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HomeMy WebLinkAboutZ-8960NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No...Z09.~0 .... Date ...N.aF.~.h... THIS CERTIFIES that the building located at U:pper. Ro&~l, ............... Hay M;?bor ColOnYstreet Map No ............. Block No ........... Lot No .................................. .U ~ F. ~LY D T . U . BEFORE conforms substantially to the C~TIFICATE OF OCCUPANCY dated .... .Apl'~.?l- .. 2-~ ....... , 19.~7. pursuant to whicl~l~ll~l~~[ No. Z8960. dated .... Maz'oh.. 2.3 ........ , 19.78, was issued, and conforum to all of the req-lre- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... L~IVATE. (llt~ .FAMILY. DWELLIN(~ ................................... The certificate is issued to .... Robert .W.. Nelson .& Margaret .C.. Nelson ....... (owner, ~ff~) of the aforesaid building. Suffolk County Department of Health Approval . .. pr, e_Ex.$s~cir~ .................. UNDERWRITERS CERTIFICATE No ............ P~e~,Ex:Lst~ng .................. HOUSE NUMBER .............. Street ...... UPl~er. Road,. Hay. I-la, bot..Colony. ............................................ Fishers..island,. Suffolk,. NY. · ·. .... ......... Building Inspector FO~M NO. 6 TOWN OF ~OUTHOLD , Building Depe~tment 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.' 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. 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 March 16, 1978 New Building ................ Addition .., ............ Old or Pre-existing Building ...... 7~ ....... Vacant Land .............. Location Of Prope . ~.ishe~s Island Town of Sour ~Y ...................... ~ ........................ .h..p..1..d.....S..u..f,f, olk~ New York ee a~ ae~e efes ~n~ 5aunts ................................. ur ~vners o? t'roperty .~oner. t..W...I~Rl~.o/1..~l..M~a.~g~.t...C~..k{~l~~ 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. O0 Applicant ..... 5worn to before me this ATTORNEY AT LA~'~NEW JERSEY .... .1.6 dnv ~ March ]avn AGENT FOR A I ............. ' .................... '"~'~"'~ ............. ~/~/J~A~NTs%mp or seal, Notary Public ...... Uni.o...~. ............. County M~. and Mms. Nelson have owned the property for approximately fifteen years and they have informed me that it has always been used as a one family residence. Furthermore, they have informed me that to their best knowledge and belief, the house is about seventy~five years old and that it always has been used as a one family dwelling. ATTORNEY AGENT FOR ~. A~ ~S. NE~ON Swomn to before me this 16th day of M~eh, 1978. DOROTHY M. SMITH NOTARY PUBLIC OF NEW JERSEY