HomeMy WebLinkAbout19549-z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-20260 Date OCTOBER 3, 1991
THIS CERTIFIES that the building ADDITIONS
Location of Property 4775 PARADISE POINT ROAD SOUTHOLD N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section 81 Block I Lot 24.5
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated NOVEMBER 23, 1990 pursuant to which
Building Permit No. 19549-Z dated NOVEMBER 29 1990
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 ADDITIONS TO EXISTING ONE FAMILY DWELLING AS APPLIEII FOR.
The certificate is issued to EDWARD M. CUNNINGS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. PENDING - SEPTEMBER 30 1991
PLUMBERS CERTIFICATION DATED SEPT. 24 1991 - MATTITUCK PLUMBING
Bui ding Inspector
Rev. 1/81
~'O N®. a
TOWN SOt~THOLD
BU!!,DlNG ®Ei~ARTAAIcNT
TOWN HALL
SOIITHAL®, N. V.
CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL
COMPLETION 01= THE WORK AUTHORIZE®?
3
........~~:`.7.:L...... 19.~'.~
N°_ 19 5 4 9 Z Date
s
} Permission is hereby granted ;
~ .
....1 c?~.....~. .7
...:.......~.:y.....~.~
3
ro ~....4?,~~ ~ o ..tea.... .
/5 ~ 5
J. • . •i....M. e.... •..........a ....................r.e re.........s ......a..a. a......
at prerr~ises located at .......~...~:~......!'.-:~4............
Caunty Tax Map Na. 1 QQ4 Section ~loclc .Lot No....~.~:.
pursuant to application dated ..~.~:'.`.~::::~:......1::~,.........., 19.x. d., and approved by the
Su}Iding Inspector.
Pee s.~.~.!~.:.~.~..
f3uilding inspector
Rew. 6/30/$0
yS ?p( Corm No. (i
L° L7\4l
L_~ ~ I TOSJN OF SOUTIIOLD ~
BUILDING DEPARTT•iBNT
QCT - P I99I ~ TOtdN BALL ~..!%C'~C~l~t~,u/ .
!ie ~6s-1sQZ (~•6•(t3~ 1057
,ii~~fi ~A..~A~~,..~o~-~~~ y. f?9'd{~
TCn^~`S Cis- .D~J'iNt7i Y~ i APPLICATION FOR CGRTIPICATE OP 'OCCUPANCY
1. 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 Copographic features.
2. Final Approval from Hesleh Dept, of water supply and sewerage-disposal(S-O form).
3. Approval of electrical installation from Board of Cire Underwriters.
4. Sworn statement from plumber cerCifying that the solder used in system contains
less than Zj10 of 19, lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code C,anpliance from archi_ect or engineer
responsible far the building.
b. SubmiC Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showint all property lines, streets, building and
' unusual natural or topographic feacures.
2. A properly completed application and a consent to inspect signed by the applicanC.
If a Certificate of Occupancy is denied, the L'uilding Inspector shall state the
reasons therefor in writing to the applicant.
Fees '
1. Certificate of Occupancy - New dwelling 725.00, Additions to dwelling $25.00,
AlteraCions to dwelling $25.00, Swimming pool 525.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses 550.00.
2. Certificate of Occupancy on Pre-existing Building - 5100.00
Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15. 0, Commercial 515.00
//FF 9t
Date /,v. /
ew Construction........... Old Or Pre- xi'sntin_g wilding.
ocation of Property
House No. Street Hamlet
ewer or Owners of Property...~-ri::'V.4`p:`:e34
,unty Tax Map No 1000, Section...0 V ~.......Bluclc....~ .........Lot.. ~
bdivision .Filed Afap............Lot......................
~~f/ Cfi /
rmit No. f ~ z'...Date Of Pcrmi.t...// z~{.y ~....Applicant
alth Dept. Approval .........................///.Underwriters Approval.........................
ginning Board Approval
west for: Temporary Certificate........... Final Certicate...........
Submitted: ~~~1K /,x
Il ~1 ~~3 APPLIC.lNT ~IU/UUU/
C(~~_`111D~P„f1
THE NEW YORK BOARD OF FIRE UNDERWRITERS PACE 1
1001071 ~ pUREAU OF ELECTRICITY (~~jp~
85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ V
pate OCTOBER 11,1991 Application No. on file 73811291/91 N 2078'0
THIS CERTIFIES THAT C ~`-`~j V`~
only the electrico! equipment os deecrihed 6eldw and introduced 6y the opplicont nomad on the ohooe opplic on
nC~n the practises of
EDWARD CUNNINGS, PARADISE RD. LAST ON LEFT, SOUTHOLD, N.Y.
in thefo/louinR location; ®Basement ® Ist FL ®Ynd F1, OUT Sertion Blcek Lot
uws examined wt SEPTEMBER 30,1991 ondfound to be in contplianre ullh the requirements o(this Board.
FI%TURE KEPTAClES SWITGNES FIXTURES RANGES COOKING DECKS OVENS DISHWASHERS EXHAUST
FANS
OUTLETS INCANDESCENT FWCNIEECENT OTHEfl AMi. K.W. AMi. K.W. AMT. KW. pMt K W AMC H P
31 8 31 25 1 ~
DRYERS FURNACE MOTORS ~ F{ITURE. A?PIIANCE FEE[Ni.R$ ;PECIA/REt'PT 71ME CLOCKS 'gEll UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K.W. al H: P, aAS H.P. AMU wo.~~ A. w.c hXRr.' AAMJ ~~Ax~T.~AMPS. TRANS. iwx, q, P. SYSTEMS AMT_ wails
NO.OF FEET
4 F 1 30 1 0 '
SERVICE DISCONNECT NO.OF 5 E R V 1 C E
AMT. AMP. TYPE METER i N tW i .F 8W 31F JW 3,e ~W NO. OF CG COND. A W G NO Of HbIEG A. G. NO OF NEUTRALS A' W G'
EQUIP. PER a OF CC.COND. OF M4lEG OF NEUiRAt
Y
OTHER APPARA7U5:
ELEC. ROOM HEATERS:1-1.5 K.W. } ~ ' r- ~ y j Z
MOTOR5:1-0.5 H.P. '
1
G.F.C.T:-3 t -~a~~n-~
SMOKE DETECTOR:-2
G & S CONTRACTOR' LIC.#578-E C//~~
BOX 215
SOUTHOLD, NY, 11971 oENERA? MANAGER' /
11
Per
Thii certificate must not be altered in any manner; return to the office of tha Board if incorrect. Inspectors may be identified by their credentials.
TEL.7G5-1802
~o5~Ff0lliC~`~ TO'4VN OI' SOY1TIIOd,D
~ OFFICE OP BilILDItiG IN5PEGTOR
~ ( ' „ ~ P.O. BOX 728
;t~~~
c°nE ° Y TOtiVNHALL ~ ~ t`t`~,i~~~jt~1,L11js,'~.~,,,w.
O ~ 't SOUTHULD, N.Y. 11971 ,~i _ ~ ~ - ~ - - ; [ ,r?~
O
~~01 ~ ~yyggf((i SAP ~ 5 i991 '
k„
7 a.?t a r e~
C E R T I F I C A T I O N ~ " ~ .`2`.~t r,
Date q
Building Permitdd No. 1~
owner F ~uar~I CvmfY#l~
(please pr(int) ~
Plumber ~d„~~~,~ue>IL. P'1~lYI~Ornat i,.~, l.~nTf
(please print) ~ i
I certify that the solder used in the water supply system
contains less than 2/10 of to lead.
- iplumber' si ture)
Sworn to before me this
Not ~ Public
Notary Pu61ic,~~6~~~ County
i
EORN F.JINMtSON
11oY~y P
Alb
•~758t1aw Yak
dbAAed In SuNalk Countg
Term Expires Feb, t6, F9"7.~.
~X~'~-^..:~ TETr.7G5-iS01
pS~~F~~K~oG~ TOWN Or SOUTIIOLD
li`-~ (,;;,,~*::~..c OFFICE Or [lUILDING iNSI'ECTOR
c {)'~'`'3"" rn r.0. (30;C 723 . .
fit- SOUTfIOLp, N.Y. 11971
O
,~~1 September 30, 1991
VICTORIA HOMES, INC.
P. O. BO% 1057
SHELTER ISLAND, NY _11964
RE: EDWARD CUNNINGS
To S•lhom This May Concern,
S^!e arc unable to complete your Certificate
of Occupancy because of the following reasons.
/x/ nn application for Certificate of Occupancy
i : not on file. (ENCLOSED)
Clo Underwriters Certificate on files.
'flic checl; is (~/not on file. )$25.00
No 11ca1Ch Dcpt. P.pproval on File.
Clo final i.nspccCion ha> been made.
Ple~~e contact our office on this matter.
Thant. you for your cooperation.
Ouildi.nq rcrmit if 1 9 5 •4 9 Z
Clu.tldi.n<i Dcpt.
Llo rlumber So.l.cler Certificate on file.
( all permits involving plumbing being
i:~ucd afCcr April 1,1904 )
cc: Eduard Cummings
1::.iD.'I,:S:'EC:I0,7 ~,De„E ( OOMMENT°
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P,OUGH FRAME &
PLUMBING
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STATE ENERGY
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TRUSTEES do : SCOTT L. HARRIS
~r ~ Supervisor
Juhn M. Bredemeyer. 111. President ~ ~
Henry P. Smi[h, Vice President y'~O1 ~aO! Town Hall, 53095 Main Road
Albers J. Krupski. Jr.
P.O. Box 1179
John L. Bednoski,Jr.
John B. Tuthill Southold. New York 11971
BOARD OF TOWN TRUSTEES Fax (516) 765-1823
Telephone 15161 765-1892 TOWN OF SOUTHOLD Telephone (5161 765-Iri00
October 24, 1990
Roy Haje
En-Consultants
1329 North Sea Road
Southampton, NY 11968
- RE: Dr. Edward Cummings
SCTM #1000-81-1-24.5
Dear Mr. Haje:
The Trustees reviewed your application submitted by Roy Haje on
behalf of Dr. Edward Cummings, for 2 additions to existing
dwelling. After an on site inspection by the Board of Trustees,
it was determined that this project is out of Trustees'
jurisdiction.
All other approvals that may be applicable should be secured
prior to the commencement of the project.
.Very truly yours,
S~
ohn M. Bredem~yer, III
President, Board of Trustees
JMB:jt
cc: CAC
Bldg. Dept.
1File
I!~ ~=~r'' E , f.
I
New York State Department of Environmental Conservation
Region 1 Headquarter ~8, ~95~0
SONY, Building 40, Stony Brook, NY 71784 DP.TE:
? ,v, ~ _
~°'y"r' Re: /-y938-a~i~ ~oo~/-e Thomas G Jorling
-'"Y`yJ~ ,nys~J Commissioner
~ 1~?- ~~clC 97/ Lac '`oL,
Dear ~,~-'^~°.~."y.~-:
A review has been/made of your proposal to: DD U•o(t~i.l[~~=~-
~
Based on the information you have submitted, the New York State Department
of nvironmental Conservation has determined that the parcel
project is:
Greater than 300' from inventoried tidal wetlands.
_ Landward of a substantial man-made structure
greater than 100' in length which was constructe prior to 9/20 77.
_ Landward of the 10' above mean sea level elevation contour on a
gradual, natural slope.
j( Landward of the topographic crest of a bluff, cliff or dune which is
T greater than 10' in elevation above mean sea level.
Therefore, no permit is raquired under tha Tidal Wetlands Act (Article 25
of the Environmental Conservation Law). Please be advised, however, that
no construction, sedimentation or disturbance of any kind may take place
seaward of the 10' contour or topographic crest without a permit. it is
your responsibility.to ensure that all necessary precautions are taken to
prevent any sedimentation or other alteration or disturbance to the
ground surface or vegetation in this area as a result of your project.
Such precautions may include providing adequate work area between the
10' contour or topographic crest and the project (i.e. a 15' to 20' wide
construction area) or erection of a temporary fence, barrier, or hay
bale berm.
Please note that any additional work, or modification to the project as
described, may require authorization by this Department. Please contact
this office iE such are contemplated.
Please be further advised that thisaletter does not relieve you of the
responsibility of obtaining any necessary permits or approvals from other
agencies.
Very truly yours,
C d.~,?,-~ C~~-~p
Deputy Regional Pe it Administrator
- -----r
ltd
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T65-1802
BUILDING DEPT. ~
INSPECTION
[ ]FOUNDATION i5T [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ INAL
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765-1802
BUILDING DEPT.
1 NSPECTIC)N
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ INAL
REMARKS:
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USER'S INFORMATION MANUAL
UPFLOW OIL FIRED FURNACES
DO' NOT' DESTROY FOFi YO11Fi SAFETY
PLEA3)r READ CAREFULLYAND KEEP l7O NOT` STORE OR USE FLAMMABLE
IN A SAFE PI,.AC~ FpR FUTURE YARORS OR E?(~UIDS IN THE VICINITY OF
,REFERENCE. THIS OR ANY OTHER APPLIANCE.
~ ~ ~ ~ ~ ~ yl/ARN[NG.
IMPROPER INSTALLATION,. ADJUSTMENfi, ALTERATION ,SERVICE OR MAINTENANCE CAN
CAUSE INJURY'OR PROPERTY DAMACaE. FOR ASSISTANCE OR ADDITIONAL INFORMATION
CONSULT A OUALIFIED INSTALLER OR SERVICE AGENCY.
CAUTION: READ THESE INSTRUCTIONS THOROUGHLY 9. Do not attach any kind of device to flue or vent.
BEFORE ATTEMPTING TO OPERATE OR MAINTAIN THIS
FURNACE. 10. Do not attempt to operate this furnace if any part has
been under water. Immediately call a qualified service
This furnace has been designed to give you many years technician to inspect the furnace and replace any part
of efficient, tlependable home comfort. With regular of the control system that has been submerged.
maintenance, this furnace will operate satisfactorily year
after year. Please read this manual thoroughly to familiarize HOW YOUR SYSTEM OPERATES
yourself with operation, maintenance and safety procedures. During the heating season the operation of your furnace is
DEVICES ATTACHED TO THE FLUE OR VENT FOR THE automatic. Your installer has provided a wall mounted
PURPOSE OF REDUCING HEAT LOSS UP THE CHIMNEY thermostat which is sensitive to the surrounding air
HAVE NOT BEEN TESTED AND HAVE NOT BEEN temperature change. When the air temperature surrounding
INCLUDED IN THE DESIGN CERTIFICATION OF THIS the thermostat decreases, the thermostat switch will close
FURNACE. WE, THE MANUFACTURER, CANNOT AND and start the oil burner of the furnace.
WILL NOT BE RESPONSIBLE FOR INJURY OR DAMAGE
CAUSED BY THE USE OF SUCH UNTESTED AND/OR As the flame from the burner warms the heat exchanger,
UNCERTIFIED DEVICES, ACCESSORIES OR the fan control willafferatimereachit'stemperaturesetting
COMPONENTS. and start the circulating air blower. Warm air will now
circulate from the supply registers throughout the dwelling
SAFETY and return to the furnace through the return air grille(s).
WARNING: IMPROPER INSTALLATION, ADJUSTMENT, When the air temperature surrounding the thermostat
ALTERATION, SERVICE OR MAINTENANCE CAN reaches the thermostat setting, the thermostat switch will
CAUSE INJURY OR PROPERTY DAMAGE. CONSULT A open and the oif burner will stop operating. The heat
QUALIFIED INSTALLER OR SERVICE AGENCY FOR exchanger w(II cool and the blower will stop operating.
SERVICE AND ASSISTANCE.
CAREFULLY FOLLOW THESE SAFETY RULES: GENERAL INFORMATION
1. Keep the air filters clean. Your heating system will
1. Disconnect electrical power before servicing appliance, operate more efficiently and provide better heating more
economically.
2. Do not alter any burner adjustments,
3, Do not attempt to start burner with oil or vapors in the 2. Arrange your furniture and drapes so that the supply
and return air registers are unobstructed.
combustion chamber.
4. Keep area around furnace free and clear of combustible 3. Keep doors and windows closed. This will reduce the
materials such as gasoline, flammable vapors and liquids, heating load on your system and increase the efficiency
rags and paper. Do not use furnace area for storage of the furnace.
purposes or as a broom closet. 4. Avoid excess use of kitchen and exhaust fans.
5. Use only No. 2 fuel oil for this furnace. Do not use S. Do not permit the heat generated by televisions, lamps
gasoline, crankcase oil or oil containing gasoline. or radios to influence the thermostat operation.
6. Do not attempt to convert furnace to natural or LP gas. 6. If you desire to operate your system with constant air
7. Maintain adequate ventilation to the furnace. circulation, ask for advice from your service contractor.
e. Do not operate the furnace without all blower doors and 92-22878-01-00
compartment covers securely in place.
LIGHTING INSTRUCTigNS
This appliance Is equipped with ~n automatic electronic MAINTENANCE
ignition device. This device lights the oil burner each time
the room thermostat (closes) calls for heat. See oil bumer WARNING: DISCONNECT ELECTRICAL POWER TO
Instructions enclosed with furnace ~or further detail. THE FURNACE BEFORE PERFORMING ANY
MAINTENANCE 70 THE UNIT.
ELVE 611WILX XE^E S41E,° FILTERS
'^X,u°" °«„X« o ,°„,fl°, AIr filters should be kept clean. A dirty filter retards the flow
of air and prevents proper airflow. Permanent fitters should
SIW1i C1A33 ~ ~ I qL BYflXEP
°„fl„E„ „°E°X be cleaned and disposable filters should be replaced at
P°„X least once a year and more often if necessary.
s«nn°X „EUv
°°E° P"„° ! In a new house the air filter may become clogged within a
JVHCTIXI B°%
SEm„° Eµ short time due to the presence of dust in the air and air
„,°"LX „WS,N° tlucts left over from new construction. For this reason it
&°„~fl M°~~ ° ,Aµ3„°^„EX should be checked more often than stated above.
Your furnace has been factory furnished with a permanent
plastic fiber filament filter, however, your Installer may have
Installed a different type of finer. Consult the appropriate
Instruction below for cleaning methods.
FIGURE 1. COMPONENT LOC'4TION HOW TO CLEAN FILTERS:
WARNING: EXPLOSION OR FLASH FIRE CAN OCCUR Glass Fiber (Disposable)
IF THE COMBUSTION CHAMBEfj IS NOT FREE OF OIL These filters should not be cleaned. They should be
WHEN RESETTING PRIMARYI CONTROL RESET checked monthly and replaced when necessary.
BUTTON. MAKE SURE THAT COMBUSTION CHAMBER 2, Aluminum Mesh
IS FREE OF OIL BEFORE USING} RESET BUTTON. Wash with detergent and water. Air dry thoroughly and
renew coating in compliance with manufacturer's
TO START FURNACE I Instructions.
1. Set room thermostat to highest setting. 3. Plastic Impregnated Fiber
2. Open shut-off valve in oil supply line. Vacuum clean or rinse as conven(ent and reinstall.
3. Close line switch. Burner should start automatically. LUBRiCATI~N
4. Bleed the fuel pump as soon as the bumer motor starts
rotating. To bleed the fuel pumlp, attach a clear plastic 1. Motors without oiling ports.
hose over the bleed plug. Loosen the plug and catch These motors are permanently lubricated. No further
the oil In an empty container. Tighten the plug when all lubrication is required.
air appears to be purged.
5. Reset room thermostat to desirQd temperature setting. 2. Motors with oiling ports.
TO STOP FURNACE ! Add from 10 to 20 drops of Electric Motor Oil or an SE
grade of non-detergent SAE-10 or 20 motor oil to each
1. Set the room thermostat to lovrest temperature setting. bearing. Frequency should be once every two years
for continuous duty or every five years for light duty.
2. Turn "Off° line switch to the furnace. Do not over oil -Excessive oi,ling can damage motor.
IF BURNER DOES NOT START ~I
1. Check fuse or breaker in the furnace circuit.
2. Assure room thermostat is set above room temperature.
3. Check oil level in the tank. '
4. Make sure that oil line shut-off valves are open.
5. Reset the button on the prirrjary control. Wait five
minutes to allow the control to cool, so that Is will
recycle.
6. Depress manual reset button on the motor.
7. After three or four failed atterhpts to light furnace a
qualified Installer should be contacted for service.
NOTE: Do not allow cad cell (o be exposed to direct
electric bulb light or sunlight. L!g'ht may enter through the
air band slots and upset the elec~rfc circuit of this device.
FILTER FRAME
INSTALLATION INSTRUCTIONS
NOTE: Filter frame must be installed on the opposite side of furnace from vent on condensing furnaces.
CUT OPENING IN FURNACE SIDE PANEL
Using impressions in jacket side as a guide, scribe CAUTION: Anyholes in the furnace Jacket must be
cut-out Yines on either side of the furnace. Dri1i seated to prevent products of combustion from be-
hole in jacket side large enough to insert metal ing drawn into the circulating air supply.
cutting shears. Insert metal cutting shears in hole
and neatly cut the opening. After cutting, remove
all burrs.
BACK OF
I I FURNACE
I I
I I
15 I I
FILTER FRAME TABLE
I I
I I FILTER SIZE
~ I MODEL AND QUANTITY
L _ _ _ _ _ _ _ _ _ _ ~ USED PER FURNACE
13/ SINGLE FILTER FRAME 16 x 25 x 1
DOUBLE FILTER FRAME (2)16 x 25 x 1
23 25/, s
FIGURE 1 -SIDE PANEL OF FURNACE
SINGLE FILTER FRAME MODEL DOUBLE FILTER FRAME MODEL
FRAME
TOP ~ INSERT
~ FILTERS
j ~ HERE
INSERT ` `
i FIL7ER5
~ HERE
I
i
i
i
With open end frame toward the front of the furnace, Position filter frame over the opening and flush
slip the hem of the filter frame over the bottom, top with the bottom and both edges of the furnace and
and side edges of the opening. No screws are with open end toward the top of the furnace. With
necessary for attachment. Insert the furnace filter in a #32 drill and holes in filter frame as a guide, drill
the frame. Arrows on the filter edges should point in matching holes in furnace edges. Attach with fib
the direction of return air flow into the furnace. sheet metal screws provided with the frame. Insert
furnace filters in frame. Arrows on filter edges
should point in the direction of return air flaw into
the furnace. Attach frame top.
CM 690 92.17712.01-09
SUPERSEDES 92-77712-01.08
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FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765.1802
Exarnined .^!?.~9., 1994 Received........... , 19.. .
Approved 1~f., 19ga. Permit No. ~.Q Sr~.~
I
Disapproved a/c D l5 ~ ~ C, ~
IM23~
. ~ ~
h........ BLDG DEFT~'?
( uilding Inspector) TOWN OF SOU7HOLD
APPLICATION FOR BUILDING PERMIT
Date 19 .
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 Ruilding Inspector.
APPLICATION IS HEREBY MADE to the Building Depart~rtent 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 inspt,ctions.
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
Stale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name oC owner of premises ....~z!ua/.r4-~:dt...~... ~-'4<.!+:'~}!vlG'.`D.j~? .
(as on the fax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corp~orppat",e officer)
Builder's License No. ......V.':~~"~~I
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of Land on which proposed work will be done. . , , ,r~~`... '
House Number Street Hamlet
County Tax Map No. 1000 Section ~ Block ~ Lot .`..~.:.S.......... 1
Snlydivision Filed Map No. Lot .
(Name)
2. State existing use and occupancy of premises and intendedu~pse and occupancy of proposed construction: '
a. Existing use and occupancy ~7'-~ N~:~..~~~.
b. Intended use and occupancy ~`.Q. , , . , , , , ,
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