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Home My WebLink AboutZ-9438FORM NO. & TOWN OF $OUTHOLB BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.. ~.9.4~ ..... Date ....F.e.~.a...ry.. ?..5. .......... , 19.. 79 THIS CERTIFIES that the building located at ~.].R~ .t .rj..~.n.. ~.~y.q .~. Map No ............. Block No ........... Lot No .................................. REQUIREMENTS ?_QR O_NE FAMILY D~fFJ~Li~G BUILT PRIOR TO conforms substantially to the ~RD~~~t~fere:.~' ~hl~fl-in this-offic~ · ~E~TIF, ICA~E OF. _OCCUPANCY dated ...Ap?.f.! .... ~ ....... , 1957.. pursuant to wnich ~.~ No.. Z945~ dated . .February..~ ........ , 19.7.9., was issued, and conforms to ~l] of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .......... .F~..!¥.a.t..~..0~. ~..F..a.m!.!¥..D~. ?!.1' !n~ ............................. The certificate is issued to ....... .~.~..i.sp.o. ?..R.... ~.m.l.t.h.. &...07... ...................... of the aforesaid building. Suffolk County Department of Health Approval ......... l~e-_~i~ci~;ln~ ............. UNDERWRITERS CERTIFICATE No .................. P~.e-,~2~Lstin4~ ............ HOUSE NUMBER .............. Street .... .E.q.~?~?.~.! .a.n' ?.v. ~. ~..~I.e,a.t.h..u.l.i.e...Aye.. .......................................... ?.?. ......... County Tax l%-,ber Building Inspector DiVision of property approved by the Planning Board, January ~0, 1979 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 New Building ............. Old or Pre-existing BuildingPrf~r.e~i~.~J, DgVacant Land ............. Location of Property Equ.aatriAn .AM.a,. &. ~eatkulio. Av~,.,..Sou.thole.. (Fishers. I81, ) N.Y. House No. Street Ham/et Owner or Owners of Property . Br. isco~ .Ro. ~mitk,..et..al ............................... County Tax Map No. 1000 Section ...... 9. ........ Block ........ 6. ...... Lot .Z...a.~.d..p.a.r.~..o..~ 5 Subdivision..J. ~D.~Y. ~,.. $~.7.9 ............. Map No ............... Lot No ............... Permit No ........... Date of Permit .......... Applicant . .~..r.~.s.qo..e..~.....S.m.i.t.h. ............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ ................. Fee Submitted $ .6...qQ ........................ Construction on above described building and p~mit meets all ap~licab~le c~des and regulations. , Applicant .... ~. >...~3.?;-...~... ~..~. ....................... Rev. 10-10-78 STATE OF NEW YORK COUNTY OF NEW YORK SS,: says: BRISCOE R. SMITH, being duly sworn, deposes and 1. I reside at 47 Avon Road, Bronxville, New York, and have personal knowledge of the matters herein referred to. 2. I am an owner of an undivided interest in the premises to be conveyed to The Rev. William J. Hilliard as shown on a survey dated October, 1978 (Revised November 24, 1978) prepared by Shepard B. Palmer (the "Premises"). 3. The buildings and improvements included in the Premises, consisting of a dwelling with patio and detached garage, have been used continuously as a single family residence since a date prior to April 9, 1957, the effective date of Chapter' 100 of the Code of the Town of Southold, and are in good condition. 4. This affidavit is made to induce the Town of Southold, acting by and through the Building Inspector, to issue a Certificate of Occupancy for the Premises. Sworn to before me this /~rf~day of February, 1979. NOTARY PUBLIC, State of New ¥or~ No. 60-45556;'4 Qualified in N. Y. & Wes[chester CO, Commission Expires March 30, 1979 ,-,.% ~ < > Z 0 m 0 < Z k~ ~< o o o o Z 0 t-- t--' k- ~ Z Z 0 0 UJ Z Z 0 0 U 0 AREA = 40,045 sq. ft. NOTE' C, oorclinate d,.istanee~ am measured fran U.S. Goast an4 Geodetic ~ Tribulation Station "PRO~~ RECEIVED BY -- App?~O¥~D BY AREA= 5.% ,052 sq. ft. TH E ILTL IARD EQUSTRIAN AVE. 8~ HEATHULIE AVE:. FISHERS ISLAND, ~EW YORK SCALE: I''= 40 ft. CHANDLER, PALMER&KING N~ORW1CH~ CT. OCT 978 R evi~d 11/24/78