¢.e. ....... i (Description) 4. Estimated Cost .......... $.~,5OD ..................... Fee ...................................... (to be paid on filing this application) 5-. If dwell'ng numb of dwelling[units Number of dwelling nits on each floor i ) er ............... u ................ If garage, number of cars . '6 If b ' 'al o 'xed .o,.ccupancy specify ature and extent of each type of use , uslness, commercl r mi , n ................... ~s~,'i~:any: pt Rear Depth ' ' 7~ Di ensions of isting stmctu · m ex r .............................. Height ............... Number ...................................... Dimensions of same structure with alterations or additions: Front ' Rear Depth .................... i · ' Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction Front ............... Rear ............... Depth Hexght ............... Nur0ber of Stories ............................................ 9. Size oflot: Front .... 211'. and 272' ' , d ' p .............. ."'. ..... .............. Rear ... 2%.1,..~r~ .... 2.20. .... De th 250' 10. Date of Purchase ......... ~/.9.4 ....... . ......... Name of Former. Owner . .8J}~..m.rp. qk.. 11. Zone or use district in which premises are situated ....... Fiar;Lr~q. ¢ .................................... 12. Does proposed construction vioiate any zoning law, ordinance or regulation: ..no ............................ 13. Will lot be regraded ......... ino ................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises 2h~ve. r.ane. ~cquS.~ Address l~OX .~45.9..I~9.t:.5,~.. Phone No.~9..8'r.8.4.2. Q ...... Name of Architect .~ Address Phone No Name of Contractor ' Address Phone No 15. Is this property within 300 feet of a tidal wetland? *Yes .... X... No ......... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ail! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ¥ORK.~ ./__ .. COUNTY OF,..~h.~h .ff.O.~].,.,;'S ............." -- ~ ~.~.(.'6.~. · ~;..'. ~0.V~ ~ .......... being duly sworn, deposes and says that he is the applicant (Name of indi6idual signing ~ontract) above named. H~ is th~ ................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this application; that ail statements contained ~ this application are true to the best of his knowledge and belief; and that the work w~l be perfo~ed in the m~ner~ set forth in the application filed therewith. Sworn to before me this ~ -? . .............. !~...~ .... dayof ~~., 19 ?¢ Nota~Public ....... ;~j ..... ~~'. County ,~ ~~ ~