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Home My WebLink AboutZ-14819FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. PRE Certificate Of Occupancy Date ....... .A.u~cu. s..t..2.0. ............... 19.8.~ THIS CERTIFIES that the building .... Ona. family, dwml 1 ing ...................... ; House No. Street Harnle~ County Tax Map No. ] 000 Section . ~..1 .~ ........ Block .....0.3 ......... Lot . .T.: .5 ........... ( Subdivision ............................... Filed Map No ......... Lot No .............. conforms substanIially to the k~e~ka~xfl~Rk~llik~R~ri~kl!q[xei~f~Rk~xO~!l~93k~[~ CERTIFICAT~' ~F..QgC~P~C~_ ~ .... $?~!~. ~ 3 ........ ,19~ 7. pursuant to wmcn~g~gNa.. ~ ~ ~A~ ~.. ~ .......... dated .. ~9~..~ ~ ............... 19 .~ ~, was issued, and conforms to aU of the requirements of the applicable provisions of the law. ~e occupancy for w~ch t~s certificate is i~ued is ......... .... 9~.. ~ ~r~. O~.L ~ ~ pg.. ............................................ :?. ....... ~e ceRificate isissued to HENRY ~. H~N AND ~RY ~. H~N ..................... io~;,'r~'~ .................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO .............. .~/..~ ................................ B.P. #11461Z C.O. #Z11867 Alteration B.P. #14514Z C.O. #Z14524 Wood stove B.P. #13997Z C.O. #Z14808 Pool (in-ground), deck & fence Building Inspector Rev. 1/81 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted m ~ 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 property showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date .... ~ .~/.~.-~ .~..~.~....' ...... New Building ............. Old or Pre-existing Building .....v~.. ..... Vacant Land ............. Location of Property . .~.~ff..c?..~.<~.-..~./,f,y'~' .~.y~....~/., ..... /-/..~.7~-~-~../.~.<-~...~'.'. ............. House No. Street Ham/et Owner or Owners of Property .. H¢-.~ ~.y... ,~.-../~...~'.~¢-~. .... . .4~.~'../~.~..,~...~.,.., .'./~..~,,~J....,. County Tax Map No. 1000 Section ...././. ~ ....... Block .... ~ ......... Lot .... .'-~.f..~.. .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and perr~i~,m,c~t~ ~H ataPtica~le codes and regulations. Applicant ........ ~...-'~'~ Rev. 10-10-78 o John /aB now or former/ I e~E fauna. Y A ice ,- s~ '-'=raen now or formerly ~ ,,; Katherine Parcky~ °~[I Area = 1.7288 Ac. 0 0 now or formerly Nicholas Parckys Another la wind ~' I" ~0 0 O. I*E. 69'20 Lid t STORY ~ O.T'S. m ~ FR. ROUSE now Michael 294.79' or formerly & Joyce Mattes now or formerly Cyd Branciforte & Margot Pursley · ................................. MILL -RD. HEALTH DEPARTMENT-DATA FOR APPRO'~ TO CONSTflUC T #1NEAr Afl[ NO OWELLHISE WITHIN I00 FED' OF THIS PROPERTY OTHER T#AM THOSE BROWN HEBEON. , WILL C~4FORM TO THE BTANht~OS OF YH~ SUPPOL~ COtMTY OEPMTME#T OF Hr, Al. TN B~RVIGEI. WEBS SURVEY FOR HENRY HAAN & MARY HAAN AT e ATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK NUMAUTMO#IZEO ALTERATION OR ADDITION TO SURVEY I A V~ATION OF SECTION T2OI ~ THE ~W M STATE [~CATI~ CAW MC~IES M ~IS ~VEY NOT KAR~G THE ~ANO SU~VE~*S ~[O ~ ON EMBOSSED ~ SHALL ~T ~ COflSID[~DTO ~AVALIO TRUE N~ARANT~S ~i~TKO HEREON ~C RUN ~Y ~ ~ ~N Wfl~ THE SU~[Y IS PREPARED AND ~ WS MMCF ~ T~ ~TL[ CMWY, GO--N- MENTAL AMNCY A~ LENDMG INSTITUTION CIS~O H~[~, ~0 TO ~[ ASSION~S OF THE WSTITUTI~. GUA~AflT[[S ARE ~T ~ ~AL MSTITUT~S ON SUB.QUINT OWNERS M DISTANCES S~N HEREON FROM ~ERTY P~SE aMO ARE NOT TO BE USED TO ESTABLISH P~PERTy UNES OR FOR THE ~[CTION ~ FENCES DATE: MAY 29,1986 SCALE: NO. 86 - 425 GUARANTEE~ 'BRAHDES & SONS lNG. !.046 YOUNG & YOUNG NOTE: ·z MONUMENT /~ STAKE I ~1 A B I HOWARD W. YOUNG, ~ND SURVEYOR ltN~lYKaL~cT~mi~w)wNwtM I[ V ~J N.Y[LI~NSE NO.45893 K W flu MMT~S K OR M~ MTM~ ~ OTHERS