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Home My WebLink About10083-zFORM NO. ,4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy eAmendea 11/9/79 No ..... Z..1,0.0.! 7. ...... Date .... .~...1~· y. ~.. ..................... 19 THIS CERTIFIES that the building ................................................ · P rt 1250 Elijah Lane Mattituck N.Y. Location of rope y .................................................. ~ ........... House No. Street Ham/et Cou;l'~y Tax Map No. 1000 Section ..!0..8 ....... Block .... ~. .......... Lot...~.: .1.~ .......... Subdivision .... ~..rP.e. I3b..~.:[.~.P...~97.~.~. ........ Filed Map No..6.6. Q9...Lot No... 7 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · . .D.o.qe.m. ,b.e.r..~.6 ...... , 1 ~'.8.. pursuant to which Building Permit No ..... .1.0.Q8. ~.Z .......... dated . .D..~9.e. tg.b.P.r..2.0. ? ........... 19 7.~. , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .................... pr.:t.v.a.i.e..O.r~.e..P.~.~-I..lY..l~.e.l,l.'l, tag ............................ The certificate is issued to Greenbriar Hoffio8 I~o. ..................... ?e¥.'o~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .. ~.-.8..0.-~.9.... 7./.2./.~.0 .... .R:..4:..Y.%.]:l. g .... UNDERWRITERS CERTIFICATE NO ..... p.e.n..d.i.tQ..g .................................... Building Inspector Rev 4/79 FORlYl NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10083 Z Permission is hereby granted to: ~-- ....... .(. . . . _ . . . . ... ~.-z~ ~..~.zz~..,...../..~. pursuant to applicatio~ dated ...~~....~ ....... , 1~, arid approved by the Building Inspector. '71 '¢J/7 .- ..... Ai) D/T~ FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall 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 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 featu res, 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses'. 1. Accurate survev of peoperty showing ail property lines, streets, buildings and unusua~ 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. 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 .......... New Building V'/ Old or Pre-existing Building Vacant Land Location of Property . ./.~7~. ~-~ .~. ~';'..~./.~'.~?../~ .~-../~..~, .~z~.,...,~..~. ,~?,/..7'.~.~../.~-~.' .................... House No, Street Hamlet Owner or Owners of Property , .~..~..~,~..~...~./,.'~..'~..../.~. · .'~.. -.~..~.../../~.~.: ....................... County Tax Map No. 1000 Section .... .z/.~.~. ...... Btock ...~.. ......... Lot...~.'~!././. ........ Subdivision..~,~..~...,~/..z~..~?/~, .,~.~.../~, ,~.~.~'. .... Filed Map No. ~..~.~.~...Lot No....~. ......... Permit No./.~.~.~.~..':?~.. Date of Permit /. ~.~/.~..~/..?.~.Applicant . .~.~..~-~/....b~.~..~, ./,.~..,~..../~...'¢'~., .~, ,/', ,/~,~-~ Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ............ ........... Construction on above described building and permit meets all applicable codes and regulations. FORM[ ~roo ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. , proved ...... , erm,, C/ Application No ........................ APPLICATION FOR BUILDING PERMIT ~,~ ...................... /..~. .................... , ~..2k'?.,. INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets oF areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this applic0tlon, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for n~c~ejsory inspections. , GREENBJllAR HOMES I.?~.~~ ~ ............. ~' (S'gnature of applicant, or ner~, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ~..w...w....~.~..::.. ~...~z.~ .................................................................... ........................................................... Name of owner of premises GREENBRIAR HOMES I1~. (Name and title of corp~te officer) Builder's License No ..................................................... Plumber's License No .... ,~,/..2.,-T..,~,.. .......................... Electrician's License No. .'.~...~..~.~......~..~.~.. ..................... Other Trode's License No. Location of and on wh ch r osed rk ' ' n Ma No ~ig ap wa w oe aa e. P .: ........................................ Lot No ....... ~. ................ Street and Numbe . .~/.~., .................... ~ ........... ....... ~_ Z~......... .... ... . . . .. .. .. ... . .. .. ..... ...................... ....' ~z-/o"~. ~.~ ~ Municlpality a. Exisiting use and occupancy ...... i....~,~/~~ --.~ ~ ,,~, __-- ................................................................. b ntended use and occupancy ~,,~,..,~..~:~.~....~,...~, ..T_,........//~....~...~..,~....,..~..,':~ .~m-., ............................. 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolitior, .................... Other Work ................................................... 4. Estimated Cost ...................... ~.C.~ ................. Fee ...................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ mummer 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 .....~. ................ I-bight .................... Number of Stories ...~...../~...~.. .......................................................................................... 9. Size of lot: Front ........... ¢6~..~...~....~ ............. ii .................. Rear ...~....¢...~..r...CJ...~. ................. Depth~?..~..'..~..~.,".~..'.~.'.'~.~ 10. Date of Purchase ....... /,.~...~....~.. ................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... .~..~../.~..~'~.....~..-~.. ............................................................. ]2, Does proposed construction violate any zoning law, ordinance or regulation: .... ,,,'~,.~. ........................................... 13. Will lot be rearaded . ....... ..~....¢.. ........... Will excess fill be removed from premises: ( ) Yes (~ No .... - . . GREENBRIAR HOMB ., r,e, o 14. mameoruwneroTpremlse ..................................................... Ad, r~ .4~.~..' ........... ~, ,,. o N ............. Name of Architect .............................................................. Address ................................ Phone No ....................... GREENBRJAR HOMES .X.. Name of Contractor ............................................ ". ............... Address .~.~...~...~..~ · Phone No.~...¢.,~.~ .~.....¢. PLOT DIAGRAM Locate clearly and distinctly all 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. ~OG, o/ STATE OF NEW,..,YQRJ.<., I ~ COUNTFY OF ..,~...¢..~'-..,4~'..~.~..JTM ...... t~.~....~....~...~....~.......~...,....~.~..~ ....... ~ .................... being duly sworn, deposes and says that he is the applicon, (Name of individual signing contract) above named. He is the ~~ .............................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the'best of his knowledge and belief; and that the work will be performed in the manner set fodh in the application filed therewith. Sworn tn before me this } 19.~.~ ...... ......... ........ , Not~ ~b~i~,~...~?~ ..................... Co~ .~~..~~~ ............................. ff. ~~ (Si~noture of o~c~nt) ~o. 52-~665~18, Suffolk L,Ot '44 -~UFFOLK cOUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF, CONSTRUCTION ONLY APPROVED .......... '~-EALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT ~ NEAREST WAT~N HAIN 4. ML-~ ~-BOURSE OF W~TER, PRIVATE V' PUBLIC ~ 9(' THERE ARE R0 DWELLINES' WITHIN IOO FEET OF THIS PROP--~'TY OTHER THAN THOSE SHOWN HEREON, ~ . · ~-~J'HE WATEI~ ~.UpPL¥ AND SE~/A~IE DIRPqSAL S YJTEM F~TRIB RESIDENCE WILL CONFORM TO THE STAJI/~OARDS~OF,/THE SUFFOLJJ~/~:O. Uf, IT~OF-/I~N~,I'MENT A° RE '8.54 Robin SUFFOLK COUN?Y ON OC~, ~ 19?Y AS FILENO. G609, ~ THE LI~,~TIONO~:WELL(W),$RPTIO TANK(ST)&CI~POOL$(CP)BROWN HEREON AR,E FROM FIELD 0B?!I~RVATION S AND OR DATA OI~TAIHE O FROM OT~E~$~ SURVEY FOR GREENBRIAR HOMES, INC. tOT NO. 7 . GREEIVBRIAR ACRES" AT MATTI~ucK TOWN OF SUFFOLK COUNTY, NEW YORK · NUNAUTHORIZED ALTERATION OR ADDITION TO THiS SURVEY IS A VIOLATION OF SECTION 7209 OFTHE NEW YORK STATE EDUCATION LAW, K' COPIES OF THJS~SURVEY NOT ~EARING THE LAND SURVEYOR'S iNKED SEAL OR EMBOSSED SEAL SHALL NOT SE CONSiDErED TO GE A VA[AG TRUE COPY ~DUARANTEE~ INOICATED HEREQN SHALL RUN ONLY TO THE PERSON ~OR WHOM THE SURVEY IS PREPARED. AND ON HIS B~EIA[.F TOTHE TITLE COMPANY, GOVERN- MENTAL A~GI~YAND LENDING INSTITUTION LISTED HEREON, AND ~1'0 ~HE ASSIGNEES OF THE LENDING INSTITUTION, ~UA~ANTEES ARE, NOT TRANSFERABLE TO AOOITtON~L INSTITUTIONS dR SUBSEQUENT OWNERS. · · K'DISTANCES,SHO~WN HEREON F~OM PROPERTY LINES TO EXISTIN6 STRUCTURES ARE FOR A SPECIFIC PURPOSE A*N0 A~E NOT TO BE USED TO ESTABLISH PROPERTY LtNES 'OR FOR TI~E I~RECTION OF FENCES. YOUNG s YOUNG ALDEN W.~YOUNG, PROFESSIONAL ENGINEER AND LAN~ SURVEYOR N.Y.S. LICENSE N0.12845 HOWARD ',~/. YOUNG, LAND SURVEYOR N.~S. LICE~NSE NO. 45895 DATE : AUG. /0, /.978 SCALE: /" -- 40~ NO. : 78- 4E5 400 OSTRANDER AVENUE RIVERHEAD , NEW YORK t.Ot -: ../ I.Ot 19 SUFFOBK COUNTY ~]BA]~TH D The sewnge dj spu~al and waier Suppl~/ in~;peCl ed by this del~j~cl~t~alld fo=~ Uhi~f of General Bngineerin~ Services SURVEY iFOR GR££NBR/AR ~/Ot~S, //vC. ~oF ~.a ~ "G~vs~,~ ~C~" AT M~TITUCK TOWN O~ SOUTHO&D SUFFOL~ COUNTY NEW YORK INDICATED ~IEREON SHALL RUN'ONLY TO R WHOM TH~ SURVEY I$ PREPAREO, TH~ TITLE COMPANY~GOVERN* dU/V£ 26,19,EO DA'rE = AU~. /0, /978 SCALE: / NO. : 78- 485 USL/FE TITLE INSUt~NGE CO OF NEW YORt( NOT TRANSFERABLE YOUNG a YOUNG ~VENUE YORK HOWARD W, YOUNG, LAND SURVEYOR N.Y.S. LICENSE NO. 45893, Lot 0 · , Lot 19 suFFonK COUNTY ~IEAL~H DE~AR~Z- S'uRvEY~FOR ~ dUNE ~G, 1~80 HOMES, INC. LOttO 7 ACRES" The sewage disposal and vJater supply AT MATT/TUCK ' DATE : fact!i%ies for this lo,cat,on have been , TOWN OF FOOTHOLD SCALE: I"= inspected b~ this departmont and found ~f .>~/~ SUFFOLK COUNTY' NEW YORK NO. : . , ' SURVEY.IS ~VIOLATION OF SECTION 7209 OFTHE Chief of Gene~al En~lnoerin~ NEW YORK S~ATE EOUC~ L~W USLIF~ TITLF INSURANCgC~ OFfl~W YORK ~NO ON,HIS~B~HALF TO T~E TITL~ COMPANY, GOVERN- ~ '/.~D ~ ~ ~NE~R~,W~TER,MAI~MI.~ ~SOUR~WATER* PRIVATE~P~BLIC~ :MENTA~ A~CY~ND'LE~ING INSTITUTrON LISTED ~ /~" "~'~ ~SU~,gO~P DIST.~EECTION~BLOCK ~ LOT ~,// HEREON~Afl~ TO THE ASSIGNEES OF THE LENDING f / O' ~/, ~H~RE ~NO ~LLINSS WITHIN I00 FEET OF ~HIS PROPERTY INSTITO~I6~. OUARANT~ ARE NOT TRANSFERAeLE r~ r ~- ~ ~ 0TH~TH~HOSE aHoWN HEREO~. ~ ~ TO ADD(TI0~AL INSTITUTIONS OR SUBSEOUENT J ~i '~ WILL~NF~M TOTHES~NDAR~T~E SUFFOL~OU~YDE~E~T :TOE~I$~I~ STRUCTUR~ARE FORA SPECIFIC ~ / ~ ~ ~ ~r ~U~DIVIE/ONsuF~LK ~flflTyMAP OflF/LEOoc~IN~ ~H~igFFOFF/CEA$ FILE N~OF ~EGGO~.CLERK, OF ~ AND LAND SURVEYOR N.~S. LICENSE N0.1284~" '~E~WELL(W),SE~ICT~K(S~a~SP~LS(CP)SN~flE~EON ' ~ N.~S, LICEN'SENO. 45895 ARE FROM F~LO ~RVAT,I~S ,~ND OR DATA O~TA!NED FROM OT~ : ,'~ ,, . , FoLL, ~ ..... I I I i A,lLk... I I~r'r fl I Illii[i' I~l,, '1 II t'L t