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Home My WebLink About8855-z~0~ NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z?~5'5. ...... Date ........... ,T~...6 ....... , 19..~ THIS CERTIFIES that the building located at . .R.0..W, off. .l~ple-L~ne(P~ree~)~- Map No.. ~ ...... Block No.~x .... Lot No, ~ .. 8euthold. · .1~,]~., ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... 8epic 1 ~[9. ?6. pursuant to which Building Pemit No. 88~5Z., · dated ...... 8ep~ '~3 , 1975 , was issued, and conforms to all of the reqnlre- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private. olde .f. amil. y .dwet].~ug .................................. The certificate is issued to E~'rol Doebler. .... YYner .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Ja~. ~ . 19~.~ · b~..R. ~.tll& . UNDERWRITERS CERTIFICATE No..~J~g ................................ HOUSE NUMBER .... 80~ .... Street . · · ~a~ .Lnne · (A~ · ? } ............... g sp c FO~tM NO. 2 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) 8855 Z Permission is hereby granted to: H.R.Reeve & Sons !nc A/C Errol Doebler & ~I Matt ituck premises located at ..... ................................................... ~t~....~X., .............................. ; ........................................... ~. ~- '" to application dat~ ................................. ~.~ ......... a..., 19.,...t.~ end app[ov~' by ........... BOld~n~ FORM NO. $ 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 submitted 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 disposal--(S-9 form 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 certihcate 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 naturol 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificote of ocCUl~3ncy $1.00 Jan 6 1977 New Bqilding ..... .X....X~...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Lccation Of Property ....~...,..O..?..~..,.....o.~:.~....~.~.~..~..,..L.~.n...e. .......... ~.o...l~.~..~...o..~...~. .................................................. Owner Or Owners Of Property ..... ..~..,~.~.O...~...?..O..~..~..~. ................................................................................. xx xx No 803 S~,bdivision ................................................................ Lot No. ,~.?.. ....... Block No ............. House ............ Permit No...~,.~.~.~..~. ...... Date Of Permit ..~/.1..3/.~.6..,Applicant ...... .~...~....~.?..e.,.v..e.....~.....S. ............................ Health Dept. Approval .... .,:T...~..~.....~. ..... .'1..~..~..?. .............. Labor Dept. Approval ....... .~.:..~..: ............................... Underwriters Approval ...~.endin~ ..........................Plann,ng' Board Approval ........................................ N · R · Request For Temporary Certificate ........................................ Fincd Certificate ............ ~ ....................... Fee Submitted $ .... ~..~.~Q ....................... Construction on above described building and p~ ~<~,.,.~p~.p~ca~ '.~ rmit meets all app cable c and regulations. Applicant ........... :~~ ..... Sworn to before me this ~ 3 °r se~l)~7 ~ 5'~ 6 dayof J&n 1~.~. ~. p I ~ c~ ......................................................... i~Z 3 ~/('sram Notary Pubhc ......... .S,~.~..°.,Z..1S.. .......... County ~O~IF¥ BUILDING DEp^¢.TMENT AT t ,¢ III ,rtrtNALD A. 13ENI~= A.I.A.. P.D. ARC VII 1" ;=C"I" wN¢.' " I __J L i I ICIONAL,O A. OENIfa A,I.A., P.C. . ARCHI'r IE c'r