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IIJSULATIOPI PER N. Y. . •
STATE ENERGY
CODE
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
+ TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N~ 17229 Z Dote ........~.......~...4 19..~..$
Permission is hereby granted to:
.DD~........tf ~...~.~.n...~r.~v'!9.a!'1:P.1:11....~d.
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..............................................................................A.................................................................................
at premises located ot ..~l7~.~......L.~....~.....~.R.4K....~
Caunty Tax Map No. 1000 Section ........~~.~........ppBlock Lot No.....4..~...........
pursuant to application doted ........~.•••A 19.~.g, and approved by the
Buildfng Inspector.
Fee
.cry
Building Inspector
Rev. 6/30/80
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J ~.-~~~lt~~~`~, ~I~`'II'"=,~~: BOARD OF HEALTH
~~~~~.'.~.~:,~-~?.ww~.~_.~ ~t 3 SETS OF PTsANS
~I FORM NO. t SURVEY .
r B~~B ~ TOWN OFSOUTHOLD CHECK .....l~
BUILDING DEPARTMENT sar2lC FoRrf
TOWN HALL
BLDG. pEi'7.
TOWNUFSOUTHOLO ~ SOUTHOLD,N.Y.11071 NOTIFY t~
TEL.:765-1II02 CALL .7.%~~..~Jo.~~,,,,,,,
MAUL T0: ~v
Examined (.R...., 19`~.~ (~0~ p~,
Approved ~..~.9...., 19~~. Permit No. ~.7 ~19.~
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Disapproved a/c J
~d..l,.. a"L~
(Building Inspector)
APPLICATION FOR BUILDING PERPAIT
Date .
INSTRUCTIONS
a. Tlus 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 t]fis 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
Re;ulations, 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 in ections.
- . ~~)1 i~ .
Signatur t"applicant, or name, if a corporation)
' (Mailing address of applicant)
State whether applicant is owner, lessee, .agent, architect, engineer, general contractor, electrician, plumber or builder.
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Name of owner of premises ...5~~~. ~~...V.R~` ~!~U , , , ~ ~,ftt~l~-,(~,~(l) (~'/U(~iD~.'~~~('~r'}~~y~QW~(,y
(as on t~e 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. ~
~cu/~n P~-~:. i....... .
Plumber's License No. ..~..r1/~~ , C~C'_~~'Xn'? 1 t~1 e~
Electrician's License No. .~..~~,..e;l.e.~:er. m) f7~~
Other Trade's License No . .
1. Location of land on which proposed work will be done . .
3~~o Cox NecK ~:Ir~I~.r~t~.
House Number ~ Str~e " " " '
QQ J~Hamlet
County Tax Map No. 1000 Section ~.l o.. BI'ock ..~U i~p Lot. lJ~!~d Q~~
Subdivision filed Map No. Lot .
(Name) 1'
State existing use and occupancy of premises and intended use apd Deco
Q 1 p ncy of proposed construction:
a. Existing use and occupancy .......d~•~-~• • 1. ! . ~.~~1~•/~• . • . •
a .
b. Intended use and occupancy .....~~~.....~1-i`>`J•,~,~1,Q '
3. Natu
P re of work (check which lapplicable): New Building , Addition Alteration ,
Re air moval Demolition
4. Estimated Cost J.~ ~.~Q escription)..
.Fee .
t
(to be pard on cling this application)
f dwelling number of dwellrrj
g n g units , , , , , , , , , , , , , Number of dwelling units on each floor , , I • , • .
P Y. P Y
7. Dimens ons of e stmglsotructrr
s,lf an anProntecittr're and extent of each t pe o use .
Y~ 4~...... Rear Depth
He.i°ht Number of Stones ' • •
vZ ..~y
Dimensions of same structure With alterations or additions: Front ..da,,$; , , , , , , , , Rear ..vr~,~(,
P ~ . ; Height o .
De th • , , ~ , , , Nuntbc of tones .
Nu ate.-.. .
• traction: Front off. . >.G Rear ..oZd.~...~.. , ...Depth .044 ~Q... .
~Dimj nsions of entire new cons'rnber of Stories , . , , , • • ; • . • •
Hcr~ tt , , ,
Size of lot; Front
] 0, Date of Purchase • ~ ' ' ' ear e t 1. .
P A..I...l Noma of Donner Owner 11,'3'. ~f~n •tt~
j..... .
1 1. Zone or use district in which remises are situated ,A , , , ' ' ' Q' ' ' ' '
12. Does proposed construction vrplate any zoning law, ordinance or regulation: • ~ •
13. Will lot be re°raded
° P ~ • • • • • • • • • • • • • • . • Will excess 611 be removed from premises: Yes ~ No
14. Name of Owner of remises , , , , , , , , , , , , ,Address .
Name of Architect "•••••••••••••••.PhoneNo
Hama of Contractor . . ~ ..........Address ...................Phone No................
..Address . ,Phone N
IS.Is this property looted within X00 feet of a tidal wetland? * ES..,.NO.... '
*If yes, Southold To~,n Trustees Permit may be required.
. I, PLOT DIAGRAM
Locate cleazly and distinctly all 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. i~
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STATE OF NEW YORK,
COUN'T'Y OF 5.S
(Name of individual signi' ' ' ' ' ' ' ' • • being duly sworn, deposes and says that he is the applicant
erg contract)
above named.
He is the
(Contractor, agent, corporate officer, etc.) • • ~ ~ • • • • • ' '
of said owner or owners, and is duly,' authorized to perform or )rave performed the said work and to make and file this
application; that all statements contaiined in this application arc true to the best of his knowledge and belief; and that the
work will be performed in the mannenset forth in the application Glcd therewith.
Sworn to before me this
~ ......day of .'I y~"-QC.1 ,
°j~~ ~ /IV fJ 1 t~.. .
Notary Public, , .h~J4'~/. , ,7}, {V ~fJ Ud ~Q; , • • . • , • , County
HELEN K OE VOE • . ,1, , Y Lam, l./, 1JiJ, , , .
~Ik~4707B
B; Su
ulkO
w~ (Signature of applicant)
Term EMpires March 30,19
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_ E N ER~Y CODE CALCULATIONS ~~oa NON-ELEGT2/L Ear)
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Fo.a : J~ot~G 9>7 ~ PEa. ~\vN 4s . f'en ~e --Ir /y 7~5T DES/yN Ca/rEa.< 0OO ~E4AEE L)dYS
DATED - O" A. ~ /O F S. A~ ~ 70 F
~UBSYSTE/\~ AREA ,Q LJESnyN A~cowcc ~cs~4N A/1owEO ,Q.E/~\,4RKS - ~
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EXTEQ/~Q \VALLS (l.~,Q~SS) O./7
EXTEQ/Qa ~vaLts (oGeQUE) ~ rf'O ~ 0.05 i~'3 0
C,>,GL1 Z /Nl.~ LI a~ ~ O 0.58 Z 7 ~ `4
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1NF/LT,C.AT/ON 3 ~ u~ O'O/8 ~f I o ~ '
/U~TES To-r,acs j~ Z 5
.~04 NEWY
1) HEATING EQUIPMENT TO MEET 7813.23 - 75$ EFF. TO THE BEST OF MY KNOWLEDGE, S<'~NCE M. TbO~T
T
HEATING CONTROLS TO MEET 7813.13 BELIEF, AND PROFESSIONAL ~
RANGE 45 TO 75 DEGREES FAHRENHEIT. JUDGEMENT THESE PLANS ARE ~ u r
3) WATER HEATING PER 7813.31 THRU .38. IN COMPLIANCE WITH THE CODE. ~
4) PIPE INSULATION 7813.19 'tp0 o32]SL-t ~@"
5) WINDOWS -DOABLE GLASS. 9~FESSIONPti
6) CONSTRUCTION TO MEET N.Y.S. ENERGY CODE. - ,i
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