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FORM N0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Ha11
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-19663 Date JANUARY 16, 1491
THIS CERTIFIES that the building ALTERATION
Location of Property 32950 MAIN ROAD ORIENT, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 19 Block 1 Lot 14.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 8, 1988 pursuant to which
Building Permit No. 17684-Z dated DECEMBER 13, 1988
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 ALTERATION TO EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to JANICE LEE THOMAS
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. N-166937 - DECEMBER 31, 1990
PLUMBERS CERTIFICATION DATED N/A
iU.w l~
/ Bu lding Inspe=ctor
Rev. 1/81
!'OHM N0. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN FlALL
SOUTHOLD, N. Y.
BUILDING PERMIT
tTH1S PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N a ~J l f b t3 4 Z Date f. p~.. c'J 19.~U
Permission is hereby granted tQ:
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. G~~R.`.L:~..I.SSJ~.......~4YLi~C•S~S~(•••<etil~l. ...C~i~... ®
/ .GE~pG.. ~
r
ct premises located at ...a~..r~..~~.....,,~ b~-'~•••
County Tax Map No 1000 Section ,r,~.. Block .......1......... Lot No ...~..T.~. .
yyi
pursuant to application dated 19...(l.~~and opproved by the
Building Inspector.
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Fee g..f
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~Bui nQ~ln to
Rev 6/30/80
Form No. 6 ~1~`j'`''~ ~ ~
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. ~ ' ~~yiy TOWN OF SOUTHOLD j a ~ S~
~;t BUILDING DEPARTMENT `
TOWN HALL L"~~~
BLDG DEPT 765-1802
TOWN OF SOUTHOLD,__ ,
APPLICATION FOR CERTIrICATE 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 Health Dept. of water supply and sewerage-dzsposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certa.fying that the solder used in system contains
less than 2/10 of 17, lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installatio*is, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requLrements.
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 >igned by the applicant.
If a Certificate of Occupancy is denied, the Building inspf>_ctor shall state the
reasons therefor in writing to the applicant.
v. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions Lo dwelling $25.00,
Alterations to dwelling $25.OOaFSwimming pool $25.00, Acce:;sory building $25.00,
Additions to accessory building~$25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.0()
3. 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 $15.00, Commercial $15.00
Date ~ C! ,'r',iti?,Q~ lS-:...~~. ~l-'.~
.
':ew Construction. 01d Or Pre-existing Building...~~"-~..~.izj'
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Location of Property. 3~~Sc~...6:?~~.CL~.:~4 ...................~:`~i1~•:'/1.............
House No. Street Hamlet
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'Jnwer or Owners of Property....... ~:~.~'.tG'.~L.....,h.G ~....~.~.G.1/':~.~5
County Tax Map No 1000, Section.....1..f .....Block .........Lot....
Subdivision .File('d Map............Lot....`.-.~.'...............
c"ermit No.li~,~~~:.5 ~t...Date Of Permit../Z %-.~I °.Applicant... .G.~S: .<d~~.....
stealth Dept. Approval ..........................Underwriters Approval...
Planning Board Approval /
Request for: Temporary Certificate..../....... Final Certicate....V.....
Fee Submitted: $,~~~~;~...~d.~~L.t. ~7 ~-i~F
j Y L ~ , . _ ~ » ~ • APPLICANT . w...:zx.~-~~wu+~~
3_..~~
PGE:1
THE NEW YORK BOARD OF FIRE UNDERWRITERS
11.95).12 BUREAU OF ELECTRICITY
BS JOHN STREET. NEW YORK, NEW YORK 10038
Date I)ECfiMBER 3],1.990 ApplicotionNo.onfilr h8626190/9U N 1.669.)7
THIS CERTIFIES THAT
only the akrrtrkal equipment as described 6ekttD and introduced by the applicant named on the obore application number in the premises of
JANICE LEE THOMAS, 37.950 MAIN RIJ, ORLF.NT, N.Y,
in thefollouring location; ? Basement ® Ixt Fl. ? Ynd Fl. OUT 3ertion Block Lot
reaa examined on DECISMBER )"7'1990 ondfound to be in comp/iancr with the reyuirementx of this Buord.
gxTUK RXTURK RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS ECEPTACIES SWITCHES INCANDESCENT F1U011EStlNT OTHER AMT. F. W. AMT. F. W. AMT. F.W. AMT. N. W. AMi. N.I.
. 9 1.1 a 9 1 12.7 1 1..2
DRYEK FURNACE MOTORS FUTUK APPLIANCE 1E~lK SPKIAL RECPi THE CLOCKS EEtt UNIT NEATEK MULTI-0UiIET DIMMERS
AMT. F. W, ql N. I. GAS N. P. AMT. NO. A. W. G. AMT. AML. AMT. AMPS. TGNS. AMT. N. P. ~
~
~ AMT. WATTS
) 6n(]
SERVICE DISCONNlCT NO.OF 5 E R V 1 C E
AMi. AAV. 719E ESP 1 / tW I .e tW t t tW 3 X AW O~RC,COND. ~ C
COND. ~ NI.IFG OF~NI
~lEGO No, of NFUTtADi ~ 'P
EtITGRAI
OTHER APPARATUS:
G.F.C.I:-1.
SAGE & I,ADEMANN INC. LJC.N3635-E
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P.O.BO% 1768
30UTHOLD, NY, 11971. OBNAI MANAWR
I1
" Per ? 1 ! •
This certificate mutt not be altered in any manner; return to the offiw of the Board if incorrect. Inspector[ may be identified by their credentials.
COPY FOR BUILDING DEPARTMlNT. THIS DOPY OF TIFIGITE MUST NOT BE ALTlRED IN ANY MANNER.
-1cLD ILS.E .'Ui. ~~'JhTE I ~OMMLNTS
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FOUt1DATI0N (1st)
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FOUNDATION (2nd) -
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II3SULATIOP3 PER 13. Y.
STATE ENERGY
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ADDITI013AL COt4MEtiTS:
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AMMENDMENT TO BUILDING PERMIT # 17684
In addition to the work cited in my original building permit,
the following tasks were undertaken to strengthen the basic
structure, increase the insulation value and stop the leaks
in my home.
Removed crumbling, bowed plaster lathe walls.
Framed interior walls with 2x4 studs.
Sistered beams and stringers on main floor.
Installed zip columns and beams in basement.
Upgraded electric to code. Jim Sage to provide underwriter's
certificate before final approval.
Replaced leaking patio door upstairs with 5' slider.
Resided exterior wall and flashed where wall meets one-story
kitchen roof.
Removed Leaking one-story kitchen roof and replaced with
new sheathing and vented roof.
Flashed and trimmed one-story mudroom roof where it joins
new one-story kitchen roof.
Removed old double-layered gabled roof of main house and rotten
fascia boards and replaced with new roof and fascia.
Removed leaking window in bathroom and installed single
stationary skylight to replace light source.
Removed old interior chimney and built new exterior chimney
on East end of house in order to bring new heating system
up to code.
Will install new oil fired hot water heating system including
a new cast iron boiler, water heater and fuel tank.
Janice Thomas
April 23, 1990
~/~~j°
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f~ rss-isoz
BUILDING DEPT.
INSPECTIOIN
[ ]FOUNDATION 1ST ( j ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[~MING [ ]FINAL
REMARKS:
0~2 ~C - -
DATE 'L" ~ INSPECTOIi~
765-1802
BUILDING DEPT.
tNSPECTIQN
[ ]FOUNDATION 1ST ( ] ROUGH PLBG.
[ ]FOUNDATION 2ND INSULATION
[ ]FRAMING [ ]FINAL
REMARKS: /T,___y~l~~?1 D
DATE INSPECTOR ~
~ ~ ~
T65-1802
BUILDING DEPT.
f NSPECTION
(]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] INSU TION
[ l FRAMING [ FINAL
REMARKS: _ d -
DATE INSPECTOR ~
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BOARD OF HEALTH
FORM N0.7 3 SETS 0~ PLANS
SURVEY
TOWN OFSOUTHOLD CHECK jt
BUILDING DEPARTMENT SEPTIC FORM
' TOWN HALL
vOUTHOLD, N.Y. 11971 NOTIFY
TEL.: 765-1802 CALL .~~.-.~.$~~~."~4,..
Examined ~~~~.r~. 1~~ MAIL T0:
,~f 6 -i~9S0 ~Q~
Approved ..F../ 19 .u.`Permrt No. . ~
Disapproved a/c , +r}~ I ~G`~ L~ ~ lJ t5
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~-~~~'~iL ..1. .,a.... ~~~'''~'--~..~.(i
(B t me nspector) TOWN
OF SO Pr
APPLICATION FOR BUILDING PERMIT 11Tfi0t.D
Date~N,c;e,;,;~~r- . ~ 15
INSTRUCTIONS
a. Tlus application must be completely filled rn by typewriter or rn ink and submitted to the Building Inspector, wit
sets Qf 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 pub&c stn
or areas, and giving a detuled description of layout of property must be drawn on the diagram which rs parC of this ap
cation.
c. The work covered by this application may not be commenced before rssuance of Building Permit.
d. Upon approval of this apphcatron, the Building Inspector will issued a Building Permit to the apphcant. Such pe.
shall be kept on the gremrses available for inspection throughout the work.
e. No buildurg shall be occupied or used m whose or in part for any purpose whatever until a Certificate of Occupa~
shall have been granted by the Building Inspector
APPLICATION IS HEREBY MADE to the Building Department for the rssuance of a Building Permit pursuant to
Buridmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance=
Regulations, for the constructron of buildings, addrtrons or alterations, or for removal or demohtron, as herein descnb
The agphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on gremrses and in building for necessa//iy ins ctrong.
ignature oi' applicant, or name, rf a corporarron)
(Marling address of apphcant)
State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build
Ot~l~ ~.~.s...`~.~~ .
Name of owner ofpremrses ....~.~!L't~.Ct ....h~.~....l.N.Oi?'1.A-S
(as on the tax roll or latest deed)
If applicant rs a corporatron, signature of duly authorized officer.
.
(Name and title of corporate office~r)f
Builder's License Na - 9..~1.~. . .
Plumber's License No
Electrician's License No -
Other Trade's License No . . .
1. Location of land on wluch proposed work w91 be done . .
32-`DSO. rnrn-t'n1.....~~(?4 r~. C~ozi'
House Number Sqtreet / Hamlet /
County Tae Mag No 1000 Section . G: • • • • . -Block , , , . , , , , , Lot .
Subdivision . Filed I<fap No Lot .
(Name) ' '
2 State errstrng use and occupancy of premises and intended use and occupancy of proposed constructron•
a.Exrstrnguseandoccupancy.....E'~~ ~hrL~ •~~'r~•`•'``fG~
. .
n
b. Intended use and occupancy , 1,'~1;=,~,~'1 J p!J.~-r-...... .
3. Nature of work (check which apphcable)• New Building Addrtion Alteration
Repair .Removal Demolition • . Other Work .
p{~~~µ. 1 w r-1~1w(,- ~o N1 1 W Si14~-1_ 'L w~w~Ou...a5 1 K1rt-r+'F-? ~ (Descn tsa[
~+.$'r7.}~.L. Si.srw G- P+9-?-ru Da .2 lu! KC~cJL.y.~ ~ ....P...
d
4 Estrmated Cost ......S`./ . P. Fee . .
(to be pard on filing this apphcatron)
5. If dwelling, number of dwelling units Number of dweihng unrts on each floor .
If garage, number of cars
6. If business, commereral or mixed occupancy, specily nature and extent of each type of use i
7. Dunensrons of existing structures, rf any. Front ..3.~. ~1 Rear ..:ko. fir. Depth . 4: Q, T'. , , , ,
Herght 2°...fr.'r... . Number of Stones .
Dunensrons of same structure wrth alterations or addrtrons Front 3 F?-....... Rear ~ r, , , ,
Depth C}-:Q Flerght . .2.~.F ..........Number of Stones .
8. Dr onstructron' Front Rear ,~epth .
Herght um
9. Size f of Front ..(~~a........... ear... .I?. Depth2~3;7t3.. Z~O;n-
10. Dat ~urchase 5~~~, JS~ , / ~ , , , , Narrye of Former Owner ~5',+~itt~~~a? ..~•><ff. ~Qfyt/(!~!
a 1 1. Zon~ drstrrct rn whrch premrses are srtuated ..r, e.s,~ t bv,7:~;~~.. s~.r:. 4 v.f.i: J~
:~i- S , .
12. Does proposed construction vrolate any zoning law, ordrnance or regulatron . .
13. Will lot be regraded 0.JJ Wrll excess Cill be removed from premrses Yes C
14 Name of Owner of premrses .S R. N,,F,4. 1.,-i,rty+trtl ..Address !'t"Fi:a. ~-.~,.4!Lr.4~.?T. Phone No. 31-x.: 3(~25r
Name of ~~11 tee ~ ....Address .----'--'J ...Phone No.
Name off.~Cn~ J~rn.Rrwre?t= cwh.T- cazP Addressgo~~pS~mMwg~~yyu~..R.aq, Phone No. 7 b?. ~b L~...
15.Is this property located within 300 feet of a tLi'dali~w~etltand? *YES....NO..,>,'.`.
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate cleaziy and drstinctly all buildings, whether exrstrng or proposed, and indicate all set-back dunensron's f.
property fines. Grve street and block number or descnptron according to deed, and show street names and indreate whet
intenor or corner iot.
SV 2 u G.~•-J
. STATE OF NEW YORK, S.S
COUNTY OF . .
. • . being duly sworn, depcses and says that he rs the agplrc
(Name of mdrvrdual srgnmg contract}
above named
Hersthe
.
(Contractor, agent, corporate officer, etc.)
of Bard owner or owners, and rs duly authorized to perform or have performed the card work and to make and file
apphcatron, that all statements contained m thrs apphcatron are true to the best of firs knowledge and belief, and that
work will be performed m the manner set forth m the apphcatron filed therewith.
Sworn to before me thrs
~ day of , 19 !f`~
NotaryPubhc, ~ L/d~- County
.r..... jl/~
NOTARY PUBItC,
~e
New Yak
(Srgnatnre of applic.
No 4707876, SuffnM Ccurd~rr
Terns Exgres M:rcA 30,18
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