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Home My WebLink About8375-zFOF,~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, BI. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . .~, .~.O .~.[c (~, .O..0.~....~..A. .... Street ~ap ~o .... g ....... Bloc~ ~¢o....~ ..... ,~ot ~o....~ .... ..~...t.~.~.T.!.T?. ~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... .~/~ ./.~., 19 .?~.. pursuant to which Building Permit N~ .~. ?..~..Z,, dated . . .~./Z ./.~. .... , 19.~..g., 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 .~. f~ I.V.A.'T.[?7.. f./1.c..c.VJ..c~PJt JPt ~A. ,.kJ G . ~,0~..(~.,.~ lq. ~.,t-C.ff ~cc> The certificate is issued to ...~ f-: .~J/f[.~. M-[../.~..~ O.Co. ~. ........ ~..off...r~.CC 11~. ...... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..~. ~. iIL.' UNDERWRITERS CERTIFICATE Iqo..../~., ~.~.~. 7,/. ~... ~.. ~.~..f.~..)..~.... HOUSE NUMBER ...._~..~..~q,.. Street .. A~,f/~(.~)./,,./~ ~.0 ~ ~...~., .............. B,,ilding I~pector "f .... ~O~tM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, H. Y. BUILDING PER. iT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CON~PLETION OF THE WORK AUTHORIZED) N? 8375 Z Date ......................... ~tltllt ......... ~3 ......... ' 19'76" Permission is hereby granted to: ..{~elae:at;.. ~'~'~r~ ~ .......................................... ~ ' ...... ~.l.~.~o~..l,m~e ......... I~.tttt~e~lr ..... FOKM NO. 6 TOWN OF SOUTHOLD 0 Building Department Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled m 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 buddings, property lines, streets, and unusual natural or topographic features 2.Final approval of Health Dept. of water supply and sewerage d~sposal--(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 cemf~cate of Code comphance from the ArcMtect 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, build,rigs 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 .~ .~.. 2..~' Date .................... ~Oof-- New I~g ...... ~ .... Addition ................ Old or Pre-existing Building ................ Vocant Land .............. Locat,on Of Property ......... ~.~...~..~....~....~...~...0.~.....L./~ .............. ..~.....~...'~....~.L..~..~.....Cr:...~ ....... O~ner Or ~.e. Of ~o~e.~ ..~.~.~.~.~ .......... ~.&b.~..~. ................................................. S.~d~,~io. ..................... ~ ................................. ~o~.o ....... ~o~ ~o ..... ~....o~ ~o.3....g~ ..... ...... ............ ...... ..................... ............ ...................... u~d~rw~,~, ~o~ ...~.~Z~ ............. ~o~,ng ~ ~o~o~ .... ~...[~ ...................... Request For Tompom~ Ce~ificote ........................................ Final Ce~ificote ...... [~. ............................ Foe Submitted $ ...~.~ ................. Construction on above describedplbUildin.g...a~__~r,,~..,mj.t~m~.a_ppli.c~,a~d r ,e .g .ul. .at i .o .nsIAp icant - '"~7~"/" --(~J'g'~'~' 'f~'""\~ '~'----"--' Sworn to before me this THE NEW YORK BOARD OF FIRE UNDERWRITERS __nr BUREAU OF ELECTRICITY I 85 JOHN STREET, NEW YORK, NEW YORK 10038 TH,S ~'"'"CE.T.~,Es'~ulYT"^T29' 1976 ,~,,,,,,'.,,,,. ~,',,. .. ,"e 869265 N 295713 ' C.T. Brown, s/s Knollwood Lane, Mattituck, L.I. ,.,~/,,t~o~,~,,~to,,.~o,,~[] ~,~.t [] ~trt [] ~,~a rt outside s~,o. mo~, FIXTURE ~ FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST DRYERS ' FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'PTJ I'IMECLOCKS I a~t, [UNITHEATERS tMULTI-OUTLET} [ ! .... SYSTEMS A~I [ K W OiL H P!! GAS H P ~[ A,V~T NO A W G A/~T A,~P / ~AiC'T TRANS AN, T H --t P NO__~OF FEET A~r__~~wA O 'OF [ SERVICE DISCONNECT I I S E R . V I C E OTHER APPARATUS Motor/s: 1-lhp., Panelboard/s: 1-2cir 100amp. (Swimming Pool) This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have frequent test and/or repairs made by a qualified person. Howard Dillingham R.F.D. #1 ~EN~.A~MAN%ME. __ Mattituck, L.I. t1952 Lic. 756E ~ ~ Per__ ]~1____~ Th,s cerhficate must not be altered m any manner, return to the off,ce of the Board if incorrect Inspectors may be ,denhf,ed by the re~