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Home My WebLink About8368-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office SouthoM, N. Y. Certificate Of Occupancy No. Z.7..1~.19. ..... Date .......... D~.e. 1~. ....... , 197~. THIS CERTIFIES that the building located at ... ~.~.a~d. A.w~. ............. Street Map No... ~ ....... Block No...m~. ..... Lot No, .X~.....F~..t.t..i.t.u.e.k ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... F.eb . 5. , 19.7.6. pursuant to which Building Permit No.8~68Z.. dated ....... .F.e.l~ .. 5.., 197.6. ., was issued, and conforms to zl! of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued isP.~$.v~t~e, olle fa~tily, dwelling .wi.th .addition ..................... The certificate is issued to Hen.~..j, Pavi~k .Jr...Owner .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N,.~ ........................ UNDERWRITERS CERTIFICATE No. ~35 %9~2 .... ~eC..9.. ~9.~.$ ................. HOUSE NUMBER .. ~0~... Street ...G~d. Ave ...... .~attitu~k ........... ........ ]~l'~i~g inspector ( FOIL~ ~O. 2 , TOWN OF SOUTHOLD BUILDING DEPARTMENT 3'OWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UT.I:-IORIZED) N? 8368 Z Permission is hereby granted to: ........... ~atf~L~ck ............................................. .......................................................... :~l~.tt&tUek~.... ~ +~, ............................................................... pumuant to applicqtion dated.~ ~ * ............. [ ........ : ;~"~u', ......... ,~' tg~.., and ge~rov~-by the FO~M NO. 6 TOWN OF SOUTHOLD , Building Deportment Tow. Clerkc Office Southold, N. Y. 1197! 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-0 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 cert,ficate of Code comphance 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 dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition .,.,..~.,. ....... Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ..../..'/~./~.~,.~.. .............. .. ..................................... Subdivision .................... : ........................................... Lot No....~. Block No..--~.... ..... ,-Elou~e No..~..~...~.~.~ ...~../..~.~.~.~...Applicant~~"-/~'~' ~~ ~gK/~/~ ~ Permit No...~...~..'~..~..~ Date Of Permit /.~.~.~..(~.4/~../~:~'x~..,e..~.;.:.~.~../...~ Health Dept. Approval ........ .~'../..~...., .................... Labor Dept. Approval ..ff../~ .............................. Underwriters Approval-,~ ............................................. Planning Board Approval ...Z~...~..~ ....................... Request For Temporary Certificate ........................................ Fincd Certificate .... ...'~.. .............................. Fee Submitted $ .~....~ ...................... Construction on above described building and permit meets all applicable codes and. regulations. ......................... Sworn to before me th~ ........ .... ..... Notary Public '~C' County (stamp or seal, ., .,, ,/FT,,H~?,NEW YORK BOARD OF FIRE:UNDERWRITERS [---~l ', ~ ql '" ~ ~, ' ~ BUREAU OF ELECTRICITY ~" '[ -d~ " 85 JOHN STREET, NEW YORK. NEW YORK 10038 = lf~ W , ' a.,e.. ]:)ee~mbe~, 9. ~976 ~pp.~*.oa~o.o.y,,~ 8~8533 ~':N' 315932 THI~ CERTIFIES THaT only the electron[ eq~ip~nt ~ &scribed below and intr~uced by t~ applicant nam~ on thd a~ applicatloa n~m~r in the premises of ~o~n PaviI~ n/s O~and ~ve., ~attSguckj L.I. FIXTURE ~XTURES DISH WASHERS l EXHAUST FANS OUTEIS SWITCHES DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS~ UHITHEATERS MULTI,OUTLET h DIMMERS SYSTEMS . 'NO, OF FEET Thh certificate must ~o,'b; altered , .n~ manner, return ,o the office o~ the Board i' incorrect. Inspedor, m~~ by ,h~als. I (. 'V I' /~_.,m~-- B¥_/~l-jT BUIL~:ING DEPAKTMt 9AM TO 4PM FO~ START CbVERING ~PcUN~ WHEN JOB C~T~ //- 75 Z54:AL.E. F¢: ~R!OVAT'tO]q Fold, ~U~!¥~¥ED FO~ tqE NR.Y dOHN P-LO g.E N C,E A. P/.:',,VUA K PAV LA K M ATTITUC K SCAb6: ~;0'= I" AZ~A: 0.9Z65 ACI~.E 0 0 NO0' // i,//× / //