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Home My WebLink About9199-z FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT O'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9199 Z Permission is hereby granted to: ..................... , ............ ; ......... :.:.:.'~ ................. ~ .......... ~o ~.~:~...~.n..,~.~.~.~..~.~...~.~.~n~..~.~x~.~ ................................................................. ................................................ ; .......................... ~ ...................................................... %~...; .................. 8/~ end ~eaehv:~od (~Vt) ~oad at promises I~at~ at ........................................................................................................................... ouh~na ,ns~.or .... - , _ I~ORM NO. $ TOWN OF $OUTHOLD , Building Depn~tment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instrucfion. A. This application must be filled in typewnter OP, 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 oil buildings, 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 certificate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site pl~n requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing oil property lines, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspechon of bu,ldings or premises, or other pertinent 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 Date Sepl:ember 14, 1977 Flew Bu. ilding ................ Addition ...... .X. ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ............................................. Owner Or Owners Of Property ......... .H...r..,...~....H..r.s........H..a..r..o..1..d..,.O.,1.,s.,e..n. ............................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No .... .~.!..~..~....Z. .... Date Of Permit .../:t../..2.!../.7..7,...,Applicant Health Dept. Approval ............................................ Lobar Dept. Approval ................................................ Underwriters Approval ..... .¥.,e..s ................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate .......X. .................................. Fee Submitted $ .....~...~ ................... Construction on above described building and p~ll applicable codes and regulations. Applic o nt . .EL 0 ~,~l~. H,~ .,Jp'~L D.I ,~..J~$'-,~T.I J3~L ...................................... S rn before me ' / ~JJJ~"~"'~~f ...J...~ ...... day of .......... ~...~..L ........ /..~,.~,/,,. (stamp or se~ ', , Notow ............. Co.. ~ ~~lted m ~t~4801 ~omm~ss~on Exe~s~? Courtly ~ -s ,v~arch 30, lg ~ fl THE NEW 'YORK, BOARD OF FIRE UNDERWRITERS ..... 1,,~ , BUREAU OF ELECTRICITY '-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 August 17,1977 "Appl,ea,ion~Vo.o,,/'le 925016 N 351946 THIS CERTIFIES THAT only the electrical equipment as described below and i~troduced by the applicant named on £he above application number i~ the premises of Harold W. 01sen, Pr±Dace Rd., (100¥ds, w/ Dean Dr.) Cu~chogue,L.I. intt, cfollo,~ingloeatlon~ I--],B.,o.~cnt ~ J~tr~. ~ ~,d'~'t. So~t~o~ m~ ~ ,e.,...,,,~.oa o. ANguS ~ [5, [977 and found to be in compliance with the requirements of this Board. ,C," ........ ,, ', ",,: ...... OUTLETS E, INCANDESCENT FLUmE,SCENT ME.CU.~ aT [ W , ~T, , ~ ~ , I ~I K W mT K, ~ . ~T ~ H ~ DRYERS ~ 'FURNACE MOTORS ' ~ FUTURE APPLIANCE FEEDERS PECIALREC'PT TI~EC~OCKS ~ EELL ~UNITHEATERS MU I.OUTLET DIMMERS SERVICE DISCONNECT NO OF S R V I C E .... ~[, mP .... ~,E EQUIP. 1 ~ 2w 1 13W 3 ~ 3w 3~ 4w Ho OF CC COND A W O NO OF HI-LEG NO OF NEUTRALS , PER ~ OF CC COND OF HI lEG OF NEUTRAl_ OTHER APPARATUS. Elec. room hea~ers: 2-1.0ku. ~ Box A3 Reeves Park This m~, nbt be blte~,d Jfl any.manner; ~~~:~._~ t