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HomeMy WebLinkAbout12845-Z Apt BFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy N Z14318~ o .................. Date April 14 ................................. l~.~.. THIS CERTIFIES that the building ..... C..O.T?.A. ? .E..g.~ .t .T ............................. Location of Property CHAPEL LANE GREENPORT House No. ' ........ Street Hem/et County Tax Map No. 1000 Section . .. 4. ~ ....... Block .... .2 .......... Lot . .1. .0: .1 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..~.~ff.. ] .1 ............ , 19 .8.3. pursuant to which Building Permit No .... .1.2.8.4. .5.Z ........... dated ........ 4 Op.... ~ ~) ............ 19 .8.4., 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 ......... ...C.kV.S. ?.~.~..#.1.. A!T....s.=c..oY?Aq.~..v.~. ~. ? .......................................... The certificate is issued to ..... SAN SIMEON RETIREMENT COMMUNITY INC. ................ io¥.'~;, '~&~k'~i~k'f ' ' '" ............... of the aforesaid building. Suffolk County Department of Health Approval .s?.hq..s.s.= 0. ! .............................. UNDERWRITERS CERTIFICATE NO ...... N .72.8029 .................................... Plumbers Certificate April 9, 1986 Building Inspector Rev. 1/81 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~ mm~Jm to the Building Inspec- tor 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, 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 p~operty showing all property lines, streets, buildings and .unusua~ 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date. ...... New Building ...~. ......... Old or Pre-existing Building ............ Vacant Land (_~_.~,~,.-~¢-,/.. Location of Property .~..~..~.....~.....~..¢-'~...~..~.....OA'~....J-..~tt...~.~,~ .~.~.../~ ?. ~..-~...~... House No. Street Hamlet Owner or Owners of Property ....~...~..~.?'.~.~.t..~.....: .............. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ 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 applicable..~des and regulations. Applicant. J..J~...~..-.~ ~, t,'~t~j~ ¢- ' ~ · . . ~ · . . ~ .......... ...... R~v, 10-10-78 Zt?3t ~:~:.~:~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY I ~ ~.~.,.~. ,r,' , .~,. .~8AS..JLOHN STREET, NEW YORK. N~)~V.?'~,I~,K/~0~030 ~"~"~""~"" ..... ~"~ N 728029 THIS CERTIFIES THAT only the el~tdcal equipment ~ ~sc~bed ~i~ and int~uc~ by the a~pllcant ~med on the a~ve application number in the p~mlses of in the following l~atlon: _ ~ B~s~ Ist FI. ~ 2nd Fl. Section Block ~t was examined on and found to be in compliance with the requirements o~ this Board. FIXTURE FIXTURES DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS RANGES COOKING DECKS ;PECIAL REC'PT. TIME CLOCKS OVENS DISH WASHERS EXHAUST FANS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: NO. OF NEUTRAL: OF NEUTRAL GENEI~AL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.