HomeMy WebLinkAboutZ-7630 FORK NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No Z7630. . . . . . . Date . . . . . . . . . . . .April. . ! 9 . . . . .. 1977. .
THIS CERTIFIES that the building located at .VP .Vh�S?0 9 x .4ve. . . . . . . . Street
Map No. Block No. . . .�-x. . . . .Lot No. . . . .I'��4e;T ,Ts1-A-T41. . tY
requiremei s for one family dwelling (taro family divide:
conforms substantially to the .1� '� �� � G' �
Built before car �.c 'ce rig peeu�arcy
dated . . . . . . . . . . .A.Pr. �� . . . ., 19. ! . pursuant to which � gNo ZK� o. . .
dated . . . . . . . . . 2-9. . ., 19.7.?., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
(East half buildi'n. ) .
issued is Private one family 4welling _(Aprrovee� .lay L4
. . . . . . . . . . . . . . . . . . . .
The certificate is issued to Ruti . F. .ftalfe. to.Arthur.&. Mam. Gweenlea.f. . . . .owners
(owner, lessee or tenant)
of the aforesaid .building.
Suffolk County Department of Health Approval P-PQ ... . s t g
UNDERWRITERS CERTIFICATE No. PXQ--. OXi5:t�-rlg . . . . . . . . . . . . . . . . . . . . . . . . . . .
HOUSE NUMBER . . . one
.. . . . . . . . . . Street . . .Nf s .�'� .s. l���'. . .V�'. . . . i. I7;i'.5. .•�.1.. . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
r
Building Inspector
A10.7'.E : C®O4O/st/�T4 D/.lTAAIC--j -14E
. M-E-�.�IJl1�'O F4orr1(/.J: CD.eJT-w® GEoOE�G
:JlJ/dv�'1� TRi.•�NGV�c.�TicLc/ .f77MTiaA! "P,P.,Gv"
rto.I
.f4.3S ' XS' SAS "
ll. rill [iw/4
Gwt "
apt
/16AO
Wd
t
i
v
v.
W4S.)B.C9 ' Up 44P.i" .-/C.7/3'E i� Cw?9-40W..4Lf .
'aq
G/1/.4.QAUt/T,EE® To
THE Ti T!E GU.aQ,�S�t/TE6 �oM.�i1NY
A?TNu2 A .a e—rA//,4 E.4 F ZZZ G am+E J✓_ G4 E FAIL_4-41-
NE,`,/ Ac WNVbAl Fb DE/IAL .�fA✓W6 J ~40
L O,-Ul AJJ®e/,4 T/v im
lv .r c co.Q O�,t/G.f �/i i••s� a'� rfr,v//`�uM
JT Alcow gO.3 Fog -rlrz4 Ts/jc
�/E�✓ �/® ;Jx�T'� .L.oN® ToTG.E A JJaiG/.4TicA/ AZAA/ Of R,20PE127 Y
JJ� . TO &5 GOB/✓E YE•D !3 Y
7-0
R . - - • AA 7,41u e A G/�E�t/LEAF.,�JI � MA�
�,,,s �-o/H i.f TL E.Q .,✓E. F/3f/E�S /S L 4�/O, �y
JC^Lr: /�= 4a AT. C7-O'AAs0464,PA,4^f4W �, /UA C.
wdG � I AX�W� /✓O/.L�.J/Cf�� CG�s/.✓.
FORM NO. G
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 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 .....4/26/77
...............................
New Building ................ Addition Old or Pre-existing Building x Vacant Land
................ . Building ................ ..............
Location Of Property ....N/S Whistler Ae..;...Fishers.Island, N. Y....... .... 06390
........... .....................
Owner Or Owners Of Property ...........Ruth. ..F....Woolfe...... ... .... ... .......................................................................................
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 .....A..................................
Fee Submitted $ ...... ......................
Construction on above described building .and permit m ets all applicable codes and regulations.
Matthe Os s eys for applicant
Applicant .....Philip......... B. Oathew. . . : - �..........................................
y
Sworn to before me this ��6I7/
,,,,26th.„ day of .....4rilA. 1977 ... (stamp or"seal)-" Z'7r3o
Notar LPG is .... Suffa EMNEN 6, 06TRANDEIN
Cc
publl®, State of New York
� /� Qltn, In Suffolk Ca