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Home My WebLink AboutZ-9695FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No.. 7.?.69.5 .......... Date ....S.e.P.t.e.m.b.e.l?. ~.6.,..19.7.9 ........ 19... THIS CERTIFIES that the building ................................................ Location of Property ....W.i.n.~..1~. pp..D.r.i.v.e. .......................... F~.shera .IslsIld House No. Street Hamlet County Tax Map No. ] 000 Section ..... 9 ......Block ..... .'10 ........ Lot ..... ? ........... Subdivision ............................... Filed Map No ......... Lot No .............. Requirements for a one family dwelling built prior to conforms substantially to the~ Certificate of Occupancy ....A?.r..i.1..2.~. ........ , 19~7... pursuant to which~BlJ~iili$~t No ..... .Z.9..~.?.~ ........... dated ............................ September 26 1~.9. ., 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 ......... ................... ~.e..F~.x.z.y., ~.e.z.z..t.n.~ ...................................... The certificate is issued to ......D . .~. ~. .e .17.' .L.....~.a.b. 999.k.. .m3.cl' .8..h.e.l.Z.q..lyl,..B..a.b.e.o. qk. ...... (owner, ~0 of the aforesaid building. Suffolk County Department of Health Approval .......... I}1../.R ..................... UNDERWRITERS CERTIFICATE NO ......................... ~./.R. ..................... Building Inspector Rev 4/79 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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 featu res. 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 peoperty 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 code or safety inspection of buildings or premises, or other pertinent informa- tion requ ired to prepare a certificate, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .. S.e. pt.e..z~.b..e¥. ],9. ,..],9.7.8 ..... New Building ........ ]-;df 1~ol.dz~r onPre'existingBuildingannexea survey,' ' x. ~it'~Jt'e' ~)'n Vacant Land ............. Location of Property ...S~.u.t.h..e.a.s.t,.e.~.l.,~, .1.$.~.e..o.f .'vy.i.~.t.h.~.o.p..D..~.v.e.:..~.i.s.h.e.~.s..I.s.l.ap.d.,..~....¥: .... House No. Street Ham/et Owner or Owners of Property .. ~.a.E~.e. [.[..~....~..a.b.c.o. qE..a..~.d..S.h..e.~.a..~.. ,..~,~.b. (;0¢.~ ............... County Tax Map No. 1000 Section ...9 ............ Block .... t.0. ......... Lot ...... 7. ......... Subdivision ................................. 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 $....$.5:.0.0 ..................... Construction on above described building and permit meets all applicable codes a~d regulations. Darrell T, Babcock a~i~Sbe~a M.-/~abcoc~k Appl,cant . . . Y... :~.~.../~/~/~~( ........... ~ilip B~att~eW~r ney In the Matter : of : Sale of Premises by GLENN W. BOOCOCKto DARRELL L. BABCOCK : and SHEILA M. BABCOCK situate at Fishers Island, New York : Title Guarantee Company : Policy No. 1207682 STATE OF NEW YORK ) SS. COUNTY OF SUFFOLK) AFFIDAVIT I, GLENN W. BOOCOCK, having been duly sworn, do depose and say: I am over the age of twenty-one (21) years and now reside at 580 Park Ave., New York, N. Y. This is to certify that there has been no physical change to the exterior of the premises designated as Lot No. 2 of the attached survey' made by Shepard B. Palmer and dated August, 1964 since the date of said survey, nor have there been any additional buildings or structures erected on said premises. This affidavit is made for the purpose of inducing the Building Inspectdr of the Town of Southold to issue a pre-existing, non-conforming Certificate of Occupancy for said Lot No. 2, knowing that he relies upon the truthfulness hereof. Glenn W. Boocock Subscribed and Sworn to before me this day of September, 1979. Notary Public