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Home My WebLink AboutZ-10220FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Date ..... .09.~.°.b?.l'..20 ................ 19, .~.0 THIS CERTIFIES that the building ................................................ Location of Property ....~./.8..~.l~... O.F..~..8.?.R..~.~. ............ .l*.I...81fi~...8..1.8...[~..~.,..~.,¥, House No. Street Hamlet County Tax Map No. lO00 Section ....~.0. ...... Block ... ? ........... Lot ...... 1.5 ......... Subdivision ............................... Filed Map No ......... Lot No .............. :~equiz,~nts fox- a one f~mtly d~elling built p:,lox- to confo~s subst~ti~ly to ~e . Oe~t~ioate of Oooup~o7 Z1 ...... ~. r.~ ..... , ~9 .~nt to ~~o ........... ~?. ...... dated . 9~.~..~ ............... 19 .~9, was issued, and conforms to aU of the requkements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ON~ FAI~LY D~r.nlNO The certificate is issued to 1~1~!~ BORR ~d GRACE E, BURR ................ new'/oYn'e'r~ ..................... of the aforesaid building. S~ffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO. .......... .,-,,,~...XVt.. '?/.. ~.. ~.....,~...~ 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 A. 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: I. 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 disposel--(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 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 or land use 3. Copy of certificate of occupancy $1.00 $5.00 D. September 12, 1980 ate .......................... New Building ............. Old or Pre-existing Building .... ¥ ....... Vacant Land ............. Location of Property ....~.o..~..;..~.a.s.t..s.~.d.e..o.~...~..e.dg.e..5~.: ........ .~.i.s.h.e.~. s..[.s.l.a.~.d.o. ?., .~.. House No. Street Ham/et Owner or Owners of Property ....~.a.Y..~,~..n.d..~..w..~F.d.s/~(.J?.'.; . :;'~... ~ ........................... County Tax Map No. 1000 Section .... ?.0 ......... 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 Submitted $ 5.00 Construction on above described building~and per~it meetsal,La~131icabJe c~des p~d regu,~tions. Applicant'S. ,~~:., ./~ ...... R~. 10-10-78 mon. ~ AREA =8700 * sq. fi. RAYMOND EDWARDS,dR. rand X~..'~...?~/?,,*;~ FRANK BURR 8~ G~CE E. BURR ew ~~C~ SCALE I ZO 0. mAND~R. PAL~SK~G ~EPT. 19so ~h,C~. In the Matter of Premises formerly of ANNA EDWARDS, situate Hedge Street, Fishers Island, New York. STATE OF NEW YORK ) SS. COUNTY OF SUFFOLK) AFFIDAVIT I, RAYMOND EDWARDS, JR., having been duly sworn, do depose and say: I am over the age of twenty-one (21) years and now reside at Peninsula Road (no #), Fishers Island, New York. I am the son of Anna Edwards and am personally familiar with premises owned by her on Hedge Street, Fishers Island, New York. Of my own personal knowledge I know that the structures on said premises, as shown by the survey of Chandler, Palmer & King, dated September, 1980, have been erected on said premises for over thirty (30) years last past, and specifically prior to the adoption of zoning by the Town of Southold. Of my own knowledge I know that Anna Edwards owned no other premises abutting upon the above described premises and that said premises have been in single and separate ownership for over thirty (30) years last past. This affidavit is made for the purpose of inducing the Building Inspector of the Town of Southold to issue a Certificate of Occupancy on said premises, knowing that he will rely upon the truthfulness hereof. Raymond Edwards, Jr. Subscribed and Sworn to before me this ~ ~ ~ day of October, 1980. Notary II~blic LUCY J. AHMAN ~otm~ Publi~, St~t-~ of New yorl, No. 52-0028880