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Home My WebLink AboutZ-10416FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy 210416 February 27, 81 N0. ................. Date ................................. 19... THIS CERTIFIES that the building ................................................ Location of Property......, Road to East End, Fishers Island, New York .................................................... House No. Street Hamlet County Tax Map No. 1000 Section ..0.0. 7 ........Block ....... 0 .. 6 0 ......Lot ....... 0. 0 . 4 ...... . Subdivision ...... .........................Filed Map No. ........Lot No. ............. conforms substantially to theau irements for a one -family dwelling built prior to Y Applicaticxl- €or -Build ng -Permit -heretofore flied-in-this'of Cid€ zlmd - - Cerjjfaggttg_gf_OccupancyZ10416 A p r i l 2 3 1957 . pursuant to which Building Permit No . ..................... dated February 27, 81 • ... • • • ... I ................ 19 .... 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 ......... Private One -Family Dwelling ..........................................I.................. The certificate is issued to Louise S. Mallory ................... (owner,—MI 8 artiidu�fl'' of the aforesaid building. Suffolk County Department of Health Approval ..... NA/ ... • • . • • • ...... . UNDERWRITERS CERTIFICATE NO ..... N/R z� X ........................................ Building Inspector Rev. 1/81 a �: 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- tor with 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, 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 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 ......4/27/.'?............ New Building Old or Pre-existing Building X" ...... Vacant Land Location of Property .................... nriya)Tte road ishers Isiand .............. House No. Street Hamlet Owner or Owners of Property ...... J4 (PP..11 , 0,' ijee f.in O' :cefe &, Anthon_ Land'-zam County Tax Map No. 1000 Section ....7 .......... Block ... ........... Lot ..... .......... Subdivision .................................Filed Map No. ..........Lot No. ............. Permit No. .......... Date of Permit ..........Applicant .................................. Health Dept.Approval ........................Labor Dept. Approval ........................ Underwriters Approval ........................Planning Board Approval ...................... Request for Temporary Certificate .....................Final Certificate ........................ Fee Submitted $ .l, O.Q ....................... Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 Applicant .....Tbe. itl..Guarantee..�QP.aY.............. . - - - - - - - - - - - - -x In the Matter of Premises of LOUISE S. MALLORY, 0. 631 acres situate on Road to East End, Fishers Island, New York. - - - - - - - - - - - - -x AFFIDAVIT STATE OF NEW YORK) SS. COUNTY OF SUFFOLK) I, W. GORDON AHMAN, having been duly sworn, do depose and say: I am over the age of twenty-one (21) years and now reside on Fishers Island, New York. I have been a resident of Fishers Island since approximately 1948 and have been engaged in the real estate business on Fishers Island for over fifteen (15) years last past. Of my own personal knowledge I know that the main residence on subject premises pre-existed the adoption of zoning by the Town of Southold on April 1, 1957. With regard to the garage on the premises, I know that there was a garage situate in the location of the present garage, prior to zoning. However, I believe that said garage was improved and enlarged some time subsequent to 1960. I make this affidavit for the purpose of inducing the Southold Town Building Inspector to issue a Certificate of Occupancy for said premises on the grounds that the structures thereon were located in their present position prior to the adoption of zoning by the Town of Southold. rdon Subscribed and Sworn to before me this R U-" day of February, 1981. 1 Notary4 Nblic LUCY J. AHMAN 4atar7 Public, Stato of New York No. 52.0023890 Qualified in Siffalk County, Term expires March 3�i 19 ! k) �. 'Jo A, -T T-_ Ir k All 3-4 4 IV Z) Fp r �• -A- i 9. 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