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Home My WebLink About9203-zNO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk'~ Office Southold, N. Y. Certificnte Of Occupnncy No..Z92_C19 ..... Date ...Sep.tember.....~3. ........ ,19. THIS CERTIFIES that the building located at . .355. RQsewo. c~cl. D~.~,¥e ..... Street Map No... 52/*0 ..... Block No .......... Lot No .......... 6 ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. April. 22 ......... , 19. T7. pursuant to which Building Permit No. .920j~Z dated .. April .. 22 ......... , 19. ?.7., was issued, and confox:ms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ........... P..r.i.v.a.~..e..s.w. ~..m.m.i.n.g. po..o.1. .................................. The certificate is issued to ...... Dor(~J;cl. G.r.~ta ................................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval .......... N/.R. ................ UNDERWRITERS CERTIFICATE No ................ .N3~.~.~99. .................... HOUSE NUMBER ..... 35.5 ..... Street ......... Rose~zQod. Dxtive. ............... ............................................... :{~/fat~uck,..Ne~..York ......... ............ FORI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. N°. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9203 Z Date .............................. . ....... ,-,~.; ~:. =;. ,~-~ r.;-;-~-~.~- ........ Permission is hereby gronted to: ................................................ .. . ................ ,l~mm~..~. ........ Jga~.t~a~ .... at- raises located at .. ~ , ~ ................................................... : ............ : ............................................... ~,~gnt to opphcot,on doted ........................... ~....~ ...... ~ 19..:.~z, ond oppm~ed by the Fee $ ............. ..=. -..-. ~ , , ........ ~ ........ FORM NO. 6 TOWN OF SOUTHOLD , Building Deportment 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 disposol--(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 o 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 pete ................. New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... .~....~..~...~........~...~.v~....{~/...~.~ ...... /~....~. ....... ~'7...,~....~'~...~.Z...~..~. .................................. Owner Or Owners Of Property ...... ~.,..~..../~.....~...~. ,~,. ........ ~.,..~.~.~...~..4 .................................................................... Health Dept. Approval ............... "~'"'i ................... Labor Dept. A. oproval ...... ~ ....................................... Underwriters Approval .~.;.~:.?~....,.r'~.~,.,..~..~..?.~..~.~,Planning Board Approval ...... ~ ............................ Request For Temporary Certificate ........................................ FinoJ Certificate ..~'~.. .............................. Fee Submitted $ ...... ~.'..~...~.. ................... Construction on above described building an/p;rmit ryjeets oil opl~licable codes and regulations. ..... ............................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stomp or seal) I '~, I '' ' '' '' THE NEW YORK BOARD OF 'FIRE UNDERWRITERS 'r ' r' ~ ~I ' ~ BUREAU OF ELECTRICITY ' i -Ts ~' H ', ' ' 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,).,e.J '" ' 3,..q$:Lgg , ; ,.4ppt~,'.ti,,.,%'o.o. fle 970230, N THIS CERTIFIES THAT , , ~ I ~, ', ,' , only the elec/~rleal eq4tlprr~ent as ¢~escr~bed below ¢~c~ introd~c~..:b.?f .~t~p~t~plic~at o~arned on the above application nun~ber in the prerr~ses of uon ~raTa~ ~osewooo~r. ~ NaTTITUC~ I~eI , I,~ h~ ' h H' ', , ', , , ~ I I , , ~ ~, ,, / L ,~ in thefollowlnglocut, ion; '[:~I,, [] outs i de , Basqn~e~. 1st Fl, ' ~ 2nd Fl. Section Block Lot was exam~nea on ' , , ~ , ~ , ~ , ~, ~ and found to be ~n comphance w~t h the reqz~iremenls ~ this Bourd. DRYERS , FURNACE MOTORS FUTURE APPLIANCE FEEDERS ~PECIAL REC'PT, TIMECLOCKS [ SELL I UNIT HEATERS [ MULTI-OUTLET t DIMMERS SERVICE DISCONNECT [ NO OF r s E R v I C E OTHER APPARATUS= , ,~ ~ ,~ ,~ , ,* t ~ ~ , , " (Swimming Pool) This"ceF?i'fica~e co've~s compliance a~ ?he date of inspec?ion only. Because'of 'unusual environments'~* is advisable: to ~ave fr~q'uent,test,,~'nd/or'repairs, , , ,, , , made, by a qualified, person.,. , r't ~1 '~ ,' ,,' ' L h ,~ ~ ~ r ~' Il~, I, d,L *~ ~' '' ~ ' ~.~. ~ ..... ' Don 'Grata ' ' ' ' ,r ' , , ,,' 244 A 9ergan Av'e. '" . ,, GEN~.A~' ' Thru certificote must not be oltered m ony monner; return to the off~ce o~ the Bo~rd if incorrect Inspectors moy be Jdenh~md by their credenflols