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Home My WebLink AboutZ-6006FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z.6..(~.. ....... Date July 1 7 ., 19 71+ THIS CERTIFIES that the building located at E/.8, .14.o.n..ta.u~...A..v..&..~../.~..S .tes~lreleet' 8t Map No. ~ ......... Block No, ...X~X. ...... Lot No...X~... F.i.~.h.e.r.s. .I..s?.n.d...B. :?': .... _ reau~re~entsfor one famll~ dwelling conforms substantially to th~[~$~t~'t~,~~lf~W~x~ I~.~c~~ Ce~.tificate of 0ceupaney d~a~tdlt., bafora .Aprll .23. ,, 19. ~?. pursuant to which]0~O'~,~,~i~N~ .600~ · · dated ........... J~y.... 1.~.., 197.I~. ., was issued, and conforms to all of the requir~ ments of the applicable provisions of the law. The occupancy for which this certificate is is.,ued is. pr~,.a.t:..o.~:..~.~.~7., .d:.,.~..~.m..~ ....................................... The certificate is issued to KI'. &...I~..Al.e..x~d..e.r..Rgbi. n.s.o.n...t.o...Ky..&..M..r.s..I,, .a~..c.c..Elwell (owner, lessee or tenant) Owners of the aforesaid building. Suffolk County Department of Health Approval pr.e.-., eXl..s.$.i.ng .................... UNDERWRITERS CERTIFICATE No. . p. re.-., e.~.~l..t,~.~.g ........................... HOUSE NUMBER .... .n.°.n. e ..... Street .... .a.s.s.i..g~..ed. ............................ Building Inspector / TOWN: OF $OUTHOLD Building Delm~tment Town Clerkm 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 ar 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 inspect/on of buildings or premises, or other pertinent in- formation required to prepare a certificate. New Building .................... Old or Pre-existing Building .............. ~ ........... Vacant Land ............................ East side of Montauk Avenue and West side of Sterling Street, Locotion Of Property Fishers Island~ New York ............... ~1~ ~.~i4. ~.~.i~ ~'["~ ~)~[~ 5~fj"'3'i~ ~'"~'~ ~"E'."'~ ~'~'~;'"~{'~"~fe, Owner Or Owners Of Property ~b~u~t~b~e~c~n~v~e~e~d~1~L~n~c~e~~~:~1~ his wife. 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 ...... ~.....:..~ ...... ; ............... F, inql C, er, tifica?,e .... ~ ............................ ~ ....... ~er~izi~a~e ~eques~ea s~a~i~gme .djvis.~on or,be ~.obinson ~ ~ bitted ~' 5 00 ~r. oper~y ana conveyance oLa por,~on Lnereo~o ~v.~r. andMrs. ~ee ~u m · ..: ................................. E/well zs in compliance wi~n existing x, oning urdinance. Construction on above described building and permitj~its all apgJicj~le codes and regulations. Applicant ~..~/~.; d'.(.~ ..~,..~ ........... .......................................... Sworn to before me this .... .1...7.t..h..... day of ....... .J..u..lz,....1.-9..7...4. ................ (stamp or sea0 Notary Public .................................... County