HomeMy WebLinkAbout11003-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Date July 21 ~1
THIS CERTIFIES that the building ................................................
Location of Property 400 Oakwood Drive, Southold, New York
House No. Street Ham/et
County Tax Map No. 1000 Section 070 .Block 012 .Lot 021
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit her~etofore filed in this office dated
December 5 1980 pursuant to which Building Permit No. ,11003 7. '
dated. .... December.. ......... 22 .. .......... 19 .8.0. , was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
Private One-Family Dwelling
The certificate is issued to Alexander O. Koke
(owne~, /e~ee-~ te~aw~- - -
of the aforesaid building.
Suffolk County Department of Health Approval 10-S0-93, 7/20/81, R. A. Villa P. E.
UNDERWRITERS CERTIFICATE NO. N523550
Rev. 1/81
Building Inspector
11002
Permission is
FOEM NO. 2
TOW~ O~ sO~v~O~
TOWN HALE
SOUTHOLD, N~ Y.
BUILDING P,ER~!T
(THIS PERMIT MUST BE KEPT ON TH,I~ PP, E/~IS~S UNTIL ~ULL
COMPLETION OF THE WORK AUTHORIZED}~!
Date ~C~i'4 '.'~'~, ~-- ~-~ 19 ~
~ ,
hereby granted to: //
............. .z. ...... ..................
...... ./..~.~. ....... ~...qt.~.~.~..~.~
~ ~.~..r~¢o c/.. ~. g .'~'~ ~ e.~ ~ ~.~.r.,c¢~..~ .................................
to ....... .................................... ~ ;, ,: /
et p~'emises located at ............:..,~...~.. .~.... '.~..~.~'..'~.~2..j 4.~..~..~[ ..... f/Y..~../.'/O~.4~?~... A./, ·
.....~...:....? ..:.. . ..............................
co~;,~ Ta~ Ma~ No. ~000 Se?n "~-7'~ ......... *~o~k' .~ t.~i.,...,i'ot No .~..~./.. ..........
; , .,..,, 19 , and approved bY the
Building Ihspector. '
Fee ..g ........... - ......
~ Inspectdr
t~ev. 6/30/80 · ~ , v
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of alt 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, Multiple Residences and similar buildings and installa-
tions, 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.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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 informa-
tion required to prepare a certificate.
Fees:
1. Certificate of occupancy $5.00
:2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date ........................
New Building .., .M~.. ....... Old or Pre-existing Building ............ Vacant Land .............
House No. Street Hamlet
County Tax Map No, 1000 Section . .~). ?.~? ......... gl,ock .O./.'~ .......... Lot. ¢~. ¢?,/. .........
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No.)!.O~..~, ..... Date of Permit . .. ~. ,Applicant .. .~,~ .~,~. ~.E.~. ................
Health Dept. Approval /~;~..~)..~,. ~'3 .......... Labor Dept. Approval ........................
Underwriters Approval..~.~.~.~,~'~ ............ Planning Board Approval
Request for Temporary Certificate ..................... Final Certificate .. ~ ..........
Fee Submitted $ .............................
Construction on above described building and permit meets all applic~.ble code~s.,and regulations.
Rev, 10-10-78
FIELD COMMENTS
FOUNDATION
(1st)
FOUNDATION
2.
ROUGHFRAME &
PLUMBING
(2nd)
INSULATION PER N.Y.
STATE ENERGY
C0~E
FINAL
ADDITIONAL COMMENTS:
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTR[GITY
~- j~[l(-3 ~.,~1')~ i~ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038
113906 - 81
TH~S CERTIFIES THAT
only ~he electrical equipmen~ ~ described below and ~ntrodflced by t~ applicant ~med on ~he above application ~mb~r ~ t~ pre~se~ of
~_~'~er ~, w/~ 0~x~d Oz'. 300~ ~/o P~e ~ l~., ~u~oid~
FIXTURE
OUTLETS
25
RECEPTACLES SWITCHES
43 28
FIXTURES
[] 2nd FI, Section Block Lot
and found to be in compliance with the requirements of this Board.
RANGES OVENS DISH WASHERS EXHAUST FANS
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TiME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
E
OF UTRALS OF NEUTRAL
t~£mid ~2ec'~lc Co.
P.O~ i~ 143
This certificate must not be altered in any manner; return to the office of the Board if lincorrect.
Inspectors may be identified b~tb~c~e~dentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF. BE ALTERED IN ANY MANN~E.