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Home My WebLink AboutZ-4861 FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. 748.61i . . . . . . Date . . . . . . . . . . . . . .October. 1.7. . ., 19. .72 THIS CERTIFIES that the building located at Private .Road . . . . . . . . . . . . . Street Map No. Y:3+Estatei3lock No. .12; . . . . . .Lot No. 3 . -> ishers• I.land R.Y. . • • • . c' i t E;1Tie _t .t.. C" f c; '1 v d 7e 1 s n conforms substantially to the � �a �� 't�� 3C � & at before %YA 1.1 61 "ate . occupancy . 19. 7 pursuant to which �r �1Vo. .p �. �3 3 . . . . . . ,� Z4861. . dated . . . . . . . . . .October. . .17, 19. .7-2, 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 -or re •faia r • dt•r 4,y ng. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . Martha. .B; Rob ins-on• • . • • • .0 wane r. • • • • • • • • . • . . • • • • • • • (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . . . . ..F.r,e_. .e .,;_stj.n . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE No. . . .pro— e2z2..;tiTzF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSE NUMBER. . .NOiy. . . . . .Street. . . . .Private •road.; no •name• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Exception: two private accessory buildings in ��; (?. . .T e."I front yard areas(non—conforming use) Building Inspector 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 triplicate 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 ....October 17.,.J.q 2..... New Building Old or Pre-existing Building ;BMilt„1952... Vacant Land ............................ Location Of Property ........Pr i„vate„egad........... ..........................................................................:......... Owner Or Owners Of Property ......Martha...B....Robinson.................................................................... Subdivision Fishers Island Estates..........Lot No. ...3....... Block No. ............ House No............. Permit No. .................... Date Of Permit ....................Applicant .................................................................. Health Dept. Approval ........ ':.:..:.�::`.:::�..�.......Labor Dept. Approval ............CV..2....�'��................ &k Underwriters Approval ..............................................Planning Board Approval .... R �............. Request For Temporary Certificate ........................................ Final Certificate ........................^................ Fee Submitted $ ........................ Construction on above described building and permit meets all applicable codes and regulations. Applicant ' 3 �!>r(4!!v`.. ................... .. ............ .. . .... ... ...... ... .... .. .... Anthony B. Tohill, Esq. , as Attorney for Sworn to before me this Martha B. Robinson ...�1 r.�`'... dayof .....QJ:. phe1; ..1�.7.2........ ly 7 o• (stamp or seal) ff y Notary Public ...............�o.......Q.....lk.... Count J.UTTA E. FITZ Stat OTARY PUB!IC, e of mew York No. 52-1236770, Sll'trlk County Term ExF yes Merch 30, 1973 s•,i E 2 s Z 77 AB .O .S S/23'00-� Z rn f1/o2 �33.,38' S'2,00• Z 68.oz' Q 'Z71 e o o J 5��-5;S 34o W 7/.L3 S 2-7 So'W .S L.3�273a•,l S7 7,B C S 37"/8�/o H/J 79. Zo' 7 / I( No TE: C•o 0 2 Q/it/A TG' O/J TAN6ES ` �/lEF20^ J7iiref co•4ST Al.v/f GEoOET/C h S2Soy /oE �J U2�/E'�/ T/2/�4,clGU.C.� T/ O�c/ �Gj�• /.77.os•� J 7-,A T i vu CHO C0/y0 CIA/7' V K� bh ago 9 � O N 1 qo s a A G� A14/ 2 7 0o"k/� 7/�• `t o ,, 3 Q 0 I8/35 qo �S 1.8�io 30 •W 27 A, k p /3.4.07 /.8 5 , E asz8.34 " �0 p G!/.4/IA.V7;CEO To 400AA 4 4,0 H. /Vc-A /,S TE/z �4•vp To i o 4CL//C, G O T/TG E /NJlJ24/�/GE GO/`9/�i1NY /N A CC 0/2,0A,t/CZ G✓/TIy 7•iU6 JTi�ic/OA/20S /�02 T/ TGE ,jU,Q✓EY.J'_. �� Ts.!� iv-CIV yo/l,re f7, X-4"VO T/T<E /0/- A V OF /'O/LO,'.E/LTY TO aE CON✓E YEO !jY AJJvC1:4T/0,-%/ - 1A 2 7"f/A 16. 20 B //V 15 O n/ r TO 7•12-LE A/o 72- S-0.9r- 9/L d4oc.e /Z LOP 3 F/JNE/ZS /JLAND� N Y JC.-tL CAOO- K/n/G � —