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Home My WebLink About9399-zNO. 4 TOWN OF SOUTHOLD BIuLBING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificete Of Occupency Dec ~3! ~977 No. Z.8.Q6~. ...... Da~e ...............Dee... 1 .~ ..... , 19..77 THIS CErTIFIeS that the building located at ~3~i~.&beth. -Lane ...........Street Map No.. xx ........ Block No..xx .......Lot No. x:x. · · Southo3,d. · I~ ........... conforms substantially to the Application for Building Permit heretofore filed in t1~;, office dated .............. J~ug...10 19.77. pursuant to which Building Permit No..939~ · dated ............Au~..11!..., 19.77., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thl, certifieat~ is issued is.. p;.~v.~.~.e..9X~e..~.a~l;L~. ~l~llng...(£~Lr.s~. f~.~or. ~¥) .............. The certificate is issued to ....R.i.c.h.a..r.d..G.~L]~.r.~le ......... .c~r~er .................... (owner, lessee or feint ) of the aforesaid building. Suffolk County Department of Health Approval .l~ec..7. ~. 19.7.7.. b~. R,..¥111a ...... UNDERWRITERS CERTIFICATE No..pending ................................... HOUSE NUMBER ...... ~.7.~. .... Street..E.l.i. zAi~.e.t.l~..L~le.. ...... ~p.tl~lTo~l,cl ....... · .~ .O.T.E.~..¥~.1. ~.e.d. ~n~t~er..~e r~t. for..any, addition~ .work. or~ ~ous~.. · .......... ToWN 'CLI~RI~'S OFFICE :~ SouTHOLD N.Y. BUILDING pERMIT (THIS PERMI~T MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9399 Z Permission is hereby granted to: Mattituck Build new one fami~'~ at premises located at ...p.~.~..~,d.....~/;~..P~.~z.i~.~.~...R~..-..(-~-l.~..~a~-~-~r~-~-) .............................. ................................................ ~ithal.d ............................................................................................ pursuant to application dated ........................... .~.l~g.....J..~. ........... , 19....~..~., and approved by the Building Inspector. FOKM NO. 6 TOWH OF $OUTHOLD 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 aT property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 December 8~ 1977 Date ................................................ New Building X~ Old or Pre-existing Building Vacant Land Pvt Rd S/S Bayview Rd. (Elizabeth La) Southold location Of Property ..................................................................................................................................... Owner Or Owners Of Property Richard Gilbride': Subdivision ................................................................ Lot No.....,~,. ..... Block No ............. House No..,3,..?'..5. .... 8/11/77 Permit No. 9399Z Dote Of Permit .................... Applicant Inland Homes~ Inc. Health Dept. Approval .7..'...S..O..7..1..0...8..'...1..2../...7../...7..7. ...... Labor Dept. Approval .....N../..r. ..................................... Underwriters Approval .............................................. Planning Board Approval ...~..s. .............................. Request For Temporary Certificate ........ ~..o. ........................... Final Certificate y,~es Fee Submitted $ .5.:..0...0. ........................... Construction on above described building~qab~pbd~.~ and regulations. Applicant ~lkiJ~ ........................ KENNB~ W. THURB~R- INLAND H(X~ES, INC. Sworn to before me this /~/' //,/~:~/;~ // ............. ~.~day of ..]~:.:.~.'J ........ /:.:~..~.~':~ ...... (stamp or seal) Nota~ Public Suffolk County -. ~:,ove~,,oer 30., :!377 x,,~,~.,~uo,~'¢o-~' 939150 ~. Richard Gi!brid. e, 375 E~izabeth Lane~ Southo2,d¢ L~I~ OUTLETS 22 ~Specia! Receptacles: 2-GoF.C.Io smoke detectors Post light Rzcha~m GzJ.brzde k F ~ 375 Elizabeth Lane ~::~'~.,"~'~?'~-~'~ / · , , , '~ ..,. M~. ~ ,, , , .... RODERIGK VAN TUYL, T~T HO~ . ,~;, ,,., ............. ,,CO', DEPT, O~.,, HEALTH ~E~VIG~, . ~TAT~ ~NT O~ INTENT , 315 Westphaha TOWN ~LE~K'S OFFt~ -- ' :m-~: ~ ', ~U~ ~ w'~ ............. ~ ........ ;'; ..... ~'" a ~ c ~ ~ "~f ~ ~'"'~ "~ ~ ...................... : .......................................... ~_..~ .................. ~....~ . ~ ~ ~/~ ~..~. ~ ....................... .... APPLIGATION FOR BUILDING PER~IT '~ ~'~. ~ ......... ~..~.,...~, .............. Box ll7~ Mattituck~ N.Y. 11952 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, General Contr&c~or Name of owner of premises ........ ~ ,R i .c .h .a .r d, .~,,i.~,T..:~.~.~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .......... .5..1..Z.-,,~. ........................... 2148-B Electrician's License No ............................................. Other Trade's License No ............................................... '.~..X Location of land on which proposed work will be done, Map No.: ...... B.a~.~.ie1~/. ................. Lot No ............. /-i~ .Street and Number ....... ,Eli3ab~ttz..]~ne~..~Sc~t~l;~o-l~ ................................................................................. Municipality State existing use and occupancy of premises and in.~ended use and occupancy of proposed construction: a. Exisiting use and occupancy Vacant b, Intended use and occupancy l- ?,..a~..~.~lf ............................................. 3. Nature of work (check which applicable): New Building......~ ..... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................. .... / ~a (Description) 4. Estimated Cost 30.~000o00 Fee ....... './. ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............. ~ ............. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............. !..O...O..*. ................................. Rear ............ ~-,0.Y. ....................... Depth ......... .X...9..?. ............... 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11, Zone or use district in which premises ore situated ..................................................................................................... |2. Does proposed construction violate any zoning Iow, ordinance or regulation: ................ lJ, O ................................... 13. Will lot be regraded . ....... ,1~....S ............. Will excess fill be removed from premises: ( ) Yes (x) No 14. Name of Owner of premises ...... RigTr~.,~d..,Gi~b~ide ....... Address ................................ Phon~ No Name of Architect .............................................................. Address ................................ Phone No ....................... Address .B. ox 117, Matti~ucd¢ 298-9696 Name of Contractor ..... t~ls4~d..Home~...I~'l¢~ ............ ............................... tmone No ....................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot cou w o .......... s.s enneth W. Thurber ' ......... ~ ......... ~.~ ......................................................... bem~ duly sworn, deposes ~ soys ~ be ~s ~he (Name ~' ~ividua[ signing contracf) above name& M~ ~ +h~ Xxx Contractor .................................. ........... o~ sold owmer or owmers, ~nd ~du~y su~o~$zed ~o perform or bore Derformed %he sG~d work Grad %o ~oke and ~h~s application; ~h~ ~[~ s~%e~e~k conto$ued ;n ~h~s cpp~ccfion ~re ~rue ~o %he bes~ o{ his know~ed~e and be~e{; ~ho~ ~e ~ork ~H; be per,or,ed }n the mon~er set ~odh ~n %he ~pp~cot~o~ fl~ed ~herew~h. ................. day of ......... ~ ....... , 19.. n~ (Sfgnature o applicant) Nota~ Public, . .............................. . 4,~pZ,t.t) I / I APPROVED AS NOTED L : t O". 0¢ rs., e .,41,C' ~" 5'- *'2' % .~ - o" - 0 ]] APPRovED AS NOTED