HomeMy WebLinkAboutZ-30221 PR~ EXISTING
CERTIFICATE OF OCCUPANCY
No: Z- 30221
06/02/04
(HOUSE NO.) (STREET)
FISHERS ISLAND
The certificate is issued to JE~IFER RUSSELL & A~O
{OWNER)
Rev. 1/81
CRESCENT AVE
TOXVN OF SOLTfBOLD
BIJI~Dt~G DEPARTMENt
TOWN HALL
765-180-*
.~PPLICATION FOR CERTBFICAI]g OF OCC[BPANC5
Ttds a~Jcation must be fil2ed in by typewriter or mk trod submitted to the Building Depmlmem with the following:
1. Final survey of propmty Mth acdurat¢ location of all bmiddngs, properiy Iiaes, s~reets, and unnm2at rmtm'al ol
2. FinalApprov~lfcomHeatthDept.~fwatersupplyandsewerage-disposal(S-gfomfy
3J )kpprowJ O( electdc~ ifismtlafion from Board of F~re UndervoSters.
5. C:6mmer¢ia~ b~]4iog,indastrie3 bu~ding~ mu~iip~e re~den~e~ mad similar bui~dings` and ths~a~ati~ns~ a ee~i ~c~
of Code Compliance from arch/leer or en kSneer respoms~al'e for the bu/lding.
6. 8ubrr~t Planning Bom'd Approval of completed slie platt reqah-emcmts,
For e~isl/_'~ b~ildL~_gs (prior to April 9~ 195~ non-coneor m lng uses. or hulkings ~ '~pr~*is4Mg" ~d uses:
$3~qg pool $25.00, Acdessory bqg~g S25.00, A~¢om.m acc~so~ b~l~g ~~s}$5%99.., , ~
L0ca~onofPiopeny. (no #)
Old or Pre-existin8 Buildimg: x
kcheck or~el
Fishers Island
Permit No.
Health Dept. Approval:
Plarm/mg Bomzl Aiypro~al:
Rcquq~st forf Tempopar5 Certificate
Fcd'~}bmitted: $
OwnerorOwner$ >fP~operty: _Jennifer Russell, Sarah F. R~ssell and Thomas W,
Suffotk Cotmty Tax Map No 1000. Section I)06,00 Block 01.0d
Sub divisio~l n-la Flled Map. n/a Lgt:
Date of permit n/a _ Applic~nt: n/a
nfs lind elwvliters Approval:
Fir~ CJd~li~¢ate:.: X , t theck one'
IIan~
002.000
n/a
CONSENT TOINSPECTION
Stephen L. Ham, III, as attorney for
Je n' er R se 1 S ah RuSS~i1
Own~l s~
That thc rmdcrsigned tis ~ ~e om~fs~ of~e p~mmes in &e To~n~ of
Sou~ol4. located at (no t;) Fox Avemre, ~ishers I~]and
which is shoval and designated on the Suffolk Com~ty Tax Map as District 1000.
Section 6 ,Block i , Lot 2 __-
That ~e tmde,~igned (has) (have) filed, or cause to bciiied, an application in the
Southold Town Building hispector's Ollice for the followkng:
pre-existin~ Certificate of Occupanay for a single-family dwelliag
That the undersigned do(es) llercby give colzsem to the Building Inspectors of the
Town of Sonthold to enter upon the above d~scribcd property, [neludkug any g4ld all
building~ moated thereon, to conduct such inspections as they may dee~n nc{zessary with
respect to the aforesaid application, including inspections to determIne tt~at said prcrrfises
comply w~th all of the laws. ordhrances, roles and regulations of the Town of Southol&
The undersigned, in consenting to such inspections, do(es) so w~th thc knowledge
and tmdcrstanding that any informa*ion obtained th thc ~onduct of such inspecnons may
bc used in subscquen~ prosecutions for violations of the laws~ 0rdtuances. talcs or
regulafior~s o f'che Town of Southold.
Datcd: April Zl, 2004
(Signamrel
,P~I Name~
(S~gnature)
CPrint N~n~
~- t4o~4
~.00 '
3/7.5'.4.$~