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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-23934 Date OCTOBER 5, 1995
THIS CERTIFIES that the building ALTERATIONS
Location of Property 45 PLATT ROAD ORIENT NY
House No. Street Hamlet
County Tax Map No. 1000 Section 18 Block 6 Lot 1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 15, 1992 pursuant to which
Building Permit No. 20497-Z dated MARCH 23, 1992
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ALTERATIONS, INSTALL ELECTRIC, INSULATION AND HEATING TO
A ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to DEBORAH WINSOR
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO.N322686 8/5/94 N332077 11/1/94 H047147 9/27/95
PLUMBERS CERTIFICATION DATED SEPTEMBER 25, 1995 DEBORAH WINSOR
Q Inspector
Rev. 1/81
rows xo. a
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°-N° 204972 Date 19
Permission Is hereby granted to: 12 vr-r
. ,
I
` / / .
E at premises located at s i
C
i
j County Tax Map No. 1000 Section 6f.... Block Lot No...../
( pursuant to application dated .V/e 19.7..-, and approved by the
Building Inspector.
Fee S•.
.r...7;
ding Inspector
S
Rev. 6/30/80
~ Form No. w
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Hea3th Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4, Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer.
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C'. Fees
1. Certificate of Occupancy - New dwelling, $25.00, Additions to dwelling, 525.00,
Alterations to dwelling $25.00, Swimming pool. $25.00, Accessory building $25.00.
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $20.00
4, Updated Certificate of Occupancy - $50.00
S. Temporary Certificate of Occupancy - Residential $1/5.00,, Commercial 515.00
Date 9/P1~1-~)
New Construction........... Old Or Pre.-existing Building
Location of Property..... ....V1F~:f/.q,.0d
house No. / Street Hamlet
Dower or Owners of Property. D/,-4d-(A'k..V'/,41.Q1.'/ ....w..j
:;ounty Tom Map No 1000, section. ../.V......... BIock....lb'7..,........ Lot.../
Subdivision ...JJ.. .tr~..}... ........y....... Filed Map............ L(ot...I.....,....
Permit No.... (X:~.y.?. ~~...Date Of Permit ..`7(/'~7. AppliCa11 .
IlenlLh Dept. Approval..... ............Underwriters Approval.......... .
'lanning Board Approval
'equest for: Temporary Certificate... Final CerticateAv
ee Submitted:
kw-W 50-101 . . , . & -
'd oc~
1111g: III
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1195039 BUREAU OF ELECTRICITY
F,' BS JOHN STREET, NEW YORK, NEW YORK 10038
Date AUGUST 05,1994 Application No. on file 06200694/94 N 322686
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant "mod on the above application number in the premises of
p/~ 45
DEB WINSOAi PLATT ROAD, ORIENT, N.Y.
in thefollowinR Location; IN Basement ® fat FL ® 2nd Fl. OUT Section Bloch Lot
was examined on JULY 281 1994 and found to be in compliance with the National Electrical Code.
FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS INCANDESCENT FLUORESCENT OTHER MIT. K W. AMT K. W. AMT. K.W AMT K. W. AMT. H P.
16 34 21 16
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTWUTIET DIMMERS
AMT. K. W. OIL H. P. GAS H. P. AMT. NO. A W. G. AMT. AMP. AMT. AMPS. TRANS. AMT. H P. SYSTEMS MAT. WATTS
NO.OF FEET
1 F
SERVICE DISCONNECT NO.OF S E R V I C E
AMT AMP TYPE METER le' ]W 1,9 ]W 3R3W S%AW NO. OF CC.COND. A W.G. NO Of HI LEG A W.G. NO.Of NEUTRALS A. W.0.
EQUIP. PER % OF CC.COND OF HI-LEG OF NEUTRAL
OTHER APPARATUS:
1
ROUGH IN ONLY-1
MOTORSt4-F H.P.
G.F.C.It-7
SM01M DETECTOR:-1
"NoTEt This is a partial, not a
complete certificate.
JIM SAGE ELEC. INC. LIC.#3635-E
350 MARINE PLACE
GENERAL MANAGER
GREENPORT, NY, 11.944 11
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified, by their credentials.'
j COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1.
I'000t4 BUREAU OF ELECTRICITY
Fy 83 JOHN STREET, NEW YORK, NEW YORK 10038
Date N0VF14BRR 01' 1994 Application No, on file 85238794/94 N 332077
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the alone application number in thepremises of
DEB WINSOR, PLATT ROAD, POLE 168, ORIENT, N.Y.
in the following location; ? Basement I st Fl. [N 2nd Fl. OUT Section Block Lot
was examined on OCTOBER 24 , 1994 and found to be in compliance With the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES '-CANDESCENT FLUORESCENT OTHER NAT. K, W, AMT A, W, T. KW. pMT K.W AMT. H P.
4 23 22 4 1. F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI.OUTLET DIMMERS
AMT. K. W. OIL H. P. GAS H P. AMT. NO A. W o AMT AMP. AMT AMPS. TRANS. EE H P NO. OF SYSTEMSFEET AMT. WATTS
SERVICE DISCONNECT NO.OF S E R V I C E
AMT. AMP. TYPE METER L R tW 1 q 3W 3 9 3W 3 0 4W NO. OF CC COND. A. W. G. NO OF HI LEG A. W. G. NO. OF NEUTRAL$ A W G.
EQUIP. PER a OF CC. COND OF MI-LEG Of NEUTRAL
OTHER APPARATUS: -
PARTIAL FINAL-1
FINISH WORK ONLY--1.
S14OKE DETECTOR a
*NOTE, This is a paxtial, riot a
comrlete certfficate.
B.J.ELLC, CO, I
BOX 16,STIMMATER AVE.
CUTCHOMM', NY, 1.1935 GENERAL MANAGER
11.
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE; 1.
8056de14
r BUREAU OF ELECTRICITY
1 85 JOHN STREET, NEW YORK, NEW YORK 10038
Date 8EPTFWIFR 2.7 ,.1995 Application No. on file 10243195195 H 047147
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant "motion the above application number in thepremises of
DEBORAH WINSOR, 45 PLATT ROADry,, ORIENT,, N.Y.
in thefollowing location; 1:1 Basement A lst Fl. El 2nd Fl. OUT
Section Block Lot
was examined on SEPTEMBER 21 , 1995 and found to be in compliance with the National Electrical Code.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST FANS
OUTLETS ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT OTHEn AMT, K W. AMT K W. AMT. KW. AMT. K. W. AMT H P
I
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECPT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K. W. OIL H. P GAS H. P AMT. NO. A. W. G. AMi AMP AMT AMPS. TRANS. AMT. H. P SYSTEMS
NO. OF FEET AML WATTS
SERVICE DISCONNECT NO. OF S E R V I C E
AMT. AMP TYPE METER 1 r 2W 103W 30: 3W 3,e' IW NO OF CC COND. A W G. A. W. G. A. W. G.
EQUIP. PER 9 Of CC. COND. NO OF HbIEG OF 11 LEG NO OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
SMOKE DBTFCTORt-2
*NO VISUAL DEFECTS: "An Plectrical
survey has been made of the exposed
electrical equipment :in the
premises indicatecl." "No ohv.f,ous
unsatisfactory condition was f
DEBORAH WINSOR
445 PLATT ROAD
ORIENT, NY, 11957 GENERAL MANAGER
1 'I
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
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Town Hall, 53095 Main Road Fax (516) 765-1823
P. O. Box 1179 •i Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
C E R T I F I ,C A T I O N
DATE: ')05b6
Building Permit No.
Owner: ~i rrA~ Will 3o,/
(please print)
PI umher: OWYtw'
(please print)
I certify that the solder used in the water supply system
contains less than 2/10 of 1% lead.
(P1 mb(errsn S-ignnature)
Sworn to before me this
-day of I J)I I-,-,19 99
Notary Public, ed!~ Count
Y
HELENE O. HORNE
Notary Public, State of New York
No. 4951364
Qualified in Suffolk Counttyy
Commission Expires May 22, 192
i
~~o~OSpFFOL~~OGy
Town Hall, 53095 Main Road °y = Fax (516) 765-1823
P. O. Box 1179 WO • Telephone (516) 765-1802
Southold, New York 11971
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
April 11, 1995
Ms. Deborah Winsor
45 Platt Road
Orient, NY 11957
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificate of Occupancy is
not on file. (Enclosed)
xx No Underwriters Certificate on file.
xx The check is not on file. $25.00
No Health Department Approval on file.
No final inspection has been made.
xx No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 20497-Z
Please contact our office on this matter. Thank you for
cooperation.
SOUTHOLD TOWN BUILDING DEPT.
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ NAL
REMARKS:
a.
DATE _ INSPECTOR
4
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INS TION
[ ] FRAMING [ INAL
REMARKS:
r
t„
DATE I c INSPECTOR / '~1
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ) ROUGH PLBG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ -T-f'lNAL
REMARKS-. - G ~a
DATE INSPECTOR
pp~
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ L"~tOUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
16,Y#RAMING [ ] FINAL
REMARKS: 6
i
DATE ~d INSPECTOR J`'
c'lEL :7i' i;;W9LNTS
- - O
H ~R
_ y V
?OUt]?ATION (1st)
FOUNDATION (2nd) c+
-I - C
2. d~ f}~117
z
0
TOUGH FRAME & '~LGC
-PLUMBING
N
3.
cri
INSULATION PER N. Y. I C-3 ,
STATE ENERGY
CODE
ill I
FINAL I JO~ cue/ +Gf '~9a Q~a+-o \
ADDITIONAL COMMENTS: m
x~
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5641, 4 Tovvvl) J-, VrV~~~,~~
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2K~fQs 6i 6y- Zol 199,
to le4 l N ~ hr s hcP~'1 or '6o 1 tl ~ 116,Me Jet
if wvl o
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7
BOARD OF HEALTH
FORM No.1 3 SETS OF PLAt1S
TOWN OF SOUTHOLD SURVEY . .
BUILDING DEPARTMENT CIICCK
TOWN HALL SEPTIC FORM
SOUTHOLD, MY, 11071
TEL.: 765-1802 t:OT I FY
CALL >7O1 c..5-7........ .
Examined , , , • , , • • 19 ttn I L TO:
Approved ~0_.~~........ 199~Permit No..~~6,Y,9
Disapproved a/c
Build pector)
APPLICATION FOR BUILDING PERMIT
Date KA:~H..1) 1992
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
,ts 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
)r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
ation.
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
hail 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
hall 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
;uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
:egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
dmit authorized inspectors on premises and in building for necessary inspections.
-1- 1....k&:
(Signature of applicant, or name, if a corporation)
A5• MI r IKQA D 10 4Eti?1 Njv
(Mailing address of applicant)
state whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
0WN F~...........................................:........................
lame of owner of premises. P?b... UJ! N561°
(as on the talc roll or latest deed)
"applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. aDwm,,............. .
Plumber's License No. 1~0.A.~ ~~!1t lb 2306
67 #$E1616'f le-' 5 9
Electrician's License No. ~f.. ~1vaa SaAG.~~jf
Other Trade's License No . • .
Location of land on which proposed work will be done . . .
! . I% ~AI I ill ..124 rv I
(louse Number Street Hamlet
County Tax Map No. 1000 Section . n t8 Block (:z Lot .
Subdivision Filed Map No. Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .e11,~iGt__~ II/?I ~Iy1,1~
b. Intended use and occupancy lV~%lj~~! f~tv~(rlr, (~1ll~Il
V f....
Repair Remopli/blel New Building Addition .Vteration
3, Nature of ork (check which aval q 91f'&W Demolition Other Work , .
4. Estimated Cost 1 py (Description)
Fee
(to be paid on filing this application)
5. If dwelling, number of dwellin"
nits Number of dwelling units on each floor .0/,,
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . J-Tq. .
7. Dimensions of existing structures, if arty; Front , , , , , , , .Rear ..'o. Depth ..?p , , , , , , , , • ,
Height Number of Stories , y, , ,
unth
p with alterations or additions: Front , , • ' • . ' ' •
'!'1~.......... Rear .~7f11~'lFr............
ensions of . same stmct..... Height 4J46it Number of Stories .yam........ ;
$ Height Dimensions of entire new constn}ction: Front . ./j/t
Rear . Depth
Num[?er of Stories .
9. Size of lot: Front ...11O Rear Depth . 10.1 10. Date of Purchase ,2l?r(~/92 Depth
Name of Former Owner .~/,I?O(5~~, r E4N?*Q.
11, Zone or use district in which prctPises are situated ..0/r(, , , • • .
12.
Does proposed construction violate any zoning law, ordinance or regulation: A0 ,
13, Will lot bere°raded .
40 ' ' ' ' • • • Will excess fill be removed from premises: Yes N
14. Name of Owner of remises
p PAW6A//?,i0W • • • • • Address (fj, , OYr+~,,.. Phone No.Cj(4:'32:3 1?
S~:.. .
Name of Architect , ' ' 'p/ ~ t
Name of Contractor . ~j/an u ? ' ' • ' ' • • Address Phone No........ ,
L5. Is this property within 3 " " ' Address N
If 0 feet of a tidal wetland? r
Yes........ Noo. . .
es Southold Town Trustees Permit may be required.
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. ,
II
_ II
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FATE OF NEW YQI~JC
OUNTY/OFV S.S
. . It
• • • t... being duly sworn, deposes and says that he is the applicant
(Na~c of individual signing
ovenamed. er/contract)
is the l.vaG Y.. l dl1VAA . .
(Contractor, agent, corporate officer, etc.)
said owner or owners, and is duly auljhorized to perform or have perfornied the said work and to make and file this
olication; that all statements contained ( in this application are true to the best of his knowledge and belief; and that the
rk will be performed in the manner set forth in the application filed therewith.
om to before me this
.........5 ay of 19
tary Public, ,E S"R~ l 11
County I
ROBERT 1. SCOTT, JR.1
NOTARY PUBLIC. State of
No. 4725089, Suffolk (Signature of applicant)
-Term Expkes May 31, 1W
PLUMBIN~G~p~~
' ALL PLL*mm wAsm
i NMTER ONES NEED ~i Y~7
1ESTING BEFORE COVERING
f LOW,
If coPPer tubing I$ used
for water distributing
system; Piping shall be
0°
ff K5 f L~0('!~ of types K or L only VOI
PLUMBER CERT/F/CAT/ON
01V LEAD CONTENT B -
CERT;f/CA7f OF O EFORE
CCUP
SOLDER USED ANCY
SUPpIy SYS /N WATER
EXCEED 2110 of EM % LEAD.
1 /LEAD, i ~
I
I? LINev wain r~f~c~ ~`"t~
I BATq
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r---~ l I
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I I ~ '(~1NINc6~ I, tii+ I C.S ~ IF I ~ 1.
I I ti _ RI t" i I
-OR
17
- - tell USE SAUNLAVIFU
Y,u^ - r - - - WITHOUT CERTIFICATE
_-I IMI I II, I' z~ ' f T - - t L a
CAF OCCUPANCY
7-
APPROVED AS NOTED
A ~ t !I
DATE. 7~ B. P. N 7 -
FEE: , NOTI B NG DEPAR WNt
AT 765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS: ,
1. FOUNDATION - TWO REQUIRED
JjN fPi~ I f NTKY FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING
S. INSULATION
A
nVUIIV IY IVIUOI
SE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL ME
fluM t+r'af 9. THE. REQUIREMENTS OF THE N.ET Y.
4 ~w~ p r::,nts t<but. s g mcr STATE CONSTRUCTION & ENERGY
DESIGN OR CONSTRUCTION ERRORS
QP ~V uBDO UNDERWRITERS RED TIFICATE
REQU
i I}~.~, NE/}f r,iNN6~,,lun!d~ PL~7 f~f 'r~r ~Et
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