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Home My WebLink About12091-zTOWN OF ~OUTHOI~D BUILDING DEPARTMENT TOwN HALL SOUTHOLD, N. Y/ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE/~ISES UNTIL ULL COMPLETION OF THE WORK: AUTHORIZED) N.o 12091 Z D,,te ...... ~,...~! .............. Permissiohisherebygronted~o,j~ /~_' / /~'.~, /> i / r'~QT. ' ~'""~ ............... 'i ............ ......... ~.'M ............... ~ ........ ~* ....................... . ................................................. ....................... ~ '~~~ ~' .~...~~' ~:~.~5 ~' ': ' -- ~o.~ ~ ~ ~o. ,ooo ~,,o~.,...!~. .......... ~,~: ~.~...:~o, ~o. :.~.:~ ............. pumuant to applicahon dat~ ...................... , ........................... ~......, 19 ........ ~ and app~ by the Bu~l~lng Inspector. Fee ........................ Building ~lnspectot COMMENTS FIELD ]~NSPECTION 1. ~'OUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-180:3 Disapproved a/c ........ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in 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 streets 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 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 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 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 to admit authorized inspectors on premises and in building for necessary inspectio, n.s. . ..... ~~ ~: '~' ' '~'~'; ' ' ;a'ti~ .... (Si~natu~ of applicant, or name, if a co po ' ) · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nmne of owner of premises ~/7',,~m,~$ ~ ~,~/~ ~'27e~/~ .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.-'~.~..~... ~'~¢ '/ Plumber's License No. t, ,* ' Electrician's License No. ': .... (~ .....~ .......... Other Trade's License No ...................... l. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section .... /./.~. .......... Block ...... .O./...-L~.. .....Lot...t~..~.. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises an. d intended use and occupancy of proposed construction: a. Existing use and occupancy ...... . .~.~.~.~..' .d~.. ............................................... b. Intended use anti occupancy 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition .............. Other Work ............... ..~...d//~' (Description) ooo - 4. Estimated Cost .... '? Fee (to be paid on ~ing this application) 5. If dwelling, number of dwelling ¢nits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... i .................................................... ' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . ~. '~. 7. Dimensions of existing structure3, if any: Front ............... Rear .............. Depilf. .............. Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Num._bet of Stories ............ :'....". ...................................... 9. Size oflot: Front ....... /.~.~.~ .......... Rear .... .).~.~. ............. --~ ~De~:'-'"''"'"'- 10. Date of Purchase ..... f?..-7 .!~ .7. ............... Name of Former Owner . 11. Zone or use district in which pr~mises are situated .............. ~ ........ ~./ ......................... 12.. Does proposed construction vio!ate a.,n~y zoning law, ordinance~0~lcegulation: ... t'.IJCl ......................... 13. Will lot be regraded ......... i /.u.o ............. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ...: ................. Address ................... PhoneNo ................ Name of Architect .......... . ................. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 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 aumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK.. .,..' y ~'~ . COUNT OF ....... . . ~ - - (Name of iffdividd~il signlng contract)/p~ J/,~z~, ' . .~.7-f:~....~..,/d .e-7 .~. SHe is the ................ i~ .......................................... (Contractor, agent, corporate officer, ~tc.) of said owr~er or owners, and is duly authorized to perform or have performed tlie said work and to make and file this application; that ail statements contgined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............ .2.~. ........ day of .~.~-.~e~.~.. ..... 19 Nota~. PuUic,.. .............................. , Count[ ~.~~~ ~ fi' (Signature of applicant) Oeoember 20, 1982 $outhold Town Building Department SouthOld Town Hall Main Road Mew ~ork - 11971 Re: Barn RenovatiOn ThOmas R. Mercier, M.D. New Suffolk Avenue ~. The abOVe mentioned Barn Renovation will utilize 3 1~" (R=11) K~a~t Eaced bart insulation in the walls and (R=19) Kraft faced bart insulation in the floor and the ceiling. The second ~1oo~ will be unheated at this time. nd dooeS will be insulated glass, thermal sidewall area. All windOWS per New york State Building co~eS to permit emergency 3. All construction will con~orm to the New york state Building and Energy Conssrvation COdeS. GAs/iw IJ copper tubing is used ~' - For wofer 8is~ri~ufin9 N ~UILnI~G D~RTME~ AT TH~ REQU REMENTS OF T~E ~.'Y. ~ATE CONSTRUCTION & ~DES. NOT R~PONS~ DESIGN OR CON~RU~I~ Mai,n Road RO. BOX 1412 Southold N.Y. 11971 0ATE i¢/~l~ 516- 765 ' 5455 =.~ .=~