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Home My WebLink About5091-zNO. 4 TOW~ 0F S0UTHOLD BUH.DING DEPAHTMENT Town Clerk's O~ice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .PVT... -R.0.,Id, (¢~,~eeng.Av~feet Map No..~ ....... Block No..~ ..... Lot No.~x~x. North- .Hill.~..Fishers- conforms su~bstantially~ to the Application for Building Permit heretofore filed in this office dated ...........l)eO ....... , 197(~. pursuant to which Building Permit No. dated ..~ ......... D~O ......., 19.70., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is /'of the aforesaid building. Suffolk County Department of Health Approval issued is . Pr. ivaf~, mm .£amtl¥. ~mlllnll. ...................................... The c~rtificate is issued t~olm..S o. I~est ........ 0~m~l~ ............................ (owner, lessee or tenant) UNDERWRITERS CERTIFICATE Noli. ~.7.~1~01 .... Aug...28...19~1~?' ............... HOUSE NUlVIBER ...nol~ ...... Street ..........................1. ................ ...... ...... ........ ' Building Inspect~r~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 5091 Z Permission is hereby granted to: ...... ~e~l ....... ~I~.~. ....................................... to .y ~..~tl~..~..t~ .~3~1~ .......... : ..................................................................... at pr~mises located at ..... ~..~...~...~.~tlll~l.../~.~JL...O~',~..~..~.~..$1~lt ...................... ..................... ~ ............ '. ........... ,~l~e.t...l~:I~-,~ ........... ~t~. .......................................... ?.~, pursuc~t to application dated ................................ ~ .................~, 19.,~jl~., and approved by the Building Inspector THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY [-- EE JOHN STREET. NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT Be~ment ~-IstFL [] 2mi Fl. outside Section I Block H w~exami~on a~found~beincompliancewiththerequirementsofthisBoard. 8~S~0~ RXTUnE RXTURS$ RANGES ~N$ EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 38 ~ '7o 81 31 7 DRYERS FURNACE MOTORS FUTURE APFUANCE FEEDERS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE OISCONNECT S E R V I C E OTHER APPARATUS: 'Unit heaters: 5-1.Skw ~otor8: 2-1/3bp, 1-1hp, 1-2hp Fanelboard/s: 1-~0CB 200ampE.. 1-15~ 100a~s. Plsc~nect Svlt~es: 1-200amp., 1-100~pe. CB 1-1.75kw Food Wa~r - 2-.5~p. Elect~ntc AW 1 f~.hp~ Ice M~ev - 1-13.Skw Water heatd~ Filters Raymond W. Edwards, Box 511 Fishers Island, L.I. ]06390 - / 11,- COPY FOR RUILDENG DEPARTMENT. THIS COPY OF ,CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Thru apphcation must be filled ~n typewnter OR ink, and submitted in DUPLICATE to the Building Inspector w~th the following; for new buildings 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 of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwnters. 4. Commercial buddings, Industrial buildings, Multiple Residences and simdar buddings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where apphcable B. For existing buildings (prior to April 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1 Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate C. Fees: 1 Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ..... ...... .19.7 . ......... New Building ..X~...v~.. ......... Addihon ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..2l'J,.'C~,~r...~.Q.,.!/~.,...(.C.z~.sc.azzt..A~e.)...EoJltk.~t!! L,...Eishe~.s..island Owner Or Owners Of Property ..~..o....~.....~.......G...~..e..$.~ ....................................................................................... Subdivision .... ~ ..................................................... Lot No. ,,,~..~;.,.,, Block No. ,,..~T~ .... House No....0, ....... Permit No...~0.c).l~. ...... Date Of Permit .D.ec.,.. J.c)7~pphcant ...~_mj_t,I~.~},.Li.1]L.CIZ'..Jt,S. SD.~., ................. Health Dept. Approval ...~..e.~..rl:.~ ........................ Labor Dept. Approval ......... ~.:..~.?. ............................. Underwr,ters Approval ...I~....~,7...~.LI'.0.} ....... .~/~./.~..Li-Planning Board Approval ...0..o..~. ..... ~.~......].c~'..Q ....... Request For Temporary Certificate ....................................... Final Certificate ....~ ............................... Fee Submitted $ .~'.?...0..0.. ......................... Construction on above described building and permit meets all applicable codes Applicant ..... .... z.ff ..... of ..... ..... a. aZk .............. Nota~ Publ c ........ ~/~ .. ..... County NO 60 1449¢~ Qual~ m ~h~ ~ Commission ~xp~res A~arch 3~, 'A'A L L