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Home My WebLink About9076-z/ t~O~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk'~ Office Southold, N. Y. Certificate Of Occupancy No... Z9.318 .... Date ..... N.o.v..e.m.be.~....2.8. ........ ,19..7..8 THIS CERTIFIES that the building located at .... Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... M.a.r.c~ .h .... 9 ....., 19...7.Tpursuant to which Building Permit No ..... .9.Q.76Z dated ...... March .... 9 ...... , 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 Private One Family Dwelling with addition * The certificate is issued to ......... .R.O..b.e.r.t., .S.l.a.d.o..n, .&..w.f. ? ........................ (owner, ~~xx of the aforesaid building. Suffolk County Department of Health Approval .............. N/.R .................. N336O 9 UNDERWRITERS CERTIFICATE No ........................................... HOUSE NUMBER .............. Street ......... .Pr..1.v.a.t..e..R.d.... ~..1..8 .............. ~.lattit.u.o.k., New York Building Inspector County Tax Number 1000-121-4-12.2 * Second floor non-habitable space FOENI NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) Ne 9076 Z Date ...................... 1,~V......~ .................... t 9...~z7. Permission is hereby granted to: 4r~.~_u..L .~ .e...e.......A./.c....:Lo.~ ..~.e.. ....................... .......... 2.~6.....W2...8.th..~q~; ....... ~)eer--.Pa.~.k ....... to ..b. ui~.~ .~d~..~.t~rA..~..al~e~.a.tiona o~ e~i&tia~..~w~l.1..f~ ................................. at premises located at ...~.~.t,..~...1.~3 .................................................................................................... ........................................... ~.~.el..Lake ......... ~;~i~;.u¢~ ........................................................... pursuant to application dated ................. ~a.~.....9 ......................... 19....~.~., and epproved by the Building Inspector. Fee $....1.~..~.Q.0 ......... Building 16~sTpect o r ~ FORM NO. 6 TOWN OF 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 fallowing; far 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 dlsposal--(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 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 Rte .... New Building ................ Addition ..~'. ......... Old or Pre-existing Building ..... ~ ......Vacant Land .............. Location Of Property ...~...~..).~V,/~.~.~.'.......t.~.,.,.~.,,t..,,.t.,,~. ...... /~.td~l~.~ ........ ~..~....~.~.. .......................................... Owner Or Owners Of Property .....~..~...~...~..~f~..L'~.. ........ ..~..L4~*...~...G....~%.[ ........................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. .... ........... ........................ Permit No. ~..~...Z~...~.... Date Of Permit ~l~tg.~,...1>~.Z.7...Applicant Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Finel Certificate ~ ................................... Fee Submitted $ .~.~..~....?. ...................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this Applicant~''~'':'''~ .... ...... ~ ......... day of (stamp ~r seal) Noraw Publ c .................................. Coun~ ~TkRY PUJLI~, Slate No, ~Ol~O-$uffolk Cou~ THE YORK BOARD NEW :'" ,,~-' BUREAU OF ELEC+RICITY obe t Sladon. LaurelwaT. Mattftuek. L. I.: ~ 1977 ' :: andfoi~n~tobe~nco~piancewththerequrementso th~s Board: '* .F.CI~ 2-Smo~e Arthur Lee 296 West-8th St. Deer Park , N...Y. '~ 11729 .~ DIc.~1359E cerfiiicofe must nor be eifere~ ..... Z~_5~.~7~ ..... ~ ' , ,. --. . .. I~' ~. ',>~ I ~ ~':,?.~' '~ APPROVED AS NOTED I ~EE: ~BY ~ ~lVJN~O0~- CEJLIN~ +~RLL3 fiEF R~ee " t ~' um~ ~ ,~ 1, BE~ "~ r; "~r.L~N(: ~OUIInA- J~' 5T~P L~W NAT 3o" ~/'xk ~, TlO, 0~ F~/z-~INC P~LL~ ~iNOO~S ~0 ¢[ I/~" INSoLRT~ ~o ' OUCTEO TO oUTSID~ FIRST floo&' , ~, ,,~'tSTIN~ poI~CH F~,NP STOOp ,) o'6 EX I ST LOFT 7 '%" '.3' POU~FD FOOTiNFz SECOND FIOOR PLUSH DORMER -SET 6fl(-H 70 FlfiST RhFTEP, ~Alts- ~" /6" Oc, CollRR~i~S [wposEO ~'X~" H~FI PlY /WTER~o~ ~R~DE Over ~RIIS~Roo~ LO~ ~/OIN~ OVFR PL'/~,IOoD-WHITE ~oo0 ~OOP ~B~ 5ELP 5ERL OVER IE L/3, PELT F~Ct~ ~Nb S~TFIT ~"~t~" ~/~ROWN ~UTTERS DECN- 6" ~EV[L ED~[ PtWE 7:¢" /c'-o FooTIN6rS F-/z',/ -j.. ~RRBC~E -" gE C Y', FIX[D ,/ F¢'=, ,J ~T, APPROVED AS NOTED DATE: ~'/"~// ~ ~ '1 II