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~ ~ I FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
210011....... Date .....J!i?Y..? 19 AO
No...........
THIS CERTIFIES that the building .
Location of Property . , .Greenwood Road _ , . , _ ..Fis~eY`$, Z,B;.,, .N.JC.
House No. ~ ~ ~ ~ Stree[ Hamlet
Count Tax Ma No. 1000 Section 012 Block ..~~..........Lot
Minor
Subdivision Fiahera Is. Dev. Corp, , , x~g Map No. ..~$5...Lot No. .1.......... .
requirements fora 2-family dwelling built prior to
conforms substantially to thaX
A ril 23 Certificate of Occupancy
p . 195?. pursuant to which~~~it44ffi. 210011
dated `T~y 2 19~ . ,was issued, and confonns to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .
Private Two-Family Dwelling
Non conforming as it is in the B-1 zoned district,
Minor sub division No. 185 approved by the Rlanning Board
June 2, 1980, with the sub standard lots approved by the
Zoning Board of_Appeals No. 2657, March 20, 1980, for
Fishers Island Development Corporation
Fisher= Island Develo went Co oratio
The certificate is issued to .............................p........ r'P........x1
lowne~l
of the aforesaid building.
Suffolk County Department of Health Approval NCR,,, , , , , , , , , , , , , , , , , , , , , , ,
UNDERWRITERS CERTIFICATE NO N/R... _ , , _ ; , .
'N'no inspection made Building Inspector
~
FORM NO. 6 ~ ~ T3- ~
TOWN OF SOUTHOLD N`°
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. Submii 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 user.
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 $5.00
2. Certificate of occupancy on pre-existing dwelling. or land use $5.00
3. Copy of certificate of occupancy $1.00
Date ...June. 2fi, .19.80...... .
New Building Old or Pre-existing Building X Vacant Land .
Location of Property . ,Greenwood Road, Fishers Island, New York
House No. Street Ham/et
Owner or Owners of Property Fishers. Island. Development,Corporation
CountyTaxMapNo.1000Section ..012......... Block ....001....... Lot...13i~
Yh~~ Fishers Island Dec~elo t Co 185 1 , _ , _ , , , , ,
Subdivision ......................1?~n....?I'd~f¢ti Map No. ....Lot No.
Permit No. Date of Permit ..........Applicant .
Health Dept. Approval .....N~?'
:...............Labor Dept. Approval N/A, , , , , , , , . , , , , , , , , ,
Underwriters Approval .....NSA ...............Planning Board Approval .~Iune..2, .]..:180.......
Request for Temporary Certificate .....................Final Certificate X............ .
Fee Submitted $ 5...00 .
Construction on above described building and p t ets plic des and regulations.
Applicant..
R' hard F. La attorney for Fishers Island
R°~~10'70-78 Development Corporation ^~z~4il
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