HomeMy WebLinkAbout9227-zF$1E~ N(k 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, BI. Y.
Cerlificnte Of Occupnncy
No. Z90.02 .... Date ...~te~y. .... 5 ............. , 19..7.0
THIS CERTIFIES that the building located at .165.. Dram Dri.~.e ........ Street
Map No. ~4.650 .... Block No ....... Lot No ......... 66 ......................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated April 27 , 19.77. pursuant to which Building Pemit No..922.7Z.
dated . . May.. /~ ........ , 19.7.7., 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 .... P~I.~.ATE. ONE. FAMILY..D¥.~.~LLNG ...............................
The certificate is issued to l~ober.t .~.
of the aforesaid building.
Suffolk County Department of Health Approval
Mart~ns .............................
( owner, ~1~
/*/27/.78 ~.obent .Vi~ 3 a ....
UNDERWRITERS CERTIFICATE No ...... ~3829Q1 ..............................
HOUSE NUMBER .~.65 .... Street ....... D~w~. Dr.i¥~ .......................
............................................ Gr. aenpo, r.*,. ,~!ew. Y.o. rk ............
Building Inspector
I~ORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
~ ~ ~o,~ .................... ~/ ......... ~./.......~,.......:~
Permission is hereby granted~t<): ,
..~.-.~..:.,.~ ......... ~.~..~.~.,.,.~.: ............
~.~ ~.~,...,~ ~'
,o ......n...::...::~ ...... ~...::~ ..... ~::,...:. ....................................................
:.;;;;:.;;::.:...:~...~.~. ......... .~.::. :.:: ................................................
pursuant to opplicetion d~ted .................. ~ ........................ , 19 ........ , ~nd epproved by the
Building Inspector,
~e ~.~.:.:: .......
FOB~M NO. $
TOWN OP SOUTHOLD
, Building Department
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 disposal . (S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Mulhple 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:
]. 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 $].00
,~,~]L ~7, 13~78
Date
X
New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property 165 Zg/~,q ~)/?~/~,
Owner Or Owners Of Property .......................................................................................................................
...... ...........................
Underwr,e ^pprova, .................. P,on. ng Board Approva ..... ....................
Request For Temfl~,~ry Certificate ........................................ Fino] Certificate ........ ~ ............................
Fee Submitted $ .....%~.. ............................
Construction on above described building and/$)ermit me.,ts all a~pli~5~le code~and regulations.
Applicant .~..~....... ~:.. 5~...~ ...............................
Sworn to before me this- ~-- 7 ~/~
(stamp or seal)
................ day of ............................................
Notary Public .................................... County
:-'* x _ THE NEW YORK BOARD OF FIRE UNDERWRITERS~,,:~,
pm * ' * - ';- BUREAU OF ELECTRICITY
F---' ,'; ~ ~ , 85 JOHN STREET, NEW YORK, NEW YORK 10038 :; ;?f ~L '~ ,~U
~gy the eg~tdcal equipment ~ desc~b~ betow and int~uc~ by the apphcant ~med on t~ ub~e apphcatto~ ~umber ~ the
'Robert W. Mart~ns, 165 Dawn Dr., 'Greenport, L.I.' -:
~,, ,~_~ .... , , -,-~ , ~ ,
FIXTURE RECEPTACLES ~l * - : FIXTURES , ' RANGES COOK NGDECKS~ OVENS D SH WASHERS~ EXHAUST FAN
DRYERS ~ FURNACE MOTORS J ~TURE ~PLIANCE FEEDERS SPECIALREc'pT] TIMECLOCKS [ BELL ]UNIT HEATERS JMULTI-OUTLE~[ -- DI~ERs
' TE SYSTEMS
SERVICE DISCONNECT NO, OF _ ', -' ~ / S E -~ R ~
2-Smoke Detector
1-2.97 Grill & Fan
Sal Prato E!ec.
Wiggins L~e , ~,
Greenport, L.I. Lic.1049 E
cerHficm~e mu~ no~ ~e o~lered ~n any monner; ~e~urn to the off~ce o~
SUFF. ~ HFuI. LTN DE:I~T. APPROVAL
~o~£~CK VA~ 'ruYL. P. c.
~.~i~l: ~UF'F. CO, OE:Fr'r. Cl(l HF-,ALT,H SERVIC. EIS ' ITATtlM£NT OF INTI:N¥
; FOR APPROVAL OF ~NSTI~UC~qON ONLY
[ O~NC~ WILL C~F~M
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OF H~LTH, SERVICE~,
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, SUFF. co. ,.~^-~ U~. Xm'"ovX~ { .. s..oX' ~0 ;~'~
L. ANE
,/
OF'THIS SURV~ MAP NOT
~O~SJ~ ~AL SHALL NOT ~ CONSlg~I~
~ ~LI~ T~U~ CO~
IlUl'l", CX). DF, PT. Ofr HEALTH IlJlt¥lCJll ~"NT OP' I NT
FO~ A,"'e'~OVA~. O~ CO~4~-~',UC~OH O4~LY
'{~{~ WATE. I~ ~UPPLY AI;L~
DA'Ti:: .... ...... DISPOEAAL SY'B*'I'I~wI$ FOR THIS
O~C~ Wl~ ~F~M ~
H,~ REF. NO: ........... STANDMDS ~F =UFFO~ CO,
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