HomeMy WebLinkAbout12845-Z Apt GFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z16323~ Date April 14 198.6
THIS CERTIFIES that tile building COTTAGE UNIT
Location of Property ............. CHAPEL LANE GREENPORT
House No. ' ...............................
Street Ham/et
County Tax Map No. ]000 Section ./~ 5 ......... 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
.... H~y..1.1 ............ 198.3.. pursuant to which Building Permit No ...... 1. .2 ~.4.5..Z .........
dated ........... d. ~ v .... ~ (2 ......... 19 .~. 4., was issued, and conforms to all of the requirements
of the applicable provisions of the taw, The occupancy for which this certificate is issued is .........
.... C LUS.~]ER. ~A1.. A P.T.... G~.C. QTTA.C;E. UN.~T ........................................
The certificate is issued to . SAN SIMEON RETIREMENT COMMUNITY INC.
................... (o~ne~', ~i'e~'~KrJ~'~]~ k' ''" ................
of the aforesaid building.
Suffolk County Department of Health Approval S P L C 8 3 - 0 1
UNDERWRITERS CERTIFICATE NO ............ iq. 7. 2 8.0.3.3 .............................
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 m~ 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 disposai-(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 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 cod~e or safety inspection of buildings or premises, or other pertinent informa-
tion required to p. repar ~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, .~. 3..~..~ .J.~..~ ......
New Building ...~. ......... Old or Pre-existing Building ............ Vacant Land · .~_z~.--~. /
Locat'on of Property .~..~...e~...~..~..¢.~...~..~.. ~. ~.~.~,~.~. ~ ~ ~ ~
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 Certificato .......................
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable c.~des and regulations.
Applicant
THE NEW YORK BOARD OF FIRE UNDERWRITERS
:~, ' :~ C '~ '~ ~' BUREAU OF ELECTRICITY
~.~ ? 85 JOHN STREET, NEW YORK, NEW YORK 10038
.~,te r,~,~-~_,.?,~.:~-,~-..'~- :'~' ,'~",~"~ '"ppli'-'ati°"'~r°'°"S'le :'-"~:~ ?::"~ N 728033
THIS CERTIFIES THAT
only the electrical equipment as described belotv and introduced by the applicant named on the above application number in the premises of
in the following location; [] Basement [] Ist FI. [] 2nd Fl. Section Block Lot
wasexaminedon i'5~'.: ~ ??~:i ]'~'(~ ~ ~ andfoundtobeincompliancewith therequirementsofthisBoard.
FIXTURE FIXTURES
OUTLETS FLUORESCENT VAPOR
RANGES
)KING DECKS OVENS DISH WASHERS EXHAUST FANS
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R V I C
NO. OF CC. COND. A, W.G. NO. OF HbLEG A.W.G.
PER .E OF CC. COND. OFHFLEG
L /
OTHER APPARATUS:~
NO. OF NEUTRALS A. W. G.
OF NEUTRAL
GENEI~AL MANAGER
Per_
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. B_UILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN AN~ MANNER.. :