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Home My WebLink About12845-Z Apt EFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building .... C..O.T.T.A.G..E..U.~ I..T .............................. Location of Property ................... ~ [t g.P.~ I~. ~AI~$ ........ .G.E E..EJq.P. Qt3 .T ............ House No. Street Ham/et County Tax Map No. lO00 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 ·. ~Ia.y.. 1 .1 ............. 19.83 pursuant to which Building Permit No.. ~ ?.8.6.5 ¢ ............. dated ... ~.a.n.....2.0. ................ 19 .8.6., 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 ......... ·. CL&ISTE~ .~ l..fi. ET.. ¢.=C O.T.TAGE..U. NIT .......................................... The certificate is issued to SAN SIMEON RETIREMENT COMMUNITY, INC. ..................... /o¥,,'0;.. ? .................... of the aforesaid building. Suffolk County Department of Health Approval .... ~ F L.C.. 83 .-.0. l .......................... UNDERWRITERS CERTIFICATE NO ........ .N.7. 2. ? 7.7.1. ................................. Plumbers Certificate April 9, 1986 ........ Building Inspector Rev. 1/81 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~a~ 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 pzoperty 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 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..f.?..:~..~ .J.~.../O ...... New Building ...~. ......... Old or Pre-existing Building ............ Vacant Land ........ .~_.. House No. Street Ham/et Owner or Owners of Property . . . .~...~~.~. ~., .~.~.....: .............. 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 Submkted $ ............................. Construction on above described building and permit meets all applicable c_odes and regulations. App t .......... Rev. 10-10-78 ?.,~,::,-~THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~' as JOHN STREET, NEW YORK, NEW YORK 10038 727771 Date '~)~0. :';]'!~'~ ],~; "~.~: 4 :' ~ D /lppllcatlon ,No. on file ~ ~ '; ~ ~ f ~' ~ THIS CERTIFIES THAT only the electrical equipment as described belote and introduced by the applicant named on the above application number in the premises Of in the following location; [] Basement [] 1st FI. [] 2nd FI. Section Block Lot was exatnlned on~ i ~*5'e~i'!£~;::~ y '~ · ? ~ - FIXTURE RE EPTA I FIXTURES I OUTLETS C CLES SWITCHES INCANDESCENT FLU_O_~_S_~._~ F MVEAR~:~RR¥ DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS AMT. K.W. OIL H. P. GAS H. P. AMT. NO. A.W.O. SERVICE mSCONNECT INO. OFI S !i,:~ ~I~ t~g. ,, ~ ~w,. ~.~ ~w~..w No. O~E~.~ON~. and found to be in compliance with the requirements of this Board. ICOOKING DECKS J OVENS J DISH WASHERS RANGES ~PECIAL REC'PT, TIME CLOCKS BELL UNIT HEATERS E R V I C MULTI-OUTLET SYSTEMS NO. OF FEET EXHAUST FANS DIMMERS A. W.G. NO. OF HI-LEG A. W, g. NO. OF NEUTRALS A.W.O. OF CC. COND. OF HI-LEG OF NEUTRAL OTHER APPARATUS: ,".;~:~;c:t _':,i. ~:e:c ~ ?,t '-' 't. ~30amp. ~ Dickerv, o~ Eiec, " ..... "~ Tsrk~-~tt~e Rd~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.