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Home My WebLink AboutZ-10359FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. ? ~0~9 THIS CERTIFIES that the build/rig S .................. Reed to Eest End Fisher s Island, N,Y, Location of Property/2/~s; ~]o: ...................................................Street 121~r~/e~ County Tax Map No. 1000 Section .../4. ........ Block ...5 ............ Lot...? ~ ............ Not A __. Subdivision..~.:[.~.h..O?..8...I.8.~?.~.d...~.]..~.~. ...... Filed Map N~..0.*.D.°?.~.Lot No. ?...B.~ .O.e.R. Reauirements for e Private One Family Dwelling Built conforms substantially to the Prior to Certificate of Occupancy · .Apl.il. 23., ......... , 19.5.Tpursuant to which ~ifd-irrg'~N~ ...... Zfi. 0~59 ......... dated ..... ~..anu8r'Y..~, .......... 19.8J, 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 ......... TME MAIN STRUCTURE - A ONE FAMILY COTTAGE - GUEST hOUSE GARAGE WITH A BED ROOM AND A TOILET, SINK, BATHROOM ( NO KITCHEN) FOR STEPHE~ A. COOK ~ CYIqI~A P. COOK The certificate is issued to ..................... /oW/e),'/~X .................... of the aforesaid building· Suffolk County Department of Health Approval . .I~../? ..................................... UNDERWRITERS CERTIFICATE NO...N./A ............................................ Building Inspector 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: 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 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. Bo 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 New Building ............. Old or Pre-existing Building ...x ......... Vacant Land ............. Location of Property ...~.o.t..9/. ~1.o.c.~ .1.6.,..I~.o..r~..e.~.it.e..1~..1~..~.o.~ .~..a.s.t .e.r.~..F.i.s.h.e.r.s..l.s.l.a.~?. ...... House No. Street Ham/et Owner or Owners of Property H. Richard Dietrich 0 Jr. New Owners: Stephen A. Cook,nd Cynthia P. Co~k . _s 16 ~ County Tax Map No. ]000 Section ............... Block ............... t. ot ................ 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,.0.0. ....................... Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 pl.'iZ h" H n ~ D 9'S- t? ,b)~. In the Matter of ale of Premises on Fishers Island, ~ew York, by H. RICHARD DIETRICH, JR., lo STEPHEN A. COOK and CYNTHIA P. COOK ]0UNTY OF CHESTER ) AFFIDAVIT I, H. RICHARD DIETRICH, JR., having been duly sworn, ~o depose and say: I am over the age of twenty-one (21) years and now ?eside at Chester Springs, Pennsylvania· The main residence of the above mentioned premises ~as constructed in or about 1926 and has been used for resi- lential purposes only· The Cottage on said premises was built at the same :ime and contains a small kitchen with cooking facilities, a ~athroom, one bedroom and a living room and has been used since ts construction as a guest house. The garage, which was also built at the same time, Contains in addition to car space, a small bathroom with toilet and sink and one bedroom, which has been used as servants uarters since its construction. ~. .~ · I,CHARD ~ICH, JR/ '~ ubs~bed and~Sworn to before me OTART PUBLIC ,~'~- ~ In the Matter of ale of Premises on Fishers Island, ~ew York, by H. RICHARD DIETRICH, JR., ;o STEPHEN A. COOK and CYNTHIA P. COOK i ......... x ) COUNTY OF CHESTER ) AFFIDAVIT I, H. RICHARD DIETRICH, JR., having been duly sworn, do depose and say: I am over the age of twenty-one (21) years and now reside at Chester Springs, Pennsylvania. The main residence of the above mentioned premises ~as constructed in or about 1926 and has been used for resi- lential purposes only. The Cottage on said premises was built at the same ;ime and contains a small kitchen with cooking facilities, a ~athroom, one bedroom and a living room and has been used since ~ts construction as a guest house. The garage, which was also built at the same time, contains in addition to car space, a small bathroom with toilet and sink and one bedroom, which has been used as servants uarters since its construction. ubs.~a~kbed and~S~orn to before me H. ~R~CHARD ~ICH,