HomeMy WebLinkAboutZ-9649FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
Date ....... Augnsg.22 ............... 19..79
THIS CERTIFIES that the building ................................................
Location of Property ?,T/S..Vhi~tler. g. venlae. ~' ' = .
......................... ~.x ~n,~.s ;r sZand
House No. Street Hamlet
County Tax Map No. ] 000 Section .... ~ ....... Block ....! .0 ......... Lot...1.~ ............
Subdivision. Y.z?.~':?e..~).~;~. ............. Filed Map No....X_/x~.....Lot No .... X,X.X)Z~X...
Requirements for one family dwelling or!or to
conforms substantially to the ..... ~llf~k:lr~bi~
Certificate of Occupancy
A~ril '~, 19... pursuant to which ~t No. .q6/~9.
dated ... g.lZ~CrtlSt..-9.2 .............. 19.7D, 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 .........
....... ~ri.~:at,::. one. fscnily..dwa!LLng .........................................
The certificate is issued to . Fh'tz'T. ?.... ancL 2~Iar.~,n. J,.. Scot.t. (~a.ew..ownCr. s ) .......... towner, te,~ee or tenant!
of the aforesaid building.
Suffolk County Department of Health Approval .......... JXI/.E ............................
UND~RWRIT£~S C£RTIFICAT~ ~O ..................................................
(no
insvect~on made ~s of 8/22/79) .~ ~
............ ,-:'. .... :~. ...... [ . [_..1.... ....
Building Inspector
Rev 4/79
Bo
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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.
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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date ...A. qg~ ~ .:~ 0, .].~7. 9 ........
New Building ............. Old or Pre-existing Building ....~. ....... Vacant Land .............
Location of Property ....~.o?. ............... .'~..h.~s. t. ke.~' .A..v.e: ¢..~.~.s. he.v .s .[s.~.a. qc]. ~ .~T,. y. ........
House No, Street Hamlet
Owner or Owners of Property . .[~.a.~.t.i~ .jT....S.c.o.t.t..a.n.d..N[.a.~¥..~....S. qqt. to. b;[~.~v~fe ...............
County Tax Map No. 1000 Section ...9. ........... Block . ~) ............ Lot... -~2 ...........
Subdivision ................................. 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 $ .5...O.Q ........................
Construction on above described building andp_ermit meets all applicable codes and regulations.
Martin J. Scott and Mary F. Scott /
Applicant .b~. ,L~[. ~.ttJ~eW. 8 .& .Os;~r~'_~,..~,sq,~.,~_v~4'.f. ~,, ./ .....
>-
0
V',/M 1S T L~_. 7_._ ,'k,V E Y-I LIE
In the Matter
of
x
Conveyance of Premises situate on the
Northerly side of Whistler Ave., Fishers :
Island, Town of Southold, County of
Suffolk, State of New York :
County Tax Map 1000~ Section 9, Block
10, Lot 12 :
.... tr n s rvafii a .... x
STATE OF
SS.
COUNTY OF Cr~wford
AFFIDAVIT
I, GERALD A. ANTIS, having been duly sworn, do depose and
say:
This is to certify that there have been no physical changes to the
exterior of the structures on the premises above described, subsequent to
the survey of Chandler, Palmer & King dated April 27, 1972, nor have there
been any new or' additional structures erected on subject premises
subsequent to said date.
This affidavit is made for the purpose of inducing the Building
Inspector of the Town of Southold to issue a Certificate of Occupancy on
said premises, knowing that he relies upon the truthfulness hereof.
Subscribed and Sworn to before me
Sept
this I_~th day of ~rt~t, 1979.