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' FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Ha11
Southold, N.X.
CERTIFICATE OF OCCUPANCY
No Z-17716 Date JANUARY 26„ {989
THIS CERTIFIES that the building SHED ADDITION
Location of Property 1530 JACKSONS LANDING MATTITUCK N.Y. _
House No. Street Hamlet
County Tax Map No. 1000 Section 106 Block 9 Lot I6
Subdivision JACKSONS LANDING Filed Map No. 5280 Lot No. I3
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JULY 5, 1988 pursuant to which
Building Permit No. 17211-Z dated JULY 14, 1988
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 SHED ADDITION ATTACHED TO DECK
The certificate is issued to GERALD JAMS
(owne)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE NO. NfA
PLUMBERS CERTIFICATION DATED N/A
''~+~1~
Building Inspector
Rev. 1/81
absat< xo. a
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N° 017211 Z Date .....Y..~~ 14.~.~
Permission is hereby grpnted tp:
....~~.~~p
~a ..~~i~c-~....a-n........~~~c~:t~=s~~....~j. 1~:~~~.-~........... r -
..........................................~2.a
ct premises located pt ~•-Fih~...................................
County Tax Map No. 1000 Section .......~Q..6..... Slock ............r~........ Lot No.....~~............
J
pursuant to ppplicotion dated .............1./?~.................................., 19..(~,~and approved by the
Building Inspector.
m~ B ~
Fee $..v..~.~..•~~
Bulldmg~Ny p~ector
- Rev. 6/30/80
i
TOWN OF SOUTHOLD
BUILDING DEPARTMENT ~ 2
TOWN HALL
BLDG. DEFT.
SOUTHOLD, NEW YORK 11971 T0W6gUFS0UTH0LD
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
DATE ~kE'7Y.?:'~..~~:...
NEW CONSTRUCTION .......OLD~OR/~P~~RE-E%I/S,TING BUILDING......pACANT LAND........
Location of Property......:..el.',3J~s,-"'-?x~%~H~''.._.._,_._mK.
HOUSE N0. STREET HAMLET l
~ ~ rz
Owner or Owners of Property...
County Taa Ma~py'No/. 1000 S/ecti~/on . t°~.~.~'Block C?~.6:E? Lot ..C'71.~ .~:`d
Subdivision..~LK~(`.$u.~Q~'„(.4t:~~Y{`r(~_, Filed Map .~.?-~.O.Lot..l:-~.....
ryry F
Permit No. U~{,Z~'~,,.Date of Permit 7.1~: ~s~ „~~,N~G+tHr_/o:^~e
...,Applicant
Health Dept. Approval Underwriters Approval.
Planning Board Approval .??4"^.~,...,,_,,,
Request for Temporary Certificate Final Certificate
25
Fee Submitted:
i ~ ~
APPLICANT.., ..1.'C'.~...
~e-3~saG
eo`~?~716
rev. 10/14/88
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THE NEW YORK BOARD OF FIRE UNDERWRITERS '
tol~ei.e,t
g ®UREAU OF ELECTRICITY
+Vf7N g:FiHF:k (3"I : ~ q~~OHN STREET. NEW YORK. NE~y3YORK t~036 N .3~ _d~, 1,
Date Applicateon No. on file h tS598R/ N
THIS CERTIFIES THAT
only the electrical equipment os described 6ek]rs and introduced 6y the applicant nomad on the above applicstion number in the promisee of
•JFR~RY dANT:5. .TAS'll"SON'S f,A,NDTNCT. I>•Oi,A: # NY'C 4, MAmY'1'1'ti<'il, M.Y. -
CNK/}9JA
in thefollouinp Inca~;tddj~ ~eA~~, ? 1st FI. ? 2nd FI. Section Block Lot
waa examined on and found to 6e in compliancy with the reyuirementx of thin Boord.
FXTUR! RXTURES RANOB COOKING alCKS OVENS qSN WASHERS EXHAUST FANS
WT~ys TACEK SWITOIES INCANDESCENT-flUOI1ESCENT
A AMT. K. W. AMT. K. W. AMi. R.W. AMi. K. W. AMT. N. P.
I ~ i 7
DRYERS RIRNACE MOTORS NITURE AFFUANCE NED[RS fFEUAI NC'FT TIME ClOC1If REII UNIT NEAi[RS MUlil-0UiIET gMMERS
AMT. K. W. OIL N. P. GAS N. P. AMT. NO. A. W. G. AMT. AMP. AMT. AAVS. TRANS. AMT. N. R SYSTWS AMT. WATR
NO.OF REi
SERVICE DISCONNKT NO.Oi 5 E R V 1 C R
AMT. AAV. TYPE 1,e ]W 1 L ]`N ] A' 3W ] X AW ~ CC. COND. A. W.O. NO.Oi N41EG A. W. G. NO.Of NEUTRMS A. W. G.
PER / Of CC. COND. Of n-1EG Of NEUIRAI
OTHER AMAEATUS:
.,.Y.t7.7:-1
l
't'.H. <'NRSHLRF: SpN
i'A.I::Yk:R'i'{)N . NY , 7 i 9'3:3 AIANAOER
i:fGk:NSF: NU.. 453 1': Per
This nrtificats must not ba alMrod in any manner; return to the office of the Boord if irlcorract. Inspectors may be iden' by their crtdaMials.
~ COPY FOR SUILDRIG ~PARTMiNT. THIS COPT OF_C:RRTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
C7z~~
7G5-1802
BUILDING DEPT.
INSPECTION
[ )FOUNDATION 1ST ( ] ROUGH PLBG.
(]FOUNDATION 2ND [ ] IN ULATION
[ ]FRAMING ~ FINAL
REMARKSe _~~!S~
DATE INSPECTOR
T ~~a . ism z
6 T~-~
~v;~Ga~L,! ~~V~~f~i_~,~. ~FORMN0.1
} M1
p ~ _ ~ ~ ! TOWN OF SOUTHOLD
yE3~ 1 BUILDING DEPARTMENT
51 ~ TOWN HALL
.a,.a SOUTHOLD, N.Y. 11971
BLDG. DC{''i. TEL.: 765.1802
TOW(U OF §OUTHOLD
Examined . ? ~,~t~.......... , 19 Received , 1 9 .
Approved 19 ~~Permit No. ~.9!~ ~ O7~~~~q-- ~~G' ~O p
Disapproved a/c CJ~~fa' ~e,~uc-~-d-
uildi~nspector
APPLICATION FOR BUILDING PERMIT
Date 19~.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or,infin~cla~n~,~sbr~~~~NtZilB~ilding Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to sched't%:;,• ,
b. Plot Ian showin location of lot and of buildin s on 're es , q emises or public streets
P g g P,
' or areas, and giving a detailed description of layout of property~~i~ius~tLm$ey~l~'~y i which is part of this appli-
cation. >y'i" ~.I£.duCRiCh4! 1"~iR
„ c. The work covered by this application may not be commend .~e,r~e$~~~,an~cy~u~ding hermit.
d. Upon approval of this application, the Building Inspector,.wil~,hssued'a ~i - t t~~h~tt~ttyhe~applicant. Such permit
shall be kept on the~premises available for inspection throughout~t k~1~4;T~~¢
e. , No buildirigshall,.be occupied or used in whole or in paurt~f~r~ • urL~yc t~v ertificate of Occupancy
shall have been grarited by the~Buildmg Inspe ctor; ~ z'y~ 8~;}
APPLICATION I~; HEREBY' MA~DL to.=the` Building Departln~t~ $t i Permit pursuant to the
Building Zone Ordinance of t)~e Towp of Southold, Suffolk C6unt}~~£ ~ ~ ~e lic ble Laws, Ordinances or
e ~ :
Regulations; for the construction of ~nildings, additions or alt~~"ati~ , o ~ 6tltr on, as herein described.
The applicant agrees'to' cSfnply with' all applicable laws, ordinan~~'•b~il'rr h~ g~~t~derand regulations, and to
admit autKarized~inapectors on~preniises and in building for necessary in~sp }ons.
y3~.R,4
(S~ or name, if a corporation)
~a.~mx.~?.~ 1~t~~~~J~?f~.-..//.~~z.
(Mailing address of appli t)
State whet/h~er~app~l"ic~an~t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
1,..L .cgrK w. ~t
Name of owner of premises V,'fi~!`z?^. !1:..lr"t~-~~ ~MA.~~!'L" .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporat~eQof~ficer)
Builder's License No. ~"G"h .
Plumber's License No. .....?'W~-- .
Electrician's License No. .
Other Trade's License No. .
1. Location of land on which proposed work will be done. ~ 4 X ~~s.~t ~~,tra
House Number Street Hamlet
County Tax Map No. 1000 Section ~"QQ. c~
C.d~l2 !De- -Block /.....J~.,.~~6. ~ . Lot . .
s
~~ubdivision d ~•cy.0.3~ ~5......... Filed Map No . Lot ~ .
(Name)
2. State existing use and occupancy of premises and intended-use and occupancy of proposed construction:
a. Existing use and occupancy .
h. Intended use and occupancy
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