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Home My WebLink About8893-zFOE]~ NO. 2 TOWN OF SOUTHOLD BUILDING DJ~PARTM£NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES Ul~'l~iL FULL COMPL~ETION OF THE WORK AUT~01~IZED) Permissi~ is hereby grant~ to' FOUM NO. $ TOWN OF ~OUTHOLD , Building Depar~ment Town Clerks Office Southold, N. Y. 11971 APPLEGATION FOR GERTIFICAT£ OF OCGUPANGY 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--($-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 19,57), 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. Swam statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspechon of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: l. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ....X. ........... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Lo at on Of Propert ................ .... Owner Or Owners Of Property .... ~r~x~S~a~!~!~?~/~D~P~e~!~~ .................... Subdivision ....0..r'...e.9..o..n.....V,.i...e..~.....E..s...~..a..~...e...s. ............... Lot No ...... .2..!... Block No ............. House No..,~.~... Permit No..$.~.~....Z. ..... Date Of Permit .l..0../..!.[.7...~..,.Applicant ..F,.c.t~J~k~...~g, cD ........................................ Health Dept. Approval ..... ~.0.12.7. ......................... Labor Dept. Approval ................................................ Underwriters Approval ..~53.0..0.~. ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate X Fee Submitted $ .-~...;~ ................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ................. ':..,~...,~-~ .':...~- 4 ...... .,,~.,<..~.,~-~--.. .................... ' ' ,]'"-- 0 Swom.l;o_before me this ' .:'~.. .......... day of ..~.'. ......................... Notary Public .~.,~..'~....v..../.... ~::ogt~t;y/~__~_Y THE £1 THIS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 2/+,1977 ..,~..t,~a,,on No. on .;',,0 s94084 N 353004 only the electrical ~qulpmen£ as described below and introduced by the applicant named on the above appllc~tion number in t~ premlsea of F~ank Bozn ~ea~y, s/e/c/ Hozseshoe D:. & Future ~d. Cucchogue, L.~. ~,,t~,~/o.o.,~.~zo~.~o.; ~ n.~me~ ~ ~.,~'~. ~ ~,,d rt. outside so~t~o~ ,.., ~.,,,,.~,,0~ o. Augu~ e 22,1977 ..d/o..d to be ~n compliance u,th tt~e requzroo, en~s of th~ Board. FIXTURE FIXTURES RANGES OUTLETS t:LOOe~$CgNt '20 35 27 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS OVENS DISH WASHERS EXHAUST FANS riME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS. Motor: l-1/2hp 1 GFCI 1,smoke detector AWG O~ CC COND 4 AWG OF HI lEG NO OF NEUTRALS AWe. OF NEUTRAL J. Crocombe Box 1175 Center Moriches, L.I.11934 lic. 746 OENER~t Per D This cerfihcate must not be altered m any manner, return to 'the office of the Board if incorrect Inspectors may be idenlifmd SUFFOLK COUNTY [~PARlh'.ENT OF HEALTH SERVICES FOR APPROVAL OF CON~T~,UCTION ONLY DATE_ HS RET. NO. ,APPROVED -- / / / / / / AT REVISION~ \ ~UBP/WJlO~ ~AP F/LE~ /~ TNE OFF/CE OF THE CLERK OF SUFFOLK COUNTY ON APRIL ~ 1~7~ AS MAP NO ~1 NEAREST WATER MAIN = ~ MILE~ ~ WATER SUPPLY = P~IVATE WE~ ~OUN~ · ~OUN~ ~00 OSTRANDER AVEN~E, RiVERHEAD, NEW YOR~ ~L~E~ W ~O~ ~OW~ SURVEY FOR: FPWNH BOFtN 10T NO 21, "OFt~GON VI E !4" ES TW TES " SCALE THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND/OR FROM DATA OBTAINED FROM OTHERS Of \00 / / WATERSUPPL~/ AND SEWAGE DISP0$~.L SYSTEMS FOR THIS RESIDENCE WILL ss- Y~ ---%- J ......... vo~ ~0'% REVISIONS AUG. II, AIO TE- a = MOIVUIWENT SUBDIVISION MAP F/LED IN THE OFFICE OF THE C£El?K OF SUFFOLK COUNTY ON APl?IL 4, 1975 AS MAP NO NE-~NEST W/ATEN /WAIN = 4 M/LES WATEiY SUPPLY = PI?IVATE WELL YOUNG & YOUNG 400 OSTRANDE~ AVENUE, RJVERHEAD, NEW YOEK ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: FRANK BORN LOT NO ~1, "OREGON VI E 14" ES T~ TES " ,AT GUARANTEED TO' i Ct/TCHUGUE i TOWN OF SOUTHO£D suFmL~ co., ~. Y. ~ ~,L~ ,",: ,~o' s~-~,r~,~ J 'z~:'")~"., OBSERVATIONS A~/OR FROM DATA OBTAINED FROM OTHERS C~FORM TO THE S TANuARDS OF THE ~OLK ~P~N~ HEALTH suFFOLK COUN'iY g~.p.-P, Tt, A[l',,T OF HEALTH SERVICES FOP- AFPROVAL OF CONSI'E. UCt'ION ONLY ,o._ - " 7 DATE__ APPROVED · REVtSIONS NO TE -- MONUMENT SUBDIVISION MAP F/LED IN THE OFF/CE OF THE CLERK OF SUFFOJ_K COUNTY ON APRIL 4~ 1975 AS MAP:NO 62~ll NEAREST WATER MAIN = 4 MILES t WATER SUPPLY -- PRIVATE WELL YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD. NEW YORK ALDEN W YOUNG HOWARD W YOUNG LAND SURVEYOR SURVEY FOR FRANK BORN LOT NO 21, "OREGON VIE W ES TA T£$ " AT CUTCHUGUE Town o~ $OU~HOLO GUARANTEED TO. SC^L~ /" = 40' J DATIr 197~ NO 76 -775 s£Pr. 17,