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Home My WebLink About6469-zFOKM NO. 4 TOWN OF $OUTHOLD: BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z9.1.02. ..... Date ....... J.~ly.... ~[2. .......... , 19..7.8 THIS CERTIFIES that the building located at . .6~.,.~.5. N.o.r~! .Rd, .(.C.o.l~,2~reet Map No ...... . ....... Block No ........... Lot No ...... ............................ UPDATED CERTIFICATE OF 0CCUI~ANCY conforms substantially to the Application for ~t heretofore filed in this office : CERTIFICATE 07 OCCUPANCY dated ... J,~ly .... '~2 ....... , 19.7.8. pursuant to which ~ No. '.Z 9.1. 0. .2 . . dated .... a'llly ....12 ........ , 19.7.8., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ............. Pri.v. ate. One. F~mily. D~,elllng ........................... The certificate is issued to .......... Mak~vtn..Waldell..: ............................ (owner,~ of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No HOUSE NUMBER ...6.~/~2.5 ...... Street ..... ~o..r.~.h..R. 9.a.d..' !.CAR.:. .2.7.! ........... Greenpo~t, N.Y. Building Inspector 1000-40-1-19 FORM NO. 4 TOWN OF SOUTHOL] BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .R,0,W,. t~./~, l~o:e~h. Roa~. ~tree~ Map No.. ~ ........ Block No.. ~ ...... Lot No...~ .... G~e~p~r.t.. ~.,.~ ~ ....... conforms substantially to the Application for BuildMg Permit heretofore ~fled in t~s office dated .............. .A~ril., ~9. ~ pursuant to which Building Permit No.. dated ............... Apri. t..~19~.~., was issued, and conforms to all o~ the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~Y~.~. ~..~.~Y. dV~g ........ : ............................. The certificate is issued to . ~..~. M~l .Na~. ~ald~ .... ~ ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. . K .~]0.~.52... A~Ag.. 22.. %973 .............. HOUSE NUMBER . .. 631+2~ ..... Street ...Nor.th. Road...(.CR2~.). ................. · Ol~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 6469 Z Permission is hereby granted to: .~.o~...~orkl~z....z~/C.....~ia~.~a~d~. & wife ................ O~.ien~ ................................................. to. ~%~..new.. ~ne...~:an$ t.~.. d.~e.t-~. ,~ .................................................................................... at premises located at ..... '~'~)~w'"'~'~'"~lO~¢~"~Oa¢}"~O~:~'} ........................................ (.£ama~..~.~,a~mi~o..~o~.) ............ ~ ..................................................... ...................................................... Greenpor.~. ........ .~.o.~, .................................................................. pursuant to application dated ......................... ~p~$~ ....... .~ ........ !, 19..~..~.., and approved by the Building Inspector. Fee ~8~.10. ............ ~ ' BuilJing inspects/? TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sabmitted in DUPLICATE to the Building Inspector with 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 disp0sal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Uhderwriters 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan~ requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, 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 buildihgs or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $S.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Dele ........ .............. New Building ................ Addition .......... Old or Pre-existing Building ................ Yaeant land .............. ~,0, 66,~, Location Of Property ...... ~. ~./~..Z-/.~ ...... ~:(Z..~ .~... 7 .. ~e~:ff../.K.-q..~...~....a~..~'.z:... ? .(..v..'. Z.: .............................................. Owner Or Owners Of Property Subdivision .............................................................. ~ot ~ ............. z~ ocK r, lo ............. House Permit No ..................... Date Of Permit .................... Applicant ..~ ............................................................... Health Dept. Approval ...... :..~.;..~.,..~.'.ZI~.~:.~. ............. Labor Dept. Approval ................................................ Underwriters Approval .~..../L.~.6'.~.~.?...;...~.~z..~.~..L./.?.7.~.Plannlng BOard Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......~...~..~.Z~..../~....Z:.~.. ........... Fee Submitted $ .................................... ~ ~''5~6/// ~-.~- 7,'~ Construction on above described building and permit meets all dpplicable codes and regulations. Applicant ............................... ~ ............................................................. Sworn t,o~/blf, ore me t~ ........ ..... Notary Public .................................... County FOItM NO. S TOWN OF SOUTHOLD Building Delmrtment Town Clerks Office Southold, N. Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new usi~: 1. Final survey of property with accurate location of all J~uildings, 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 Un&erwriters. 4. Commercial buildings, Industrial buildings, Multiple Re~sidences oiad similar buildings and installations, a certificate of Code compliance from the~ Architect or Engineer responsible for the building. S. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buil~Jings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, og~cupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...~...~...~......./...?..~.~. ........ New Building ~'- Old or Pre-existing Building ................ ~ ........... Vacant Land Location Of Property ....~..,...~..,.~...~.,.......~,...~.....~...~...L...~..~.~.~.~j ............................ Owner Or Owners Of Property .~...~....~....~.,.~~ ............................. Subdivision ........................................................ ;~.....Lo, No .......... !.. Block ,o ............ _. HZ~_"o ............. Permit No. ~..~....~...~...~ Date Of Permlt ..~-.....~...~..~..Applicant ...~.'~.~.~-. ............. Health Dept. Approvol ........ ~ ............. ; .................. Labor Dept. ,~pproval ................ ..~........~. .................. .................................. Underwriters Approval ..il ..................... Board Approval ...... Request For Temporary Certificate ........................................ Final Certificate ....... ~ ........................... Fee Submitted $ Construction on above described building and permit meets all a:ppliTle codes and regulations. App,ca,, ...... ........................................ Sworn to before me this ... ,~. ,~...7..~.. day of ..... ..~,.~..~.. ............................. (stamp or seal) ~'~. Notary Public ....?.~../~...~..~..<..~.. ........ County FLOYD F. KING, JR, ~7 Notary Publid. State of New York No. 52-7267800 Suffolk County Term Expire~ March 30 t97~/ FOItM NO. 6 TOWN OF Building Delmftment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new use: ]. 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-g farm or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, 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 o certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3~ Copy of certificate of occupancy $1.00 $5.00 Date .................. New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~..~...~..,.~t....::~...~...~'.......~.~i...~.....(.~..'~..~.~....~. ............................... Owner Or Owners Of Property .~,,,,~,..,~.,..~...~~ ................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~..~/...~...?...~... Date Of Permit ~...~.:..~?.Applicant ...,~.....~:~Z~..~.........'-~...~ .................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........ ~ ........................... Final' Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ...~'.2.~..~.~: day of .f~,...~._.~ ........ Z.~....~ ........ Nota~ Public ...~,...:~.........:..:. ............ County (stamp or seal) MARY O. /(LOS IIOTARY PUBLIC, STATE OF NEW YONIJ : ~52-7306925 SUFFOLK COUNTY ~emmissi0n Expires March 30, -,~,~cK E'L ~"V',~T'/ozV' _7"-- 4, Il'f~' -~)//V'/ Jo' -¢ I I ) ~ ~ ( 17/¢" / I /.--~,.~ -I~ ,~ _ /,, /~ "'1' T '~5'lAp OF LAk. ID ~ul~vr=y ~- D p- ¢~ r~ 6 l~'kr~,pol2T ~ sJ~v ¥o~ -~-- ZS' r)t6UT OF w~y I