HomeMy WebLinkAboutZ-9872 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No....Z9II72 February 14 0
Date .................................1
THIS CERTIFIES that the building .
Location of Property ...............Central. Ayenue.. , ,Fishers. Island,..N.Y.
House No. Street Hamlet
County Tax Map No. 1000 Section ~Q .....Block ...........Lot 8.......... .
Subdivision ...............................Filed Map No. ........Lot No. .
requirements for a commercial building built prior to
conforms substantially to the
Certificate of Occupancy 29872...,
Aril, 23 , , , , , , , . , 19 57 ursuant to which~99l~iK>ifi1i~~5.
.p
dated Febx't1a~y, ,14, , , , , , , , , , , , , 19 8Q ,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 .
.........................Gas Station
The certificate is issued to ......Francis T., Doyen
(owner?9Xie
of the aforesaid building.
Suffolk County Department of Health Approval N~R , , , , , , , , , , , , , , , , , , , ,
UNDERWRITERS CERTIFICATE NO Nf
R .
Building Inspector
Rsv 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-
torwith 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, acertificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. 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.
C. Fees: '
1. Certificate of occupancy
2. Certificate of occupancy on existing el(ing or land u $5.00
3. Copy of certificate of occupancy 1.00
Date ~
New Building Old or Pre-existing Building Vacant Land .
Location of Property C.~ ~/h/rG_ U~ iT/ v ~ S(f~;2 S ,1 SYrfy/~~///%
House No. Street Hamlet
Owner or Owners of Property r~. -
/ - 17
County Tax Map No. 1000 Section Block . , Lot ../~2._....
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 $ ....~9........ ~
Construction on above described building and permit meets
all applicable codes and regula ' ns. G G 7
Applicant ~-E~~aa Zc
.................f.-.........~~
ate. ~o-ioae /{D ~ /~7/1` ST/~ E
E,~/~~
/f r Y%
STATE OF NEW YORK
COUNTY OF SUFFOLK SS.:
FRANCIS T. DOYEN, being duly sworn deposes and says:
1. I am the owner of the premises located on the
southerly side of Central Avenue, Fishers Island,
Town of Southold, County of Suffolk and State of
New York, and known on the County Tax Map as
District 1000, Section 10, Block 1, Lot 8.
2. I know of my own knowledge that the gas station
building located on the aforementioned parcel was
constructed and was on the aforesaid premises prior
to April, 1957. In fact, I would state that it has
been there for more than 35 years past.
3. I make this affidavit knowing that the Town of
Southold Building Department will rely upon the
truth of same in issuing to me a pre-existing
Certificate of Occupancy.
~.~-u~ °T ~ ~1a-~a-e-~-.
Fraacis T. Doyen
Sworn to before me
this la ~ day of February, 1980.
Notary P bl c
LL'.,Y F.ri P;IhN
9otaiy F_r c SLnw Xoxw
Quelifisd is _~„f->!t: Ccuntyp
Sean e~~c~., e3uuh s0. 19 p /