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Home My WebLink About8886-zTOWN OF SOUTHOI.r~ BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. ~.~.~[.0... Date ............ (~...~. .... , 19.~..] THIS CERTIFIES that the building located at . -~.j;... ~.~. ~ .~. ........... S~eet Map No. ~ ~ ..... Block No...~. LotNo.~&~.~~ ........... confo~s substantially to ~e Applica~on for Building Permit heretofore fried in this office dated ....... ~ .~..., 1~.~. p~suant to which B~lding Pe~t No.~.~.~ dated ........ " ....~ 7 .... , 19~.., was hsued, ~d co~o~ to ~ of ~e req~ merits of the applicable pro~sions of the law. The occup~cy for w~& ~ certificate h ~ o~r, less~ or ~n~t ) of ~e aforesaid building. S~olk Co~ty Department of Health Approval . ~ .~/ .......................... ~DERWRITERS CERTIFICA~ No..~. ~ ~.. ~ .~.~ ...... .~.~ ~h~ ~ ...... HOUSE N~ER ~ ~ ff~... St~et ...~~. ~ .... ~.~. ~ ~. .... ~ Building Inspector FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTJ~,ENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COA4PLETION OF THE WORK AUTHORIZED) 8886 Z Date ........................... ~p.t, ..... 9.~7. ......... , ] 9...~6 Permission is hereby granted to: ~d'"'Ja~ oI~ s ..... ~f.C...He_!___~_ ~:.._Eas .~ .......... ...................... 2.emo~$~. ........................................ at premiss located at ,~/f-~--.l~t.~.~-e-.-R~a~---.~2?-} .................................................................... .... :.:.....:.; ...................................... ['.ec~£c ....... ]~,~. .......................................................................... fo application dated ......................... SepG..-.-P? ............ , 19.~.., and approved by the Building Inspector ~ORM NO. $ TOWN OF SOUTHOLD , 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 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 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 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..................... ) .............................................................................................................. Owner Or Owners Of Property ...m.~..?.~.Z~'...(~..:~'. ....... ,/.:.,.~.'~.:..~...~.~',.~.'../.../..0..~.'....../~../.'..~...~..~...~.:'.~...!..,:=. Subdivision ................................................................ Lot No ............. Block No ............. House No.....~ ....... Permit No. Date Of Permit .................................................................. Health Dept. Approval .............. ~:....!.f. .................... Labor Dept. Approval .................. ; ..... ~ ....................... Ulnderwriters Approval ............ ~ ................................. Planning Board Approval .................... ' .................... I Request For Temporary Cqrtificate ........................................ Fincd Certificate Foe Submitted $ .................................... Construction on above descnbed building and permit meets all applicable codes and regulations. Sworn to before me this ................ day of ...~ ....................... /. ..... (stamp Notary Public ~~..~... County THE NEW YORK BOARD OF FIRE UNDERWRITERS .dp ~ BUREAU OF ELECTRICITY r- May 26, 1977 , ss JO.N $'raEET, NEW YORK. NEW 'tORte mO38 TUlS CEaTIFIES TUAT ' 913577 only the electrical equipmen¢ as described below and introduced by the applicmtt named on the above application number in the premises of Southold-~'loor Covering, North Road, e/o Peeon Lane, Peconlc, L. I. .~,, o,,,ni,,oa o,,May 19, 1977 and found to be in compliance with the requirement, of this Board. DRYERS [ FURNACE MOTORS FUTURE APFI.IANCE I:EEOERS ;PECIALREC'PI '~IMECL~)~I~i I' B;LL IUI~Ii~HE'~TE~S M [ -OUTI~E~ DIMMERS OTHER APPARATUS~ ~ - h~ ~ ,' ~ , Edward T. ~at~Ick .... , South Jamesport, L. I., llgY0 '~' ' Lic;~8~SE'~ Per This certificate must not be altered in any manner; return to the office of the 8oard if incorrect. Inspectors m~ be identJJed by thei~