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•OEM NO.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
\\\f'/
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 16 1 ? z Date .9..8.7
Permission is hereby granted to:
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to '..say...G. 4.~ -1......j V
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at premises located at RIP..w1..... ,~p~...o...Q?Orit w....7:. ].J.........? !d (~Qnl....~ P~!~'SI
County Tax Mop No. 1000 Section .ar..... Block ;0......... Lot No......
pursuant to application dated QAA 1 tM 19. .7, and approved by the
Building Inspector.
Fee
.
.
dti ~ S-~ I y6'~ Iding Inspector
Rev. 6/30/80
FIELD INSPECTION DATE COM[ Et~'15
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FOUNDATION (2nd) m
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INSULATION PER N. Y.
STATE ENERGY
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ADDITIONAL COMMENTS: x
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FORM NO. 1
D -
TOWN OF SOUTHOLD 3 1987
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971 g' 'r
TEL.: 765-1802 _TO;•'" c r
Examined 191~~ Received........... , 19.. .
Appro /.tam Zt IcS:?. Permit No.
Disapproved a/c66
(Bui ding Inspector)
APPLICATION FOR BUILDING PERMIT
Date B-L5- 19g7
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 appli a s, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or dem ition, a herein described.
The applicant agrees to comply with all applicable laws, ordinan s, building code, housing code, nd egulations, and to
admit authorized inspectors on premises and in building for nece_ssaipspections.
. .
( ture of applicant, or na 1 a corporation)
.19'11... .
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...kSLtt .
(as on the tax roll or latest deed)
If a cant is a corporation du thorized officer.
S bp-x- ei M Q6..T~Z.2 Co v a.a2.P .
(Name and title of co ate officer) 1' 2$
der's License No. Q
1 4 .
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done.
?4..?1:1PPrc2( r4 . l7aa Pc? 'n . U2.6~w ` o...
House Number Street Hamlet
County Tax Map No. 1000 Section .....2T Block ( Lot I
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 . . . . k-~OMe- .
b. Intended use and occupancy .........~f ..pf-. -'R . I . • p91x'. .
3. Nature of work (check which applicable): New Building Addition ? Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost D 7c7c..... Fee .
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use
7. Dimensions o existing structures, if any: Front -S Fr Rear 2S. Depth "771
. .
Height ..2QF'.r Number of Stories `D`7..... .
Dimensions of same structure with alterations or additions: Front SA~` O-- Rear ..4--.7. . F-T- .
Depth Height Z( Number of Stories Tw.R .
8. Dimensions of entire new construction: Front f~' Rear ~T.... Depth ~ 4 .
Height ? 4. Number of Stories .
9. Size of lot: Front ...7~•.~3.F~r7 Rear ....??:S(P.f~17 Depth .17.C~:bO~i7~j;5~37,~-r
10. Date of Purchase e of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded Will excess fill be emoved from premises: es No
14. Name of Owner of premises Av. 94, A5~+i Addr SU~`~II~~~~~~Zr~ lie No........ .
S4* V6i rt.f P' R • •
Name of Architect Addres 2z3L{sj...... hone No............... .
Name of Contractor) A-t . RCsJCR .C~ #T. PAddress .4a?~. MMY. t~4vRQ•Phone No.?4s16~
so-MA-Mr3 VU
PLOT DIAGRAM
Locate clearly 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.
STATE OF NEW YORK, S.S
COUNTY OF
R' • . : ~ ^'CY(Z being duly swom, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the >~PPENoar ..m R._.Tr?L r -.~~r ? r. .
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained 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 7
`-3./...... day of 19e
Notary Public, N v
!1': xo"'!..Z) County
NOfMt M 3WdNwYMB (Signature of applicant)
No. 4707878, swM C wpb
Tare Expires Morch 30,18 4/
ENERGY CODE CALCULATIONS (~oa Nov-ELEGTR/G <rEAT~
roA: Qn Few XsC11 PE.n. n\VN C,.S /V : 2 cf-li/TE.Ci.4 6000 LE*AEr 6A,-5
SK /ppOs L A N e DATED : L9 7 O• r4. /O F S. A• 70 F
/v 5
~UBSYSTEM AAFA .4 DES/¢t! .A"owso des/y.u A4.4owEo V 8TU44 - 57-U// &EA\,4QKS
EXTEA/DA. \VALLS (4ROS.S) o./7
- XTSAJ4NA WALLS ~C,AttQUE) 62 g ~ p 0.05 /fig O
6.LAZ /N* % 7 % 0.58 2 7/ J
p~2S ! o.yo .36
GE/L/Nl~S / GY~F 43 Z. 3 D , D 0.05 780
FLmQ y3 c ! O.os 130 J
2NF/LTQATION V ~L~,, E) 3 c¢ 0) 0.0/8 3 4-7 0
/Up TES TOTALS /0 7 d O
/
JC. 1
1) HEATING EQUIPMENT TO MEET 7813.23 - 75$ EFF. TO THE BEST OF MY IQJOWLEDGE, ~i E• > 2) HE„iZNC CONTROLS TO BELIE°, AND PROFESSIONAL
RANGE 45 TO 75 DEGREES FAHRENHEIT. JUDGEMENT THESE PLANS ARE 2 Q _ q - z
IN COMPLIANCE WITH THE CODE. - = m
3) WATER HEATING PER 7813.31 THRU .38.
4) PIPE INSULATION 7813.19,' a
5) WINDOWS -DOUBLE GLASS. ~
6) CONSTRUCTION TO MEET N.Y.S. ENERGY CODE. sr 3? 2 5 A Gar
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QF Pi,OpEicTY
MAP
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Fouwlla~ Ora R+N ~LaaR 4'~~^l OCCUR OCCUPANCY OR `
USE IS USE IS UNLAWFUL
WITHOU' NITHOUT CERTIFICATE r-LUMBER CERTIFICAIIv,)
OF OCCU )F OCCUPANCY ON LEAD CONTENT BEFORE
CERTIFICATE OF OCCUPANCY
APPROVED AS NOTED
SOLDER USED IN WATER a 31 $ 7 ,1(,I lad
SUPPLY SYSTEM CANNOT a ATE BY
EXCEED 2110 of 1% LEAD. Ps: 0_Bv
_ NOTIFY BUILDING DEPARTMENT AT
m{ 785-1 BQ2 9 AM; To, 4 FM FOR THE F,0Ui,0vmNG-INSPECTIONS;
- FOUNDATION '1W ! EQUIR€D
TI, a ' N copper tubing is used Fos f ousE AMINE ftfP MRING
for water distributing ROUGE
syster ; piping shall be S. INRULA00r'
~i ~ arm t~ C4.of•t' of typas K or L on 4. RNAL un.aSTRUCTaow MUST - BE C0N1Ff ETE POR C 0
. ALL Com•,TRWTION NSP~lALL MEET THE REO.UiftEMENTS (X-, THE N.Y -
COOS NOT MkiSPONSIBLE FOR
. `p 9°~rb4. F71 aTATE CONSTRLJGT10N S ENERGY +1~aalON iDfi CUNSTPtUCT10h =RRORS
}ice
a~ yil.OFE§7 .N
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11~ J/ 111 /'A J $ . 1 u"'. r ?
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own. x,24 _57 -
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