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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.... 2.10012....... Date .....Ju],3r..$ ]980
THIS CERTIFIES that the building .
Location of Property ...Oraeriwood .Road FSsherB •Is,,• N.yy'.
House No. Street Ffamlet
County Tax Map No. 1000 Section QQg......Block ..(~01..........Lot •13,,;z ,
SUbdjvlUslOn Tiishers •Is.. Dev. • Corp. • • . •~Od Map No. ..18.5• •Lot No.
..2..........
requirements fora 2-family dwell~.ng built prig to
conforms substantially to the a=•~ t>==~~- =
Certificate of Occupancy
....Apri1..2'~- , 19 5:~. pursuant to which~j~~j~. ...210012• , • • • .
dated Jq}iyr. 2 1980. ,was issued, and conforms to all of the requirements
of the applicable provisions of the ]aw. The occupancy for which this certificate is issued is .
A Private Two-Family Dwellings '
Non conforming as it is in the B-1 zoned diatrict•
Minor sub division No. 185 approved by the Planning Board
Jtme 2, 1980, with the sub standard lots approved by the
Zoning Board of Appeals No. 2657, March 20, 1980, for
Fishers Island Development Corporation.
The certificate is issued to ..pishers • Is.'Land• D81tB10 ent• C rati0Y1 .
(owner,~~
of the aforesaid building.
Suffolk County Department of Health Approval jR/.R .
UNDERWRITERS CERTIFICATE NO N/.R........................... .
Building Inspector
*no inspection made
Rev 4h9
FORMNO.6 Y~.o-v~IT' _Go,-.f~,,w'~F t, (mac ~~l
TOWN OF SOUTHOLD -~~~e Vfi.
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 re~onsible 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 $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
Date ..June 26, 1980 .
New Building .............Old or Pre-existing Building ....X....... Vacant Land .
Location of Property ..Greenwood, Road,, Fiche;s, Is,l~td,, ,N~W..X9~'k .
House No. Street Hamlet
Owner or Owners of Property .Fishers ,Island, Dey~loptngftt ,Gpxpq;ati,on, , , , , , , , , , , , ,
County Tax Map No. 1000 Section ..912......... Block ....991....... Lot ..~3 ~ .
SubdivisionF'?ai~'S.~S~s~d.1?@V~~9ba1~t. WxP..'Map No. ...1$S....Lot No. ...2 .
Permit No. Date of Permit ..........Applicant .
Health Dept. Approval .....N/A ...............Labor Dept. Approval ....W,lA .
Underwriters Approval .....NSA ...............Planning Board Approval ,June 2, 1980
Request for Temporary Certificate .....................Final Certificate X .
FeeSubmitted$ 5.,00,,,,,,,,,,,,,,,,,,,,,,,,
Construction on above described building and p t eets pl' b codes and regulations.
Applicant
R' hard F. L attorney for Fishers Island
R«. ~o-~oaa Development Corporation
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