HomeMy WebLinkAboutZ-6006 FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No.Z6006. . . . . . . Date . . . . . . . . . .July . . 7 . . . . . . .119 71+ .
THIS CERTIFIES that the building located at E/S .Montauk AT 8c i°T/3 Ste�r et St
Map No.3= . . . . . . . . Block No. ? *:�. . . . . .Lot No .Fishers I sland N.Y
conforms substantially to th e irpment for one famil dwelling
b ;tidl.t pursuant to whit Certificate
ime NcZ.6006 Occupancy
da a . .be�fore. .A.Fx� ]� .23. . 19.1�7.
dated . . . . . . . . . . .Jolly . . . 1.?. ., 10k ., 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 dwelling
The certificate is issued Mr & Mrs Lance Elwell
(owner, lessee or tenant) Owners
of the aforesaid building.
Suffolk County Department of Health Approval Pre.-- sxLi Ae . . . . . . . . . . . . . . . . . . . .
UNDERWRITERS CERTIFICATE No. . PXe-' .exis�in&. . . . . . . . . . . . . . . . . . . . . . . . . . .
HOUSE NUMBER . . . . none. . . . . Street . . . .assigned
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
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.
S. 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.
Date .......July..17r...1974..............
New Building .................... Old or Pre-existing Building .................X........... Vacant Land ............................
East side of Montauk venue and West side of Sterling Street,
Location Of Property ......Fishers Island, New York ,,, , ,,,, , , ,,,, ,, ,, , ,,
Alexander �'. - o'binson, yi:: and Ann Y,: Robinson, h1s wife,
Owner Or Owners Of Property about to.be. ..conveyed. . to.Lan Elwell and Roberta C. Elwell, his
.. .. . ............. ....... ........ .......................................................... wife.
Subdivision ................................................................Lot No. ............ Block No. ............ House No.........
PermitNo. .................... Date Of Permit ....................Applicant ...................:..............................................
Health Dept. Approval .............. . ..........................Labor Dept. Approval ................................................
UnderwritersApproval ..............................................Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate .............................
5 00 Certificate rdeguestd statip-a the division of ftY e obinso�nMrs..
ro ert an conveyance o ortion t�hereo o r. an
Fee Submitted $ ....................................glwell is in compliance with existing Zoning Or inance.
Construction on above described building and permit s all app '' le codes and regulations.
Applicant //
........... .. ��� Yl:....�-'�.... . ...... r....... ..........................................
l�f'torney for Applicant
Sworn to before me this
17th... day of ......Julyt...1974................ (stamp or seal) `/
4 (I I� ?/
NotaryPublic .................................... County ��� '
NOTE C0013Ott4^T.E S, 'ARE MS,A►SURrzD � . • '
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pLAN OF 3' OPERTY -TO �E CONVE ED 8
ALEXANDER L . R061NSON JR .
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r Q. ��;Yt��'t A N �1 L R O !
LWELL �, 4i �.;. r ANU
GUARANTEED To LANCE AND ROBERTA O• �•.
corlpkaY ' ` TO
A TITLE .i1.Is�R�*�eE T E L.�
R1C rt . JjI �:� RO
AND THE,-:AME TITLE D►vlStol�l Iht A�COR.DAIICE 1 -i q R ` C.
GUAR.AhLT'EED TITLE j';u` , ;'• ;` L A N A1V D �-
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wrrw -r+iE MINIMU[�1 STAHOARDS� FOR �,�1 ;r .- ;.1+ /+ n c `^,.
YORK. S TATE LAN D ti. \� {3 ' . " / I S i_ C
$u0.VEY5 of THE �fEw �, ,/i CAL i '4•� CHANDLER PALM ER Klti=
ASSOCIATION
TITLE NO-1 .�7- 78139 MAY 7
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