HomeMy WebLinkAboutZ-10960 FORM N0.4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. ..4199~Q........ Date APF'.~~.2a,..........,19$2.
THIS CERTIFIES that tligbuilding .
Location of Property ........................'rihis.tler.'.s . Avenue...... F'iahers..Island
House No. Street Nam/et
County Tax Map No. 1000 Section UO9• • . • ...Block 7 O..........I,ot .eas t..part:..of . 1 1
Minor Minor Suh,
Subdivision...Yierttce,-F.I?CO ..............~'ifled-Mi1aprN,~o. .2~6{7~...LhotiNo. parcel..A.'..
conform su~sefa>1~laRy toot~ie lca'{laoaefa°cc~u+~3iag~trabt~wse~o~to~ta~a3.lia~u~~ca8aiocL
Certificate of Occupancy _
Apr.i1..23......... , 19 .54 pursuant to which$a;!I~inghel~ltit•No. Z.1.Q96O........... .
dated .....April .2'7 ..............19 $2 ,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 .
.....a . pa.iv ata..one-.familx . dw.e.ll ing .3{~SI..R3S't..q>i . 8R~3 ~3•Ag . @pT.1g@,~.... .
(accessory use)
The certificate is issued to F?,st~et'S..IS1.1nd. D.e.v~ lopW~py, ,Gprp,o,rgt:~o,q , , , , , , , , ,
(owner, /asses orSOmat}
of the aforesaid building.
Suffolk County Department of Health Approval ...not• •rlequ.ired.. • .
UNDERWRITERS CERTIFICATE NO...........49t„rgguired,,,,,,,,,,,,,,,,,,,,,,,,,
fVariance'gratiDed by the Zoning Board of Appeals, appeal X2952,
3/19/82, .Planning Board granted a set-off on the property,
2/8/82.
, ~
Building Inspector
Rev. 1/81
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.
Q 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 ...April 12, 1982
New Building .............Old or Pre-existing Building X........ Vacant Land .
Location of Property .Whistler,',s,Avenue,, Fishers. Island,,, ,New .York .
House No. Street Hamlet
Owner or Owners of Property Fishers Island Development Corporation
ERSt YPRT OF
County Tax Map No. 1000 Section 9........... Block ...1.Q Lot ...11.......... .
~I E~C~ - ~I OCC MI?~oiz SU3 ?A
7 ~ ~.iZCG L R
Subdivision ................................'.P~ Map No. ..........Lot No.
Permit No. ...N~?~.... Date of Permit NSA ......Applicant N/A . . . . . . . . . . . . . .
Health Dept. Approval N/.A .................Labor Dept. Approval .....N/.
A............... .
Underwriters Approval N/.A .................Planning Board Approval .
Board of Appeals Approval~3%19%$2~~~
Request for Temporary Certificate .....................Final Certificate .....X................ .
Fee Submitted$5.00
Construction on above described building and permitme~''ts a//ll ap i le des and regulations.
Applicant ~ ~~C . ~ l/'t .
Ric~ard F. L k,~ sq. for Fishers Island
Rev. to-~o-~a Development Corporation
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