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Home My WebLink AboutZ-7707 BTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, BI. Y. Certificete Of Occupancy THIS CERTIFIES that the building located at . .~./.$..l~.qU..e.~..t~.~.a~., A.?? ..... Street Map No. ~ Block No. XX .Lot No. ~ ~equ~,r~aents fox' o~ fa~Ll)' dwelling & Housing code ...................... dated ~tpl, 2~ , 19..~.. pursuant to which Z~..- dated ........... ~..~. :..e...~,W/9 .... , was issued, and co,~o~s ~ m of the r~u~ merits of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to . .a. :r.~ .r.t..I.:..~..~..t.o. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .P.~.~...e.x~'. ~.t..~. ,~ .................... UNDERWRITEBS CERTIFICATE No. P.~.~'...~.x.~..~.t..~.~. ............................. ~OUSE NU~mER ..... .~.o..m. .... Street .... ~q~.~.t.~..l.~...~..~. ..... ?~..h.e.=.~.. ~..~..... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD 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: ]. Final survey of property with accurate Iocatien of all buildings, property lines, streets, anti 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 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 .J.un, e~..2 ..... 19.7.7. .................. New Building ................ Addition ................ Old or Pre-existing Building ................ ×x× Vacant Land .............. Location Of Property north s±de of EquesCr±an Avenue, F±shers Island, N. Y. Owner Or Owners Of Property Herbert I. Lord Subdivision none .... ................................................................ Lot No. Block No. House No ......~.7.... Permit No .................. m-Date Of Permit .................... Applicant --- Health Dept. Approval ......... ~o.t...~pp.l--igab. le. Labor Dept. Approval .... nD.t:...~.pl~.%,~.b.%.~. .......... not applicable nt applicable Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ 5.00 ....... Z.~ .~... day of .~...u...~..e. .............. 1977. ...... Notary Public .... · ...... Construction on above described building and permit meets all applicable codes and r§gulations. Applicant ·'~[ ~b.~r r..iZ.:...~ord...~...~rT.~±.]:~i, am..~.:...~ss.ek~ ;....a,ct: orne¥ Sworn to before me this ~d ~e~ (stamp or seal) NOTARY PUBLIC, State of New York Qualified in Suffolk Counly Commission Expires March 30, 19~ A F F I D A V I T STATE OF MICHIGAN t COUNTY OF WAYNE t SS.: HERBERT I. LORD, being duly sworn, deposes and says: 1. That he is the owner of certain premises on the north side of Equestrian Avenue on Fisher's Island in the Town of Southold, Suffolk County, New York; 2. That he makes this affidavit in support of an application for a Certificate of Pre-Existing Use or a Certi- ficate of Occupancy; 3. That deponent purchased the premises on September 30, 1948 from Echo Valley Farm and Ruth Morgan Oliver; deponent is in the process of selling same to Richard I. Purnell and Marguerite H. Purnell; 4. Your deponent states that he has not made any exterior alterations or additions or structural changes to exceDt An the sDring of 1951 the premises since his acquisition of same/and requests that the application for a Certificate as stated above be granted; 5. A copy of an up-dated survey will be provided to the Building Department of the Town of Southold within a short period of time if same is not annexed hereto. Herbert I. Lord Sworn to before me this 31st day of May ., 1977 Notary Public ~0'~ Public, Wayne County, 4 J I-