HomeMy WebLinkAboutZ-8974 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. . Z8974 Date . .April 6 , 19.78.
THIS CERTIFIES that the building located at .Oriental .Ave Street
Map No. Block No. Lot No.
y V r• :r I3 . • - O, F r LY • ,y,,;� B tLT BEFORE
conforms substantially to the a y;cH c 21 u s.s..v>v c-'r4't a o 9 o's't h S a e i� ,s s 3'_ t r ' '
dated . . . .April. . . .23 , 1957 . pursuant to whichGila NoPC CY
`W
dated . . . .April 6 , 19.7.8., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is PRIVATE ONE FAMILY DWELLING
The certificate is issued to J. & Cargl B. Marshall
(owner, ppeectentudr)
of the aforesaid building.
Suffolk County Department of Health Approval Pre-
Existing
UNDERWRITERS CERTIFICATE No. . . . . PreExi8tIng
HOUSE NUMBER Street Oriental..Ave
Fishers .Island,. N.Y.
,4771/:;:-/6.7t-
Building Inspector
FORMER OWNERS-Walter F. Griffin Jr. & Phyllis Griffin
N.
FORM NO. 6
TOWN OF SOUTHOLD
Building Deportment
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 triplicate to the Building
Inspector 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
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.
Date March 21; 1978
New Building Old or Pre-existing Building X Vacant Land
Location Of Property ...... N. X.
Owner Or Owners Of Property Walter F. Griffin, Jr., and Phyllis F. Griffin
Subdivision Lot No. Block No. House 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 $ 5. 00
Construction on above described building Anthonynd perm't 5`ts all ap•
is ble codes and resin mons.
shall/ ',��
Applicant ..12Y i.• .. at e s, torney
Sworn to before me this
day of (stamp or seal)
Notary Public County
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