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Home My WebLink AboutZ-6899NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . I/.~. 8~,~in$ .t~ ......... Street Map No..~X ...... .... Block No.. l ...... Lot No, .. ~X... ~i~S · I~&..N.X, dated .......... ~eb.. ~ .... , 19.~&, was issued, ~d co~orms to ~l of the req~ ments of the applicable pro~sions of the law. The occupancy for which this ce~ificate is issued is .[~..~. f~ .d~21~ ........................................... The certificate is issued to . ~tS. ~, .~F~. & .Blsia .~a~ .... ~e .... (owner, lessee or ten,t) of the aforesaid building. Suffolk Co~ty Dep~tment of He~th Approv~ .pF~..e~S.~: ................... UNDERWRITERS CERTIFICATE No..~. ~S~[ ............................ HOUSE NUMBER .... ~ ..... Street ........ ~rl~g. 51 .................... FORM NO. 6 TOWN OF SOUTHOLD , Building Depoetment 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 ]957), 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 F.e,b r _]_]__n_ r. ~,..2 .z~.. l~ 7. S. ........... New B~tilding ................ Addition ................ Old or Pre-existing Building .... ..x. ......... Vacant Land .............. Location Of Property ~e~S~t~S~d~e~S'~t~e~j;~g~S~e~e~t~;~~~:~ ................................... Owner Or Owners Of Property .... ~e~b~t~M~];~e~;~:~a~d~u~e~:~:~~ ........ 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 ........................................ FinaJ Certificate .......................................... Fee Submitted $ ...5......0..0. ......................... Attorney foy//l~ar~is B. Parsons and Elsie W. Parsons Sworn to before me this // · ..~.....~.......~. day of ..... ?...e..b..~..y..:...]:~].~ ....... ~ (stam~ or seed ~'~ 'f~'~'f~Z'z'°r-~' MAPi~ N. RAYNOR Notary Public ......... ..%ufl'f'oZk. .............County ~a~A~ PUBL'C. State of N.w T~' ~.~1~¢/~;[ & Term Expires March ~0, [~ ,~ ~ ~'[ATTHEW$ ~: OSTRANDER ~.TTORNEYS AND COUNSELLORS AT LAW 4,5 HAMPTON ROAD SOUTHAMPTON~ N. Y. 11968 February 24, 1976 Southold Town Building Inspector Southold New Yorkl1971 Re: F. Herbert Miller, Jr. and June H. Miller- Harris B. Parsons and Elsie W. Parsons In response to your telephone call to my office while I was away with regard to the issuance of a new Certificate of Occupancy for property that was formerly in the name of Russell Doench, for which a Certificate of Occupancy was issued in 1972, will you kindly forward to me a current Certificate of Occupancy for the pre-existing structure shown on the survey enclosed herewith, issued in the name of Harris B. Parsons and Elsie W. Parsons, his wife. I am enclosing herewith an application for the same, together with our check in the amount of $5.00 in payment thereof. PBM:JET Enclosures WEST HARBOR AR LA=O,25 * Acres dnli hole in N 3/° ~3' boulder 14.3?,OI'E hole in ~L ~ - -- -.. ./~.water RiQht of Way , 0,,~ GUARANTEED ~ TITLE GUARANTEE ~ '0:~ cO~PAN Y 'Nm ceo" ~ANCE W~T" m"~ ~'' % Vr SURVEYS OF THE NEW YORK STATE ~ ~5~ ~ ~ , LAND TITLE ASSOCiATiON. ~ ~ t~.~/ NOTE' Coordinate distances are measured from U.S. Coast and Geodetic Survey Triangulation Station "PROS" PLAN OF PROPERTY TO BE CONVEYED BY dUNE H. MILLER T_~O HARRIS B.~ELSIEW, PARSONS STERLING STREET FISHERS ISLAND, NEW YORK SCALE:I" = 20ft. CHANDLER, PALMER~KING Norwich,Conn. DECEMBER 50, 1975