HomeMy WebLinkAboutZ-6751 rot;u xo. a
TOWN OF SOUTHOI.D
BUII.DING DEPABTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No.Z67.~"~....... Date Oct... 19. ~5
THIS CERTIFIES that the building located at ...gyt(loop)Road• o8f
• A~
Map No..r .L.Sst• • • Block No...1Fp......Lot No.. r~. • • •Bfahers • is28IId• • •A.y:
conforms substantially to the
da~edt before AAr~. F3..., 19..5? ursuant to which ~~~~°occupanoy
p Zb751.. .
dated Aot• • • •2~• 19.~~r., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ..Pri~rate• one• £amll~ •dwelling
The certificate is issued to . lloyrwlds• rxul?ont •Jr• • ....Owc?ea .
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval ~..Bre~ SYisting .
UNDERWRITERS CERTIFICATE No.grs+.Trxisti~
HOUSE NUMBER Aon....... Street .
j,~.,.
Building Inspector
FORM NO. 6
TOWN OF SOUTNOLD
Building Department
Town Clerks Office
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
Inspector with the following; for new buildings or new use:
1. Final survey of property with accurnte 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
installations, 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.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of property 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 in-
formation required to prepare o certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
October 22, 1975
Date
New Building Addition Old or Pre-existing Building .....X........ Vacant Lond
Location Of Property ...Private Road,...Fishers,Island,{„N.,.,Y;, in Park
P Y
Owner Or Owners Of Pro ert Henry Ferguson
plan
Subdivision ...Fishex:s..IsLand.CQr{>....acig../.....Lot No..q.~.g.... Block No....4D..... House No
Permit No Date Of Permit ....................Applicant
Health Dept. Approval ............................................Labor Dept. Approval
Underwriters Approval ..............................................Planning Board Approval
Request For Temporary Certificate Final Certificate ..X.....................................
Fee Submitted $ ......5..DA
Construction on above described building and permit meets all applicable codes ond~ regulations.
B enry son /~y~~ ~G2~~~
Applicant ....Y...... ~ /.l
~~~a££o'rriey
Sworn to before me this,~_~ ~
......~.ZF?d.. day o~-:'~... 9.tR#g ....1.. - (stamp or seol)~ p~Z71`/7~~~]
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TITLE ASSOCIAT\oU. IROf1 133.05'
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TITLE r-l v- 1L9o490
PLAN OF P~OPE~TY
TO 6E' GOt~.tyEYED TO
2EYNoLDS vvPONT, Jam. ~
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F15HEt~5 1St-A?.1n. NEW YOS[Y~
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ADO1T'IONS OCT. Lo,19"js