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HomeMy WebLinkAboutZ-7707 FORM NO. 4 i 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y: Certificate Of Occupancy No..4 7�7 Date . . . . . . Jt e 8. 19. ''I? THIS`CERTIFIES;that thebuilding•located-at 1 /8 $querstlam AVe. Street Map,No. R.. .'. . . . . . . Block.No., Lot No 888 4P shePs w alaud .:..;>.a; ...,.. ..requirements .for one.:... family due ling:...&,Housing ;acde c for s ubstantially.to the. but; before ® e :oectpanoy dated . . . . . 4r 23 y:. . ';`,19 pursuant,to which` 0.� ?p7. . . dine $ :197 dated . . . . . . . . . , 19'.',. ,'., was issued, and conforms to all of the require, ments of the, applicable provisions of the law. The occupancy-.for which this certificate.is issued is Private; one: family dwell�,as wsth ld?C Becessory building Herbe.rt . : ord to. Rich r The certificate is issued to . . . . . . a�4 gWiB. n� : , �WnerB (owner, lessee.,or�tenant) of the aforesaid building. K Suffolk County Department of Health-Approval ':.PTe� ®slsting UNDERWRITERS CERTIFICATE,Nq. pre= existing ; HOUSE NUMBER . . . . .1��A8 . . . . Street . . . B�uestri.an AVe P1,sher8 .1a.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '. •;.:.�..�=-y . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Building Inspector r FORM NO. 6 TOWN OF SOUTHOLD Building Department 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 .►Luxke...7.,....19.7.7................... New BuildingAddition xxx •••••••••••••••• .......:........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...north side of Equestrian Avenue, Fishers. Island, N. Y. .......... ............ .................................,:................................ Owner Or Owners Of Property .....•Herbert I . Lord ......................................................................................................... Subdivision none .Lot No. - Block No. House No..... ... Permit No. .....-.-Date Of Permit .........-.--...... ........Applicant " ............ ....- ..................................................... Health Dept. Approval .........no:t..a.pp.lic.ab:le.Labor Dept. Approval ....no.t...aPP.1;,rr b],P........... not applicable nt applicable Underwriters Approval ..............................................Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....• Xxx Fee Submitted $ 5 . 00 Construction on above described building .and permit meets all applicable codes and regulations. W. Applicant ..Heyber•r..I•.•..•Lord...,...by-W i-lI m.-W:�j ••E-ss•eks•,•••at•torney Sworn to before me this and /age/nt 7. .. day of �7une 1977 r b16l 7� ` .... ...................................... (stamp or seal),,, ���� JUTTA E. FITZ Notary Public ... NOTARY PUBLIC, State of New York (� ............... Q, No. 52-1236770 /� L Qualified in Suffolk County Commission Expires March 30, 19lq �l { A F F I D A V I T STATE OF MICHIGAN COUNTY OF WAYNE SS . : HERBERT I. LORD, being duly sworn, deposes and says : 1. That he is the owner of certain premises on the north side of Equestrian Avenue on Fisher's Island in the Town of Southold, Suffolk County, New York; 2 . That he makes this affidavit in support of an application for a Certificate of Pre-Existing Use or a Certi- ficate of Occupancy; 3. That deponent purchased the premises on September 30, 1948 from ,Echo Valley Farm and Ruth Morgan Oliver; deponent is in the process of selling same to Richard I. Purnell and Marguerite H. Purnell; 4. Your deponent states that he has not made any exterior alterations or additions or structural changes to the remises since his acquisition of same t n the s s t 1951 p q e�an� reques�s t�iat the application for a Certificate as stated above be granted; 5 . A copy of an up-dated survey will be provided to the Building Department of the Town of Southold within a short period of time if same is not annexed hereto. Herbert I. Lord Sworn to before me this 31st day of May , 1977 Notary Pub 1 is R'HRRESE PAWI:IK 'Aai$ty Public,Wayne County,M161gM Us omission Facgi=a Novcmbez 1,19� 7 A�10 G E o D C T I G 'T' SiA-71 OKI - i 40 ► ;; ; ioN•- - _ __ - _.__..------._- �- ,^ �/'M ONE / r U IL \rV p i. • :2dW. ! �s. 00' I69z.54- a w. 3o77,47 S,4Z°-ZO .4„W. E UEST 1At�l �i iE ?.luE , 'f ! �1.._A_A O G P�O P E K TY TO E C O t�l 1/E E D ; r55 TO QPofo�oA.,� t•;, UD MAi�GVE�lT� H. F''UZV,.JE I-L A1-1 S% Q �': A5<bTVACT O-AC . 11�1 D.CCO`�Sj,�NlG r " ` AND MAf�6UF-9'ITE H F�IC1-1A�(� I. u E ' �' S O� THE. �E`N Y©F�-'�, •ST.�.TE �A11D � \ • I :=; � � �? SC A.I.E: 1'' a ZO F'T. 37704 40 C H C4 EGT t CUT 20 Iq _ 1 ' 1 ,