The URL can be used to link to this page

Home My WebLink About25857-zFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) FULL PERMIT NO. 25857 Z Date 8, 1999 Permission is hereby ~ed to: C WALLACE MAIN ROAD NY 11! for : CONSTRUCTION OF A MASTER BEDROOM SECOND FLOOR FOR AN EXISTING WITH BATHROOM & UNFINISHED ~ILY DWFLLING AS APPLIED FOR. at premises located at I3557 MAIN RD pursuant to application~ated MAY 14 Building Inspector. / Fee $ 145.00/ 199§ SOUTHOLD 0004 Lot No. 009.002 ~nd approved by the Authorized S lature Rev. 2/19/98 ORIGINAL BUILDING PERMIT REVIEW CHECK LIST Owners Name: ~'IA~I~,: _ ~O~ h~/e, Reviewed: Architect/ Date Engineer: Submitted: SCTM #: District: 1,000 Section: (.01 Block: t~ Lot: Project Subdivision Location: 5~5t] ]q~$/~0~0 Name: Single & separate Requir. e~'~ certtfication: (yes/mo)/ ~' X } ~J' t N 6.1 D t,o c, ll ~v.~,e~ Re.q. ~f Req. '0~ [Front Yard Proposed:__] [Side Yard ~' Proposed: Project Description: [Lot coverage Proposed. .} [Rear Yard Proposed. __.] ¢ AGENCY PERMITS REOUIRED FOR REVIEW Permit N.A. NO YES Number Suffolk County Health Dept. New York State D, E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: Notes: ADDITIONAL COMMENTS: BLDG, DEPT. TOWN OF SgUTI-!OLD l~isappr~ed a/c · FOR14 NO. I TOI~I OF S011THOLD BUILDII'IG DEPARTi4ENT TOI~I HALL SOUTHOLD, N.Y. 11971 TEL: 765-1802 (Building Inspector) 'I~.ICATION, FOR BUILDINC PERI4IT INSTRUCTIONS BOARD OF HEALTH ...~-'; ......... 3 SETS DF/PLANS ............... ~ SURVEY ....................... c.Bc~'~"..~.?.~/. ................. SEPTIC FOP-,I'I ................... NOTIFY: CALL ?~:Z~.5 ....... I4AIL TO: .................... a. 'this applicatian ~,,~t be ecmpletely filled in by ~itef or in ink and sul~itted to the Building Inspector ~ril 3 sets of plus, accurate plot plan to Scale;' Fee according to schedule. \ b. Plot plan ~ring location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed deecription of layout of property ~tmt be dra~ on the fliagr~n ~hich is part of this application. e. The x,~rk ec~red by this application my not be ec~eoced before issuance of Building Penuit. d. Upon approval of this al~lieatian, the Building Inspector ~111 issue a Building Pemit to the applicant. Such permit shall be kept on the premises available for inspection thret~h~t the ~ark. e. No Imilding shall be occupied or used in ~ahole or ia part for any imrpose ~/aatever until a Certificate of Occupancy shall have been granted by ~e Building Inspector. APPLICt~gtCIq IS I~iE~f ~ to the Building l]epa~i~at for the issuance of a Building Pemit purauant to the Building Zone Ordinance of the To~ of Southold, Suffolk County~ ~ ]fork, and other applicable La~s, Ordinances or P~ulatio~, for the constroction of buildings, additions or alteratians, or for renoval or demolition, as herein described. ~he applicant agrees to conply ~ith all appliceble la~a, ordinaaee!, Imilding code, hotmiEg code, and regulations, and to ad, it authorized inspectors on pr~xises and in building for necessm~y inspections. (S(gnature of applicant, or name~if a corporation) / (Plailing address/~f applicant) / is~ lessee, agent, architect, engineer, goneral contractor, electrician, plmaber or builder State lahether applicant ' ........................................ ¥ ................ :' .... ;;'2 ....... ; ....... .... i ................... ....... ...... .............................. · //(~ ~ t~ ~ll ar latest .~ . I~ al~hca~t is a eerporati~t,/, signature oi ~ly authorzzed (l~e and title of corporate officer) Builders License No .......................... Phx~ers License Bo ........... Electricians License No ...................... Other Trade's License No ............. .. .. . , .. I. Incation of land on ~daich proposed ~ork w111 be done .............................................................. ' 5"' ~)~ourtJo,L.~.. .................. ....... .~ ~.:~ Z...ib~..~.. ........ .-~......~..d~.. ................................ Poase Number Street H~nlet o~ ~ ~. ~ ~tian ....o..~/. ....... Bl~ ...... ~.. ....... ~t ...~.:..~. ....... ~ubdivision ...................................... Filed lqap No ................ l~t ............... (~) 2. State existing use and occupancy of premises and i~e~, use and occupancy of proposed construction: a. ~,t~ng ~ ~ oc=~,,~ .... ~.~z~....~.:..~. .... ~.:~...o~... ......................... b. ~t~aed ~ ~ oc~,~ .......... 7' ................ '"'"'" ....................................... J. ~]~ure or ~ori~ tcm~k ~ch appticable): ~ ~ildi~ .......... ~iti~ ......... ~teratlon .......... ~ir ~al ' l~liti~ Orlmr ...... ~ ..... ~ ......... f~ .............................................. (to ~ ~id ~ fili~ this a~li~ti~) 5. If ~lli~, ~mr of ~lli~ ~mits ... ~r oE ~lling ~ics ~ e~ fl~r ................ If ~rage, ~r of ~rs .... + ................................. }~i~,t ....... ~ ........... ,. ~r o[ Storlea ...~ ................ ~pth ...... ~ ........... ~i~r ....... ~ ......... ~r o[ Storle~ .... ~ ....... 8. Di~nsi~ of entire ~ ~st~tim: ~t 3~ ~ar ~& ~p~ .~ ......... t~iO~t .... ~ .............. ~ ~r of Stories ... ....... ................. ~ o~ ~ a~,~i~ i. ~,~ ~t~i~, ~ ,i~ .~<1~d.~ ....................................... ~s ~o~ mt~ti~ viotate a~ ~i~ 1~, o~i~e or re~lati~: ...~ ................. ~ill loc ~ ~ .......... ~ .......... ~ill ~ss Jill ~ o~ ~,it~t ~mD ....... ~,~ ~. ~27..__~ ~ of ~tr~tor ......... re ....... ; ............... . ....~ ss ............... .~ ............. ~ ~ .............. 15. Is d~isp~ ~r ~thiu ~ ~t of n ti&l~tl~? * ~ ....... . .. ~ ......... ~.. ; PLOT DIAGRA~ . Imate clearly ~ disti~tly all ~ildi~s, ~r ~isci~ or ~o~, ~ i~i~Ce all ~t-~ d~nsi~ ~ ~r~ liras. Oi~ strut ~ bl~ ~r or &~ripti~ ~co~ing to ~fl~r interior or co~r lot. RFA'IE G6 Ixl~ SS 03U1~1¥ OF ....................... (~ of i~[vi~ si~it~ c~tract) } (~tractor, a~nt, e~r~rate of[icer, etc.) o~ ~id ~r or ~rs, ~ is duly ~thori~ to ~rfom or h~ ~rfom~ Om ~id ~ m~ to ~ aM file this a~lleati~; that all stat~n~s c~ta'~ in this a~flieati~ are t~ to ~e ~st o[ his ~1~ a~ ~[ief~ a~ LINDA J. COOPER Notary Public, State of New York - No. 4822563, Suffolk, Coq~_ty t lerm Expires December 31,~ (SYgnamre of Appticaut) .t -: h'~ tn~ best of my knowledge, bellief, anti ~,u'iess]onal judgement, these plans and specificat~ :~ 'e in compliance with .the New Yorick State Energy :;onscrvation Code, secbe~/!,~ part ~ _ 'p&g#VIBER cERTIFICATION ON ~ cONTENT BEFORE CERTI~ OF OCCUPANCY SOLDER ~ IN wATER SUPPLY $~ CANNOT EXCEED 2/10 OF I~ IF. AD. ALL & WATER '(ESTING # copper tubing I~ ueed for w~t~r dletftbuflng ~/stem; piping Eh'l! tm UNOERWRITERS CERTIFICATE REQUIRED OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY FEE, ~ r~.~ BY:. NOTIFY BUILDING DEPARTMENT AT ~' / FOLLOWING INSPECTIONS: I FOUNDATION - 'i~NO REQUIRED 'PROVIRE $1~O~-'DET~CTI ~O FOR POURED CONCRETE ALAIBI DEVICES .~ T~ PART. 121,! s. INSULATION 4. FINAL - CONSTRUCTION MUST N.Y3 NUILDINR CODL SE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. PROVIDE OPENINGS FOR STATE CONSTRUCTION & ENERGY EliERGENCYESCAPEAS CODES. NOT ,ESPONSiRLE FOR REQUIRED BY PAR/. 714 OF DESIGN OR CONSTRUCTION ERRORS N.Y. STATE BUILDING CODE. ROBERT I BROWN, ARCHITECT, P.C. drawing title scale. drawing no. ¸,1 issues/revisions. , -~ ~ . , ~ ~BE~T L B~OWN, A~CNIT~CT, P.O. gA~T ~V~TtO~ WE~T E~VAr~ON, - ~ , I i - '~ ' ~ ~ ~' ~ ' ~ -- ~ ~'~ ~ ~ prolecttltle, .......... ~, ' ~ =:~--_ I , ~ ~ __ : ~ UAY ~ ~ 1~9~ ~ I ~ I ROBERT L BROWN, ARCHITECT, P.C. title. title. scale, issue. drawing no. 4qOl 1;0 ~ ROBERT I. client/owner, projec!title. drawing title, date, scale. /~t~/~ issue. ~Y 1 2 1999 drawing no, ref, no. Yqot.